Main Article Content
Abstract
This current study looked at the risk factors and preventive measures among persons living with HIV who access ART care at the Sunyani Bono Regional Hospital. A cross-sectional study was used because it simultaneously assesses both outcome and exposure variables. 340 people out of the projected 5430 in the municipality were sampled. Convenience sampling was used to select currently well PLWHA attending the ART clinic in the Bono Regional Hospital for the study. The most prevalent potential risk factors identified were lack of purification of drinking water (88.5%), farming and gardening activities (42.9%), handling cat feces without personal protection (21.0%), not washing fruits before eating (3.1%), not washing vegetables before cooking (1.2%), and an unquantified consumption of undercooked meat. The preventive measures assessed were the use of co-trimoxazole preventive therapy (CPT) and antiretroviral therapy (ART), adherence to which was tested for their relationships with socio-demographic characteristics and challenges to adherence at the first four levels of the social-ecological model. Strong predictors of adherence were occupation and satisfaction with ARVs. However, in this study, no significant relationship was found with the multivariate analysis. Similarly, no significant relationship was identified between age and adherence to CPT at any stage of the analysis in this research study. It is recommended that clinicians who are involved in ART care encourage patients in all categories of occupations to make their treatment a priority since their health is vital to all other pursuits in their lives.
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References
- Abuelezam, N., McCormick, A., Surface, E., Fussell, T., Freedberg, K., Lipsitch, M., & Seage, G. (2019). Modelling the epidemiologic impact of achieving UNAIDS fast track 90-90-90 and 95-95-95 targets in South Africa. Epidemiology & Infection, 147.
- Addo, S. A., Abdulai, M., Yawson, A., Baddoo, A. N., Zhao, J., Workneh, N., Okae, I., & Wiah, E. (2018). Availability of HIV services along the continuum of HIV testing, care and treatment in Ghana. BMC Health Services Research, 18(1), 1–10.
- Agrawal, D., & Hussain, N. (2005). Decompressive craniectomy in cerebral toxoplasmosis. European Journal of Clinical Microbiology and Infectious Diseases, 24(11), 772–773.
- Azovtseva, O., Viktorova, E., Bakulina, E., Shelomov, A., & Trofimova, T. (2020). Cerebral toxoplasmosis in HIV-infected patients over 2015–2018 (a case study of Russia). Epidemiology & Infection, 148.
- Bamba, S., Zoungrana, J., Nikièma, Z., Sondo, A. K., Ndiaye, J.-L., & Bretagne, S. (2017). Impact of alternative treatment approach for cerebral toxoplasmosis among HIV/AIDS patients from a resourcepoor setting in Burkina Faso. Annals of Parasitology, 63(3).
- Bhatti, A. B., Usman, M., Kandi, V., Bhatti, A. B., Usman, M., & Kandi, V. (2016). Current Scenario of HIV/AIDS, Treatment Options, and Major Challenges with Compliance to Antiretroviral Therapy. Cureus, 8(3). https://doi.org/10.7759/cureus.515
- Boakye, D. S., & Mavhandu-Mudzusi, A. H. (2019). Nurses knowledge, attitudes and practices towards patients with HIV and AIDS in Kumasi, Ghana. International Journal of Africa Nursing Sciences, 11, 100147. https://doi.org/10.1016/j.ijans.2019.05.001
- Carlucci, J. G., Kamanga, A., Sheneberger, R., Shepherd, B. E., Jenkins, C. A., Spurrier, J., & Vermund, S. H. (2008). Predictors of Adherence to Antiretroviral Therapy in Rural Zambia. JAIDS Journal of Acquired Immune Deficiency Syndromes, 47(5), 615–622. https://doi.org/10.1097/QAI.0b013e318165dc25
- Connolly, M. P., Haitsma, G., Hernández, A. V., & Vidal, J. E. (2017). Systematic review and meta-analysis of secondary prophylaxis for prevention of HIV-related toxoplasmic encephalitis relapse using trimethoprim-sulfamethoxazole. Pathogens and Global Health, 111(6), 327–331. https://doi.org/10.1080/20477724.2017.1377974
- Dzansi, G., Tornu, E., & Chipps, J. (2020). Promoters and inhibitors of treatment adherence among HIV/AIDS patients receiving antiretroviral therapy in Ghana: Narratives from an underserved population. PloS One, 15(3), e0230159.
