PeerJ Preprints: HIVhttps://peerj.com/preprints/index.atom?journal=peerj&subject=5050HIV articles published in PeerJ PreprintsConformity and communal decision-making: First-tester effects on acceptance of home-based HIV counseling and testing in Ugandahttps://peerj.com/preprints/270062018-06-272018-06-27Mari Armstrong-HoughAmanda J MeyerAchilles KatambaJ. Lucian Davis
Background: Individuals’ observation of how group members ahead of them behave can profoundly shape their perceptions, judgements, and subsequent behaviors. Moreover, social influence theories from the sociology of networks suggest that individuals’ social status and social network position determine the scope of their influence on other group members. We set out to examine the role of conformity and communal decision-making in shaping individual decisions to test for HIV during home-based TB contact investigation in Kampala, Uganda.
Methods: We analyzed the HIV testing decisions of individuals who were offered free, optional, home-based HIV testing during a home visit by community health workers. We used generalized estimating equations (GEE) to estimate how the testing decision made by the first individual in a household offered testing influenced the subsequent testing decisions of other household members.
Results: Community health workers visited 55 households with two or more eligible household members and offered 160 individuals HIV testing. Seventy-five (47%) declined the test. Individuals in households where the first person invited declined HIV testing had four times the risk of declining themselves (RR: 3.96, 95% CI: 1.7-9.0, p=0.001) compared to individuals in households where the first person invited agreed to HIV testing, controlling for individual age and gender.
Conclusions: The decision of the first individual offered HIV testing seems to influence the decisions of subsequent household members when they are also offered testing. Even when results are confidential, individual decisions may be shaped by the testing behavior of the first household member offered the test.
Background: Individuals’ observation of how group members ahead of them behave can profoundly shape their perceptions, judgements, and subsequent behaviors. Moreover, social influence theories from the sociology of networks suggest that individuals’ social status and social network position determine the scope of their influence on other group members. We set out to examine the role of conformity and communal decision-making in shaping individual decisions to test for HIV during home-based TB contact investigation in Kampala, Uganda.Methods: We analyzed the HIV testing decisions of individuals who were offered free, optional, home-based HIV testing during a home visit by community health workers. We used generalized estimating equations (GEE) to estimate how the testing decision made by the first individual in a household offered testing influenced the subsequent testing decisions of other household members.Results: Community health workers visited 55 households with two or more eligible household members and offered 160 individuals HIV testing. Seventy-five (47%) declined the test. Individuals in households where the first person invited declined HIV testing had four times the risk of declining themselves (RR: 3.96, 95% CI: 1.7-9.0, p=0.001) compared to individuals in households where the first person invited agreed to HIV testing, controlling for individual age and gender.Conclusions: The decision of the first individual offered HIV testing seems to influence the decisions of subsequent household members when they are also offered testing. Even when results are confidential, individual decisions may be shaped by the testing behavior of the first household member offered the test.HIV infected patients attendance in a Brazilian public health service: A short reporthttps://peerj.com/preprints/267882018-03-292018-03-29Larissa Silva dos SantosKátia AzevedoLicinio SilvaSolange OliveiraLedy Oliveira
Background. Continuous health monitoring of human immunodeficiency virus (HIV) infected patients is critical to allow uninterrupted access to antiretroviral therapy (ART) and sustained viral suppression. Despite public health effort for patient retention in care, many HIV-infected patients fail to maintain effective engagement in Health Services. This study reports the attendance of HIV infected individuals for routine exams in a Brazilian outpatient clinic.
Methods. Patients were enrolled in two moments, 2010/2011 and 2014/2015, as they attended the public service for monitoring HIV infection status. The individuals that agreed to participate the study signed an informed consent and completed a structured questionnaire.
Results. Of 58 initially expected patients, only 31 participated in the second part of the study. The reasons for these individuals not returning to the health service during the study period were not related to death (1.7%) and the majority of them still remained enrolled in the service and in follow-up.
Discussion. The difficulty of HIV infected patients in returning to healthcare services have been reported by several authors. Among the barriers that prevent monitoring, we suggest that noncompliance may also be linked to years of study. However this subject needs more investigation.
