Southern African journal of HIV medicine最新文献

{"title":"Delivery models of HIV pre-exposure prophylaxis and their influence on uptake in South Africa: An integrative review.","authors":"Junior M Ntimani, Andile G Mokoena-de Beer, Deliwe R Phetlhu","doi":"10.4102/sajhivmed.v26i1.1684","DOIUrl":"https://doi.org/10.4102/sajhivmed.v26i1.1684","url":null,"abstract":"<p><strong>Background: </strong>Maximising the use of HIV pre-exposure prophylaxis (PrEP) is crucial to eliminate new HIV transmissions, especially in high-prevalence areas such as South Africa. Strengthening access and acceptability of PrEP is essential for effective HIV prevention and to ensure sufficient uptake among those at risk.</p><p><strong>Objectives: </strong>This review aims to explore the existing PrEP delivery models in the South African public health settings and their influence on its uptake.</p><p><strong>Method: </strong>An integrative review approach was followed and electronic databases, namely PubMed, Medline, EBSCOhost, and Google Scholar, were searched. We selected qualitative and quantitative studies that focused on South Africa, written in English, and were published in peer-reviewed journals between 2016 and 2024.</p><p><strong>Results: </strong>Two distinct models were identified, namely the health facility-based model and the community-based model which is inclusive of the use of pharmacies. Both models have constraints and facilitators that impact on access and acceptability, thus influencing uptake.</p><p><strong>Conclusion: </strong>Decentralisation as a means to ensure access, and awareness to facilitate acceptability, are critical drivers of the PrEP service's success. Therefore, it is critical to develop intervention strategies that focus on access and acceptability among the target population, driven by the need to overcome barriers and ensure sustainability.</p>","PeriodicalId":94212,"journal":{"name":"Southern African journal of HIV medicine","volume":"26 1","pages":"1684"},"PeriodicalIF":0.0,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12067631/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144060771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Southern African HIV Clinicians Society guideline on pre-exposure prophylaxis to prevent HIV.","authors":"Pippa Macdonald, Gonasagrie Nair, Camilla Wattrus, Saiqa Mullick, Melanie Pleaner, Elzette Rousseau, Hasina Subedar, Dvora Joseph-Davey, Johan Hugo, Sinead Delany-Moretlwe, Linda-Gail Bekker","doi":"10.4102/sajhivmed.v26i1.1713","DOIUrl":"https://doi.org/10.4102/sajhivmed.v26i1.1713","url":null,"abstract":"","PeriodicalId":94212,"journal":{"name":"Southern African journal of HIV medicine","volume":"26 1","pages":"1713"},"PeriodicalIF":0.0,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12067563/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144046918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Blood and urine early treatment response biomarkers in HIV-associated disseminated tuberculosis.","authors":"Linda Boloko, Marcia Vermeulen, Bianca Sossen, Abulele Bekiswa, Phiona E Namale, Chad Centner, Robert J Wilkinson, Charlotte Schutz, Graeme Meintjes, David A Barr","doi":"10.4102/sajhivmed.v26i1.1664","DOIUrl":"https://doi.org/10.4102/sajhivmed.v26i1.1664","url":null,"abstract":"<p><strong>Background: </strong>Treatment response biomarkers are needed in the care of patients hospitalised with HIV-associated tuberculosis (TB).</p><p><strong>Objectives: </strong>We describe the changes in bacillary load during early treatment using quantitative and semi-quantitative measures of <i>Mycobacterium tuberculosis</i> in blood and urine.</p><p><strong>Method: </strong>We collected serial blood and urine samples at multiple timepoints in consenting adult patients with HIV and positive urine lipoarabinomannan (LAM), admitted to Mitchells Plain Hospital, Cape Town. Blood and urine Xpert Ultra, mycobacterial blood culture and urine LAM were performed. Survival analysis and mixed-effects modelling were used to determine time to a negative test, and to give the predicted probability of a positive test at the different timepoints.</p><p><strong>Results: </strong>Sixteen participants, predominantly male (63%), with median age 39 years (interquartile range [IQR] 36-43), and CD4 count 27 cells/mm³ (IQR 8-83) were included. At day 14, urine LAM, urine Xpert Ultra and blood Xpert Ultra remained positive in between 75% and 86% of the participants. A mixed-effects model predicted a decline in ordinal values of urine Xpert Ultra (cycle threshold), blood Xpert Ultra (cycle threshold) and blood culture (time-to-positivity) in response to anti-TB treatment. Conversely, urine LAM grade intensity increased over the 14 days.