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Woldegeorgis BZ, Asgedom YS, Habte A, Kassie GA, Badacho AS. Highly active antiretroviral therapy is necessary but not sufficient. A systematic review and meta-analysis of mortality incidence rates and predictors among HIV-infected adults receiving treatment in Ethiopia, a surrogate study for resource-poor settings. BMC Public Health 2024; 24:1735. [PMID: 38943123 PMCID: PMC11214252 DOI: 10.1186/s12889-024-19268-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 06/25/2024] [Indexed: 07/01/2024] Open
Abstract
BACKGROUND Owing to the introduction of highly active antiretroviral therapy (HAART), the trajectory of mortality and morbidity associated with human immunodeficiency virus (HIV) infection has significantly decreased in developed countries. However, this remains a formidable public health challenge for people living with HIV in resource-poor settings. This study was undertaken to determine the pooled person-time incidence rate of mortality, analyze the trend, and identify predictors of survival among HIV-infected adults receiving HAART. METHODS Quantitative studies were searched in PubMed, Embase, Scopus, Google Scholar, African Journals Online, and Web of Science. The Joana Briggs Institute critical appraisal tool was used to assess the quality of the included articles. The data were analyzed using the random-effects Dersimonian-Laird model. RESULTS Data abstracted from 35 articles involving 39,988 subjects were analyzed. The pooled person-time incidence rate of mortality (all-cause) was 4.25 ([95% uncertainty interval (UI), 3.65 to 4.85]) per 100 person-years of observations. Predictors of mortality were patients aged ≥ 45 years (hazard ratio (HR), 1.70 [95% UI,1.10 to 2.63]), being female (HR, 0.82 [95% UI, 0.70 to 0.96]), history of substance use (HR, 3.10 [95% UI, 1.31 to 7.32]), HIV positive status non disclosure (HR, 3.10 [95% UI,1.31 to 7.32]), cluster of differentiation 4 + T cell - count < 200 cells/mm3 (HR, 3.23 [95% UI, [2.29 to 4.75]), anemia (HR, 2.63 [95% UI, 1.32 to 5.22]), World Health Organisation classified HIV clinical stages III and IV (HR, 3.02 [95% UI, 2.29 to 3.99]), undernutrition (HR, 2.24 [95% UI, 1.61 to 3.12]), opportunistic infections (HR, 1.89 [95% UI, 1.23 to 2.91]), tuberculosis coinfection (HR, 3.34 [95% UI, 2.33 to 4.81]),bedridden or ambulatory (HR,3.30 [95% UI, 2.29 to 4.75]), poor treatment adherence (HR, 3.37 [95% UI,1.83 to 6.22]), and antiretroviral drug toxicity (HR, 2.60 [95% UI, 1.82 to 3.71]). CONCLUSION Despite the early introduction of HAART in Ethiopia, since 2003, the mortality rate has remained high. Therefore, guideline-directed intervention of identified risk factors should be in place to improve overall prognosis and increase quality-adjusted life years.
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Affiliation(s)
- Beshada Zerfu Woldegeorgis
- Department of Internal Medicine, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia.
| | - Yordanos Sisay Asgedom
- Department of Epidemiology, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Aklilu Habte
- School of Public Health, College of Medicine and Health Sciences, Wachemo University, Hosanna, Ethiopia
| | - Gizachew Ambaw Kassie
- School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Abebe Sorsa Badacho
- School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
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Araujo Chaveron L, Pham TTP, Nguyen BT, Tran TH, Le NTH, Pham TH, Ngo KP, Tong HT, Phan HTT, Ait-Ahmed M, Nguyen TA, Taieb F, Madec Y. Injecting drug use increases the risk of death in HIV patients on antiretroviral therapy in Vietnam. AIDS Care 2024; 36:631-640. [PMID: 37339000 DOI: 10.1080/09540121.2023.2224549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 06/07/2023] [Indexed: 06/22/2023]
Abstract
The Human Immunodeficiency Virus (HIV) epidemic remains a major public health issue worldwide. In Vietnam, the HIV epidemic is essentially driven by people who inject drugs (PWID). This study aims to compare mortality and loss to follow-up (LTFU) between PWID and other patients. From June 2017 to April 2018, HIV-infected adults were enrolled in a prospective cohort from time of ART initiation in six provinces of North Vietnam. The end date was July 2020. Mortality and LTFU were described using competing-risk survival models. Factors associated with mortality and with LTFU were identified using Cox models with a competing-risk approach. Of the 578 participants, 261 (45.2%) were PWID and almost exclusively male. 49 patients died, corresponding to a mortality rate (95% confidence interval (CI)) of 3.7 (2.8-4.9) per 100 person-months, and 79 were lost to follow-up, corresponding to a rate (95% CI) of 6.0 (4.8-7.4) per 100 person-months. PWID were at higher risk of death but not of LTFU. Overall, LTFU was high in both groups. Latecomers to clinical visits were more at risk of both death and LTFU. Therefore, this should be a warning to clinical teams and preventive actions taken in these patients.Trial registration: ClinicalTrials.gov identifier: NCT03249493..
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Affiliation(s)
- Lucia Araujo Chaveron
- EHESP French School of Public Health, Paris, France
- Institut Pasteur, Epidemiology of Emerging Diseases, Université de Paris, Paris, France
| | - Tram Thi Phuong Pham
- HIV Molecular Laboratory, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Binh Thanh Nguyen
- HIV Molecular Laboratory, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Tram Hong Tran
- HIV Molecular Laboratory, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Nhung Thi Hong Le
- HIV Molecular Laboratory, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Thang Hong Pham
- HIV Molecular Laboratory, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Khanh Phuong Ngo
- Training and Research Management Center, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Ha Thi Tong
- Training and Research Management Center, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Huong Thi Thu Phan
- Ministry of Health, Vietnam Administration of HIV/AIDS Control (VAAC), Hanoi, Vietnam
| | - Mohand Ait-Ahmed
- Institut Pasteur, Center for Translational Research, Université de Paris, Paris, France
| | - Tuan Anh Nguyen
- HIV and AIDS Department, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Fabien Taieb
- Institut Pasteur, Center for Translational Research, Université de Paris, Paris, France
- Institut Pasteur, Department of international affairs, Université de Paris, Paris, France
| | - Yoann Madec
- Institut Pasteur, Epidemiology of Emerging Diseases, Université de Paris, Paris, France
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Magocha B, Molope M, Palamuleni M, Saruchera M. The Interface between the State and NGOs in Delivering Health Services in Zimbabwe-A Case of the MSF ART Programme. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7137. [PMID: 38063567 PMCID: PMC10706040 DOI: 10.3390/ijerph20237137] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 11/26/2023] [Accepted: 11/27/2023] [Indexed: 12/18/2023]
Abstract
An over-reliance on donor funding for HIV/AIDS healthcare services remains a concern in Africa. This study, therefore, explores the partnership between the Zimbabwean government and an international non-governmental organisation in delivering HIV/AIDS healthcare services. An interpretivist paradigm and descriptive phenomenological design were used to elicit the opinions, perceptions, and experiences of forty purposively sampled key informants. Thematic analysis was employed using ATLAS.ti version 7.1.4 to analyse the data. The differences in terms of policies, structures, and administrative issues between the partners identified challenges in the implementation of the programme. This was demonstrated through the reversal of the gains attained in prevention, care, and treatment. This raises concerns for increased risk of defaulters, drug resistance, and deaths. Therefore, the partners in this endeavour should negotiate an aligned approach for the efficient delivery of HIV/AIDS healthcare services.
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Affiliation(s)
- Blessing Magocha
- Population and Health Research Entity, North-West University, Mafikeng 2735, South Africa; (M.M.); (M.P.)
| | - Mokgadi Molope
- Population and Health Research Entity, North-West University, Mafikeng 2735, South Africa; (M.M.); (M.P.)
| | - Martin Palamuleni
- Population and Health Research Entity, North-West University, Mafikeng 2735, South Africa; (M.M.); (M.P.)
| | - Munyaradzi Saruchera
- Africa Centre for HIV/Aids Management, Stellenbosch University, Stellenbosch 7602, South Africa;
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Salim M, Kamran M, Khan I, Saljoqi AUR, Ahmad S, Almutairi MH, Sayed AA, Aleya L, Abdel-Daim MM, Shah M. Effect of larval diets on the life table parameters of dengue mosquito, Aedes aegypti (L.) (Diptera: Culicidae) using age-stage two sex life table theory. Sci Rep 2023; 13:11969. [PMID: 37488190 PMCID: PMC10366198 DOI: 10.1038/s41598-023-39270-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 07/22/2023] [Indexed: 07/26/2023] Open
Abstract
The current study regarding the effects of larval diets on the life table parameters of dengue mosquitoes, Aedes aegypti was conducted under laboratory conditions at 27 ± 2 °C and 60 ± 5% relative humidity at NIFA (Nuclear Institute for Food and Agriculture) Peshawar, Pakistan. The data on life table parameters of Ae. aegypti reared on Diet 1 (replacement diet), Diet 2 (Khan's diet for Anopheles), Diet 3 (Khan's modified diet) and Diet 4 (IAEA diet) were analyzed using the age-stage, two-sex life table software. Diet 4 (IAEA) was used as a control for comparison. The results indicated that significantly maximum percentage of egg hatching of Ae. aegypti was observed when reared on Diet 4 (73.86%) and Diet 3 (72.90%), while less % of egg hatching was recorded in Diet 1 (40.67%) and Diet 2 (55.53%). The data further showed that the Diet 3 had a highest intrinsic rate of increase (r) (0.097 ± 5.68 day-1), finite rate of increase (λ) (1.10 ± 6.26 day-1) and net reproductive rate (R0) (11.99 ± 1.52 eggs/female) followed by Diet 2 and Diet 4. The mean generation time (T) of Ae. aegypti reared on Diet 3 (23.67 ± 0.86 days) and Diet 1 (24.05 ± 0.61 days) was significantly shorter than Diet 2 (26.15 ± 0.71 days) and Diet 4 (26.41 ± 0.38 days). The overall results revealed that Diet 3 showed good results at different life table parameters of Ae. aegypti and can be used as the preferred diet in the Sterile Insect Technique (SIT) where the mass culture of mosquitoes is required.
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Affiliation(s)
- Muhammad Salim
- Department of Plant Protection, Faculty of Crop Protection Sciences, The University of Agriculture, Peshawar, Pakistan.
| | - Muhammad Kamran
- Department of Plant Protection, Faculty of Crop Protection Sciences, The University of Agriculture, Peshawar, Pakistan
| | - Inamullah Khan
- Pakistan Atomic Energy Commission, Nuclear Institute for Food and Agriculture (NIFA), P. O. Box 446, Peshawar, Pakistan
| | - Ahmad Ur Rahman Saljoqi
- Department of Plant Protection, Faculty of Crop Protection Sciences, The University of Agriculture, Peshawar, Pakistan
| | - Sarir Ahmad
- Department of Plant Protection, Faculty of Crop Protection Sciences, The University of Agriculture, Peshawar, Pakistan
- Department of Entomology, Abdul Wali Khan University Mardan, Mardan, 23200, Pakistan
| | - Mikhlid H Almutairi
- Department of Zoology, College of Science, King Saud University, P.O. Box 2455, 11451, Riyadh, Saudi Arabia
| | - Amany A Sayed
- Zoology Department, Faculty of Science, Cairo University, Giza, 12613, Egypt
| | - Lotfi Aleya
- Chrono-Environnement Laboratory, UMR CNRS 6249, CEDEX, Bourgogne, Franche-Comté University, 25030, Besançon, France
| | - Mohamed M Abdel-Daim
- Pharmacology Department, Faculty of Veterinary Medicine, Suez Canal University, Ismailia, 41522, Egypt
| | - Muddaser Shah
- Natural and Medical Sciences Research Center, University of Nizwa, Birkat Al Mauz, P.O. Box 33, Nizwa, 616, Oman
- Department of Botany, Abdul Wali Khan University Mardan, Mardan, 23200, Pakistan
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Albus SL, Harrison RE, Moudachirou R, Nanan-N’Zeth K, Haba B, Casas EC, Isaakidis P, Diallo A, Camara I, Doumbuya M, Sako FB, Cisse M. Poor outcomes among critically ill HIV-positive patients at hospital discharge and post-discharge in Guinea, Conakry: A retrospective cohort study. PLoS One 2023; 18:e0281425. [PMID: 36913379 PMCID: PMC10010544 DOI: 10.1371/journal.pone.0281425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 01/23/2023] [Indexed: 03/14/2023] Open
Abstract
INTRODUCTION Optimal management of critically ill HIV-positive patients during hospitalization and after discharge is not fully understood. This study describes patient characteristics and outcomes of critically ill HIV-positive patients hospitalized in Conakry, Guinea between August 2017 and April 2018 at discharge and 6 months post-discharge. METHODS We carried out a retrospective observational cohort study using routine clinical data. Analytic statistics were used to describe characteristics and outcomes. RESULTS 401 patients were hospitalized during the study period, 230 (57%) were female, median age was 36 (IQR: 28-45). At admission, 229 patients (57%) were on ART, median CD4 was 64 cells/mm3, 166 (41%) had a VL >1000 copies/ml, and 97 (24%) had interrupted treatment. 143 (36%) patients died during hospitalisation. Tuberculosis was the major cause of death for 102 (71%) patients. Of 194 patients that were followed after hospitalization a further 57 (29%) were lost-to-follow-up (LTFU) and 35 (18%) died, 31 (89%) of which had a TB diagnosis. Of all patients who survived a first hospitalisation, 194 (46%) were re-hospitalised at least once more. Amongst those LTFU, 34 (59%) occurred immediately after hospital discharge. CONCLUSION Outcomes for critically ill HIV-positive patients in our cohort were poor. We estimate that 1-in-3 patients remained alive and in care 6 months after their hospital admission. This study shows the burden of disease on a contemporary cohort of patients with advanced HIV in a low prevalence, resource limited setting and identifies multiple challenges in their care both during hospitalisation as well as during and after re-transitioning to ambulatory care.
