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HIV Seropositivity: HELP
Articles from Africa
Based on 943 articles published since 2008
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These are the 943 published articles about HIV Seropositivity that originated from Africa during 2008-2019.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6 · 7 · 8 · 9 · 10 · 11 · 12 · 13 · 14 · 15 · 16 · 17 · 18 · 19 · 20
1 Editorial Morbidity and mortality of black HIV-positive patients with end-stage kidney disease receiving chronic haemodialysis in South Africa. 2015

Wearne, Nicola. ·Division of Nephrology, Department of Medicine, Groote Schuur Hospital, Cape Town, South Africa. nicola.wearne@uct.ac.za. ·S Afr Med J · Pubmed #26242526.

ABSTRACT: -- No abstract --

2 Editorial Overcoming Impediments to Global Implementation of Early Antiretroviral Therapy. 2015

Abdool Karim, Salim S. ·From the Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa; and the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York. ·N Engl J Med · Pubmed #26193047.

ABSTRACT: -- No abstract --

3 Editorial When one can infect two: a reflection on the impact of HIV discordance on child HIV infection. 2010

Binagwaho, Agnes / Ratnayake, Niloo / Mukherjee, Joia / Mugabo, Jules / Karita, Etienne / Pegurri, Elisabetta. ·Rwanda Ministry of Health, Kigali, Rwanda. ·Pan Afr Med J · Pubmed #21120009.

ABSTRACT: This is an opinion piece based on data and experience from Rwanda. The authors believe this opinion piece may help improve current programs on prevention of HIV transmission from mother to child in Africa taking into account the prevalence of HIV sero-discordance in couples. The authors recommend that if we want to ensure newborns stay HIV negative, PMTCT protocols should offer a series of HIV tests linked with antenatal visits and the lactation period as well as HIV testing of current sexual partners. Moreover, if the male partner is found to be positive and the woman is negative, programs should provide intensive counseling on the use of condoms. The lives of three individuals have the potential to be changed from HIV testing and counseling. Morally, this cannot be ignored.

4 Review The global tuberculosis epidemic and progress in care, prevention, and research: an overview in year 3 of the End TB era. 2018

Floyd, Katherine / Glaziou, Philippe / Zumla, Alimuddin / Raviglione, Mario. ·Global TB Programme, WHO, Geneva, Switzerland. · Centre for Clinical Microbiology, Division of Infection and Immunity, University College London, and National Institute for Health Research Biomedical Research Centre, UCL Hospitals NHS Foundation Trust, London, UK; UNZA-UCLMS Research and Training Programme, Lusaka, Zambia. Electronic address: a.zumla@ucl.ac.uk. ·Lancet Respir Med · Pubmed #29595511.

ABSTRACT: Tuberculosis is the number one cause of death from infectious disease globally and drug-resistant forms of the disease are a major risk to global health security. On the occasion of World Tuberculosis Day (March 24, 2018), we provide an up-to-date review of the status of the tuberculosis epidemic, recommended diagnostics, drug treatments and vaccines, progress in delivery of care and prevention, progress in research and development, and actions needed to accelerate progress. This Review is presented in the context of the UN Sustainable Development Goals and WHO's End TB Strategy, which share the aim of ending the global tuberculosis epidemic. In 2016, globally there were an estimated 10·4 million new cases of tuberculosis, and 600 000 new cases with resistance to rifampicin (the most powerful first-line drug). All countries and age groups are affected by tuberculosis, but most cases (90%) in 2016 were in adults, and almost two-thirds were accounted for by seven countries: India, Indonesia, China, Philippines, Pakistan, South Africa, and Nigeria. The sex ratio (male to female) was 1·9 and 10% of patients with newly diagnosed tuberculosis were also HIV-positive. There were 1·7 million deaths from tuberculosis in 2016, including 0·4 million deaths among people co-infected with HIV (officially classified as deaths caused by HIV/AIDS). Progress in care and prevention means that the global mortality rate (deaths per 100 000 people per year) is decreasing by 3·4% per year and incidence (new cases per 100 000 people per year) is decreasing by 1·9% per year. From 2000 to 2016, the annual global number of tuberculosis deaths decreased by 24% and the mortality rate declined by 37%. Worldwide, an estimated 53 million deaths were averted through successful treatment. Nonetheless, major gaps in care and prevention remain. For example, the 6·3 million new cases of tuberculosis reported globally in 2016 represented only 61% of the estimated incidence; only one in five of the estimated number of people with drug-resistant tuberculosis was enrolled in treatment. Pipelines for new diagnostics, drugs, and vaccines are progressing, but slowly. Actions needed to accelerate progress towards global milestones and targets for reductions in the burden of tuberculosis disease set for 2020, 2025, 2030, and 2035 include closing coverage gaps in testing, reporting of cases, and overall access to health care, especially in countries that account for the largest share of the global gap; multisectoral efforts to reduce prevalence of major risk factors for infection and disease; and increased investment in research and development.

5 Review Factors impacting antiretroviral therapy adherence among human immunodeficiency virus-positive adolescents in Sub-Saharan Africa: a systematic review. 2018

Ammon, N / Mason, S / Corkery, J M. ·Picturing Health, PO Box 122, Zomba, Malawi. Electronic address: nadineammon77@gmx.de. · Department of Pharmacy, Pharmacology and Postgraduate Medicine, University of Hertfordshire, College Lane Campus, Hatfield, Hertfordshire, AL10 9AB, UK. Electronic address: s.mason3@herts.ac.uk. · Department of Pharmacy, Pharmacology and Postgraduate Medicine, University of Hertfordshire, College Lane Campus, Hatfield, Hertfordshire, AL10 9AB, UK. Electronic address: j.corkery@herts.ac.uk. ·Public Health · Pubmed #29501984.

