Southern African Journal of Hiv Medicine最新文献

{"title":"A case series of emtricitabine-induced pure red cell aplasia.","authors":"Nithendra Manickchund,&nbsp;Camille du Plessis,&nbsp;Melanie-Anne A John,&nbsp;Thandekile C Manzini,&nbsp;Bernadett I Gosnell,&nbsp;Mahomed-Yunus S Moosa","doi":"10.4102/sajhivmed.v22i1.1271","DOIUrl":"https://doi.org/10.4102/sajhivmed.v22i1.1271","url":null,"abstract":"<p><strong>Background: </strong>Anaemia is common in patients with retroviral disease. New or worsening anaemia after initiation of antiretroviral (ARV) treatment has a broad differential diagnosis.</p><p><strong>Objectives: </strong>We describe six patients who developed transfusion-dependent anaemia on first-line therapy (tenofovir, emtricitabine and efavirenz) and, by exclusion, implicated emtricitabine in the aetiology of the anaemia.</p><p><strong>Method: </strong>We conducted a retrospective chart review of patients seen at the Infectious Diseases specialist clinic at King Edward VIII Hospital in KwaZulu-Natal between 2014 and 2016. We focused on patients with isolated, refractory and transfusion-dependent anaemia occurring after initiation of ARVs, in whom bone marrow biopsies were consistent with pure red cell aplasia (PRCA) without an identifiable secondary cause.</p><p><strong>Results: </strong>All the patients were female, with a median (range) age and baseline CD4 cell count of 42.5 (23-61) years and 237 (83-329) cells/mm³, respectively. Before presenting with symptomatic anaemia, the duration on emtricitabine was 4.5 (2-8) months. At presentation, all patients had an HIV viral load of < 1000 copies/mL and a CD4 cell count of 314 (213-389) cells/mm³. The median time to recovery following the discontinuation of emtricitabine was 2 (1-4) months. After a median of 12 months, all patients were successfully rechallenged with emtricitabine and remained well for a follow-up period of 24 (7-36) months.</p><p><strong>Conclusion: </strong>This study provides strong circumstantial evidence that emtricitabine plays an important role in the pathogenesis of reversible PRCA. The mechanisms through which emtricitabine induces PRCA remain unclear and require further study.</p>","PeriodicalId":49489,"journal":{"name":"Southern African Journal of Hiv Medicine","volume":" ","pages":"1271"},"PeriodicalIF":1.7,"publicationDate":"2021-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8424770/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39416453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of impaired pulmonary function in people living with HIV in an urban African setting.","authors":"Sarah E van Riel,&nbsp;Kerstin Klipstein-Grobusch,&nbsp;Roos E Barth,&nbsp;Diederick E Grobbee,&nbsp;Charles Feldman,&nbsp;Erica Shaddock,&nbsp;Sarah L Stacey,&nbsp;Willem D F Venter,&nbsp;Alinda G Vos","doi":"10.4102/sajhivmed.v22i1.1252","DOIUrl":"https://doi.org/10.4102/sajhivmed.v22i1.1252","url":null,"abstract":"<p><strong>Background: </strong>Studies have associated HIV with an increased risk of obstructive lung disease (OLD).</p><p><strong>Objectives: </strong>We aimed to identify the predictive factors for impaired lung function in an urban, African, HIV-positive population.</p><p><strong>Method: </strong>A cross-sectional study was performed in Johannesburg, South Africa, from July 2016 to November 2017. A questionnaire was administered and pre- and post-bronchodilator spirometry conducted. The predictors investigated included age, sex, antiretroviral treatment (ART) duration, body mass index, history of tuberculosis (TB) or pneumonia, occupational exposure, environmental exposure, smoking and symptoms of OLD (cough, wheeze, mucus and dyspnoea). Impaired lung function was defined as a forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) ratio of < 0.70, or below the 20th percentile of normal.</p><p><strong>Results: </strong>The 98 ART-naïve participants (mean age = 34.0, standard deviation [s.d.] = 8.2), 85 participants on first-line ART (mean age = 36.9, s.d. = 6.6) and 189 participants on second-line ART (mean age = 43.5, s.d. = 7.9) were predominantly female (65.6%). Of the participants, 64 (17.2%) had impaired lung function and 308 had normal lung function. Linear regression identified age (β = -0.003, <i>P</i> < 0.01), male sex (β = -0.016, <i>P</i> = 0.03) and history of TB or pneumonia (β = -0.024, <i>P</i> < 0.01) as independent predictors of a lower FEV1/FVC ratio. Following logistic regression, only a history of TB or pneumonia (odds ratio = 2.58, 95% confidence interval = 1.47-4.52) was significantly related to impaired lung function (area under the receiver operating characteristic curve = 0.64).</p><p><strong>Conclusion: </strong>Our data show that a history of TB or pneumonia predicts impaired lung function. In order to improve timely access to spirometry, clinicians should be alert to the possibility of impaired lung function in people with a history of TB or pneumonia.