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Affiliation(s)
- Sebastian Ludwig Albus
- Medecins Sans Frontieres, Guinea Mission, Operational Centre Bruxelles, Bruxelles, Belgium
- * E-mail:
| | - Rebecca E. Harrison
- Medecins Sans Frontieres, Guinea Mission, Operational Centre Bruxelles, Bruxelles, Belgium
| | - Ramzia Moudachirou
- Medecins Sans Frontieres, Guinea Mission, Operational Centre Bruxelles, Bruxelles, Belgium
| | - Kassi Nanan-N’Zeth
- Medecins Sans Frontieres, Guinea Mission, Operational Centre Bruxelles, Bruxelles, Belgium
| | - Benoit Haba
- Medecins Sans Frontieres, Guinea Mission, Operational Centre Bruxelles, Bruxelles, Belgium
| | - Esther C. Casas
- Medecins Sans Frontieres, Southern African Medical Unit, Cape Town, South Africa
| | - Petros Isaakidis
- Medecins Sans Frontieres, Southern African Medical Unit, Cape Town, South Africa
| | - Abdourahimi Diallo
- Medecins Sans Frontieres, Guinea Mission, Operational Centre Bruxelles, Bruxelles, Belgium
| | - Issiaga Camara
- Gamal Abdel Nasser University of Conakry Faculty of Medicine, Unite de Soins, Formation et de la Recherche (USFR), Conakry, Guinea
| | - Marie Doumbuya
- Gamal Abdel Nasser University of Conakry Faculty of Medicine, Unite de Soins, Formation et de la Recherche (USFR), Conakry, Guinea
| | - Fode Bangaly Sako
- Gamal Abdel Nasser University of Conakry Faculty of Medicine, Unite de Soins, Formation et de la Recherche (USFR), Conakry, Guinea
| | - Mohammed Cisse
- Gamal Abdel Nasser University of Conakry Faculty of Medicine Pharmacy and Odonto- Stomatology, Conakry, Guinea
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Intimate partner violence and HIV treatment adherence in urban South Africa: Mediating role of perinatal common mental disorders. SSM - MENTAL HEALTH 2022; 2:100112. [PMID: 36688232 PMCID: PMC9792377 DOI: 10.1016/j.ssmmh.2022.100112] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/28/2022] [Accepted: 05/04/2022] [Indexed: 01/25/2023] Open
Abstract
Background Antiretroviral therapy (ART) has potential to eliminate perinatal HIV infections, but adherence to ART in late pregnancy and postpartum is often suboptimal. Intimate partner violence (IPV) may influence non-adherence among perinatal women living with HIV (WWH), but few quantitative studies have examined this over time or explored mechanisms for this association. Methods We used secondary data from a parent trial in Johannesburg comprising WWH from the control arm (n=63) and WWH ineligible for the trial (n=133). Trained nurse researchers administered questionnaires at first antenatal visit on past-year psychological, physical, and/or sexual IPV (WHO instrument), socio-demographics (age, food security, education), and perinatal common mental symptoms of depression (Hospital Anxiety and Depression Screener-d); anxiety (HADS-a); post-traumatic stress disorder (PTSD; Harvard Trauma Questionnaire). At endline visit 2-4 months postpartum, nurse researchers assessed self-reported ART adherence using a visual analog scale (with ≥95% considered "good"). We fitted structural equation models (SEM) in MPlus to explore direct and indirect effects of IPV on ART adherence. Results Of 196 perinatal WWH, 53.1% reported IPV exposure at baseline. The majority of participants (85.7%) had good perinatal ART adherence. In adjusted models, IPV at baseline was associated with halved odds of good adherence (aOR=0.51, 95%CI=0.20-0.96). IPV was associated with higher adjusted odds of probable depression (aOR=4.64), anxiety (aOR=2.85), and PTSD (aOR=3.42). In SEM, IPV had a direct (standardized coef=-0.22) and indirect effect (coef=-0.05) on ART via common mental disorders. The total effect of IPV on perinatal adherence was of moderate size (coef= -0.27) and the model had good fit (CFI=0.972; TLI=0.969; RMSEA=0.045; SRMR=0.076). Conclusion IPV was longitudinally associated with perinatal ART non-adherence in part due to its relationship with mental health symptomology. Addressing IPV within clinical care has potential to improve perinatal mental health, maternal HIV outcomes, and HIV-free infant survival.
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Analysis of virological response to therapy and resistance profile in treatment-experienced and naive HIV-1 infected Romanian patients receiving regimens containing darunavir boosted with ritonavir or cobicistat. Biomed Pharmacother 2022; 150:113077. [PMID: 35658217 DOI: 10.1016/j.biopha.2022.113077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 04/28/2022] [Accepted: 04/29/2022] [Indexed: 11/21/2022] Open
Abstract
77% of Romanians infected with HIV receive antiretroviral therapy, with the challenge of maintaining long-term therapeutic success (the viral load becoming/remaining undetectable). The main purpose of this study was to provide comparative analysis of the long-term virological response to therapeutic regimens containing pharmacokinetically enhanced darunavir (DRV) with ritonavir (RTV) or cobicistat (COBI). The second aim was to evaluate the viral resistance profile to therapy, by number/type/frequency of viral mutations. This retrospective study was conducted on 462 patients infected with subtype F HIV-1, registered at the "Matei Bals" National Institute of Infectious Diseases, between 2018 and 2021: 384 patients received (among other ARV) DRV 600 mg, enhanced with RTV 100 mg (twice daily) and 78 patients received DRV 800 mg boosted with COBI 150 mg (once daily). The virological response was measured by determining the viral load (HIV-1 RNA copies/mL), while the incidence of viral resistance to therapy was assessed by genotyping tests. Comparing the patients with undetectable viremia, from the 1st visit to the 3rd one, the outcomes showed that at the last visit, 84.6% subjects in the DRV/c group achieved virological efficiency over those from DRV/r group (76.8%). The differences observed between this time points are statistically significant p < 0.05. DRV/c administered in combination with other ARV, in subtype F HIV-1 infected patients, proved to be more virologically effective, maintaining a favorable long-time result. When comparing the outcomes of the two groups, a statistically significant difference of p < 0.05 was obtained. 32 patients (27 from DRV/r group and 5 from DRV/c group) were evaluated with persistent HIV-1 ARN plasma load > 1000 copies/mL, during all 3 clinical visits. They formed a research sub-group evaluated in terms of resistance to therapy and were reported as virological failures. 28.12% of the sub-group with persistent HIV-1 RNA > 1000 copies/mL were from the DRV/r group and only 3.12% from the DRV/c group. Drug mutations (DRM) involved in antiretroviral resistance/sensitivity occurred both in the protease gene, and in the reverse transcriptase gene, with the involved ARV classes being protease inhibitors, nucleoside reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors. 16 different types of mutations were evaluated in the PR gene and 20 mutations were evaluated in RT gene.
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Schmidt HMA, Schaefer R, Nguyen VTT, Radebe M, Sued O, Rodolph M, Ford N, Baggaley R. Scaling up access to HIV pre-exposure prophylaxis (PrEP): should nurses do the job? Lancet HIV 2022; 9:e363-e366. [PMID: 35358418 PMCID: PMC9046094 DOI: 10.1016/s2352-3018(22)00006-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/04/2022] [Accepted: 01/06/2022] [Indexed: 12/14/2022]
Abstract
Task sharing has been one of the most important enabling policies supporting the global expansion of access to HIV testing and treatment. The WHO public health approach, which relies on delivery of antiretroviral therapy (ART) by nurses, has enabled a trebling of the number of people receiving ART during the past decade. WHO recognises that HIV pre-exposure prophylaxis (PrEP) can also be provided by nurses; however, many countries still do not have policies in place that support nurse provision of PrEP. In sub-Saharan Africa, most countries allow nurses to prescribe ART, but only a few countries have policies in place that allow nurses to prescribe PrEP. Nurse-led PrEP delivery is particularly low in the Asia-Pacific region, which has some of the world's fastest growing epidemics. Even in many high-income countries, PrEP scale-up has been limited because policies often require medical doctors or specialists to prescribe. Service providers in many countries are coming to realise that scaling up access to PrEP cannot be achieved by medical doctors alone, and nurse-led PrEP delivery can help to lay the groundwork for supporting uptake of other HIV prevention approaches that will become available in the future. Countries with policies that authorise nurses to prescribe ART could be early adopters and help to pave the way for wider adoption of nurse-led PrEP delivery.
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Affiliation(s)
- Heather-Marie A Schmidt
- UNAIDS Regional Office for Asia and the Pacific, Bangkok, Thailand; Global HIV, Hepatitis and STIs Programmes, World Health Organization, Geneva, Switzerland
| | - Robin Schaefer
- Global HIV, Hepatitis and STIs Programmes, World Health Organization, Geneva, Switzerland
| | | | - Mopo Radebe
- World Health Organization, Pretoria, South Africa
| | - Omar Sued
- Pan American Health Organization, Washington, DC, USA
| | - Michelle Rodolph
- Global HIV, Hepatitis and STIs Programmes, World Health Organization, Geneva, Switzerland
| | - Nathan Ford
- Global HIV, Hepatitis and STIs Programmes, World Health Organization, Geneva, Switzerland.
| | - Rachel Baggaley
- Global HIV, Hepatitis and STIs Programmes, World Health Organization, Geneva, Switzerland
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Predictors of loss to follow-up from HIV antiretroviral therapy in Namibia. PLoS One 2022; 17:e0266438. [PMID: 35421126 PMCID: PMC9009635 DOI: 10.1371/journal.pone.0266438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 03/21/2022] [Indexed: 11/24/2022] Open
Abstract
Despite progress on population-level HIV viral suppression, unknown outcomes amongst people who have initiated antiretroviral therapy (ART) in low- and middle-income countries, commonly referred to as loss to follow-up (LTFU), remains a barrier. The mean global estimate of LTFU is 20%, exceeding the World Health Organization target of <15%. Pervasive predictors associated with LTFU include younger age, low body mass index, low CD4 count, advanced HIV clinical stage and certain ART regimens. In Namibia, ART use by eligible individuals exceeds 85%, surpassing the global average. Nonetheless, LTFU remains a barrier to achieving viral suppression and requires research to elucidate context-specific factors. An observational cohort study was conducted in Namibia in 2012 by administering surveys to individuals who presented for HIV care and initiated ART for the first time. Additional data were collected from routine medical data monitoring systems. Participants classified as LTFU at 12 months were traced to confirm their status. Predictors of LTFU were analyzed using multivariable logistic regression. Of those who presented consecutively to initiate ART, 524 were identified as eligible to enroll in the study, 497 enrolled, and 474 completed the baseline questionnaire. The cohort had mean age 36 years, 39% were male, mean CD4 cell count 222 cells/mm3, 17% were WHO HIV clinical stage III-IV, and 14% started efavirenz-based regimens. Tracing participants classified as LTFU yielded a re-categorization from 27.8% (n = 132) to 14.3% (n = 68) LTFU. In the final multivariable model, factors associated with confirmed LTFU status were: younger age (OR 0.97, 95% CI 1.00–1.06, p = 0.02); male sex (OR 2.34, CI 1.34–4.06, p = 0.003); difficulty leaving work or home to attend clinic (OR 2.55, CI 1.40–4.65, p = 0.002); and baseline efavirenz-based regimen (OR 2.35, CI 1.22–4.51, p = 0.01). Interventions to reduce LTFU should therefore target young men, particularly those who report difficulty leaving work or home to attend clinic and are on an efavirenz-based regimen.