ABSTRACT: OBJECTIVES: Eighty-two percent of human immunodeficiency virus (HIV)-positive adolescents live in Sub-Saharan Africa (SSA). Despite the availability of antiretroviral therapy (ART), adherence levels are suboptimal, leading to poor outcomes. This systematic review investigated factors impacting ART adherence among adolescents in SSA, including religious beliefs and intimate relationships. METHODS: A systematic review was conducted between June and August 2016 using eight electronic databases, including Cochrane and PubMed. Published, ongoing and unpublished research, conducted in SSA from 2004 to 2016, was identified and thematic analysis was used to summarise findings. RESULTS: Eleven studies from eight SSA countries, published in English between 2011 and 2016, reported on factors impacting ART adherence among adolescents living with HIV (ALHIV). Forty-four barriers and 29 facilitators to adherence were identified, representing a complex web of factors. The main barriers were stigma, ART side-effects, lack of assistance and forgetfulness. Facilitators included caregiver support, peer support groups and knowledge of HIV status. CONCLUSIONS: Stigma reflects difficult relations between ALHIV and their HIV-negative peers and adults. Most interventions target only those with HIV, suggesting a policy shift towards the wider community could be beneficial. Recommendations include engaging religious leaders and schools to change negative societal attitudes. Limitations of the review include the urban settings and recruitment of predominantly vertically infected participants in most included studies. Therefore, the findings cannot be extrapolated to ALHIV residing in rural locations or horizontally infected ALHIV, highlighting the need for further research in those areas.

6 Review Treatment of cervical cancer in HIV-seropositive women from developing countries: a protocol for a systematic review. 2018

Mapanga, Witness / Chipato, Tsungai / Feresu, Shingairai A. ·School of Health Systems and Public Health, Epidemiology & Biostatistics, University of Pretoria, 5-10 H.W. Snyman Building, Pretoria, South Africa. witnessmapanga@yahoo.co.uk. · , 47 Newstead Road, Harare, Marlborough, Zimbabwe. witnessmapanga@yahoo.co.uk. · College of Health Sciences, University of Zimbabwe-University of California, San Francisco Collaborative Research Programme, University of Zimbabwe, Avondale, Harare, Zimbabwe. · School of Health Systems and Public Health, Epidemiology & Biostatistics, University of Pretoria, 5-10 H.W. Snyman Building, Pretoria, South Africa. ·Syst Rev · Pubmed #29370853.

ABSTRACT: BACKGROUND: Cervical cancer has become the most common cancer affecting women in Africa. Significantly, 85% of these annual deaths occur in the developing world, with the majority being middle-aged women. Research has shown that in sub-Saharan Africa, cervical cancer trends are on the rise in the past two decades because of HIV and this has resulted in an increase in cervical cancer cases among young women. However, little or no information exists that has shown that any of the available treatment methods are more effective than others when it comes to treating cervical cancer in HIV-seropositive women. The aim of this protocol is to offer a plan on how to systematically review cervical cancer treatment methods available for HIV-seropositive women in developing countries. METHODS/DESIGN: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) statement was used to develop the protocol for the systematic review which will be reported in accordance with the PRISMA guidelines. A number of databases, Embase, MEDLINE, PubMed, CINAHL and Cochrane Library, will be searched for relevant studies, and citation and reference list tracking will be used to search for additional studies. Prospective and retrospective cohort studies, case-control, randomised controlled trials and cross-sectional studies that were carried out in and for the developing world will be eligible for inclusion. Peer-reviewed studies and grey literature examining cervical cancer treatment modalities in HIV-seropositive women will be included. Descriptive statistics and tables will be used to summarise results, and meta-analysis will be used where appropriate. DISCUSSION: The review findings will provide the current picture of the existing treatment methods being used to treat cervical cancer in HIV-seropositive women in developing countries. The findings might be used for the establishment of evidence-based guidelines for treatment of cervical cancer in seropositive women as well as prompt policy-makers and governments to decide and support future research in a way to find a lasting solution. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42017054676 https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=54676.

7 Review Human Immunodeficiency Virus Infection and Hip and Knee Arthroplasty. 2017

Dimitriou, Dimitrios / Ramokgopa, Mmampapatla / Pietrzak, Jurek R T / van der Jagt, Dick / Mokete, Lipalo. ·1Department of Orthopaedic Surgery, University of the Witwatersrand, Johannesburg, South Africa. ·JBJS Rev · Pubmed #28953137.

ABSTRACT: BACKGROUND: Modern management of human immunodeficiency virus (HIV) infection has afforded patients longevity while increasing the burden of arthroplasty procedures because of the increased risk of osteonecrosis, fragility fractures, and degenerative joint disease. Early publications on hip and knee arthroplasty in HIV-positive patients reported a high risk of complications, although some more recent publications demonstrated acceptable outcomes. Despite the widespread nature of the HIV pandemic, there is a paucity of literature addressing outcomes following joint arthroplasty in infected patients. We pooled available studies to obtain the best evidence regarding the safety of total hip and knee arthroplasty procedures in HIV-positive patients. The studies identified were heterogeneous, precluding a meta-analysis. However, we performed a review of the literature focusing on complications and outcomes. METHODS: Twenty-one published English-language articles involving 6,516,186 joints were identified by a systematic review as suitable for inclusion in the study. The articles were analyzed for complication and prosthesis survivorship rates and relative risks. RESULTS: An overall complication rate of 3.3% was found across the 19 articles that provided such data. HIV-positive patients had a significantly elevated risk of periprosthetic joint infection, at 7.6%, compared with HIV-negative patients, at 3.3% (relative risk = 2.28, 95% confidence interval = 2.14 to 2.43). Eleven articles were suitable for analysis of prosthesis survivorship, and survivorship rates did not differ significantly between HIV-positive and negative patients. CONCLUSIONS: Total hip and total knee arthroplasty appear to be safe procedures with acceptable outcomes in HIV-positive patients. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

8 Review Prevalence of HIV-Seropositivity and Associated Impact on Mortality among Injured Patients from Low-and Middle-Income Countries: A Systematic Review and Meta-Analysis. 2017

Aluisio, Adam R / Rege, Soham / Stewart, Barclay T / Kinuthia, John / Levine, Adam C / Mello, Michael J / Farquhar, Carey. ·Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, USA. · Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, United States. · Department of Surgery, University of Washington, Seattle, USA. · Department of Interdisciplinary Health Sciences, Stellenbosch University, Cape Town, South Africa. · Department of Research & Programs, Kenyatta National Hospital, Nairobi, Kenya. · Department of Global Health, University of Washington, Seattle, USA. · Department of Epidemiology, University of Washington, Seattle, USA. · Department of hMedicine, University of Washington, Seattle, USA. ·Curr HIV Res · Pubmed #28933280.

