Southern African Journal of HIV Medicine <p>The&nbsp;<em>Southern African Journal of HIV Medicine</em>&nbsp;is a medical journal focused on HIV/AIDS treatment, prevention and related topics relevant to clinical and public health practice. The purpose of the journal is to disseminate original research results and to support high-level learning related to HIV Medicine. It publishes original research articles, editorials, case reports/case series, reviews of state-of-the-art clinical practice, and correspondence.</p> <p>Other websites related to this journal:&nbsp;<a title="" href="" target="_blank" rel="noopener"></a></p> en-US Southern African Journal of HIV Medicine 1608-9693 <p>The author(s) retain copyright on work published by AOSIS unless specified otherwise.</p><p><strong>Licensing and publishing rights</strong></p><p>Author(s) of work published by AOSIS are required to grant AOSIS the unlimited rights to publish the definitive work in any format, language and medium, for any lawful purpose. AOSIS requires journal authors to publish their work in open access under the <span style="text-decoration: underline;">Creative Commons Attribution 4.0 International</span> (CC BY 4.0) licence. </p><p>Read more here: <a href="" target="_blank"></a>.</p><p>The authors retain the non-exclusive right to do anything they wish with the published article(s), provided attribution is given to the applicable journal with details of the original publication, as set out in the official citation of the article published in the journal. The retained right specifically includes the right to post the article on the authors’ or their institution’s websites or in institutional repositories.</p><p>Previously published work may have been published under a different licence. We advise the community that if they would like to reuse the work to consult the applicable licence at article level.</p> SAHCS 2021 Conference Summary <p>No Abstract</p> David C. Spencer Copyright (c) 0 2023-02-20 2023-02-20 23 1 Dolutegravir for second-line treatment: Programmatic implications of new evidence <p>No Abstract</p> Ying Zhao Gary Maartens Graeme Meintjes Copyright (c) 0 2023-02-20 2023-02-20 23 1 COP27 Climate Change Conference: Urgent action needed for Africa and the world <p>No Abstract</p> David Ofori-Adjei Chris Zielinski Lilia Zakhama Paul Yonga Sahar Yassien Mohammad James Tumwine Abdelmadjid Snouber Siaka Sidibé Maha El-Adawy Arash Rashidian Friday Okonofua Lukoye Atwoli Fhumulani M. Mulaudzi Joy Muhia Robert Mash Laurie Laybourn-Langton James Kigera Jean-Marie Kayembe Ntumba Abraham Haileamlak Aiah A. Gbakima Gregory E. Erhabor Copyright (c) 0 2023-02-20 2023-02-20 23 1 Erratum: Southern African HIV Clinicians Society 2022 guideline for the management of sexually transmitted infections: Moving towards best practice <p>No Abstract</p> Remco P.H. Peters Nigel Garret Nomathemba Chandiwana Ranmini Kularatne Adrian J. Brink Karen Cohen Katherine Gill Thato Chidarikire Camilla Wattrus Jeremy S. Nel Mahomed Y.S. Moosa Linda-Gail Bekker Copyright (c) 0 2023-02-20 2023-02-20 23 1 Multiple opportunistic infections (pulmonary tuberculosis, <i>Mycobacterium avium</i> complex and parvovirus B19) in a single patient <p><strong>Introduction</strong>: HIV infection is a common disease in the South African population. The virus can lead to the development of many opportunistic&nbsp; infections. This case study examines co-infection with three opportunistic infections and the need for clinical suspicion of infections in our HIV&nbsp; population.<br><strong>Patient presentation</strong>: A 36-year-old unemployed female residing in Soweto, Johannesburg, presented at Chris Hani Baragwanath Hospital (CHBAH). She&nbsp; was HIV positive, defaulting treatment, with no other comorbidities. She presented to CHBAH with general body weakness, diarrhoea, cough and&nbsp; constitutional symptoms; clinically she appeared pale and chronically ill. A differential diagnosis was made of multiple infections co-inhabiting the<br>patient.<br><strong>Management and outcome</strong>: The patient had blood, sputum, radiological and invasive bone marrow aspiration, and trephine biopsies completed. The&nbsp; investigations revealed that she was co-infected with <em>Mycobacterium tuberculosis</em> (MTB), <em>Mycobacterium avium</em> complex (MAC) and parvovirus B19. The&nbsp; TB and disseminated MAC infection were managed with rifampicin, isoniazid, ethambutol, pyrazinamide and azithromycin, and reinitiation of&nbsp; antiretroviral (ARV) treatment was planned on further follow-up of the ARV drug resistance test. The parvovirus B19 infection was managed with&nbsp; immunoglobulins (Polygam) and steroids (prednisone). She was discharged successfully for further follow-up.</p> <p><strong>Conclusion</strong>: A thorough history, clinical examination and subsequent targeted investigations are vital to arriving at the correct diagnosis or diagnoses.&nbsp; The case presented above serves to illustrate how three life-threatening opportunistic infections (OIs), all with differing treatments, may present in a&nbsp; single patient. Clinicians caring for immunosuppressed patients need to remain vigilant for the presence of multiple OIs occurring simultaneously.</p> Midhun T. John Michelle Venter Jenifer Vaughan Marianne Black Daniel Prince Aishwarya M. Luke Mithra John Copyright (c) 0 2023-02-20 2023-02-20 23 1 Alere Determine-tuberculosis lipoarabinomannan positivity in disseminated non-tuberculous mycobacteria: An illustrative case series <p><strong>Introduction</strong>: In outpatients, the World Health Organization recommends that the urine Alere Determine-tuberculosis lipoarabinomannan (AlereLAM)&nbsp; should be used to support the diagnosis of tuberculosis (TB) in people living with HIV (PLHIV) with CD4 counts ≤ 100 cells/μL or with signs of being&nbsp; ‘seriously ill’. There is a risk of a false-positive AlereLAM in disseminated non-tuberculous mycobacterial (NTM) infections and it may be difficult to differentiate a single infection (either <em>Mycobacterium tuberculosis</em> or NTM) from dual infection.<br><strong>Patient presentation</strong>: We report three patients, enrolled in an operational study assessing AlereLAM use in an outpatient setting, who had advanced HIV&nbsp; (all CD4 &lt; 20 cells/μL) and strongly positive (grade 4+) AlereLAM results in whom <em>Mycobacterium avium</em> or kansasii were later cultured from blood or&nbsp; urine and sputum. Management and outcome: Based on positive AlereLAM results, all three were initiated on TB treatment. One died before NTM&nbsp; infection was detected. Two were managed for dual infection (TB and NTM) but died within two years.<br><strong>Conclusion</strong>: Tuberculosis remains a leading cause of death and a disproportionate number of these deaths occur in PLHIV. Tuberculous treatment should&nbsp; be initiated based on a positive AlereLAM result, and this should be followed by additional testing to confirm the diagnosis of TB and to obtain&nbsp; drug susceptibility results. In those not responding to TB treatment where the only positive result was an AlereLAM, an alternative or additional diagnosis&nbsp; of NTM infection should be considered, particularly in patients with a very low CD4 count.</p> Riana Greyling Graeme Meintjes Bianca Sossen Copyright (c) 0 2023-02-20 2023-02-20 23 1 Splenic hydatid disease in pregnancy <p><strong>Introduction</strong>: Hydatid disease in the South African setting remains an important differential diagnosis in many appropriate clinical presentations, such&nbsp; as splenomegaly. Splenic hydatid disease in pregnancy is a rare and complex disease to manage.<br><strong>Patient presentation</strong>: In this case report we describe a case of isolated splenic hydatid disease in an HIV-positive woman presenting in her third&nbsp; trimester of pregnancy.<br><strong>Management and outcome</strong>: A multidisciplinary team consisting of specialists from the highrisk maternity unit, hepatobiliary surgery and infectious diseases planned the management of the patient, which included pre-operative albendazole and elective caesarean section with assisted forceps delivery&nbsp; at 36 weeks’ gestation. An elective splenectomy in the post-partum period was planned for definitive management.<br><strong>Conclusion</strong>: Our aim is to highlight the unique treatment challenges of hydatid disease in pregnancy and the need for a multidisciplinary team approach&nbsp; when managing complex cases of hydatid disease.