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HIV Prevalence and Associated Factors Among Men in South Africa 30 Years into the Epidemic: The Fifth Nationwide Cross-Sectional Survey. AIDS Behav 2022; 26:986-995. [PMID: 34460028 DOI: 10.1007/s10461-021-03453-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2021] [Indexed: 10/20/2022]
Abstract
We investigated HIV prevalence and associated factors among men ≥ 15 years in South Africa using data from a 2017 nationwide cross-sectional survey. HIV prevalence was 10.5% among 6 646 participants. Prevalence increased from 4.1% in the younger men (15-24 years), 12.5% in young men (25-34 years) to 12.7% in older men (≥ 35 years). Odds of being infected with HIV were lower among younger men who had secondary level education and those who reported poor/fair self-rated health. Young and older men of other race groups had lower odds of HIV infection. Odds of infection were lower among young men who had moderate/high exposure to HIV communication programmes. Men not aware of their HIV status had higher odds of HIV infection, including older men who never married. Improved access to education, behavioral change programmes, and awareness of HIV status are necessary to reduce the risk of HIV infection among Black African men.
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Ujewe SJ, van Staden WC. Inequitable access to healthcare in Africa: reconceptualising the "accountability for reasonableness framework" to reflect indigenous principles. Int J Equity Health 2021; 20:139. [PMID: 34120614 PMCID: PMC8201902 DOI: 10.1186/s12939-021-01482-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 05/27/2021] [Indexed: 11/23/2022] Open
Abstract
Background The “Accountability for Reasonableness” (A4R) framework has been widely adopted in working towards equity in health for sub-Saharan Africa (SAA). Its suitability for equitable health policy in Africa hinges, at least in part, on its considerable successes in the United States and it being among the most comprehensive ethical approaches in addressing inequitable access to healthcare. Yet, the conceptual match is yet to be examined between A4R and communal responsibility as a common fundamental ethic in SAA. Methodology A4R and its applications toward health equity in sub-Saharan Africa were conceptually examined by considering the WHO’s “3-by-5” and the REACT projects for their accounting for the communal responsibility ethic in pursuit of health equity. Results Some of the challenges that these projects encountered may be ascribed to an incongruity between the underpinning ethical principle of A4R and the communitarian ethical principle dominant in sub-Saharan Africa. These are respectively the fair equality of opportunity principle derived from John Rawls’ theory, and the African communal responsibility principle. Conclusion A health equity framework informed by the African communal responsibility principle should enhance suitability for SAA contexts, generating impetus from within Africa alongside the affordances of A4R.
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Affiliation(s)
- Samuel J Ujewe
- Global Emerging Pathogens Treatment Consortium (GET-Africa), Lagos, Nigeria.
| | - Werdie C van Staden
- Centre for Ethics and Philosophy of Health Sciences, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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12
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Improving continuity of HIV/AIDS care through electronic health records in resource-limited settings: A Botswana perspective. HEALTH POLICY AND TECHNOLOGY 2021. [DOI: 10.1016/j.hlpt.2021.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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13
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Hoang NT, Foo TJ, Tran BX, Do NT, Vu GT, Nguyen CT, Pham HQ, Latkin CA, Ho CSH, Ho RCM. Structural barriers for retention of HIV/AIDS patients after initiating antiretroviral therapy in outpatient clinics of Vietnam. AIDS Care 2021; 34:992-999. [PMID: 34018428 DOI: 10.1080/09540121.2021.1929816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Little evidence is available about structural factors associated with the retention in care for people living with HIV/AIDS (PLWH) in Vietnam. This retrospective longitudinal study was conducted among PLWH initiating antiretroviral therapy (ART) in 62 ART clinics from 15 provinces, to estimate retention rates and identify specific related structural factors. Facility-related factors such as location, duration of HIV service implantation, level of healthcare facility, frequency of drugs dispensed, integration of HIV care were examined. Cox proportional hazard model was employed to estimate the retention rate and association between facility-level factors and loss-to-follow up (LTFU). Among 20,119 patients, the retention rates after 6, 12, 24, 36 and 48 months were 96.5% (95% CI = 96.2%-96.7%), 93.6% (95% CI = 93.2%-93.9%), 90.2% (95% CI = 89.8%-90.6%), 87.9% (95% CI = 87.4%-88.4%) and 86.0% (95% CI = 85.4%-86.5%), respectively. Facility-level factors associated with increased risk of LTFU included duration of HIV service implementation, frequency of drug dispensed per month, integration of HIV care and of treatment procedures into general care, clinics at central or provincial level and in the Middle region of Vietnam. Such association should be addressed in future care planning and HIV/AIDS management to ensure greater coverage of therapy in Vietnam.
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Affiliation(s)
- Nhien Thi Hoang
- EPIC Project, Vietnam Authority of HIV/AIDS Control, Hanoi, Vietnam
| | - Tiara J Foo
- Department of Internal Medicine, National University of Singapore, Singapore
| | - 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
| | - Nhan Thi Do
- EPIC Project, Vietnam Authority of HIV/AIDS Control, Hanoi, Vietnam
| | - Giang Thu Vu
- Center of Excellence in Evidence-based Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | - Cuong Tat Nguyen
- Institute for Global Health Innovations, Duy Tan University, Danang, Viet Nam.,Faculty of Medicine, Duy Tan University, Danang, Vietnam
| | - Hai Quang Pham
- Institute for Global Health Innovations, Duy Tan University, Danang, Viet Nam.,Faculty of Medicine, Duy Tan University, Danang, 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
| | - Roger C M Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore
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14
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Workie KL, Birhan TY, Angaw DA. Predictors of mortality rate among adult HIV-positive patients on antiretroviral therapy in Metema Hospital, Northwest Ethiopia: a retrospective follow-up study. AIDS Res Ther 2021; 18:27. [PMID: 33952282 PMCID: PMC8097881 DOI: 10.1186/s12981-021-00353-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 04/26/2021] [Indexed: 01/16/2023] Open
Abstract
Background Globally Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) is an ongoing public health issue associated with high morbidity and mortality. Efforts have been made to reduce HIV/AIDS-related morbidity and mortality by delivering antiretroviral therapy. However, the incidence and predictors of mortality in border areas like Metema were not investigated. This study aimed to assess predictors of mortality rate among adult HIV-positive patients on antiretroviral therapy at Metema Hospital. Methods Retrospective follow-up study was employed among ART patients from January 1, 2013, to December 30, 2018. Data were entered in Epi-data 3.1 and exported to STATA 14 for analysis. Kaplan–Meier and Log-Rank test was used to compare survival differences among categories of different variables. In bi-variable analysis p-values < 0.20 were entered into a multivariable analysis. Multivariate Weibull model was used to measure the risk of death and identify the significant predictors of death. Variables that were statistically significant at p-value < 0.05 were concluded as predictors of mortality. Result A total of 542 study participants were included. The overall incidence rate was 6.7 (95% CI: 5.4–8.4) deaths per 100 person-years of observation. Being male (HR = 2.4; 95% CI: 1.24–4.62), STAGE IV (HR = 5.64; 95% CI: 2.53–12.56), stage III (HR = 3.31; 95% CI: 1.35–8.10), TB-coinfection (HR = 3.71; 95% CI: 1.59–8.64), low hemoglobin (HR = 4.14; 95% CI: 2.18–7.86), BMI ≤ 15.4 kg/m2 (HR = 2.45; 95% CI: 1.17–5.10) and viral load > 1000 copy/ml (HR = 6.70; 95% CI: 3.4–13.22) were found to be a significant predictor for mortality among HIV patients on ART treatment. Conclusion The incidence of death was high. Being male, viral load, those with advanced STAGE (III & IV), TB co-infected, low BMI, and low hemoglobin were at a higher risk of mortality. Special attention should be given to male patients and high public interventions needed among HIV patients on ART to reduce the mortality rate. Supplementary Information The online version contains supplementary material available at 10.1186/s12981-021-00353-z.
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15
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Fuseini H, Gyan BA, Kyei GB, Heimburger DC, Koethe JR. Undernutrition and HIV Infection in Sub-Saharan Africa: Health Outcomes and Therapeutic Interventions. Curr HIV/AIDS Rep 2021; 18:87-97. [PMID: 33606196 PMCID: PMC8404370 DOI: 10.1007/s11904-021-00541-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW Sub-Saharan Africa (SSA) is disproportionately burdened by the twin epidemics of food insecurity and HIV infection, and protein-calorie undernutrition is common among persons with HIV (PWH) initiating antiretroviral therapy (ART) in the region. In this review, we discuss the intersection of HIV infection and undernutrition, health outcomes among undernourished PWH starting ART, and the demonstrated and potential benefits of therapeutic interventions such as micro/macronutrient supplementation and pharmacological agents. RECENT FINDINGS A low body mass index (BMI), used as a general indicator of poor nutrition in most studies, is associated with impaired immune recovery and increased mortality in the early ART period. The increased risk of mortality is multifactorial, and contributors include undernutrition-related immune system dysfunction, increased susceptibility to opportunistic infections, and metabolic and cardiovascular dysregulation. Clinical trials of micro/macronutrient supplementary feeding, appetite stimulants (hormones and anabolic agents), and recombinant adipokines have shown a benefit for weight gain and metabolic health, but there are few data on mortality or immune recovery. A substantial proportion of PWH in SSA are undernourished, and undernutrition contributes to an increased risk of mortality and other adverse health outcomes. To date, there have been few prospective trials of nutritional supplementation and/or pharmacologic therapy among undernourished PWH in SSA, though findings from other settings suggest a potential benefit in this population.
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Affiliation(s)
- Hubaida Fuseini
- Department of Immunology, Noguchi Memorial Institute for Medical Research, Legon, Ghana.
- Department of Virology, Noguchi Memorial Institute for Medical Research, Legon, Ghana.
- Divison of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, 37232-2582, USA.
| | - Ben A Gyan
- Department of Immunology, Noguchi Memorial Institute for Medical Research, Legon, Ghana
- Department of Virology, Noguchi Memorial Institute for Medical Research, Legon, Ghana
| | - George B Kyei
- Department of Immunology, Noguchi Memorial Institute for Medical Research, Legon, Ghana
- Department of Virology, Noguchi Memorial Institute for Medical Research, Legon, Ghana
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
| | | | - John R Koethe
- Divison of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, 37232-2582, USA
- Vanderbilt Institute for Global Health, Nashville, TN, USA
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16
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Desai KT, Patel F, Patel PB, Bansal RK. Role of demographic and clinical factors in survival of HIV patients on antiretroviral therapy. Trop Doct 2021; 51:403-408. [PMID: 33550938 DOI: 10.1177/0049475520981257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Our retrospective cohort study assesses the survival probability and identifies the demographic and clinical predictors of mortality in HIV patients taking antiretroviral therapy using an antiretroviral therapy centre data in Western India. Secondary data on 7532 registered HIV-infected individuals between September 2006 and January 2013 were analysed. The probability of survival at 75 months was 84.9%. Significant indicators of poor chances of survival were greater age, lower occupation class, lower CD4 count, poor functional status; higher stage of disease, lower weight, the presence and type of opportunistic infections, co-trimoxazole therapy and poor adherence to antiretroviral therapy. We thus find that, in addition to pre-ART, antiretroviral therapy clinical status and treatment adherence, socioeconomic status plays an important influence on ultimate survival of HIV patients on antiretroviral therapy.
