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Background: The World Health Organisation's (WHO) key population-based strategy for ending the human immunodeficiency virus (HIV) epidemic is universal HIV test and treat (UTT) along with pre-exposure prophylaxis (PrEP), and post-exposure prophylaxis (PEP). Despite the successful scale-up of the UTT strategy in sub-Saharan Africa (SSA), the quality of life (QoL) of people living with HIV (PLHIV) remains sub-optimal. Poor QoL in PLHIV may threaten the UNAIDS 95-95-95 programme targets. Monitoring QoL of PLHIV has become a key focus of HIV research among other outcomes so as to understand health-related QoL (HRQoL) profiles and identify interventions to improve programme performance. This study aimed to describe HRQoL profiles and identify their predictors in PLHIV in KwaZulu Natal, South Africa. Methods: We conducted a secondary data analysis of a cross-sectional survey conducted between May and June 2022 among PLHIV (n = 105) accessing HIV services at an outpatient clinic in KwaZulu-Natal, South Africa. Socio-demographic, HRQoL (EQ-5D-5L index scores), clinical data, depressive symptoms (CES-D-10), and viral load data were collected from all participants. We examined predictors of HRQoL using generalised linear models controlling for age and sex. Results: The mean age of the participants was 45 years (SD = 13). The proportion of participants with disabilities and comorbidities were 3% and 18%, respectively. Depressive symptoms were present in 49% of the participants. Participant's mean EQ-5D-5L index score was 0.87 (SD = 0.21) and ranged from 0.11 to 1.0. The mean general health state (EQ-VAS) was 74.7 (SD = 18.8) and ranged from 6 to 100. Factors that reduced HRQoL were disability (β = −0.607, p ≤ 0.001), comorbidities (β = − 0.23, p ≤ 0.05), presence of depressive symptoms (β = −0.10, p ≤ 0.05), and old age (β = −0.04, p ≤ 0.05). Factors that increased HRQoL were a good perceived health state (β = 0.147, p ≤ 0.001) and availability of social support (β = 0.098, p ≤ 0.05). Conclusion: A combination of old age (60 years and above), any disability and comorbidities had a considerable effect on HRQoL among PLHIV. Our findings support the recommendation for an additional fourth UNAIDS target that should focus on ensuring that 95% of PLHIV have the highest possible HRQoL. Psycho-social support interventions are recommended to improve the HRQoL of PLHIV. [ABSTRACT FROM AUTHOR]

Background: The 2030 Agenda for Sustainable Development recognises the importance of addressing HIV and NCDs, and establishes the need to address female and child specific health outcomes as a whole. Women experience a triple burden of ill-health spanning non-communicable diseases (NCDs), reproductive and maternal health conditions and human immune deficiency virus (HIV) in sub-Saharan Africa (SSA). Method: A scoping review methodology was used to map and describe what is known about the health needs, service experiences and health outcomes of women living with HIV (WLHIV), diabetes and/or hypertension in SSA. Results: The final data set of 15 records represented seven SSA countries (Kenya, South Africa, Tanzania, Uganda, Ghana, Malawi and Zimbabwe). Following final charting and analysis of the data, four themes emerged: Prevalence of NCD and related co-morbidities; Environmental, biological and cultural determinates of health; Access to healthcare services and medication; and Integrated HIV.NCD care. Conclusion: The evidence base with detail on this gendered health topic within the African sustainable development agenda is limited. subject is small. Further research which involves women in the community and female patients receiving integrated care for HIV and NCDs at hospital and primary care levels in SSA is warranted on a larger scale. [ABSTRACT FROM AUTHOR]