- Errata: Evaluation of co-trimoxazole Adherence in Infants of HIV Positive Mothers aged 6 weeks to 6 months in Lagos Nigeria. Nigerian Hospital Practice, 23(4–5), Article 4–5. https://doi.org/10.4314/nhp.v23i4-5.
- Eshun-Wilson, I., Rohwer, A., Hendricks, L., Oliver, S., & Garner, P. (2019). Being HIV positive and staying on antiretroviral therapy in Africa: A qualitative systematic review and theoretical model. PloS One, 14(1), e0210408.
- Global HIV Programme. (2021). Retrieved 28 October 2021, from https://www.who.int/teams/global-hiv-hepatitis-and-stis-programmes/hiv/strategic-information/hiv-data-and-statistics
- Irungu, B. N., Koech, L. C., Ondicho, J. M., & Keter, L. K. (2021). Quality assessment of selected co-trimoxazole suspension brands marketed in Nairobi County, Kenya. PLOS ONE, 16(9), e0257625. https://doi.org/10.1371/journal.pone.0257625
- Kelly, M., McCarthy, S., & Sahm, L. J. (2014). Knowledge, attitudes and beliefs of patients and carers regarding medication adherence: A review of qualitative literature. European Journal of Clinical Pharmacology, 70(12), 1423–1431.
- Kijlstra, A., & Jongert, E. (2008a). Control of the risk of human toxoplasmosis transmitted by meat. International Journal for Parasitology, 38(12), 1359–1370. https://doi.org/10.1016/j.ijpara.2008.06.002
- Kijlstra, A., & Jongert, E. (2008b). Control of the risk of human toxoplasmosis transmitted by meat. International Journal for Parasitology, 38(12), 1359–1370. https://doi.org/10.1016/j.ijpara.2008.06.002
- Kirk, O., Lundgren, J. D., Nielsen, H., & Gerstoft, J. (1999). Can chemoprophylaxis against opportunistic infections be discontinued after an increase in CD4 cells induced by highly active antiretroviral therapy? Aids, 13(13), 1647–1651.
- Kongsaengdao, S., Samintarapanya, K., Oranratnachai, K., Prapakarn, W., & Apichartpiyakul, C. (2008). Randomized controlled trial of pyrimethamine plus sulfadiazine versus trimethoprim plus sulfamethoxazole for treatment of toxoplasmic encephalitis in AIDS patients. Journal of the International Association of Physicians in AIDS Care, 7(1), 11–16.
- Kumarasamy, N., Safren, S. A., Raminani, S. R., Pickard, R., James, R., Krishnan, A. S., Solomon, S., & Mayer, K. H. (2005). Barriers and facilitators to antiretroviral medication adherence among patients with HIV in Chennai, India: A qualitative study. AIDS Patient Care & STDs, 19(8), 526–537.
- Lee, G. T., Antelo, F., & Mlikotic, A. A. (2009). Cerebral toxoplasmosis. Radiographics, 29(4), 1200–1205.
- Luma, H. N., Tchaleu, B. C. N., Mapoure, Y. N., Temfack, E., Doualla, M. S., Halle, M. P., Joko, H. A., & Koulla-Shiro, S. (2013). Toxoplasma encephalitis in HIV/AIDS patients admitted to the Douala general hospital between 2004 and 2009: A cross sectional study. BMC Research Notes, 6(1), 1–5.
