HIV Infection and AIDS in Sub-Saharan Africa: Current Status, Challenges, and Opportunities

Kharsany and Karim (2016) carried out a systematic review looking into the epidemiology of HIV infections across sub-Saharan Africa covering the factors that promote high incidence and mortality rates. Moreover, it investigates the priorities for mitigating the progression of HIV to an epidemic. It considers the means of maximizing the usage of the already limited resources to achieve these objectives. These objectives were diverse making the discussion widely informative but poorly focused. Kharsany and Karim (2016) did little to describe their methods of selecting sources for their report; hence, it is impossible to note if they conducted the due diligence necessary to pick the right publications to include in the review and if their quality was considered at all. The authors compared the results of the studies in their review separately. They concluded that the young women in this region are at most risk of infection as was replicated in various studies in different settings. This finding was arrived at with a comparison of the various demographics and their ability to enact preventative measures. The replication of the results across numerous articles supports the external validity of the results. Based on this, they were significantly accurate and in targeting young women for optimal epidemiological effect in controlling HIV infections.
Abongomera et al. (2017) considered the level of adherence to antiretroviral therapy (ART) and its efficacy in the suppression of the viral load in children by assessing the attitudes of their caregivers towards medicine.

This objective was sufficiently succinct. Moreover, the use of the Beliefs about Medicine Questionnaire (BMQ) and the Medication Events Monitoring System (MEMs) caps provided qualitative and quantitative data respectively. They used the MEMs caps instead of pill counts and caregiver reports to track adherence to ARTs because of their significant association to the suppression of viral load. The BMQ is empirically validated to measure “concern” and “necessity” in medication decisions. This research was a sub-study of a larger clinical trial that aimed to assess the efficacy of three nucleoside reverse transcriptase inhibitors (NRTIs). This main study’s design created a suitable context for the performance of the sub-study. Hence, the evidence-backed methodology adds to the internal validity of the research. In essence, the data was collected from the participants of the main study in a manner that tested a factor that might determine the efficacy of the drug: the vigilance of the HIV-infected child’s caregiver. The relationship between the researchers and the participants was not highlighted in the report. Moreover, the ethical concerns were not highlighted; possibly, the primary study covered these issues given it was a clinical trial on humans. Multi-variable multiple regressions assisted in analyzing the data for the research. The findings were clear enough for the establishment of inferences that might have clinical significance. This research indicates that the attitudes of caregivers toward the medication could influence the prognosis of HIV infection.
Bijker et al. (2017) assessed the levels and determinants of adherence to ART in sub-Saharan Africa and Asia. The Pan-African (PASER-M) and TREAT Asia (TASER-M) studies provided participants with verifiable demographic traits that underwent adherence appraisal with a 6-month assessment on using a visual analog scale. The primary confounding factor was the loss of participants due to death, lack of follow-up, ART discontinuance or alternation of the regimen. Consequently, such prospective studies face the challenge of attrition bias that this study controlled for by extending the follow-up time to a year not considering their status, and missing inputs and time-dependent variables being replaced by the last observation carried forward method. The findings indicated that the African cohort reported more suboptimal adherence vis-à-vis the Asian cohort. In the African group, males and young persons were more likely to have suboptimal adherence while injecting drug users and men who have sex with men showed high adherence in the Asian cohort. Moreover, long ART durations and poor economic conditions discouraged adherence. The researchers alternated the definitions of low adherence with similar results. Hence, the findings were significantly accurate. These results are believable and could be used to develop interventions that limit the barriers and risk- actors for non-adherence. This research indicates that ART adherence is a multi-variate problem that requires comprehensive interventions to ensure optimal functioning of the drugs.
Omonaiye, Kusljic, Nicholson, and Manias (2018) conducted a systematic review of the literature covering the adherence of HIV-infected pregnant women to ART in sub-Saharan Africa. They found articles with the keywords HIV AND (Pregnancy OR Pregnant*) AND (PMTCT OR “PMTCT Cascade” OR “Vertical Transmission” OR “Mother-to-Child”) AND (Prevent OR Prevention) AND (HAART OR “Antiretroviral Therapy” OR “Triple Therapy”) AND (Retention OR Concordance OR Adherence OR Compliance) in CINAHL, Global Health and MEDLINE databases. They ended up with 51 of the most relevant articles that met their inclusion criteria outlined in their PRISMA diagram. They conducted an in-depth analysis of the articles considering their authors, regional context, study designs, participants and applied intervention to determine the quality of the paper. Overall, transportation costs, stigma, food insufficiency, disclosure or non-disclosure of HIV status, community and family have a significant effect on adherence to antiretroviral prescriptions among pregnant women. Besides, finding out HIV status before pregnancy had more adherence to ARTs than finding out mid-term. These results were replicable across various studies showing external validity. Targeting these factors could improve the adherence levels of pregnant women undergoing ART.