Background: Sub-Saharan Africa is experiencing a dual burden of chronic human immunodeficiency virus and non-communicable diseases. A pragmatic parallel arm cluster randomised trial (INTE-AFRICA) scaled up 'one-stop' integrated care clinics for HIV-infection, diabetes and hypertension at selected facilities in Uganda. These clinics operated integrated health education and concurrent management of HIV, hypertension and diabetes. A process evaluation (PE) aimed to explore the experiences, attitudes and practices of a wide variety of stakeholders during implementation and to develop an understanding of the impact of broader structural and contextual factors on the process of service integration. Methods: The PE was conducted in one integrated care clinic, and consisted of 48 in-depth interviews with stakeholders (patients, healthcare providers, policy-makers, international organisation, and clinical researchers); three focus group discussions with community leaders and members (n = 15); and 8 h of clinic-based observation. An inductive analytical approach collected and analysed the data using the Empirical Phenomenological Psychological five-step method. Bronfenbrenner's ecological framework was subsequently used to conceptualise integrated care across multiple contextual levels (macro, meso, micro). Results: Four main themes emerged; Implementing the integrated care model within healthcare facilities enhances detection of NCDs and comprehensive co-morbid care; Challenges of NCD drug supply chains; HIV stigma reduction over time, and Health education talks as a mechanism for change. Positive aspects of integrated care centred on the avoidance of duplication of care processes; increased capacity for screening, diagnosis and treatment of previously undiagnosed comorbid conditions; and broadening of skills of health workers to manage multiple conditions. Patients were motivated to continue receiving integrated care, despite frequent NCD drug stock-outs; and development of peer initiatives to purchase NCD drugs. Initial concerns about potential disruption of HIV care were overcome, leading to staff motivation to continue delivering integrated care. Conclusions: Implementing integrated care has the potential to sustainably reduce duplication of services, improve retention in care and treatment adherence for co/multi-morbid patients, encourage knowledge-sharing between patients and providers, and reduce HIV stigma. Trial registration number: ISRCTN43896688. [ABSTRACT FROM AUTHOR]

Introduction: The World Health Organization's (WHO's) new global health strategy on HIV represents a major step toward a broader conceptualization of HIV care. It recognizes the importance of addressing chronic care more fully and–for the first time ever–the health‐related quality of life (HRQoL) of people living with HIV (PLHIV). Methods: A thorough literature review was conducted in order to analyse how the WHO strategy on HIV for 2022‐2030 addresses the monitoring of the HRQoL of PLHIV for the next decade and compared it to that of other countries and health authorities. Results: Unlike for other issues, the strategy does not include quantitative targets for 2030, thus falling short of committing to monitoring global progress in improving the long‐term well‐being of PLHIV. Conclusions: We urge national health systems not to wait for WHO to lead on this issue. Seeking good HRQoL outcomes for PLHIV can confer far‐reaching benefits on health systems. The feasibility of monitoring population‐level HRQoL has been demonstrated through the use of simple tools like patient‐reported outcome measures (PROMs) and patient‐reported experience measures (PREMs). Many countries can already set HRQoL monitoring targets, similar to those presented in this viewpoint, while we work toward an agreed minimum metric for use by all countries. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular diseases are projected to bypass HIV as the most common cause of death in sub-Saharan Africa (SSA) by 2030. People living with HIV (PLHIV) are more likely to develop complications of cardiovascular disease. This poses a major developmental challenge. Methods: A scoping review of qualitative literature mapped what is known about cardiovascular disease awareness, prevention and management from the perspectives of PLHIV in SSA. Six qualitative studies from Malawi, Kenya, and South Africa were charted and analysed thematically. Results: Patients were aware of cardiovascular diseases but had varied attitudes and practices towards prevention. Social support and fear of developing life-threatening complications motivated some PLHIV to change their health behaviours. Financial hardship, unavailability of medication, and hearsay prevented adherence to lifestyle measures and medical treatment. Conclusions: Targetted prevention initiatives are critical in response to the unique needs of PLHIV and improve overall health indices in the SSA region. [ABSTRACT FROM AUTHOR]

