Tag Archives: Immune Deficiency

HIV Testing Training

Celia---HIV-Basics

Celia Fisher delivering HIV Training at The Michael Wood Centre

At the moment around 100,000 people in Britain are living with HIV, and it is estimated that as many as one in four of them don’t know they are infected. It’s hoped that making HIV tests much more accessible will encourage many people to take control over their own health.

HIV Testing has been available for just under 30 years, presently it’s available from GU clinics and registered testing centres such as LASS and from April next year, home testing for HIV will become legal in the UK.

To slow down the spread of HIV and help people to access treatment, LASS invests in rapid testing services in community settings. There is particularly low uptake in some African communities, so LASS trains volunteers from these communities to carry out testing and provide information.

They provide testing at a range of events and venues including African football tournaments to reach people who otherwise wouldn’t be tested. We also provides services for people with HIV who maybe coping with other issues like poor mental health.  We also provide healthy living training.

Would you like to become a community HIV tester with LASS? We are running the training sessions for this at LASS on Thursday 26th & Friday 27th September – from 9.30 to 4.30 each day at The Michael Wood Centre.

This course is available to LASS volunteers only.

The course covers theory and practice about HIV transmission, Basic HIV knowledge, treatment and benefits of testing, Pre-test “discussion” and information, Sharing test results, Inclusive practices and consideration of different communities and cultures, Role play scenarios, Procedures to use testing kits and Working with different clients.   Following the training, you will need to complete a written test.

To enrol on the course, please contact us on 0116 2559995 or email Celia or Eric for more information.

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Education for awareness of and attitudes to HIV

Positive? (www.learningpositive.com) is a HIV information service website and the end work of the commitment and hard work of many UK Stakeholders, Partners and key players who in many different ways gave of their time, skills and expertise to help put together this innovative teaching and learning resource.

This highly accessible teaching and learning tool will challenge you, engage you, and empower you. By working through the different sections of the website, on your own, with friends or under the direction of your teacher, you will deepen your understanding of the facts about HIV whilst increasing your awareness of its social impact.

The interactive website is a tool to teach young people about HIV, how it affects people in the UK, how to prevent it spreading and how to reduce the discrimination experienced by those living with HIV. It also provides insights into the global dimension of the epidemic and introduces a series of interactive activities to raise awareness among the new generation and encourage positive, campaigning action to be taken.

As well as learning about HIV for yourself, you will also use your knowledge and understanding to develop an original campaign to advocate for people with HIV. As you work through the various activities, remember to think about which information would work well in raising awareness about key issues related to HIV.

The site helps to educate issues such as prejudice and stigma, discrimination, criminalisation and human rights and many more.  Check it out, it’s very useful for yourself and to pass to others.

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HIV treatment integrated into general health care delivers ‘equal or better’ results in MSF programmes

Outcomes for people taking antiretroviral treatment in Médecins sans Frontières’ (MSF) integrated general healthcare programmes were as good or better than those in vertical HIV programmes, researchers report in a nine-country study published the advance online edition of the Journal of Acquired Immune Deficiency Syndromes.

While those in integrated programmes may have started ART at a more advanced disease stage, the risk of death was similar to those in vertical programmes but loss to follow-up was less (aHR 1.02; 95% CI: 0.83-1.24 and aHR 0.71; 95% CI: 0.61-0.83, respectively) among patients followed for up to 30 months.

The authors say this analysis of retrospective observational cohort data from 17 programmes (seven vertical and 10 integrated) on ART delivery and care “validates the programme design of integration and its associated benefits.”

The success of scale-up of access to ART in resource-poor settings with outcomes matching those of resource-rich settings has been achieved primarily through large-scale vertical treatment programmes, notably in urban areas.

However, resource demands make vertical programmes neither feasible nor appropriate in rural settings or in areas of low HIV prevalence with other competing health issues.

The authors suggest programmes integrating HIV care into other health activities offer a possible feasible alternative model using HIV resources and staff to provide both HIV and non-HIV services.

Benefits include:

  • Improved access to HIV care in areas where vertical programmes are not feasible.
  • Retention in care made easier since services are both closer to the patient and spread across disciplines.
  • Strengthened health programmes as HIV often brings additional resources including clinical training, improved laboratory services and procurement supply systems.
  • HIV treated as any other illness may reduce stigma.
  • Same staff able to treat many different conditions in the same place.
  • Improved programme cohesiveness.

Yet, the advantages that integration brings may mean sacrificing the quality of care that dedicated services and specialised staff provide in vertical programmes. With this in mind the authors chose to compare outcomes of patients treated with ART in MSF’s integrated and vertical HIV programmes.

Vertical programmes were defined as specifically designed to treat HIV in a population. Integrated programmes were defined as providing comprehensive health care within which HIV was included as part of general healthcare services.

Although programmes differed in their degree of integration into general health services, all testing and treatment protocols, adherence counselling and patient follow-up, data collection and monitoring, laboratory protocols and drug supply and procurement were standardised across all MSF programmes; and out-of-programme training and advisory staff were the same. Drugs and materials were supplied through MSF but the programmes were integrated into Ministry of Health facilities.

The authors used Cox regression to determine the link between death and programme design, adjusting for potential confounders including gender, and at baseline: age, body mass index, clinical WHO stage, tuberculosis; programme age at the patient’s start of ART (providing ART for 12 months or more or less than 12 months) and setting (rural or urban).

Ninety per cent (15876) of the 17,561 adults who started ART in the 17 programmes were treated in the vertical programmes with the remaining 10% (1685) in the integrated programmes. Eighty-eight per cent (15,403) had at least six months of follow-up for inclusion in the 12-month treatment outcome analysis. 14,523 had complete data for inclusion in the Cox regression.