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Affiliation(s)
- Kanan T Desai
- Postgraduate Resident, Department of Community Medicine, 29033Surat Municipal Institute of Medical Education and Research (SMIMER), Surat, India
| | - Fenil Patel
- Postgraduate Resident, Department of Community Medicine, 29033Surat Municipal Institute of Medical Education and Research (SMIMER), Surat, India
| | - Prakash B Patel
- Assistant Professor, Department of Community Medicine, 29033Surat Municipal Institute of Medical Education and Research (SMIMER), Surat, India
| | - R K Bansal
- Professor & Head, Department of Community Medicine, 29033Surat Municipal Institute of Medical Education and Research (SMIMER), Surat, India
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17
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Effects of undernutrition on mortality and morbidity among adults living with HIV in sub-Saharan Africa: a systematic review and meta-analysis. BMC Infect Dis 2021; 21:1. [PMID: 33390160 PMCID: PMC7780691 DOI: 10.1186/s12879-020-05706-z] [Citation(s) in RCA: 195] [Impact Index Per Article: 65.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 12/11/2020] [Indexed: 01/04/2023] Open
Abstract
Background Undernutrition is one of the most common problems among people living with HIV, contributing to premature death and the development of comorbidities within this population. In Sub-Saharan Africa (SSA), the impacts of these often inter-related conditions appear in a series of fragmented and inconclusive studies. Thus, this review examines the pooled effects of undernutrition on mortality and morbidities among adults living with HIV in SSA. Methods A systematic literature search was conducted from PubMed, EMBASE, CINAHL, and Scopus databases. All observational studies reporting the effects of undernutrition on mortality and morbidity among adults living with HIV in SSA were included. Heterogeneity between the included studies was assessed using the Cochrane Q-test and I2 statistics. Publication bias was assessed using Egger’s and Begg’s tests at a 5% significance level. Finally, a random-effects meta-analysis model was employed to estimate the overall adjusted hazard ratio. Results Of 4309 identified studies, 53 articles met the inclusion criteria and were included in this review. Of these, 40 studies were available for the meta-analysis. A meta-analysis of 23 cohort studies indicated that undernutrition significantly (AHR: 2.1, 95% CI: 1.8, 2.4) increased the risk of mortality among adults living with HIV, while severely undernourished adults living with HIV were at higher risk of death (AHR: 2.3, 95% CI: 1.9, 2.8) as compared to mildly undernourished adults living with HIV. Furthermore, the pooled estimates of ten cohort studies revealed that undernutrition significantly increased the risk of developing tuberculosis (AHR: 2.1, 95% CI: 1.6, 2.7) among adults living with HIV. Conclusion This review found that undernutrition has significant effects on mortality and morbidity among adults living with HIV. As the degree of undernutrition became more severe, mortality rate also increased. Therefore, findings from this review may be used to update the nutritional guidelines used for the management of PLHIV by different stakeholders, especially in limited-resource settings. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-020-05706-z.
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18
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Claassen CW, Keckich D, Nwizu C, Abimiku A, Salami D, Obiefune M, Gilliam BL, Amoroso A. HIV Viral Dynamics of Lopinavir/Ritonavir Monotherapy as Second-Line Treatment: A Prospective, Single-Arm Trial. J Int Assoc Provid AIDS Care 2020; 18:2325958218823209. [PMID: 30798695 PMCID: PMC6748552 DOI: 10.1177/2325958218823209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Characterizing viral response to lopinavir/ritonavir (LPV/r) monotherapy as second-line treatment may guide recommendations for resource-limited settings (RLS). Methods: We conducted a 48-week prospective, single-arm study of LPV/r monotherapy in patients failing first-line therapy in Nigeria. The primary outcome was sustained HIV-1 viral load (VL) <400 copies/mL at 48 weeks. Results: Of 30 enrolled patients, 28 (93%) achieved viral suppression on LPV/r, while 29 (96%) experienced low-level viremia. At 48 weeks, 9 (30%) met the primary outcome of sustained viral suppression; 14 (47%) patients were suppressed on LPV/r in a snapshot analysis. Detectable VLs at 12 and 24 weeks were strongly associated with treatment failure at 48 weeks. New resistance mutations were not detected. The trial was stopped early due to treatment failure. Conclusion: In this study, the rate of virologic failure among patients on a second-line lopinavir monotherapy regimen was relatively high and predicted by early detectable viremia. However, no LPV/r-associated resistance mutations were detected despite fluctuating low-level viremia, demonstrating the high genetic barrier to resistance of the protease inhibitor class which could be useful in RLS.
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Affiliation(s)
- Cassidy W Claassen
- 1 Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Chidi Nwizu
- 1 Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA.,3 Center for Clinical Care and Clinical Research, Abuja, Nigeria
| | - Alash'le Abimiku
- 1 Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Donald Salami
- 4 University of Maryland, Maryland Global Initiatives Corporation, Abuja, Nigeria
| | - Michael Obiefune
- 3 Center for Clinical Care and Clinical Research, Abuja, Nigeria.,4 University of Maryland, Maryland Global Initiatives Corporation, Abuja, Nigeria
| | - Bruce L Gilliam
- 1 Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Anthony Amoroso
- 1 Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
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19
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Mehtani NJ, Rosman L, Moss WJ. Immunogenicity and Safety of the Measles Vaccine in HIV-Infected Children: An Updated Systematic Review. Am J Epidemiol 2019; 188:2240-2251. [PMID: 31210268 DOI: 10.1093/aje/kwz144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 05/15/2019] [Accepted: 06/05/2019] [Indexed: 01/26/2023] Open
Abstract
Children infected with human immunodeficiency virus (HIV) are at increased risk of measles morbidity and mortality. We searched abstracts from the PubMed, Embase, and Latin American and Caribbean Center on Health Sciences Information databases for articles published from the earliest date available through September 26, 2017. The primary outcome of interest was serological responses to measles vaccine, stratified by HIV infection status. A total of 2,858 potentially eligible articles were identified, and the final review included 12 studies published between 1992 and 2013, 9 of which reported data on vaccine safety. The studies we included represented 3,573 children, of whom at least 335 were infected with HIV, 788 were HIV-exposed but not infected, and 1,478 were unexposed to HIV. Four of the 12 studies found statistically significant reductions in seropositivity among HIV-infected children compared with HIV-uninfected children within 4 months of vaccination (prevalence ratio range, 0.44-0.70), and forest plots provided visual trends of decreasing immunity over time among HIV-infected children in 2 additional studies. No vaccine-related deaths or serious adverse events were reported. This updated review demonstrated limitations of the existing published literature but supported evidence of reduced immunogenicity of measles vaccine among HIV-infected children, supporting the World Health Organization recommendation to revaccinate HIV-infected children against measles following immune reconstitution with combination antiretroviral therapy.
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Affiliation(s)
- Nicky J Mehtani
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Lori Rosman
- Welch Medical Library, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - William J Moss
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
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20
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Misgina KH, Weldu MG, Gebremariam TH, Weledehaweria NB, Alema HB, Gebregiorgis YS, Tilahun YG. Predictors of mortality among adult people living with HIV/AIDS on antiretroviral therapy at Suhul Hospital, Tigrai, Northern Ethiopia: a retrospective follow-up study. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2019; 38:37. [PMID: 31783924 PMCID: PMC6883545 DOI: 10.1186/s41043-019-0194-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 10/17/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Ethiopia is striving to achieve a goal of "zero human immune deficiency virus/acquired immune deficiency syndrome (HIV/AIDS)-related deaths." However, little has been documented on the factors that hamper the progress towards achieving this goal. Therefore, the ultimate aim of this study was to determine predictors of mortality among adult people living with HIV/AIDS on antiretroviral therapy (ART). METHODS A retrospective follow-up study was employed on all adult HIV/AIDS patients who started ART between January 1 and December 30, 2010, at Suhul Hospital, Tigrai Region, Northern Ethiopia. Data were collected by trained fourth-year Public Health students using a checklist. Finally, the collected data were entered into SPSS version 16. Then after, Kaplan-Meier curves were used to estimate survival probability, the log-rank test was used for comparing the survival status, and Cox proportional hazards model were applied to determine predictors of mortality. RESULTS The median follow-up period was 51 months (ranging between 1 and 60 months, inter-quartile range (IQR) = 14 months). At the end of follow-up, 37 (12.5%) patients were dead. The majority of these cumulative deaths, 19 (51.4%) and 29 (78.4%), occurred within 3 and 4 years of ART initiation respectively. Consuming alcohol (adjusted hazard ratio (AHR) = 2.23, 95% CI = 1.15, 4.32), low body weight (AHR = 2.38, 95% CI = 1.03, 5.54), presence of opportunistic infections (AHR = 2.18, 95% CI = 1.09, 4.37), advanced WHO clinical stage (AHR = 2.75, 95% CI = 1.36, 5.58), and not receiving isoniazid prophylactic therapy (AHR = 3.00, 95% CI = 1.33, 6.74) were found to be independent predictors of mortality. CONCLUSION The overall mortality was very high. Baseline alcohol consumption, low body weight, advanced WHO clinical stage, the presence of opportunistic infections, and not receiving isoniazid prophylactic therapy were predictors of mortality. Strengthening behavioral and nutritional counseling with close clinical follow-up shall be given much more emphasis in the ART care and support program.
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Affiliation(s)
| | | | | | | | | | | | - Yonas Girma Tilahun
- Center of International Reproductive Health Training (CIRHT), Bahir Dar University, Bahir Dar, Ethiopia
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21
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McCord R, Cronk R, Tomaro J, Reuland F, Behnke N, Mmodzi Tseka J, Banda C, Kafanikhale H, Mofolo I, Hoffman I, Bartram J. The implementation of environmental health policies in health care facilities: The case of Malawi. Int J Hyg Environ Health 2019; 222:705-716. [PMID: 31101502 DOI: 10.1016/j.ijheh.2019.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 04/03/2019] [Accepted: 05/03/2019] [Indexed: 11/30/2022]
Abstract
Establishing and maintaining safe and sufficient environmental health (EH) conditions in health care facilities (HCFs) is important to prevent and control infections. In 2018, the Government of Malawi finalized an environmental health policy that defines specific targets and programs for EH in healthcare settings. This and other related policies have been used since 2010 as a guide for EH practice in HCFs, but the implementation of these policies has been incomplete to-date. This study qualitatively examines the successes and shortcomings of implementing these policies in Malawi's public HCFs. Thematic analysis of interviews with 53 respondents from all levels of government was used to identify the successes of the policies and the barriers to effective implementation using Contextual Interaction Theory. The greatest identified strength lies in the design of the EH department and its ability to connect individual HCFs and EH actors directly to the policy-making level of government. Identified barriers to implementation include: insufficient financial support; lack of human resources; incomplete reporting; poor stakeholder coordination; and insufficient training of EH actors. We recommend refresher trainings for all EH actors, the establishment of a directorate level EH position, and strengthened coordination to improve the collection, analysis, and reporting of monitoring data to enable EH actors to advocate for the additional funding needed to develop programs for EH personnel and to apply effective EH interventions.
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Affiliation(s)
- R McCord
- The Water Institute, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (UNC-CH), USA; Carolina Population Center, University of North Carolina at Chapel Hill (UNC-CH), USA.
| | - R Cronk
- The Water Institute, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (UNC-CH), USA; Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, UNC-CH, USA
| | - J Tomaro
- The Water Institute, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (UNC-CH), USA; Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, UNC-CH, USA
| | - F Reuland
- The Water Institute, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (UNC-CH), USA; Carnegie Endowment for International Peace, Washington, DC, USA
| | - N Behnke
- The Water Institute, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (UNC-CH), USA; Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, UNC-CH, USA
| | | | - C Banda
- Malawi Ministry of Health and Population and Population, Lilongwe, Malawi
| | - H Kafanikhale
- Malawi Ministry of Health and Population and Population, Lilongwe, Malawi
| | - I Mofolo
- UNC Project-Malawi, Lilongwe, Malawi; Department of Medicine, UNC-CH, USA
| | - I Hoffman
- UNC Project-Malawi, Lilongwe, Malawi; Department of Medicine, UNC-CH, USA
| | - J Bartram
- The Water Institute, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (UNC-CH), USA; Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, UNC-CH, USA
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Vojnov L, Taegtmeyer M, Boeke C, Markby J, Harris L, Doherty M, Peter T, Ford N. Performance of non-laboratory staff for diagnostic testing and specimen collection in HIV programs: A systematic review and meta-analysis. PLoS One 2019; 14:e0216277. [PMID: 31048881 PMCID: PMC6497381 DOI: 10.1371/journal.pone.0216277] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 04/17/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND In most high HIV burden countries, many HIV patients do not have reliable access to required diagnostic laboratory tests. Task shifting of clinical tasks to lower cadres of health care workers and lay counselors has been successful in scaling up treatment for HIV and may also be an effective strategy in expanding access to essential diagnostic testing. METHODS We screened major electronic databases between 1 January 2005 to 26 August 2018 to identify studies assessing ease of use and accuracy of task shifting of HIV-related diagnostic testing and/or specimen collection to non-laboratory health staff. Two independent reviewers screened all titles and abstracts for studies that analyzed diagnostic accuracy, patient impact, ease-of-use, or cost-effectiveness. Studies were assessed for quality, bias, and applicability following the QUADAS-2 framework. We generated summary estimates using random-effects meta-analyses. RESULTS We identified 42 relevant studies. Overall, point-of-care CD4 testing performed by non-laboratory staff had a mean bias of -54.44 (95% CI: -72.40 --36.48) compared to conventional laboratory-based. Though studies were limited, the diagnostic accuracy of point-of-care alanine transaminase enzyme (ALT) and hemoglobin testing performed by non-laboratory staff was comparable to conventional laboratory-based testing by laboratory professionals. Point-of-care testing and/or specimen collection were generally found to be acceptable and easy to use for non-laboratory staff. CONCLUSIONS Task shifting of testing using point-of-care technologies to non-laboratory staff was comparable to laboratory professionals operating the same technology in the laboratory. Some variability was observed comparing the performance of point-of-care CD4 testing by non-laboratory staff to conventional laboratory-based technologies by laboratory professionals indicating potential lower performance was likely technological rather than operator caused. The benefits of task shifting of testing may outweigh any possible harms as task shifting allows for increased decentralization, access of specific diagnostics, and faster result delivery.