</p><p><strong>Conclusion: </strong><i>M. tuberculosis</i> DNA was detectable in urine and blood in decreasing quantity up to 14 days of standard treatment in patients with HIV-associated TB. Urine Alere LAM showed an increasing grade intensity during this period. Further research in larger groups and extended periods are needed to assess relation to clinical outcomes.</p>","PeriodicalId":94212,"journal":{"name":"Southern African journal of HIV medicine","volume":"26 1","pages":"1664"},"PeriodicalIF":0.0,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12067621/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144013644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transition of adolescents from paediatric to adult HIV care in South Africa: A policy review.","authors":"Charné Petinger, Talitha Crowley, Brian van Wyk","doi":"10.4102/sajhivmed.v26i1.1674","DOIUrl":"https://doi.org/10.4102/sajhivmed.v26i1.1674","url":null,"abstract":"<p><p>The successful roll-out and improved delivery of antiretroviral therapy (ART) services has led to paediatric HIV patients surviving to reach adolescence. Adolescents living with HIV (ALHIV) are challenged when transitioning to adult HIV care programmes where they must negotiate new care pathways, changes in healthcare providers and self-manage their chronic condition, in addition to dealing with the psychological and physiological developmental changes of adolescence. The transition process needs to be well guided, to ensure that ALHIV on ART maintain optimal adherence and remain engaged in care. Viral suppression and retention in care are significantly lower for older adolescents (15-19 years) compared to children and younger adolescents under 15 years - coinciding with the post-transition period. Comprehensive and structured transition protocols may have a significant impact on positive health outcomes. In sub-Saharan Africa, there is a dearth of policies and implementation guidelines for ALHIV who are transitioning to adult HIV care. The current review reports on policies and guidelines for transitioning ALHIV to adult HIV care in South Africa. Eight policies were identified, which were developed at global (<i>n</i> = 2), national (<i>n</i> = 2) and provincial levels (<i>n</i> = 1), and guided implementation (<i>n</i> = 3). Current national and provincial policies provide guidance on when to transition a patient clinically to facilitate the switch to adult ART regimens. Although global policies and implementation guidelines emphasise specific and comprehensive care for ALHIV on ART, these are not carried over to national and provincial policies in South Africa. Further development of policies is required to guide comprehensive, adolescent-friendly transition processes for ALHIV on ART in South Africa.</p>","PeriodicalId":94212,"journal":{"name":"Southern African journal of HIV medicine","volume":"26 1","pages":"1674"},"PeriodicalIF":0.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12067582/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High paediatric HIV viral load rejection rate in South Africa, a retrospective review.","authors":"Tanya Y Murray, Gayle G Sherman, Dumisani Mlotshwa, Ahmad F Haeri Mazanderani","doi":"10.4102/sajhivmed.v26i1.1687","DOIUrl":"10.4102/sajhivmed.v26i1.1687","url":null,"abstract":"","PeriodicalId":94212,"journal":{"name":"Southern African journal of HIV medicine","volume":"26 1","pages":"1687"},"PeriodicalIF":0.0,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11966703/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143782311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Setting up a pharmacy HIV pre-exposure prophylaxis delivery model: Lessons and recommendations for implementation.","authors":"Tsitsi Nyamuzihwa, Kelechi E Oladimeji, Athini Nyatela, Lettie Makola, Samanta T Lalla-Edward, Angela Tembo","doi":"10.4102/sajhivmed.v26i1.1683","DOIUrl":"10.4102/sajhivmed.v26i1.1683","url":null,"abstract":"","PeriodicalId":94212,"journal":{"name":"Southern African journal of HIV medicine","volume":"26 1","pages":"1683"},"PeriodicalIF":0.0,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11966706/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143782313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic use of abdominal ultrasound in detecting extrapulmonary tuberculosis or lymphoma in an HIV-endemic region.","authors":"Ellouise C Adams, Katherine Antel, Jenna L Bailey, Karryn L Brown, Dharshnee R Chetty, David Richardson, Estelle Verburgh","doi":"10.4102/sajhivmed.v26i1.1679","DOIUrl":"10.4102/sajhivmed.v26i1.1679","url":null,"abstract":"<p><strong>Background: </strong>Extrapulmonary tuberculosis (EPTB) is common among people living with HIV (PLWH). Abdominal ultrasound is an accessible investigation, frequently employed to support the diagnosis of EPTB, but may lead to misdiagnoses of diseases with overlapping clinical features, such as lymphoma.