Department of Public Health, Federal University of Technology, Owerri, Nigeria.
RAHI Medical Outreach, Port Harcourt, Nigeria.
PLoS One. 2019 May 9;14(5):e0213742. doi: 10.1371/journal.pone.0213742. eCollection 2019.
This study assesses malaria prevention and treatment behaviour among people living with HIV/AIDS (PLWHA) in Owerri, South Eastern Nigeria. Although Nigeria bears one of the world's largest burdens of both malaria and HIV, there is almost no research studying how co-infected patients manage their care. We systematically sampled 398 PLWHA receiving care at Imo State Specialist Hospital and the Federal Medical Centre in Owerri to complete a structured, pre-tested questionnaire on malaria care-seeking behaviour. Descriptive statistics were reported and chi-square tests and multivariate logistic regressions were also used. The majority of HIV-infected patients (78.9%) reported having had an episode of suspected malaria quarterly or more often. There was a large variation in care-seeking patterns: on suspicion of malaria, 29.1% of participants engaged in self-medication; 39.2% went to drug shops, and only 22.6% visited HIV/AIDS care centres. Almost 40% waited more than 24 hours before initiating treatment. Most (60.3%), reported taking recommended artemisinin-based combination treatments (ACT) but a significant minority took only paracetamol (25.6%) or herbal remedies (3.5%). Most (80%) finished their chosen course of treatment; and completion of treatment was significantly associated with the frequency of suspected malaria occurrence (p = 0.03). Most (62.8%) did not take anti-malaria medication while taking antiretroviral treatment (ART) and almost all (87.6%) reported taking an ACT regimen that could potentially interact with Nigeria's first-line ART regimen. Our findings suggest the need to pay more attention to malaria prevention and control as a crucial element in HIV/AIDS management in this part of Nigeria and other areas where malaria and HIV/AIDS are co-endemic. Also, more research on ART-ACT interactions, better outreach to community-level drug shops and other private sector stakeholders, and clearer guidelines for clinicians and patients on preventing and managing co-infection may be needed. This will require improved collaboration between programmes for both diseases.
本研究评估了尼日利亚东南部奥韦里（Owerri）地区艾滋病毒/艾滋病（PLWHA）患者的疟疾预防和治疗行为。尽管尼日利亚是世界上疟疾和艾滋病毒负担最重的国家之一，但几乎没有研究关注合并感染患者如何管理其护理。我们系统地在伊莫州立专科医院和奥韦里联邦医疗中心抽取了 398 名接受治疗的 PLWHA，让他们填写一份关于疟疾求医行为的结构化、预先测试的问卷。报告了描述性统计数据，并使用了卡方检验和多变量逻辑回归。大多数 HIV 感染者（78.9%）报告说每季度或更频繁地出现疑似疟疾发作。求医模式存在很大差异：怀疑疟疾时，29.1%的参与者自行用药；39.2%去药店，只有 22.6%去艾滋病病毒/艾滋病护理中心。近 40%的人在开始治疗前等待超过 24 小时。大多数人（60.3%）报告服用了推荐的青蒿素为基础的联合治疗（ACT），但少数人只服用扑热息痛（25.6%）或草药（3.5%）。大多数人（80%）完成了他们选择的疗程；怀疑疟疾发作的频率与完成治疗显著相关（p=0.03）。大多数人（62.8%）在服用抗逆转录病毒治疗（ART）时不服用抗疟疾药物，几乎所有人（87.6%）报告服用了一种可能与尼日利亚一线 ART 方案相互作用的 ACT 方案。我们的研究结果表明，需要更加关注疟疾的预防和控制，将其作为尼日利亚和其他疟疾和艾滋病毒/艾滋病共存地区艾滋病管理的一个关键因素。此外，可能需要对 ART-ACT 相互作用进行更多研究，向社区一级药店和其他私营部门利益攸关方进行更好的宣传，并为临床医生和患者制定关于预防和管理合并感染的更明确指南。这将需要改善这两种疾病的规划之间的合作。