</p> Kirstie F. Thomson Florence Mahlobo Denasha L. Reddy Copyright (c) 0 2023-02-20 2023-02-20 23 1 Cutaneous squamous cell carcinoma in vertically acquired HIV and epidermodysplasia verruciformis <p><strong>Introduction</strong>: Acquired epidermodysplasia verruciformis (EV) is a skin disorder that has been described in individuals with perinatally acquired HIV. Many&nbsp; cases have been identified in sub-Saharan Africa in keeping with the epidemiology of HIV infection compared to the rest of the world, where cases&nbsp; are rare. Epidermodysplasia verruciformis skin lesions may undergo malignant transformation. There are few documented cases of malignant&nbsp; transformation of these skin lesions. We describe a patient with an EV-like skin rash who developed cutaneous squamous cell carcinoma (SCC).</p> <p><strong>Patient presentation</strong>: A 25-year-old man, on antiretroviral treatment for 12 years, presented with a generalised skin rash since the age of 11 years, and a 7-month history of a persistent scalp ulcer. He had no history of trauma, radiation or other chronic conditions. Despite an undetectable HIV viral load, he&nbsp; had failed to immune reconstitute (CD4 42 cells/µL). Physical examination revealed a generalised hypopigmented, papular skin rash resembling verruca plana and a 3 cm × 3 cm ulcer with rolled edges on the right parietal region of the scalp. There were no palpable lymph nodes in the head and neck areas. Biopsy of the ulcer revealed moderately differentiated SCC.</p> <p><strong>Management and outcome</strong>: Wide local excision of the lesion was done under local anaesthesia and histological analysis confirmed completely excised&nbsp; moderately differentiated SCC. Further examination four weeks later revealed two, smaller, histologically similar scalp lesions which were completely&nbsp; excised.</p> <p><strong>Conclusion</strong>: Patients with acquired EV require thorough, frequent examination for skin lesions with possible malignant transformation. Early&nbsp; identification of malignant transformation and treatment with surgical intervention is curative.</p> Linda A. Mandikiyana Chirimuta Francis J. Ndowa Margaret J. Pascoe Copyright (c) 0 2023-02-20 2023-02-20 23 1 Emergent dolutegravir resistance in integrase-naïve, treatment experienced patients from Zimbabwe <p>We report two cases of dolutegravir (DTG) resistance in highly treatment experienced patients. Monitoring for treatment failure and adherence support is&nbsp; important in highly treatment experienced patients taking DTG.</p> <p><strong>What this study adds</strong>: Dolutegravir is the mainstay of HIV treatment programmes and emergence of drug resistance to DTG is of public health relevance.</p> Linda A. Mandikiyana Chirimuta Margaret J. Pascoe Sara Lowe Copyright (c) 0 2023-02-20 2023-02-20 23 1 Factors influencing the high rejection rates of HIV 1/2 serology samples at Charlotte Maxeke Johannesburg Academic Hospital and the cost implications <p><strong>Background</strong>: HIV enzyme-linked immunosorbent assay (ELISA) is one of the most requested test sets within Virology and forms an essential part of&nbsp; patient management. Assessment of the rejection criteria is a key quality indicator, crucial for improving laboratory services and efficiency to ensure&nbsp; accurate and reliable results.</p> <p><strong>Objectives</strong>: The aim of this study was to identify the factors that influence the HIV 1/2 serology rejection rates (RR) at Charlotte Maxeke Johannesburg&nbsp; Academic Hospital and to evaluate the associated costs.</p> <p><strong>Methods</strong>: A retrospective study was conducted (June to December 2019) to identify the RR and rejection criteria of HIV serology samples throughout the&nbsp; total testing process. Descriptive analysis using percentages and frequencies was used to analyse the RR by phase, health establishment, ward and&nbsp; healthcare professional. A cost analysis incorporating minor and major costs was modelled in each phase of testing, and the total cost of rejections was&nbsp; calculated.</p> <p><strong>Results</strong>: A total of 6678 tests were received, and 738 were rejected (RR = 11.1%). The preanalytical phase contributed significantly to the overall RR, with&nbsp; the requirement of a separate sample (57.44%) the most common reason for rejection. The total cost per rejected test was $2.47, which amounted to a&nbsp; total rejection cost of $197.55, of which $158.18 was caused by the pre-analytical rejection criteria.</p> <p><strong>Conclusion</strong>: High RR of HIV tests were noted, resulting in significant cost wastage. Identification and analysis of rejections must be implemented across&nbsp; all laboratories to improve the efficiency of testing, provide a cost-saving benefit and maintain high laboratory standards.&nbsp;</p> Bhaveshan Reddy Naseem Cassim Florette Treurnicht Zinhle Makatini Copyright (c) 0 2023-02-20 2023-02-20 23 1 Predictors of low antiretroviral adherence at an urban South African clinic: A mixed-methods study <p><strong>Background</strong>: Low adherence to antiretroviral treatment (ART) in people living with HIV (PLHIV) remains a critical issue, especially in vulnerable&nbsp; populations. Although ART is responsible for greatly reducing the mortality and morbidity associated with HIV, low treatment adherence continues to&nbsp; impact the effectiveness of ART. Considering that a high level of adherence to ART is required for the excellent clinical outcomes with which ART is often&nbsp; associated, understanding the complex contextual and personal factors that limit high levels of treatment adherence remains paramount. Poor&nbsp; adherence remains an issue in many South African communities many years after the introduction of ART.</p> <p><strong>Objectives</strong>: Our study sought to understand the specific factors and the interactions among them that contribute to non-adherence in this patient&nbsp; population in order to devise successful and contextually appropriate interventions to support ART adherence in PLHIV.</p> <p><strong>Methods</strong>: This mixed-methods study employed a study-specific questionnaire (N = 103) and semi-structured interviews (N = 8) to investigate the factors&nbsp; linked to non-adherence at the Heideveld Community Day Centre in Cape Town, South Africa.</p> <p><strong>Results</strong>: Over half (57.3%) of participants were ART non-adherent. Non-adherence was correlated with younger age, negative self-image and a low belief&nbsp; in the necessity of ART (P &lt; 0.05). In patient interviews, alcohol use, treatment fatigue and stigmatisation emerged as contributors to suboptimal&nbsp; adherence.</p> <p><strong>Conclusion</strong>: The results suggest that there remains a need for context-sensitive interventions&nbsp; support PLHIV in South African communities. Future&nbsp; research needs to ensure that these targeted interventions take these factors into consideration.</p> Connor P. Bondarchuk Nwabisa Mlandu Tasneem Adams Elma de Vries Copyright (c) 0 2023-02-20 2023-02-20 23 1 The influence of smoking and HIV infection on pulmonary function <p><strong>Background</strong>: Prevalence of HIV, smoking, and pulmonary infections in South Africa are high.</p> <p><strong>Objectives</strong>: We investigated the role of smoking and HIV status on lung function.</p> <p><strong>Methods</strong>: This is a secondary analysis of a cross-sectional study conducted in South Africa. Data included demographics, pulmonary risk factors and a&nbsp; spirometry test to obtain the forced expiratory volume in one second (FEV1) and the ratio of FEV1/forced vital capacity (FVC). In the initial multivariable&nbsp; regression analysis, the effect of smoking on pulmonary function in HIV-positive adults was assessed. The analysis was repeated, assessing the influence&nbsp; of HIV status on lung function in both HIV-negative and HIV-positive smokers. The models were adjusted for age, sex, body mass index (BMI), time since&nbsp; HIV diagnosis, antiretroviral treatment (ART) use, occupational hazards, history of tuberculosis or pneumonia, indoor smoking and the presence of an&nbsp; indoor fireplace during childhood.</p> <p><strong>Results</strong>: This study included 524 people living with HIV (PLWH, 66.7% female, mean age 40.9 years [s.d.; 9.4]) and 79&nbsp; HIV-negative smokers (77.2% male, mean age 34.4 years [s.d.: 12.1]). Of the PLWH, 118 (22.5%) were past or current smokers and 406 (77.5%) were non-&nbsp; smokers. Smoking was not associated with changes in the FEV1 or FEV1/FVC ratio in multivariable regression analysis. In the second analysis, HIV status&nbsp; was also not associated with reduced pulmonary function following adjustment for confounders.</p> <p><strong>Conclusion</strong>: Neither smoking nor being HIV-positive&nbsp; was associated with decreased pulmonary function in this relatively young population. These findings should be confirmed in a longitudinal study,&nbsp; including an older population.