</p>","PeriodicalId":49489,"journal":{"name":"Southern African Journal of Hiv Medicine","volume":" ","pages":"1252"},"PeriodicalIF":1.7,"publicationDate":"2021-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8424741/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39416449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bone outcomes in virally suppressed youth with HIV switching to tenofovir disoproxil fumarate.","authors":"Kate Braithwaite,&nbsp;Tristan D McPherson,&nbsp;Yanhan Shen,&nbsp;Stephen Arpadi,&nbsp;Stephanie Shiau,&nbsp;Gillian Sorour,&nbsp;Karl-Günter Technau,&nbsp;Michael T Yin","doi":"10.4102/sajhivmed.v22i1.1243","DOIUrl":"https://doi.org/10.4102/sajhivmed.v22i1.1243","url":null,"abstract":"<p><strong>Background: </strong>Tenofovir disoproxil fumarate (TDF) is included in first-line antiretroviral treatment (ART) for adolescents living with HIV (ALWH). Associated toxicities remain a concern.</p><p><strong>Objective: </strong>We evaluated bone and renal safety outcomes in virologically suppressed South African ALWH after switching to TDF.</p><p><strong>Method: </strong>We recruited virally suppressed (< 100 copies/mL) adolescents, aged 15-20 years, who switched from an abacavir (ABC)-based to a TDF-based efavirenz regimen. Bone mass and renal function were assessed at Week 0 and at Week 24 after the switch to TDF using dual-energy X-ray absorptiometry (DXA) and serum renal markers. A change in the lumbar spine (LS) and the whole-body less head (WBLH) bone mineral density (BMD) Z-scores and the estimated glomerular filtration rate (eGFR) between the two measures were compared (paired <i>t</i>-tests) and stratified by sex.</p><p><strong>Results: </strong>Fifty participants (48% male), with a median duration of prior ART of 11.4 years, were enrolled. Among 47 participants with 24-week DXA results, 15 (32%) had either no change or a decreased LS-BMD after the switch, with a mean change of -1.6%. Overall, more female participants experienced this outcome: 58% versus 4%, <i>P</i> < 0.0001. The mean change (standard deviation) in the LS-Z-score was -0.03 (0.25) and in the WBLH-Z-score was 0.02 (0.24). A decrease in the eGFR from 132.2 to 120.4 was observed (<i>P</i> = 0.0003); however, the levels remained clinically acceptable.</p><p><strong>Conclusion: </strong>South African ALWH switching from abacavir to TDF-based ART experienced statistically significant decreases in eGFR but not in LS and WBLH BMD. Female ALWH were more likely to experience a decrease in LS-BMD and may require closer monitoring.</p>","PeriodicalId":49489,"journal":{"name":"Southern African Journal of Hiv Medicine","volume":" ","pages":"1243"},"PeriodicalIF":1.7,"publicationDate":"2021-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8424762/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39416448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Giant bacillary angiomatosis.","authors":"Jeremy Nel,&nbsp;Prudence Ive,&nbsp;Carolina Nel","doi":"10.4102/sajhivmed.v22i1.1257","DOIUrl":"https://doi.org/10.4102/sajhivmed.v22i1.1257","url":null,"abstract":"","PeriodicalId":49489,"journal":{"name":"Southern African Journal of Hiv Medicine","volume":" ","pages":"1257"},"PeriodicalIF":1.7,"publicationDate":"2021-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8335775/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39313521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical, radiological, and laboratory predictors of a positive urine lipoarabinomannan test in sputum-scarce and sputum-negative patients with HIV-associated tuberculosis in two Johannesburg hospitals.","authors":"Lior Chernick,&nbsp;Ismail S Kalla,&nbsp;Michelle Venter","doi":"10.4102/sajhivmed.v22i1.1234","DOIUrl":"https://doi.org/10.4102/sajhivmed.v22i1.1234","url":null,"abstract":"<p><strong>Background: </strong>Tuberculosis (TB) is a major cause of mortality in persons living with HIV (PLWH). Sputum-based diagnosis of TB in patients with low CD4 counts is hampered by paucibacillary disease and consequent sputum scarcity or negative sputum results. Urine lipoarabinomannan (LAM) has shown promise in the point-of-care detection of TB in this patient subset but lacks sensitivity, and its exact role in a diagnostic algorithm for TB in South Africa remains to be clarified.</p><p><strong>Objectives: </strong>The objective of this study was to better define the patient profile and the TB characteristics associated with a positive urine LAM (LAM+ve) test.</p><p><strong>Method: </strong>This multicentre retrospective record review examined the clinical, radiological, and laboratory characteristics of hospitalised PLWH receiving urine LAM testing with sputum-scarce and/or negative sputum GeneXpert ^® (mycobacterium tuberculosis/resistance to rifampicin [MTB/RIF]) results.