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Schönrich G, Raftery MJ. The PD-1/PD-L1 Axis and Virus Infections: A Delicate Balance. Front Cell Infect Microbiol 2019; 9:207. [PMID: 31263684 PMCID: PMC6584848 DOI: 10.3389/fcimb.2019.00207] [Citation(s) in RCA: 181] [Impact Index Per Article: 36.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 05/27/2019] [Indexed: 12/17/2022] Open
Abstract
Programmed cell death protein (PD-1) and its ligands play a fundamental role in the evasion of tumor cells from antitumor immunity. Less well appreciated is the fact that the PD-1/PD-L1 axis also regulates antiviral immune responses and is therefore modulated by a number of viruses. Upregulation of PD-1 and its ligands PD-L1 and PD-L2 is observed during acute virus infection and after infection with persistent viruses including important human pathogens such as human immunodeficiency virus (HIV), hepatitis C virus (HCV), and hepatitis B virus (HBV). Experimental evidence suggests that insufficient signaling through the PD-1 pathway promotes immunopathology during acute infection by exaggerating primary T cell responses. If chronic infection is established, however, high levels of PD-1 expression can have unfavorable immunological consequences. Exhaustion and suppression of antiviral immune responses can result in viral immune evasion. The role of the PD-1/PD-L1 axis during viral infections is further complicated by evidence that PD-L1 also mediates inflammatory effects in the acute phase of an immune response. In this review, we discuss the intricate interplay between viruses and the PD-1/PD-L1 axis.
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Affiliation(s)
- Günther Schönrich
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Virology, Berlin, Germany
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202
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Shimizu K, Nishiura H, Imamura A. Investigation of the Proportion of Diagnosed People Living with HIV/AIDS among Foreign Residents in Japan. J Clin Med 2019; 8:jcm8060804. [PMID: 31195745 PMCID: PMC6616594 DOI: 10.3390/jcm8060804] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 05/29/2019] [Accepted: 06/03/2019] [Indexed: 01/07/2023] Open
Abstract
Foreign residents represent an increasing proportion of newly diagnosed human immunodeficiency virus (HIV) infections and acquired immunodeficiency syndrome (AIDS) cases in Japan, though scant research has addressed this. This study aimed to estimate the diagnosed proportion of people living with HIV/AIDS (PLWHA) among foreign residents in Japan, covering 1990–2017 and stratifying by geographic region of the country of origin. A balance equation model was employed to statistically estimate the diagnosed proportion as a single parameter. This used published estimates of HIV incidence and prevalence, population size, visit duration, travel volume, as well as surveillance data on HIV/AIDS in Japan. The proportion varied widely by region: People from Western Europe, East Asia and the Pacific, Australia and New Zealand, and North America were underdiagnosed, while those from sub-Saharan Africa, South and South-East Asia, and Latin America were more frequently diagnosed. Overall, the diagnosed proportion of PLWHA among foreign residents in Japan has increased, but the latest estimate in 2017 was as low as 55.3%; lower than the estimate among Japanese on the order of 80% and far below the quoted goal of 90%. This finding indicates a critical need to investigate the underlying mechanisms, including disparate access to HIV testing.
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Affiliation(s)
- Kazuki Shimizu
- Graduate School of Medicine, Hokkaido University, Kita 15 Jo Nishi 7 Chome, Kita-ku, Sapporo-shi, Hokkaido 060-8638, Japan.
- CREST, Japan Science and Technology Agency, Honcho 4-1-8, Kawaguchi, Saitama 332-0012, Japan.
| | - Hiroshi Nishiura
- Graduate School of Medicine, Hokkaido University, Kita 15 Jo Nishi 7 Chome, Kita-ku, Sapporo-shi, Hokkaido 060-8638, Japan.
- CREST, Japan Science and Technology Agency, Honcho 4-1-8, Kawaguchi, Saitama 332-0012, Japan.
| | - Akifumi Imamura
- Department of Infectious Diseases, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo 113-8677, Japan.
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203
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Mangal TD, Pascom ARP, Vesga JF, Meireles MV, Benzaken AS, Hallett TB. Estimating HIV incidence from surveillance data indicates a second wave of infections in Brazil. Epidemics 2019; 27:77-85. [PMID: 30772250 PMCID: PMC6543066 DOI: 10.1016/j.epidem.2019.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 01/31/2019] [Accepted: 02/04/2019] [Indexed: 12/25/2022] Open
Abstract
Emerging evidence suggests that HIV incidence rates in Brazil, particularly among men, may be rising. Here we use Brazil's integrated health systems data to develop a mathematical model, reproducing the complex surveillance systems and providing estimates of HIV incidence, number of people living with HIV (PLHIV), reporting rates and ART initiation rates. An age-structured deterministic model with a flexible spline was used to describe the natural history of HIV along with reporting and treatment rates. Individual-level surveillance data for 1,077,295 cases (HIV/AIDS diagnoses, ART dispensations, CD4 counts and HIV/AIDS-related deaths) were used to calibrate the model using Bayesian inference. The results showed a second wave of infections occurring after 2001 and 56,000 (95% Credible Interval 43,000-71,000) new infections in 2015, 37,000 (95% CrI 28,000-54,000) infections in men and 16,000 (95% CrI 10,000-23,000) in women. The estimated number of PLHIV by end-2015 was 838,000 (95% CrI 675,000-1,083,000), with 80% (95% CrI 62-98%) of those individuals reported to the Ministry of Health. Women were more likely to be diagnosed and reported than men; 86.8% of infected women had been reported compared with 75.7% of men. Likewise, ART initiation rates for women were higher than those for men. The second wave contradicts previous estimates of HIV incidence trends in Brazil and there were persistent differences in the rates of accessing care between men and women. Nevertheless, the Brazilian HIV program has achieved high rates of detection and treatment, making considerable progress over the past ten years.
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Affiliation(s)
- Tara D Mangal
- Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, United Kingdom.
| | - Ana Roberta Pati Pascom
- Ministry of Health, Department of STI, HIV/AIDS and Viral Hepatitis, SRTVN Quadra 701, Lote D, Edifício PO700, CEP: 70719-040, Brasilia, Distrito Federal, Brazil
| | - Juan F Vesga
- Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, United Kingdom
| | - Mariana Veloso Meireles
- Ministry of Health, Department of STI, HIV/AIDS and Viral Hepatitis, SRTVN Quadra 701, Lote D, Edifício PO700, CEP: 70719-040, Brasilia, Distrito Federal, Brazil
| | - Adele Schwartz Benzaken
- Ministry of Health, Department of STI, HIV/AIDS and Viral Hepatitis, SRTVN Quadra 701, Lote D, Edifício PO700, CEP: 70719-040, Brasilia, Distrito Federal, Brazil
| | - Timothy B Hallett
- Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, United Kingdom
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204
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Kinetics of Early Innate Immune Activation during HIV-1 Infection of Humanized Mice. J Virol 2019; 93:JVI.02123-18. [PMID: 30867315 PMCID: PMC6532090 DOI: 10.1128/jvi.02123-18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 03/01/2019] [Indexed: 02/07/2023] Open
Abstract
Human immunodeficiency virus type 1 (HIV-1) infection is associated with aberrant immune activation; however, most model systems for HIV-1 have been used during established infection. Here, we utilize ultrasensitive HIV-1 quantification to delineate early events during the eclipse, burst, and chronic phases of HIV-1 infection in humanized mice. We show that very early in infection, HIV-1 suppresses peripheral type I interferon (IFN) and interferon-stimulated gene (ISG) responses, including the HIV-1 restriction factor IFI44. At the peak of innate immune activation, prior to CD4 T cell loss, HIV-1 infection differentially affects peripheral and lymphoid Toll-like receptor (TLR) expression profiles in T cells and macrophages. This results in a trend toward an altered activation of nuclear factor κB (NF-κB), TANK-binding kinase 1 (TBK1), and interferon regulatory factor 3 (IRF3). The subsequent type I and III IFN responses result in preferential induction of peripheral ISG responses. Following this initial innate immune activation, peripheral expression of the HIV-1 restriction factor SAM domain- and HD domain-containing protein 1 (SAMHD1) returns to levels below those observed in uninfected mice, suggesting that HIV-1 interferes with their basal expression. However, peripheral cells still retain their responsiveness to exogenous type I IFN, whereas splenic cells show a reduction in select ISGs in response to IFN. This demonstrates the highly dynamic nature of very early HIV-1 infection and suggests that blocks to the induction of HIV-1 restriction factors contribute to the establishment of viral persistence.IMPORTANCE Human immunodeficiency virus type 1 (HIV-1) infection is restricted to humans and some nonhuman primates (e.g., chimpanzee and gorilla). Alternative model systems based on simian immunodeficiency virus (SIV) infection of macaques are available but do not recapitulate all aspects of HIV-1 infection and disease. Humanized mice, which contain a human immune system, can be used to study HIV-1, but only limited information on early events and immune responses is available to date. Here, we describe very early immune responses to HIV-1 and demonstrate a suppression of cell-intrinsic innate immunity. Furthermore, we show that HIV-1 infection interacts differently with innate immune responses in blood and lymphoid organs.
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205
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Dwyer-Lindgren L, Cork MA, Sligar A, Steuben KM, Wilson KF, Provost NR, Mayala BK, VanderHeide JD, Collison ML, Hall JB, Biehl MH, Carter A, Frank T, Douwes-Schultz D, Burstein R, Casey DC, Deshpande A, Earl L, El Bcheraoui C, Farag TH, Henry NJ, Kinyoki D, Marczak LB, Nixon MR, Osgood-Zimmerman A, Pigott D, Reiner RC, Ross JM, Schaeffer LE, Smith DL, Davis Weaver N, Wiens KE, Eaton JW, Justman JE, Opio A, Sartorius B, Tanser F, Wabiri N, Piot P, Murray CJL, Hay SI. Mapping HIV prevalence in sub-Saharan Africa between 2000 and 2017. Nature 2019; 570:189-193. [PMID: 31092927 PMCID: PMC6601349 DOI: 10.1038/s41586-019-1200-9] [Citation(s) in RCA: 260] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 04/10/2019] [Indexed: 12/16/2022]
Abstract
HIV/AIDS is a leading cause of disease burden in sub-Saharan Africa. Existing evidence has demonstrated that there is substantial local variation in the prevalence of HIV; however, subnational variation has not been investigated at a high spatial resolution across the continent. Here we explore within-country variation at a 5 × 5-km resolution in sub-Saharan Africa by estimating the prevalence of HIV among adults (aged 15-49 years) and the corresponding number of people living with HIV from 2000 to 2017. Our analysis reveals substantial within-country variation in the prevalence of HIV throughout sub-Saharan Africa and local differences in both the direction and rate of change in HIV prevalence between 2000 and 2017, highlighting the degree to which important local differences are masked when examining trends at the country level. These fine-scale estimates of HIV prevalence across space and time provide an important tool for precisely targeting the interventions that are necessary to bringing HIV infections under control in sub-Saharan Africa.
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Affiliation(s)
- Laura Dwyer-Lindgren
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Michael A Cork
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Amber Sligar
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Krista M Steuben
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Kate F Wilson
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Naomi R Provost
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | - John D VanderHeide
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Michael L Collison
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Jason B Hall
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Molly H Biehl
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Austin Carter
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Tahvi Frank
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Dirk Douwes-Schultz
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Roy Burstein
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Daniel C Casey
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Aniruddha Deshpande
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Lucas Earl
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Charbel El Bcheraoui
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Tamer H Farag
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Nathaniel J Henry
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Damaris Kinyoki
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Laurie B Marczak
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Molly R Nixon
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | - David Pigott
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Robert C Reiner
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Jennifer M Ross
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Lauren E Schaeffer
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - David L Smith
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Nicole Davis Weaver
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Kirsten E Wiens
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Jeffrey W Eaton
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Jessica E Justman
- ICAP, Mailman School of Public Health, Columbia University, New York, NY, USA
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Alex Opio
- Medireal Investment Uganda, Entebbe, Uganda
| | - Benn Sartorius
- Public Health Medicine, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Frank Tanser
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
- Research Department of Infection & Population Health, University College London, London, UK
| | - Njeri Wabiri
- HIV/AIDS, STIs & TB Research Programme, Human Sciences Research Council, Pretoria, South Africa
| | - Peter Piot
- London School of Hygiene & Tropical Medicine, London, UK
| | | | - Simon I Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
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206
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Tran BX, Phan HT, Latkin CA, Nguyen HLT, Hoang CL, Ho CSH, Ho RCM. Understanding Global HIV Stigma and Discrimination: Are Contextual Factors Sufficiently Studied? (GAP RESEARCH). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16111899. [PMID: 31146379 PMCID: PMC6603743 DOI: 10.3390/ijerph16111899] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 05/26/2019] [Accepted: 05/27/2019] [Indexed: 01/01/2023]
Abstract
Stigma and discrimination are among the greatest challenges that people living with human immunodeficiency virus (HIV) face, and both are known to negatively affect quality of life as well as treatment outcomes. We analyzed the growing research and current understanding of HIV-related stigma and contextual factors in HIV/AIDS (human Immunodeficiency virus/ acquired immunodeficiency syndrome) bibliography. A total of 5984 publications published from 1991 to 2017 were retrieved from the Web of Science database. The number of papers and their impacts have been considerably grown in recent years. Research landscapes related to stigma and discrimination include clinical, physical and mental health outcomes, risk behaviors of most-at-risk populations, and HIV-related services. We found a lack of empirical studies not only on social, cultural and economic contexts, but also on specific interventions for particular settings and sub-populations. This study highlights certain gaps and provides a basis for future studies and interventions on this critical issue given the changing drivers of HIV epidemics.
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Affiliation(s)
- Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam.
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21206, USA.
| | - Hai Thanh Phan
- Institute for Global Health Innovations, Duy Tan University, Da Nang 550000, Vietnam.
| | - Carl A Latkin
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21206, USA.
| | - Huong Lan Thi Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang 550000, Vietnam.
| | - Chi Linh Hoang
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam 700000, Vietnam.
| | - Cyrus S H Ho
- Department of Psychological Medicine, National University Hospital, Singapore 117599, Singapore.
| | - Roger C M Ho
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam 700000, Vietnam.
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117599, Singapore.
- Institute for Health Innovation and Technology (iHealthtech) National University of Singapore, Singapore 117599, Singapore.