ABSTRACT: BACKGROUND: Although HIV and injury contribute substantially to disease burdens in lowand middle-income countries (LMIC), their intersection is poorly characterized. OBJECTIVE: This systematic review assessed the prevalence and associated mortality impact of HIVseropositivity among injured patients in LMIC. METHODS: A systematic search of PubMed, EMBASE, Global Health, CINAHL, POPLINE and Cochrane databases through August 2016 was performed. Prospective and cross-sectional reports of injured patients from LMIC that evaluated HIV-serostatus were included. Two reviewers identified eligible records (kappa=0.83); quality was assessed using GRADE criteria. HIV-seroprevalence and mortality risks were summarized and pooled estimates were calculated using random-effects models with heterogeneity assessed. RESULTS: Of 472 retrieved records, sixteen met inclusion. All reports were of low or very low quality and derived from sub-Saharan Africa. HIV-serostatus was available for 3,994 patients. Individual report and pooled HIV-seroprevalence estimates were uniformly greater than temporally matched national statistics (range: 4.5-35.0%). Pooled reports from South Africa were three-fold greater than matched national prevalence (32.0%, 95% CI, 28.0-37.0%). Mortality data were available for 1,398 patients. Heterogeneity precluded pooled mortality analysis. Among individual reports, 66.7% demonstrated significantly increased relative risks (RR) of death; none found reduced risk of death among HIV-seropositive patients. Increased mortality risk among HIV-seropositive patients ranged from 1.86 (95% CI, 1.11-3.09) in Malawi to 10.7 (95% CI, 1.32-86.1) in South Africa. CONCLUSION: The available data indicate that HIV-seropositivity among the injured is high relative to national rates and may increase mortality, suggesting that integrated HIV-injury programming could be beneficial. Given the data limitations, further study of the HIV-injury intersection is crucially needed.

9 Review Interventions for treating tuberculous pericarditis. 2017

Wiysonge, Charles S / Ntsekhe, Mpiko / Thabane, Lehana / Volmink, Jimmy / Majombozi, Dumisani / Gumedze, Freedom / Pandie, Shaheen / Mayosi, Bongani M. ·Cochrane South Africa, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, Cape Town, Western Cape, South Africa, 7505. ·Cochrane Database Syst Rev · Pubmed #28902412.

ABSTRACT: BACKGROUND: Tuberculous pericarditis can impair the heart's function and cause death; long term, it can cause the membrane to fibrose and constrict causing heart failure. In addition to antituberculous chemotherapy, treatments include corticosteroids, drainage, and surgery. OBJECTIVES: To assess the effects of treatments for tuberculous pericarditis. SEARCH METHODS: We searched the Cochrane Infectious Diseases Group Specialized Register (27 March 2017); the Cochrane Central Register of Controlled Trials (CENTRAL), published in the Cochrane Library (2017, Issue 2); MEDLINE (1966 to 27 March 2017); Embase (1974 to 27 March 2017); and LILACS (1982 to 27 March 2017). In addition we searched the metaRegister of Controlled Trials (mRCT) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) search portal using 'tuberculosis' and 'pericard*' as search terms on 27 March 2017. We searched ClinicalTrials.gov and contacted researchers in the field of tuberculous pericarditis. This is a new version of the original 2002 review. SELECTION CRITERIA: We included randomized controlled trials (RCTs) and quasi-RCTs. DATA COLLECTION AND ANALYSIS: Two review authors independently screened search outputs, evaluated study eligibility, assessed risk of bias, and extracted data; and we resolved any discrepancies by discussion and consensus. One trial assessed the effects of both corticosteroid and Mycobacterium indicus pranii treatment in a two-by-two factorial design; we excluded data from the group that received both interventions. We conducted fixed-effect meta-analysis and assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS: Seven trials met the inclusion criteria; all were from sub-Saharan Africa and included 1959 participants, with 1051/1959 (54%) HIV-positive. All trials evaluated corticosteroids and one each evaluated colchicine, M. indicus pranii immunotherapy, and open surgical drainage. Four trials (1841 participants) were at low risk of bias, and three trials (118 participants) were at high risk of bias.In people who are not infected with HIV, corticosteroids may reduce deaths from all causes (risk ratio (RR) 0.80, 95% confidence interval (CI) 0.59 to 1.09; 660 participants, 4 trials, low certainty evidence) and the need for repeat pericardiocentesis (RR 0.85, 95% CI 0.70 to 1.04; 492 participants, 2 trials, low certainty evidence). Corticosteroids probably reduce deaths from pericarditis (RR 0.39, 95% CI 0.19 to 0.80; 660 participants, 4 trials, moderate certainty evidence). However, we do not know whether or not corticosteroids have an effect on constriction or cancer among HIV-negative people (very low certainty evidence).In people living with HIV, only 19.9% (203/1959) were on antiretroviral drugs. Corticosteroids may reduce constriction (RR 0.55, 0.26 to 1.16; 575 participants, 3 trials, low certainty evidence). It is uncertain whether corticosteroids have an effect on all-cause death or cancer (very low certainty evidence); and may have little or no effect on repeat pericardiocentesis (RR 1.02, 0.89 to 1.18; 517 participants, 2 trials, low certainty evidence).For colchicine among people living with HIV, we found one small trial (33 participants) which had insufficient data to make any conclusions about any effects on death or constrictive pericarditis.Irrespective of HIV status, due to very low certainty evidence from one trial, it is uncertain whether adding M. indicus pranii immunotherapy to antituberculous drugs has an effect on any outcome.Open surgical drainage for effusion may reduce repeat pericardiocentesis In HIV-negative people (RR 0.23, 95% CI 0.07 to 0.76; 122 participants, 1 trial, low certainty evidence) but may make little or no difference to other outcomes. We did not find an eligible trial that assessed the effects of open surgical drainage in people living with HIV.The review authors found no eligible trials that examined the length of antituberculous treatment needed nor the effects of other adjunctive treatments for tuberculous pericarditis. AUTHORS' CONCLUSIONS: For HIV-negative patients, corticosteroids may reduce death. For HIV-positive patients not on antiretroviral drugs, corticosteroids may reduce constriction. For HIV-positive patients with good antiretroviral drug viral suppression, clinicians may consider the results from HIV-negative patients more relevant.Further research may help evaluate percutaneous drainage of the pericardium under local anaesthesia, the timing of pericardiectomy in tuberculous constrictive pericarditis, and new antibiotic regimens.