References
Abongomera, G., Cook, A., Musiime, V., Chabala, C., Lamorde, M., Abach, J., … & Kityo, C. (2017). Improved adherence to antiretroviral therapy observed among HIV-infected children whose caregivers had positive beliefs in medicine in Sub-Saharan Africa. AIDS and Behavior, 21(2), 441-449.
Bijker, R., Jiamsakul, A., Kityo, C., Kiertiburanakul, S., Siwale, M., Phanuphak, P., … & Boender, T. S. (2017). Adherence to antiretroviral therapy for HIV in Sub‐Saharan Africa and Asia: a comparative analysis of two regional cohorts. Journal of the International AIDS Society, 20(1), 21218.
Kharsany, A. B., & Karim, Q. A. (2016). HIV Infection and AIDS in Sub-Saharan Africa: Current Status, Challenges and Opportunities. The open AIDS journal, 10, 34-48. doi:10.2174/1874613601610010034
Omonaiye, O., Kusljic, S., Nicholson, P., & Manias, E. (2018). Medication adherence in pregnant women with human immunodeficiency virus receiving antiretroviral therapy in sub-Saharan Africa: a systematic review. BMC public health, 18(1), 805.

Appendix
Table 1 Evaluation Table
Authors/Year of Citation Research Design Data Collection Methods Sample Characteristics Key Findings
Abongomera et al., 2017 Randomized controlled clinical trial The Beliefs about Medicine Questionnaire informed on caregivers attitudes while the Medication Events Monitoring caps and viral load of HIV-1 informed the adherence to medication. Caregivers of children with HIV infection Caregivers that believe in the efficacy of the medication ensured high adherence of their patients to ARTs.
Bijker et al., 2017
Multicenter prospective study A 30-day visual analog scale recorded patient-reported adherence to ART. Predictors of non-adherence were analyzed through regressions and imputations. HIV-infected persons taking first-line ARTs and have follow-up episodes with their providers to assess adherence and viral load Low adherence was common in males, young persons and persons taking concomitant medication in the African cohort. Homosexuals had higher adherence while injecting drug users reported lower adherence in the Asian cohort.
Kalichman, Pellowski & Chen, 2013
Case series Test of Functional Health Literacy in Adults (TOFHLA), audio-computerized self-interviewing and CD4 counts and viral loads were used to extract the variables 474 HIV/AIDS-infected persons getting antiretroviral therapy with less than 90 % on the health literacy test Individuals that requested informational assistance adopted multiple adherence strategies, poor adherence and stifling of HIV infection.
Kharsany & Karim, 2016
Systematic review Persons at risk of or infected with HIV/AIDS Preventing HIV infection in young women will have positive epidemiological results
Omonaiye, Kusljic, Nicholson & Manias, 2018
Systematic review Electronic search of MEDLINE, CINAHL, and Global Health Database Articles with keywords: HIV AND (Pregnancy OR Pregnant*) AND (PMTCT OR “PMTCT Cascade”
OR “Vertical Transmission” OR “Mother-to-Child”) AND (Prevent OR Prevention) AND (HAART OR “Antiretroviral
Therapy” OR “Triple Therapy”) AND (Retention OR Concordance OR Adherence OR Compliance) Transportation costs, stigma, food insufficiency, disclosure or non-disclosure of HIV status, community and family have a significant effect on adherence to antiretroviral prescriptions among pregnant women. Also, finding out HIV status before pregnancy had more adherence to ARTs than finding out mid-term.