</p> Annelotte E. Sussenbach Sjors W.L. van Gijzel Samanta T. Lalla-Edward Willem D.F. Venter Erica Shaddock Charles Feldman Kerstin Klipstein-Grobusch Alinda G. Vos Copyright (c) 0 2023-02-20 2023-02-20 23 1 Cytomegalovirus retinitis and antiretroviral treatment: A fifteen year experience <p><strong>Background</strong>: South Africa’s public antiretroviral treatment (ART) programme has undergone progressive changes since its introduction in 2004. The&nbsp; effect of this on the burden of the AIDS-defining opportunistic infection, cytomegalovirus retinitis (CMVR), in SA, has not been fully appreciated.</p> <p><strong>Objectives</strong>: To determine the effect of ART availability in the public sector of SA on the trend in the number of cases of newly diagnosed CMVR over time.</p> <p><strong>Methods</strong>: This is a retrospective study from 01 November 2002 to 31 August 2017 that took place at a tertiary hospital in the KwaZulu-Natal (KZN)&nbsp; province.</p> <p><strong>Results</strong>: A total of 383 participants were included in the study, with 60.1% being female and 94% of black African origin. The mean age of patients was&nbsp; 34.08 years (SD ± 7.24). A linear trend model suggested an overall linear decrease in the number of new cases of CMVR per year (R<sup>2</sup> of 0.67). The average&nbsp; number of new cases of CMVR per year prior to ART being available to all persons living with HIV (PLWH) with a CD4+ ≤ 350 cells/μL and after was 34 and 13, respectively, and the difference (61.76%) between these values was statistically significant, P = 0.001. The median CD4+ count at diagnosis of CMVR was 22 (interquartile range: 9–51.25) cells/μL. An overall 51% of patients in this study were on ART at diagnosis of CMVR. There was a higher proportion of&nbsp; patients on ART ≤ 6 months (63.3%), compared with those on ART &gt; 6 months (36.7%), and the difference was statistically significant, P &lt; 0.01.</p> <p><strong>Conclusion</strong>: ART has resulted in a decrease in the burden of CMVR on ophthalmic services for many in KZN, particularly following the introduction of ART&nbsp; for all PLWH with a CD4 ≤ 350 cells/μL.</p> Serisha Jay Narain Linda Visser Wilbert Sibanda Copyright (c) 0 2023-02-23 2023-02-23 23 1 Evaluation of the modified Wells score in predicting venous thromboembolic disease in patients with tuberculosis or HIV in a South African setting <p><strong>Background</strong>: There is paucity of data on the modified Wells score (MWS) utility on patients with venous thromboembolism (VTE) in a South African&nbsp; setting where there is a high burden of HIV and tuberculosis (TB). This study analyses the performance of this score in HIV/TBinfected patients compared with non-infected patients.</p> <p><strong>Objectives</strong>: To assess the performance of the MWS as an additional risk factor for VTE in hospitalised patients with a high burden of HIV/TB infections.</p> <p><strong>Method</strong>: This study was a retrospective cross-sectional cohort analysis of the utility of the MWS in 156 HIV/TB-infected and non-infected adult patients&nbsp; diagnosed with VTE on compression ultrasonography (CUS) or computed tomography pulmonary angiography (CTPA) in a medical inpatient setting over&nbsp; six months. Patients with HIV and/or TB were assessed as having an additional risk factor (1 point for each), and this was compared with the MWS. A&nbsp; McNeymar’s paired sample chi-squared test was used to compare the sensitivity of this score against the MWS.</p> <p><strong>Results</strong>: Of the 156 patients with VTE who were enrolled, HIV was the commonest risk factor (42.31%) with TB accounting for 10.90% of cases. When the&nbsp; MWS adjusted for HIV/TB was used, the sensitivity increased from 25% to 100% for the HIV–/TB+ category, it increased from 77.36% to 98.11% in the&nbsp; HIV+/TB– category and it increased from 84.62% to 92.95% in the HIV+/TB+ category. These differences were statistically significant at P &lt; 0.05 in all&nbsp; categories.</p> <p><strong>Conclusion</strong>: The MWS performs better when the infectivity of HIV/TB is included as an additional risk factor in the score.</p> Tweedy Keokgale Sarah A. van Blydenstein Ishmail S. Kalla Copyright (c) 0 2023-02-20 2023-02-20 23 1 Association between socio-economic factors and HIV self-testing knowledge amongst South African women <p><strong>Background</strong>: Self-testing for HIV is an effective and alternative method of increasing HIV testing rates and a strategy for reaching populations that are underserved by HIV testing services. Nonetheless, many resource-constrained settings are yet to adopt HIV self-testing (HIVST) into their national HIV programmes.</p> <p><strong>Objectives</strong>: This study aimed to examine the association between socio-economic factors and HIVST knowledge amongst South African women.</p> <p><strong>Method</strong>: We used nationally representative data from the 2016 South African Demographic and Health Survey. A sample of 8182 women of reproductive&nbsp; age was analysed. The outcome variable was HIVST knowledge. This was measured dichotomously; know versus do not know about HIVST. The&nbsp; multivariable logistic model was used to examine the measures of association, with the level of significance set at P &lt; 0.05.</p> <p><strong>Results</strong>: The prevalence rate of HIVST knowledge was found to be approximately 24.5% (95% confidence interval [CI]: 22.9–26.1) amongst South African&nbsp; women. Women with tertiary education were 3.93 times more likely to have HIVST knowledge, when compared with those with no formal education&nbsp; odds ratio [OR]: 3.93; 95% CI: 1.37–11.26). Rural residents had a 33%&nbsp; reduction in HIVST knowledge when compared with those residing in urban areas&nbsp; (OR: 0.67; 95% CI: 0.51–0.89). The odds of interaction between the richer and richest women who have good knowledge of HIV infection were 1.88 and&nbsp; 2.24 times more likely to have HIVST knowledge, respectively, when compared with those from the poorest wealth household who have good knowledge&nbsp; of HIV infection.</p> <p><strong>Conclusion</strong>: Based on the low level of HIVST knowledge, the findings emphasise the importance of developing effective HIVST&nbsp; educational campaigns. Moreover, programmes should be designed to address the unique needs of the socio-economically disadvantaged women.&nbsp;</p> Michael Ekholuenetale Chimezie I. Nzoputam Osaretin C. Okonji Copyright (c) 0 2023-02-20 2023-02-20 23 1 Utilisation of cervical cancer screening among women living with HIV at Kenya’s national referral hospital <p><strong>Background</strong>: In 2009, Kenyatta National Hospital (KNH) integrated cervical cancer screening within HIV care using visual inspection with acetic acid (VIA)&nbsp; and Pap smear cytology.</p> <p><strong>Objectives</strong>: We evaluated utilisation of cervical cancer screening and human papillomavirus&nbsp; (HPV) vaccination among women living with HIV (WLHIV)&nbsp; receiving HIV care at KNH.</p> <p><strong>Method</strong>: From November 2019 to February 2020, WLHIV aged ≥ 14 years were invited to participate in a survey following receipt of routine HIV services.&nbsp; We assessed awareness of cervical cancer, uptake of cervical cancer screening, uptake of the HPV vaccine, and barriers to utilisation of these services. In a&nbsp; subset of survey participants, focus group discussions (FGDs) were also conducted to identify screening barriers.</p> <p><strong>Results</strong>: Overall, 305 WLHIV articipated in the survey. Median age was 36 years (interquartilerange [IQR]: 28–43), 41% were married, and 38% completed secondary education. Most&nbsp; (90%) had HIV RNA &lt; 1000 copies/mL. Awareness of cervical cancer was high (84%), although only 45% of WLHIV had&nbsp; screened for cervical cancer at the referral hospital and only 13% knew how to prevent high-risk HPV. No participants had received an HPV vaccination.&nbsp; Older age, higher education, and knowledge of the HPV vaccine were associated with higher likelihood of cervical cancer screening (P &lt; 0.05). In FGDs,&nbsp; barriers to utilising the services included user fees, fear of the procedure impacting fertility, age and gender of the provider, and long waiting times.&nbsp;&nbsp;&nbsp;</p> <p><strong>Conclusion</strong>: Despite integration with HIV services, the utilisation of cervical cancer screening was low among WLHIV and implementation barriers&nbsp; contributed to low utilisation.</p> James M. Kangethe Aliza Monroe-Wise Peter N. Muiruri James G. Komu Kenneth K. Mutai Mirriam M. Nzivo Jillian Pintye Copyright (c) 0 2023-02-20 2023-02-20 23 1 Determinants of health-related quality of life in young adults living with perinatally acquired HIV infection in Botswana <p><strong>Background</strong>: Due to the successful antiretroviral therapy (ART) programme in Botswana, large numbers of perinatally HIV-infected adolescents are&nbsp; emerging into young adulthood. Young adulthood is a critical period of human development. However, there is lack of information on the factors&nbsp; affecting the health-related quality of life (HRQOL) of young adults living with perinatally acquired HIV (YALPH) in Botswana.