</p><p><strong>Objectives: </strong>To describe the abdominal ultrasound features and confirmed diagnoses of patients referred to a biopsy clinic with unexplained lymphadenopathy.</p><p><strong>Method: </strong>This was a retrospective descriptive study of patients attending the peripheral lymph node biopsy clinic at Groote Schuur Hospital between 2017 and 2020, who had abdominal ultrasound examinations while being investigated for unexplained lymphadenopathy. Ultrasound features were compared to the final diagnosis made on the lymph node biopsy.</p><p><strong>Results: </strong>Thirty-four patients were included, most of whom were PLWH (59%). Approximately one-third had a confirmed diagnosis of lymphoma (29%) and approximately one-third had a confirmed diagnosis of tuberculosis (32%). Splenic hypoechoic lesions were more common in patients with lymphoma (64%) than in patients with tuberculosis (46%) and malignancy (17%). Ascites was equally distributed between patients with tuberculosis (36%) and lymphoma (36%). The ultrasound report and confirmed diagnoses agreed in 40% of patients with tuberculosis. Additionally, 36% of patients with confirmed lymphoma were suspected to have tuberculosis based on the abdominal ultrasound.</p><p><strong>Conclusion: </strong>Abdominal ultrasound abnormalities such as splenic hypoechoic lesions, lymphadenopathy, and ascites/pleural effusion have a differential diagnosis including both tuberculosis and lymphoma, and should be investigated accordingly.</p>","PeriodicalId":94212,"journal":{"name":"Southern African journal of HIV medicine","volume":"26 1","pages":"1679"},"PeriodicalIF":0.0,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11966698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143782309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pharmacokinetics, pharmacogenetics, and toxicity of co-administered efavirenz and isoniazid.","authors":"Jessica Taylor, Gary Maartens, Simiso Sokhela, Nomathemba Chandiwana, Godspower Akpomiemie, Francois Venter, Phumla Sinxadi","doi":"10.4102/sajhivmed.v26i1.1661","DOIUrl":"10.4102/sajhivmed.v26i1.1661","url":null,"abstract":"<p><strong>Background: </strong><i>CYP2B6</i> slow metabolisers have higher efavirenz concentrations, which are further increased by isoniazid inhibiting efavirenz's accessory metabolic pathway.</p><p><strong>Objectives: </strong>We investigated the association between <i>CYP2B6</i> genotype and toxicity in people living with HIV (PLWH) on isoniazid and efavirenz.</p><p><strong>Method: </strong>We enrolled participants from the efavirenz arm of the ADVANCE trial (reference no.: NCT03122262), who received isoniazid and consented to genotyping. We compared efavirenz concentrations on and off isoniazid, stratified by <i>CYP2B6</i> genotype. We explored associations between the <i>CYP2B6</i> genotype and efavirenz concentrations on isoniazid; and changes over 24 weeks in lipids, alanine aminotransferase (ALT), fasting plasma glucose (FPG), sleep quality, and Modified Mini Screen (MMS) scores.</p><p><strong>Results: </strong>A total of 168 participants, median age 31 years, 57% female, had classifiable <i>CYP2B6</i> genotypes. Efavirenz concentrations on isoniazid were higher (pseudo-median difference 0.49 µg/mL (95% confidence interval [CI] [0.19-0.91]) and associated with increases in total and high-density lipoprotein (HDL)-cholesterol. <i>CYP2B6</i> slow metabolisers had higher efavirenz concentrations on isoniazid than extensive metabolisers (<i>β</i> = 1.66 [95% CI 0.98-2.34]). <i>CYP2B6</i> slow metabolisers had greater increases in total (<i>β</i> = 0.44 mmol/L [95% CI 0.01-0.86]) and HDL-cholesterol (<i>β</i> = 0.39 mmol/L [95% CI 0.21-0.57]) than extensive metabolisers. There were no associations between efavirenz concentrations or <i>CYP2B6</i> genotype, and change in ALT, FPG, low-density lipoprotein (LDL)-cholesterol, triglycerides, sleep quality, or MMS scores.</p><p><strong>Conclusion: </strong><i>CYP2B6</i> slow metabolisers on isoniazid and efavirenz had greater efavirenz concentrations and increases in total and HDL-cholesterol. We found no association between <i>CYP2B6</i> genotype or efavirenz concentrations and sleep or psychiatric symptoms.</p>","PeriodicalId":94212,"journal":{"name":"Southern African journal of HIV medicine","volume":"26 1","pages":"1661"},"PeriodicalIF":0.