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Monitoring the impact of decentralised chronic care services on patient travel time in rural Africa - methods and results in Northern Malawi

Monitoring the impact of decentralised chronic care services on patient travel time in rural Africa - methods and results in Northern Malawi

Results: The model showed how the opening of further ART clinics in Karonga District reduced median potential travel time from 83 to 43 minutes, and median actual travel time fell from 83 to 47 minutes. The proportion of patients not attending their nearest clinic increased from 6% when two clinics were open, to 12% with four open. Discussion: Integrating GPS information with patient data shows the impact of decentralisation on travel time and clinic choice to inform policy and research questions. In our case study, travel time decreased, accompanied by an increased uptake of services. However, the model also identified an increasing proportion of ART patients did not attend their nearest clinic.

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Varying intervals of antiretroviral medication dispensing to improve outcomes for HIV patients (The INTERVAL Study): study protocol for a randomized controlled trial

Varying intervals of antiretroviral medication dispensing to improve outcomes for HIV patients (The INTERVAL Study): study protocol for a randomized controlled trial

This study has several limitations. Apart from the entry viral load, the study will not perform follow-up viral load testing. Therefore, results for the secondary outcome of viral load will be limited to those tests per- formed within the context of routine care. In Zambia, viral load monitoring is performed annually, and in Malawi, monitoring occurs every 2 years. We anticipate that viral load results may be missing from a large num- ber of participants as these programs are both early in their viral load scale-up efforts. Because of these con- cerns, viral suppression is a secondary outcome. Our definition of a “ stable ” ART patient was developed in conjunction with HIV experts and takes into consider- ation published literature on this topic [2, 15 – 17]. Our results may not be generalizable in settings that use a different definition of stable. There may be a subset of unstable ART patients who struggle with retention be- cause of circumstances that prevent frequent follow-up

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Prevalence of intestinal parasites and associated risk factors among HIV/AIDS patients with pre-ART and on-ART attending dessie hospital ART clinic, Northeast Ethiopia

Prevalence of intestinal parasites and associated risk factors among HIV/AIDS patients with pre-ART and on-ART attending dessie hospital ART clinic, Northeast Ethiopia

The prevalence of intestinal parasite among pre-ART patients was (39%) in this study in line with that of Camer- oon study (40.5%), Gondar (43.5%) [12,14]. However; lower in studies Brazil (63.9%), in selected ART centers of Adama, Afar and Dire-Dawa (52%), Arbaminch Chencha and Gideo (45%), in different parts of Ethiopia (57.2%) ([15-17], unpublished data). This low prevalence in this study might be due to geographic difference in sample size (more than one study area for most reports), considering those patients with, time gap where those studies were done averagely four years ago but nowadays there is a bet- ter awareness of the patients about intestinal parasite infection and their cause. They may be diagnosed for parasites by direct wet mount and treated as well.

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Lipoatrophy of the footpad in HIV-treated patients is associated with increased PAI-1

Lipoatrophy of the footpad in HIV-treated patients is associated with increased PAI-1

from lower limbs) in women (Galli et al., 2003), indicating that the present study findings may well be of importance for both sexes. Secondly, as expected, the treatment naïve control group was younger and had had shorter known time with HIV infection as compared to the ART patients. On the other hand, it is our opinion that a comparison with a HIV-positive control group has an advantage in sorting out more specific ART related effects in contrast to using a matched HIV-negative control group. Thirdly, there were some problems motivating the naïve controls to participate in the study. However, there were no apparent demographic or clinical differences between the participating and non-participating control patients.