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Affiliation(s)
- Lara Vojnov
- Clinton Health Access Initiative, Boston, Massachusetts, United States of America
| | - Miriam Taegtmeyer
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
| | - Caroline Boeke
- Clinton Health Access Initiative, Boston, Massachusetts, United States of America
| | - Jessica Markby
- Clinton Health Access Initiative, Boston, Massachusetts, United States of America
| | - Lindsay Harris
- Clinton Health Access Initiative, Boston, Massachusetts, United States of America
| | - Meg Doherty
- World Health Organization, Geneva, Switzerland
| | - Trevor Peter
- Clinton Health Access Initiative, Boston, Massachusetts, United States of America
| | - Nathan Ford
- World Health Organization, Geneva, Switzerland
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Angdembe MR, Rai A, Bam K, Pandey SR. Predictors of mortality in adult people living with HIV on antiretroviral therapy in Nepal: A retrospective cohort study, 2004-2013. PLoS One 2019; 14:e0215776. [PMID: 31013320 PMCID: PMC6481250 DOI: 10.1371/journal.pone.0215776] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 04/08/2019] [Indexed: 11/20/2022] Open
Abstract
Background In Nepal, since 2004, 19,388 people living with HIV (PLHIV) have been
enrolled on antiretroviral therapy (ART). The aim of this study was to
measure mortality rate and to identify predictors of mortality in adult (≥15
years) PLHIV who initiated ART between 2004 and 2013 in five large ART
centers of Nepal. Methods This retrospective cohort study of 3,799 (60.5% male) adult PLHIV uses
secondary data collected from standard ART registers. Time from ART
initiation (baseline) to death or censoring (loss to follow-up or December
31, 2013) was assessed. Mortality rates per 100 person-years were
calculated. Kaplan-Meier models were used to estimate the probability of
mortality over time. Predictors of mortality were determined using
Cox-regression models. Results The overall mortality rate was 6.98 (95% CI: 6.46–7.54) per 100 person-years,
4.11 (95% CI: 3.53–4.79) in females and 9.14 (95% CI: 8.36–9.99) in males.
Mortality rates were higher in early months after ART initiation,
particularly in the first three months. Baseline predictors of mortality
were ART center, male gender (adjusted HR = 2.08, 95% CI: 1.69–2.57),
residence outside the ART district (AHR = 1.45, 95% CI:1.19–1.76), World
Health Organization clinical stage III (AHR = 1.67, 95% CI: 1.13–2.46) and
IV (AHR = 2.21, 95% CI: 1.45–3.36), bedridden <50% time in the last month
(AHR = 1.92, 95% CI: 1.52–2.41), bedridden >50% time in the last month
(AHR = 3.82, 95% CI: 2.95–4.94), lower bodyweight/kg (AHR = 1.04, 95% CI:
1.03–1.05), CD4 count <150 cell/mm3 (AHR = 2.14, 95% CI:
1.05–4.34) and treatment not switched to second-line regimen (AHR = 3.05,
95% CI: 1.35–6.90). Conclusions Mortality rates were higher soon after ART initiation, particularly in males
and gradually decreased over time. Poor baseline clinical characteristics
were significantly associated with higher mortality. Increased ART coverage
with decentralization of sites to lower levels including community
dispensing, differentiated and improved service delivery and initiation of
ART at a less advanced disease stage may reduce early mortality.
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Affiliation(s)
| | - Anjana Rai
- Saath-Saath Project, Nepal, Kathmandu,
Nepal
| | - Kiran Bam
- Saath-Saath Project, Nepal, Kathmandu,
Nepal
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Indriati DW, Kotaki T, Khairunisa SQ, Witaningrum AM, Matondang MQY, Ueda S, Nasronudin, Purnama A, Kurniawan D, Kameoka M. Appearance of Drug Resistance Mutations Among the Dominant HIV-1 Subtype, CRF01_AE in Maumere, Indonesia. Curr HIV Res 2019; 16:158-166. [PMID: 29732988 DOI: 10.2174/1570162x16666180502114344] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 04/17/2018] [Accepted: 04/24/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND OBJECTIVES Human Immunodeficiency Virus (HIV) is still a major health issue in Indonesia. In recent years, the appearance of drug resistance-associated mutations has reduced the effectiveness of Antiretroviral Therapy (ART). We conducted genotypic studies, including the detection of drug resistance-associated mutations (from first-line regimen drugs), on HIV-1 genes derived from infected individuals in Maumere, West Nusa Tenggara. Maumere, a transit city in West Nusa Tenggara, which has a high HIV-1 transmission rate. METHOD We collected 60 peripheral blood samples from 53 ART-experienced and 7 ART-naive individuals at TC Hillers Hospital, Maumere between 2014 and 2015. The amplification and a sequencing analysis of pol genes encoding protease (the PR gene) and reverse transcriptase (the RT gene) as well as the viral env and gag genes were performed. HIV-1 subtyping and the detection of drug resistance-associated mutations were then conducted. RESULTS Among 60 samples, 46 PR, 31 RT, 30 env, and 20 gag genes were successfully sequenced. The dominant HIV-1 subtype circulating in Maumere was CRF01_AE. Subtype B and recombinant viruses containing gene fragments of CRF01_AE, subtypes A, B, C, and/or G were also identified as minor populations. The major drug resistance-associated mutations, M184V, K103N, Y188L, and M230I, were found in the RT genes. However, no major drug resistance-associated mutations were detected in the PR genes. CONCLUSION CRF01_AE was the major HIV-1 subtype prevalent in Maumere. The appearance of drug resistance-associated mutations found in the present study supports the necessity of monitoring the effectiveness of ART in Maumere.
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Affiliation(s)
- Dwi Wahyu Indriati
- Indonesia-Japan Collaborative Research Center for Emerging and Re-emerging Infectious Disease, Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia.,Department of Health, Faculty of Vocational Studies, Universitas Airlangga, Surabaya, Indonesia
| | - Tomohiro Kotaki
- Indonesia-Japan Collaborative Research Center for Emerging and Re-emerging Infectious Disease, Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia.,Department of International Health, Kobe University Graduate School of Health Sciences, Hyogo, Japan
| | - Siti Qamariyah Khairunisa
- Indonesia-Japan Collaborative Research Center for Emerging and Re-emerging Infectious Disease, Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia
| | - Adiana Mutamsari Witaningrum
- Indonesia-Japan Collaborative Research Center for Emerging and Re-emerging Infectious Disease, Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia
| | - Muhammad Qushai Yunifiar Matondang
- Indonesia-Japan Collaborative Research Center for Emerging and Re-emerging Infectious Disease, Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia
| | - Shuhei Ueda
- Indonesia-Japan Collaborative Research Center for Emerging and Re-emerging Infectious Disease, Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia.,Department of International Health, Kobe University Graduate School of Health Sciences, Hyogo, Japan
| | - Nasronudin
- Indonesia-Japan Collaborative Research Center for Emerging and Re-emerging Infectious Disease, Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia.,Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | | | | | - Masanori Kameoka
- Department of International Health, Kobe University Graduate School of Health Sciences, Hyogo, Japan.,Center for Infectious Diseases, Kobe University, Graduate School of Medicine, Hyogo, Japan
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25
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Maseko SB, Govender D, Govender T, Naicker T, Lin J, Maguire GEM, Kruger HG. Optimized Procedure for Recovering HIV-1 Protease (C-SA) from Inclusion Bodies. Protein J 2019; 38:30-36. [PMID: 30666487 DOI: 10.1007/s10930-018-9805-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
HIV-1 is an infectious virus that causes acquired immunodeficiency syndrome (AIDS) and it is one of the major causes of deaths worldwide. The production of HIV-1 protease (PR) on a large scale has been a problem for scientists due to its cytotoxicity, low yield, insolubility, and low activity. HIV-1 C-SA protease has been cloned, expressed, and purified previously, however, with low recovery (0.25 mg/L). Herein we report an optimal expression and solubilisation procedure to recover active HIV-1 C-SA protease enzyme from inclusion bodies. The HIV protease was expressed in seven different vectors (pET11b, pET15b, pET28a pET32a, pET39b, pET41b and pGEX 6P-1). The highest expression was achieved when the vector pET32a (Trx tag) was employed. A total of 19.5 mg of fusion protein was refolded of which 5.5 mg of active protease was obtained after cleavage. The free protease had a high specific activity of 2.81 µmoles/min/mg. Interestingly the Trx-fusion protein also showed activity closer (1.24 µmoles/min/mg) to that of the free protease suggesting that the pET32a vector (Trx tag) expressed in BL21(DE3) pLysS provides a more efficient way to obtain HIV-1 protease.
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Affiliation(s)
- Sibusiso B Maseko
- Catalysis and Peptide Research Unit, School of Health Sciences, University of KwaZulu-Natal, Durban, 4001, South Africa
| | - Deidre Govender
- Catalysis and Peptide Research Unit, School of Health Sciences, University of KwaZulu-Natal, Durban, 4001, South Africa
| | - Thavendran Govender
- Catalysis and Peptide Research Unit, School of Health Sciences, University of KwaZulu-Natal, Durban, 4001, South Africa
| | - Tricia Naicker
- Catalysis and Peptide Research Unit, School of Health Sciences, University of KwaZulu-Natal, Durban, 4001, South Africa
| | - Johnson Lin
- School of Life Sciences, University of KwaZulu-Natal, Durban, 4001, South Africa
| | - Glenn E M Maguire
- Catalysis and Peptide Research Unit, School of Health Sciences, University of KwaZulu-Natal, Durban, 4001, South Africa.,School of Chemistry and Physics, University of KwaZulu-Natal, Durban, 4001, South Africa
| | - Hendrik G Kruger
- Catalysis and Peptide Research Unit, School of Health Sciences, University of KwaZulu-Natal, Durban, 4001, South Africa.
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Hepatitis B virus coinfection is associated with high early mortality in HIV-infected Tanzanians on antiretroviral therapy. AIDS 2019; 33:465-473. [PMID: 30702515 DOI: 10.1097/qad.0000000000002073] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES There is limited data on the effect of antiviral therapies on clinical outcomes in HIV and hepatitis B virus (HBV)-infected individuals in sub-Saharan Africa. DESIGN Single center, prospective longitudinal cohort study at Management and Development for Health supported HIV Care and Treatment clinics in Dar es Salaam, Tanzania. METHODS Between April 2014 and December 2015, HIV-infected, HBV-infected and HIV/HBV-coinfected, treatment naïve, Tanzanian adults more than 18 years of age were eligible for enrollment and followed for 10-18 months after initiating antivirals. All HIV-infected and HIV/HBV-coinfected participants received tenofovir, lamivudine and efavirenz; HBV-infected participants received lamivudine. Multivariate regression models were constructed to identify factors associated with mortality in HIV-infected and HIV/HBV-coinfected participants. RESULTS A total of 265 HIV-infected, 165 HBV-infected and 64 HIV/HBV-coinfected participants were analyzed. At baseline, HBV-infected participants were younger and had a higher BMI than HIV-infected and HIV/HBV-coinfected participants. After a median of 371 (interquartile range 50) days on treatment, there were 40 deaths. Mortality was significantly higher among HIV/HBV-coinfected participants compared with HIV and HBV-infected participants [HIV/HBV-coinfected 12 of 64 (19%) vs. HIV-infected 26 of 265 (10%) and HBV-infected two of 265 (1%), P < 0.01]. High baseline HIV RNA and low hemoglobin levels, but not HBV coinfection were independently associated with early mortality in multivariate analyses of HIV-infected participants. CONCLUSION High rates of early mortality were observed after treatment initiation in HIV/HBV-coinfected individuals compared with participants with HIV or HBV alone, despite robust aspartate aminotransferase to platelet ratio index declines and high rates of virologic suppression. HIV rather than HBV-related factors are more important contributors to mortality in these individuals.
