Southern African Journal of Hiv Medicine最新文献

{"title":"Urine lipoarabinomannan for rapid tuberculosis diagnosis in HIV-infected adult outpatients in Khayelitsha.","authors":"Bianca Sossen,&nbsp;Amanda Ryan,&nbsp;Joanna Bielawski,&nbsp;Riana Greyling,&nbsp;Gillian Matthews,&nbsp;Sheetal Hurribunce-James,&nbsp;René Goliath,&nbsp;Judy Caldwell,&nbsp;Graeme Meintjes","doi":"10.4102/sajhivmed.v22i1.1226","DOIUrl":"https://doi.org/10.4102/sajhivmed.v22i1.1226","url":null,"abstract":"<p><strong>Background: </strong>Decreasing tuberculosis (TB) mortality is constrained by diagnostic and treatment delays. The World Health Organization (WHO) recently actively recommended the point-of-care Alere Determine Lipoarabinomannan Ag assay (AlereLAM) to assist in the diagnosis of tuberculosis in specific HIV-infected outpatients.</p><p><strong>Objectives: </strong>The primary objective of this study was to compare time to ambulatory TB treatment in HIV-infected adults with CD4 ≤ 100 cells/μL before and after ('primary comparison groups') availability of AlereLAM. In pre-specified subgroups, we prospectively assessed AlereLAM-positive prevalence.</p><p><strong>Method: </strong>Clinicians prospectively performed AlereLAM in HIV-infected adults with TB symptoms and either CD4 ≤ 100 cells/μL or 'seriously ill' criteria. In a retrospective arm of equal duration, clinicians retrospectively collected data on HIV-infected adults with CD4 ≤ 100 cells/μL who initiated TB treatment.</p><p><strong>Results: </strong>A total of 115 prospectively eligible adults (of whom 55 had CD4 ≤ 100 cells/μL) and 77 retrospectively eligible patients were included. In the primary comparison groups, the retrospective and prospective arms had similar age and sex distribution. With availability of AlereLAM, the time to TB treatment decreased from a median of 4 to 3 days (p = 0.0557). With availability of AlereLAM, same-day TB treatment initiation rose from 9.1% to 32.7% (p = 0.0006). In those with CD4 ≤ 100 only, those with 'seriously ill' criteria only, and in those meeting either, or both, of these criteria, AlereLAM was positive in 10.5%, 21.9%, 34.8% and 48.4% respectively.</p><p><strong>Conclusion: </strong>Availability of AlereLAM led to more patients initiating same-day TB treatment. Using both CD4 ≤ 100 and 'seriously ill' criteria gave the greatest yield. Results of this study have informed local policy design.</p>","PeriodicalId":49489,"journal":{"name":"Southern African Journal of Hiv Medicine","volume":" ","pages":"1226"},"PeriodicalIF":1.7,"publicationDate":"2021-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8111664/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38996211","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":"Erratum: Unexpected low frequency of respiratory symptoms in an HIV-positive urban sub-Saharan population compared to an HIV-negative control group.","authors":"Maren Kummerow,&nbsp;Erica J Shaddock,&nbsp;Kerstin Klipstein-Grobusch,&nbsp;Roos B Barth,&nbsp;Diederick E Grobbee,&nbsp;W D Francois Venter,&nbsp;Charles Feldman,&nbsp;Alinda Vos","doi":"10.4102/sajhivmed.v22i1.1180","DOIUrl":"https://doi.org/10.4102/sajhivmed.v22i1.1180","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.4102/sajhivmed.v20i1.1010.].</p>","PeriodicalId":49489,"journal":{"name":"Southern African Journal of Hiv Medicine","volume":" ","pages":"1180"},"PeriodicalIF":1.7,"publicationDate":"2021-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8063566/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38940527","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":"Human immunodeficiency virus and mortality from coronavirus disease 2019: A systematic review and meta-analysis.","authors":"Timotius I Hariyanto,&nbsp;Jane Rosalind,&nbsp;Kevin Christian,&nbsp;Andree Kurniawan","doi":"10.4102/sajhivmed.v22i1.1220","DOIUrl":"https://doi.org/10.4102/sajhivmed.v22i1.1220","url":null,"abstract":"<p><strong>Background: </strong>Persons living with human immunodeficiency virus (PLWH) constitute a vulnerable population in view of their impaired immune status. At this time, the full interaction between HIV and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been incompletely described.