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207
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Nakazwe C, Michelo C, Sandøy IF, Fylkesnes K. Contrasting HIV prevalence trends among young women and men in Zambia in the past 12 years: data from demographic and health surveys 2002-2014. BMC Infect Dis 2019; 19:432. [PMID: 31101081 PMCID: PMC6525340 DOI: 10.1186/s12879-019-4059-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 05/01/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The HIV epidemic remains a concern on the global health agenda, despite progress made in reducing incidence. Investigation of trends among young people is important for monitoring HIV incidence and informing programming. The study examined geographical and sub-population differences in HIV prevalence trends among young people aged 15-24 years in Zambia. METHODS This study analysed data from Zambia Demographic and Health Surveys (ZDHSs) that were conducted in 2001-2, 2007, and 2013-14. A two-stage cluster stratified sampling procedure was used to select samples of 8050, 7969, and 18,052 for the three surveys, respectively. Young people (15-24 years) with known HIV status were selected for analysis. The outcome variable was HIV status. Log binomial regression analysis of generalised linear models was used to test for trends. RESULTS Overall HIV prevalence declined over the period 2001-2 to 2013-14 among women and men aged 15-49 years (17.8 and 12.9% to 15.1 and 11.3%, respectively). There was, however, an increase in HIV prevalence among urban young men over this period, from 3.7% in 2001-2 to 7.3% in 2013-14 (aRR 2.17, 95% CI 0.99-4.75), and, in rural areas, from 2.6 to 3.6% (aRR 1.46, 95% CI 0.78-2.75). In contrast, HIV prevalence among women declined over the same period of time. In urban areas, HIV prevalence among women declined from 15.2 to 10.7% (aRR 0.66, 95% CI 0.53-0.93), while in rural areas it declined from 8.2 to 4.8% (aRR 0.41, 95% CI 0.59-0.85). In addition, there was a narrowing gender gap in terms of HIV infection, as the prevalence ratio of females to males declined from 4.2 and 3.1 to 1.5 and 1.3, in urban and rural areas, respectively. CONCLUSIONS The increase in HIV prevalence among urban young men over the past 12 years, contrasting declining trends among young women in both urban and rural populations, suggests differential effects of prevention efforts. Furthermore, findings that Zambia's overall national HIV prevalence decline masks some striking sex and rural/urban differentials, indicate the need for reconsidering the prevention efforts for young urban men.
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Affiliation(s)
- Chola Nakazwe
- Centre for International Health, University of Bergen, Bergen, Norway. .,School of Public Health, University of Zambia, Lusaka, Zambia. .,Central Statistical Office, Lusaka, Zambia.
| | - Charles Michelo
- School of Public Health, University of Zambia, Lusaka, Zambia.,Department of Global Public Health and Primary Care, Centre for Intervention Science in Maternal and Child Health, University of Bergen, Bergen, Norway
| | - Ingvild F Sandøy
- Centre for International Health, University of Bergen, Bergen, Norway.,Department of Global Public Health and Primary Care, Centre for Intervention Science in Maternal and Child Health, University of Bergen, Bergen, Norway
| | - Knut Fylkesnes
- Centre for International Health, University of Bergen, Bergen, Norway.,School of Public Health, University of Zambia, Lusaka, Zambia.,Department of Global Public Health and Primary Care, Centre for Intervention Science in Maternal and Child Health, University of Bergen, Bergen, Norway
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208
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Livelihood Risk, Culture, and the HIV Interface: Evidence from Lakeshore Border Communities in Buliisa District, Uganda. J Trop Med 2019; 2019:6496240. [PMID: 31223313 PMCID: PMC6541934 DOI: 10.1155/2019/6496240] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 04/28/2019] [Indexed: 01/22/2023] Open
Abstract
Background While studies have focused on HIV prevalence and incidence among fishing communities, there has been inadequate attention paid to the construction and perception of HIV risk among fisher folk. There has been limited research with respect to communities along Lake Albert on the border between Uganda and the Democratic Republic of Congo (DRC). Methods We conducted a qualitative study on three landing sites of Butiaba, Bugoigo, and Wanseko on the shores of Lake Albert along the border of Uganda and the Democratic Republic of Congo. Data were collected using 12 Focus Group Discussions and 15 key informant interviews. Analysis was done manually using content and thematic approaches. Results Lakeshore livelihoods split families between men, women, and children with varying degrees of exposure to HIV infection risk. Sustaining a thriving fish trade was dependent on taking high risks. For instance, profits were high when the lake was stormy. Landing sites were characterized by widespread prostitution, alcohol consumption, drug abuse, and child labour. Such behaviors negatively affected minors and in many ways predisposed them to HIV infection. The lake shore-border heterogeneity resulted in a population with varying HIV knowledge, attitudes, behavior, and competencies to risk perception and adaptation amidst negative masculinities and negative resilience. Conclusion The susceptibility of lakeshore communities to HIV is attributable to a complex combination of geo-socio, the available (health) services, economic, and cultural factors which converged around the fishing livelihood. This study reveals that HIV risk assessment is an interplay of plural rationalities within the circumstances and constraints that impinge on the daily lives by different actors. A lack of cohesion in a multiethnic setting with large numbers of outsiders and a large transient population made the available HIV interventions less effective.
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209
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Abstract
Intermittent outbreaks of infectious diseases have had profound and lasting effects on societies throughout history. Those events have powerfully shaped the economic, political, and social aspects of human civilization, with their effects often lasting for centuries. Epidemic outbreaks have defined some of the basic tenets of modern medicine, pushing the scientific community to develop principles of epidemiology, prevention, immunization, and antimicrobial treatments. This chapter outlines some of the most notable outbreaks that took place in human history and are relevant for a better understanding of the rest of the material. Starting with religious texts, which heavily reference plagues, this chapter establishes the fundamentals for our understanding of the scope, social, medical, and psychological impact that some pandemics effected on civilization, including the Black Death (a plague outbreak from the fourteenth century), the Spanish Flu of 1918, and the more recent outbreaks in the twenty-first century, including SARS, Ebola, and Zika.
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210
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Stuart RM, Grobicki L, Haghparast-Bidgoli H, Panovska-Griffiths J, Skordis J, Keiser O, Estill J, Baranczuk Z, Kelly SL, Reporter I, Kedziora DJ, Shattock AJ, Petravic J, Hussain SA, Grantham KL, Gray RT, Yap XF, Martin-Hughes R, Benedikt CJ, Fraser-Hurt N, Masaki E, Wilson DJ, Gorgens M, Mziray E, Cheikh N, Shubber Z, Kerr CC, Wilson DP. How should HIV resources be allocated? Lessons learnt from applying Optima HIV in 23 countries. J Int AIDS Soc 2019; 21:e25097. [PMID: 29652100 PMCID: PMC5898225 DOI: 10.1002/jia2.25097] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 03/05/2018] [Indexed: 12/01/2022] Open
Abstract
Introduction With limited funds available, meeting global health targets requires countries to both mobilize and prioritize their health spending. Within this context, countries have recognized the importance of allocating funds for HIV as efficiently as possible to maximize impact. Over the past six years, the governments of 23 countries in Africa, Asia, Eastern Europe and Latin America have used the Optima HIV tool to estimate the optimal allocation of HIV resources. Methods Each study commenced with a request by the national government for technical assistance in conducting an HIV allocative efficiency study using Optima HIV. Each study team validated the required data, calibrated the Optima HIV epidemic model to produce HIV epidemic projections, agreed on cost functions for interventions, and used the model to calculate the optimal allocation of available funds to best address national strategic plan targets. From a review and analysis of these 23 country studies, we extract common themes around the optimal allocation of HIV funding in different epidemiological contexts. Results and discussion The optimal distribution of HIV resources depends on the amount of funding available and the characteristics of each country's epidemic, response and targets. Universally, the modelling results indicated that scaling up treatment coverage is an efficient use of resources. There is scope for efficiency gains by targeting the HIV response towards the populations and geographical regions where HIV incidence is highest. Across a range of countries, the model results indicate that a more efficient allocation of HIV resources could reduce cumulative new HIV infections by an average of 18% over the years to 2020 and 25% over the years to 2030, along with an approximately 25% reduction in deaths for both timelines. However, in most countries this would still not be sufficient to meet the targets of the national strategic plan, with modelling results indicating that budget increases of up to 185% would be required. Conclusions Greater epidemiological impact would be possible through better targeting of existing resources, but additional resources would still be required to meet targets. Allocative efficiency models have proven valuable in improving the HIV planning and budgeting process.
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Affiliation(s)
- Robyn M Stuart
- Department of Mathematical Sciences, University of Copenhagen, Copenhagen, Denmark.,Burnet Institute, Melbourne, VIC, Australia
| | - Laura Grobicki
- Institute for Global Health, University College London, London, UK
| | | | - Jasmina Panovska-Griffiths
- Clinical Operational Research Unit, Department of Mathematics, University College London, London, UK.,Department of Applied Health Research, University College London, London, UK.,Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Jolene Skordis
- Institute for Global Health, University College London, London, UK
| | - Olivia Keiser
- Institute of Global Health, University of Geneva, Geneva, Switzerland.,Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Janne Estill
- Institute of Global Health, University of Geneva, Geneva, Switzerland.,Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Institute of Mathematical Statistics and Actuarial Science, University of Bern, Bern, Switzerland
| | - Zofia Baranczuk
- Institute of Global Health, University of Geneva, Geneva, Switzerland.,Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Institute of Mathematics, University of Zurich, Zurich, Switzerland
| | - Sherrie L Kelly
- Burnet Institute, Melbourne, VIC, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | | | - David J Kedziora
- Burnet Institute, Melbourne, VIC, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,School of Physics, University of Sydney, Sydney, NSW, Australia
| | | | | | | | - Kelsey L Grantham
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Richard T Gray
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Xiao F Yap
- Burnet Institute, Melbourne, VIC, Australia
| | | | | | | | | | | | | | | | | | | | - Cliff C Kerr
- Burnet Institute, Melbourne, VIC, Australia.,School of Physics, University of Sydney, Sydney, NSW, Australia
| | - David P Wilson
- Burnet Institute, Melbourne, VIC, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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211
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Deribew A, Biadgilign S, Deribe K, Dejene T, Tessema GA, Melaku YA, Lakew Y, Amare AT, Bekele T, Abera SF, Dessalegn M, Kumsa A, Assefa Y, Glenn SD, Frank T, Carter A, Misganaw A, Wang H. The Burden of HIV/AIDS in Ethiopia from 1990 to 2016: Evidence from the Global Burden of Diseases 2016 Study. Ethiop J Health Sci 2019; 29:859-868. [PMID: 30700953 PMCID: PMC6341438 DOI: 10.4314/ejhs.v29i1.7] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Background The burden of HIV/AIDS in Ethiopia has not been comprehensively assessed over the last two decades. In this study, we used the 2016 Global Burden of Diseases, Injuries and Risk factors (GBD) data to analyze the incidence, prevalence, mortality and Disability-adjusted Life Years Lost (DALY) rates of Human Immunodeficiency Virus / Acquired Immune Deficiency Syndrome (HIV/AIDS) in Ethiopia over the last 26 years. Methods The GBD 2016 used a wide range of data source for Ethiopia such as verbal autopsy (VA), surveys, reports of the Federal Ministry of Health and the United Nations (UN) and published scientific articles. The modified United Nations Programme on HIV/AIDS (UNAIDS) Spectrum model was used to estimate the incidence and mortality rates for HIV/AIDS. Results In 2016, an estimated 36,990 new HIV infections (95% uncertainty interval [UI]: 8775-80262), 670,906 prevalent HIV cases (95% UI: 568,268–798,970) and 19,999 HIV deaths (95% UI: 16426-24412) occurred in Ethiopia. The HIV/AIDS incidence rate peaked in 1995 and declined by 6.3% annually for both sexes with a total reduction of 77% between 1990 and 2016. The annualized HIV/AIDS mortality rate reduction during 1990 to 2016 for both sexes was 0.4%. Conclusions Ethiopia has achieved the 50% reduction of the incidence rate of HIV/AIDS based on the Millennium Development Goals (MDGs) target. However, the decline in HIV/AIDS mortality rate has been comparatively slow. The country should strengthen the HIV/AIDS detection and treatment programs at community level to achieve its targets during the Sustainable Development Program (SDGs)-era.
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Affiliation(s)
- Amare Deribew
- St. Paul Millennium Medical College, Addis Ababa, Ethiopia Hospital.,Nutrition International, Ethiopia
| | | | - Kebede Deribe
- Wellcome Trust Brighton & Sussex Centre for Global Health Research, Brighton & Sussex Medical School, Falmer, Brighton, UK.,School of Medicine, Addis Ababa University, Ethiopia
| | - Tariku Dejene
- Center for Population Studies, Addis Ababa University, Addis Ababa, Ethiopia
| | - Gizachew Assefa Tessema
- School of Public Health, University of Adelaide, Adelaide, Australia.,Department of Reproductive Health, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Yohannes Adama Melaku
- School of Public Health, Mekelle University, Mekelle, Ethiopia.,School of Medicine, University of Adelaide, Adelaide, Australia
| | - Yihune Lakew
- Ethiopian Public Health Association, Addis Ababa, Ethiopia
| | - Azmeraw T Amare
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.,Department of Epidemiology, University of Groningen, Groningen, the Netherlands
| | - Tolessa Bekele
- Department of Public Health, College of Medicine and Health Sciences, Madda Walabu University, Ethiopia
| | - Semaw F Abera
- School of Public Health, Mekelle University, Mekelle, Ethiopia.,Kilte Awlaelo-Health and Demographic Surveillance Site, Tigray, Ethiopia.,Institute of Biological Chemistry and Nutrition, Hohenheim University, Stuttgart, Germany
| | | | | | - Yibeltal Assefa
- University of Queensland, School of Public Health, Australia
| | - Scott D Glenn
- Institute of Health Metrics and Evaluation, University of Washington
| | - Tahvi Frank
- Institute of Health Metrics and Evaluation, University of Washington
| | - Austin Carter
- Institute of Health Metrics and Evaluation, University of Washington
| | - Awoke Misganaw
- Institute of Health Metrics and Evaluation, University of Washington
| | - Haidong Wang
- Institute of Health Metrics and Evaluation, University of Washington
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212
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Opanga L, Mulaku MN, Opanga SA, Godman B, Kurdi A. Adverse effects of chemotherapy and their management in Pediatric patients with Non-Hodgkin's Lymphoma in Kenya: A descriptive, situation analysis study. Expert Rev Anticancer Ther 2019; 19:423-430. [PMID: 31023089 DOI: 10.1080/14737140.2019.1606717] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Chemotherapy-related side effects and their management in patients with Non-Hodgkin's Lymphoma (NHL) are not well defined in developing countries, including Kenya. This needs addressing considering the high number of patients with cancer in these countries. Consequently, we sought to determine the common side effects of chemotherapy used to treat NHL in pediatric patients and its implications. METHODS Observational study conducted at the Kenyatta National Hospital in patients aged ≤15 years. Some data was collected by reviewing patients' records admitted to the pediatric oncology ward, December 2016 to May 2017; and additional data was collected retrospectively (review of patients' records with NHL, January-2014 to May-2017). Data were analyzed descriptively. RESULTS Overall, out of the identified NHL patients (n = 85), 93% (n = 79) had chemotherapy-related side effects. The majority of patients suffered from side effects were managed; apart from 23% to 24% of the documented anemia and hypersensitivity, respectively. CONCLUSIONS Whilst the majority of the reported side-effects were being managed, the lack of management of some side effects raises real concerns since this indicates either failure to manage or failure to document their management in patients' records, both of which should be addressed appropriately to improve future care.