- MacCarthy, S., Saya, U., Samba, C., Birungi, J., Okoboi, S., & Linnemayr, S. (2018). “How am I going to live?”: Exploring barriers to ART adherence among adolescents and young adults living with HIV in Uganda. BMC Public Health, 18(1), 1158. https://doi.org/10.1186/s12889-018-6048-7
- Matheus, M., Serrat, A., Vante, I., & Shinde, A. (2021). Anisocoria, An Unusual Physical Exam Finding Leading To A Concurrent Diagnosis Of Cerebral Toxoplasmosis And Hiv/Aids. Journal of Infectious Diseases & Case Reports. SRC/JIDSCR-152. DOI: Https://Doi. Org/10.47363/JIDSCR/2021 (2), 137, 3.
- Mboera, L. E. G., Kishamawe, C., Kimario, E., & Rumisha, S. F. (2019). Mortality Patterns of Toxoplasmosis and Its Comorbidities in Tanzania: A 10-Year Retrospective Hospital-Based Survey. Frontiers in Public Health, 7, 25. https://doi.org/10.3389/fpubh.2019.00025
- Müller, P., & Velez Lapão, L. (2021). Mixed methods systematic review and metasummary about barriers and facilitators for the implementation of cotrimoxazole and isoniazid – preventive therapies for people living with HIV [Preprint]. HIV/AIDS. https://doi.org/10.1101/2021.04.30.21256370
- Navia, B. A., Petito, C. K., Gold, J. W., Cho, E., Jordan, B. D., & Price, R. W. (1986). Cerebral toxoplasmosis complicating the acquired immune deficiency syndrome: Clinical and neuropathological findings in 27 patients. Annals of Neurology, 19(3), 224–238.
- Ogendi, E., Maina, N., Kagira, J., Ngotho, M., Mbugua, G., & Karanja, S. (2013a). Questionnaire Survey on the Occurrence of Risk factors for Toxoplasma gondii infection amongst Farmers in Thika District, Kenya. Journal of the South African Veterinary Association, 84(1). https://doi.org/10.4102/jsava.v84i1.191
- Owusu, A. Y. (2020). Social contexts of living with HIV/AIDS in the Eastern Region of Ghana. Istanbul University Journal of Sociology, 39(2), 425–454.
- Pappoe, F., Cheng, W., Wang, L., Li, Y., Obiri-Yeboah, D., Nuvor, S. V., Ambachew, H., Hu, X., Luo, Q., & Chu, D. (2017). Prevalence of Toxoplasma gondii infection in HIV-infected patients and food animals and direct genotyping of T. gondii isolates, Southern Ghana. Parasitology Research, 116(6), 1675–1685.
- Reda, A. A., & Biadgilign, S. (2012). Determinants of Adherence to Antiretroviral Therapy among HIV-Infected Patients in Africa. AIDS Research and Treatment, 2012, e574656. https://doi.org/10.1155/2012/574656
- Rostami, A., Keshavarz, H., Shojaee, S., Mohebali, M., & Meamar, A. R. (2014). Frequency of Toxoplasma gondii in HIV Positive Patients from West of Iran by ELISA and PCR. 9(4), 8.
- Saavedra, A., Campinha-Bacote, N., Hajjar, M., Kenu, E., Gillani, F. S., Obo-Akwa, A., Lartey, M., & Kwara, A. (2017). Causes of death and factors associated with early mortality of HIV-infected adults admitted to Korle-Bu Teaching Hospital. Pan African Medical Journal, 27(1).
- Scott Sutton, S., Magagnoli, J., & Hardin, J. W. (2016). Impact of Pill Burden on Adherence, Risk of Hospitalization, and Viral Suppression in Patients with HIV Infection and AIDS Receiving Antiretroviral Therapy. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 36(4), 385–401. https://doi.org/10.1002/phar.1728
- Smurzynski, M., Wu, K., Benson, C. A., Bosch, R. J., Collier, A. C., & Koletar, S. L. (2010a). Relationship between CD4+ T-cell counts/HIV-1 RNA plasma viral load and AIDS defining events among persons followed in the ACTG Longitudinal Linked Randomized Trials (ALLRT) study. Journal of Acquired Immune Deficiency Syndromes (1999), 55(1), 117.