</p><p><strong>Objective: </strong>The purpose of this study was to explore the impact of HIV and SARS-CoV-2 co-infection on mortality.</p><p><strong>Method: </strong>We systematically searched PubMed and the Europe PMC databases up to 19 January 2021, using specific keywords related to our aims. All published articles on coronavirus disease 2019 (COVID-19) and HIV were retrieved. The quality of the studies was evaluated using the Newcastle-Ottawa Scale for observational studies. Statistical analysis was performed with Review Manager version 5.4 and Comprehensive Meta-Analysis version 3 software.</p><p><strong>Results: </strong>A total of 28 studies including 18 255 040 COVID-19 patients were assessed in this meta-analysis. Overall, HIV was associated with a higher mortality from COVID-19 on random-effects modelling {odds ratio [OR] = 1.19 [95% confidence interval (CI) = 1.01-1.39], <i>p</i> = 0.03; <i>I</i> ² = 72%}. Meta-regression confirmed that this association was not influenced by age (<i>p</i> = 0.208), CD4 cell count (<i>p</i> = 0.353) or the presence of antiretroviral therapy (ART) (<i>p</i> = 0.647). Further subgroup analysis indicated that the association was only statistically significant in studies from Africa (OR = 1.13, <i>p</i> = 0.004) and the United States (OR = 1.30, <i>p</i> = 0.006).</p><p><strong>Conclusion: </strong>Whilst all persons ought to receive a SARS-CoV-2 vaccine, PLWH should be prioritised to minimise the risk of death because of COVID-19. The presence of HIV should be regarded as an important risk factor for future risk stratification of COVID-19.</p>","PeriodicalId":49489,"journal":{"name":"Southern African Journal of Hiv Medicine","volume":" ","pages":"1220"},"PeriodicalIF":1.7,"publicationDate":"2021-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8063497/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38940448","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":"Undisclosed exposure to antiretrovirals prior to treatment initiation: An exploratory analysis.","authors":"Lufuno G Mavhandu-Ramarumo,&nbsp;Lisa A M Tambe,&nbsp;Nontokozo D Matume,&nbsp;David Katerere,&nbsp;Pascal O Bessong","doi":"10.4102/sajhivmed.v22i1.1200","DOIUrl":"https://doi.org/10.4102/sajhivmed.v22i1.1200","url":null,"abstract":"<p><strong>Background: </strong>The proportion of individuals with a history of exposure ('pre-exposure') to antiretrovirals (ARVs) prior to formal initiation into antiretroviral treatment (ART) is unknown.</p><p><strong>Objectives: </strong>This study describes the detection of ARVs in plasma and/or hair, of persons who self-reported no pre-exposure to ART at their first-time initiation onto ART in three clinics in the province of Limpopo, South Africa (SA).</p><p><strong>Method: </strong>Concentrations of tenofovir (TDF), emtricitabine (FTC) and efavirenz (EFV) in the plasma and hair of individuals initiating ART were analysed using a validated liquid chromatography tandem mass spectrometry (LC-MS/MS) method. Next generation sequences of HIV polymerase gene were analysed with Geneious software 11.15, and drug resistance (DR) mutations were determined according to the Stanford HIV Drug-Resistance database. Participants' demographic data were collected on a structured questionnaire. Data that describe prior exposure to ARV were also collected by this self-reporting method.</p><p><strong>Results: </strong>Paired blood and hair samples were collected from 77 individuals newly initiated onto ART from 2017 to 2019. We detected at least one of the drugs in the plasma or hair of 41/77 (53.2%) patients who responded with a 'no' to the question 'have you received ARVs before initiation onto ART?' Thirty-one participants (<i>n</i> = 31/77, 40.3%) had TDF in either plasma or hair. Emtricitabine and EFV were found in the plasma or hair of 12/77 (15.6%) and 25/77 (32.4%) of participants respectively. Six (<i>n</i> = 6/77, 7.792%) had all three ARVs in plasma or hair. Prevalence of DR mutations at the > 5% significance threshold level in those known to have had ARV-exposure determined by LC-MS/MS prior to ART-initiation was not significant (χ² = 0.798; <i>p</i> = 0.372), when compared to those who had no prior exposure but still showed DR.