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Affiliation(s)
- Linda Opanga
- a Department of Pharmacology and Pharmacognosy, School of Pharmacy , University of Nairobi , Nairobi , Kenya
| | - Mercy N Mulaku
- a Department of Pharmacology and Pharmacognosy, School of Pharmacy , University of Nairobi , Nairobi , Kenya
| | - Sylvia A Opanga
- b Department of Pharmaceutics and Pharmacy Practice, Division of Clinical Pharmacy, School of Pharmacy , University of Nairobi , Nairobi , Kenya
| | - Brian Godman
- c Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde , Glasgow , UK.,d Division of Clinical Pharmacology , Karolinska Institute , Stockholm , Sweden.,e School of Pharmacy , Sefako Makgatho Health Sciences University , Garankuwa , South Africa
| | - Amanj Kurdi
- c Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde , Glasgow , UK.,f Department of Pharmacology , College of Pharmacy, Hawler Medical University , Erbil , Iraq
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213
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Domingo P, Suarez-Lozano I, Gutierrez F, Estrada V, Knobel H, Palacios R, Antela A, Blanco JR, Fulladosa X. Predictive factors of renal impairment in HIV-infected patients on antiretroviral therapy: Results from the VACH longitudinal cohort study. Nefrologia 2019; 39:497-505. [PMID: 31027896 DOI: 10.1016/j.nefro.2019.01.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 11/23/2018] [Accepted: 01/14/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The use of combination antiretroviral therapy has led to dramatic improvements in the life expectancy of HIV-infected persons. As result, the HIV population is aging and increasingly facing illnesses typically seen in the elderly, such as chronic kidney disease (CKD). METHODS A retrospective longitudinal study was conducted using data from years 2010 and 2014 in all HIV-infected persons enrolled at the Spanish VACH cohort. We analyzed the prevalence and the predictive factors for developing CKD (estimated glomerular filtration rate, eGFR<60mL/min/1.73m2). RESULTS The CKD prevalence at baseline was 456/8968, 5.1% [4.6-5.6%]. Of 8512 HIV-positive individuals examined without CKD at baseline (73.7% male, median age 44 years-old), 2.15% developed CKD (eGFR<60mL/min/1.73m2). The odds ratios [95%CI] for the independent predictive factors identified were gender (male) 0.54 [0.39-0.75], age (per year) 1.08 [1.07-1.10], AIDS diagnosis 1.40 [1.03-1.91], protease inhibitor-based regimens 1.49 [1.10-2.02], hypertension 1.37 [0.94-1.99], diabetes 1.84 [1.33-2.55] and history of cardiovascular events 1.66 [0.96-2.86]. CONCLUSION The prevalence and risk factors for CKD and its progression are high in the VACH cohort. Thus, preventive measures such as control of hypertension, diabetes and obesity, as well as efforts for avoiding exposure to nephrotoxic drugs, including some antiretrovirals, are warranted in this aging HIV population.
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Affiliation(s)
- Pere Domingo
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
| | | | - Félix Gutierrez
- Infectious Diseases Unit, Hospital Universitario de Elche, Alicante, Spain
| | - Vicente Estrada
- Infectious Diseases Unit, Hospital Clínico San Carlos, Madrid, Spain
| | - Hernando Knobel
- Infectious Diseases Unit, Hospital del Mar, Barcelona, Spain
| | - Rosario Palacios
- Infectious Diseases Unit, Hospital Universitario Virgen de la Victoria, Malaga, Spain
| | - Antonio Antela
- Infectious Diseases Unit, Complexo Hospitalario Universitario, Santiago de Compostela, Spain
| | | | - Xavier Fulladosa
- Nephrology Unit, Hospital Universitario de Bellvitge, Barcelona, Spain
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214
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Wang FS, Zhang L, Douek D, McMichael A, Xu XN, Lewin SR. Strategies for an HIV cure: progress and challenges. Nat Immunol 2019; 19:1155-1158. [PMID: 30333614 DOI: 10.1038/s41590-018-0242-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Fu Sheng Wang
- Clinical and Research Center for Infectious Diseases, Beijing 302 Hospital, Beijing, China. .,Division of Treatment and Care, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
| | - Linqi Zhang
- Comprehensive AIDS Research Center of Tsinghua University, Beijing, China
| | - Daniel Douek
- Vaccine Research Center, NIAID, NIH, Bethesda, MD, USA
| | - Andrew McMichael
- Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| | - Xiao-Ning Xu
- Department of Medicine, Chelsea & Westminster Hospital, Imperial College London, London, UK
| | - Sharon R Lewin
- The Peter Doherty Institute for Infection and Immunity, The University of Melbourne and Royal Melbourne Hospital, Melbourne, Victoria, Australia. .,Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, Victoria, Australia.
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215
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Bollyky TJ, Templin T, Cohen M, Schoder D, Dieleman JL, Wigley S. The relationships between democratic experience, adult health, and cause-specific mortality in 170 countries between 1980 and 2016: an observational analysis. Lancet 2019; 393:1628-1640. [PMID: 30878225 PMCID: PMC6484695 DOI: 10.1016/s0140-6736(19)30235-1] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 01/05/2019] [Accepted: 01/11/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Previous analyses of democracy and population health have focused on broad measures, such as life expectancy at birth and child and infant mortality, and have shown some contradictory results. We used a panel of data spanning 170 countries to assess the association between democracy and cause-specific mortality and explore the pathways connecting democratic rule to health gains. METHODS We extracted cause-specific mortality and HIV-free life expectancy estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 and information on regime type from the Varieties of Democracy project. These data cover 170 countries and 46 years. From the Financing Global Health database, we extracted gross domestic product (GDP) per capita, also covering 46 years, and Development Assistance for Health estimates starting from 1990 and domestic health spending estimates starting from 1995. We used a diverse set of empirical methods-synthetic control, within-country variance decomposition, structural equation models, and fixed-effects regression-which together provide a robust analysis of the association between democratisation and population health. FINDINGS HIV-free life expectancy at age 15 years improved significantly during the study period (1970-2015) in countries after they transitioned to democracy, on average by 3% after 10 years. Democratic experience explains 22·27% of the variance in mortality within a country from cardiovascular diseases, 16·53% for tuberculosis, and 17·78% for transport injuries, and a smaller percentage for other diseases included in the study. For cardiovascular diseases, transport injuries, cancers, cirrhosis, and other non-communicable diseases, democratic experience explains more of the variation in mortality than GDP. Over the past 20 years, the average country's increase in democratic experience had direct and indirect effects on reducing mortality from cardiovascular disease (-9·64%, 95% CI -6·38 to -12·90), other non-communicable diseases (-9·14%, -4·26 to -14·02), and tuberculosis (-8·93%, -2·08 to -15·77). Increases in a country's democratic experience were not correlated with GDP per capita between 1995 and 2015 (ρ=-0·1036; p=0·1826), but were correlated with declines in mortality from cardiovascular disease (ρ=-0·3873; p<0·0001) and increases in government health spending (ρ=0·4002; p<0·0001). Removal of free and fair elections from the democratic experience variable resulted in loss of association with age-standardised mortality from non-communicable diseases and injuries. INTERPRETATION When enforced by free and fair elections, democracies are more likely than autocracies to lead to health gains for causes of mortality (eg, cardiovascular diseases and transport injuries) that have not been heavily targeted by foreign aid and require health-care delivery infrastructure. International health agencies and donors might increasingly need to consider the implications of regime type in their efforts to maximise health gains, particularly in the context of ageing populations and the growing burden of non-communicable diseases. FUNDING Bloomberg Philanthropies and the Bill & Melinda Gates Foundation.
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Affiliation(s)
| | - Tara Templin
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, USA
| | | | | | - Joseph L Dieleman
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Simon Wigley
- Department of Philosophy, Bilkent University, Ankara, Turkey
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216
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Dlamini NN, Meyer JC, Kruger D, Kurdi A, Godman B, Schellack N. Feasibility of using point prevalence surveys to assess antimicrobial utilisation in public hospitals in South Africa: a pilot study and implications. Hosp Pract (1995) 2019; 47:88-95. [PMID: 30963821 DOI: 10.1080/21548331.2019.1592880] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES There is currently a lack of data regarding antimicrobial use among public hospitals in South Africa. This is a concern given their growing use and increasing antimicrobial resistance rates in South Africa. Consequently, the objectives of this study were to firstly determine the appropriateness of point prevalence survey (PPS) data collection instruments for performing antimicrobial utilization studies among public sector hospitals in South Africa; secondly, to determine current antimicrobial utilization in a public sector hospital, and thirdly evaluate the prescribing of antimicrobials with those contained within the national Essential Medicines List and Standard Treatment Guidelines (EML/STGs). The findings will be used to guide future activities in South Africa. METHODS A PPS was conducted in Dr George Mukhari Academic Hospital. For each in-patient ward, all patients' files were completely surveyed on a single day. The number of patients who were on antimicrobials served as the numerator and the denominator comprised the total number of patients in the ward. RESULTS 39 wards and 512 patient files were surveyed. The overall prevalence of antimicrobial use was 37.7%, highest in the ICUs. Beta lactamase inhibitors and antimicrobials for tuberculosis were the most prevalent antimicrobials. More than two thirds (83%) of antimicrobial treatment was modified following culture sensitivity test results when requested, and 98% of antimicrobials prescribed were contained within the current EML/STGs. In 10.8% of occasions, antimicrobials appear to have been prescribed other than for treatment, i.e. no systemic infection. There were concerns though with the lack of IV to oral switching. CONCLUSION The PPS method offers a standardized tool that can be used to identify targets for quality improvement. However, there were concerns with the time taken to conduct PPS studies, which is an issue in resource limited settings. This is being addressed alongside concerns with the lack of IV to oral switching.
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Affiliation(s)
- Nokuthula N Dlamini
- a School of Pharmacy , Sefako Makgatho Health Sciences University , Ga-Rankuwa , Pretoria , South Africa
| | - Johanna C Meyer
- a School of Pharmacy , Sefako Makgatho Health Sciences University , Ga-Rankuwa , Pretoria , South Africa
| | - Danie Kruger
- a School of Pharmacy , Sefako Makgatho Health Sciences University , Ga-Rankuwa , Pretoria , South Africa.,b Pharmacy , Private Hospital , Pretoria , South Africa
| | - Amanj Kurdi
- c Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences , University of Strathclyde , Glasgow , UK
| | - Brian Godman
- a School of Pharmacy , Sefako Makgatho Health Sciences University , Ga-Rankuwa , Pretoria , South Africa.,c Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences , University of Strathclyde , Glasgow , UK.,d Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet , Karolinska University Hospital Huddinge , Stockholm , Sweden.,e Health Economics Centre , Liverpool University Management School , Liverpool , UK
| | - Natalie Schellack
- a School of Pharmacy , Sefako Makgatho Health Sciences University , Ga-Rankuwa , Pretoria , South Africa
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217
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Deribew A, Deribe K, Dejene T, Tessema GA, Melaku YA, Lakew Y, Amare AT, Bekele T, Abera SF, Dessalegn M, Kumsa A, Assefa Y, Kyu H, Glenn SD, Misganaw A, Biadgilign S. Tuberculosis Burden in Ethiopia from 1990 to 2016: Evidence from the Global Burden of Diseases 2016 Study. Ethiop J Health Sci 2019; 28:519-528. [PMID: 30607066 PMCID: PMC6308773 DOI: 10.4314/ejhs.v28i5.2] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background The burden of Tuberculosis (TB) has not been comprehensively evaluated over the last 25 years in Ethiopia. In this study, we used the 2016 Global Burden of Diseases, Injuries and Risk Factors (GBD) data to analyze the incidence, prevalence and mortality rates of tuberculosis (TB) in Ethiopia over the last 26 years. Methods The GBD 2016 is a mathematical modeling using different data source for Ethiopia such as verbal autopsy (VA), prevalence surveys and annual case notifications. Age and sex specific causes of death for TB were estimated using the Cause of Death Ensemble Modeling (CODEm). We used the available data such as annual notifications and prevalence surveys as an input to estimate incidence and prevalence rates respectively using DisMod-MR 2.1, a Bayesian meta-regression tool. Results In 2016, we estimated 219,186 (95%UI: 182,977–265,292) new, 151,602 (95% UI: 126,054–180,976) prevalent TB cases and 48,910(95% UI: 40,310–58,195) TB deaths. The age-standardized TB incidence rate decreased from 201.6/100,000 to 88.5/100,000 (with a total decline of 56%) between 1990 to 2016. Similarly, the age-standardized TB mortality rate declined from 393.8/100,000 to 100/100,000 between 1990 and 2016(with a total decline of 75%). Conclusions Ethiopia has achieved the 50% reduction of most of the Millennium Development Goals (MDGs) targets related to TB. However, the decline of TB incidence and prevalence rates has been comparatively slow. The country should strengthen the TB case detection and treatment programs at community level to achieve its targets during the Sustainable Development Program (SDGs)-era.
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Affiliation(s)
- Amare Deribew
- St. Paul Hospital Millennium Medical College, Ethiopia.,Nutrition International, Ethiopia
| | - Kebede Deribe
- Wellcome Trust Brighton & Sussex Centre for Global Health Research, Brighton & Sussex Medical School, Brighton, UK.,School of Medicine, Addis Ababa University, Ethiopia
| | - Tariku Dejene
- Center for Population Studies, Addis Ababa University, Ethiopia
| | - Gizachew Assefa Tessema
- School of Public Health, University of Adelaide, Adelaide, Australia.,Department of Reproductive Health, Institute of Public Health, University of Gondar, Ethiopia
| | - Yohannes Adama Melaku
- School of Public Health, Mekelle University, Ethiopia.,School of Medicine, University of Adelaide, Adelaide, Australia
| | | | - Azmeraw T Amare
- College of Medicine and Health Sciences, Bahir Dar University, Ethiopia.,Department of Epidemiology, University of Groningen, Groningen, the Netherlands
| | - Tolessa Bekele
- College of Medicine and Health Sciences, Madda Walabu University, Ethiopia
| | - Semaw F Abera
- School of Public Health, Mekelle University, Ethiopia.,Kilte Awlaelo-Health and Demographic Surveillance Site, Tigray, Ethiopia.,Institute of Biological Chemistry and Nutrition, Hohenheim University, Stuttgart, Germany
| | | | | | - Yibeltal Assefa
- University of Queensland, School of Public Health, Australia
| | - Hmwe Kyu
- Institute of Health Metrics and Evaluation, University of Washington
| | - Scott D Glenn
- Institute of Health Metrics and Evaluation, University of Washington
| | - Awoke Misganaw
- Institute of Health Metrics and Evaluation, University of Washington
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218
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Late Onset of Antiretroviral Therapy in Adults Living with HIV in an Urban Area in Brazil: Prevalence and Risk Factors. J Trop Med 2019; 2019:5165313. [PMID: 31080478 PMCID: PMC6475541 DOI: 10.1155/2019/5165313] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 03/04/2019] [Accepted: 03/21/2019] [Indexed: 12/22/2022] Open
Abstract
Introduction Highly active antiretroviral therapy has been available since 1996. Early initiation of antiretroviral therapy (ART) leads to improved therapeutic response and reduced HIV transmission. However, a significant number of people living with HIV (PLHIV) still start treatment late. Objective This study aimed to analyze characteristics and factors associated with late initiation of ART among HIV-infected treatment-naïve patients. Methods This cross-sectional study included PLHIV older than 17 years who initiated ART at two public health facilities from 2009 to 2012, in a city located in Midwestern Brazil. Pregnant women were excluded. Data were collected from medical records, antiviral dispensing forms, and the Logistics Control of Medications System (SICLOM) of the Brazilian Ministry of Health. Late initiation of ART was defined as CD4+ cell count < 200 cells/mm3 or presence of AIDS-defining illness. Uni- and multivariate analysis were performed to evaluate associated factors for late ARV using SPSS®, version 21. The significance level was set at p<0.05. Results 1,141 individuals were included, with a median age of 41 years, and 69.1% were male. The prevalence of late initiation of ART was 55.8% (95%CI: 52.9-58.7). The more common opportunistic infections at ART initiation were pneumocystosis, cerebral toxoplasmosis, tuberculosis, and histoplasmosis. Overall, 38.8% of patients had HIV viral load equal to or greater than 100,000 copies/mL. Late onset of ART was associated with higher mortality. After logistic regression, factors shown to be associated with late initiation of ARV were low education level, sexual orientation, high baseline viral load, place of residence outside metropolitan area, and concomitant infection with hepatitis B virus. Conclusion These results revealed the need to increase early treatment of HIV infection, focusing especially on groups of people who are more socially vulnerable or have lower self-perceived risk.