Background. Continuous health monitoring of human immunodeficiency virus (HIV) infected patients is critical to allow uninterrupted access to antiretroviral therapy (ART) and sustained viral suppression. Despite public health effort for patient retention in care, many HIV-infected patients fail to maintain effective engagement in Health Services. This study reports the attendance of HIV infected individuals for routine exams in a Brazilian outpatient clinic.Methods. Patients were enrolled in two moments, 2010/2011 and 2014/2015, as they attended the public service for monitoring HIV infection status. The individuals that agreed to participate the study signed an informed consent and completed a structured questionnaire.Results. Of 58 initially expected patients, only 31 participated in the second part of the study. The reasons for these individuals not returning to the health service during the study period were not related to death (1.7%) and the majority of them still remained enrolled in the service and in follow-up.Discussion. The difficulty of HIV infected patients in returning to healthcare services have been reported by several authors. Among the barriers that prevent monitoring, we suggest that noncompliance may also be linked to years of study. However this subject needs more investigation.A qualitative view of the HIV epidemic in coastal Ecuadorhttps://peerj.com/preprints/21892016-06-302016-06-30Adam L BeckmanMagdelana M WilsonVishaal PrabhuNicola SoekoeHumberto MataLauretta E Grau
In 2013 approximately 37,000 people were living with HIV in Ecuador (prevalence 0.4%), representing a generalized epidemic where most new infections arise from sexual interactions in the general population. Studies that examine attitudes towards people living with HIV (PLWH), individual risk perception of acquiring HIV amongst Ecuadorians, and the ways in which levels of risk perception may affect risk behaviors are lacking. This qualitative study aimed to fill this gap in the literature by investigating these issues in the rural, coastal community of Manglaralto, Ecuador, which has among the highest incidence of HIV in Ecuador. We conducted interviews with 15 patients at Manglaralto Hospital. Analysis of interview transcripts revealed widespread negative attitudes towards PLWH, prevalent risk behaviors such as multiple sex partners and lack of condom use, and low individual risk-perception of contracting HIV. These findings underscore the need for increased efforts to prevent further growth of the HIV epidemic in Ecuador.
In 2013 approximately 37,000 people were living with HIV in Ecuador (prevalence 0.4%), representing a generalized epidemic where most new infections arise from sexual interactions in the general population. Studies that examine attitudes towards people living with HIV (PLWH), individual risk perception of acquiring HIV amongst Ecuadorians, and the ways in which levels of risk perception may affect risk behaviors are lacking. This qualitative study aimed to fill this gap in the literature by investigating these issues in the rural, coastal community of Manglaralto, Ecuador, which has among the highest incidence of HIV in Ecuador. We conducted interviews with 15 patients at Manglaralto Hospital. Analysis of interview transcripts revealed widespread negative attitudes towards PLWH, prevalent risk behaviors such as multiple sex partners and lack of condom use, and low individual risk-perception of contracting HIV. These findings underscore the need for increased efforts to prevent further growth of the HIV epidemic in Ecuador.Parents' phases and children's stages of HIV disclosurehttps://peerj.com/preprints/17272016-02-092016-02-09Grace GachanjaGary J BurkholderAimee Ferraro
Background: HIV-positive parents are challenged with disclosure to their children. Some do not disclose at all, others disclose to some children, and many take years to fully disclose to all their children. Methods: This qualitative phenomenological study was conducted in Kenya to describe the lived experiences of HIV-positive parents and their children during the disclosure process. Sixteen HIV-positive parents were engaged in in-depth, semi-structured interviews. Interview data were analyzed using the modified Van Kaam method. Results: Parents had a total of 37 living children; 15 HIV-positive, 11 HIV-negative, and 11 of unknown HIV status. Parents went through four phases (secrecy, exploratory, readiness, full disclosure) of disclosure; most admitted needing healthcare professionals’ help to move their children through the three child stages (no, partial, full) of disclosure . Most parents were in between the exploratory and full disclosure phases but had taken years to navigate these phases. Twelve children (HIV-negative and unknown status) had full disclosure of their parents’ illnesses, nine HIV-positive children had full disclosure of their own and their parents’ illnesses, and 10 children (five HIV-positive, four unknown status, and one HIV-negative) had partial disclosure of their own and/or their parents’ illnesses. Parents had indefinite plans to disclose to the six children with no disclosure. Conclusion: Despite being challenged with disclosure, parents progressively navigated the disclosure phases and fully disclosed to the majority of their children. However, the creation of HIV disclosure guidelines, services, and programs would help hasten the time it takes for them to fully disclose to all their children.