</p><p><strong>Conclusion: </strong>Antiretroviral levels in the hair of individuals initiating treatment imply prolonged prior-exposure to that ARV. The presence of ARV in plasma and hair of persons living with HIV (PLWH) who deny ARV-use, requires an explanation. A larger study at multiple sites and regular DR surveillance of ART-naïve PLWH will be necessary to confirm the generalisability of these findings to the wider South African population.</p>","PeriodicalId":49489,"journal":{"name":"Southern African Journal of Hiv Medicine","volume":" ","pages":"1200"},"PeriodicalIF":1.7,"publicationDate":"2021-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8063556/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38940528","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":"Immune activation and arterial stiffness in lean adults with HIV on antiretroviral therapy.","authors":"Longa Kaluba,&nbsp;Fastone Goma,&nbsp;Chris Guure,&nbsp;Sody Munsaka,&nbsp;Wilbroad Mutale,&nbsp;Douglas C Heimburger,&nbsp;Theresa Chikopela,&nbsp;John R Koethe","doi":"10.4102/sajhivmed.v22i1.1190","DOIUrl":"https://doi.org/10.4102/sajhivmed.v22i1.1190","url":null,"abstract":"Background Greater T-cell activation was associated with reduced vascular compliance amongst persons living with HIV (PLWH) especially among overweight and obese individuals. There is a paucity of data regarding immune activation and arterial stiffness amongst PLWH in sub-Saharan Africa (SSA). Objective To determine the association between immune activation and arterial stiffness in lean PLWH in SSA. Method Forty-eight human immunodeficiency virus positive (HIV+) adults on antiretroviral therapy (ART) >5 years and 26 HIV-negative adults, all with BMI < 25 kg/m2 and no history of CVD, were enrolled. The relationship of vascular compliance with circulating CD4+ and CD8+ naïve, memory, activated and senescent T cells, and serum 8-isoprostane was assessed by HIV status. Results Increased immune activation was observed in the CD4+ and CD8+ T cells of PLWH, 16.7% vs. 8.9% and 22.0% vs. 12.4% respectively; p < 0.001 (both). Furthermore, a higher proportion of senescent CD4+ T cells were associated with a lower carotid-femoral pulse wave velocity (cfPWV; p = 0.01), whilst a higher proportion of activated CD8+ T cells were associated with a lower carotid-radial pulse wave velocity (crPWV; p = 0.04), after adjustment for BMI and age. However, PLWH also had a higher median carotid-femoral augmentation index (cfAiX) (21.1% vs. 6.0%; p < 0.05) in comparison to their HIV controls. Conclusion Our population of lean PLWH had increased immune activation and higher cfAiX, a marker of arterial stiffness, compared to HIV-negative persons. The negative association between immune activation and arterial stiffness as measured by crPWV in PLHW on long-term treatment needs further elucidation.","PeriodicalId":49489,"journal":{"name":"Southern African Journal of Hiv Medicine","volume":" ","pages":"1190"},"PeriodicalIF":1.7,"publicationDate":"2021-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8008040/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25582060","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":"Ocular manifestations of people living with HIV in Tunisia.","authors":"Dorsaf Saadouli,&nbsp;Lamia Ammari,&nbsp;Khaoula Ben Mansour,&nbsp;Yosra Yahyaoui,&nbsp;Sameh Aissa,&nbsp;El Afrit Mohamed Ali,&nbsp;Salem Yahyaoui,&nbsp;Hanene Tiouri","doi":"10.4102/sajhivmed.v22i1.1193","DOIUrl":"https://doi.org/10.4102/sajhivmed.v22i1.1193","url":null,"abstract":"<p><strong>Background: </strong>Ocular involvement is a common complication of human immunodeficiency virus (HIV). Knowledge about this topic in Tunisia is limited.