Browsing by Subject "AIDS"

Six percent of the world’s population of youth living with HIV (YLWH) reside in Tanzania. Despite scale up of antiretroviral therapy (ART), poor ART adherence contributes to AIDS related morbidity and mortality in YLWH. Reasons for poor adherence include mental health challenges, HIV-related stigma, and lack of psychosocial support. Sauti Ya Vijana (SYV), a group-based, lay counselor delivered, 10-session mental health intervention for Tanzanian youth living with HIV was developed. The objective of this study was to describe the mental health outcomes of SYV in youth living with HIV.

This mixed-methods study enrolled 128 YLWH, aged 12-24, in Moshi, Tanzania to receive either the SYV intervention or treatment as usual. Youth in both arms completed structured questionnaires assessing their demographics, mental health and stigma symptoms, and self-reported ART adherence, at baseline, 6 months, 12 months, and 18 months study timepoints. A mixed effects linear regression model was used to analyze the change in stigma and mental health measures from baseline to the three follow-up timepoints. A subset of 10 youth who were randomized to the intervention arm completed semi-structured in-depth interviews at least one year after the intervention. Interviews were conducted in Kiswahili, and interview guide topics included participant description of history of depression symptoms, current challenges, recollection of specific SYV topics, and their experience during and after the SYV intervention. Interviews were transcribed and translated to English. Inductive thematic analysis using NVivo was used to analyze interview transcripts and identify common themes.

One hundred and five youth were randomized; 58 to the intervention arm and 47 to the treatment as usual arm. Average age of participants at baseline was 17.8 years and 49% of enrolled participants were male. Majority of the youth (86%) randomized to the intervention arm attended at least 8 out of 10 SYV sessions. The study was not powered to statistically detect treatment effect, but youth enrolled in both study groups showed improvement in their mental health and internal stigma measures at all follow-up timepoints in comparison to baseline. Ten youth, 18-25 years of age, were interviewed. Seven of the ten participants were male, and 60% were responders. All participants attended at least eight of the 10 intervention sessions and all baseline, 6 months, and 18-month follow-up appointments. Participants all reported experiencing intermittent symptoms of depression such as feelings of sadness. Current challenges included difficult interpersonal relationships and taking ART on time. The most memorable SYV lessons were coping skills such as breathing exercises. Participants described how SYV helped them have “more confidence”, accept themselves, and incorporate positive coping skills such as relaxation (deep breathing) when they felt stressed.

The findings provide evidence that providing a 10-session group based mental health intervention can have a long-term impact on the psychosocial outcomes of YLWH and can improve resilience in this population. Implementation of the SYV intervention into the routine HIV clinical care has promise to improve overall well-being of YLWH.

Introduction: Mortality among HIV-infected individuals in sub-Saharan Africa, the region most affected by the HIV epidemic, has declined remarkably since the rapid scale-up of antiretroviral therapy (ART). Despite encouraging trends, an unacceptably high number of people in this region continue to die from HIV disease, accounting for nearly 70% of all HIV deaths globally. Although a substantial number of these deaths could be averted by further expansion of ART coverage, high rates of morality for those initiated on treatment threaten the success of large-scale ART coverage. A knowledge of the predicators of death among individuals on ART could lead to targeted interventions, thus reducing excess mortality. In this study, we investigated a cohort of HIV-infected individuals on ART in the Coping with HIV/AIDS in Tanzania (CHAT) to describe which predictors are associated with the outcome of death.

Methods: The Coping with HIV/AIDS in Tanzania (CHAT) study was an observational cohort study conducted between 2008 and 2012. A cohort of HIV-infected individuals on ART are analyzed by Kaplan-Meier models to estimate mortality and Cox proportional hazards to identify predictors of mortality.

Results: There were 25 deaths in 1775 person-years of follow-up. This overall mortality rate provides an incidence density of 1.4 deaths per 100 person-years. In univariate analysis, the factors associated with the predictor of mortality were male gender, secondary or higher education, and pre-ART CD4 count below 100 cells per milliliter. No such associations were found for age, marital status, asset score, underweight status, SF-8 physical health functioning, depressive symptoms, and perceived stigma. In multivariable analysis, significant predictors of mortality were gender, secondary or higher education, and pre-ART CD4 below 100 cells per milliliter.

Conclusion: A lower rate of mortality was detected among this cohort of HIV-infected individuals on ART in Tanzania. Male gender and pre-ART CD4 cell count below 100 cells per milliliter significant predictors of mortality. Interventions that target earlier engagement in care and improved outcomes for high risk groups such as men will lead to further optimization of HIV care.

The most robust neurocognitive effect of marijuana use is memory impairment. Memory deficits are also high among persons living with HIV/AIDS, and marijuana use among this population is disproportionately common. Yet research examining neurocognitive outcomes resulting from co-occurring marijuana and HIV is virtually non-existent. The primary aim of this case-controlled study was to identify patterns of neurocognitive impairment among HIV patients who used marijuana compared to HIV patients who did not use drugs by comparing the groups on domain T-scores. Participants included 32 current marijuana users and 37 non-drug users. A comprehensive battery assessed substance use and neurocognitive functioning. Among the full sample, marijuana users performed significantly worse on verbal memory tasks compared to non-drug users and significantly better on attention/working memory tasks. A secondary aim of this study was to test whether the effect of marijuana use on memory was moderated by HIV disease progression, but these models were not significant. This study also examined whether the effect of marijuana use was differentially affected by marijuana use characteristics, finding that earlier age of initiation was associated with worse memory performance. These findings have important clinical implications, particularly given increased legalization of this drug to manage HIV infection.