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Is the Sexual Behaviour of HIV Patients on Antiretroviral therapy safe or risky in Sub-Saharan Africa? Meta-Analysis and Meta-Regression

Is the Sexual Behaviour of HIV Patients on Antiretroviral therapy safe or risky in Sub-Saharan Africa? Meta-Analysis and Meta-Regression

In addition, one may argue that the dramatic improve- ment in their health after beginning ART may have given HIV patients the hope of living long. Their previ- ous sufferings had been an extremely bad experience; and professionals probably counseled them not to put themselves and their partners at risk of infection with new HIV strains, with HIV strains resistant to antiretro- viral drugs and with other sexually transmitted infec- tions. In support of this hypothesis, a qualitative study from Uganda reported that many ART patients were worried about risking their improving health through HIV super-infection and about the risk of resuming sex- ual practice [40]. The positive behavioral change among ART patients in Sub-Saharan Africa may also be the ef- fect of good adherence to clinic visits, which will provide the chance to refresh their knowledge on HIV and to re- ceive further warnings during every visit. A study con- ducted in six public HIV clinics has established the association of good ART adherence with decreased risky sexual behaviors [41].

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Utilization of antiretroviral treatment in Ethiopia between February and December 2006: spatial, temporal, and demographic patterns

Utilization of antiretroviral treatment in Ethiopia between February and December 2006: spatial, temporal, and demographic patterns

Although the number of new HIV infections worldwide still outpaced the expansion of antiretroviral treatment (ART) for HIV infection in 2006, major inroads have been made in recent years in developing countries. The Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) made generic antiretrovirals (ARVs) eligible for funding in 2002, drastically reducing the price of these drugs and promoted the development of simpler fixed- dose combination therapies [1]. The 3 × 5 Initiative of WHO gave early impetus to securing resources for treat- ment and led to a near-doubling of people put on treat- ment. The U.S. President's Emergency Plan for AIDS Relief (PEPFAR), in collaboration with the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) programs supported major scale-up of programs in many countries [1], and they are the two largest donors in the HIV/AIDS sector in Ethiopia [2]. Ethiopia, one of PEPFAR's 15 focus countries, received nearly $500 million between 2003 and 2006 from PEPFAR and the Global Fund [3,4]. In 2006, rapid expansion of ART services in health centers was pur- sued to increase access to treatment in rural areas [5]. Under the guidance of the Strategic Framework of the National Response to HIV/AIDS in Ethiopia for 2001– 2005, and the Road Map 2004–2006, the ART rollout plan is being implemented with support from govern- ment sectors, NGOs, the private sector, faith-based organ- izations and the communities [6]. They use the public health approach advocated by WHO, which emphasizes standardized, simplified treatment protocols and decen- tralized service delivery involving mid-level health profes- sionals [7]. Ethiopia has made significant progress in the recruitment and processing of eligible ART patients for referral by urban associations (kebeles) and community health workers, and in the provision of home-based health care by faith-based organizations and traditional burial societies (iddir) using nurses [8-10]. Also a M.Sc. program in Health Monitoring and Evaluation has recently been launched to reduce manpower shortage [11]. The ambitious ART plan of the Ethiopian govern- ment called for 100,000 of the estimated 286,258 people living with HIV/AIDS (PLWHA) in need of continuous, lifelong treatment to be put on ART by the end of 2006 [6].

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Peripheral Recognition

Peripheral Recognition

exhibition "Lifelike." 19 Experiencing "Lifelike" brought this childlike naivety, wonderment, and confusion of the real. The exhibition accurately reproduced reality, as any good simulacra does, but only in facade. Everything looked real, but most of the artworks were created out of unexpected materials. They were unexpected alchemic illusions—magically transforming materials into states that are not normally of their nature. One particular example was Hefty 2-Ply (Figure 11), by Jud Nelson. This piece appeared to be a stretched and saggy garbage sack that has about reached its limit. It feels as though it is about to collapse under its own weight. This particular garbage sack is in fact heavy, as it is composed of marble. A facade of everyday reality was constructed through unexpected and typically precious materials. The precious and valuable materials have taken on a form of refuse. This created a perceptual framework that did the reverse for me. Instead of looking at art objects as "the real" I started seeing "the real" as art objects. For example, when I left I thought I was looking at a barometer print (with the same