- Smurzynski, M., Wu, K., Benson, C. A., Bosch, R. J., Collier, A. C., & Koletar, S. L. (2010b). Relationship between CD4+ T-cell counts/HIV-1 RNA plasma viral load and AIDS defining events among persons followed in the ACTG Longitudinal Linked Randomized Trials (ALLRT) study. Journal of Acquired Immune Deficiency Syndromes (1999), 55(1), 117.
- Swami, A., Thakuria, R., & Kharat, S. (2015). Cerebral toxoplasmosis in a treatment naive HIV patient with high CD4 count responding to treatment with a regime of cotrimoxazole and pyrimethamine: Do we need to start prophylaxis for toxoplasmosis at a higher CD4 count. HIV/AIDS Research and Treatment, 2(3), 72–75.
- Tetteh, R. A., Nartey, E. T., Lartey, M., Yankey, B., Mantel-Teeuwisse, A. K., Leufkens, H. G., Acheampong, F., & Dodoo, A. N. (2018). Knowledge and Attitudes of HIV Infected Patients on the Adverse Effects of Antiretroviral Medicines in Ghana. THE USE AND SAFETY OF ANTIRETROVIRAL MEDICINES-LESSONS FROM GHANA, 117.
- Teutsch, S. M., Juranek, D. D., Sulzer, A., Dubey, J. P., & Sikes, R. K. (1979). Epidemic Toxoplasmosis Associated with Infected Cats. New England Journal of Medicine, 300(13), 695–699. https://doi.org/10.1056/NEJM197903293001302
- Vidal, J. E. (2019). HIV-Related Cerebral Toxoplasmosis Revisited: Current Concepts and Controversies of
- an Old Disease. Journal of the International Association of Providers of AIDS Care, 18, 2325958219867315. https://doi.org/10.1177/2325958219867315
- Vidal, J. E., Hernandez, A. V., De Oliveira, A. C. P., Dauar, R. F., Barbosa Jr, S. P., & Focaccia, R. (2005). Cerebral toxoplasmosis in HIV-positive patients in Brazil: Clinical features and predictors of treatment response in the HAART era. AIDS Patient Care & Stds, 19(10), 626–634.
- Zachariah, R., Ford, N., Philips, M., S.Lynch, Massaquoi, M., Janssens, V., & Harries, A. D. (2009). Task shifting in HIV/AIDS: Opportunities, challenges and proposed actions for sub-Saharan Africa. Transactions of the Royal Society of Tropical Medicine and Hygiene, 103(6), 549–558. https://doi.org/10.1016/j.trstmh.2008.09.019
References
Abuelezam, N., McCormick, A., Surface, E., Fussell, T., Freedberg, K., Lipsitch, M., & Seage, G. (2019). Modelling the epidemiologic impact of achieving UNAIDS fast track 90-90-90 and 95-95-95 targets in South Africa. Epidemiology & Infection, 147.
Addo, S. A., Abdulai, M., Yawson, A., Baddoo, A. N., Zhao, J., Workneh, N., Okae, I., & Wiah, E. (2018). Availability of HIV services along the continuum of HIV testing, care and treatment in Ghana. BMC Health Services Research, 18(1), 1–10.
Agrawal, D., & Hussain, N. (2005). Decompressive craniectomy in cerebral toxoplasmosis. European Journal of Clinical Microbiology and Infectious Diseases, 24(11), 772–773.
Azovtseva, O., Viktorova, E., Bakulina, E., Shelomov, A., & Trofimova, T. (2020). Cerebral toxoplasmosis in HIV-infected patients over 2015–2018 (a case study of Russia). Epidemiology & Infection, 148.
Bamba, S., Zoungrana, J., Nikièma, Z., Sondo, A. K., Ndiaye, J.-L., & Bretagne, S. (2017). Impact of alternative treatment approach for cerebral toxoplasmosis among HIV/AIDS patients from a resourcepoor setting in Burkina Faso. Annals of Parasitology, 63(3).