10 Review Interleukin-2 as an adjunct to antiretroviral therapy for HIV-positive adults. 2017

Onwumeh, Jennifer / Okwundu, Charles I / Kredo, Tamara. ·Community Health Division, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa, 7505. · Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town, South Africa, 7505. · Cochrane South Africa, South African Medical Research Council, PO Box 19070, Cape Town, South Africa. ·Cochrane Database Syst Rev · Pubmed #28542796.

ABSTRACT: BACKGROUND: Human immunodeficiency virus (HIV) continues to be a leading cause of morbidity and mortality, particularly in sub-Saharan Africa. Although antiretroviral drugs have helped to improve the quality of life and life expectancy of HIV-positive individuals, there is still a need to explore other interventions that will help to further reduce the disease burden. One potential strategy is the use of interleukin-2 (IL-2) in combination with antiretroviral therapy (ART). IL-2 is a cytokine that regulates the proliferation and differentiation of lymphocytes and may help to boost the immune system. OBJECTIVES: To assess the effects of interleukin-2 (IL-2) as an adjunct to antiretroviral therapy for HIV-positive adults. SEARCH METHODS: We searched the following sources up to 26 May 2016: the Cochrane Central Register of Controlled Trials (CENTRAL), published in the Cochrane Library; MEDLINE; Embase; the Web of Science; LILACS; the World Health Organization (WHO) International Clinical Trial Registry Platform (ICTRP); and ClinicalTrials.gov. We also checked conference abstracts, contacted experts and relevant organizations in the field, and checked the reference list of all studies identified by the above methods for any other potentially eligible studies. SELECTION CRITERIA: Randomized controlled trials (RCTs) that evaluated the effects of IL-2 as an adjunct to ART in reducing the morbidity and mortality in HIV-positive adults. DATA COLLECTION AND ANALYSIS: Two review authors independently screened records and selected trials that met the inclusion criteria, extracted data, and assessed the risk of bias in the included trials. Where possible, we compared the effects of interventions using risk ratios (RR), and presented them with 95% confidence intervals (CI). We assessed the overall certainty of the evidence using the GRADE approach. MAIN RESULTS: Following a comprehensive literature search up to 26 May 2016, we identified 25 eligible trials. The interventions involved the use of IL-2 in combination with ART compared with ART alone. There was no difference in mortality apparent between the IL-2 group and the ART alone group (RR 0.97, 95% CI 0.80 to 1.17; 6 trials, 6565 participants, high certainty evidence). Seventeen of 21 trials reported an increase in the CD4 cell count with the use of IL-2 compared to control using different measures (21 trials, 7600 participants). Overall, there was little or no difference in the proportion of participants with a viral load of less than 50 cells/mL or less than 500 cells/mL by the end of the trials (RR 0.97, 95% CI 0.81 to 1.15; 5 trials, 805 participants, high certainty evidence) and (RR 0.96, 95% CI 0.82 to 1.12; 4 trials, 5929 participants, high certainty evidence) respectively. Overall there may be little or no difference in the occurrence of opportunistic infections (RR 0.79, 95% CI 0.55 to 1.13; 7 trials, 6141 participants, low certainty evidence). There was probably an increase in grade 3 or 4 adverse events (RR 1.47, 95% CI 1.10 to 1.96; 6 trials, 6291 participants, moderate certainty evidence). None of the included trials reported adherence. AUTHORS' CONCLUSIONS: There is high certainty evidence that IL-2 in combination with ART increases the CD4 cell count in HIV-positive adults. However, IL-2 does not confer any significant benefit in mortality, there is probably no difference in the incidence of opportunistic infections, and there is probably an increase in grade 3 or 4 adverse effects. Our findings do not support the use of IL-2 as an adjunct to ART in HIV-positive adults. Based on our findings, further trials are not justified.

11 Review Association of opioid agonist therapy with the initiation of antiretroviral therapy - a systematic review. 2016

Mlunde, Linda Beatrice / Sunguya, Bruno Fokas / Mbwambo, Jessie Kazeni Kilonzo / Ubuguyu, Omary Said / Yasuoka, Junko / Jimba, Masamine. ·Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan. Electronic address: lindasozy@gmail.com. · Department of Community Health, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, P.O. Box 65015, Dar es Salaam, Tanzania. Electronic address: sunguya@gmail.com. · Department of Psychiatry and Mental Health, Muhimbili National Hospital, P.O. Box 65000, Dar es Salaam, Tanzania. Electronic address: jmbwambo@gmail.com. · Department of Psychiatry and Mental Health, Muhimbili National Hospital, P.O. Box 65000, Dar es Salaam, Tanzania. Electronic address: oubuguyu@yahoo.com. · Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan. Electronic address: jyasuoka@post.harvard.edu. · Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan. Electronic address: mjimba@m.u-tokyo.ac.jp. ·Int J Infect Dis · Pubmed #27044520.

ABSTRACT: OBJECTIVES: People who inject drugs are at high risk of HIV infection but often face barriers in accessing medical care including access to antiretroviral therapy (ART). Evidence is available about the effectiveness of opioid agonist therapy on drug dependency and risk behaviors. However, it remains scattered regarding access to ART among HIV-positive people who inject drugs. We conducted a systematic review to examine the association of opioid agonist therapy with ART initiation among HIV-positive people who inject drugs. METHODS: We searched the literature for evidence from seven databases. We conducted a narrative synthesis and meta-analysis to examine the association of opioid agonist therapy with ART initiation. RESULTS: Five out of 2,901 identified studies met the inclusion criteria. Three out of five studies reported that, HIV-positive people receiving opioid agonist therapy initiated ART more than those not receiving opioid agonist therapy. In meta-analysis, opioid agonist therapy was associated with ART initiation among HIV positive people who inject drugs (pooled odds ratio: 1.68; 95% confidence interval: 1.03-2.73). CONCLUSIONS: Opioid agonist therapy is positively associated with ART initiation among HIV-positive people who inject drugs. It is important to scale up opioid agonist therapy among people who inject drugs to improve their ART initiation.