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219
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Is the cardiovascular health of South Africans today comparable with African Americans 45 years ago? J Hypertens 2019; 37:1606-1614. [PMID: 30950976 DOI: 10.1097/hjh.0000000000002082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Hypertension occurs frequently among black populations around the world. In the United States (US) health system, interventions since the 1960s resulted in improvements in hypertension awareness, management and control among African Americans. This is in stark contrast to current health systems in African countries. To objectively assess the current situation in South Africa, we compared the cardiovascular health status of African Americans from 1960 to 1980 to black South Africans from recent years, as there is potential to implement best practices from the US. We also reviewed the recent cardiovascular health changes of a South African population over 10 years. METHODS Men and women were included from three studies performed in the United States (Evans County Heart Study; Charleston Heart Study; NHANES I and II) and one in South Africa (PURE, North West Province). We compared blood pressure (BP), BMI, cholesterol, diabetes and smoking status. RESULTS Age-adjusted SBP and DBP of South African men were lower than US studies conducted from 1960 to 1971 (Evans County; Charleston; NHANES I; all P < 0.001) but similar to NHANES II (P = 0.987) conducted in 1976. South African women had lower SBP than all four of the US studies (all P < 0.001); their DBP was lower than Evans County and Charleston studies, but similar to NHANES I and II. Reviewing South African data, BMI increased steeply over 10 years in women (P < 0.001) but not men (P = 0.451). CONCLUSION Blood pressure of South Africans is lower than African Americans from the 1960s, but comparable for 1970s to 1980s. With obesity of South African women rising sharply, escalating figures for hypertension and diabetes are anticipated.
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220
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Kempton J, Hill A, Levi JA, Heath K, Pozniak A. Most new HIV infections, vertical transmissions and AIDS-related deaths occur in lower-prevalence countries. J Virus Erad 2019. [DOI: 10.1016/s2055-6640(20)30058-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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221
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Kempton J, Hill A, Levi JA, Heath K, Pozniak A. Most new HIV infections, vertical transmissions and AIDS-related deaths occur in lower-prevalence countries. J Virus Erad 2019; 5:92-101. [PMID: 31191912 PMCID: PMC6543482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The Joint United Nations Programme on HIV/AIDS (UNAIDS) targets aim to reduce new HIV infections below 500,000 per year by 2020. Despite targeted prevention programmes, total new infections remained in 2016 and 2017 at 1,800,000 cases. We have aimed to analyse data from 2017 and to compare HIV incidence, AIDS-related deaths and provision of antiretroviral therapy (ART) to adults, pregnant women and children living with HIV in lower- and higher-prevalence countries. Vertical or mother-to-child transmission (MTCT) and early infant diagnosis (EID) rates were also investigated. METHODS UNAIDSinfo data use the Spectrum model to represent country-level HIV data. Countries with epidemics over 40,000 HIV cases were separated into higher prevalence (≥4.5%) and lower prevalence (<4.5%). Least squares linear regression, weighted by epidemic size and controlled for gross domestic product/capita, was used to compare HIV prevalence with estimated ART coverage in adults (≥15 years), children (0-14 years), pregnant women, and EID rates and MTCT rates. Data were then compared between higher- and lower-prevalence groups, including numbers of new HIV infections and AIDS-related deaths. RESULTS Data were available for 56 countries. Twelve higher-prevalence countries accounted for 16.7 million and 44 lower-prevalence ones for 15.1 million people living with HIV, altogether making up 87.5% of the global estimate. Lower-prevalence countries had less ART coverage for adults, pregnant women and children, lower EID rates and higher AIDS-related death levels. There were more new HIV infections in adults and children in lower- than higher-prevalence countries. CONCLUSIONS Most new HIV infections, MTCTs and AIDS-related deaths occurred in countries with an HIV prevalence rate below 4.5%. Many of these countries are not targeted by access programmes, such as the President' Emergency Plan for AIDS Relief. More intensive programmes of diagnosis and treatment are needed in these countries in the effort to reduce global new HIV infections below 500,000 per year by 2020.
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Affiliation(s)
- Joe Kempton
- Imperial College Healthcare NHS Trust,
London,
UK
| | - Andrew Hill
- Liverpool School of Tropical Medicine,
UK,Corresponding author: Andrew Hill,
Department of Translational Medicine,
University of Liverpool,
70 Pembroke Place,
Liverpool L69 3GF,
UK
| | - Jacob A Levi
- Chelsea and Westminster NHS Foundation Trust,
London,
UK
| | | | - Anton Pozniak
- Chelsea and Westminster Hospital,
London,
UK,London School of Hygiene and Tropical Medicine,
London,
UK
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Goga A, Singh Y, Jackson D, Mukungunugwa S, Wafula R, Eliya M, Ng'ambi WF, Nabitaka L, Chirinda W, Bhardwaj S, Essajee S, Hayashi C, Pillay Y. How are countries in sub-Saharan African monitoring the impact of programmes to prevent vertical transmission of HIV? BMJ 2019; 364:l660. [PMID: 30957768 PMCID: PMC6434514 DOI: 10.1136/bmj.l660] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Ameena Goga and colleagues describe how five countries in sub-Saharan Africa are monitoring the effectiveness of national programmes to prevent vertical transmission of HIV
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Affiliation(s)
- Ameena Goga
- Health Systems Research Unit, South African Medical Research Council, South Africa
- Department of Paediatrics, University of Pretoria, South Africa
| | - Yagespari Singh
- Health Systems Research Unit, South African Medical Research Council, South Africa
| | - Debra Jackson
- School of Public Health, University of the Western Cape, Cape Town, South Africa
- Unicef, Health Section, New York, USA
| | - Solomon Mukungunugwa
- PMTCT, Paediatric HIV Care Treatment, AIDS and TB Unit, Ministry of Health, Harare, Zimbabwe
| | - Rose Wafula
- National Aids and STI Control Program, Kenya
| | - Michael Eliya
- Ministry of Health, HIV and AIDS Department, Lilongwe, Malawi
| | - Wingston Felix Ng'ambi
- Health Economics and Policy Unit, Department of Health Systems and Policy, College of Medicine, Lilongwe Campus, University of Malawi, Lilongwe, Malawi
| | | | - Witness Chirinda
- Health Systems Research Unit, South African Medical Research Council, South Africa
| | | | | | | | - Yogan Pillay
- HIV/AIDS, TB, MCWHN, National Department of Health, Pretoria, South Africa
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223
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Jesus TS, Landry MD, Hoenig H. Global Need for Physical Rehabilitation: Systematic Analysis from the Global Burden of Disease Study 2017. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16060980. [PMID: 30893793 PMCID: PMC6466363 DOI: 10.3390/ijerph16060980] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 02/19/2019] [Accepted: 03/15/2019] [Indexed: 12/29/2022]
Abstract
Background: To inform global health policies and resources planning, this paper analyzes evolving trends in physical rehabilitation needs, using data on Years Lived with Disability (YLDs) from the Global Burden of Disease Study (GBD) 2017. Methods: Secondary analysis of how YLDs from conditions likely benefiting from physical rehabilitation have evolved from 1990 to 2017, for the world and across countries of varying income levels. Linear regression analyses were used. Results: A 66.2% growth was found in estimated YLD Counts germane to physical rehabilitation: a significant and linear growth of more than 5.1 billion YLDs per year (99% CI: 4.8–5.4; r2 = 0.99). Low-income countries more than doubled (111.5% growth) their YLD Counts likely benefiting from physical rehabilitation since 1990. YLD Rates per 100,000 people and the percentage of YLDs likley benefiting from physical rehabilitation also grew significantly over time, across locations (all p > 0.05). Finally, only in high-income countries did Age-standardized YLD Rates significantly decrease (p < 0.01; r2 = 0.86). Conclusions: Physical rehabilitation needs have been growing significantly in absolute, per-capita and in percentage of total YLDs. This growth was found globally and across countries of varying income level. In absolute terms, growths were higher in lower income countries, wherein rehabilitation is under-resourced, thereby highlighting important unmet needs.
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Affiliation(s)
- Tiago S Jesus
- Global Health and Tropical Medicine & WHO Collaborating Center on Health Workforce Policy and Planning, Institute of Hygiene and Tropical Medicine-NOVA University of Lisbon, Rua da Junqueira 100, 1349-008 Lisbon, Portugal.
| | - Michel D Landry
- Physical Therapy Division, Department of Orthopeadic Surgery, School of Medicine, Duke University, Durham, NC 27705, USA.
- Duke Global Health Institute (DGHI), Duke University, Durham, NC 27710, USA.
| | - Helen Hoenig
- Physical Medicine and Rehabilitation Service, Durham Veterans Administration Medical Center, Durham, NC 27705, USA.
- Division of Geriatrics, Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA.
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224
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Heffron R, Stalter R, Pyra M, Nanda K, Erikson DW, Hladik F, Blue SW, Davis NL, Mugo N, Kourtis AP, Lingappa JR, Baeten JM. HIV risk associated with serum medroxyprogesterone acetate levels among women in East and southern Africa. AIDS 2019; 33:735-744. [PMID: 30585845 PMCID: PMC6399047 DOI: 10.1097/qad.0000000000002123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Some observational studies have found increased HIV risk associated with self-reported use of injectable depot medroxyprogesterone acetate. Testing blood samples for medroxyprogesterone acetate (MPA), the progestin in depot medroxyprogesterone acetate, permits validation of self-reported data, and exploration of whether potential HIV risk is correlated with MPA levels, which are highest soon after injection. METHODS We conducted a case-control study testing archived serum from women who participated in three longitudinal studies of HIV prevention in East and southern Africa. Case samples, from women who acquired HIV, were from visits that occurred at or immediately prior to the first evidence of HIV infection. Secondary analyses restricted to case samples collected within 15 and 30 days of the estimated date of HIV infection. Matched control samples were from women who remained HIV uninfected. We used multivariable conditional logistic regression to compare exogenous hormone levels, quantified through mass spectrometry, among cases and controls. RESULTS When restricted to cases with samples collected within 15 days or less of estimated date of HIV infection, MPA detection was more frequent among women who acquired HIV (adjusted odds ratio = 2.75, 95% confidence interval 1.22-6.19). In this subset, the increase in HIV risk was only among samples with MPA detected at a low level of 0.02-0.50 ng/ml: 36.7% of cases and 9.4% of controls, adjusted odds ratio = 6.03, 95% confidence interval 2.50-14.54. CONCLUSION Detection of MPA at low levels close to the estimated time of HIV acquisition was significantly more frequent among women who acquired HIV. Studies are needed that explore biological mechanisms elicited by any MPA level and HIV risk.
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Affiliation(s)
| | | | - Maria Pyra
- University of Washington, Seattle, Washington
| | - Kavita Nanda
- Global Health, Population and Nutrition, FHI360, Durham, North Carolina
| | - David W Erikson
- Endocrine Technologies Core, Oregon National Primate Research Center, Hillsboro, Oregon
| | - Florian Hladik
- Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington
| | - Steven W Blue
- Endocrine Technologies Core, Oregon National Primate Research Center, Hillsboro, Oregon
| | - Nicole L Davis
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Nelly Mugo
- University of Washington, Seattle, Washington
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Athena P Kourtis
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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225
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Essouma M, Tangie LN, Temgoua MN, Kenfack UG, Ndam AN, Danwang C. Severe clinical immunodeficiency in a patient with human immunodeficiency virus infection and relatively high CD4 counts: a case report. J Med Case Rep 2019; 13:86. [PMID: 30867046 PMCID: PMC6417181 DOI: 10.1186/s13256-019-1982-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 01/15/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The coexistence of neuromeningeal cryptococcosis and Kaposi's sarcoma is not surprising in a patient with human immunodeficiency virus infection and a low CD4 count, although it is rarely described. However, we describe such an association in a patient with human immunodeficiency virus infection and a relatively high CD4 count. CASE PRESENTATION A 41-year old Cameroonian woman presented to our hospital with subacute occipital headaches associated with photophobia, blurred vision, phonophobia, projectile vomiting, and tonic seizures. In her past history, there was an human immunodeficiency virus infection known for 12 years, for which she had been taking (with good compliance) tenofovir-lamivudine-efavirenz-based antiretroviral therapy for the same period of time. One month before the consultation, gastric Kaposi's sarcoma had been diagnosed, justifying the treatment with doxorubicin she had received. A clinical examination was unremarkable. A computed tomography scan of her brain was normal, and cerebrospinal fluid analysis revealed Cryptococcus neoformans. Her CD4 count was 353/mm3. Orally administered antifungal treatment with fluconazole (1200 mg/day) and flucytosine (1500 mg × 4/day) was started immediately, but she died on the sixth day of this treatment. CONCLUSION This clinical case shows that the coexistence of neuromeningeal cryptococcosis and gastric Kaposi's sarcoma is possible in all patients with human immunodeficiency virus infection, regardless of CD4 count.
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Affiliation(s)
- Mickael Essouma
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | - Larry N. Tangie
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | - Mazou N. Temgoua
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | - Ulrich Gabin Kenfack
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | - Antonin N. Ndam
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
- Hepatogastroenterology Unit, Yaounde General Hospital, Yaounde, Cameroon
| | - Celestin Danwang
- Department of Surgery and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
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226
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The contraceptive medroxyprogesterone acetate, unlike norethisterone, directly increases R5 HIV-1 infection in human cervical explant tissue at physiologically relevant concentrations. Sci Rep 2019; 9:4334. [PMID: 30867477 PMCID: PMC6416361 DOI: 10.1038/s41598-019-40756-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 02/19/2019] [Indexed: 02/06/2023] Open
Abstract
The intramuscular progestin-only injectable contraceptive, depo-medroxyprogesterone acetate (DMPA-IM), is more widely used in Sub-Saharan Africa than another injectable contraceptive, norethisterone enanthate (NET-EN). Epidemiological data show a significant 1.4-fold increased risk of HIV-1 acquisition for DMPA-IM usage, while no such association is shown from limited data for NET-EN. We show that MPA, unlike NET, significantly increases R5-tropic but not X4-tropic HIV-1 replication ex vivo in human endocervical and ectocervical explant tissue from pre-menopausal donors, at physiologically relevant doses. Results support a mechanism whereby MPA, unlike NET, acts via the glucocorticoid receptor (GR) to increase HIV-1 replication in cervical tissue by increasing the relative frequency of CD4+ T cells and activated monocytes. We show that MPA, unlike NET, increases mRNA expression of the CD4 HIV-1 receptor and CCR5 but not CXCR4 chemokine receptors, via the GR. However, increased density of CD4 on CD3+ cells was not observed with MPA by flow cytometry of digested tissue. Results suggest that DMPA-IM may increase HIV-1 acquisition in vivo at least in part via direct effects on cervical tissue to increase founder R5-tropic HIV-1 replication. Our findings support differential biological mechanisms and disaggregation of DMPA-IM and NET-EN regarding HIV-1 acquisition risk category for use in high risk areas.