Bhatti, A. B., Usman, M., Kandi, V., Bhatti, A. B., Usman, M., & Kandi, V. (2016). Current Scenario of HIV/AIDS, Treatment Options, and Major Challenges with Compliance to Antiretroviral Therapy. Cureus, 8(3). https://doi.org/10.7759/cureus.515
Boakye, D. S., & Mavhandu-Mudzusi, A. H. (2019). Nurses knowledge, attitudes and practices towards patients with HIV and AIDS in Kumasi, Ghana. International Journal of Africa Nursing Sciences, 11, 100147. https://doi.org/10.1016/j.ijans.2019.05.001
Carlucci, J. G., Kamanga, A., Sheneberger, R., Shepherd, B. E., Jenkins, C. A., Spurrier, J., & Vermund, S. H. (2008). Predictors of Adherence to Antiretroviral Therapy in Rural Zambia. JAIDS Journal of Acquired Immune Deficiency Syndromes, 47(5), 615–622. https://doi.org/10.1097/QAI.0b013e318165dc25
Connolly, M. P., Haitsma, G., Hernández, A. V., & Vidal, J. E. (2017). Systematic review and meta-analysis of secondary prophylaxis for prevention of HIV-related toxoplasmic encephalitis relapse using trimethoprim-sulfamethoxazole. Pathogens and Global Health, 111(6), 327–331. https://doi.org/10.1080/20477724.2017.1377974
Dzansi, G., Tornu, E., & Chipps, J. (2020). Promoters and inhibitors of treatment adherence among HIV/AIDS patients receiving antiretroviral therapy in Ghana: Narratives from an underserved population. PloS One, 15(3), e0230159.
Errata: Evaluation of co-trimoxazole Adherence in Infants of HIV Positive Mothers aged 6 weeks to 6 months in Lagos Nigeria. Nigerian Hospital Practice, 23(4–5), Article 4–5. https://doi.org/10.4314/nhp.v23i4-5.
Eshun-Wilson, I., Rohwer, A., Hendricks, L., Oliver, S., & Garner, P. (2019). Being HIV positive and staying on antiretroviral therapy in Africa: A qualitative systematic review and theoretical model. PloS One, 14(1), e0210408.
Global HIV Programme. (2021). Retrieved 28 October 2021, from https://www.who.int/teams/global-hiv-hepatitis-and-stis-programmes/hiv/strategic-information/hiv-data-and-statistics
Irungu, B. N., Koech, L. C., Ondicho, J. M., & Keter, L. K. (2021). Quality assessment of selected co-trimoxazole suspension brands marketed in Nairobi County, Kenya. PLOS ONE, 16(9), e0257625. https://doi.org/10.1371/journal.pone.0257625
Kelly, M., McCarthy, S., & Sahm, L. J. (2014). Knowledge, attitudes and beliefs of patients and carers regarding medication adherence: A review of qualitative literature. European Journal of Clinical Pharmacology, 70(12), 1423–1431.
Kijlstra, A., & Jongert, E. (2008a). Control of the risk of human toxoplasmosis transmitted by meat. International Journal for Parasitology, 38(12), 1359–1370. https://doi.org/10.1016/j.ijpara.2008.06.002
Kijlstra, A., & Jongert, E. (2008b). Control of the risk of human toxoplasmosis transmitted by meat. International Journal for Parasitology, 38(12), 1359–1370. https://doi.org/10.1016/j.ijpara.2008.06.002
Kirk, O., Lundgren, J. D., Nielsen, H., & Gerstoft, J. (1999). Can chemoprophylaxis against opportunistic infections be discontinued after an increase in CD4 cells induced by highly active antiretroviral therapy? Aids, 13(13), 1647–1651.