12 Review Review: Head and neck squamous cell carcinoma in sub-Saharan Africa. 2015

Faggons, C E / Mabedi, C / Shores, C G / Gopal, S. ·Department of Otolaryngology/Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA. · Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi. · UNC Project-Malawi, Lilongwe, Malawi. ·Malawi Med J · Pubmed #26715951.

ABSTRACT: AIM: Review the literature from 1990 to 2013 to determine known anatomic sites, risk factors, treatments, and outcomes of head and neck squamous cell carcinoma (HNSCC) in sub-Saharan Africa. METHODS: Using a systematic search strategy, literature pertaining to HNSCC in sub-Saharan Africa was reviewed and patient demographics, anatomic sites, histology, stage, treatment, and outcomes were abstracted. The contributions of human immunodeficiency virus (HIV), human papillomavirus (HPV) and behavioural risk factors to HNSCC in the region were assessed. RESULTS: Of the 342 papers identified, 46 were utilized for review, including 8611 patients. In sub-Saharan Africa, the oropharyngeal/oral cavity was found to be the most common site, with 7750 cases (90% of all cases). Few papers distinguished oropharyngeal from oral cavity, making identification of possible HPV-associated oropharyngeal squamous cell carcinoma (SCC) difficult. SCC of the nasopharynx, nasal cavity, or paranasal sinuses was identified in 410 patients (4.8% of all cases). Laryngeal SCC was found in 385 patients (4.5% of all cases), and only 66 patients (0.8% of all cases) with hypopharyngeal SCC were identified. In 862 patients with data available, 43% used tobacco and 42% used alcohol, and reported use varied widely and was more common in laryngeal SCC than that of the oropharyngeal/oral cavity. Toombak and kola nut use was reported to be higher in patients with HNSCC. Several papers reported HIV-positive patients with HNSCC, but it was not possible to determine HNSCC prevalence in HIV-positive compared to negative patients. Reports of treatment and outcomes were rare. CONCLUSIONS: The oropharyngeal/oral cavity was by far the most commonly reported site of HNSCC reported in sub-Saharan Africa. The roles of risk factors in HNSCC incidence in sub-Saharan Africa were difficult to delineate from the available studies, but a majority of patients did not use tobacco and alcohol.

13 Review Optimal management of cervical cancer in HIV-positive patients: a systematic review. 2015

Ntekim, Atara / Campbell, Oladapo / Rothenbacher, Dietrich. ·College of Medicine, University of Ibadan, Ibadan, Nigeria. · Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany. ·Cancer Med · Pubmed #26136407.

ABSTRACT: The clinical management of cervical cancer in HIV-positive patients has challenges mainly due to the concerns on immune status. At present, their mode of management is similar to HIV-seronegative patients involving the use of chemotherapy and radiotherapy concurrently as indicated. HIV infection, cancer, radiotherapy, and chemotherapy lower immunity through reduction in CD4 cell counts. At present there are no treatment guidelines for HIV-positive patients. This study was done to systematically review the literature on cervical cancer management in HIV-positive patients and treatment outcomes. A systematic literature search was done in the major databases to identify studies on the management of HIV-positive patients with cervical cancer. Identified studies were assessed for eligibility and inclusion in the review following the guidelines of The Cochrane Handbook for Systematic Reviews and CRD's (Centre for Reviews and Dissemination) guidance for undertaking reviews in health care. Eight eligible studies were identified from the literature. Three of them were prospective while five were retrospective studies. Notably, the average age at diagnosis of cervical cancer in HIV-positive patients was a decade lower than in seronegative patients. There was no difference in distribution of stages of disease at presentation between HIV-positive and negative patients. Mild acute toxicity (Grades 1 and 2) was higher in HIV-positive patients than in HIV-negative patients in hematopoietic system. In the grades 3 and 4 reactions, anemia was reported in 4% versus 2% while gastrointestinal reactions were reported in 5% versus 2% respectively. In general, patients who were started early on HAART had higher rates of treatment completion. The study supports the suggestion that HAART should be commenced early at cervical cancer diagnosis in HIV-positive patients diagnosed with cervical cancer to ensure less toxicity and better treatment compliance.

14 Review Transplantation in resource-limited setting: using HIV-positive donors for HIV-positive patients. 2015

Muller, Elmi. ·Groote Schuur Hospital, University of Cape Town, South Africa. ·Clin Nephrol · Pubmed #25725240.

ABSTRACT: BACKGROUND: A HIV positive-to-positive program was started in South Africa in 2008. The program was started because dialysis is not freely available to everyone, but severely limited and only available to a selected group of patients. PATIENTS AND METHODS: Between September 2008 and March 2015, 29 patients were transplanted from HIV-positive brain-dead donors at Groote Schuur Hospital transplant team. Donors were either naïve to anti-retroviral therapy or on first line therapy. The recipients were selected to have undetectable plasma HIV type 1 RNA levels and be on a stable antiretroviral regimen. CD4+ T-cell counts of at least 200/mm3 in last 6 months prior to transplant, with no previous serious opportunistic infections. RESULTS: Survivors in the study were followed for a median of 2.4 years. The rate of patient survival was 84% at 1 year and 74% at 5 years. The corresponding graft survival rate was 93% and 84%. CONCLUSION: Using HIV-positive donors might resolve some of the problems we are experiencing in getting enough donors for our patients wit ESRD. In the USA the HOPE act was accepted in 2014 and this might now also impact on the use of HIV positive donors elsewhere in the world.

15 Review Renal transplantation in human immunodeficiency virus (HIV)-positive children. 2015

McCulloch, Mignon I / Kala, Udai K. ·Department of Paediatrics, Red Cross Children's Hospital, University of Cape Town, Cape Town, South Africa, mignonmcculloch@yahoo.co.uk. ·Pediatr Nephrol · Pubmed #24691821.