Introduction: Although HIV continues to have a high prevalence among adults in sub- Saharan Africa (SSA), the burden of noncommunicable diseases (NCD) such as diabetes and hypertension is increasing rapidly. There is an urgent need to expand the capacity of healthcare systems in SSA to provide NCD services and scale up existing chronic care management pathways. A scoping review mapped extant policy and evidence based literature on the feasibility of integrating NCD care with HIV in the region. Methods: A scoping review methodology was utilised to conduct a systematic search of peer-reviewed and grey literature published in English language and with no date limitation. A systematic search was conducted on PubMed, Embase, CINAHL, and the Cochrane library. The initial search identified 231 records considered for inclusion in this review. Twelve duplicate records were removed. The remaining 219 records were screened by title and abstract of which 165 records were excluded and 54 records were selected for full-text review. A further 16 records were excluded due to a lack of relevance or the unavailability of the full text article. Finally, 38 were charted and analysed thematically. Results: Thirty-eight studies were included. These comprised a range of different models to integrate NCD and HIV care in the region, reflecting differences in health system environments, and disease epidemiology. The studies provide a variety of evidence that integration of HIV and NCD care can be feasible and can improve clinical effectiveness and identify barriers and facilitators to integration and task shifting. The review confirms that integrated HIV and NCD care services is by-and-large feasible, being both clinically effective and cost-effective. Conclusion: The review may inform the understanding of how best to develop an integrated model of care service by reducing barriers to uptake, linkage and retention in HIV, diabetes and hypertension treatment in SSA countries. [ABSTRACT FROM AUTHOR]

Background: The HIV epidemic in the Sub Saharan (SSA) region disproportionately affects women and girls and is further concentrated amongst prisoners. Given the male dominated prison environment, women's health needs are frequently ill resourced. This research investigated the health inequalities of Zimbabwean women prisoners. Methods: Using multi-stakeholder qualitative and theatre performance-based practice as research methodology, within an art-based research approach, we examined the extent to which prison Forum Theatre validated prior research findings, fostered dialogic communication, and fuelled discourse to generate solutions to women prisoner rights to health and equivalence of care. Results: Analysis found five themes: female vulnerabilities and rejecting the criminal identity; group solidarity against prison security protocols and rights to confidential health care; prisoner peer hierarchies and threat to well-being; challenging the prison system; and multiple perspectives beyond the performance. Conclusions Forum theatre offers an innovative medium to empower women prisoners and actualize sexual health rights based approaches in prisons in Zimbabwe, and Africa using a transformative sustainable development approach. [ABSTRACT FROM AUTHOR]

To raise awareness and knowledge of the human immunodeficiency virus (HIV); information, education and communication (IEC) strategies are needed. Entertainment education (EE) uses performing arts and theatre, as form of HIV programming, and is increasingly utilised in sub-Saharan Africa (SSA), a region impacted by a generalised HIV epidemic. A scoping review was conducted mapping and describing extant performance and theatre arts literature in HIV programming in the region. 27 records (between 1999-2019) were charted and thematically analysed. Performance theatre as a health education and promotion strategy in HIV programming was reported in South Africa, Botswana, Mozambique, Namibia, Swaziland, Uganda, Malawi, Lesotho, Zambia, Nigeria and Tanzania. This innovative strategy raised awareness, enhanced knowledge and corrected community myths; was transformative in changing cultural views and attitudes; and enhancing behaviour change. This review highlights the potential for continued use of innovative performance and theatre arts in HIV interventions and HIV programming in SSA. [ABSTRACT FROM AUTHOR]