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227
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Jiang H, Chen X, Li J, Tan Z, Cheng W, Yang Y. Predictors of condom use behavior among men who have sex with men in China using a modified information-motivation-behavioral skills (IMB) model. BMC Public Health 2019; 19:261. [PMID: 30832640 PMCID: PMC6399930 DOI: 10.1186/s12889-019-6593-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 02/25/2019] [Indexed: 01/11/2023] Open
Abstract
Background Men who have sex with men (MSM) are at high risk for human immunodeficiency virus (HIV) infection in China. Correct and consistent condom use is one of the most effective strategies for preventing the spread of HIV. This study developed a modified Information-Motivation-Behavioral Skills (IMB) model to predict condom use behavior among Chinese MSM. Methods A cross-sectional study was conducted to collect data using self-administered electronic questionnaire. Participants were recruited from HIV Voluntary Counseling and Testing clinics in six district Centers for Disease Control and Prevention in Guangzhou and two community-based HIV service centers (Lingnan Partners and Zhitong Charity) from May to September 2017. Structural equation modeling was performed to develop the modified IMB model with extended multilevel factors. Results Among the 976 MSM included, 52.05% had engaged in anal intercourse with a condom every time. The final modified IMB model fitted the data more ideally than the conventional model. The final modified IMB model revealed that behavioral skills positively contributed directly to condom use (β = 0.385, p < 0.001) and partially mediated the associations between information (β = 0.106, p = 0.005) and motivation (β = 0.390, p < 0.001) and condom use. Regarding the extended multilevel factors, education, income, receiving HIV prevention services, sexual partner seeking behavior, depression, intimate partner violence, and child sexual abuse had indirect impacts on condom use that were mediated by information, motivation, and/or behavioral skills (p < 0.05). All paths from the latent variable to the corresponding observed variables were statistically significant (p < 0.001). Conclusion The modified IMB model with extended multilevel factors could serve as a theoretical framework for behavioral interventions for condom use among Chinese MSM. Further prospective studies are needed to examine the predictive power of the modified IMB model. Electronic supplementary material The online version of this article (10.1186/s12889-019-6593-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hongbo Jiang
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, No. 283 Jianghai Road, Haizhu District, Guangzhou, China
| | - Xiaobin Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, No. 283 Jianghai Road, Haizhu District, Guangzhou, China
| | - Jing Li
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, No. 283 Jianghai Road, Haizhu District, Guangzhou, China
| | - Zhimin Tan
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, No. 283 Jianghai Road, Haizhu District, Guangzhou, China
| | - Weibin Cheng
- Department of AIDS/STD Control and Prevention, Guangzhou Center for Disease Control and Prevention, No. 1 Qide Road, Baiyun District, Guangzhou, China.
| | - Yi Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, No. 283 Jianghai Road, Haizhu District, Guangzhou, China.
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228
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Depressive Symptoms at HIV Testing and Two-Year All-Cause Mortality Among Men Who Inject Drugs in Vietnam. AIDS Behav 2019; 23:609-616. [PMID: 30357641 DOI: 10.1007/s10461-018-2318-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
People who inject drugs (PWID) with HIV experience an elevated risk of death. A potentially important determinant of survival is the high burden of depression. This study examined the relationship of depressive symptoms at HIV testing with 2-year all-cause mortality among newly diagnosed HIV-positive PWID in Vietnam. At HIV testing, 141 PWID (42%) experienced severe depressive symptoms, and over the 2 years following diagnosis, 82 PWID (24%) died. Controlling for potential confounders, the 2-year risk of death among those with depressive symptoms was 9.7% (95% CI - 1.2, 20.6%) higher than the risk among those without depressive symptoms. This increased risk of mortality for PWID with depressive symptoms was relatively consistent throughout the 2-year period: at 6, 12, and 18 months, the risk difference was 12.6% (5.5-19.7%), 13.9% (4.6-23.2%), and 11.0% (0.9-21.1%), respectively. HIV diagnosis may provide an important opportunity for depression screening and treatment, subsequently improving survival in this key population.Trial registry: ClinicalTrials.gov NCT01689545.
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229
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Akrami F, Abbasi M. Ethical Considerations from the Viewpoint of Headquarters Experts on HIV/AIDS Prevention and Control Strategic Program. Int J Prev Med 2019; 10:8. [PMID: 30774842 PMCID: PMC6360846 DOI: 10.4103/ijpvm.ijpvm_275_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 11/05/2018] [Indexed: 11/04/2022] Open
Abstract
Background The HIV control and prevention program is one of the Public Health programs that confronts with many ethical challenges. This study aimed to explore ethical considerations from the viewpoint of headquarters experts on HIV and AIDS prevention and control strategic plan. Methods In this qualitative study with content analysis design, focus group discussion method was utilized. After purposeful introduction of the experts and previous coordination about subject and time, two discussion sessions were held with the participation of six ministry and university headquarters experts of HIV control program. After frequent reviews of the data and using deductive content analysis, main themes and subthemes were categorized. In order to transformability of the findings to similar situations, the data were checked by three external reviewers. Results The participants agreed that HIV/AIDS control requires focusing on prevention, treatment, and support services, and considering the general population and all vulnerable groups. In this study, five main themes were emerged: informing and empowering to make autonomous decisions, observing confidentiality, prohibiting stigma and discrimination, and being accountable. Conclusions The viewpoint of participants indicates on the more need to pay attention the mentioned ethical considerations when compiling and finalizing the program. Moreover, in addition to instructing moral norms in PH programs with a special look to HIV/AIDS and how to apply them in the formulation and implementation of program, systematic evaluation of the program by an ethical framework is recommended to ensure the achievement to the goals of program.
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Affiliation(s)
- Forouzan Akrami
- Medical Ethics and Law Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahmoud Abbasi
- Medical Ethics and Law Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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230
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Hoang CD, Tran BX, Pham MD, Nguyen LH, Do HN, Vuong QH, Ho MT, Dam VN, Vuong TT, Nguyen HH, Nguyen V, Pham HQ, Ha GH, Latkin CA, Ho CSH, Ho RCM. HIV- and AIDS-related knowledge and attitude of residents in border regions of Vietnam. Harm Reduct J 2019; 16:11. [PMID: 30732621 PMCID: PMC6367780 DOI: 10.1186/s12954-019-0282-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 01/29/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Residents in border areas are vulnerable to HIV/AIDS due to high rates of risk behaviors such as unprotected sexual practices or illicit drug use. Improving knowledge and attitude toward HIV/AIDS prevention and treatment are vital to diminish the burden of the HIV epidemic in this setting. However, evidence about this issue in Vietnam has been limited. This study aims to explore the knowledge and attitude toward HIV/AIDS among people in Vietnam border zones. METHODS We conducted a cross-sectional study in three border communes in Thanh Hoa province with 600 HIV(-) residents. Data about socio-demographic characteristics, general HIV knowledge, knowledge about prevention of mother-to-child transmission, treatment and care, HIV testing services, and attitude toward HIV/AIDS were collected. Multivariate Tobit regression was used to determine related factors with the knowledge and attitude. RESULTS The highest percentage of people having correct statements was for "HIV could be transmitted from mother to child" (98.2%), while the lowest percentage was for item "Know health facilities where HIV-positive people could register for care and check-up" (28.2%). People had the highest score in "Knowledge about HIV transmission routes" and the lowest score in "Knowledge about HIV/AIDS prevention measures". Most of the people were not afraid of being exposed to HIV-positive individuals (66.0%), willing to buy goods from HIV-positive sellers (78.9%), and willing to take care of people living with HIV in their family (90.1%). Education, ethnic, marital status, occupations, and HIV/AIDS information sources were found to be associated with knowledge and attitude toward HIV/AIDS. CONCLUSIONS The general knowledge and attitude on HIV/AIDS of residents were relatively good. Educational campaigns to improve knowledge and attitude toward PLWH, involving peer educators and local associations, are potential strategies for sustaining HIV intervention in this remote setting.
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Affiliation(s)
- Canh Dinh Hoang
- Vietnam Authority of HIV/AIDS Control, Ministry of Health, Hanoi, Vietnam
| | - Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam. .,Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
| | - Manh Duc Pham
- Vietnam Authority of HIV/AIDS Control, Ministry of Health, Hanoi, Vietnam
| | - Long Hoang Nguyen
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | - Ha Ngoc Do
- Youth Research Institute, Ho Chi Minh Communist Youth Union, Hanoi, Vietnam
| | - Quan Hoang Vuong
- Center for Interdisciplinary Social Research, Phenikaa University, Hanoi, Vietnam
| | - Manh Tung Ho
- Center for Interdisciplinary Social Research, Phenikaa University, Hanoi, Vietnam
| | | | | | - Hai Hong Nguyen
- Vietnam Authority of HIV/AIDS Control, Ministry of Health, Hanoi, Vietnam
| | - Vu Nguyen
- Department of Neurosurgery Spine-Surgery, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Hai Quang Pham
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | - Giang Hai Ha
- Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam
| | - Carl A Latkin
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Cyrus S H Ho
- Department of Psychological Medicine, National University Hospital, Singapore, Singapore
| | - Roger C M Ho
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam.,Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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231
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Sisay M, Edessa D, Ayele Y, Getachew M. Pattern of and reasons for antiretroviral therapy regimen change among adult HIV/AIDS patients at regional hospital in Eastern Ethiopia: A 10-year retrospective study. SAGE Open Med 2019; 7:2050312119827092. [PMID: 30746143 PMCID: PMC6360642 DOI: 10.1177/2050312119827092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 01/07/2019] [Indexed: 12/21/2022] Open
Abstract
Objectives Despite the successes of treatment with antiretroviral therapy in reducing morbidity and mortality among HIV-infected patients, long-term sustainability of the initial regimen has become challenging. Therefore, this study is aimed to address pattern of and reasons for change of antiretroviral therapy regimens among HIV/AIDS patients at Jugel Hospital, Eastern Ethiopia. Methods A retrospective cross-sectional study was conducted to review medical records of 220 patients who had been on treatment and experienced regimen change at least once from September 2006 to August 2016. Structured data abstraction format was customized from World Health Organization guideline. Data were entered in Epi-data version 3.1, and exported to and analyzed with Statistical Package for Social Sciences version 20. Following descriptive statistics, binary logistic regression was run to determine the association between selected variables and second-time regimen change. Results The mean age of patients was 37.6 (±8.9) years and 62.3% of them were female. Majority of the patients were presented to the hospital with World Health Organization clinical stage III (59.1%) and CD4 count below 200 cells/mm3 (68.6%). The mean duration of stay on initial regimen was found to be 3.26 (±1.92) years. The average number of initial regimen changes per year was 22 (±11.28). In two-thirds (66.36%) of the patients, their initial regimen was changed to tenofovir disproxil fumarate-based alternatives. The most-frequent reason for initial regimen change was toxicity (32.3%). Among those who experienced the regimen change for the first time, the prevalence of second-time regimen change was found to be 18.18%. Patients who had been taking tuberculosis treatment along with antiretroviral therapy were more likely to get their regimen changed for the second-time compared to those who were not infected with tuberculosis (adjusted odds ratio: 3.40; 95% confidence interval: 1.87-6.47). Besides, patients who were on zidovudine-based (adjusted odds ratio: 0.26; 95% confidence interval: 0.33-0.47) and tenofovir disoproxil fumarate-based regimens (adjusted odds ratio: 0.03; 95% confidence interval: 0.01-0.12) were less likely to get their regimen changed for the second-time compared to those who were on stavudine-based regimens. Conclusion The majority of the patients had their treatment regimen changed because of drug-related toxicities, treatment failure, and comorbid conditions. Some regimen changes might be attributable to failure of either hospital supply system or patient-related factors which would have been prevented considering limited number of treatment options. There must be consideration of risks and benefits prior to changing a particular regimen.
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Affiliation(s)
- Mekonnen Sisay
- Department of Pharmacology and Toxicology, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Dumessa Edessa
- Department of Clinical Pharmacy, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Yohanes Ayele
- Department of Clinical Pharmacy, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Abstract
: Neurological conditions associated with HIV remain major contributors to morbidity and mortality and are increasingly recognized in the aging population on long-standing combination antiretroviral therapy (cART). Importantly, growing evidence shows that the central nervous system (CNS) may serve as a reservoir for viral replication, which has major implications for HIV eradication strategies. Although there has been major progress in the last decade in our understanding of the pathogenesis, burden, and impact of neurological conditions associated with HIV infection, significant scientific gaps remain. In many resource-limited settings, antiretrovirals considered second or third line in the United States, which carry substantial neurotoxicity, remain mainstays of treatment, and patients continue to present with severe immunosuppression and CNS opportunistic infections. Despite this, increased global access to cART has coincided with an aging HIV-positive population with cognitive sequelae, cerebrovascular disease, and peripheral neuropathy. Further neurological research in low-income and middle-income countries (LMICs) is needed to address the burden of neurological complications in HIV-positive patients, particularly regarding CNS viral reservoirs and their effects on eradication.
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233
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Nguyen TMT, Tran BX, Fleming M, Pham MD, Nguyen LT, Nguyen ALT, Le HT, Nguyen TH, Hoang VH, Le XTT, Vuong QH, Ho MT, Dam VN, Vuong TT, Nguyen V, Nguyen HLT, Do HP, Doan PL, Nguyen HH, Latkin CA, Ho CSH, Ho RCM. HIV knowledge and risk behaviors among drug users in three Vietnamese mountainous provinces. Subst Abuse Treat Prev Policy 2019; 14:3. [PMID: 30646945 PMCID: PMC6334422 DOI: 10.1186/s13011-019-0191-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 01/03/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Globally, people who inject drugs are highly vulnerable to HIV transmission. Methadone maintenance treatment (MMT) programs are one of the most cost-effective mechanisms to substitute opioid use and improve the quality of life of patients. Since the coverage of MMT is still limited and even for those patients who are treated, improving their knowledge on HIV and maintaining healthy behaviors are key to maximizing the outcomes of HIV harm reduction programs. This study examined the knowledge on HIV, perceived risk and HIV testing among drug users accessing methadone maintenance services in three Vietnamese mountainous areas. METHODS A cross-sectional study of 300 people enrolling for MMT services in three provinces in Vietnam was conducted. The factors associated with the knowledge, attitudes, and practices of respondents about HIV/AIDS were exploited using multivariable logistic model. RESULTS Of the 300-people surveyed, 99% knew of HIV and 60.6% were identified as having good knowledge. While 75.2% identified that injecting drugs was a risk factor for HIV, 52.2% thought they were not at risk of HIV mainly as they did not share needles. 92.6% had undergone HIV testing with 17.4% being positive, a number which was significantly lower than Vietnam's national average for people who inject drugs. Age, ethnicity and education were associated with knowledge of HIV while ART treatment was linked to self-assessed HIV status. CONCLUSIONS This study sheds new light on the knowledge attitudes and practices of people who inject drugs, particularly males in mountainous areas of Vietnam regarding HIV prevention. Overall, knowledge was good with most conducting safe practices towards transmission. Enhanced education and targeting of minority groups could help in increasing the numbers receiving MMT and HIV services.