Kongsaengdao, S., Samintarapanya, K., Oranratnachai, K., Prapakarn, W., & Apichartpiyakul, C. (2008). Randomized controlled trial of pyrimethamine plus sulfadiazine versus trimethoprim plus sulfamethoxazole for treatment of toxoplasmic encephalitis in AIDS patients. Journal of the International Association of Physicians in AIDS Care, 7(1), 11–16.
Kumarasamy, N., Safren, S. A., Raminani, S. R., Pickard, R., James, R., Krishnan, A. S., Solomon, S., & Mayer, K. H. (2005). Barriers and facilitators to antiretroviral medication adherence among patients with HIV in Chennai, India: A qualitative study. AIDS Patient Care & STDs, 19(8), 526–537.
Lee, G. T., Antelo, F., & Mlikotic, A. A. (2009). Cerebral toxoplasmosis. Radiographics, 29(4), 1200–1205.
Luma, H. N., Tchaleu, B. C. N., Mapoure, Y. N., Temfack, E., Doualla, M. S., Halle, M. P., Joko, H. A., & Koulla-Shiro, S. (2013). Toxoplasma encephalitis in HIV/AIDS patients admitted to the Douala general hospital between 2004 and 2009: A cross sectional study. BMC Research Notes, 6(1), 1–5.
MacCarthy, S., Saya, U., Samba, C., Birungi, J., Okoboi, S., & Linnemayr, S. (2018). “How am I going to live?”: Exploring barriers to ART adherence among adolescents and young adults living with HIV in Uganda. BMC Public Health, 18(1), 1158. https://doi.org/10.1186/s12889-018-6048-7
Matheus, M., Serrat, A., Vante, I., & Shinde, A. (2021). Anisocoria, An Unusual Physical Exam Finding Leading To A Concurrent Diagnosis Of Cerebral Toxoplasmosis And Hiv/Aids. Journal of Infectious Diseases & Case Reports. SRC/JIDSCR-152. DOI: Https://Doi. Org/10.47363/JIDSCR/2021 (2), 137, 3.
Mboera, L. E. G., Kishamawe, C., Kimario, E., & Rumisha, S. F. (2019). Mortality Patterns of Toxoplasmosis and Its Comorbidities in Tanzania: A 10-Year Retrospective Hospital-Based Survey. Frontiers in Public Health, 7, 25. https://doi.org/10.3389/fpubh.2019.00025
Müller, P., & Velez Lapão, L. (2021). Mixed methods systematic review and metasummary about barriers and facilitators for the implementation of cotrimoxazole and isoniazid – preventive therapies for people living with HIV [Preprint]. HIV/AIDS. https://doi.org/10.1101/2021.04.30.21256370
Navia, B. A., Petito, C. K., Gold, J. W., Cho, E., Jordan, B. D., & Price, R. W. (1986). Cerebral toxoplasmosis complicating the acquired immune deficiency syndrome: Clinical and neuropathological findings in 27 patients. Annals of Neurology, 19(3), 224–238.
Ogendi, E., Maina, N., Kagira, J., Ngotho, M., Mbugua, G., & Karanja, S. (2013a). Questionnaire Survey on the Occurrence of Risk factors for Toxoplasma gondii infection amongst Farmers in Thika District, Kenya. Journal of the South African Veterinary Association, 84(1). https://doi.org/10.4102/jsava.v84i1.191
Owusu, A. Y. (2020). Social contexts of living with HIV/AIDS in the Eastern Region of Ghana. Istanbul University Journal of Sociology, 39(2), 425–454.
Pappoe, F., Cheng, W., Wang, L., Li, Y., Obiri-Yeboah, D., Nuvor, S. V., Ambachew, H., Hu, X., Luo, Q., & Chu, D. (2017). Prevalence of Toxoplasma gondii infection in HIV-infected patients and food animals and direct genotyping of T. gondii isolates, Southern Ghana. Parasitology Research, 116(6), 1675–1685.