Background: HIV-positive parents are challenged with disclosure to their children. Some do not disclose at all, others disclose to some children, and many take years to fully disclose to all their children. Methods: This qualitative phenomenological study was conducted in Kenya to describe the lived experiences of HIV-positive parents and their children during the disclosure process. Sixteen HIV-positive parents were engaged in in-depth, semi-structured interviews. Interview data were analyzed using the modified Van Kaam method. Results: Parents had a total of 37 living children; 15 HIV-positive, 11 HIV-negative, and 11 of unknown HIV status. Parents went through four phases (secrecy, exploratory, readiness, full disclosure) of disclosure; most admitted needing healthcare professionals’ help to move their children through the three child stages (no, partial, full) of disclosure . Most parents were in between the exploratory and full disclosure phases but had taken years to navigate these phases. Twelve children (HIV-negative and unknown status) had full disclosure of their parents’ illnesses, nine HIV-positive children had full disclosure of their own and their parents’ illnesses, and 10 children (five HIV-positive, four unknown status, and one HIV-negative) had partial disclosure of their own and/or their parents’ illnesses. Parents had indefinite plans to disclose to the six children with no disclosure. Conclusion: Despite being challenged with disclosure, parents progressively navigated the disclosure phases and fully disclosed to the majority of their children. However, the creation of HIV disclosure guidelines, services, and programs would help hasten the time it takes for them to fully disclose to all their children.Healthcare professionals' perspectives on HIV disclosure of a parent's and a child's illness in Kenyahttps://peerj.com/preprints/17262016-02-092016-02-09Grace GachanjaGary J BurkholderAimee Ferraro
Background: Many HIV-affected families have both parent(s) and child(ren) infected. HIV disclosure to children continues to be a great global challenge for HIV-positive parents and healthcare professionals (HCPs); parents and HCPs differ on how and when to disclose to children. Methods: Six HCPs including a physician, clinical officer, psychologist, registered nurse, social worker, and a peer educator participated in a larger qualitative phenomenological study conducted to describe the lived experiences of HIV-positive parents and their children during the disclosure process in Kenya. Each HCP underwent an in-depth, semi-structured interview; transcribed data were analyzed using the modified Van Kaam method in NVivo8. Results: Despite HCPs providing parents with regular advice on the benefits of HIV disclosure, fear of stigma, discrimination, and disclosure consequences caused parents to delay disclosure of a parent’s and/or a child’s illness to their HIV-negative and positive children respectively for lengthy periods. While awaiting parental consent for full disclosure, HCPs were forced to provide age-appropriate disease-related information to children. HCPs preference however, was to fully disclose to children in their parents’ presence at the clinic, when children started asking questions and/or displayed maturity and understanding of the illness. Conclusion: Parents are known to prefer disclosing to their children at a time and place of their choosing. Conversely, it appears that HCPs may prefer to disclose to children when they judge the time as being right. For favorable disclosure outcomes, further studies are needed to reconcile the most suitable timing, setting, and person to disclose to HIV-positive and negative children.