</p><p><strong>Results: </strong>More than a third of patients, 121/342 (35%), were LAM+ve. The positive yield was greater in the sputum-scarce than the sputum-negative group, 66/156 (42%) versus 55/186 (30%), <i>P</i> = 0.0141, respectively. Patients who were LAM+ve were more likely to be confused (odds ratio [OR] = 2.2, 95% confidence interval [CI] = 1.2-3.7, <i>P</i> = 0.0045), have a higher median heart rate (<i>P</i> = 0.0135) and an elevated quick sepsis-related organ failure assessment score (≥ 2), OR = 3.5, 95% CI = 1.6-7.6, <i>P</i> = 0.0014. A LAM+ve test was significantly associated with disseminated TB (dTB), <i>P</i> < 0.0001, TB-related immune reconstitution inflammatory syndrome (IRIS), <i>P</i> = 0.0035, and abdominal TB, <i>P</i> < 0.0001. Laboratory predictors of a LAM+ve status included renal dysfunction, <i>P</i> = 0.044, severe anaemia, <i>P</i> = 0.0116, and an elevated C-reactive protein, <i>P</i> = 0.0131. Of the 12 PLWH with disseminated non-TB mycobacteria cultured from the blood and/or bone marrow, <i>n</i> = 9 (75%) had a LAM+ve result (OR = 5.8, 95% CI = 1.6-20.8, <i>P</i> = 0.0053).</p><p><strong>Conclusion: </strong>Urine LAM testing of hospitalised PLWH with suspected active TB had significant diagnostic utility in those that were sputum-scarce or sputum-negative. A LAM+ve result was associated with dTB, clinical and laboratory markers of severe illness, and TB-IRIS. Disseminated non-tuberculous mycobacterial infection of hospitalised PLWH may also yield urine LAM+ve results, and mycobacterial cultures must be checked in those non-responsive to conventional TB treatment. Selective use of the LAM test in the critically ill is likely to maximise the diagnostic yield, improve the test's predictive value, and reduce the time to TB diagnosis and initiation of treatment.</p>","PeriodicalId":49489,"journal":{"name":"Southern African Journal of Hiv Medicine","volume":" ","pages":"1234"},"PeriodicalIF":1.7,"publicationDate":"2021-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8335785/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39313520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence of cardiometabolic diseases in a Lesotho HIV cohort: Evidence for policy decision-making.","authors":"Motlalepula Sebilo,&nbsp;Neo R T Ledibane,&nbsp;Simbarashe Takuva","doi":"10.4102/sajhivmed.v22i1.1246","DOIUrl":"https://doi.org/10.4102/sajhivmed.v22i1.1246","url":null,"abstract":"<p><strong>Background: </strong>Antiretroviral treatment (ART) has been associated with the development of certain cardiometabolic diseases (CMDs). The burden of CMDs amongst ART-experienced patients in sub-Saharan Africa was unknown.</p><p><strong>Objective: </strong>We quantified the burden of CMDs and identified the associated risk factors in a large treatment cohort on ART at a high-volume facility in Lesotho.</p><p><strong>Methods: </strong>In this retrospective cohort study, we extracted data from the daily dispensing electronic system and routine clinical records of 785 adults on ART between 2011 and 2015 in Maseru, Lesotho. CMD was defined as a diagnosis of hypertension, diabetes mellitus or dyslipidaemia (singly or collectively). Descriptive statistics were used to describe the disease burden; Kaplan-Meier curves and cause-specific Cox proportional hazards models were fitted to examine the impact of the ART regimen and identify the risk factors associated with the occurrence of CMD.</p><p><strong>Results: </strong>Of the 785 participants, 473 (60%) were women. The median age of the group was 42 years, interquartile range (IQR), 36-51 years. The overall incidence of CMD was 5.6 (95% confidence interval [CI] = 4.4-7.1) per 100 person-months of follow-up. The median time to onset of CMD was 16.6 months (IQR = 7.4-23.4). ART was not associated with the occurrence of CMD (cause-specific hazard ratio [CHR] = 1.55; 95% CI = 0.14-16.85; <i>P</i> = 0.72). Higher body mass index (BMI) was associated with the occurrence of diabetes mellitus (CHR = 1.19; 95% CI = 1.14-1.38; <i>P</i> = 0.026).</p><p><strong>Conclusion: </strong>The incidence of CMD in this relatively young patient population is low yet noteworthy. We recommend that patients living with HIV and AIDS should be routinely screened for CMD. Higher BMI is generally associated with the occurrence of CMD.