ABSTRACT: Renal transplantation is being performed in adult human immunodeficiency virus (HIV)-positive patients and increasingly in paediatric patients as well. A multidisciplinary team involving an infectious disease professional is required to assist with HIV viral-load monitoring and in choosing the most appropriate highly active antiretroviral therapy (HAART). Drug interactions complicate immunosuppressant therapy and require careful management. The acute rejection rates appear to be similar in adults to those in noninfective transplant recipients. Induction with basiliximab and calcineurin-based immunosuppression appears to be safe and effective in these recipients. Prophylaxis is advised for a variety of infections and may need life-long administration, especially in children. Organ shortage remains a significant problem, and kidneys from deceased HIV-positive donors have been used successfully in a small study population. Overall, with careful planning and close follow-up, successful renal transplantation for paediatric HIV-infected recipients is possible.

16 Review Effect of HIV infection on the outcome of cancer therapy in children. 2014

Stefan, Daniela C. ·Department of Paediatrics and Child Health, Tygerberg Hospital and Stellenbosch University, Tygerberg, Cape Town, South Africa. Electronic address: Cristina.Stefan@mrc.ac.za. ·Lancet Oncol · Pubmed #25439698.

ABSTRACT: SUMMARY: Systematic studies comparing the outcomes of cancer treatment between children with and without HIV are scarce. The literature seems to suggest that, even with present therapeutic advances, prognosis is poor with HIV infection. The aim of this Review was to assess scientific publications from 1990 to present, addressing the difficulties associated with treatment of cancer in children with AIDS and the adaptive changes in therapy. Although much progress has been achieved, further research is needed about antiretroviral and cytotoxic drug interactions, the optimum use of supportive therapy including stem cells and bone marrow transplant, the timing of the initiation of highly active antiretroviral therapy, and the optimum use of protease inhibitors.

17 Review Melanocyte biology and function with reference to oral melanin hyperpigmentation in HIV-seropositive subjects. 2014

Feller, Liviu / Chandran, Rakesh / Kramer, Beverley / Khammissa, Razia A G / Altini, Mario / Lemmer, Johan. ·1 Department of Periodontology and Oral Medicine, University of Limpopo , Medunsa Campus, South Africa . ·AIDS Res Hum Retroviruses · Pubmed #25026474.

ABSTRACT: The color of normal skin and of oral mucosa is not determined by the number of melanocytes in the epithelium but rather by their melanogenic activity. Pigmented biopolymers or melanins are synthesized in melanosomes. Tyrosinase is the critical enzyme in the biosynthesis of both brown/black eumelanin and yellow/red pheomelanin. The number of the melanosomes within the melanocytes, the type of melanin within the melanosomes, and the efficacy of the transfer of melanosomes from the melanocytes to the neighboring keratinocytes all play an important role in tissue pigmentation. Melanin production is regulated by locally produced factors including proopiomelanocortin and its derivative peptides, particularly alpha-melanocyte-stimulating hormone (α-MSH), melanocortin 1 receptor (MC1R), adrenergic and cholinergic agents, growth factors, cytokines, and nitric oxide. Both eumelanin and pheomelanin can be produced by the same melanocytes, and the proportion of the two melanin types is influenced by the degree of functional activity of the α-MSH/MC1R intracellular pathway. The cause of HIV oral melanosis is not fully understood but may be associated with HIV-induced cytokine dysregulation, with the medications commonly prescribed to HIV-seropositive persons, and with adrenocortical dysfunction, which is not uncommon in HIV-seropositive subjects with AIDS. The purpose of this article is to discuss some aspects of melanocyte biology and HIV-associated oral melanin hyperpigmentation.

18 Review Drug-drug interactions in HIV positive cancer patients. 2014

Flepisi, Brian Thabile / Bouic, Patrick / Sissolak, Gerhard / Rosenkranz, Bernd. ·Department of Medicine, Division of Clinical Pharmacology, Stellenbosch University, Cape Town, South Africa. Electronic address: brian2@sun.ac.za. · Department of Medical Microbiology, Stellenbosch University, Cape Town, South Africa. Electronic address: pbouic@synexagroup.com. · Department of Medicine, Division of Clinical Haematology, Stellenbosch University, Cape Town, South Africa. Electronic address: sissolak1@telkomsa.net. · Department of Medicine, Stellenbosch University, Cape Town, South Africa. Electronic address: rosenkranz@sun.ac.za. ·Biomed Pharmacother · Pubmed #24863536.

ABSTRACT: Clinically relevant drug-drug interactions (DDIs) refer to the pharmacological or clinical response to the administration or co-exposure of a drug with another drug that modifies the patient's response. Treatment regimens, which include agents that are involved in the cytochrome P450 (CYP450) enzyme system and transporter systems, such as P-glycoprotein may be associated with higher risk of clinically significant drug interactions. In addition, potential DDIs increase with the increasing number of concomitant drugs. HIV positive cancer patients who receive concomitant chemotherapy and combination antiretroviral therapy (cART) may achieve better response rates and higher rates of survival than those who receive chemotherapy alone, but they may be at increased risk of drug interactions. DDIs in HIV positive cancer patients receiving concomitant chemotherapy and cART may increase or decrease antineoplastic drug concentrations, potentially resulting in life threatening interactions, increased toxicity or loss of efficacy. Avoiding and managing potential interactions between cART and antineoplastic agents is an increasingly important challenge. Based on the current literature, more safety and pharmacokinetic studies are needed with the aim to document a clear survival benefit for patients undergoing chemotherapy and concomitant or sequential administration of cART.

19 Review The dual impact of antiretroviral therapy and sexual behaviour changes on HIV epidemiologic trends in Uganda: a modelling study. 2014

Shafer, Leigh Anne / Nsubuga, Rebecca N / Chapman, Ruth / O'Brien, Katie / Mayanja, Billy N / White, Richard G. ·Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada Medical Research Council Unit on AIDS/Uganda Virus Research Institute, Entebbe, Uganda. · Medical Research Council Unit on AIDS/Uganda Virus Research Institute, Entebbe, Uganda. · London School of Hygiene and Tropical Medicine, London, UK. ·Sex Transm Infect · Pubmed #24567521.