Background: Many HIV-affected families have both parent(s) and child(ren) infected.HIV disclosure to children continues to be a great global challenge for HIV-positive parents and healthcare professionals (HCPs); parents and HCPs differ on how and when to disclose to children. Methods: Six HCPs including a physician, clinical officer, psychologist, registered nurse, social worker, and a peer educator participated in a larger qualitative phenomenological study conducted to describe the lived experiences of HIV-positive parents and their children during the disclosure process in Kenya. Each HCP underwent an in-depth, semi-structured interview; transcribed data were analyzed using the modified Van Kaam method in NVivo8. Results: Despite HCPs providing parents with regular advice on the benefits of HIV disclosure, fear of stigma, discrimination, and disclosure consequences caused parents to delay disclosure of a parent’s and/or a child’s illness to their HIV-negative and positive children respectively for lengthy periods. While awaiting parental consent for full disclosure, HCPs were forced to provide age-appropriate disease-related information to children. HCPs preference however, was to fully disclose to children in their parents’ presence at the clinic, when children started asking questions and/or displayed maturity and understanding of the illness. Conclusion: Parents are known to prefer disclosing to their children at a time and place of their choosing. Conversely, it appears that HCPs may prefer to disclose to children when they judge the time as being right. For favorable disclosure outcomes, further studies are needed to reconcile the most suitable timing, setting, and person to disclose to HIV-positive and negative children.What's happening with HIV in Papua New Guinea?https://peerj.com/preprints/15002015-11-122015-11-12Peter F Heywood
Introduction: In the 30 years since its identification in Papua New Guinea the response to HIV and its subsequent spread has waxed and waned and taken new directions as the social and biomedical environment changed. More than 30 years later the surveillance system continues to falter and there has still not been a national survey on which estimates can be based. Absent a functioning surveillance system, PNG ‘’estimates’’ the size of the epidemic from time to time based on mathematical models of the epidemic. This has resulted in widely varying estimates and confusion about the course of the epidemic. After appearance of the virus PNG struggled to design and implement an effective response. A new government at the end to the 1990s saw a strengthened response and formation of a National AIDS Council (NAC) located, eventually, in the Office of the Prime Minister. Around the same time PNG commenced a process of decentralizing government services to provinces and districts. DOH was expected to continue to provide services even though overall control now was with the NAC and responsibility for services was decentralized.Discussion: PNG is now reliant on mathematical models to estimate the course of the epidemic. Even though the most recent results indicate a fall in incidence since 2005, two recent reviews indicate that programs have not been effective at most levels and that the dual architecture of the government response has failed to adjust to the decentralization of government activities. Thus we now have the situation where models indicate lower prevalence than originally projected even though interventions are apparently ineffective and we have no reliable independent data to indicate why? There are two lessons from the PNG experience. First, the importance of establishing an effective HIV surveillance system. And second, realization that the NAC approach, originally seen as a panacea by donors and agencies, has not worked in PNG. The critical thing now is to return control of the HIV/AIDS program to the DOH on the condition that, except for surveillance and setting standards, it decentralizes the program to provinces and districts.
Introduction: In the 30 years since its identification in Papua New Guinea the response to HIV and its subsequent spread has waxed and waned and taken new directions as the social and biomedical environment changed. More than 30 years later the surveillance system continues to falter and there has still not been a national survey on which estimates can be based. Absent a functioning surveillance system, PNG ‘’estimates’’ the size of the epidemic from time to time based on mathematical models of the epidemic. This has resulted in widely varying estimates and confusion about the course of the epidemic. After appearance of the virus PNG struggled to design and implement an effective response. A new government at the end to the 1990s saw a strengthened response and formation of a National AIDS Council (NAC) located, eventually, in the Office of the Prime Minister. Around the same time PNG commenced a process of decentralizing government services to provinces and districts. DOH was expected to continue to provide services even though overall control now was with the NAC and responsibility for services was decentralized.Discussion: PNG is now reliant on mathematical models to estimate the course of the epidemic. Even though the most recent results indicate a fall in incidence since 2005, two recent reviews indicate that programs have not been effective at most levels and that the dual architecture of the government response has failed to adjust to the decentralization of government activities. Thus we now have the situation where models indicate lower prevalence than originally projected even though interventions are apparently ineffective and we have no reliable independent data to indicate why? There are two lessons from the PNG experience. First, the importance of establishing an effective HIV surveillance system. And second, realization that the NAC approach, originally seen as a panacea by donors and agencies, has not worked in PNG. The critical thing now is to return control of the HIV/AIDS program to the DOH on the condition that, except for surveillance and setting standards, it decentralizes the program to provinces and districts.The experiences of HIV-positive and HIV-negative children after receiving disclosure of their own and their parents’ illnesses, respectivelyhttps://peerj.com/preprints/13282015-08-262015-08-26Grace Gachanja
The aim of this research brief is to describe a study that sought to understand the post-disclosure experiences of HIV-positive and negative children after they received disclosure of their own and their parents’ illnesses, respectively. This is the first study from Sub-Saharan Africa (SSA) that describes the post-disclosure experiences of HIV-positive and negative children in one study. Prior studies in SSA have mostly centered on the post-disclosure experiences of HIV-positive children after receiving disclosure of their own illnesses, or HIV-positive mothers’ descriptions of the effect of maternal disclosure on their HIV-negative children.