</p>","PeriodicalId":49489,"journal":{"name":"Southern African Journal of Hiv Medicine","volume":" ","pages":"1246"},"PeriodicalIF":1.7,"publicationDate":"2021-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8252144/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39159216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Indicator-focussed technical assistance in South Africa's HIV programme: A stepped-wedge evaluation.","authors":"Geoffrey A Jobson,&nbsp;Jean Railton,&nbsp;Barry Mutasa,&nbsp;Lucy Ranoto,&nbsp;Christine Maluleke,&nbsp;James McIntyre,&nbsp;Helen Struthers,&nbsp;Remco Peters","doi":"10.4102/sajhivmed.v22i1.1229","DOIUrl":"https://doi.org/10.4102/sajhivmed.v22i1.1229","url":null,"abstract":"<p><strong>Background: </strong>There is a lack of research on technical assistance (TA) interventions in low- and middle-income countries. Variation in local contexts requires tailor-made approaches to TA that are structured and replicable across intervention sites whilst retaining the flexibility to adapt to local contexts. We developed a systematic process of TA using multidisciplinary roving teams to provide support across the various elements comprising local HIV services.</p><p><strong>Objectives: </strong>To examine the effectiveness of targeting specific HIV and TB programme indicators for improvement using roving teams.</p><p><strong>Method: </strong>We conducted a cluster-randomised stepped-wedge evaluation of a TA support package focussing on clinical, managerial and pharmacy services in the Mopani district of the Limpopo province, South Africa (SA). Three roving teams delivered the intervention. Seventeen primary and community healthcare centres that had 400-600 patients on antiretroviral therapy (ART) were selected for inclusion. The TA package was implemented for six consecutive months across facilities until all had received the same level of support. Data were collected from the relevant health management information systems for 11 routine indicators.</p><p><strong>Results: </strong>The mean proportion of PLWH screened for tuberculosis (TB) at ART initiation increased from 85.2% to 87.2% (<i>P</i> = 0.65). Rates of retention in care improved, with the mean proportion of patients retained in care at three months post-ART initiation increasing from 79.9% to 87.4% (<i>P</i> < 0.001) and from 70.3% to 77.7% (<i>P</i> < 0.01) after six months. Finally, the mean proportion of patients with TB who completed their treatment increased from 80.6% to 82.1% (<i>P</i> = 0.75).</p><p><strong>Conclusion: </strong>Tailored TA interventions in SA using a standardised structure and process led to a significant improvement in retention-in-care rates and to non-significant improvements in the proportion of PLWH screened for TB and of those who completed their treatment.</p>","PeriodicalId":49489,"journal":{"name":"Southern African Journal of Hiv Medicine","volume":" ","pages":"1229"},"PeriodicalIF":1.7,"publicationDate":"2021-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8252139/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39159269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of incidental premature cardiac calcifications in an HIV-infected South African population using conventional computed tomography chest radiography.","authors":"Luize Muller,&nbsp;Tanusha Sewchuran,&nbsp;Miranda Durand","doi":"10.4102/sajhivmed.v22i1.1241","DOIUrl":"https://doi.org/10.4102/sajhivmed.v22i1.1241","url":null,"abstract":"<p><strong>Background: </strong>International literature reported an increased prevalence of cardiovascular disease in persons living with HIV (PLWH), inferring an association with accelerated coronary atherosclerosis and plaque formation. Few local studies of HIV-related cardiac disease have confirmed this. Early identification of cardiac plaques would assist clinicians with risk stratification and implementation of treatment strategies to reduce morbidity and mortality. In resource-limited settings the use of conventional computed tomography (CT) may have a role in identifying at-risk individuals.</p><p><strong>Objectives: </strong>This hypothesis-generating study was aimed at determining the contribution of HIV to accelerated vascular aging by assessing cardiac calcifications, incidentally detected on conventional CT chest imaging, in a young HIV-positive population.</p><p><strong>Method: </strong>A retrospective quantitative analysis was performed at a tertiary hospital in KwaZulu-Natal, South Africa, over a 5-year period. Young patients (18-45 years) who underwent CT chest imaging for varied indications were included, further sub-categorised by immune status, the presence, absence and location of calcifications. Patients with unknown HIV statuses were excluded.</p><p><strong>Results: </strong>An increased probability of cardiac calcification with increasing age, independent of the HIV status, was established. No statistically significant difference could be demonstrated between the cohorts. In the pre-contrasted subcategory, a lower <i>P</i>-value suggested an 'imminent' statistical significance. Contrast may have obscured some calcifications. The failure to record the immune status in a large number of patients resulted in their exclusion and limited the study.