ABSTRACT: OBJECTIVES: Antiretroviral therapy (ART) availability in a population may influence risky sexual behaviour. We examine the potential impact of ART on the HIV epidemic, incorporating evidence for the impact that ART may have on risky sexual behaviour. METHODS: A mathematical model, parameterised using site-specific data from Uganda and worldwide literature review, was used to examine the likely impact of ART on HIV epidemiologic trends. We varied assumptions about rates of initiating ART, and changes in sexual partner turnover rates. RESULTS: Modelling suggests that ART will reduce HIV incidence over 20 years, and increase prevalence. Even in the optimistic scenario of ART enrollment beginning after just five months of infection (in HIV stage 2), prevalence is estimated to rise from a baseline of 10.5% and 8.3% among women and men, respectively, to at least 12.1% and 10.2%, respectively. It will rise further if sexual disinhibition occurs or infectiousness while on ART is slightly higher (2% female to male, rather than 0.5%). The conditions required for ART to reduce prevalence over this period are likely too extreme to be achievable. For example, if ART enrolment begins in HIV stage 1 (within the first 5 months of infection), and if risky sexual behaviour does not increase, then 3 of our 11 top fitting results estimate a potential drop in HIV prevalence by 2025. If sexual risk taking rises, it will have a large additional impact on expected HIV prevalence. Prevalence will rise despite incidence falling, because ART extends life expectancy. CONCLUSIONS: HIV prevalence will rise. Even small increases in partner turnover rates will lead to an additional substantial increase in HIV prevalence. Policy makers are urged to continue HIV prevention activities, including promoting sex education, and to be prepared for a higher than previously suggested number of HIV infected people in need of treatment.

20 Review Systematic review of the performance of HIV viral load technologies on plasma samples. 2014

Sollis, Kimberly A / Smit, Pieter W / Fiscus, Susan / Ford, Nathan / Vitoria, Marco / Essajee, Shaffiq / Barnett, David / Cheng, Ben / Crowe, Suzanne M / Denny, Thomas / Landay, Alan / Stevens, Wendy / Habiyambere, Vincent / Perrins, Jos / Peeling, Rosanna W. ·Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom. · Department of Microbiology and Immunology, University of North Carolina, Chapel Hill, North Carolina, United States of America. · Department of HIV/AIDS, World Health Organization, Geneva, Switzerland. · HIV, Medicine and Science, Clinton Health Access Initiative, New York, New York, United States of America. · Department of Haematology, United Kingdom National External Quality Assessment Service (UK NEQAS) for Leucocyte Immunophenotyping, Sheffield, United Kingdom. · Department of Technology and Innovation, Pangaea Global AIDS Foundation, San Fransisco, California, United States of America. · Centre for Biomedical Research, Burnet Institute, Melbourne, Australia. · Department of Medicine, Duke Human Vaccine Institute and Center for HIV/AIDS Vaccine Immunology, Durham, North Carolina, United States of America. · Department of Immunology- Microbiology, Rush University Medical Center, Chicago, Illinois, United States of America. · Department of Molecular Medicine and Haematology, University of the Witwatersrand, Johannesburg, South Africa. ·PLoS One · Pubmed #24558359.

ABSTRACT: BACKGROUND: Viral load (VL) monitoring is the standard of care in developing country settings for detecting HIV treatment failure. Since 2010 the World Health Organization has recommended a phase-in approach to VL monitoring in resource-limited settings. We conducted a systematic review of the accuracy and precision of HIV VL technologies for treatment monitoring. METHODS AND FINDINGS: A search of Medline and Embase was conducted for studies evaluating the accuracy or reproducibility of commercially available HIV VL assays. 37 studies were included for review including evaluations of the Amplicor Monitor HIV-1 v1.5 (n = 25), Cobas TaqMan v2.0 (n = 11), Abbott RealTime HIV-1 (n = 23), Versant HIV-1 RNA bDNA 3.0 (n = 15), Versant HIV-1 RNA kPCR 1.0 (n = 2), ExaVir Load v3 (n = 2), and NucliSens EasyQ v2.0 (n = 1). All currently available HIV VL assays are of sufficient sensitivity to detect plasma virus levels at a lower detection limit of 1,000 copies/mL. Bias data comparing the Abbott RealTime HIV-1, TaqMan v2.0 to the Amplicor Monitor v1.5 showed a tendency of the Abbott RealTime HIV-1 to under-estimate results while the TaqMan v2.0 overestimated VL counts. Compared to the Amplicor Monitor v1.5, 2-26% and 9-70% of results from the Versant bDNA 3.0 and Abbott RealTime HIV-1 differed by greater than 0.5log10. The average intra and inter-assay variation of the Abbott RealTime HIV-1 were 2.95% (range 2.0-5.1%) and 5.44% (range 1.17-30.00%) across the range of VL counts (2log10-7log10). CONCLUSIONS: This review found that all currently available HIV VL assays are of sufficient sensitivity to detect plasma VL of 1,000 copies/mL as a threshold to initiate investigations of treatment adherence or possible treatment failure. Sources of variability between VL assays include differences in technology platform, plasma input volume, and ability to detect HIV-1 subtypes. Monitoring of individual patients should be performed on the same technology platform to ensure appropriate interpretation of changes in VL. Prospero registration # CD42013003603.

21 Review Systematic review of neuroimaging studies in vertically transmitted HIV positive children and adolescents. 2014

Hoare, Jacqueline / Ransford, Gabrielle L / Phillips, Nicole / Amos, Taryn / Donald, Kirsten / Stein, Dan J. ·Department of Psychiatry and Mental Health, University of Cape Town, Anzio Road Observatory, 7925, Cape Town, South Africa, hoare.jax@googlemail.com. ·Metab Brain Dis · Pubmed #24338026.