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11966721/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143782312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors associated with accuracy of rapid HIV test performance in the Eastern Cape, South Africa.","authors":"Amanda A Mohlala, Edith Phalane, Claris Siyamayambo, Musa Jaiteh, Refilwe N Phaswana-Mafuya","doi":"10.4102/sajhivmed.v26i1.1641","DOIUrl":"10.4102/sajhivmed.v26i1.1641","url":null,"abstract":"<p><strong>Background: </strong>Testing for HIV using rapid test devices assists in determining HIV status and ascertains if treatment is required. Rapid HIV quality assurance (QA) training is conducted to ensure accuracy of test results in non-laboratory settings.</p><p><strong>Objectives: </strong>This study aimed to determine the factors associated with the accuracy of rapid HIV testing among primary healthcare (PHC) workers who received HIV testing QA training in the Eastern Cape, South Africa.</p><p><strong>Method: </strong>A cross-sectional analytical study design was used to purposively recruit 167 PHC workers with prior training on HIV testing QA. Data were collected in 2022 using a self-administered questionnaire. STATA version 17.0 was used for data analysis.</p><p><strong>Results: </strong>Tester accuracy measured by a proficiency testing (PT) score of greater than 80% was achieved among 64.7% of the testers. Comprehensive HIV QA training was significantly associated with a PT score of greater than 80% (<i>P</i> = 0.001). On multivariable analyses, a PT score of greater than 80% was less likely with rural facilities (adjusted odd ratios [aOR] = 0.56, 95% confidence interval [CI]: 0.36-0.92, <i>P</i> = 0.020), Grade 12 education (aOR = 0.40, 95% CI: 0.19-0.85, <i>P</i> = 0.017), mentorship (aOR = 0.55, 95% CI: 0.35-0.85, <i>P</i> = 0.008), and attitudes towards inaccurate HIV results (aOR = 0.13, 95% CI: 0.02-0.82, <i>P</i> = 0.03); while implementation of QA processes (aOR = 3.94, 95% CI: 1.22-12.74, <i>P</i> = 0.022) and elements of QA in the HIV Testing Services register (aOR = 4.93, 95% CI: 1.45-16.74, <i>P</i> = 0.011) were associated with a PT score of greater than 80%.</p><p><strong>Conclusion: </strong>Exposure to comprehensive rapid HIV QA training were associated with higher tester accuracy. A framework for QA training is required for standardisation of training in the country.</p>","PeriodicalId":94212,"journal":{"name":"Southern African journal of HIV medicine","volume":"26 1","pages":"1641"},"PeriodicalIF":0.0,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11886584/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143589012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differentiated HIV service delivery model for female sex workers in sub-Saharan Africa: A systematic review.","authors":"Lifutso Motsieloa, Edith Phalane, Amal Abdulrahman, Refilwe N Phaswana-Mafuya","doi":"10.4102/sajhivmed.v26i1.1626","DOIUrl":"10.4102/sajhivmed.v26i1.1626","url":null,"abstract":"<p><strong>Background: </strong>Ensuring uninterrupted HIV treatment for female sex workers (FSWs), who face a disproportionately high HIV burden, is crucial for curbing HIV transmission and disease. Structural, social, and legal barriers impede their access to HIV services. The differentiated service delivery (DSD) model, designed to tailor and decentralise HIV services, aims to overcome these barriers. However, the impact of the DSD model for HIV treatment uptake among FSWs in sub-Saharan Africa (SSA) is not well documented.</p><p><strong>Objectives: </strong>To assess the implementation of the DSD model in improving HIV treatment outcomes among FSWs in SSA.</p><p><strong>Method: </strong>A systematic review literature was conducted to include available records from January 2019 to March 2024, using electronic databases such as EBSCOhost, Science Direct, SCOPUS, PubMed Central, and others. Ten studies met the eligibility criteria for inclusion for the review. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was registered with the International Prospective Register of Systematic Reviews (ID: CRD42023440551).</p><p><strong>Results: </strong>The uptake of HIV treatment services varied depending on whether the DSD model was facility-based, community-based, or a combination of both. Community-based models were generally preferred and led to better treatment outcomes due to their comprehensive health services.</p><p><strong>Conclusion: </strong>To improve HIV treatment outcomes for FSWs in SSA, it is essential to strengthen DSD model implementation, access, and utilisation, particularly at the community level.</p>","PeriodicalId":94212,"journal":{"name":"Southern African journal of HIV medicine","volume":"26 1","pages":"1626"},"PeriodicalIF":0.0,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11886544/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143589098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}