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Affiliation(s)
| | - Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD USA
- Vietnam Young Physician Association, Hanoi, Vietnam
| | | | - Manh Duc Pham
- Vietnam Authority of HIV/AIDS Control, Ministry of Health, Hanoi, Vietnam
| | - Long Thanh Nguyen
- Vietnam Authority of HIV/AIDS Control, Ministry of Health, Hanoi, Vietnam
| | | | - Huong Thi Le
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Thang Huu Nguyen
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Van Hai Hoang
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Xuan Thanh Thi Le
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Quan Hoang Vuong
- Centre for Interdisciplinary Social Research, Phenikaa University, Hanoi, Vietnam
- Université Libre de Bruxelles, B-1050 Brussels, Belgium
| | - Manh Tung Ho
- Institute of Philosophy, Vietnam Academy of Social Sciences, Hanoi, Vietnam
| | | | | | - Vu Nguyen
- Department of Neurosurgery Spine-Surgery, Hanoi Medical University Hospital, Hanoi, Vietnam
| | | | - Huyen Phuc Do
- Center of Excellence in Evidence-based Medicine, Nguyen Tat Thanh University, Ho Chi Minh city, Vietnam
| | - Phuong Linh Doan
- Center of Excellence in Evidence-based Medicine, Nguyen Tat Thanh University, Ho Chi Minh city, Vietnam
| | - Hai Hong Nguyen
- Center of Excellence in Evidence-based Medicine, Nguyen Tat Thanh University, Ho Chi Minh city, Vietnam
| | - Carl A. Latkin
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD USA
| | - Cyrus S. H. Ho
- Department of Psychological Medicine, National University Hospital, Singapore, Singapore
| | - Roger C. M. Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Singapore
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Demir OM, Candilio L, Fuster D, Muga R, Barbaro G, Colombo A, Azzalini L. Cardiovascular disease burden among human immunodeficiency virus-infected individuals. Int J Cardiol 2019; 265:195-203. [PMID: 29885686 DOI: 10.1016/j.ijcard.2018.03.137] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 03/17/2018] [Accepted: 03/30/2018] [Indexed: 12/20/2022]
Abstract
Human Immunodeficiency Virus (HIV) infection affects 36.7 million people worldwide, it accounted for 1.1 million deaths in 2015. The advent of combined antiretroviral therapy (cART) has been associated with a decrease in HIV-related morbidity and mortality. However, there are increasing concerns about long-lasting effects of chronic inflammation and immune activation, leading to premature aging and HIV-related mortality. Cardiovascular diseases, especially coronary artery disease, are among the leading causes of death in HIV-infected patients, accounting for up to 15% of total deaths in high income countries. Furthermore, as cART availability expands to low-income countries, the burden of cardiovascular related mortality is likely to rise. Hence, over the next decade HIV-associated cardiovascular disease burden is expected to increase globally. In this review, we summarize our understanding of the pathogenesis and risk factors associated with HIV infection and cardiovascular disease, in particular coronary artery disease.
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Affiliation(s)
- Ozan M Demir
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy; Department of Cardiology, Hammersmith Hospital, Imperial College NHS Healthcare Trust, London, United Kingdom
| | - Luciano Candilio
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy; Department of Cardiology, Hammersmith Hospital, Imperial College NHS Healthcare Trust, London, United Kingdom
| | - Daniel Fuster
- Department of Internal Medicine, Addiction Unit, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Robert Muga
- Department of Internal Medicine, Addiction Unit, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Giuseppe Barbaro
- Department of Internal Medicine and Infectious Diseases, Policlinico Umberto Primo, Rome, Italy
| | - Antonio Colombo
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Lorenzo Azzalini
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy.
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235
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Vascular cognitive impairment and HIV-associated neurocognitive disorder: a new paradigm. J Neurovirol 2019; 25:710-721. [DOI: 10.1007/s13365-018-0706-5] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 11/15/2018] [Accepted: 11/16/2018] [Indexed: 02/07/2023]
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236
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Basu S, Garg S, Sharma N, Singh MM. Improving the assessment of medication adherence: Challenges and considerations with a focus on low-resource settings. Tzu Chi Med J 2019; 31:73-80. [PMID: 31007485 PMCID: PMC6450154 DOI: 10.4103/tcmj.tcmj_177_18] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Improving patient survival and quality of life in chronic diseases requires prolonged and often lifelong medication intake. Less than half of patients with chronic diseases globally are adherent to their prescribed medications which preclude the full benefit of treatment, worsens therapeutic outcomes, accelerates disease progression, and causes enormous economic losses. The accurate assessment of medication adherence is pivotal for both researchers and clinicians. Medication adherence can be assessed through both direct and indirect measures. Indirect measures include both subjective (self-report measures such as questionnaire and interview) and objective (pill count and secondary database analysis) measures and constitute the mainstay of assessing medication adherence. However, the lack of an inexpensive, ubiquitous, universal gold standard for assessment of medication adherence emphasizes the need to utilize a combination of measures to differentiate adherent and nonadherent patients. The global heterogeneity in health systems precludes the development of a universal guideline for evaluating medication adherence. Methods based on the secondary database analysis are mostly ineffectual in low-resource settings lacking electronic pharmacy and insurance databases and allowing refills without updated, valid prescriptions from private pharmacies. This significantly restricts the choices for assessing adherence until digitization of medical data takes root in much of the developing world. Nevertheless, there is ample scope for improving self-report measures of adherence. Effective interview techniques, especially accounting for suboptimal patient health literacy, validation of adherence questionnaires, and avoiding conceptual fallacies in reporting adherence can improve the assessment of medication adherence and promote understanding of its causal factors.
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Affiliation(s)
- Saurav Basu
- Department of Community Medicine, Maulana Azad Medical College, New Delhi, India
| | - Suneela Garg
- Department of Community Medicine, Maulana Azad Medical College, New Delhi, India
| | - Nandini Sharma
- Department of Community Medicine, Maulana Azad Medical College, New Delhi, India
| | - M Meghachandra Singh
- Department of Community Medicine, Maulana Azad Medical College, New Delhi, India
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Zhou Y, Chen Y, He H, Liao J, Duong HT, Parviz M, Jin D. A homogeneous DNA assay by recovering inhibited emission of rare earth ions-doped upconversion nanoparticles. J RARE EARTH 2019. [DOI: 10.1016/j.jre.2018.05.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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238
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Jung IY, Rupasinghe D, Woolley I, O'Connor CC, Giles M, Azwa RISR, Choi JY. Trends in mortality among ART-treated HIV-infected adults in the Asia-Pacific region between 1999 and 2017: results from the TREAT Asia HIV Observational Database (TAHOD) and Australian HIV Observational Database (AHOD) of IeDEA Asia-Pacific. J Int AIDS Soc 2019; 22:e25219. [PMID: 30615271 PMCID: PMC6322485 DOI: 10.1002/jia2.25219] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 11/05/2018] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION AIDS-related deaths in people living with HIV/AIDS have been decreasing in number since the introduction of combination antiretroviral treatment (cART). However, data on recent causes of death in the Asia-Pacific region are limited. Hence, we analysed and compared AIDS-related and non-AIDS-related mortality in high- and low-income settings in the region. METHODS Patients from the TREAT Asia HIV Observational Database (TAHOD) and Australian HIV Observational Database (AHOD) receiving cART between 1999 and 2017 were included. Causes of death verification were based on review of the standardized Cause of Death (CoDe) form designed by the D:A:D group. Cohorts were grouped as AHOD (all high-income sites), TAHOD-high (high/upper-middle income countries) and TAHOD-low (lower-middle income countries). TAHOD sites were split into high/upper-middle income and lower-middle income country settings based on World Bank classifications. Competing risk regression was used to analyse factors associated with AIDS and non-AIDS-related mortality. RESULTS Of 10,386 patients, 522 died; 187 from AIDS-related and 335 from non-AIDS-related causes. The overall incidence rate of deaths during follow-up was 0.28 per 100 person-years (/100 PYS) for AIDS and 0.51/100 PYS for non-AIDS. Analysis indicated that the incidence rate of non-AIDS mortality decreased from 0.78/100 PYS to 0.37/100 PYS from year groups 2003 to 2007 to 2013 to 2017 (p < 0.001). Similarly, incidence rates of AIDS-related deaths decreased from 0.51/100 PYS to 0.09/100 PYS from year groups 2003 to 2007 to 2013 to 2017 (p < 0.001). More recent years of follow-up were associated with reduced hazard for non-AIDS mortality (2008 to 2012: aSHR (adjusted sub-hazard ratio) 0.72, 95% confidence interval (CI) 0.54 to 0.96, p = 0.027; 2013 to 2017: aSHR 0.64, 95% CI 0.47 to 0.87, p = 0.004) compared to years 2003 to 2007. The AHOD cohort had almost twice the hazard of non-AIDS mortality compared to TAHOD-low (lower-middle income sites) (aSHR 1.72, 95% CI, 1.20 to 2.46, p = 0.003); there were no differences between cohorts for AIDS-related mortality (p = 0.834). CONCLUSION AIDS and non-AIDS-related mortality rates have decreased over the past years in the Asia-Pacific region. There is a greater risk for non-AIDS-associated deaths in the AHOD cohort compared to lower-middle income settings in TAHOD.
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Affiliation(s)
- In Young Jung
- Department of Internal MedicineYonsei University Wonju College of MedicineWonjuSouth Korea
- AIDS Research InstituteYonsei University College of MedicineSeoulSouth Korea
| | | | - Ian Woolley
- Monash Infectious DiseasesMonash Health and Monash UniversityClaytonVic.Australia
- Department of Infectious DiseasesThe Alfred Hospital and Monash UniversityMelbourneVic.Australia
| | - Catherine C O'Connor
- The Kirby InstituteUNSW SydneySydneyNSWAustralia
- Sexual Health ServiceSydney Local Health DistrictCamperdownNSWAustralia
- Central Clinical SchoolUniversity of SydneySydneyNSWAustralia
| | - Michelle Giles
- Department of Infectious DiseasesThe Alfred Hospital and Monash UniversityMelbourneVic.Australia
| | - Raja ISR Azwa
- University of Malaya Medical Centre (UMMC)Kuala LumpurMalaysia
| | - Jun Yong Choi
- AIDS Research InstituteYonsei University College of MedicineSeoulSouth Korea
- Department of Internal MedicineYonsei University College of MedicineSeoulSouth Korea
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239
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Collaud F, Bortolussi G, Guianvarc'h L, Aronson SJ, Bordet T, Veron P, Charles S, Vidal P, Sola MS, Rundwasser S, Dufour DG, Lacoste F, Luc C, Wittenberghe LV, Martin S, Le Bec C, Bosma PJ, Muro AF, Ronzitti G, Hebben M, Mingozzi F. Preclinical Development of an AAV8-hUGT1A1 Vector for the Treatment of Crigler-Najjar Syndrome. MOLECULAR THERAPY-METHODS & CLINICAL DEVELOPMENT 2018; 12:157-174. [PMID: 30705921 PMCID: PMC6348934 DOI: 10.1016/j.omtm.2018.12.011] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 12/26/2018] [Indexed: 12/12/2022]
Abstract
Adeno-associated viruses (AAVs) are among the most efficient vectors for liver gene therapy. Results obtained in the first hemophilia clinical trials demonstrated the long-term efficacy of this approach in humans, showing efficient targeting of hepatocytes with both self-complementary (sc) and single-stranded (ss) AAV vectors. However, to support clinical development of AAV-based gene therapies, efficient and scalable production processes are needed. In an effort to translate to the clinic an approach of AAV-mediated liver gene transfer to treat Crigler-Najjar (CN) syndrome, we developed an (ss)AAV8 vector carrying the human UDP-glucuronosyltransferase family 1-member A1 (hUGT1A1) transgene under the control of a liver-specific promoter. We compared our construct with similar (sc)AAV8 vectors expressing hUGT1A1, showing comparable potency in vitro and in vivo. Conversely, (ss)AAV8-hUGT1A1 vectors showed superior yields and product homogeneity compared with their (sc) counterpart. We then focused our efforts in the scale-up of a manufacturing process of the clinical product (ss)AAV8-hUGT1A1 based on the triple transfection of HEK293 cells grown in suspension. Large-scale production of this vector had characteristics identical to those of small-scale vectors produced in adherent cells. Preclinical studies in animal models of the disease and a good laboratory practice (GLP) toxicology-biodistribution study were also conducted using large-scale preparations of vectors. These studies demonstrated long-term safety and efficacy of gene transfer with (ss)AAV8-hUGT1A1 in relevant animal models of the disease, thus supporting the clinical translation of this gene therapy approach for the treatment of CN syndrome.
