Open Access Original Research Article

Prevalence of Diabetes Mellitus, Hypertension and Lipodystrophy in HAART Receiving HIV Patients in Southern Ethiopia

Vedavalli Sachithananthan, Eskinder Loha, Mesfin Gose

International STD Research & Reviews, Page 1-11
DOI: 10.9734/ISRR/2013/1897

Aims: In Ethiopia, AIDS has become the leading cause of mortality in the 15-49 years age group, accounting for an estimated 43% of all young adult deaths. Though the introduction of highly active antiretroviral therapy (HAART), improved survival and quality of life, early data from those treated, raised concerns about a possible increase in both peripheral and coronary arterial disease through lipodystrophy, diabetes mellitus and dyslipidemia. Hence an attempt was made in this study to understand risk factors of HIV positive subjects and prevalence of lipodystrophy, type II diabetes mellitus and hypertension in subjects receiving HAART.

Study Design:  Institution based cross sectional and retrospective study was conducted.

Place and Duration of Study and Sample: Study participants were men and women who were HIV/AIDS patients receiving HAART from Sodo government hospital, Southern Ethiopia from December 1st, 2009 - January 30th, 2010. 

Methodology: By using the subjects’ electronic database as sampling frame, a total of 176 subjects were recruited for the study using simple random sampling method. Data was collected on socio demographic characteristics, HAART use, CD4 count, subjects’ status at the start of treatment, measure of body fat distribution, physical activity, blood pressure and blood glucose.

Results: Prevalence of Diabetes mellitus was seen in 8% of the subjects. Hypertension was seen in 15.9% of the subjects. In multivariate analysis adjusted for age and duration of HAART both lipoatrophy and lipohypertrophy were significantly associated with diabetes mellitus while only lipohypertrophy (adjusted for age) remained to be significantly associated with hypertension.

Conclusion: Since lipoatrophy (adjusted for age and duration of HAART) was significantly associated with diabetes mellitus and lipohypertrophy (adjusted for age and duration of HAART) was associated with diabetes mellitus and (adjusted for age) was associated with hypertension, there is a need to investigate types of HAART regimens which do not lead to lipodystrophy and associated diabetes mellitus or hypertension in AIDS/HIV subjects.

Open Access Original Research Article

Syndromic Management Approach and Wet Mount Microscopy of Trichomonas vaginalis in Pregnant Women and Sexually Transmitted Infection Clinic Attendants in Merawi Health Center, Merawi, Amhara Regional State, Ethiopia

Muluneh Ademe, Tadesse Kebede, Nigus Fikrie

International STD Research & Reviews, Page 30-38
DOI: 10.9734/ISRR/2013/3343

Background: Trichomonas vaginalis is a flagellated single cell protozoan parasite, which carries the distinction of being the only truly sexually transmitted parasitic infection in humans.

Aim: To determine the prevalence of Trichomonas vaginalis among pregnant women and sexually transmitted infection clinic attendants in Merawi Health center. Syndromic management approach was also evaluated for its effective diagnosis of trichomoniasis.

Methodology: In this study, a total of 222 women were enrolled. Majority of them were in the age group of 15-25 years (48.6%, 108). Identification of the Trichomonas vaginalis trophozoites was performed by wet mount microscopy of vaginal samples (vaginal discharge and vaginal swab) and clinical diagnosis by the syndromic management approach was performed by health workers in the health center.

Result: Syndromic management approach has identified 4 women (1.8%) who had self-reported symptoms related to trichomoniasis. However, the laboratory wet mount diagnosis has identified 14 (6.3%) women who were positive for the trophozoites of Trichomonas vaginalis. The sensitivity of syndromic management approach with respect to the wet mount microscopy was 21.4%.

Conclusion: Syndromic management approach is highly insensitive in screening out trichomoniasis, even, as compared with the less sensitive laboratory test (wet mount microscopy). Hence, we support the need for improved diagnostic parameters to reduce adverse trichomoniasis associated reproductive health outcomes.

Open Access Review Article

Barriers and Facilitators of Adherence in User-Dependent HIV Prevention Trials, a Systematic Review

Julie Ambia, Kawango Agot

International STD Research & Reviews, Page 12-29
DOI: 10.9734/ISRR/2013/3531

Background: Suboptimal adherence to investigational products has been associated with ineffectual outcomes in clinical trials. This review provides a summary of factors that influenced adherence in HIV prevention trials.

Method: Our search included user-dependent trials that focused on sexual transmission of HIV. MEDLINE, Cochrane CENTRAL, Web of Knowledge v5.6, and Clinicaltrials.gov databases were searched as of August, 2012 and HIV/AIDS conference abstracts, March 2013.

Results: Twenty four HIV prevention trials were included. Main barriers related to adherence included; pregnancies, mobility and relocation from study area, adherence declining overtime as a result of fatigue, stigma and negative rumors about the clinical trials, and gel volume to be inserted perceived as too much. Other reported barriers were side effects, alcohol use, running out of study product after missing clinic visits, pill/gel sharing, forgetting to take/use study product, unplanned sex (in studies with coital-dependent dosing), concealing trial participation from partner, difficulty in sustaining high adherence levels in study products with a short half-life of 1-3 hours, and simultaneous use of multiple products. Key facilitators of adherence included; male involvement in trial related activities or disclosure of study participation to male partner, product acceptability, older age (>25 years), and high risk perception of HIV. Other facilitators were; routinizing pill taking, perceived enhancement of male partner’s sexual pleasure, adequate supply of study product, good staff-participant relationship, less education, unannounced adherence support visits, and no overt side effects experienced as reported by participants.

Conclusion: Information on investigational prevention products should be packaged and delivered in ways that appeal to realities of participants’ lives while remaining scientifically factual. Trials should customize adherence messages to address difficulties with study product use and prioritize community engagement to respond to issues around stigma, rumors and potential partner concerns. Additionally, efforts towards increasing HIV risk perception are central to optimizing adherence.

Open Access Review Article

Adapting Cervical Dysplasia Screening, Treatment and Prevention Approaches to Low Resource Settings

Elizabeth K. Vonder Haar, Kei Kawana, Danny J. Schust

International STD Research & Reviews, Page 39-48
DOI: 10.9734/ISRR/2013/5781

Cervical cancer is a common disorder worldwide. Screening and treatment paradigms in highly developed countries have dramatically decreased disease prevalence and the implementation of preventive vaccination against high risk human papillomavirus (HPV) subtypes should decrease prevalence even further. Promising advances are also being made toward the development of a therapeutic vaccine for cervical neoplasia. Under-resourced countries suffer from an inability to implement many of the approaches to prevention and diagnosis that have proved successful in countries with adequate resources. Several protocols are presently being developed that are low cost and require minimal training and infrastructure that may allow low-resource areas to begin to improve the early diagnosis of low and moderate grade cervical neoplasia. These protocols should support efforts at early treatment to prevent progression to cancer. Simultaneous expansion of prophylactic and possibly therapeutic vaccine availability is essential in the worldwide fight against this prevalent but largely preventable disease.