Reda, A. A., & Biadgilign, S. (2012). Determinants of Adherence to Antiretroviral Therapy among HIV-Infected Patients in Africa. AIDS Research and Treatment, 2012, e574656. https://doi.org/10.1155/2012/574656
Rostami, A., Keshavarz, H., Shojaee, S., Mohebali, M., & Meamar, A. R. (2014). Frequency of Toxoplasma gondii in HIV Positive Patients from West of Iran by ELISA and PCR. 9(4), 8.
Saavedra, A., Campinha-Bacote, N., Hajjar, M., Kenu, E., Gillani, F. S., Obo-Akwa, A., Lartey, M., & Kwara, A. (2017). Causes of death and factors associated with early mortality of HIV-infected adults admitted to Korle-Bu Teaching Hospital. Pan African Medical Journal, 27(1).
Scott Sutton, S., Magagnoli, J., & Hardin, J. W. (2016). Impact of Pill Burden on Adherence, Risk of Hospitalization, and Viral Suppression in Patients with HIV Infection and AIDS Receiving Antiretroviral Therapy. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 36(4), 385–401. https://doi.org/10.1002/phar.1728
Smurzynski, M., Wu, K., Benson, C. A., Bosch, R. J., Collier, A. C., & Koletar, S. L. (2010a). Relationship between CD4+ T-cell counts/HIV-1 RNA plasma viral load and AIDS defining events among persons followed in the ACTG Longitudinal Linked Randomized Trials (ALLRT) study. Journal of Acquired Immune Deficiency Syndromes (1999), 55(1), 117.
Smurzynski, M., Wu, K., Benson, C. A., Bosch, R. J., Collier, A. C., & Koletar, S. L. (2010b). Relationship between CD4+ T-cell counts/HIV-1 RNA plasma viral load and AIDS defining events among persons followed in the ACTG Longitudinal Linked Randomized Trials (ALLRT) study. Journal of Acquired Immune Deficiency Syndromes (1999), 55(1), 117.
Swami, A., Thakuria, R., & Kharat, S. (2015). Cerebral toxoplasmosis in a treatment naive HIV patient with high CD4 count responding to treatment with a regime of cotrimoxazole and pyrimethamine: Do we need to start prophylaxis for toxoplasmosis at a higher CD4 count. HIV/AIDS Research and Treatment, 2(3), 72–75.
Tetteh, R. A., Nartey, E. T., Lartey, M., Yankey, B., Mantel-Teeuwisse, A. K., Leufkens, H. G., Acheampong, F., & Dodoo, A. N. (2018). Knowledge and Attitudes of HIV Infected Patients on the Adverse Effects of Antiretroviral Medicines in Ghana. THE USE AND SAFETY OF ANTIRETROVIRAL MEDICINES-LESSONS FROM GHANA, 117.
Teutsch, S. M., Juranek, D. D., Sulzer, A., Dubey, J. P., & Sikes, R. K. (1979). Epidemic Toxoplasmosis Associated with Infected Cats. New England Journal of Medicine, 300(13), 695–699. https://doi.org/10.1056/NEJM197903293001302
Vidal, J. E. (2019). HIV-Related Cerebral Toxoplasmosis Revisited: Current Concepts and Controversies of
an Old Disease. Journal of the International Association of Providers of AIDS Care, 18, 2325958219867315. https://doi.org/10.1177/2325958219867315
Vidal, J. E., Hernandez, A. V., De Oliveira, A. C. P., Dauar, R. F., Barbosa Jr, S. P., & Focaccia, R. (2005). Cerebral toxoplasmosis in HIV-positive patients in Brazil: Clinical features and predictors of treatment response in the HAART era. AIDS Patient Care & Stds, 19(10), 626–634.
Zachariah, R., Ford, N., Philips, M., S.Lynch, Massaquoi, M., Janssens, V., & Harries, A. D. (2009). Task shifting in HIV/AIDS: Opportunities, challenges and proposed actions for sub-Saharan Africa. Transactions of the Royal Society of Tropical Medicine and Hygiene, 103(6), 549–558. https://doi.org/10.1016/j.trstmh.2008.09.019