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Peer support and improved quality of life among persons living with HIV on antiretroviral treatment: A randomised controlled trial from north-eastern Vietnam

Peer support and improved quality of life among persons living with HIV on antiretroviral treatment: A randomised controlled trial from north-eastern Vietnam

The study sample was selected from four districts in Quang Ninh province, which consisted of 71 communes (28 urban and 43 rural). The total population of the 71 communes was 612,541 in 2009. Cluster-based sampling at the level of the commune was employed in order to minimize contamination between patients living near each other. In cluster sampling, the 71 communes were randomised to either intervention (36 communes) or control (35 communes), after an initial matching accord- ing to rural–urban, population and vicinity to hospital. In both intervention and control communes, all patients who came from the same commune were then treated similarly in a standardized way according to the study protocol. The study enrolled HIV positive patients who were ARV-naïve and eligible to initiate ART according to the Vietnamese national guidelines at the time of the study. Inclusion criteria were as following: clinical stage 4 of HIV disease (AIDS related illnesses) regardless of CD4+ count, clinical stage 3 (severe opportunistic infec- tions) with CD4+ <350/μl, clinical stage 1 and 2 (asymp- tomatic or mild infection) with CD4+ count of <200/μl [25] . Exclusion criteria were pregnancy, age under 18 or above 60, mental illness and institutionalization. While the larger DOTARV study began in 2007, the present sub-study focusing on QOL and internal stigma included all DOTARV participants recruited from October 2008 to November 2009. Two-hundred seventy-five partici- pants were consecutively selected from both the inter- vention and the control groups (i.e. all persons eligible for ART and meeting inclusion criteria from both inter- vention and control communes were enrolled in this sub-study). Among these, 24 died within six months of ART initiation, twelve patients did not come for the interview at twelve months and eleven dropped out of

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Risk factors and outcomes for the Q151M and T69 insertion HIV-1 resistance mutations in historic UK data

Risk factors and outcomes for the Q151M and T69 insertion HIV-1 resistance mutations in historic UK data

Matched case–control analyses were conducted in order to investigate factors associated with the occurrence of each of the mutations studied. These analyses only included patients for whom resistance test data could be matched to clinical records in the UK CHIC study. ART- experienced patients were defined as ‘cases’ at time of blood sampling for the first observation of the relevant mutation and were matched in a 1:10 ratio to ‘controls’, who were randomly sampled (without replacement) from a subset of patients with at least one resistance test avail- able for whom the relevant mutation had never been detected. Matching in each instance was conditional on the control patient having first initiated ART within 6 months (in calendar time) of the case patient doing so, and current and historic treatment variables for both case and control patients were defined with respect to the time of blood sampling for the resistance test in the case patient. Multivariable conditional logistic regression analyses were conducted accounting for the matched case–control groups. This form of analysis was cho- sen so that key factors associated with the development of the resistance mutations could be investigated whilst controlling for the evolution of ART drug combinations and treatment strategies over time. The complexity of ART histories for each patient and the limited numbers of cases available for analysis precluded more complex modelling of the probability of the development of each resistance mutation conditional on full details of ART history.

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Delay in the Provision of Antiretroviral Therapy to HIV infected TB Patients in Nigeria

Delay in the Provision of Antiretroviral Therapy to HIV infected TB Patients in Nigeria

A documented CD4 cell count was missing for 35% of patients. For the more than 40% of health workers interviewed who reported basing their decision to initiate ART on CD4 cell count results, this is problematic. However, this practice is counter to recommended guidelines to begin ART in HIV-positive TB patients irrespective of CD4 cell count, and is likely a major barrier to timely ART uptake. For those that did have a CD4 cell count reported, a CD4 cell count greater or equal to 50cells/µL significantly predicted timely ART, as well as TB treatment completion or cure. The former finding is similar to those from a collaborative analysis of data from South African cohorts, which found that the overall time to starting ART was strongly associated with patient CD4 cell counts [12]. It is important to note that we expected a shorter time to ART initiation for people with lower CD4 counts, and defined “timely ART” differently based on a CD4 cutoff of 50cell/µL; this, while perhaps influencing the likelihood of meeting the expected timeframe, is appropriate based on WHO and Nigerian guidelines. Unfortunately, only 40% of healthcare workers interviewed knew that patients with lower CD4 cell counts should start ART earlier. Clearly, additional training and supportive supervision of health care workers in ART clinics is required.