</p> <p><strong>Objectives</strong>: The objective of this study was to assess the HRQOL and its determinants among YALPH who were enrolled on ART at Botswana-Baylor&nbsp; Children’s Clinical Centre of Excellence in Gaborone, Botswana.</p> <p><strong>Method</strong>: A cross-sectional study assessed the HRQOL of 509 YALPH aged 18–30 years using the WHOQOL-HIV BREF. Data about other variables of&nbsp; interest were abstracted from medical records. Bivariate analyses were performed using t and Chi-square tests to determine the associations between&nbsp; demographic and clinical variables and general HRQOL. The variables that were associated with the general HRQOL at P-value &lt; 0.1 were included in the&nbsp; multivariable analysis using the logistic regression approach.</p> <p><strong>Results</strong>: The majority of participants had good general HRQOL (78.4%). The highest mean&nbsp; HRQOL score was in the Physical domain (5.4 [± 2.9]) and the lowest in the Environment domain (13.8 [± 2.7]). The factors that were significantly&nbsp; associated with the general HRQOL included: level of education attained (P = 0.012), employment status (P = 0.069), viral load suppression (P = 0.073) and&nbsp; self-reported illness (P = 0.001).</p> <p><strong>Conclusion</strong>: Interventions that effectively increase educational attainment, employment opportunities, ART adherence,&nbsp; and prevention or management of illness are needed to promote good HRQOL among YALPH in Botswana.</p> Grace Karugaba Gloria Thupayagale Tshweneagae Mary M. Moleki Onkabetse V. Mabikwa Mogomotsi Matshaba Copyright (c) 0 2023-02-20 2023-02-20 23 1 Tracking adverse drug reactions and medication errors in the Central Chronic Medicine Dispensing and Distribution (CCMDD) programme in South Africa <p><strong>Background</strong>: The South African Central Chronic Medicine Dispensing and Distribution (CCMDD) programme is a National Health Insurance (NHI) initiative that improves access to medicine for patients.</p> <p><strong>Objectives</strong>: To describe the frequency of adverse drug reactions (ADRs) and medication errors reported in stable patients living with HIV.</p> <p><strong>Method</strong>: This descriptive cross-sectional survey was conducted from August 2020 to October 2020, targeting tenofovir disoproxil fumarate/lamivudine&nbsp; /dolutegravir (TLD) and tenofovir disoproxil fumarate/emtricitabine/efavirenz (TEE) patients. The distribution of ADRs and medication errors is presented.</p> <p><strong>Results</strong>: Of 9621 patients, 30.8% (n = 2967) were interviewed, 40.2% (n = 1192) on TLD and 59.8% (n = 1775) on TEE regimens. The majority were women&nbsp; (TLD: 55.8%, n = 665; TEE: 75.4%, n = 1338); 15% (179/1192) reported ADRs on TLD. Medication errors were low on TLD (1.6%, n = 19) and TEE (1.2%, n =&nbsp; 22). Receipt of incorrect medication (eight each in TLD and TEE) and associated hospitalisations (one vs two, respectively) were low. Common TLD-&nbsp; associated ADRs were weight gain (47.5%, n = 85), headaches (44.7%, n = 80), insomnia (39.7%, n = 71), restlessness (36.9%, n = 66), dizziness (29.6%, n =&nbsp; 53), brain fog (27.9%, n = 50), nervousness (27.4%, n = 49), rash on the skin (24.6%, n = 44) and poor concentration (21.2%, n = 38).</p> <p><strong>Conclusion</strong>: About one in seven patients reported ADRs under TLD. Medication errors were low, possibly due to effective quality control measures and&nbsp; stable patients being on the programme. Knowing the frequency of ADRs and medication errors is critical for enhancing the CCMDD programme.</p> Kennedy Otwombe Maggie Munsamy Mukesh Dheda Nishana Ramdas Corlee Herbst Merlin Pillay Tanya van Tonder Celicia Serenata Samanta Lalla-Edward Copyright (c) 0 2023-02-20 2023-02-20 23 1 Digitally supported HIV self-testing increases facility-based HIV testing capacity in Ekurhuleni, South Africa <p><strong>Background</strong>: HIV testing is the first step for linkage to HIV prevention or treatment services. Facility-based HIV testing is the most utilised method, but&nbsp; faces challenges such as limited work space and human resources. Digitally supported HIV self-testing (HIVST) provided in clinics shifts testing to the&nbsp; client, potentially empowering the client, and addresses such constraints.</p> <p><strong>Objectives</strong>: The study primary objective was to determine the feasibility of integrating digitally supported HIVST into the clinic. Secondary objectives&nbsp; were to describe HIV testing volume, populations reached, and antiretroviral treatment (ART) initiation.</p> <p><strong>Method</strong>: We conducted an analysis of prospectively collected data during implementation of digitally supported HIVST in two healthcare facilities based&nbsp; in South Africa from June 2019 to September 2019. We described implementation and client characteristics using HIVST and compared testing before and during implementation.</p> <p><strong>Results</strong>: During the 4-month implementation period there were 35 248 client visits. A total of 6997 (19.9%) of these visits involved HIV testing. Of those&nbsp; testing, 2278 (32.5%) used HIVST. Of the 2267 analysed, 264 (11.6%) were positive: 182 (12%) women and 82 (11%) men. Of those, 230 (95.4%) were&nbsp; confirmed HIV positive and 150 (65%) initiated ART within 14 days. During a four-month pre-implementation period, 14.5% of the clients tested for HIV.&nbsp; Compared to the pre-implementation period, we observed a 25% increase in HIV testing.</p> <p><strong>Conclusion</strong>: Digitally supported HIVST increased the number of&nbsp; clients completing HIV testing in the health facility, without a need to significantly increase staff or space. Facilitybased digitally assisted HIVST has the&nbsp; potential to increase HIV testing in high HIV prevalence clinic populations.</p> Nolundi T. Mshweshwe-Pakela Tonderai Mabuto Luke Shankland Alex Fischer Dikeledi Tsukudu Christopher J. Hoffmann Copyright (c) 0 2023-02-20 2023-02-20 23 1 Factors associated with viral suppression among adolescents on antiretroviral therapy in Free State province, South Africa <p><strong>Background</strong>: In 2019, about 1.7 million adolescents between the ages of 10 and 19 years were living with HIV worldwide, of which 170 000 were newly&nbsp; infected with HIV in 2019. South Africa has the highest number of persons living with HIV. Although there has been major improvement in access to&nbsp; antiretroviral therapy (ART), it is still unclear what proportion of adolescents (aged 10–19 years) are virally suppressed in the provinces of South Africa.<br><strong>Objectives</strong>: To determine the prevalence of and the factors associated with viral suppression among adolescents (10–19 years) on ART in the Thabo&nbsp; Mofutsanyane District Municipality of the Free State province of South Africa.<br><strong>Method</strong>: A retrospective cross-sectional analysis of demographic, clinical and treatmentrelated information that were extracted from an electronic database was conducted using Statistical Package for the Social Sciences version 26.<br><strong>Results</strong>: The median duration on ART was 6.58 years. Although 78% (n = 4520) of adolescents living with HIV who were on ART achieved viral suppression&nbsp; (&lt; 1000 copies/mL), only 9.5% (n = 430) were fully suppressed at &lt; 50 copies/mL. In multivariate analysis, the odds of being virally suppressed reduced&nbsp; with increasing age at ART initiation. Adolescents with CD4 counts greater than 500 cells/mm3 at baseline had a higher odds ratio of viral suppression&nbsp; (adjusted odds ratio [AOR]: 1.77; confidence interval [CI]: 1.28–2.47). The odds of viral suppression were significantly lower among those not retained in&nbsp; care (AOR: 0.45; CI: 0.35–0.58).<br><strong>Conclusion</strong>: Tailored interventions should be developed to improve viral suppression among adolescents on ART</p> Balsam A.Y. Elashi Brian E. van Wyk Copyright (c) 0 2023-02-20 2023-02-20 23 1 Rechallenge after anti-tuberculosis drug-induced liver injury in a high HIV prevalence cohort <p><strong>Background</strong>: There are limited data on the outcomes of rechallenge with anti-tuberculosis therapy (ATT) following anti-tuberculosis drug-induced liver&nbsp; injury (AT-DILI) in a high HIV prevalence setting.</p> <p><strong>Objectives</strong>: To describe the outcomes of rechallenge with first-line ATT.</p> <p><strong>Method</strong>: Hospitalised participants with AT-DILI who were enrolled into a randomised controlled trial of N-acetylcysteine in Cape Town, South Africa, were followed up until completion of ATT rechallenge. We described rechallenge outcomes, and identified associations with recurrence of liver injury on&nbsp; rechallenge (positive rechallenge).