The aim of this research brief is to describe a study that sought to understand the post-disclosure experiences of HIV-positive and negative children after they received disclosure of their own and their parents’ illnesses, respectively. This is the first study from Sub-Saharan Africa (SSA) that describes the post-disclosure experiences of HIV-positive and negative children in one study. Prior studies in SSA have mostly centered on the post-disclosure experiences of HIV-positive children after receiving disclosure of their own illnesses, or HIV-positive mothers’ descriptions of the effect of maternal disclosure on their HIV-negative children.Marital disharmony in a couple's marriage and its psychological effects on their children during the HIV disclosure process in Kenyahttps://peerj.com/preprints/13272015-08-262015-08-26Grace Gachanja
The aim of this research brief is to summarize a case report study that described an HIV-positive married couple’s poor disclosure experience of their illnesses to all their children in the household. It is important to communicate this couple’s HIV disclosure experience to healthcare professionals so that they are aware of the problems that can occur if married or cohabiting couples do not collaborate with each other during the disclosure process. The data presented in the case report study and in this research brief should be used to provide targeted counseling to HIV-positive parents or cohabiting couples considering disclosure to their children.
The aim of this research brief is to summarize a case report study that described an HIV-positive married couple’s poor disclosure experience of their illnesses to all their children in the household. It is important to communicate this couple’s HIV disclosure experience to healthcare professionals so that they are aware of the problems that can occur if married or cohabiting couples do not collaborate with each other during the disclosure process. The data presented in the case report study and in this research brief should be used to provide targeted counseling to HIV-positive parents or cohabiting couples considering disclosure to their children.From predicting to analyzing HIV-1 resistance to broadly neutralizing antibodieshttps://peerj.com/preprints/13042015-08-132015-08-13Anna FeldmannNico Pfeifer
Treatment with broadly neutralizing antibodies (bNAbs) has recently proven effective against HIV-1 infections in humanized mice, non-human primates, and humans. For optimal treatment, susceptibility of the patient's viral strains to a particular bNAb has to be ensured. Since no computational approaches are so far available, susceptibility can only be tested in expensive and time-consuming neutralization experiments. Here, we present well-performing computational models (AUC up to 0.84) that can predict HIV-1 resistance to bNAbs given the envelope sequence of the virus. Having learnt important binding sites of the bNAbs from the envelope sequence, the models are also biologically meaningful and useful for epitope recognition. Additional to the prediction result, we provide a motif logo that displays the contribution of the pivotal residues of the test sequence to the prediction. As our prediction models are based on non-linear kernels, we introduce a new visualization technique to improve the model interpretability. Moreover, we confirmed previous experimental findings that there is a trend towards antibody resistance for the subtype B population of the virus. While previous experiments considered rather small and selected cohorts, we were able to show a similar trend for the global HIV-1 population comprising all major subtypes by predicting the neutralization sensitivity for around 36,000 HIV-1 sequences - a scale-up which is very difficult to achieve in an experimental setting.