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27
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Almeida-Brasil CC, Moodie EEM, Cardoso TS, Nascimento ED, Ceccato MDGB. Comparison of the predictive performance of adherence measures for virologic failure detection in people living with HIV: a systematic review and pairwise meta-analysis. AIDS Care 2018; 31:647-659. [PMID: 30516060 DOI: 10.1080/09540121.2018.1554241] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
A critical feature of an adherence assessment tool is its ability to predict virologic failure in people living with HIV (PLHIV). We, therefore, aimed to compare the predictive performance of commonly used adherence measures. We systematically searched MEDLINE, Embase and LILACS up to February 2018, to identify relevant observational studies comparing the effects of any two of the following adherence measurements on virologic outcomes: electronic monitoring, pill count, pharmacy refill, self-report and physician assessment. We analyzed data by pairwise meta-analyzes with a random-effects model. The proportion of virologic failures among non-adherent participants in each adherence measure was used to calculate the odds ratio (OR), with 95% Confidence Intervals (95%CI). Heterogeneity was assessed, with potential causes identified by sensitivity and subgroup analysis. We included 38 studies with individual patient data for 18,010 patients. All possible comparisons between pairs of the five adherence measures were considered and a total of nine comparison groups could be established. Meta-analysis suggested that self-report was a better predictor of virologic failure than pill count when the recall period was within one week (OR: 2.35, 95%CI: 1.07-5.18, p = 0.03). Physician assessment had higher odds of predicting virologic failure than did either self-report (OR: 2.63, 95%CI: 1.37-5.26, p < 0.01) or pharmacy refill (OR: 3.57, 95%CI: 1.69-7.14, p < 0.001). There was no difference in the predictive performance between any of the other measures that we were able to compare (p > 0.05). The combination of multiple measures did not increase the predictive value when compared to any of the measures alone. Low-cost and simple adherence measures such as self-report predict virologic failure better than or equally well as objective measures. Our results suggest that there is no need to use expensive or time-consuming adherence measures when the objective is to identify PLHIV at risk of treatment failure.
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Affiliation(s)
- Celline Cardoso Almeida-Brasil
- a Department of Social Pharmacy , Universidade Federal de Minas Gerais , Belo Horizonte , Brazil.,b Department of Epidemiology, Biostatistics and Occupational Health , McGill University , Montréal , Canada
| | - Erica E M Moodie
- b Department of Epidemiology, Biostatistics and Occupational Health , McGill University , Montréal , Canada
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28
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Omonaiye O, Nicholson P, Kusljic S, Manias E. A meta-analysis of effectiveness of interventions to improve adherence in pregnant women receiving antiretroviral therapy in sub-Saharan Africa. Int J Infect Dis 2018; 74:71-82. [PMID: 30003952 DOI: 10.1016/j.ijid.2018.07.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 07/03/2018] [Accepted: 07/03/2018] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE We evaluated the effectiveness of interventions aimed at improving antiretroviral therapy (ART) adherence during pregnancy in sub-Saharan Africa. METHODS For this meta-analysis, the following databases were searched: MEDLINE Complete, Embase, Global Health, CINAHL Complete, and Google Scholar. Randomized and nonrandomized studies were considered for inclusion if they involved an intervention with the intent of improving medication adherence among pregnant women taking ART in sub-Saharan Africa. Databases were searched from inception to the end of August 2017. The primary outcome assessed was adherence to ART, defined as the proportion of women adherent to treatment in the control and intervention groups. Risk ratios and random effect meta-analysis were undertaken, and heterogeneity was examined with the I2 statistic. RESULTS The systematic search of databases yielded a total of 402 articles, of which 19 studies were selected for meta-analysis with a total of 27,974 participants. Nine types of interventions were identified in the 19 studies to improve ART adherence. The test for the subgroup differences showed that there was a statistically significant difference among the 9 subgroups of interventions, χ2 (8)=102.38; p=0.00001. Collectively, in the meta-analysis, the various intervention types made a significant impact on improving medication adherence. The overall effect estimate with 95% CI was as follows: 1.25 (95% CI=1.03, 1.52, p=0.03). The following risk ratio results for meta-analysis were obtained for the three interventions that showed significant impact on adherence; namely social support and structural support, 1.58 (95% CI=1.36, 1.84, p<0.00001); education, social support and structural support=2.60 (95% CI=1.95, 3.45, p<0.00001); and device reminder=1.13 (95% CI=1.05, 1.20, p=0.0004). The proportion of women who were adherent to ART as a result of the interventions was 59.3% compared with 22.5% in the control groups. CONCLUSION The use of device reminder, a combination of social support and structural support, and education, social support and structural support has the potential to improve ART adherence during pregnancy. Good quality prospective observational studies and randomized control trials are needed in sub-Saharan Africa to determine the most effective interventions.
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Affiliation(s)
- Olumuyiwa Omonaiye
- Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Deakin University, Melbourne Burwood, Victoria, Australia.
| | - Pat Nicholson
- Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Deakin University, Melbourne Burwood, Victoria, Australia
| | - Snezana Kusljic
- Department of Nursing, The University of Melbourne, Melbourne, Australia
| | - Elizabeth Manias
- Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Deakin University, Melbourne Burwood, Victoria, Australia
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29
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[Survival in HIV-1 patients receiving antiretroviral therapy in Morocco]. Rev Epidemiol Sante Publique 2018; 66:311-316. [PMID: 30177238 DOI: 10.1016/j.respe.2018.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 06/12/2018] [Accepted: 07/13/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The purpose was to study factors associated with the survival of HIV-1 patients receiving antiretroviral therapy in Morocco. MATERIAL AND METHOD This was a retrospective study of a cohort of 182 HIV-1 patients receiving antiretroviral therapy in the department of dermatology venereology at the Military Instruction Hospital Mohamed V in Rabat during the period from 1 January 2006 to 1 January 2017. Death of any cause during the study period was considered to be the result of HIV infection. The log-rank test was used to compare the survival curves based on determinants. The Cox regression model analyzed the determinants of survival since induction of antiretroviral therapy. RESULTS The median follow-up time was 4.7 years (IQR: 1.97-8.18). The mortality rate was 75 deaths per 1000 person-years. Advanced clinical stage CDC C (RR: 2.72; CI 95%: 1.33-5.56) and treatment with indinavir (RR: 1.41; CI 95%: 0.77-2.59) were significantly associated with death. CONCLUSION Initiation of antiretroviral therapy in the early stage of the disease and use of less toxic molecules are recommended to reduce mortality.
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Benzekri NA, Seydi M, NDoye I, Toure M, Kiviat NB, Sow PS, Hawes SE, Gottlieb GS. HIV and the dual burden of malnutrition in Senegal, 1994-2012. Int J STD AIDS 2018; 29:1165-1173. [PMID: 29914295 DOI: 10.1177/0956462418777364] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aims of this study were to determine the nutritional status of HIV-positive versus HIV-negative adults in Senegal and to identify predictors of nutritional status among people living with HIV (PLHIV). We conducted a retrospective study using data from individuals enrolled in previous studies in Senegal. Undernutrition was defined as body mass index (BMI) <18.5 and overnutrition was defined as BMI ≥25.0. Subcategories of overnutrition were overweight (defined as BMI 25.0-29.9) and obesity (BMI ≥30.0). Predictors of nutritional status were identified using multinomial logistic regression. Data from 2448 adults were included; 1471 (60%) were HIV positive. Among HIV-negative individuals, the prevalence of undernutrition decreased from 23% in 1994-1999 to 5% in 2006-2012, while the prevalence of overnutrition increased from 19 to 55%. Among PLHIV, undernutrition decreased from 52 to 37% and overnutrition increased from 10 to 15%. Women had greater odds of obesity (odds ratio [OR] 11.4; p < 0.01). Among HIV-positive women, undernutrition was associated with WHO stage 3 or 4 and CD4 cell count <200; antiretroviral therapy (ART) and education were protective. Obesity was associated with age > 35 years, commercial sex work, and alcohol use. Among HIV-positive men, WHO stage 3 or 4 and CD4 cell count <200 were predictive of undernutrition; ART was protective. Our study highlights the need for the integration of nutrition interventions into HIV programs in Senegal and suggests that for nutrition programs to be most effective, strategies may need to differ when targeting men versus women. Furthermore, improving access to education and focusing on women for nutrition interventions could be of particularly high impact at the household level.
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Affiliation(s)
- Noelle A Benzekri
- 1 Department of Medicine, University of Washington, Seattle, WA, USA
| | - Moussa Seydi
- 2 Centre Hospitalier Universitaire de Fann, Dakar, Senegal
| | - Ibrahima NDoye
- 3 Conseil National de Lutte contre le Sida, Dakar, Senegal
| | - Macoumba Toure
- 2 Centre Hospitalier Universitaire de Fann, Dakar, Senegal
| | - Nancy B Kiviat
- 4 Department of Pathology, University of Washington, Seattle, WA, USA
| | - Papa Salif Sow
- 2 Centre Hospitalier Universitaire de Fann, Dakar, Senegal
| | - Stephen E Hawes
- 5 Department of Global Health, University of Washington, Seattle, WA, USA.,6 Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Geoffrey S Gottlieb
- 1 Department of Medicine, University of Washington, Seattle, WA, USA.,5 Department of Global Health, University of Washington, Seattle, WA, USA
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Matoga MM, Rosenberg NE, Stanley CC, LaCourse S, Munthali CK, Nsona DP, Haac B, Hoffman I, Hosseinipour MC. Inpatient mortality rates during an era of increased access to HIV testing and ART: A prospective observational study in Lilongwe, Malawi. PLoS One 2018; 13:e0191944. [PMID: 29415015 PMCID: PMC5802850 DOI: 10.1371/journal.pone.0191944] [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: 04/13/2017] [Accepted: 01/13/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In the era of increased access to HIV testing and antiretroviral treatment (ART), the impact of HIV and ART status on inpatient mortality in Malawi is unknown. METHODS We prospectively followed adult inpatients at Kamuzu Central Hospital medical wards in Lilongwe, Malawi, between 2011 and 2012, to evaluate causes of mortality, and the impact of HIV and ART status on mortality. We divided the study population into five categories: HIV-negative, new HIV-positive, ART-naïve patients, new ART-initiators, and ART-experienced. We used multivariate binomial regression models to compare risk of death between categories. RESULTS Among 2911 admitted patients the mean age was 38.5 years, and 50% were women. Eighty-one percent (81%) of patients had a known HIV status at the time of discharge or death. Mortality was 19.4% and varied between 13.9% (HIV-negative patients) and 32.9% (HIV-positive patients on ART ≤1 year). In multivariable analyses adjusted for age, sex and leading causes of mortality, being new HIV-positive (RR = 1.64 95% CI: 1.16-2.32), ART-naive (RR = 2.28 95% CI: 1.66-2.32) or being a new ART-initiator (RR = 2.41 95% CI: 1.85-3.14) were associated with elevated risk of mortality compared to HIV-negative patients. ART-experienced patients had comparable mortality (RR = 1.33 95% CI: 0.94-1.88) to HIV-negative patients. CONCLUSION HIV related mortality remains high among medical inpatients, especially among HIV-positive patients who recently initiated ART or have not started ART yet.