</p> <p><strong>Results</strong>: Seventy-nine participants were rechallenged of whom 41 (52%) were female. Mean age was 37 years&nbsp; (standard deviation [s.d.] ±10). Sixty-eight (86%) were HIV-positive, of whom 34 (50%) were on antiretroviral therapy (ART) at time of AT-DILI presentation.&nbsp; Five participants had serious adverse reactions to an aminoglycoside included in the alternate ATT regimen given after first-line ATT interruption: acute kidney injury in three and hearing<br>loss in two. The median time from first-line ATT interruption to start of first-line ATT rechallenge was 13 days (interquartile range [IQR]: 8–18 days).&nbsp; Antiretroviral therapy was interrupted for a median of 32 days (IQR: 17–58) among HIV-positive participants on ART before AT-DILI. Fourteen participants&nbsp; had positive rechallenge (18%). Positive rechallenge was associated with pyrazinamide rechallenge (P = 0.005), female sex (P = 0.039) and first episode of&nbsp; tuberculosis (TB) (P = 0.032).</p> <p><strong>Conclusion</strong>: Rechallenge was successful in most of our cohort. Pyrazinamide rechallenge should be carefully considered.</p> Muhammed Shiraz Moosa Gary Maartens Hannah Gunter Shaazia Allie Mohamed F. Chughlay Mashiko Setshedi Sean Wasserman David F. Stead Karen Cohen Copyright (c) 0 2023-02-20 2023-02-20 23 1 COVID-19 vaccine acceptance and associated factors among people living with HIV in the Middle East and North Africa region <p><strong>Background</strong>: Identifying coronavirus disease 2019 (COVID-19) vaccine acceptance and associated factors among people living with HIV (PLHIV) in the&nbsp; Middle East and North Africa region is important to meet the need for broad-scale vaccination against COVID-19.</p> <p><strong>Objectives</strong>: To investigate the COVID-19 vaccine acceptance rate and factors among PLHIV in the Middle East and North Africa region.</p> <p><strong>Method</strong>: An online cross-sectional survey was conducted among PLHIV currently living in Egypt, Tunisia and Saudi Arabia between March 2021 and&nbsp; August 2021.</p> <p><strong>Results</strong>: Of the 540 respondents, 19.3% reported already being vaccinated against COVID-19 (n = 104), 32.0% responded ‘definitely yes’ (n = 173), and&nbsp; 13.3% responded ‘probably yes’ (n = 72) for intention to receive a COVID-19 vaccine, with an overall COVID-19 vaccine acceptance rate of 64.6% among&nbsp; PLHIV in the region. The most significant predictors of COVID-19 vaccine acceptance included feeling less worried about COVID-19 transmission post-&nbsp; vaccination (221.0% higher odds), and believing the disease is vaccine-preventable (160.0% higher odds). Reported barriers to COVID-19 vaccine&nbsp; acceptance include concerns about vaccine effectiveness and belief that HIV medications protect against COVID-19 transmission, living in a rural area and&nbsp; reporting less-frequent engagement with HIV care. Nine out of 10 participants reported that the chances of them getting COVID-19 vaccine would&nbsp; increase if given adequate information and if their doctor recommended it.</p> <p><strong>Conclusion</strong>: Findings of the study can help researchers, health officials, and other health system actors understand the predictors and barriers to&nbsp; COVID-19 vaccine acceptance reported by PLHIV. This understanding could inform the future planning of interventions tailored to PLHIV.&nbsp;</p> Rahma Mohamed Trenton M. White Jeffrey V. Lazarus Amany Salem Reham Kaki Wafa Marrakchi Sara G.M. Kheir Ibrahim Amer Fida M. Ahmed Maie A. Khayat Nabeela Al-Abdullah Batool Ali Roaa Sultan Bandar Alamri Anouf Abdulmajid Ikbal Kooli Mohamed Chakroun Tariq A. Madani Gamal Esmat Ahmed Cordie Copyright (c) 0 2023-02-20 2023-02-20 23 1 The sexual and reproductive health needs of young people living with HIV in Gauteng, South Africa <p><strong>Background</strong>: HIV has been the focus of health systems strengthening in South Africa for the past two decades. Despite progress, sexual and&nbsp; reproductive health (SRH) challenges such as contraception, condom usage and HIV disclosure of young people living with HIV (YPLHIV) remain&nbsp; inadequately addressed. Therefore, the purpose of the study was to describe the SRH needs of YPLHIV and make recommendations to address identified&nbsp; gaps.</p> <p><strong>Objective</strong>s: To explore and describe the SRH needs and potential systemic gaps of YPLHIV with an aim to make recommendations for improvement and&nbsp; contribute to the development of an integrated approach to SRH care in HIV programming.</p> <p><strong>Method</strong>: A quantitative cross-sectional research design with purposive sampling was utilised. YPLHIV were recruited from five healthcare facilities in&nbsp; Gauteng, South Africa, for face-to-face interviews.</p> <p><strong>Results</strong>: One hundred and six YPLHIV with a median age of 18 years were enrolled. A large proportion (57/106; 53.8%) of respondents reported being&nbsp; either single or double orphaned. Sex-related discussions with parents were reported by only 36/106 (34.0%). History of teenage pregnancy was reported&nbsp; in 39/70 (56.0%) of female respondents. A high prevalence of multiple sexual partnerships 41/97 (42.2%) was noted. Consensual partner HIV disclosure&nbsp; was low at 47/97 (48.4%) and the male gender was associated with low 10/35 (28.6%) disclosure of serostatus to sexual partners.</p> <p><strong>Conclusion</strong>: Multiple SRH needs were identified. Interventions are needed to improve parental guidance on SRH issues, increase contraception&nbsp; knowledge and access, and provide better male-centred care.&nbsp;</p> Bandile E. Ndlazi Thembekile Masango Copyright (c) 0 2023-02-20 2023-02-20 23 1 Rifampicin resistance and mortality in patients hospitalised with HIV-associated tuberculosis <p><strong>Background</strong>: Patients with HIV and drug-resistant tuberculosis (TB) are at high risk of death.</p> <p><strong>Objectives</strong>: We investigated the association between rifampicin-resistant TB (RR-TB) and mortality in a cohort of patients who were admitted to hospital&nbsp; at the time of TB diagnosis.</p> <p><strong>Method</strong>: Adults hospitalised at Khayelitsha Hospital and diagnosed with HIV-associated TB during admission, were enrolled between 2013 and 2016.&nbsp; Clinical, biochemical and microbiological data were prospectively collected and participants were followed up for 12 weeks.</p> <p><strong>Results</strong>: Participants with&nbsp; microbiologically confirmed TB (n = 482) were enrolled a median of two days (interquartile range [IQR]: 1–3 days) following admission. Fifty-three&nbsp; participants (11.0%) had RR-TB. Participants with rifampicin-susceptible TB (RS-TB) received appropriate treatment a median of one day (IQR: 1–2 days)&nbsp; following enrolment compared to three days (IQR: 1–9 days) in participants with RR-TB. Eight participants with RS-TB (1.9%) and six participants with RR-&nbsp; TB (11.3%) died prior to the initiation of appropriate treatment. Mortality at 12 weeks was 87/429 (20.3%) in the RS-TB group and 21/53 (39.6%) in the RR-&nbsp; TB group. RR-TB was a significant predictor of 12-week mortality (hazard ratio: 1.88; 95% confidence interval: 1.07–3.29; P = 0.03).</p> <p><strong>Conclusion:</strong> Mortality at&nbsp; 12 weeks in participants with RR-TB was high compared to participants with RS-TB. Delays in the initiation of appropriate treatment and poorer&nbsp; regimen efficacy are proposed as contributors to higher mortality in hospitalised patients with HIV and RR-TB. </p> Ruan Spies Charlotte Schutz Amy Ward Avuyonke Balfour Muki Shey Mark Nicol Rosie Burton Bianca Sossen Robert Wilkinson David Barr Graeme Meintjes Copyright (c) 0 2023-02-20 2023-02-20 23 1 Delays in third-line antiretroviral therapy and outcomes in North West province <p><strong>Background:</strong> Rapid switching from second-line to third-line antiretroviral therapy (TLART) is crucial for achieving viral suppression and reducing illness related to ART failure.<br><strong>Objectives</strong>: This retrospective cohort study quantified the waiting periods for TLART initiation after virological failure on second-line therapy was&nbsp; detected, assessed factors associated with delays and assessed the outcomes of patients started on TLART.<br><strong>Method</strong>: Data were abstracted from records of individuals eligible for TLART, and the time to TLART initiation was calculated. Reasons for delays were&nbsp; categorised according to patient, clinician and administrative processes.