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Incidence of tuberculosis among HIV infected individuals on long term antiretroviral therapy in private healthcare sector in Pune, Western India

Incidence of tuberculosis among HIV infected individuals on long term antiretroviral therapy in private healthcare sector in Pune, Western India

All patients > 12 years of age who had registered into the ART program between 1st March 2009 and 1st March 2017, initiated ART and completed atleast 6 months of follow up were included. Individuals who were non- naïve to ART at enrollment due to transfer in from another service were excluded. Baseline demographic data like age, gender, weight, hepatitis B co-infection, prevalent TB, co-morbidities like diabetes mellitus (DM), CD4 count (FACS Count, Becton Dickinson, Franklin Lakes, NJ, USA), addictions and hemoglobin (Hb) were collected from the database. CD4 count and Plasma HIV-1 viral load (NucliSENS Easy Q real-time nucleic acid sequence-based amplification (NASBA), BioMérieux®, France, detection limit - 20 to 10,000,000 copies/ml) values, which were done 6 months after ART start and yearly thereafter were also collected. Details of ART regimens and duration of ART was recorded for all patients. WHO and Indian National AIDS control organization (NACO) guidelines [28, 29] were followed for starting first line ART and switch to second line or third line ART in our cohort.

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Elite Delights: The Structure of Art Gallery Networks in India

Elite Delights: The Structure of Art Gallery Networks in India

The valorization of innovation over the classical canon became a norm in Europe at the end of the nineteenth century, when “modernist” artists began to rely on art dealers and art critics in order to differentiate their practice from handicrafts and functional purposes, and to pursue “art for art’s sake” against religious, political, and economic patronages. The “dealer-critic system” (Moulin 1967) evolved after World War II in Western areas, mainly through the rise of art museums and their curators (Heinich and Pollak 1989; Jeanpierre and Sofio 2015), whose authority played a key role in the economic valorization of the new “abstract” styles launched by avant-garde artists and their galleries (Crane 1987; Verlaine 2013). Since the 1970s, the game has become more complex with a lot of new players, both geographically (through globalization, still segmented between “East” and “West” (Crane 2016)) and functionally, with mainly economic actors: international fairs (Yogev and Krund 2012; Roux 2006); “big” collectors and auction firms (Moureau and Sagot-Duvauroux 2012; Quemin 2013); web dealers and web hierarchized databases (Moulin 1992; Moulin 2000)—all of whom impose more and more market logics and values (Borja and Sofio 2009).

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Art and Art History Scholarship Art and Art History

Art and Art History Scholarship Art and Art History

Balas’s interpretations remain loyal to the work of great predecessors in the tradition of Renaissance art history: De Tolnay and Panofsky, as well as, more recently, Summers and Steinberg. Not only does she state that, “There can be no question of Michelangelo’s allegiance to Neoplatonism” (57), but the artist is said to have felt guilty about his Neoplatonism, as well as “the pagan iconography of his art,” and “probably, certain aspects of his private life” (63). The doubleness of the portraits is never discussed in terms of an artist’s tendency to “dipinge se,” as Leonardo deprecatingly put it. Moreover, once resemblance is no longer required of portraiture, the whole genre evaporates into airy nothingness. The face of the vanquished man is scarcely identifiable on visual grounds with any particular visage. The question of finish, incidentally, does not come up (Balas has said elsewhere she considers the Victory finished).