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Affiliation(s)
- Fanny Collaud
- INTEGRARE, Genethon, INSERM, Univ. Evry, Université Paris-Saclay, 91002 Evry, France
| | - Giulia Bortolussi
- International Center for Genetic Engineering and Biotechnology, 34149 Trieste, Italy
| | - Laurence Guianvarc'h
- INTEGRARE, Genethon, INSERM, Univ. Evry, Université Paris-Saclay, 91002 Evry, France
| | - Sem J Aronson
- Amsterdam UMC, University of Amsterdam, Tytgat Institute for Liver and Intestinal Research, AG&M, 1105 BK Amsterdam, the Netherlands
| | | | - Philippe Veron
- INTEGRARE, Genethon, INSERM, Univ. Evry, Université Paris-Saclay, 91002 Evry, France
| | - Severine Charles
- INTEGRARE, Genethon, INSERM, Univ. Evry, Université Paris-Saclay, 91002 Evry, France
| | - Patrice Vidal
- INTEGRARE, Genethon, INSERM, Univ. Evry, Université Paris-Saclay, 91002 Evry, France
| | - Marcelo Simon Sola
- INTEGRARE, Genethon, INSERM, Univ. Evry, Université Paris-Saclay, 91002 Evry, France
| | - Stephanie Rundwasser
- INTEGRARE, Genethon, INSERM, Univ. Evry, Université Paris-Saclay, 91002 Evry, France
| | - Delphine G Dufour
- INTEGRARE, Genethon, INSERM, Univ. Evry, Université Paris-Saclay, 91002 Evry, France
| | - Florence Lacoste
- INTEGRARE, Genethon, INSERM, Univ. Evry, Université Paris-Saclay, 91002 Evry, France
| | - Cyril Luc
- INTEGRARE, Genethon, INSERM, Univ. Evry, Université Paris-Saclay, 91002 Evry, France
| | | | - Samia Martin
- INTEGRARE, Genethon, INSERM, Univ. Evry, Université Paris-Saclay, 91002 Evry, France
| | - Christine Le Bec
- INTEGRARE, Genethon, INSERM, Univ. Evry, Université Paris-Saclay, 91002 Evry, France
| | - Piter J Bosma
- Amsterdam UMC, University of Amsterdam, Tytgat Institute for Liver and Intestinal Research, AG&M, 1105 BK Amsterdam, the Netherlands
| | - Andres F Muro
- International Center for Genetic Engineering and Biotechnology, 34149 Trieste, Italy
| | - Giuseppe Ronzitti
- INTEGRARE, Genethon, INSERM, Univ. Evry, Université Paris-Saclay, 91002 Evry, France
| | - Matthias Hebben
- INTEGRARE, Genethon, INSERM, Univ. Evry, Université Paris-Saclay, 91002 Evry, France
| | - Federico Mingozzi
- INTEGRARE, Genethon, INSERM, Univ. Evry, Université Paris-Saclay, 91002 Evry, France
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Kamtchum-Tatuene J, Al-Bayati Z, Mwandumba HC, Solomon T, Christmas SE, Benjamin LA. Serum concentration of anti-Cytomegalovirus IgG and ischaemic stroke in patients with advanced HIV infection in Malawi. PLoS One 2018; 13:e0208040. [PMID: 30481210 PMCID: PMC6258562 DOI: 10.1371/journal.pone.0208040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 11/10/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Studies in high-income settings have shown association between Cytomegalovirus (CMV) infection and adverse cardiovascular outcome, especially in HIV infection. We aimed to study the association between serum concentration of anti-CMV IgG and ischaemic stroke in HIV-infected Malawians. METHODS Our sample was derived from a case-control stroke study in Malawi. Serum concentration of anti-CMV IgG was measured using enzyme-linked immunosorbent assay. Multivariable logistic regression was used to study the association between high concentrations of anti-CMV IgG (above the third tertile) and ischaemic stroke while adjusting for cardiovascular risk factors. RESULTS Overall, 139 HIV-positive adults (48.2% women; 48 ischaemic stroke cases and 91 controls; median age: 45 years) were included. The median CD4+ count was 136 and 401 cell/mm3 (IQR: [75-278] and [230-533]) in cases and controls, respectively. High concentration of anti-CMV IgG was associated with ischaemic stroke in the univariable model (OR = 2.56 [1.23-5.34]) but not after adjusting for duration of antiretroviral therapy (ART), CD4+ count, and other cardiovascular risk factors (OR = 0.94 [0.29-3.08]). Low CD4+ count was an independent predictor of stroke. There was a negative correlation between serum concentration of anti-CMV IgG and CD4+ count (rho = -0.30, p < 0.001). CONCLUSIONS High concentration of anti-CMV IgG is not independently associated with ischaemic stroke in HIV-infected Malawians. Larger cohort studies are needed to further investigate the role of humoral response to CMV in the pathophysiology of HIV-associated stroke.
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Affiliation(s)
- Joseph Kamtchum-Tatuene
- Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
| | - Zaid Al-Bayati
- Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
| | - Henry Charles Mwandumba
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Tom Solomon
- Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
| | - Stephen E. Christmas
- Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
| | - Laura A. Benjamin
- Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
- * E-mail:
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Chihana ML, Huerga H, Van Cutsem G, Ellman T, Wanjala S, Masiku C, Szumilin E, Etard JF, Davies MA, Maman D. Impact of "test and treat" recommendations on eligibility for antiretroviral treatment: Cross sectional population survey data from three high HIV prevalence countries. PLoS One 2018; 13:e0207656. [PMID: 30475865 PMCID: PMC6261019 DOI: 10.1371/journal.pone.0207656] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 11/05/2018] [Indexed: 12/02/2022] Open
Abstract
Background Latest WHO guidelines recommend starting HIV-positive individuals on antiretroviral therapy treatment (ART) regardless of CD4 count. We assessed additional impact of adopting new WHO guidelines. Methods We used data of individuals aged 15–59 years from three HIV population surveys conducted in 2012 (Kenya) and 2013 (Malawi and South Africa). Individuals were interviewed at home followed by rapid HIV and CD4 testing if tested HIV-positive. HIV-positive individuals were classified as “eligible for ART” if (i) had ever been initiated on ART or (ii) were not yet on ART but met the criteria for starting ART based on country’s guidelines at the time of the survey (Kenya–CD4< = 350 cells/μl and WHO Stage 3 or 4 disease, Malawi as for Kenya plus lifelong ART for all pregnant and breastfeeding women, South Africa as for Kenya plus ART for pregnant and breastfeeding women until cessation of breastfeeding). Findings Of 18,991 individuals who tested, 4,113 (21.7%) were HIV-positive. Using country’s ART eligibility guidelines at the time of the survey, the proportion of HIV-infected individuals eligible for ART was 60.0% (95% CI: 57.2–62.7) (Kenya), 73.4% (70.8–75.8) (South Africa) and 80.1% (77.3–82.6) (Malawi). Applying WHO 2013 guidelines (eligibility at CD4< = 500 and Option B+ for pregnant and breastfeeding women), the proportions eligible were 82.0% (79.8–84.1) (Kenya), 83.7% (81.5–85.6) (South Africa) and 87.6% (85.0–89.8) (Malawi). Adopting “test and treat” would mean a further 18.0% HIV-positive individuals (Kenya), 16.3% (South Africa) and 12.4% (Malawi) would become eligible. In all countries, about 20% of adolescents (aged 15–19 years), became eligible for ART moving from WHO 2013 to “test and treat” while no differences by sex were observed. Conclusion Countries that have already implemented 2013 WHO recommendations, the burden of implementing “test and treat” would be small. Youth friendly programmes to help adolescents access and adhere to treatment will be needed.
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Affiliation(s)
- Menard Laurent Chihana
- Centre for Infectious Diseases and Epidemiology, University of Cape Town, Cape Town, South Africa
- Epicentre, Cape Town, South Africa
- * E-mail:
| | | | - Gilles Van Cutsem
- Centre for Infectious Diseases and Epidemiology, University of Cape Town, Cape Town, South Africa
- Southern Africa Medical Unit, Médecins Sans Frontières, Cape Town, South Africa
| | - Tom Ellman
- Southern Africa Medical Unit, Médecins Sans Frontières, Cape Town, South Africa
| | | | | | | | - Jean Francois Etard
- Epicentre, Paris, France
- IRD UMI 233, INSERM U1175, Montpellier University, TransVIHMI, Montpellier, France
| | - Mary-Ann Davies
- Centre for Infectious Diseases and Epidemiology, University of Cape Town, Cape Town, South Africa
| | - David Maman
- Centre for Infectious Diseases and Epidemiology, University of Cape Town, Cape Town, South Africa
- Epicentre, Cape Town, South Africa
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Uwimana Nicol J, Rohwer A, Young T, Bavuma CM, Meerpohl JJ. Integrated models of care for diabetes and hypertension in low- and middle-income countries (LMICs) : Protocol for a systematic review. Syst Rev 2018; 7:203. [PMID: 30458841 PMCID: PMC6247752 DOI: 10.1186/s13643-018-0865-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 10/31/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In low- and middle-income countries (LMICs), the burden of non-communicable diseases (NCDs) is growing against an existing burden of other diseases such as HIV/AIDS. Integrated models of care can help address the rising burden of multi-morbidity. Although integration of care can occur at various levels and has been defined in numerous ways, our aim is to assess the effects of integration of service delivery at primary healthcare level in LMICs. METHODS We will consider randomised controlled trials (RCTs), cluster RCTs, non-randomised trials, controlled before-after studies and interrupted time series that examine integrated models of care among people with multi-morbidities, of which diabetes or hypertension is one, living in LMICs. We will compare fully integrated models of care to stand-alone care, partially integrated models of care to stand-alone care and fully integrated models to partially integrated models of care. Primary outcomes include all-cause mortality, disease-specific morbidity, HbA1c, systolic blood pressure and cholesterol levels. Secondary outcomes include access to care, retention in care, adherence, continuity of care, quality of care and cost of care. We will conduct a comprehensive search in the following databases: MEDLINE, EMBASE, the Cochrane Central Register of Control Trials, LILACS, Africa-Wide Information, CINAHL and Web of Science. In addition, we will search trial registries, relevant conference abstracts and check references lists of included studies. Selection of studies, data extraction and assessment of risk of bias will be performed independently by two review authors. We will resolve discrepancies through discussion with a third author. We will contact study authors in case of missing data. If included studies are sufficiently homogenous, we will pool results in a meta-analysis. Clinical heterogeneity related to the population, intervention, outcomes and context will be documented in table format and explored through subgroup analysis. We will assess χ 2 and I 2 tests for statistical heterogeneity. We will use GRADE to make judgements about the certainty of evidence and present findings in a summary of findings table. DISCUSSION In light of limited evidence on the provision of comprehensive care for diabetes and hypertension, and its comorbidity in LMCIs, we believe that the findings of this systematic review will provide a synthesis of evidence on effective models of integrated care for diabetes and hypertension and their comorbidities at primary healthcare level. This will enable policy-makers to device policies and programs that are evidence informed. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018099314 .
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Affiliation(s)
- Jeannine Uwimana Nicol
- Centre for Evidence-Based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl drive, Parow, Cape Town, 7500, South Africa.
- School of Public Health, College of Medicine and Health Science, University of Rwanda, Kicukiro, Kigali, Rwanda.
| | - Anke Rohwer
- Centre for Evidence-Based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl drive, Parow, Cape Town, 7500, South Africa
| | - Taryn Young
- Centre for Evidence-Based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl drive, Parow, Cape Town, 7500, South Africa
| | - Charlotte M Bavuma
- College of Medicine and Health Science, University of Rwanda, Kicukiro, Kigali, Rwanda
| | - Joerg J Meerpohl
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Medical Center-University of Freiburg, Breisacher Strasse 153, 79110, Freiburg, Germany
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Diouf O, Gueye-Gaye A, Sarr M, Mbengue AS, Murrill CS, Dee J, Diaw PO, Ngom-Faye NF, Diallo PAN, Suarez C, Gueye M, Mboup A, Toure-Kane C, Mboup S. Evaluation of Senegal's prevention of mother to child transmission of HIV (PMTCT) program data for HIV surveillance. BMC Infect Dis 2018; 18:588. [PMID: 30453945 PMCID: PMC6245718 DOI: 10.1186/s12879-018-3504-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 11/05/2018] [Indexed: 11/30/2022] Open
Abstract
Background With the expansion of Prevention of Mother to Child Transmission (PMTCT) services in Senegal, there is growing interest in using PMTCT program data in lieu of conducting unlinked anonymous testing (UAT)-based ANC Sentinel Surveillance. For this reason, an evaluation was conducted in 2011–2012 to identify the gaps that need to be addressed while transitioning to using PMTCT program data for surveillance. Methods We conducted analyses to assess HIV prevalence rates and agreements between Sentinel Surveillance and PMTCT HIV test results. Also, a data quality assessment of the PMTCT program registers and data was conducted during the Sentinel Surveillance period (December 2011 to March 2012) and 3 months prior. Finally, we also assessed selection bias, which was the percentage difference from the HIV prevalence among all women enrolled in the antenatal clinic and the HIV prevalence among women who accepted PMTCT HIV testing. Results The median site HIV prevalence using routine PMTCT HIV testing data was 1.1% (IQR: 1.0) while the median site prevalence from the UAT HIV Sentinel Surveillance data was at 1.0% (IQR: 1.6). The Positive per cent agreement (PPA) of the PMTCT HIV test results compared to those of the Sentinel Surveillance was 85.1% (95% CI 77.2–90.7%), and the percent-negative agreement (PNA) was 99.9% (95% CI 99.8–99.9%). The overall HIV prevalence according to UAT was the same as that found for women accepting a PMTCT HIV test and those who refused, with percent bias at 0.00%. For several key PMTCT variables, including “HIV test offered” (85.2%), “HIV test acceptance” (78.0%), or “HIV test done” (58.8%), the proportion of records in registers with combined complete and valid data was below the WHO benchmark of 90%. Conclusions The PPA of 85.1 was below the WHO benchmarks of 96.6%, while the combined data validity and completeness rates was below the WHO benchmark of 90% for many key PMTCT variables. These results suggested that Senegal will need to reinforce the quality of onsite HIV testing and improve program data collection practices in preparation for using PMTCT data for surveillance purposes.
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Affiliation(s)
- Ousmane Diouf
- Laboratory of Bacteriology and Virology of Aristide Le Dantec University Hospital, Dakar, Senegal.,Present Address: IRESSEF: Institut de Recherche en Santé, de Surveillance Epidémiologique et de Formations, Arrondissement 4 Rue 2 D1, Pole Urbain de Diamniado, 7325, Dakar, BP, Senegal
| | - Astou Gueye-Gaye
- Laboratory of Bacteriology and Virology of Aristide Le Dantec University Hospital, Dakar, Senegal.,Present Address: IRESSEF: Institut de Recherche en Santé, de Surveillance Epidémiologique et de Formations, Arrondissement 4 Rue 2 D1, Pole Urbain de Diamniado, 7325, Dakar, BP, Senegal
| | - Moussa Sarr
- Westat, 1600 Research Blvd, WB 258, Rockville, MD, 20850, USA.