<br><strong>Results</strong>: Fifty-four patients were eligible for TLART. The median delay from the date of first viral load &gt; 1000 copies/mL on second-line therapy to the start&nbsp; of TLART was 640 days (interquartile range [IQR]: 451–983 days). Of the patients that failed second-line and had an application for TLART, 41 (75.6%) were eventually initiated on TLART, and 11 (20.4%) died while waiting. Delays were primarily due to non-response to the first unsuppressed viral load&nbsp; while on second-line ART: 467 days (IQR: 232–803 days).<br><strong>Conclusion</strong>: This study showed a prolonged waiting period for TLART initiation mainly between detected high viral load to requesting of resistance tests;&nbsp; many factors could have contributed, including clinicians’ delayed responses to elevated viral loads. Mortality was high before TLART could be initiated.&nbsp; The process of TLART initiation needs to be made more efficient. Healthcare services should be strengthened to (1) recognise and manage virological&nbsp; failure early and identify those eligible for resistance testing, (2) ensure access to resistance testing and appropriately skilled clinicians, and (3) streamline&nbsp; approvals and delivery of TLART.</p> Babalwa Majova Ebrahim Variava Neil Martinson Copyright (c) 0 2023-02-20 2023-02-20 23 1 HIV viral load suppression before and after COVID-19 in Kinshasa and Haut Katanga, Democratic Republic of the Congo <p><strong>Background</strong>: The coronavirus disease 2019 (COVID-19) pandemic resulted in unique programmatic opportunities to test hypotheses related to the&nbsp; initiation of antiretroviral treatment (ART) and viral load (VL) suppression during a global health crisis, which would not otherwise have been possible.</p> <p><strong>Objectives</strong>: To generate practice-relevant evidence on the impact of initiating ART preCOVID-19 versus during the COVID-19 pandemic on HIV VL.</p> <p><strong>Method</strong>: Logistic regression was performed on data covering 6596 persons with HIV whose VL data were available, out of 36 585 persons who were&nbsp; initiated on ART between 01 April 2019 and 30 March 2021.</p> <p><strong>Results</strong>: After controlling for covariates such as age, gender, duration on ART, tuberculosis status at the time of the last visit, and rural vs urban status,&nbsp; the odds of having a VL &lt; 1000 copies/mL were significantly higher for clients who started ART during the COVID-19 pandemic than the year before&nbsp; COVID-19 (adjusted odds ratio [AOR]: 2.50; confidence interval [CI]: 1.55–4.01; P &lt; 0.001). Odds of having a VL &lt; 1000 copies/mL were also significantly&nbsp; higher among female participants than male (AOR: 1.23; CI: 1.02–1.48), among patients attending rural clinics compared to those attending urban clinics&nbsp; (AOR: 1.83; CI: 1.47–2.28), and in clients who were 15 years or older at the time of their last visit (AOR: 1.50; CI: 1.07–2.11).</p> <p><strong>Conclusion</strong>: Viral loads did not deteriorate despite pandemic-induced changes in HIV services such as the expansion of multi-month dispensing (MMD),&nbsp; which may have played a protective role regardless of the general negative impacts of response to the COVID-19 crises on communities and individuals.&nbsp; What this study adds: This research capitalises on the natural experiment of COVID-19-related changes in HIV services and provides new practice-relevant&nbsp; research evidence.</p> Gulzar H. Shah Gina D. Etheredge Stacy W. Smallwood Lievain Maluantesa Kristie C. Waterfield Osaremhen Ikhile John Ditekemena Elodie Engetele Elizabeth Ayangunna Astrid Mulenga Bernard Bossiky Copyright (c) 0 2023-02-20 2023-02-20 23 1 Weight gain in children from birth to 10 years on antiretroviral treatment <p><strong>Background</strong>: Inadequate weight gain could indicate clinical deterioration in infants and children living with HIV (CLHIV). The World Health Organization’s&nbsp; (WHO) weight-for-age z-score (WAZ) growth standards and reference charts are currently used in South Africa to assess weight gain in CLHIV on&nbsp; antiretroviral treatment (ART).</p> <p><strong>Objectives</strong>: To assess weight gain patterns of infants and children initiated on ART and to compare weight gain patterns between the WHO WAZ growth&nbsp; standards and populationspecific curves constructed from data of CLHIV on ART.</p> <p><strong>Method</strong>: A quantitative, retrospective and descriptive-comparative design was used. The weight gain patterns of 98 infants and children from birth to 10&nbsp; years old during the 24-month period following ART initiation were recorded and assessed using two different growth harts.</p> <p><strong>Results</strong>: The children’s rate&nbsp; of weight and length gain improved significantly over 24 months since ART initiation, but complete catch-up growth was never achieved. Most (69%) of&nbsp; the children had increased weight gain according to the WAZ growth standard and reference charts versus only 16% according to the HIV-specific weight&nbsp; gain curves.</p> <p><strong>Conclusion</strong>: Antiretroviral treatment improved weight and height gain in CLHIV, but the interpretations of weight gain differed significantly&nbsp; between the WHO chart and HIV-specific weight gain curves. Population- and treatment-specific references could improve weight monitoring in CLHIV&nbsp; and assist in the timeous identification of malnutrition.</p> Janine Scholtz Susanna M. Ellis Herculina S. Kruger Copyright (c) 0 2023-02-20 2023-02-20 23 1 Oral pre-exposure prophylaxis uptake, adherence, and adverse events among South African men who have sex with men and transgender women <p><strong>Background</strong>: HIV prevention programmes that include pre-exposure prophylaxis (PrEP) for men who have sex with men (MSM) and transgender women&nbsp; (TGW) in South Africa have not been widely implemented.</p> <p><strong>Objectives</strong>: The authors examined oral PrEP uptake, adherence, and adverse events among HIV-uninfected MSM and TGW to inform intervention&nbsp; acceptability and feasibility.</p> <p><strong>Method</strong>: In 2015, MSM and TGW in two South African cities were offered a comprehensive package of HIV prevention services, including daily oral PrEP,&nbsp; and were followed for one year. Different models of PrEP delivery were used at each site. Adherence was measured using self-report and pill-count data&nbsp; and tenofovir-diphosphate (TFV-DP) concentrations.</p> <p><strong>Results</strong>: Among 135 participants who were eligible for PrEP, 82 (61%) initiated PrEP, of whom 67 (82%) were on PrEP at study end. Participants were on&nbsp; PrEP for a median of 294 out of 314.5 possible days (93% protected days). The median time from PrEP initiation to discontinuation or study end was 305&nbsp; days (interquartile range: 232–325 days). Across the follow-up time points, 57% – 72% of participants self-reported taking protective levels of PrEP and&nbsp; 59% – 74% were adherent to PrEP as indicated by pill counts. Fewer (≤ 18%) achieved protective TFV-DP concentrations of ≥ 700 fmol/punch in dried blood&nbsp; spots. Side effects, while typically mild, were the most commonly cited reason by participants for early PrEP discontinuation.</p> <p><strong>Conclusion</strong>: Many MSM and TGW initiated and maintained PrEP, demonstrating that PrEP can be successfully delivered to South African MSM and TGW in&nbsp; diverse programmatic contexts. Biologic adherence measures suggest MSM and TGW may experience challenges taking PrEP regularly. Counselling&nbsp; for coping with side effects and motivating daily pill taking is recommended to support South African MSM and TGW in achieving protection with PrEP.</p> Linda-Gail Bekker Danielle Giovenco Stefan Baral4 Karen Dominguez Rachel Valencia Travis Sanchez A.D. McNaghten Ryan Zahn Clarence S. Yah Zinhle Sokhela Richard Kaplan Refliwe N. PhaswanaMafuya Chris Beyrer Patrick S. Sullivan Copyright (c) 0 2023-02-20 2023-02-20 23 1 Incidence of hepatitis C virus infection among people living with HIV: An Egyptian cohort study <p><strong>Background</strong>: Egypt used to have one of the highest hepatitis C virus (HCV) infection prevalence rates worldwide, with an estimated HCV prevalence of around 4.5% to 6.7%.</p> <p><strong>Objectives</strong>: To determine the HCV infection incidence rate amid Egyptian patients living with HIV.</p> <p><strong>Method</strong>: A total of 460 HIV-positive patients were recruited in a retrospective cohort study from Imbaba Fever Hospital, Cairo, between January 2016 and&nbsp; March 2019. The patients had a negative baseline and at least one other HCV antibody test. Hepatitis C virus antibody testing was done by antibody&nbsp; sandwich third-generation enzyme-linked immunosorbent assay. The hepatitis C virus infection incidence rate among HIV-infected patients was&nbsp; calculated using the person-time incidence rate.