</p><p><strong>Objective: </strong>To investigate ophthalmic manifestations in patients living with HIV in Tunisia.</p><p><strong>Method: </strong>This was an observational study, performed between January 2007 and December 2016. We included patients with ocular disorders related to HIV. The data were recorded retrospectively from chart review.</p><p><strong>Results: </strong>Amongst 98 people living with HIV (PLWH), 36 participants (55 eyes) had ocular manifestations. The mean age was 32.2 ± 5.6 years. Twenty-four patients were men and 12 were women. The mean value of CD4+ T-cell count was 156.5 ± 4.2 cells/µL. Bilateral lesions were found in 19 eyes. Best corrected visual acuity was better than 6/12 in 36 eyes. The most common ocular finding was dry eye syndrome (22%), cotton-wool spots (20%) and retinal haemorrhage (16%) followed by cytomegalovirus (CMV) retinitis (9%), anterior uveitis (7%), toxoplasmosis (4%) and tuberculosis retinochoroiditis (7%) Herpetic keratitis (5%), Herpes zoster ophthalmicus (2%) and syphilitic chorioretinitis (2%). Papilledema was found in three eyes (5%). Panuveitis was observed in four eyes (7%): three of them were associated with chorioretinal toxoplasmosis, syphilitic chorioretinitis and CMV retinitis. The fourth was attributable to immune recovery uveitis. A CD4+ T-cell count of ≤ 200 cells/µL was found to be an independent risk factor for developing posterior segment manifestations.</p><p><strong>Conclusion: </strong>Various ophthalmic manifestations were observed in PLWH. The most common lesion was retinopathy. Ocular involvement can be serious leading to poor visual prognosis, which requires close collaboration between the ophthalmologist and infectious disease physician.</p>","PeriodicalId":49489,"journal":{"name":"Southern African Journal of Hiv Medicine","volume":" ","pages":"1193"},"PeriodicalIF":1.7,"publicationDate":"2021-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8008002/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25582061","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":"Access to HIV services and viral load suppression among children during the 90-90-90 strategy implementation in South Africa: A time series analysis.","authors":"Juliet C Y Nyasulu,&nbsp;Innocent Maposa,&nbsp;Bernard P Sikhakhane,&nbsp;Himani Pandya","doi":"10.4102/sajhivmed.v22i1.1187","DOIUrl":"https://doi.org/10.4102/sajhivmed.v22i1.1187","url":null,"abstract":"<p><strong>Background: </strong>During the era of the Millennium Development Goals (MDG), children were shown to have less access to human immunodeficiency virus (HIV) services than their adult counterparts; hence the call to prioritise children in the implementation of the Sustainable Development Goals (SDGs). However, South African (SA) national data in 2019 indicated that almost 3 years into the implementation of the 90-90-90 strategy, only 59% of children living with HIV had been tested for HIV compared to 90% of adults.</p><p><strong>Objectives: </strong>To evaluate the access of children to HIV services and record the viral load (VL) suppression rates during the implementation of the 90-90-90 strategy in the City of Johannesburg (COJ), South Africa.</p><p><strong>Methods: </strong>This study applied a quasi-experimental interrupted time-series (ITS) design using the monthly District Health Information System (DHIS) and National Health Laboratory Services (NHLS) databases spanning the period from 2015 to 2020, that is, before and after the implementation and roll-out of the 90-90-90 strategy. Data were extracted from these databases into MS Excel 2010 spreadsheets and analysed with Stata 15 software from Stata Corp using a two-tailed <i>t</i>-test at a 5% level of significance.