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Most of the patients were on long term ART, more than 5 years {81 (40.5%)}. Most of the patients were on ZLN regimen {97 (48.5%)}. Compliance over the preceding 3 months was 94.84± 14.93% for ART and 88.97±23.75% for opportunistic infection prophylaxis. There was no significant difference in compliance in relation to age group, sex, educational status, residence, religion, habits, HIV status of spouse or child, the regimen of ART and frequency of dosing. The compliance was better among those on long term treatment, i.e., those on treatment for more than 5 years compared to those who started ART in last 1 year (p=0.06). The most common reasons given by patients for non-compliance were going away from home, busy with other work and simply forgot. Better compliance was associated with higher CD4 count.

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Comparison of Antiretroviral Therapy (ART) Efficiency and Different HLA Class II Haplotypes

Comparison of Antiretroviral Therapy (ART) Efficiency and Different HLA Class II Haplotypes

HIV / AIDS patients treated with the АRТ basic scheme were made HLA class II haplotype sharing analysis. In total group of the research HIV/AIDS infected patients were included: those who have prescription for ART; who had not previously received to ART therapy; who have followed treatment the most; who were treated with АRТ basic scheme 24 to 48 weeks. In the research there were included 254 HIV-infected patients who were treated in the Infectology Centre of Latvia, 195 men and 59 - women (mean age 34.7 years). 63 of the 254 were infected with HIV using intravenous drugs. 132 heterosexual patients, 59- homosexual patients were infected through sexual contact with HIV-infected partners. ART treatment guidelines are based on international treatment guidelines. ART initiation criteria: acute retroviral syndrome; symptomatic HIV infection; 200 cells/µl<CD4; <350 cells/µl + HIV - RNA> 20 000 copies/ml [12]. Treatment includes АRТ basic scheme: NNRTI 2NRTI + - + 3TC/AZT EFV (Efavirenz+Lamivudine/Azidothymidine)-EFV/ABC/3TC(Efavirenz+ Abacavir/Lamivudine).

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Characterization of Genotypic Mutations and Antiretroviral Resistance among Viremic HIV Infected Patients in a High HIV Prevalence Area: Treatment Challenge and Transmission Risk

Characterization of Genotypic Mutations and Antiretroviral Resistance among Viremic HIV Infected Patients in a High HIV Prevalence Area: Treatment Challenge and Transmission Risk

There have been few reports evaluating the prevalence of genotypic mutations and antiretroviral resistance among chronic HIV-infected Veterans within the United States. This retrospective cross-sectional study characterizes the rates and changes in HIV genotypic mutations and antiretroviral resistance among viremic patients from 2001 to 2006 at the VA Medical Center located in Washington, DC. The District of Columbia is the metropolitan area with the highest HIV prevalence within the United States. De-identified, linked HIV RNA, genotypic reverse transcriptase (RT) and protease (Pr) mutations and antiretroviral resistance results were assessed for changes during the 6-year period. Aggregated clinic and antiretroviral utilization, and HIV acquisition risk data were evaluated for patients in care during this time. Among 990 viremic samples, the rate of any detected RT or Pr mutation fell from 100% in 2001 to 95% in 2006. This was primarily attributable to the 15% - 20% decrease seen for RT gene mutations against nucleoside/nucleotide class and non-nucleoside class during this period. Resistance to didanosine, stavudine, zidovudine, nevirapine and efavirenz decreased, and tenofovir resistance increased. Despite stable rates of Pr gene mutations, atazanavir resistance in- creased by 22% from 2003 to 2006. Some but not all changes in genotypic mutations and resistance patterns reflected our patients’ antiretroviral drug utilization. As sexual contacts (77%) and injection drug use (22%) were the leading acquisition risks disclosed by our HIV-infected patients, the high prevalence and changing patterns of HIV genotypic mutations and drug resistance among these patients have had pivotal impacts not only on HIV treatment but potential transmission into our community.