</p> <p><strong>Results</strong>: Two hundred and eighteen patients were finally included: 146 (31.7%) patients were excluded for having a positive baseline HCV Ab result and 96&nbsp; patients were excluded for not having a follow-up HCV Ab test. Eighteen patients had HCV seroconversion (8.3%), achieving an incidence rate of 4.06&nbsp; cases per 100 person-years (95% confidence interval: 3.87–4.24). Injection drug use (IDU) was the commonest risk factor among seroconverters, with an&nbsp; HCV incidence rate of 7.08 cases per 100 person-years. Injection drug use history was reported in 83.3% of the seroconverters and in only 47.2% of non-&nbsp; seroconverters; P = 0.005.</p> <p><strong>Conclusion</strong>: Egyptian HIV-infected patients show a high incidence rate of HCV infection especially among those who have a history of IDU. Accordingly,&nbsp; attention should be paid for prevention, screening and timely treatment of HCV in patients infected with HIV. What this study adds: The demonstration of&nbsp; a high HCV infection incidence rate among HIVinfected patients and shows the need for screening and prevention in this population.&nbsp;</p> Fatma Elrashdy Suzan Hagag Rahma Mohamed Shereen Abdel Alem Safa Meshaal Ahmed Cordie Aisha Elsharkawy Gamal Esmat Copyright (c) 0 2023-02-20 2023-02-20 23 1 Comparative performance of cardiovascular risk prediction models in people living with HIV <p><strong>Background</strong>: Current cardiovascular risk assessment in people living with HIV is based on general risk assessment tools; however, whether these tools&nbsp; can be applied in sub-Saharan African populations has been questioned.</p> <p><strong>Objectives</strong>: The study aimed to assess cardiovascular risk classification of common cardiovascular disease (CVD) risk prediction models compared to the&nbsp; Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) 2010 and 2016 models in people living with HIV.</p> <p><strong>Method</strong>: Cardiovascular disease risk was estimated by Framingham Cardiovascular and Heart Disease (FHS-CVD, FHS-CHD), Atherosclerotic&nbsp; Cardiovascular Disease (ASCVD) and D:A:D 2010 and 2016 risk prediction models for HIV-infected participants of the Ndlovu Cohort Study, Limpopo, rural South Africa. Participants were classified to be at low (&lt; 10%), moderate (10% – 20%), or high-risk (&gt; 20%) of CVD within 10 years for general CVD and five&nbsp; years for D:A:D models. Kappa statistics were used to determine agreement between CVD risk prediction models. Subgroup analysis was performed<br>according to age.</p> <p><strong>Results</strong>: The analysis comprised 735 HIV-infected individuals, predominantly women (56.7%), average age 43.9 (8.8) years. The median predicted CVD risk&nbsp; for D:A:D 2010 and FHS-CVD was 4% and for ASCVD and FHS-CHD models, 3%. For the D:A:D 2016 risk prediction model, the figure was 5%. High 10-&nbsp; year CVD risk was predicted for 2.9%, 0.5%, 0.7%, 3.1% and 6.6% of the study participants by FHS-CVD, FHS-CHD, ASCVD, and D:A:D 2010 and 2016. Kappa&nbsp; statistics ranged from 0.34 for ASCVD to 0.60 for FHS-CVD as compared to the D:A:D 2010 risk prediction model.</p> <p><strong>Conclusion</strong>: Overall, predicted CVD risk is low in this population. Compared to D:A:D 2010, CVD risk estimated by the FHS-CVD model showed similar&nbsp; overall results for risk classification. With the exception of the D:A:D model, all other risk prediction models classified fewer people to be at high&nbsp; estimated CVD risk. Prospective studies are needed to develop and validate CVD risk algorithms in people living with HIV in sub-Saharan Africa.&nbsp; </p> Irtiza S. Tahir Alinda G. Vos Johanna A.A. Damen Roos E. Barth Hugo A. Tempelman Diederick E. Grobbee Karine Scheuermaier Willem D.F. Venter Kerstin Klipstein-Grobusch Copyright (c) 0 2023-02-20 2023-02-20 23 1 Experiences in receiving financial incentives to access HIV care in Johannesburg, South Africa <p><strong>Background</strong>: Financial incentivisation has been used to improve all steps of the HIV cascade with varying results. Most studies conducted on the matter&nbsp; are of a quantitative nature, not giving enough space for in-depth understanding as to why financial incentives work or do not work.</p> <p><strong>Objectives</strong>: To describe experiences with, and opinions on, the use of financial incentives to promote linkage to and retention in care from the&nbsp; perspective of people living with HIV.</p> <p><strong>Method</strong>: We performed a qualitative cross-sectional study. In-depth interviews were conducted with adult men and women with HIV accessing health&nbsp; services or research study visits. After codebook development, NVivo 12 software was used to code and analyse the data.</p> <p><strong>Results</strong>: Through the provision of financial incentives, participants were able to cover basic needs. However, some deemed financial incentives as a form&nbsp; of income rather than a nudge to spark interest in changing their health behaviour. Participants communicated that a need for some type of incentive&nbsp; exists and recommended food vouchers as the best possible solution.</p> <p><strong>Conclusion</strong>: Financial incentivisation can facilitate engagement in the HIV care continuum through providing support to people living with HIV. What this&nbsp; study adds: This study complements the body of research that explores the feasibility of using incentives and which of them may be most beneficial in&nbsp; encouraging patients with HIV to enter into and sustain HIV care.</p> Sara Rachel Schlehr Leanne Singh Athini Nyatela Sizwe Nqakala Samanta T. Lalla-Edward Copyright (c) 0 2023-02-20 2023-02-20 23 1 COVID-19 and HIV viral load suppression in children and adolescents in Durban, South Africa <p><strong>Background:</strong> The coronavirus disease 2019 (COVID-19) pandemic poses challenges to paediatric and adolescent HIV treatment programme. Modelling&nbsp; exercises raised concerns over potential impact of disruptions.</p> <p><strong>Objectives</strong>: To describe the impact of the COVID-19 pandemic on viral load (VL) testing among infants, children and adolescents on antiretroviral&nbsp; treatment (ART) in Durban, South Africa.</p> <p><strong>Method</strong>: Routinely collected, aggregated data of monthly VL counts done on all those less than 19 years old from January 2018 to January 2022 was&nbsp; analysed. An interrupted time series analysis using a Prais-Winsten linear regression model, including terms for lockdowns and excess mortality determined VL trends.</p> <p><strong>Results</strong>: The unadjusted mean VL was 2166 (confidence interval [CI]: 252.2) and 2016 (CI: 241.9), P = 0.039, and percentage VL suppression rates (72.9%,&nbsp; CI: 2.4% vs 73.6%, CI: 1.8%) across COVID and pre-COVID periods, showing no significant difference, P = 0.262. In the interrupted time series analysis,&nbsp; modelled monthly VL counts did not differ significantly by lockdown level (e.g., level 5 lockdown: –210.5 VLs, 95% CI: –483.0 to +62.1, P = 0.138) or excess&nbsp; mortality (–0.1, 95% CI: –6.3 to 6.1, P = 0.969). A significant downward trend in VL testing over time, including during the pre-COVID-19 period (–6.6 VL per&nbsp; month, 95% CI: –10.4 to –2.7, P = 0.002), was identified.</p> <p><strong>Conclusion</strong>: Viral load suppression for children and adolescents were not negatively affected by COVID-19. A trend of decrease in VL testing predated&nbsp; COVID-19.</p> <p><strong>What this study adds</strong>: Evidence presented that HIV VL testing and suppression rates in children and adolescents in a high burden setting were&nbsp; sustained through the COVID pandemic.</p> Asandile Mathamo Kimesh L. Naidoo Jienchi Dorward Thashir Archary Christian Bottomley Moherndran Archary Copyright (c) 0 2023-02-20 2023-02-20 23 1 Effect of a ward-based outreach team and adherence game on retention and viral load suppression <p><strong>Background</strong>: Only 66% of South African people living with HIV (PLWH) are virologically suppressed. Therefore, it is important to develop strategies to improve outcomes.</p> <p><strong>Objectives</strong>: Assess the effect of interventions on 12-month retention in care and virological suppression in participants newly initiated on antiretroviral&nbsp; therapy.</p> <p><strong>Method</strong>: Fifty-seven clinics were randomised into four arms: Ward-based primary health care outreach teams (WBPHCOTs); Game; WBPHCOT–Game in&nbsp; combination; and Control (standard of care). Sixteen clinics were excluded and four re-allocated because lay counsellors and operational team leaders&nbsp; failed to attend the required training. Seventeen clinics were excluded due to non-enrolment.