ABSTRACT: One of the most serious consequences of vertical HIV-infection is its impact on the central nervous system (CNS). Although much work has been done to elucidate the complex mechanism of HIV associated neurotoxicity, several questions remain unanswered. The purpose of this review is to summarise what is already known in the field of neuroimaging in vertically acquired HIV, addressing three aims and to highlight possible future directions in using neuroimaging and neurocognitive testing to understand the spectrum of neurocognitive disorders in HIV positve children. Here we aim to address several clinically relevant questions in pediatric neuroHIV, using the current evidence base by conducting a systematic review. We aim to investigate what is known about the relationship between cognitive impairment and central nervous system damage in HIV as seen in neuroimaging studies, and to search for any evidence in the current literature which suggests a spectrum of neuocognitive disorders in vertically infected HIV. Secondly, we aim to enquire whether children with a clinical diagnosis of encephalopathy are clearly distinguishable from HIV positive children without encephalopathy on neuroimaging and neurocognitive testing. Finally aim to investigate what is known about the effect on the CNS of antiretroviral therapy in paediatric HIV. Three separate databases were searched and two investigators systematically evaluated the titles, abstracts, and keywords associated with each individual article to determine those that may have met the inclusion and exclusion criteria. Following this process 11 studies were included in the review. Thus there was limited available data to address the 3 questions posed.

22 Review [Potential sexual exposure to HIV: experience of the infectious diseases unit of Casablanca and literature review]. 2014

Traoré, Youssouf / Bensghir, Rajaa / Oulad Lahsen, Ahd / Lamdini, Hassam / Marhoum El Filali, Kamal. ·CHU Ibn Rochd, service des maladies infectieuses, 20100 Casablanca, Maroc. Electronic address: drtraore@hotmail.com. · CHU Ibn Rochd, service des maladies infectieuses, 20100 Casablanca, Maroc. ·Presse Med · Pubmed #24332700.

ABSTRACT: -- No abstract --

23 Review Salmonella thyroiditis: a case report and review of the literature. 2013

Maraj, Amisha / Kiss, A / Luvhengo, Thifhelimbilu E. ·Department of General Surgery, Chris Hani Baragwanath Academic Hospital and University of Witwatersrand, Johannesburg, South Africa. docmish@hotmail.co.uk. ·S Afr J Surg · Pubmed #24209705.

ABSTRACT: Thyroid abscesses are rare, and Staphylococcus aureus is the main causative organism. Abscesses caused by other organisms are even rarer. This report describes a case of salmonella thyroiditis in an HIV-positive patient. Fine-needle aspiration cytology was performed and Salmonella sp. were cultured. The patient was successfully treated with antibiotics and incision and drainage.

24 Review Challenges in lymphoma diagnosis in HIV positive patients in the South African setting. 2013

Wiggill, T M / Mayne, E S / Willem, P. ·Department of Molecular Medicine and Haematology, National Health Laboratory Service and University of the Witwatersrand, Johannesburg, South Africa. Electronic address: tracey.wiggill@nhls.ac.za. ·Transfus Apher Sci · Pubmed #23981653.

ABSTRACT: An increase in high grade B-cell lymphomas has been noted in HIV infection. Sub-Saharan Africa is the epicentre of the epidemic and in Gauteng, South Africa >90% of patients with high grade lymphoma tested positive for HIV infection. The diagnosis of lymphoma may be challenging in HIV because of reactive conditions which mimic lymphomas, the atypical clinical presentation and the atypical histological findings. The WHO classification divides lymphomas into discrete categories. Despite this, tumours in HIV positive patients commonly show atypical morphological, immunophenotypic, molecular and cytogenetic features, making exact classification difficult. This has lead to an increase in the diagnosis of the highly aggressive B-cell lymphoma, unclassifiable with features intermediate between DLBCL and BL. It appears likely that HIV-associated lymphomas represent a continuum of disease.

25 Review Male involvement in prevention programs of mother to child transmission of HIV: a systematic review to identify barriers and facilitators. 2013

Morfaw, Frederick / Mbuagbaw, Lawrence / Thabane, Lehana / Rodrigues, Clarissa / Wunderlich, Ana-Paula / Nana, Philip / Kunda, John. ·Department of Obstetrics and Gynaecology, Faculty of Medicines and Biomedical Sciences, University of Yaounde 1, PO Box 1364, Yaounde, Cameroon. ikomi_fred@yahoo.com ·Syst Rev · Pubmed #23320454.

ABSTRACT: BACKGROUND: Many reports point to the beneficial effect of male partner involvement in programs for the prevention of mother-to-child-transmission (PMTCT) of HIV in curbing pediatric HIV infections. This paper summarizes the barriers and facilitators of male involvement in prevention programs of mother-to-child-transmission of HIV. METHODS: We searched PubMed, EMBASE, CINAHL and the Cochrane Central Register of Controlled Trials (CENTRAL) for studies published in English from 1998 to March 2012. We included studies conducted in a context of antenatal care or PMTCT of HIV reporting male actions that affected female uptake of PMTCT services. We did not target any specific interventions for this review. RESULTS: We identified 24 studies from peer-reviewed journals; 21 from sub-Saharan Africa, 2 from Asia and 1 from Europe. Barriers to male PMTCT involvement were mainly at the level of the society, the health system and the individual. The most pertinent was the societal perception of antenatal care and PMTCT as a woman's activity, and it was unacceptable for men to be involved. Health system factors such as long waiting times at the antenatal care clinic and the male unfriendliness of PMTCT services were also identified. The lack of communication within the couple, the reluctance of men to learn their HIV status, the misconception by men that their spouse's HIV status was a proxy of theirs, and the unwillingness of women to get their partners involved due to fear of domestic violence, stigmatization or divorce were among the individual factors. Actions shown to facilitate male PMTCT involvement were either health system actions or factors directly tied to the individuals. Inviting men to the hospital for voluntary counseling and HIV testing and offering of PMTCT services to men at sites other than antenatal care were key health system facilitators. Prior knowledge of HIV and prior male HIV testing facilitated their involvement. Financial dependence of women was key to facilitating spousal involvement. CONCLUSIONS: There is need for health system amendments and context-specific adaptations of public policy on PMTCT services to break down the barriers to and facilitate male PMTCT involvement. TRIAL REGISTRATION: The protocol for this review was registered with the International prospective register of systematic reviews (PROSPERO) record CRD42011001703.

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