</p><p><strong>Results: </strong>Overall, a significant increase was observed in the number of individuals tested for HIV, <i>n</i> = 757, <i>p</i> = 0.0086, and retained in care <i>n</i> = 2523, <i>p</i> = 0.001 over the whole period of analysis beginning in April 2015. Adult HIV testing, antiretroviral treatment (ART) initiation and retention in care had been decreasing in absolute numbers over a 10-month period before the intervention. An increase in these three data elements was observed following the implementation of the 90-90-90 program. On the other hand, children aged 0-15 years had demonstrated a significant increase in absolute numbers tested for HIV, <i>n</i> = 171, <i>p</i> = 0.001, but an insignificant increase in number of ART initiations, <i>n</i> = 14.33, <i>p</i> = 0.252, before implementation but a decrease after this. The overall VL suppression rates for children were lower than those of adults.</p><p><strong>Conclusion: </strong>Although the COJ has recorded progress in adult HIV testing, ART initiation and retention, children living with HIV aged 0-15 years continue to experience less access to HIV services and lower VL suppression than youths and adults of ≥ 15 years. Therefore, to ensure that the 90-90-90 targets are achieved across different age groups, children must be prioritised so that they can equally access these services with adults.</p>","PeriodicalId":49489,"journal":{"name":"Southern African Journal of Hiv Medicine","volume":" ","pages":"1187"},"PeriodicalIF":1.7,"publicationDate":"2021-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8008010/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25582059","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":"HIV-1/2 differentiation in a South African public laboratory.","authors":"Rendani T Mafuyeka,&nbsp;Lynne M Webber,&nbsp;Piet Becker,&nbsp;Simnikiwe H Mayaphi","doi":"10.4102/sajhivmed.v22i1.1185","DOIUrl":"https://doi.org/10.4102/sajhivmed.v22i1.1185","url":null,"abstract":"<p><strong>Background: </strong>The human immunodeficiency virus type-2 (HIV-2) prevalence in South Africa (SA) is unknown, however, sporadic cases have been reported. Human immunodeficiency virus -1 and 2 differentiation is not part of most South African public laboratories' testing algorithm. Human immunodeficiency virus -2 diagnosis using serology assays may be complicated by HIV-1 and HIV-2 antibody cross-reactivity.</p><p><strong>Objectives: </strong>To determine the proportion of HIV-2 infections in specimens that tested HIV-1/2 positive at a public laboratory in Tshwane.</p><p><strong>Method: </strong>A total of 480 specimens that were previously tested with fourth generation ELISA platforms (Modular E170 [Roche, Switzerland] and Architect i2000 [Abbott, Germany]) were randomly selected. Human immunodeficiency virus -1 and 2 antibody differentiation testing was carried out using the Multispot HIV-1/2 rapid assay (Bio-Rad Laboratories, USA). An in-house nested HIV-2 PCR assay targeting the 5'-long terminal repeats (5'-LTR) region was evaluated and used as a confirmatory test.</p><p><strong>Results: </strong>The study tested 480 HIV-1/2 seropositive patients and their mean age was 36.7 years (range 3-82 years). Of the 480 patients, 292 (60.8%) were female, 182 (37.9%) were male and 6 (1.3%) were not specified. Human immunodeficiency virus differentiation results were as follows: 466 (97.1%) were positive for only HIV-1 antibodies, 11 (2.3%) [95%CI: (0.98%; 3.74%)] were positive for both HIV-1 and HIV-2 antibodies, 3 (0.6%) were negative for both antibodies and none were positive for only HIV-2 antibodies. Of the 11 specimens with both HIV-1 and HIV-2 antibodies, seven had sufficient volume for confirmatory testing and were all negative on the in-house HIV-2 PCR assay.</p><p><strong>Conclusion: </strong>The multispot HIV-1/2 rapid assay demonstrated cross-reactivity between HIV-1 and HIV-2 antibodies. Human immunodeficiency virus -2 infections were not detected.