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Affiliation(s)
| | - Nora E. Rosenberg
- University of North Carolina Project, Lilongwe, Malawi
- University of North Carolina, Chapel Hill, North Carolina, United States of America
| | | | - Sylvia LaCourse
- University of Washington, Seattle, Washington, United States of America
| | | | | | - Bryce Haac
- University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Irving Hoffman
- University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Mina C. Hosseinipour
- University of North Carolina Project, Lilongwe, Malawi
- University of North Carolina, Chapel Hill, North Carolina, United States of America
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Fekade D, Weldegebreal T, Teklu AM, Damen M, Abdella S, Baraki N, Belayhun B, Berhan E, Kebede A, Assefa Y. Predictors of Survival among Adult Ethiopian Patients in the National ART Program at Seven University Teaching Hospitals: A Prospective Cohort Study. Ethiop J Health Sci 2018; 27:63-71. [PMID: 28465654 PMCID: PMC5402798 DOI: 10.4314/ejhs.v27i1.7s] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background In Ethiopia, the publicly funded antiretroviral treatment (ART) program was started in 2005. Two hundred seventy-five thousand patients were enrolled in the national ART program by 2012. However, there is limited data on mortality and predictors of death among adult patients in the ART program. The study aimed to estimate mortality and risk factors for death among adult, ART-naïve patients, started in the national ART program from January 2009 to July 2013. Methods Multi-site, prospective, observational cohort study of adult, age > 18 years, ART-naïve patients, started in the national ART program at seven university-affiliated hospitals from January 2009 – July 2013. Kaplan-Meier and Cox regression analyses were used to estimate survival and determine risk factors for death. Results A total of 976 patients, 594 females (60.9 %), were enrolled into the study. Median age of the cohort was 33years. The median CD4 count at start of ART was 144 cells/µl (interquartile range (IQR) 78–205), and 34.2% (330/965) had CD4 < 100. Sixty-three percent (536/851) had viral load greater than 5 log copies/ml (IQR 4.7–5.7) at base line. One hundred and one deaths were recorded during follow-up period, all-cause mortality rate 10.3%; 5.4 deaths/100 person years of observation, 95% confidence interval 4.4–6.5. Seventy percent of the deaths occurred within six months of starting ART. Cox regression analyses showed that the following measures independently predicted mortality: age >51 years, (Adjusted Hazard Ratio (AHR) 4.01, P=0.003), WHO stages III&IV, (AHR 1.76, p = 0.025), CD4 count, <100, (AHR 2.36, p =0.006), and viral load >5 log copies /ml (CHR 1.71, p = 0.037). Conclusion There is high early on- ART mortality in patients presenting with advanced immunodeficiency. Detecting cases and initiating ART before onset of advanced immunodeficiency might improve survival.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Amha Kebede
- Ethiopian Public Health Institute, Addis Ababa
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Mathabire Rücker SC, Tayea A, Bitilinyu-Bangoh J, Bermúdez-Aza EH, Salumu L, Quiles IA, Szumilin E, Chirwa Z, Rick F, Maman D. High rates of hypertension, diabetes, elevated low-density lipoprotein cholesterol, and cardiovascular disease risk factors in HIV-infected patients in Malawi. AIDS 2018; 32:253-260. [PMID: 29135581 PMCID: PMC5757671 DOI: 10.1097/qad.0000000000001700] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 10/12/2017] [Accepted: 10/25/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Data on cardiovascular disease risks among HIV-infected patients taking antiretroviral therapy (ART) over long periods of time are lacking in Sub-Saharan Africa. METHODS A cross-sectional study was conducted in Chiradzulu, Malawi from December 2015 to June 2016. HIV-infected persons on ART for more than 10 years (patients) and HIV-negative individuals (controls) from selected clinics participated. Following informed consent, a standardized questionnaire, clinical and laboratory examinations were performed. The prevalence of cardiovascular disease risk factors was calculated and stratified by age group. RESULTS Overall, 379 HIV-infected patients and 356 controls participated. Median time on ART among patients was 11.6 years (interquartile range 10.6-12.4).Within the 30-44, 45-59, and at least 60-year age groups, respectively, the prevalence of hypertension was 10.8, 20.4, and 44.7% among patients and 6.1, 25.8, and 42.9% among controls. Hypertension was previously undiagnosed in 60.3% patients and 37.0% controls with elevated blood pressure. The prevalence of diabetes within the respective age groups was 5.0, 6.4, and 13.2% among patients, and 3.4, 4.2, and 1.7% among controls. HIV-infected patients were more likely to have an glycated hemoglobin at least 6.0% (adjusted odds ratio 1.9; 95% confidence interval 1.1-3.2, P = 0.02). Prevalence of low-density lipoprotein cholesterol more than 130 mg/dl within the respective age groups was 8.0, 15.4, and 23.7% among patients and 1.8, 12.5, and 11.8% among controls. CONCLUSION Noncommunicable diseases were a significant burden in Malawi, with high prevalence of hypercholesterolemia in all survey participants and an especially acute diabetes burden among older HIV infected. Hypertension screening and treatment services are needed among identified high-risk groups to cover unmet needs.
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Affiliation(s)
| | | | | | | | | | | | | | - Zengani Chirwa
- HIV and AIDS Department, Ministry of Health Malawi, Lilongwe, Malawi
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Wamoyi J, Renju J, Moshabela M, McLean E, Nyato D, Mbata D, Bonnington O, Seeley J, Church K, Zaba B, Wringe A. Understanding the relationship between couple dynamics and engagement with HIV care services: insights from a qualitative study in Eastern and Southern Africa. Sex Transm Infect 2017; 93:sextrans-2016-052976. [PMID: 28736395 PMCID: PMC5739843 DOI: 10.1136/sextrans-2016-052976] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 04/23/2017] [Accepted: 04/29/2017] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To explore the interplay between couple dynamics and the engagement of people living with HIV (PLHIV) with HIV care and treatment services in three health and demographic surveillance sites in Tanzania, Malawi and South Africa. METHODS A qualitative study was conducted involving 107 in-depth interviews with PLHIV with a range of HIV care and treatment histories, including current users of HIV clinics, and people not enrolled in HIV care. Interviews explored experiences of living with HIV and how and why they chose to engage or not with HIV services. Thematic analysis was conducted with the aid of NVivo 10. RESULTS We found an interplay between couple dynamics and HIV care and treatment-seeking behaviour in Tanzania, Malawi and South Africa. Being in a relationship impacted on the level and type of engagement with HIV services in multiple ways. In some instances, couples living with HIV supported each other which improved their engagement with care and strengthened their relationships. The desire to fulfil societal expectations and attract a new partner, or have a baby with a new partner, or to receive emotional or financial support, strengthened on-going engagement with HIV care and treatment. However, fear of blame, abandonment or abuse resulted in unwillingness to disclose and often led to disputes or discord between couples. There was little evidence of intracouple understanding of each other's lived experiences with HIV, and we found that couples rarely interacted with the formal health system together. CONCLUSIONS Couple dynamics influenced engagement with HIV testing, care and treatment for both partners through a myriad of pathways. Couple-friendly approaches to HIV care and treatment are needed that move beyond individualised care and which recognise partner roles in HIV care engagement.
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Affiliation(s)
- Joyce Wamoyi
- National Institute for Medical Research, Mwanza, Tanzania
| | - Jenny Renju
- London School of Hygiene and Tropical Medicine, London, UK.,Malawi Epidemiology and Intervention Research Unit, Karonga, Malawi
| | - Mosa Moshabela
- Africa Health Research Institute, KwaZulu Natal, South Africa.,University of KwaZulu Natal, Durban, South Africa
| | - Estelle McLean
- London School of Hygiene and Tropical Medicine, London, UK.,Malawi Epidemiology and Intervention Research Unit, Karonga, Malawi
| | - Daniel Nyato
- National Institute for Medical Research, Mwanza, Tanzania
| | - Doris Mbata
- National Institute for Medical Research, Mwanza, Tanzania
| | | | - Janet Seeley
- London School of Hygiene and Tropical Medicine, London, UK.,Africa Health Research Institute, KwaZulu Natal, South Africa
| | - Kathryn Church
- London School of Hygiene and Tropical Medicine, London, UK
| | - Basia Zaba
- London School of Hygiene and Tropical Medicine, London, UK
| | - Alison Wringe
- London School of Hygiene and Tropical Medicine, London, UK
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Naidoo K, Hassan-Moosa R, Yende-Zuma N, Govender D, Padayatchi N, Dawood H, Adams RN, Govender A, Chinappa T, Abdool-Karim S, Abdool-Karim Q. High mortality rates in men initiated on anti-retroviral treatment in KwaZulu-Natal, South Africa. PLoS One 2017; 12:e0184124. [PMID: 28902869 PMCID: PMC5597205 DOI: 10.1371/journal.pone.0184124] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 08/18/2017] [Indexed: 12/20/2022] Open
Abstract
In attaining UNAIDS targets of 90-90-90 to achieve epidemic control, understanding who the current utilizers of HIV treatment services are will inform efforts aimed at reaching those not being reached. A retrospective chart review of CAPRISA AIDS Treatment Program (CAT) patients between 2004 and 2013 was undertaken. Of the 4043 HIV-infected patients initiated on ART, 2586 (64.0%) were women. At ART initiation, men, compared to women, had significantly lower median CD4+ cell counts (113 vs 131 cells/mm3, p <0.001), lower median body mass index (BMI) (21.0 vs 24.2 kg/m2, p<0.001), higher mean log viral load (5.0 vs 4.9 copies/ml, p<0.001) and were significantly older (median age: 35 vs. 32 years, p<0.001). Men had higher mortality rates compared to women, 6.7 per 100 person-years (p-y), (95% CI: 5.8-7.8) vs. 4.4 per 100 p-y, (95% CI: 3.8-5.0); mortality rate ratio: 1.54, (95% CI: 1.27-1.87), p <0.001. Age-standardised mortality rate was 7.9 per 100 p-y (95% CI: 4.1-11.7) for men and 5.7 per 100 p-y (95% CI: 2.7 to 8.6) for women (standardised mortality ratio: 1.38 (1.15 to 1.70)). Mean CD4+ cell count increases post-ART initiation were lower in men at all follow-up time points. Men presented later in the course of their HIV disease for ART initiation with more advanced disease and experienced a higher mortality rate compared to women.
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Affiliation(s)
- Kogieleum Naidoo
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, KwaZulu-Natal, South Africa
- MRC-CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Razia Hassan-Moosa
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, KwaZulu-Natal, South Africa
| | - Nonhlanhla Yende-Zuma
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, KwaZulu-Natal, South Africa
- MRC-CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Dhineshree Govender
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, KwaZulu-Natal, South Africa
| | - Nesri Padayatchi
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, KwaZulu-Natal, South Africa
- MRC-CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Halima Dawood
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, KwaZulu-Natal, South Africa
| | - Rochelle Nicola Adams
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, KwaZulu-Natal, South Africa
| | - Aveshen Govender
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, KwaZulu-Natal, South Africa
| | - Tilagavathy Chinappa
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, KwaZulu-Natal, South Africa
| | - Salim Abdool-Karim
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, KwaZulu-Natal, South Africa
- MRC-CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
- Mailman School of Public Health, Department of Epidemiology, Columbia University, New York, New York, United States of America
| | - Quarraisha Abdool-Karim
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, KwaZulu-Natal, South Africa
- Mailman School of Public Health, Department of Epidemiology, Columbia University, New York, New York, United States of America
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Kulkarni S, Jadhav S, Khopkar P, Sane S, Londhe R, Chimanpure V, Dhilpe V, Ghate M, Yelagate R, Panchal N, Rahane G, Kadam D, Gaikwad N, Rewari B, Gangakhedkar R. GeneXpert HIV-1 quant assay, a new tool for scale up of viral load monitoring in the success of ART programme in India. BMC Infect Dis 2017; 17:506. [PMID: 28732472 PMCID: PMC5521114 DOI: 10.1186/s12879-017-2604-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 07/17/2017] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Recent WHO guidelines identify virologic monitoring for diagnosing and confirming ART failure. In view of this, validation and scale up of point of care viral load technologies is essential in resource limited settings. METHODS A systematic validation of the GeneXpert® HIV-1 Quant assay (a point-of-care technology) in view of scaling up HIV-1 viral load in India to monitor the success of national ART programme was carried out. Two hundred nineteen plasma specimens falling in nine viral load ranges (<40 to >5 L copies/ml) were tested by the Abbott m2000rt Real Time and GeneXpert HIV-1 Quant assays. Additionally, 20 seronegative; 16 stored specimens and 10 spiked controls were also tested. Statistical analysis was done using Stata/IC and sensitivity, specificity, PPV, NPV and %misclassification rates were calculated as per DHSs/AISs, WHO, NACO cut-offs for virological failure. RESULTS The GeneXpert assay compared well with the Abbott assay with a higher sensitivity (97%), specificity (97-100%) and concordance (91.32%). The correlation between two assays (r = 0.886) was statistically significant (p < 0.01), the linear regression showed a moderate fit (R2 = 0.784) and differences were within limits of agreement. Reproducibility showed an average variation of 4.15 and 3.52% while Lower limit of detection (LLD) and Upper limit of detection (ULD) were 42 and 1,740,000 copies/ml respectively. The misclassification rates for three viral load cut offs were not statistically different (p = 0.736). All seronegative samples were negative and viral loads of the stored samples showed a good fit (R2 = 0.896 to 0.982). CONCLUSION The viral load results of GeneXpert HIV-1 Quant assay compared well with Abbott HIV-1 m2000 Real Time PCR; suggesting its use as a Point of care assay for viral load estimation in resource limited settings. Its ease of performance and rapidity will aid in timely diagnosis of ART failures, integrated HIV-TB management and will facilitate the UNAIDS 90-90-90 target.