</p><p><strong>Conclusion: </strong>The increased prevalence of incidentally detected cardiac calcifications in young HIV-infected individuals warrants further evaluation and cardiovascular risk stratification.</p>","PeriodicalId":49489,"journal":{"name":"Southern African Journal of Hiv Medicine","volume":" ","pages":"1241"},"PeriodicalIF":1.7,"publicationDate":"2021-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8182472/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39124034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Continuous quality improvement in HIV and TB services at selected healthcare facilities in South Africa.","authors":"Sisanda Gaga,&nbsp;Nokuzola Mqoqi,&nbsp;Raymond Chimatira,&nbsp;Singilizwe Moko,&nbsp;Jude O Igumbor","doi":"10.4102/sajhivmed.v22i1.1202","DOIUrl":"https://doi.org/10.4102/sajhivmed.v22i1.1202","url":null,"abstract":"<p><strong>Background: </strong>Continuous quality improvement (CQI) is essential for HIV and tuberculosis (TB) services. Similarly, a thorough understanding of the requirements and impact of CQI is critical to its successful institutionalisation. However, this is currently lacking.</p><p><strong>Objectives: </strong>The objective of this study is to describe the CQI implementation process and examine its effect on HIV and TB service delivery at selected primary healthcare facilities in two South African districts.</p><p><strong>Method: </strong>We used a separate sample, pre- and post-test, quasi-experimental study design based on data collected from the clinical audit of patient cohorts seen in 2014 and 2015 respectively. Quality was measured based on the extent to which prescribed services were provided. Tailored CQI interventions were implemented based on service delivery gaps identified by the 2014 CQI audit. Data were summarised and analysed using a combination of univariate and multivariate analysis.</p><p><strong>Results: </strong>The services identified as low quality were related to opportunistic infections management and laboratory practices. Compliance to prescribed service items in antiretroviral treatment initiation and monitoring, pharmacy and laboratory management, exceeded 70% across study sites. Over 80% of low quality service delivery items were optimised in less than six months with targeted quality improvement support.</p><p><strong>Conclusion: </strong>The observed improvements signal the effectiveness of the CQI approach, its capacity to rapidly improve under-performance, its high replicability and the need to provide quality maintenance support to sustain or improve healthcare facilities performing well. The study strongly underscores the need to improve the management of opportunistic infections and complications, particularly TB.</p>","PeriodicalId":49489,"journal":{"name":"Southern African Journal of Hiv Medicine","volume":" ","pages":"1202"},"PeriodicalIF":1.7,"publicationDate":"2021-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8182456/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39124031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determination of lopinavir/ritonavir concentrations in four different oral solutions for the application of antiretroviral therapy in very young, HIV-1-infected children.","authors":"Nils von Hentig,&nbsp;Carlo Angioni,&nbsp;Christoph Königs","doi":"10.4102/sajhivmed.v22i1.1222","DOIUrl":"https://doi.org/10.4102/sajhivmed.v22i1.1222","url":null,"abstract":"An antiretroviral regimen containing lopinavir/ritonavir (LPV/r) in addition to two nucleoside reverse transcriptase inhibitors (NRTIs) is the main treatment option for HIV-1-infected infants in most African countries.7,8 The LPV/r combination is available as a meltrex tablet, in a fixeddose combination added to NRTIs, or as a liquid formulation that is bodyweight-dose adjusted.2,5,6,9,10,11,12,13 The tablet formulation is not applicable for very young children because of their inability to swallow the tablet. Crushing of the LPV/r meltrex formulation is not recommended, and the liquid formulation remains the only alternative for very young patients. However, as the taste of the pure LPV/r liquid formulation is unpalatable, many parents seek alternative ways to give the medicine, including mixing the LPV/r oral solution with formula milk, for example, as part of the child’s nutrition. However, flocculation of the oral solution results, and no bioavailability data are available.","PeriodicalId":49489,"journal":{"name":"Southern African Journal of Hiv Medicine","volume":" ","pages":"1222"},"PeriodicalIF":1.7,"publicationDate":"2021-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8182455/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39124032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}