</p>","PeriodicalId":49489,"journal":{"name":"Southern African Journal of Hiv Medicine","volume":" ","pages":"1185"},"PeriodicalIF":1.7,"publicationDate":"2021-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8008004/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25582058","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":"Ten years of nurse-initiated antiretroviral treatment in South Africa: A narrative review of enablers and barriers.","authors":"Talitha Crowley,&nbsp;Elizabeth Mokoka,&nbsp;Nelouise Geyer","doi":"10.4102/sajhivmed.v22i1.1196","DOIUrl":"https://doi.org/10.4102/sajhivmed.v22i1.1196","url":null,"abstract":"<p><strong>Background: </strong>The roll out of nurse-initiated and managed antiretroviral treatment (NIMART) was implemented in 2010 by the National Department of Health (NDoH) in South Africa in response to the large numbers of persons living with HIV who needed treatment. To enable access to treatment requires shifting the task from doctors to nurses, which had its own challenges, barriers and enablers.</p><p><strong>Objectives: </strong>The aim of this narrative is to review content on the implementation of NIMART in South Africa over the period 2010-2020, with a focus on enablers and barriers to the implementation.</p><p><strong>Method: </strong>A comprehensive search of databases, namely, PubMed, Google Scholar and Cumulative Index to Nursing and Allied Health Literature (CINAHL), yielded qualitative, quantitative and mixed-method studies that addressed various topics on NIMART. Inclusion and exclusion criteria were set and 38 publications met the inclusion criteria for the review.</p><p><strong>Results: </strong>Training, mentorship, tailored tuberculosis (TB) and HIV guidelines, integration of services and monitoring and support have enabled the implementation of NIMART. This resulted in increased knowledge and confidence of nurses to initiate patients on antiretroviral treatment (ART) and decreased time to initiation and loads on referral facilities. Barriers such as non-standardised training, inadequate mentoring, human resource constraints, health system challenges, lack of support and empowerment, and challenges with legislation, policy and guidelines still hinder NIMART implementation.</p><p><strong>Conclusion: </strong>Identifying barriers and enablers will assist policymakers in implementing a structured programme for NIMART in South Africa and improve access, as well as the training and mentoring of professional nurses, which will enhance their competence and confidence.</p>","PeriodicalId":49489,"journal":{"name":"Southern African Journal of Hiv Medicine","volume":" ","pages":"1196"},"PeriodicalIF":1.7,"publicationDate":"2021-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8007995/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25582062","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":"World AIDS Day 2020: Reflections on global and South African progress and continuing challenges.","authors":"Yogan Pillay,&nbsp;Leigh Johnson","doi":"10.4102/sajhivmed.v22i1.1205","DOIUrl":"https://doi.org/10.4102/sajhivmed.v22i1.1205","url":null,"abstract":"<p><strong>Background: </strong>Reflecting on progress and challenges in meeting global human immunodeficiency virus (HIV) targets is often done ahead of World AIDS Day. This article reflects on progress and the continuing challenges in meeting targets in South Africa (SA).</p><p><strong>Objective: </strong>To review policy and implementation related progress and continuing challenges towards eliminating HIV as a public health threat by 2030.</p><p><strong>Method: </strong>Policy analysis and review of modeling data from Thembisa 4.3.</p><p><strong>Results: </strong>South Africa has made significant progress in the adoption of policies with two exceptions. While there are gaps in reaching the 90-90-90 implementation targets, progress has been made in the past decade.</p><p><strong>Conclusion: </strong>While progress has been made in the past decade towards the global targets, much work remains to ensure that HIV transmission is curtailed and those that require treatment are initiated on treatment and are virally suppressed.</p>","PeriodicalId":49489,"journal":{"name":"Southern African Journal of Hiv Medicine","volume":" ","pages":"1205"},"PeriodicalIF":1.7,"publicationDate":"2021-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8008044/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25576979","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}