Jornal de AIDS e Pesquisa Clínica

Objective: This study aimed to assess infant feeding practice and associated factor among HIV positive mothers attending ART service in governmental health institutions of Bahirdar town, Ethiopia, 2017.
Methods: Institution based cross-sectional study was conducted in 3 Health centers and 1 Hospital which provides ART service in Bahirdar town from March to April, 2017. A total of 230 mother-infant pairs attending ART were selected by systematic random sampling technique. Structured interview was used to gather data on feeding practices. The data were coded, entered, cleaned and analyzed by SPSS software version 23. Bivariate and multivariate models were run to assess any relationship between each independent variable and outcome variables. Crude and adjusted odds ratios were used to ascertain for any association between the dependent and predictor variables while significance was determined using 95% confidence intervals.
Results: The majority 173 (75.2%) practiced exclusive breast feeding up to six months of age. 13.9% and 10.9% of mothers practiced exclusive replacement feeding and mixed feeding, respectively. In multiple logistic regressions, Attended postnatal care (AOR (95% CI: 6.69 (1.647-27.178))), Time of initiation of first breast feeding after delivery (AOR (95% CI: 13.94 (2.98-65.05))), awareness of mothers on mother to child transmission of HIV via breast feeding was significantly associated with infant feeding practice (AOR (95% CI: 0.004 (0.00-0.05))).
Conclusion: The study revealed that majority of the mothers’ experienced exclusive breast feeding (75.2%), postnatal care, time of initiation of first breast feeding after delivery and knowledge of MTCT during breast feeding were independent predictors of infant feeding practice.

Objective: The fixed dose combination (FDC) of tenofovir disoproxil (TD) fumarate/emtricitabine (FTC) has been the most widely used backbone treatment for HIV until recently. In 2016, tenofovir alafenamide (TAF)/FTC became available as FDC, which promises superior renal and bone safety. However, in November 2016, the German Federal Joint Committee concluded that there is no additional benefit to the use of TAF versus TD fumarate. The decision of choosing TD or TAF in FDC with FTC is of economic impact as cost-saving generics (Gx-TD/FTC) became available in Germany in August 2017.
Methods: A budget impact analysis (BIA) was conducted to estimate the impact of Gx-TD/FTC on the German healthcare system for 5-years. The BIA compared a theoretical setting with and without introduction of Gx-TD/FTC; calculating the respective costs for antiretroviral treatment, monitoring, and adverse event management.
Results: Based on the model assumptions, low and high values of year-wise savings with Gx-TD/FTC throughout 5 years were estimated. The scenario of Gx-TD/FTC use growing to 35% by year 5, deemed the most realistic scenario(switch from TDF/FTC to Gx-TD/FTC only), would result in a saving of €22.6 million in first year and a maximum saving of €31.8 million by second year. In a maximum patient share scenario (80%) for Gx-TD/FTC which includes switch from branded TD fumarate/FTC and TAF/FTC, savings increased from €22.6 million annually to a maximum of €62.1 million.
Conclusion: The estimated savings are based on a conservative approach and will be higher with increasing generic price rebates. Additionally, this analysis makes cautious assumptions in favor of patient safety and care pathways. This analysis highlights the potential for substantial and sustainable cost savings by the use of Gx-TD/FTC for the German healthcare system which is most pronounced when patients from branded TD fumarate/FTC and TAF/ FTC are switched to this generic treatment.

Aim: To determine the epidemiological profile and semiological characteristics of osteoarticular manifestations in people infected with human immunodefienciency virus (HIV) in the northern region of Togo.
Patients and methods: It was a cross-sectional study conductedon the records of patients with rheumatic affection and infected with HIV, admitted in rheumatologic consultation in Kara teaching hospital (Togo) from April 2012 to February 2017.
Results: Fifty-eight patients (70.69% female and 29.31% male) were HIV positive. Their meanage during consultation was 47.94 ± 9.13 years old. Traders (37.93%) and workers of informal sector (22.41%) were the most affected. The HIV infection was known by the patientin 45 cases before the consultation among which 41have beenunder antiretroviral therapy (ART). The main rheumatic manifestations were: degenerative pathology of the spine (28 cases), infectious pathology (12 cases of which 7 were Pott's disease), reactive arthritis (9 cases) and osteonecrosis (5 cases). The mean body mass index in the 58 patients was 23.77 Kg/m² ± 6.44.Fever(13.79%)and alteration of general condition (43.10%) were the main other signs observed. Anemia was present in 50% of cases. The erythrocyte sedimentation ratein the first hourwas higher than 50 mm in 62.06% of cases.
Conclusion: The degenerative pathology of the spine is common in rheumatic patients infected with HIV in Togo. However, there is an increasing part of the osteonecrosis directly related to HIV and the ART.

To evaluate support services for immigrant people living with HIV, a survey was done among HIV care providers of all 27 HIV treatment centers in the Netherlands. Although multiple support services are available, there is a need for additional care in the form of peer support, psychosocial care, and care for refugees and undocumented immigrants in rural areas. With the increase of immigrants in Europe, evaluation of support services in other European countries is recommended.