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People who are asymptomatic and feel healthy, including pregnant women, may be less motivated to initiate antiretroviral therapy (ART) or achieve high adherence. We assessed whether ART initiation, and viral suppression 6, 12, and 24 months after ART initiation, were lower in HIV-infected members of serodiscordant couples who initiated during pregnancy or with higher CD4 counts. We used data from the Partners Demonstration Project, an open-label study of the delivery of integrated pre-exposure prophylaxis and ART (at any CD4 count) for HIV prevention among high-risk HIV serodiscordant couples in Kenya and Uganda. Differences in viral suppression (HIV RNA 500 cells/mm3) and during pregnancy were estimated using Poisson regression. Of 865 HIV-infected participants retained after becoming eligible for ART during study follow-up, 95% initiated ART. Viral suppression 24 months after ART initiation was high overall (97%), and comparable among those initiating ART at CD4 counts >500, 351–500, and ≤350 cells/mm3 [96% vs. 97% vs. 97%; relative risk (RR) 0.98; 95% confidence interval (CI): 0.93–1.03 for CD4 > 500 vs.

Background: Tuberculosis among non-UK-born Black Africans has been gradually recognized as a public health problem in the UK despite the various interventions implemented. Objectives: To explore the perceptions of non-UK-born Black Africans about TB health risk; to explore the health seeking behavior of the non-UK-born Black Africans in relation to TB and to explore lay views on TB health education and screening as opportunities for health promotion. Methodology and Study Design: A qualitative methodology was used on a purposively selected sample of 12 non-UK-born Black Africans living in Leeds. Face-to-face interviews were conducted to explore the lay perceptions about TB. Thematic analysis was used to derive important themes in accordance to the study objectives. Ethical approval was provided by Leeds Metropolitan University. Setting: Community setting of non-UK-born Black Africans in Leeds, UK. Results: This population holds mixed views and perceptions about tuberculosis, few facilitators and many barriers existed to current TB prevention efforts. The barriers included: language barriers, barriers related to services and systems, immigration status and stigma despite the benefits involved. The potential for black African communities to readily increase the likelihood of behavior change was found as an important finding for this study. Conclusions: Tuberculosis is a preventable public health problem. Involvement of the non-UK-born black Africans communities in the TB prevention may be beneficial for reducing and tackling TB rates in this population. Such an approach is potentially inexpensive and more readily implementable than other suggested strategies such as changes to immigration policies.

A 79-year-old man reports an 18-kg weight loss over the previous six months. Seven months before admission, his house burned down and insomnia and anorexia developed. One month before admission, he began having diffuse abdominal pain that a proton-pump inhibitor did not improve.