Massive scale-up of HIV and AIDS treatment services with good clinical outcomes is feasible in primary care settings in sub-Saharan Africa. Most mortality occurs early, suggesting that earlier diagnosis and treatment may improve outcomes.

Background The impact of COVID-19 on physical and mental health and employment after hospitalisation with acute disease is not well understood. The aim of this study was to determine the effects of COVID-19-related hospitalisation on health and employment, to identify factors associated with recovery, and to describe recovery phenotypes. MethodsThe Post-hospitalisation COVID-19 study (PHOSP-COVID) is a multicentre, long-term follow-up study of adults (aged ≥18 years) discharged from hospital in the UK with a clinical diagnosis of COVID-19, involving an assessment between 2 and 7 months after discharge, including detailed recording of symptoms, and physiological and biochemical testing. Multivariable logistic regression was done for the primary outcome of patient-perceived recovery, with age, sex, ethnicity, body-mass index, comorbidities, and severity of acute illness as covariates. A posthoc cluster analysis of outcomes for breathlessness, fatigue, mental health, cognitive impairment, and physical performance was done using the clustering large applications k-medoids approach. The study is registered on the ISRCTN Registry (ISRCTN10980107). Findings We report findings for 1077 patients discharged from hospital between March 5 and Nov 30, 2020, who underwent assessment at a median of 5•9 months (IQR 4•9-6•5) after discharge. Participants had a mean age of 58 years (SD 13); 384 (36%) were female, 710 (69%) were of white ethnicity, 288 (27%) had received mechanical ventilation, and 540 (50%) had at least two comorbidities. At follow-up, only 239 (29%) of 830 participants felt fully recovered, 158 (20%) of 806 had a new disability (assessed by the Washington Group Short Set on Functioning), and 124 (19%) of 641 experienced a health-related change in occupation. Factors associated with not recovering were female sex, middle age (40-59 years), two or more comorbidities, and more severe acute illness. The magnitude of the persistent health burden was substantial but only weakly associated with the severity of acute illness. Four clusters were identified with different severities of mental and physical health impairment (n=767): very severe (131 patients, 17%), severe (159, 21%), moderate along with cognitive impairment (127, 17%), and mild (350, 46%). Of the outcomes used in the cluster analysis, all were closely related except for cognitive impairment. Three (3%) of 113 patients in the very severe cluster, nine (7%) of 129 in the severe cluster, 36 (36%) of 99 in the moderate cluster, and 114 (43%) of 267 in the mild cluster reported feeling fully recovered. Persistently elevated serum C-reactive protein was positively associated with cluster severity.Interpretation We identified factors related to not recovering after hospital admission with COVID-19 at 6 months after discharge (eg, female sex, middle age, two or more comorbidities, and more acute severe illness), and four different recovery phenotypes. The severity of physical and mental health impairments were closely related, whereas cognitive health impairments w...

Y THE END OF 2006, AN ESTImated 2.3 million children worldwide were living with human immunodeficiency virus type 1 (HIV-1). 1 Although most children acquire the virus through largely preventable mother-to-child transmission, roll-out of perinatal HIV prevention services has been sluggish worldwide. As a result, each day more than 1000 children become newly infected. 2 Without treatment, approximately half will die by their second birthday 3 ; however, lives can be extended and morbidity avoided with combination antiretroviral therapy (ART). In Zambia, recent progress has been made toward reducing new pediatric infections through aggressive scale-up of perinatal HIV prevention services. 4 Despite these efforts, 130 000 children are Author Affiliations are listed at the end of this article.

Background: The provision of food supplementation to food insecure patients initiating antiretroviral therapy may improve adherence to medications. Methods: A home-based adherence support program at 8 government clinics assessed patients for food insecurity. 4 clinics provided food supplementation and 4 acted as controls. The analysis compared adherence (assessed by medication possession ratio [MPR]), CD4, and weight gain outcomes among food insecure patients enrolled at the food clinics to those of controls. Results: Between May 1, 2004 and March 31, 2005, 636 food insecure adults were enrolled. Food supplementation was associated with better adherence to therapy. 258 of 366 (70%) of patients in the food group achieved an MPR of 95% or greater versus 79 of 166 (48%) among controls (relative risk, RR=1.5; 95%CI:1.2-1.8). This finding was unchanged after adjustment for sex, age, baseline CD4 count, baseline WHO stage, and baseline hemoglobin. We did not observe a significant effect of food supplementation on weight gain or CD4 cell response. Conclusions: This analysis suggests that providing food to food insecure patients initiating ART is feasible and may improve adherence to medication. A large randomized study of the clinical benefits of food supplementation to ART patients is urgently needed to inform international policy.

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