Median time on ART for all patients was 12.7 months (IQR: 4.5-24.0) and 6.8 months (IQR: 2.3-15.0) for vertical and integrated programmes, respectively.

Before adjusting for possible confounders, estimates showed a higher proportion of deaths in integrated programmes, 11.9% compared to 7.9%. The authors suggest this is explained because patients were more clinically immunosuppressed at baseline (a higher proportion at WHO clinical stage 4).

This is in keeping with other findings. Patients targeted in integrated programme often present for care when they are already sick. In contrast, the authors note, to vertical programmes that do large-scale community counselling and testing so attracting more asymptomatic patients.

After adjusting for other factors the Cox proportional hazards model showed the risks of death were similar in both programmes, with clinical WHO stage at the start of ART the most significant influence (aHR 1.99, 95% CI: 1.74-2.29). And, the risk of loss-to-follow-up was 29% less in integrated than in vertical programmes.

Reasons include, the authors suggest, integrated services allow for better treatment of co-existing illnesses, including tuberculosis; lower patient numbers mean more individualised care and follow-up; easier access with services closer to the patient; and normalisation of HIV reduces stigma.

The authors note these findings are comparable to other published studies. They cite the ART-LINC cohort of 18 programmes in low-income settings in Africa, Asia and Latin Americas. Combined death and loss to follow-up rates were 21%, 19% and 24% for ART-LINC, MSF vertical and integrated programmes, respectively.

The greater the programme experience, the more protective it was against death (aHR 0.77, 95% CI: 0.66-0.89).

However, risk of loss to follow-up was greater in more experienced programmes (aHR 3.33, 95% CI: 2.92-3.79). The authors suggest as programmes grow in size less time is spent on patient selection, preparation and counselling for ART adherence.

Not surprisingly, the risk was even greater among patients treated in rural settings (aHR 3.82, 95% CI: 3.49-4.20) because of travel distances and limited travel options, note the authors.

Limitations include: the Cox hazards model, because of the body mass index variable, did not follow the assumption of proportional hazards, so potentially reducing its power.

Vertical programmes were larger and predominantly in urban centres so may have had an unmeasured effect on outcomes.

The range of programmes from different countries over a number of years supports the generalizability of the findings yet data quality, in spite of a standardised database, may have varied.

Sensitivity analyses, however, did not change the main findings.

The authors conclude “In a time of intense debate regarding the merits of specific funding to HIV services, our data provide evidence in these settings [rural and relatively low prevalence) that resources dedicated to HIV through integrated programmes can benefit the individual patient, and as previously described can also strengthen the health system as a whole.”

Original Article by Carole Leach-Lemens at NAM

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Exercise Guidelines Published for People with HIV Over 50

A combination of aerobic and resistance exercises, three times a week for at least six weeks, is recommended to improve cardiovascular, metabolic and muscle function in people living with HIV older than 50 years of age, according to suggested guidelines published ahead of print by the Journal of the Association of Nurses in AIDS Care.

A great deal has been written about the potential benefits of regular exercise, particularly for older individuals living with, or at risk for, various age-related health complications. Because people living with HIV appear to face a higher risk of certain age-related problems—notably increased rates of cardiovascular disease (CVD) and various metabolic health issues at younger ages—and may also be taking numerous medications, there has been interest in utilizing drug-free lifestyle changes to improve disease-free survival.

Anella Yahiaoui, a research assistant at the University of Washington, and her colleagues set out to develop exercise recommendations for people living with HIV, based on the quantity and quality of exercise-based research that has been conducted and published.

Much of the available HIV-specific research—12 studies were included in the analysis—focused on younger individuals and primarily demonstrated positive effects of aerobic and resistance exercise on symptoms of wasting syndrome, notably muscle size and strength. Data were limited with respect to the effects of exercise on today’s most concerning age-related health complications among people living with HIV.

Yahiaoui’s team therefore included data from studies exploring the benefits of exercise in frail HIV-negative adults over the age of 65 and HIV-negative adults over the age of 55 with metabolic syndrome—a group of risk factors, similar to those seen in HIV-positive people with lipodystrophy, that occur together and increase the risk for CVD, stroke and type 2 diabetes.

Among the HIV-negative study volunteers with metabolic syndrome, exercise was independently associated with improvements in lipid levels and markers of insulin resistance, compared with matched patients who did not exercise. Among frail patients, some studies showed benefits associated with aerobic and resistance exercise, whereas others did not.

Based on the review of published data, Yahiaoui and her colleagues were able to devise a handful of key recommendations for people living with HIV over the age of 50.  Aerobic exercise, for example, should be performed at least three times a week for 20 to 40 minutes, aiming for a heart rate between 50 and 90 percent of the maximum heart rate.

Resistance exercises—which includes weight lifting and calisthenics, such as pushups, pull-ups and sit-ups—should involve each major muscle group and be performed after an aerobic exercise has been completed, again at least three times a week. One or two sets of six to eight repetitions of each exercise, with 20 to 30 seconds between each set, is  the recommended initial goal, eventually building up to three sets of ten repetitions of each exercise as endurance and strength improves.

Stretching, before and after exercising, is also recommended to prevent injuries.

There is, however, the possibility of too much of a good thing, the authors warn.  Athletes who exercise frequently and strenuously are at an increased risk of various infections, which can potentially lead to serious health problems in people living with HIV. In turn, Yahiaoui’s group cautions, exercise should not exceed 90 minutes of strenuous activity.

“Further research is warranted to study the benefits and risks of physical exercise in older HIV-infected patients,” the authors conclude.

Original Article via Aidsmeds.com

Also see “Aging & HIV Positive: A Growing Demographic

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