High levels of undiagnosed and untreated HCV infection exist in prison populations globally. Prisons are a key location to identify, treat and prevent HCV infection among people who inject drugs (PWID). Understanding prisoners’ lived experiences of the HCV continuum of care informs how HCV care can be effectively delivered to this marginalised and high-risk population. This study aimed to explore Irish prisoners’ experience of prison and community-based HCV care. We conducted one-to-one interviews with 25 male prisoners with chronic HCV infection. Data collection and analysis was informed by grounded theory. The mean age of participants and first incarceration was 39.5 and 18.3 years respectively. The mean number of incarcerations was eight. The following themes were identified: medical and social factors influencing engagement (fear of treatment and lack of knowledge, HCV relevance and competing priorities), adverse impact of HCV on health and wellness, positive experience of prison life and health care and the transformative clinical and non-clinical changes associated with HCV treatment and cure. Findings suggest that prison release was associated with multiple stressors including homelessness and drug dependence which quickly eroded the health benefits gained during incarceration. The study generated a substantive theory of the need to increase the importance of HCV care among the routine competing priorities associated with the lives of PWID. HCV infected prisoners often lead complex lives and understanding their journeys through the HCV continuum can inform the development of meaningful HCV care pathways. Many challenges exist to optimising HCV treatment uptake in this group and incarceration is an opportunity to successfully engage HCV infected prisoners who underutilise and are underserved by community-based medical services. Support and linkage to care on release is essential to optimising HCV management. [ABSTRACT FROM AUTHOR]

Club drug use among gay, bisexual and other men who have sex with men is increasingly normalised within sexual contexts and is associated with increased sexual risk behaviours. The term Chemsex is used to describe sexualised drug use lasting several hours or days with multiple sexual partners. A small pilot study, underpinned by interpretative phenomenological analysis (IPA), was conducted in Dublin, Ireland. Interviews were conducted with 10 men who were experiencing physical and emotional health problems as a consequence of their participation in sexualised drug use and wished to exit the Chemsex scene. Interviews explored experiences of sexualised drug use, motives to partake, the organisation of Chemsex parties and group connectivity, drugs used, harm reduction, pleasure and consequences of participation over time. Four basic themes emerged from the analysis: social and cyber arrangements within the Dublin Chemsex scene; poly drug use and experiences of drug dependence; drug and sexual harm reduction within the Chemsex circle of novices and experts; and sexualised drug use, escapism and compulsive participation. Two higher-order themes were also apparent: first, the reinforcing aspects of drug and sexual pleasure; and second, the interplay between excess drug consumption and sex, and drug dependence. [ABSTRACT FROM AUTHOR]

Background: Opioid dependence, characterised by socio economic disadvantage and significant morbidity and mortality, remains a major public health problem in Ireland. Through the methadone treatment protocol (MTP), Irish general practice has been a leader in the introduction and expansion of Irish harm reduction services, including opioid substitution treatment (OST), needle and syringe programs (NSP) and naloxone provision. These services have been effective in engaging opiate users in treatment, reducing human deficiency virus (HIV) and hepatitis C virus (HCV) transmission and reducing-drug related morbidities. Challenges remain in relation to choice of substitution treatments, timely access to OST services, adequate coverage of NSP, naloxone provision and increasing drug-related deaths. Methods: A narrative review was conducted and designed to present a broad perspective on the Irish MTP and to describe its history and development in terms of clinical care, stakeholder views and changing trends. Results: Three themes emerged from the analysis; The History of the Methadone Treatment Protocol, Service User and Provider Views and Challenges and Developments. Despite the initial concern about methadone maintenance treatment (MMT) in Ireland, increased participation by Irish GPs in the treatment of opioid dependence is observed over the last two decades. There are now over 10,000 people on methadone treatment in Ireland, with 40% treated in general practice. The MTP provides structure, remuneration and guidance to GPs and is underpinned by training, ongoing education and a system of quality assurance provided by the Irish College of General Practice (ICGP). Challenges include the negative views of patients around how methadone services are delivered, the stigma associated with methadone treatment, the lack of choice around substitution medication, waiting lists for treatment in certain areas and rates of fatal overdose. Conclusion: Twenty years of the MTP has been the mainstay of harm reduction services in Ireland. It has provided a network of specially trained GPs who provide methadone to over 10,000 patients across Ireland within a structured framework of training, quality assurance and remuneration. With the ongoing commitment of Irish specialists in the field of addiction medicine, further improvements to support and treat patients can be made. [ABSTRACT FROM AUTHOR]

A foreword to the journal "Journal of Ethnicity in Substance Abuse" is presented.