Treatment with broadly neutralizing antibodies (bNAbs) has recently proven effective against HIV-1 infections in humanized mice, non-human primates, and humans. For optimal treatment, susceptibility of the patient's viral strains to a particular bNAb has to be ensured. Since no computational approaches are so far available, susceptibility can only be tested in expensive and time-consuming neutralization experiments. Here, we present well-performing computational models (AUC up to 0.84) that can predict HIV-1 resistance to bNAbs given the envelope sequence of the virus. Having learnt important binding sites of the bNAbs from the envelope sequence, the models are also biologically meaningful and useful for epitope recognition. Additional to the prediction result, we provide a motif logo that displays the contribution of the pivotal residues of the test sequence to the prediction. As our prediction models are based on non-linear kernels, we introduce a new visualization technique to improve the model interpretability. Moreover, we confirmed previous experimental findings that there is a trend towards antibody resistance for the subtype B population of the virus. While previous experiments considered rather small and selected cohorts, we were able to show a similar trend for the global HIV-1 population comprising all major subtypes by predicting the neutralization sensitivity for around 36,000 HIV-1 sequences - a scale-up which is very difficult to achieve in an experimental setting.Parents' and children's emotions spanning the HIV disclosure process in Kenyahttps://peerj.com/preprints/9462015-04-012015-04-01Grace GachanjaGary J BurkholderAimee Ferraro
Background: HIV disclosure from parent to child is challenging. While disclosure is expected to be emotional for parents and children, the total disclosure experience has not been described. The purpose of this study was to understand the lived experiences of HIV-positive parents and their children in Kenya during the disclosure process. Methods: Phenomenological qualitative data were collected using in-depth semistructured interviews. Thirty four participants consisting of HIV-positive parents, children (infected and uninfected), and healthcare professionals (HCPs) were enrolled. Data analysis was performed using NVivo 8 and the Van Kaam method. Results: Pre-disclosure, parents were plagued with fear/worry of stigma, judgment, rejection, blame; and the reaction/consequences of disclosure on their children. Guilt and shame for bringing the illness into the home abounded. Children sensed, wondered, and worried about secrets within their homes. During disclosure, parents experienced catharsis, guilt, confusion, and panic when children reacted negatively. Children experienced shock, disbelief, anger, sadness, worry, depression, confusion, and catharsis from finally knowing what was wrong. Post-disclosure parents alternated between relief, guilt, and depression as their children’s behavior changed due to disclosure. Children experienced unhappiness, depression, hopelessness, self-hate, and withdrawal. Recovery time varied lasting from a few hours to four months later; some children ultimately felt relief and self-acceptance. However, stress exposure caused disclosure emotions to reappear. Conclusion: HIV disclosure process is accompanied by alternating negative and positive feelings for both parents and children. To ease the process, HCPs should provide support services such as disclosure practice sessions/training, counseling, peer support groups, and stress management.
Background: HIV disclosure from parent to child is challenging. While disclosure is expected to be emotional for parents and children, the total disclosure experience has not been described. The purpose of this study was to understand the lived experiences of HIV-positive parents and their children in Kenya during the disclosure process. Methods: Phenomenological qualitative data were collected using in-depth semistructured interviews. Thirty four participants consisting of HIV-positive parents, children (infected and uninfected), and healthcare professionals (HCPs) were enrolled. Data analysis was performed using NVivo 8 and the Van Kaam method. Results: Pre-disclosure, parents were plagued with fear/worry of stigma, judgment, rejection, blame; and the reaction/consequences of disclosure on their children. Guilt and shame for bringing the illness into the home abounded. Children sensed, wondered, and worried about secrets within their homes. During disclosure, parents experienced catharsis, guilt, confusion, and panic when children reacted negatively. Children experienced shock, disbelief, anger, sadness, worry, depression, confusion, and catharsis from finally knowing what was wrong. Post-disclosure parents alternated between relief, guilt, and depression as their children’s behavior changed due to disclosure. Children experienced unhappiness, depression, hopelessness, self-hate, and withdrawal. Recovery time varied lasting from a few hours to four months later; some children ultimately felt relief and self-acceptance. However, stress exposure caused disclosure emotions to reappear. Conclusion: HIV disclosure process is accompanied by alternating negative and positive feelings for both parents and children. To ease the process, HCPs should provide support services such as disclosure practice sessions/training, counseling, peer support groups, and stress management.