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One year survival of ART and conventional restorations in patients with disability

One year survival of ART and conventional restorations in patients with disability

Atraumatic Restorative Treatment (ART): Soft demi- neralised carious tissues were removed from dentinal le- sions in primary and permanent teeth using hand instruments only (ART Kit; Henry Schein, Chicago, USA) according to the ART protocol [14]. In proximal cavities, a steel matrix band (Palodent, Denstply Caulk, Milford, DE) and wooden wedges were used. 10% poly- acrylic acid (dentine conditioner, GC America, Chicago, USA) and wet and dry cotton wool pellets were used to condition and dry the cavity. Under cotton roll isolation, cavities were restored with one of the two encapsulated high-viscosity glass-ionomer cements: EQUIA system (GC, Tokyo, Japan) or Chemfil Rock (Dentsply/De Trey, Konstanz, Germany). The type of cement used was ran- domised between patients as follows: A flip of a coin de- termined which cement was used in the first patient. The other material was then applied in the second

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Are We Losing the Art of Actively Listening to Our Patients? Connecting the Art of Active Listening with Emotionally Competent Behaviors

Are We Losing the Art of Actively Listening to Our Patients? Connecting the Art of Active Listening with Emotionally Competent Behaviors

Empathy is recognizing feelings in others and tuning into their verbal and nonverbal cues. Emotional empathy allows the health care professional to respond professionally to colleagues or patients in an attempt to meet their needs. An integral part of responding professionally includes accurately synthesizing interpreted words into meaning interventions. According to many experts, emotional empathy is learned by experience and by model- ing. Professionals describe this as knowing implicitly what to do with distressed colleagues or patients. The ac- tions resulting from the emotional response or recognition of other’s needs are often nonverbal, for example, a touch, a smile, or genuinely listening.

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Switching to dual/monotherapy determines an increase in CD8+ in HIV-infected individuals: an observational cohort study

Switching to dual/monotherapy determines an increase in CD8+ in HIV-infected individuals: an observational cohort study

All analyses were restricted to patients in the cohort who did the following: started a combination ART (cART) regi- men including three antiretrovirals from being ART-naïve; had reached a confirmed HIV RNA ≤ 50 copies/mL; had switched to either another triple regimen or to double or monotherapy for any reason and at any time after achieving suppression, had maintained virological suppression after 12 months on this same regimen which had been switched to and had in the time window [−3; +3] around 12 months from the switch at least one CD4 and CD8 measurement available (only the first switch episode after achieving sup- pression was included). Those who switched to triple ther- apies were considered as the control group in order to have a more uniform population and to avoid, if possible, biases.

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Are routine tuberculosis programme data suitable to report on antiretroviral therapy use of HIV infected tuberculosis patients?

Are routine tuberculosis programme data suitable to report on antiretroviral therapy use of HIV infected tuberculosis patients?

However, there is much that can be improved in report- ing on ART-use in co-infected patients. A reduction of the incorrect recording of patients in the TB register as using ART of whom ART-use was not confirmed by the HIV patient record would improve data quality. In our study we found this incorrect recording on ART-use in 17% of co-infected patients. We did not evaluate the reasons for this. Anecdotal evidence informed us that patients at times state they already use ART, whereas in fact they do not. Reasons why patients do not state their ART-use correctly might be even more complex than the reasons why patients do not start ART. A recent qualita- tive study in Malawi found that not starting ART was related to both health system and patient reasons [8]. Rea- sons in the former category included ART not being offered and non-availability of ART drugs. Fear of drug toxicity was the main patient related reason. The study showed that to implement the recommendation to start all co-infected patients on ART irrespective of the CD4+ cell count requires substantial efforts from the health sys- tem [9]. A study in Cameroon explained a test rate of 95% partly because patients usually follow health care provi- ders’ recommendations [10]. This shows the importance of the health care provider offering ART.

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