</p> <p><strong>Results</strong>: A total of 558 participants from Tshwane district were enrolled. After excluding ineligible participants, 467 participants were included in the&nbsp; analysis: WBPHCOTs (n = 72); Games (n = 126); WBPHCOT–Games (n = 85); and Control (n = 184). Retention in care at 12 months was evaluable in 340&nbsp; participants (86.2%) were retained in care and 13.8% were lost to follow-up. The intervention groups had higher retention in care than the Control group,&nbsp; but this only reached statistical significance in the Games group (96.8% vs 77.8%; relative risk [RR] 1.25; 95% confidence interval [CI]: 1.13–1.38; P = 0.01).&nbsp; The 12 month virologic suppression rate was 75.3% and was similar across the four arms.</p> <p><strong>Conclusion</strong>: This study demonstrated that an adherence game intervention could help keep PLWH in care.</p> <p><strong>What this study adds</strong>: Evidence that&nbsp; interventions, especially Games, could improve retention in care.</p> Sanele Ngcobo Steve Olorunju Tshifhiwa Nkwenika Theresa Rossouw Copyright (c) 0 2023-02-20 2023-02-20 23 1 Effect of obesity on dolutegravir exposure in Black Southern African adults living with HIV <p><strong>Background</strong>: Dolutegravir, a component of the preferred first-line antiretroviral therapy regimen, has been associated with increased weight gain. South Africa has a high prevalence of obesity, especially among women. Understanding dolutegravir exposure in patients with obesity is important for dose optimisation.</p> <p><strong>Objectives</strong>: We compared the pharmacokinetic parameters of dolutegravir in Southern African adults living with HIV with and without obesity.</p> <p><strong>Method</strong>: Blood samples were collected at various time points over a 24 h-period for dolutegravir assays. Non-compartmental analysis was conducted and&nbsp; geometric mean ratios (GMRs), with 90% confidence intervals (CIs), were generated to compare dolutegravir pharmacokinetic parameters between&nbsp; the groups. Regression analyses to assess predictors of dolutegravir exposure were done.</p> <p><strong>Results</strong>: Forty participants were enrolled, 26 were women and 10 had obesity. Dolutegravir area under the concentration-time curve to 24-h and the&nbsp; maximum concentrations were not statistically significantly lower in participants with obesity: GMR 0.91 (90% CI: 0.71–1.16) and GMR 0.86 (90% CI:&nbsp; 0.68–1.07), respectively. In a multivariate linear regression analysis adjusting for age, gender, body mass index, creatinine clearance and randomisation&nbsp; arm (tenofovir alafenamide or tenofovir disoproxil fumarate), a unit increase in body mass index was associated with 1.2% lower dolutegravir area under&nbsp; the concentration-time curve to 24-h (P = 0.035).</p> <p><strong>Conclusion</strong>: Dolutegravir exposure was marginally lower in participants with obesity, but this is not clinically significant. Our findings suggest that there&nbsp; is no need to dose adjust dolutegravir in people with obesity.</p> Enkosi Mondleki Clifford G. Banda Nomathemba C. Chandiwana Simiso Sokhela Lubbe Wiesner Francois Venter Gary Maartens Phumla Z. Sinxadi Copyright (c) 0 2023-02-20 2023-02-20 23 1 Age-related differences in the vascular function and structure of South Africans living with HIV <p><strong>Background</strong>: As the life expectancy of people living with the HIV increases because of antiretroviral treatment (ART), their risk for vascular co-morbidities&nbsp; and early vascular ageing (EVA) also increases.</p> <p><strong>Objective</strong>: We aimed to investigate whether HIV infection relates to vascular structure and function in black South African adults and whether this&nbsp; relationship is age dependent.</p> <p><strong>Method</strong>: This cross-sectional study carried out in urban and rural areas of North West province, South Africa, included 572 age- and sex-matched people&nbsp; living with HIV (PLWH) and without HIV. Participants from the EndoAfrica study and PURE study were stratified according to tertiles of age. Measures of&nbsp; vascular structure (carotid intima-media thickness) and function (carotid-femoral pulse wave velocity, central systolic blood pressure, central pulse&nbsp; pressure and pulse pressure amplification) were determined.</p> <p><strong>Results</strong>: Blood pressure measures were lower in PLWH compared with their controls (all P ≤ 0.001), especially in the younger and middle-aged groups (all&nbsp; P ≤ 0.031), whilst vascular measures did not differ (all P ≥ 0.611). In multivariate linear regression analyses, vascular measures were not associated with a&nbsp; HIV- positive status in either the total or any of the age groups.</p> <p><strong>Conclusion</strong>: Black South Africans living with HIV have a less adverse blood pressure profile than their counterparts without HIV. The HIV-positive status&nbsp; was not associated with measures of vascular structure or function in any age group. The results suggest that HIV does not contribute to EVA in this&nbsp; population; however, further longitudinal investigation is warranted.&nbsp;</p> Anisca Louwrens Carla M.T. Fourie Shani Botha-Le Roux Yolandi Bree Copyright (c) 0 2023-02-20 2023-02-20 23 1 Ethically acceptable consent approaches to adolescent research in South Africa <p><strong>Background</strong>: Adolescents are a unique population with significant unmet health needs. They are often excluded from research that may benefit them as&nbsp; they are perceived as vulnerable and needing protection from research participation. For Research Ethics Committees, conflicting positions in statutes,&nbsp; regulations and ethical guidelines about who provides informed consent for adolescent involvement in health research can be a significant barrier to&nbsp; approving adolescent research. For researchers, the requirement for parental/guardian proxy consent or prolonged approval processes may potentially&nbsp; result in the exclusion of those adolescents most vulnerable and at risk, particularly if issues such as gender-based violence, gender identity, sexuality&nbsp; and sexual practices are in question.</p> <p><strong>Objectives</strong>: To describe the challenges to adolescent research and suggest strategies to address these.</p> <p><strong>Method</strong>: We consider the legal and ethical framework in South Africa regarding the consenting age for adolescents in research, outline the challenges&nbsp; and, using examples of best practices, suggest strategies to address the current conundrum.</p> <p><strong>Results</strong>: We suggest three principles to guide Research Ethics Committees on their approach to reviewing health research involving adolescents.&nbsp; Strategies to develop ethically acceptable approaches to adolescent research and consent processes are described, which include community&nbsp; involvement. We elaborate on examples of nuanced approaches to adolescent research.</p> <p><strong>Conclusion</strong>: The inclusion of adolescents in research is critical in informing appropriate and effective health services for this vulnerable population, whilst&nbsp; providing an opportunity to link them into care and services where relevant.</p> Marian Loveday Ameena Goga Ames Dhai Melodie Labuschaigne Theresa Roussouw Theresa Burgess Ann Strode Melissa Wallace Marc Blockman Brodie Daniels Elizabeth Spooner Linda-Gail Bekker Copyright (c) 0 2023-02-20 2023-02-20 23 1 Low-level viraemia despite emergence of dolutegravir-resistant variants <p>No Abstract</p> Johannes C. Botha Kim Steegen Mariam Edoo Jeremy Nel Gert U. van Zyl Copyright (c) 0 2023-02-20 2023-02-20 23 1 Where are the children? Case finding in 5–14-year-olds living with HIV in Johannesburg <p>No Abstract</p> Jackie L. Dunlop Carol L. Tait Moyahabo Mabitsi Kate Rees Copyright (c) 0 2023-02-20 2023-02-20 23 1 Psychosocial support for adolescents and youth living with HIV during COVID-19: A differentiated approach is needed <p>No Abstract</p> Carol L. Tait Njabulo Mbanda Rudairo Tumba Marnie J. Vujovic Kate Rees Copyright (c) 0 2023-02-20 2023-02-20 23 1 Understanding patients reinitiating antiretroviral therapy in two South African districts <p>No Abstract</p> Kate Rees Melanie Bisnauth Cara O’Connor Tshifhiwa Ramvhulela Nomzamo Vali Copyright (c) 0 2023-02-20 2023-02-20 23 1 Corrigendum: The influence of HIV infection and antiretroviral treatment on pulmonary function in individuals in an urban setting in sub-Saharan Africa <p>No Abstract</p> Oda E. van den Berg Erica J. Shaddock Sarah L. Stacey Charles Feldman Roos E. Barth Diederick E. Grobbee Willem D.F. Venter Kerstin Klipstein-Grobusch Alinda G. Vos Copyright (c) 0 2023-02-20 2023-02-20 23 1 Erratum: Southern African HIV Clinicians Society 2022 guideline for the management of sexually transmitted infections: Moving towards best practice <p>No Abstract</p> Remco P.H. Peter Nigel Garret Nomathemba Chandiwana Ranmini Kularatne Adrian J. Brink Karen Cohen Katherine Gill Thato Chidarikire Camilla Wattrus Jeremy S. Nel Mahomed Y.S. Moosa Linda-Gail Bekker Copyright (c) 0 2023-02-20 2023-02-20 23 1