| | - Abdou Salam Mbengue
- Laboratory of Bacteriology and Virology of Aristide Le Dantec University Hospital, Dakar, Senegal.,Present Address: IRESSEF: Institut de Recherche en Santé, de Surveillance Epidémiologique et de Formations, Arrondissement 4 Rue 2 D1, Pole Urbain de Diamniado, 7325, Dakar, BP, Senegal
| | | | - Jacob Dee
- Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, USA
| | - Papa Ousmane Diaw
- Laboratory of Bacteriology and Virology of Aristide Le Dantec University Hospital, Dakar, Senegal.,Present Address: IRESSEF: Institut de Recherche en Santé, de Surveillance Epidémiologique et de Formations, Arrondissement 4 Rue 2 D1, Pole Urbain de Diamniado, 7325, Dakar, BP, Senegal
| | | | | | - Carlos Suarez
- Westat, 1600 Research Blvd, WB 258, Rockville, MD, 20850, USA
| | - Massaer Gueye
- Laboratory of Bacteriology and Virology of Aristide Le Dantec University Hospital, Dakar, Senegal.,Present Address: IRESSEF: Institut de Recherche en Santé, de Surveillance Epidémiologique et de Formations, Arrondissement 4 Rue 2 D1, Pole Urbain de Diamniado, 7325, Dakar, BP, Senegal
| | - Aminata Mboup
- Laboratory of Bacteriology and Virology of Aristide Le Dantec University Hospital, Dakar, Senegal.,Present Address: IRESSEF: Institut de Recherche en Santé, de Surveillance Epidémiologique et de Formations, Arrondissement 4 Rue 2 D1, Pole Urbain de Diamniado, 7325, Dakar, BP, Senegal
| | - Coumba Toure-Kane
- Laboratory of Bacteriology and Virology of Aristide Le Dantec University Hospital, Dakar, Senegal
| | - Souleymane Mboup
- Laboratory of Bacteriology and Virology of Aristide Le Dantec University Hospital, Dakar, Senegal.,Present Address: IRESSEF: Institut de Recherche en Santé, de Surveillance Epidémiologique et de Formations, Arrondissement 4 Rue 2 D1, Pole Urbain de Diamniado, 7325, Dakar, BP, Senegal
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Chhim K, Mburu G, Tuot S, Sopha R, Khol V, Chhoun P, Yi S. Factors associated with viral non-suppression among adolescents living with HIV in Cambodia: a cross-sectional study. AIDS Res Ther 2018; 15:20. [PMID: 30445984 PMCID: PMC6240223 DOI: 10.1186/s12981-018-0205-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 10/30/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Adolescents living with HIV on antiretroviral therapy (ART) have worse treatment adherence, viral suppression, and mortality rates compared to adults. This study investigated factors associated with viral non-suppression among adolescents living with HIV in Cambodia. METHODS A cross-sectional study was conducted in August 2016 among 328 adolescents living with HIV aged 15-17 years who were randomly selected from 11 ART clinics in the capital city of Phnom Penh and 10 other provinces. Clinical and immunological data, including CD4 count and viral load, were obtained from medical records at ART clinics. Adolescents were categorized as having achieved viral suppression if their latest viral load count was < 1000 ribonucleic acid (RNA) copies/mL. Multivariate logistic regression analysis was performed to identify factors independently associated with viral non-suppression. RESULTS The mean age of the participants was 15.9 years (SD = 0.8), and 48.5% were female. Median duration on ART was 8.6 (interquartile range = 6.0-10.6) years. Of total, 76.8% of the participants had achieved viral suppression. After adjustment for other covariates, the likelihood of having viral non-suppression remained significantly lower among adolescents who were: older/aged 17 (AOR = 0.46, 95% CI 0.21-0.98), had been on ART for more than 9 years (AOR = 0.35, 95% CI 0.19-0.64), had most recent CD4 count of > 672 (AOR = 0.47, 95% CI 0.26-0.86), had a relative as the main daily caregiver (AOR = 0.37, 95% CI 0.17-0.80), and did not believe that there is a cure for AIDS (AOR = 0.40, 95% CI 0.21-0.75) compared to their reference group. The likelihood of having viral non-suppression also remained significantly higher among adolescents who had first viral load > 628 RNA copies/mL (AOR = 1.81, 95% CI 1.05-4.08) and among those who were receiving HIV care and treatment from an adult clinic (AOR = 2.95, 95% CI 1.56-5.59). CONCLUSIONS The proportion of adolescents living with HIV with viral suppression in this study was relatively high at 76.8%, but falls short of the global target of 90%. Programs targeting younger adolescents and adolescents in transition from pediatric to adult care with a range of interventions including psychosocial support and treatment literacy could further improve viral suppression outcomes.
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Affiliation(s)
- Kolab Chhim
- KHANA Center for Population Health Research, No. 33, Street 71, Phnom Penh, Cambodia
| | - Gitau Mburu
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Sovannary Tuot
- KHANA Center for Population Health Research, No. 33, Street 71, Phnom Penh, Cambodia
| | - Ratana Sopha
- KHANA Center for Population Health Research, No. 33, Street 71, Phnom Penh, Cambodia
| | - Vohith Khol
- National Center for HIV/AIDS, Dermatology and STD, Phnom Penh, Cambodia
| | - Pheak Chhoun
- KHANA Center for Population Health Research, No. 33, Street 71, Phnom Penh, Cambodia
| | - Siyan Yi
- KHANA Center for Population Health Research, No. 33, Street 71, Phnom Penh, Cambodia
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- Center for Global Health Research, Touro University California, Vallejo, CA USA
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245
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Hatton GB, Madla CM, Rabbie SC, Basit AW. Gut reaction: impact of systemic diseases on gastrointestinal physiology and drug absorption. Drug Discov Today 2018; 24:417-427. [PMID: 30453059 DOI: 10.1016/j.drudis.2018.11.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 10/25/2018] [Accepted: 11/13/2018] [Indexed: 12/17/2022]
Abstract
It was in 400 BC that Hippocrates reportedly stated that "death sits in the colon". The growth in our knowledge of the intestinal microbiome, the gut-brain axis and their function and imbalance has distinctly uncovered the complex relationship between the gut to disease predisposition and development, heralding the problem and the solution to disease pathology. Human studies of new drug molecules are typically performed in healthy volunteers and their specific disease indication. Approved drugs, however, are used by patients with diverse disease backgrounds. Here, we review the current literature of the gastrointestinal tract reacting to systemic disease pathology that elicits physiological and functional changes that consequently affect oral drug product performance.
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Affiliation(s)
- Grace B Hatton
- UCL School of Pharmacy, University College London, 29-39 Brunswick Square, London, WC1N 1AX, UK
| | - Christine M Madla
- UCL School of Pharmacy, University College London, 29-39 Brunswick Square, London, WC1N 1AX, UK
| | - Sarit C Rabbie
- UCL School of Pharmacy, University College London, 29-39 Brunswick Square, London, WC1N 1AX, UK
| | - Abdul W Basit
- UCL School of Pharmacy, University College London, 29-39 Brunswick Square, London, WC1N 1AX, UK.
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246
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Malan L, Labuschagne Q, Brechtelsbauer E, Goff DA, Schellack N. Sustainable Access to Antimicrobials; A Missing Component to Antimicrobial Stewardship-A Tale of Two Countries. Front Public Health 2018; 6:324. [PMID: 30488031 PMCID: PMC6246712 DOI: 10.3389/fpubh.2018.00324] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 10/25/2018] [Indexed: 12/31/2022] Open
Abstract
Antimicrobial stewardship encompasses a wide range of processes and interventions designed to ensure that antimicrobials are used in the most effective manner. An important, but often neglected process to include is medicine procurement within hospitals, as the untimely administration of antimicrobials has a direct impact on patient care and antimicrobial resistance. A tender system (an open Request for Proposal, RFP) in South Africa is used in the procurement process to supply medicines and pharmaceutical supplies, whereas in the United States, each hospital is responsible for their own procurement processes. Possible key challenges facing countries to ensure a sustainable medical procurement are poor procurement practices, outdated information systems, and unavailability of human resources to support the current system. This article describes the need for adequate pharmacist–led inventory management systems, for sustainable antimicrobial delivery and the successful implementation of antimicrobial stewardship programs. Strategies to improve inventory control and medication delivery for public sector hospitals in South Africa include the development of national pharmaceutical data management standards. Pharmacist involvement in inventory management principles will ensure that antimicrobials are consistently in adequate supply for patient use, hence promoting safe and effective use while decreasing antimicrobial resistance.
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Affiliation(s)
- Lucille Malan
- Division of Clinical Pharmacy, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
| | - Quinten Labuschagne
- Division of Clinical Pharmacy, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
| | | | - Debra A Goff
- Department of Pharmacy, Wexner Medical Center, The Ohio State University, Columbus, OH, United States
| | - Natalie Schellack
- Division of Clinical Pharmacy, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
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Lee YH, Bang JH, Park SM, Kang CR, Cho SI, Oh MD, Lee JK. Cost-Effectiveness of Voluntary HIV Testing Strategies in a Very Low-Prevalence Country, the Republic of Korea. J Korean Med Sci 2018; 33:e304. [PMID: 30416412 PMCID: PMC6221859 DOI: 10.3346/jkms.2018.33.e304] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 08/16/2018] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The Republic of Korea has a very low prevalence of human immunodeficiency virus (HIV) infection, but the number of new HIV diagnoses has steadily risen, strongly indicating a large number of undetected HIV infections. Thus, it is important for Korean public health authorities to adopt and encourage cost-effective HIV detection tools, such as rapid HIV screening tests. In this study, we aimed to evaluate the cost-effectiveness of enzyme-linked immunosorbent assays (ELISA) and rapid tests in a public health center (PHC) setting. METHODS We developed a decision analytic model to assess the per-examinee cost and the cost-effectiveness of identifying HIV patients in a PHC setting using two HIV testing strategies: conventional HIV screening by ELISA versus rapid HIV testing. Analysis was performed in two scenarios: HIV testing in an average-risk population and in a high-risk population. RESULTS Compared to the ELISA, the rapid test was cost-saving and cost-effective. The per-examinee cost was USD 1.61 with rapid testing versus USD 3.38 with ELISA in an average-risk population, and USD 4.77 with rapid testing versus USD 7.62 with ELISA in a high-risk population. The cost of identifying a previously undiagnosed HIV case was USD 26,974 with rapid testing versus USD 42,237 with ELISA in an average-risk population, and USD 153 with rapid testing versus USD 183 with ELISA in a high-risk population. CONCLUSION Rapid testing would be more cost-effective than using conventional ELISA testing for identifying previously undiagnosed HIV-infected cases in Korea, a country with extremely low HIV prevalence.
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Affiliation(s)
- Young Hwa Lee
- Department of Epidemiology, Seoul National University Graduate School of Public Health, Seoul, Korea
| | - Ji Hwan Bang
- Division of Infectious Diseases, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Sang Min Park
- Department of Family Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Cho Ryok Kang
- Environmental Health Division, Seoul Metropolitan Government, Seoul, Korea
| | - Sung-Il Cho
- Department of Epidemiology, Seoul National University Graduate School of Public Health, Seoul, Korea
| | - Myoung-don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jong-Koo Lee
- Department of Family Medicine, Seoul National University College of Medicine, Seoul, Korea
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Davies N, Heffron R. Global and national guidance for the use of pre-exposure prophylaxis during peri-conception, pregnancy and breastfeeding. Sex Health 2018; 15:501-512. [PMID: 30447703 PMCID: PMC6790372 DOI: 10.1071/sh18067] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 09/15/2018] [Indexed: 12/30/2022]
Abstract
Pre-exposure prophylaxis (PrEP) is a well-established biomedical HIV prevention strategy and recommended to reduce HIV risk during peri-conception, pregnancy and breastfeeding. Efforts are needed to translate global recommendations into national guidelines and implementation strategies. This article presents the current status of policy guidance for the use of PrEP during peri-conception, pregnancy and breastfeeding, with a particular focus on high prevalence countries, including those in sub-Saharan Africa. PrEP clinical guidelines released by ministries of health or other national-level health bodies, with a particular focus on recommendations for PrEP use during peri-conception, pregnancy and breastfeeding, were reviewed and summarised. Among countries with PrEP guidelines and/or policy, pregnancy is recognised as a period with increased HIV vulnerability, and some recommend PrEP use specifically during pregnancy. Only one country notes that PrEP is contraindicated during pregnancy, recognising a gap in complete safety data from women using PrEP throughout pregnancy. PrEP is not contraindicated as a peri-conception HIV prevention strategy in any country, but only three countries have specific guidance for peri-conception HIV prevention. Multiple barriers to the implementation of PrEP during pregnancy and breastfeeding are discussed, including barriers at the policy, health systems, social and personal levels. Although pregnancy is a period of heightened risk and fertility rates are high in many settings with high HIV burden, few PrEP policies have included guidance for PrEP use specific to peri-conception, pregnancy and breastfeeding periods. This gap can be overcome by the development or adoption of national clinical guidelines and implementation strategies from exemplary countries.
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Possagno LP, Franco A, Paranhos LR, Grando LJ, de Lima AAS, Bezerra ISQ, Fernandes Â. Morphological analysis of the skeletal development in lateral cephalometric radiographs of HIV infected children ongoing Highly Active Antiretroviral Therapy. Med Oral Patol Oral Cir Bucal 2018; 23:e691-e697. [PMID: 30341265 PMCID: PMC6261001 DOI: 10.4317/medoral.22610] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 08/05/2018] [Indexed: 01/04/2023] Open
Abstract
Background To investigate the skeletal development of HIV infected children through a morphological analysis of the cervical vertebrae (CV) in lateral cephalometric radiographs. Material and Methods The sample consisted of 86 lateral cephalometric radiographs of male and female children aged between 6 and 14 years old. The radiographs were equally distributed in groups 1 (HIV infected children) and 2 (non-infected children, paired by sex and age). Two examiners analyzed the CV according to the method of Hassel and Farman (1995). Spearman correlation coefficient was used to associate age and skeletal development within groups, while Mann-Whitney test compared the skeletal development between groups. Results The correlation of age and skeletal development in group 1 reached 0.17, 0.27 and 0.27 (p >0.05) for C2, C3 and C4, respectively, while in group 2 it reached 0.65, 0.54 and 0.60, respectively (p <0.001). Differences were not significant between groups (p >0.05). Conclusions HIV infected and non-infected children showed a similar development of the CV. However, the weak correlation between age and CV development in HIV infected children highlights the need for careful decisions prior to therapeutic approaches – especially those founded on the prediction of skeletal development, such as maxillofacial surgeries, and orthopedic and orthodontic procedures. Key words:Cervical vertebrae, growth and development, HIV, radiology.
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Affiliation(s)
- L-P Possagno
- Department of Stomatology, Federal University of Paraná, Av. Prefeito Lothário Meissner 632, Jardim Botânico, Curitiba, Paraná, Brazil,
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Rate of cardiovascular, renal and bone disease and their major risks factors in HIV-infected individuals on antiretroviral therapy in Spain. Enferm Infecc Microbiol Clin 2018; 37:373-379. [PMID: 30389268 DOI: 10.1016/j.eimc.2018.09.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 09/24/2018] [Accepted: 09/27/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND The life expectancy of HIV-infected individuals has dramatically improved with potent antiretroviral therapies. However, organ-specific toxicities of some antiretrovirals and persistent inflammation and immune activation due to residual virus replication account for a high burden of age-associated comorbidities in the HIV population. METHODS The prevalence of overt cardiovascular, renal and bone diseases as well as their major risk factors were cross-sectionally examined during the year 2014 in the VACH cohort, a large nationwide population of HIV-infected individuals in Spain. RESULTS A total of 10,897 HIV-infected patients were examined. Seventy-one point four percent were male and the mean age was 48 years. Mean time since HIV diagnosis was 15.8 years and mean time on antiretroviral therapy was 13.1 years. The proportion of patients with undetectable viral load was 87.1%, whereas 65.7% had CD4 counts>500 cells/mm3. Overall, cardiovascular, renal and bone disease were recorded in 4.7%, 5.9% and 2.8%, respectively. The prevalence of major risk factors was as follows: smoking 51.3%, alcohol abuse 7.8%, overweight/obesity 42.2%, diabetes 19.9%, dyslipidaemia 72.6%, hypertension 25.6%, and osteoporosis 11.1%. In the subset of patients older than 55 years-old (18%), all figures for overt disease and their major risk factors were significantly greater. CONCLUSION Major age-related medical conditions and most of their risk factors are highly prevalent in HIV-infected individuals on long-term antiretroviral therapy in Spain. Preventive actions, including careful selection of antiretroviral agents, should be prioritized in the ageing HIV population.
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