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Affiliation(s)
- Smita Kulkarni
- Department of Virology, National AIDS Research Institute, Plot No 73, G-block, M I D C, Bhosari, Pune, Maharashtra, 411026, India.
| | - Sushama Jadhav
- Department of Virology, National AIDS Research Institute, Plot No 73, G-block, M I D C, Bhosari, Pune, Maharashtra, 411026, India
| | - Priyanka Khopkar
- Department of Virology, National AIDS Research Institute, Plot No 73, G-block, M I D C, Bhosari, Pune, Maharashtra, 411026, India
| | - Suvarna Sane
- Department of Virology, National AIDS Research Institute, Plot No 73, G-block, M I D C, Bhosari, Pune, Maharashtra, 411026, India
| | - Rajkumar Londhe
- Department of Virology, National AIDS Research Institute, Plot No 73, G-block, M I D C, Bhosari, Pune, Maharashtra, 411026, India
| | - Vaishali Chimanpure
- Department of Virology, National AIDS Research Institute, Plot No 73, G-block, M I D C, Bhosari, Pune, Maharashtra, 411026, India
| | - Veronica Dhilpe
- Department of Virology, National AIDS Research Institute, Plot No 73, G-block, M I D C, Bhosari, Pune, Maharashtra, 411026, India
| | - Manisha Ghate
- Department of Virology, National AIDS Research Institute, Plot No 73, G-block, M I D C, Bhosari, Pune, Maharashtra, 411026, India
| | - Rajendra Yelagate
- Department of Virology, National AIDS Research Institute, Plot No 73, G-block, M I D C, Bhosari, Pune, Maharashtra, 411026, India
| | - Narayan Panchal
- Department of Virology, National AIDS Research Institute, Plot No 73, G-block, M I D C, Bhosari, Pune, Maharashtra, 411026, India
| | - Girish Rahane
- Department of Virology, National AIDS Research Institute, Plot No 73, G-block, M I D C, Bhosari, Pune, Maharashtra, 411026, India
| | - Dilip Kadam
- Byramjee Jeejeebhoy Medical College (BJMC), Sassoon General Hospital, Jai Prakash Narayan Road, Near Pune Railway Station, Pune, Maharashtra, 411001, India
| | - Nitin Gaikwad
- Yashwantrao Chavan Memorial Hospital (YCM), No.476/2692, Sant Tukaram Nagar, Pimpri, Pimpri-Chinchwad, Pune, Maharashtra, 411018, India
| | - Bharat Rewari
- World Health Organization (WHO) Country office for India, World Health House, Indraprastha Estate, Mahatma Gandhi Marg, New Delhi, Delhi, 110002, India
| | - Raman Gangakhedkar
- Department of Virology, National AIDS Research Institute, Plot No 73, G-block, M I D C, Bhosari, Pune, Maharashtra, 411026, India
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Qiu T, Ding P, Fu G, Huan X, Xu X, Zhang Z, Liu X, Yang H, Mandel J, Wei C, McFarland W, Yan H. Immunologic treatment failure among HIV-infected adult patients in Jiangsu province, China. Sci Rep 2017; 7:42381. [PMID: 28220792 PMCID: PMC5318988 DOI: 10.1038/srep42381] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 01/10/2017] [Indexed: 11/09/2022] Open
Abstract
The National Free Antiretroviral Treatment Program was implemented in Jiangsu Province, China in 2005. We conducted a retrospective, open cohort study to determine treatment failure rates and associated risk factors. Data were obtained from the national web-based antiretroviral treatment database. WHO criteria were used to define immunologic treatment failure. Kaplan-Meier methods were used to determine treatment failure rates and Cox proportional hazards modeling was used to identify risk factors. A total of 5,083 (87.8%) having at least one CD4 cell count measure were included from 2005 to 2013. Overall, 30.4% had immunologic treatment failure with cumulative treatment failure rates increasing to 50.5% at month 60 and 64.1% at month 90. Factors predicting treatment failure included being treated in the Centers for Disease Control and Prevention system (HR 1.69, 95% CI 1.14-2.50, p = 0.009) or jail hospital (HR 1.20, 95% CI 1.08-1.34, p = 0.001), and having a baseline CD4 count >350 cells/uL (HR 2.37, 95% CI 1.94-2.89. p < 0.001). Immunologic treatment failure was moderate to substantial among treated HIV patients. Providing second-line regimens and shifting treatment providers to professional hospitals should be considered to consolidate gains in averting morbidity and mortality.
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Affiliation(s)
- Tao Qiu
- Institute of HIV/AIDS/STI Prevention and Control, Jiangsu Provincial Center for Diseases Control and Prevention, Nanjing, 210009, China
| | - Ping Ding
- Institute of HIV/AIDS/STI Prevention and Control, Jiangsu Provincial Center for Diseases Control and Prevention, Nanjing, 210009, China
| | - Gengfeng Fu
- Institute of HIV/AIDS/STI Prevention and Control, Jiangsu Provincial Center for Diseases Control and Prevention, Nanjing, 210009, China
| | - Xiping Huan
- Institute of HIV/AIDS/STI Prevention and Control, Jiangsu Provincial Center for Diseases Control and Prevention, Nanjing, 210009, China
| | - Xiaoqin Xu
- Institute of HIV/AIDS/STI Prevention and Control, Jiangsu Provincial Center for Diseases Control and Prevention, Nanjing, 210009, China
| | - Zhi Zhang
- Institute of HIV/AIDS/STI Prevention and Control, Jiangsu Provincial Center for Diseases Control and Prevention, Nanjing, 210009, China
| | - Xiaoyan Liu
- Institute of HIV/AIDS/STI Prevention and Control, Jiangsu Provincial Center for Diseases Control and Prevention, Nanjing, 210009, China
| | - Haitao Yang
- Jiangsu Institute of Parasite Diseases, Wuxi, China
| | - Jeff Mandel
- Global Health Sciences, University of California, San Francisco, California, USA
| | - Chongyi Wei
- Global Health Sciences, University of California, San Francisco, California, USA
| | - Willi McFarland
- Global Health Sciences, University of California, San Francisco, California, USA
| | - Hongjing Yan
- Institute of HIV/AIDS/STI Prevention and Control, Jiangsu Provincial Center for Diseases Control and Prevention, Nanjing, 210009, China
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Coppock D, Zambo D, Moyo D, Tanthuma G, Chapman J, Re VL, Graziani A, Lowenthal E, Hanrahan N, Littman-Quinn R, Kovarik C, Albarracin D, Holmes JH, Gross R. Development and Usability of a Smartphone Application for Tracking Antiretroviral Medication Refill Data for Human Immunodeficiency Virus. Methods Inf Med 2017; 56:351-359. [PMID: 29582932 PMCID: PMC9868897 DOI: 10.3414/me17-01-0045] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Adherence to antiretroviral medication leads to HIV suppression and decreased morbidity and mortality. In resource- limited settings, the dependence on paper medical charts and unstable electronic health records creates a challenge to monitoring medication adherence. A pharmacy-based strategy that utilizes existing cellular phone infrastructure may lead to a more stable system to monitor adherence. OBJECTIVES To develop and evaluate the usability of a smartphone-based software application (app) for tracking antiretroviral medication refill data in a resource-limited setting. METHODS A pharmacy-based smartphone app for tracking HIV medication adherence was developed through a multi-step rapid prototyping process. The usability of the app was assessed during the daily activities of pharmacy dispensers at HIV clinics in and around Gaborone, Botswana using a validated computer usability survey. RESULTS The study demonstrated the effective development of and favorable end-user responses to a pharmacy-based HIV medication adherence app. End users had suggestions for minor changes to improve the app's functionality. CONCLUSIONS In resource-limited settings where electronic health record support is limited, such a system was feasible and appealing. In the future, this system may allow for improved HIV medication adherence tracking and be applied to medications beyond antiretrovirals.
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Affiliation(s)
- Dagan Coppock
- University of Pennsylvania, Perelman School of Medicine, Division of Infectious Diseases, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Dikai Zambo
- Botswana-UPenn Partnership, University of Botswana, Gaborone, Botswana
| | | | - Gobe Tanthuma
- Institute of Health Sciences, Princess Marina Hospital Campus, Gaborone, Botswana
| | | | - Vincent Lo Re
- University of Pennsylvania, Perelman School of Medicine, Division of Infectious Diseases, Hospital of the University of Pennsylvania, Philadelphia, PA, USA;,University of Pennsylvania, Perelman School of Medicine, Clinical Center for Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, Philadelphia, PA, USA
| | - Amelia Graziani
- University of Pennsylvania, Perelman School of Medicine, Division of Infectious Diseases, Hospital of the University of Pennsylvania, Philadelphia, PA, USA;,University of Pennsylvania, Perelman School of Medicine, Department of Pharmacy, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Elizabeth Lowenthal
- Children’s Hospital of Philadelphia, Philadelphia, PA, USA;,University of Pennsylvania, Perelman School of Medicine, Clinical Center for Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, Philadelphia, PA, USA
| | - Nancy Hanrahan
- Northeastern University, Bouve College of Health Sciences, School of Nursing, Boston, MA, USA
| | | | - Carrie Kovarik
- Botswana-UPenn Partnership, University of Botswana, Gaborone, Botswana;,University of Pennsylvania, Perelman School of Medicine, Department of Dermatology, Philadelphia, PA, USA
| | - Dolores Albarracin
- University of Illinois at Urbana-Champaign, Department of Psychology, Champaign, IL, USA
| | - John H. Holmes
- University of Pennsylvania, Perelman School of Medicine, Clinical Center for Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, Philadelphia, PA, USA
| | - Robert Gross
- University of Pennsylvania, Perelman School of Medicine, Division of Infectious Diseases, Hospital of the University of Pennsylvania, Philadelphia, PA, USA;,University of Pennsylvania, Perelman School of Medicine, Clinical Center for Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, Philadelphia, PA, USA
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Cuong DD, Sönnerborg A, Van Tam V, El-Khatib Z, Santacatterina M, Marrone G, Chuc NTK, Diwan V, Thorson A, Le NK, An PN, Larsson M. Impact of peer support on virologic failure in HIV-infected patients on antiretroviral therapy - a cluster randomized controlled trial in Vietnam. BMC Infect Dis 2016; 16:759. [PMID: 27986077 PMCID: PMC5162085 DOI: 10.1186/s12879-016-2017-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 11/09/2016] [Indexed: 11/10/2022] Open
Abstract
Background The effect of peer support on virologic and immunologic treatment outcomes among HIVinfected patients receiving antiretroviral therapy (ART) was assessed in a cluster randomized controlled trial in Vietnam. Methods Seventy-one clusters (communes) were randomized in intervention or control, and a total of 640 patients initiating ART were enrolled. The intervention group received peer support with weekly home-visits. Both groups received first-line ART regimens according to the National Treatment Guidelines. Viral load (VL) (ExaVir™ Load) and CD4 counts were analyzed every 6 months. The primary endpoint was virologic failure (VL >1000 copies/ml). Patients were followed up for 24 months. Intention-to-treat analysis was used. Cluster longitudinal and survival analyses were used to study time to virologic failure and CD4 trends. Results Of 640 patients, 71% were males, mean age 32 years, 83% started with stavudine/lamivudine/nevirapine regimen. After a mean of 20.8 months, 78% completed the study, and the median CD4 increase was 286 cells/μl. Cumulative virologic failure risk was 7.2%. There was no significant difference between intervention and control groups in risk for and time to virologic failure and in CD4 trends. Risk factors for virologic failure were ART-non-naïve status [aHR 6.9;(95% CI 3.2–14.6); p < 0.01]; baseline VL ≥100,000 copies/ml [aHR 2.3;(95% CI 1.2–4.3); p < 0.05] and incomplete adherence (self-reported missing more than one dose during 24 months) [aHR 3.1;(95% CI 1.1–8.9); p < 0.05]. Risk factors associated with slower increase of CD4 counts were: baseline VL ≥100,000 copies/ml [adj.sq.Coeff (95% CI): −0.9 (−1.5;−0.3); p < 0.01] and baseline CD4 count <100 cells/μl [adj.sq.Coeff (95% CI): −5.7 (−6.3;−5.4); p < 0.01]. Having an HIV-infected family member was also significantly associated with gain in CD4 counts [adj.sq.Coeff (95% CI): 1.3 (0.8;1.9); p < 0.01]. Conclusion There was a low virologic failure risk during the first 2 years of ART follow-up in a rural low-income setting in Vietnam. Peer support did not show any impact on virologic and immunologic outcomes after 2 years of follow up. Trial registration NCT01433601.
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Affiliation(s)
- Do Duy Cuong
- Global Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden. .,Infectious Diseases Department, Bach Mai Hospital, Hanoi, Vietnam.
| | - Anders Sönnerborg
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.,Division of Clinical Virology, Department of Laboratory Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Vu Van Tam
- Global Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Vietnam-Sweden Uong Bi General Hospital, Quang Ninh, Vietnam
| | - Ziad El-Khatib
- Global Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,World Health Programme, Université du Québec en Abitibi-Témiscamingue (UQAT), Rouyn-Noranda, Canada
| | - Michele Santacatterina
- Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Gaetano Marrone
- Global Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | | | - Vinod Diwan
- Global Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Anna Thorson
- Global Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Nicole K Le
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | | | - Mattias Larsson
- Global Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden. .,Oxford University Clinical Research Unit (OUCRU), Hanoi, Vietnam.
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40
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Dalhatu I, Onotu D, Odafe S, Abiri O, Debem H, Agolory S, Shiraishi RW, Auld AF, Swaminathan M, Dokubo K, Ngige E, Asadu C, Abatta E, Ellerbrock TV. Outcomes of Nigeria's HIV/AIDS Treatment Program for Patients Initiated on Antiretroviral Treatment between 2004-2012. PLoS One 2016; 11:e0165528. [PMID: 27829033 PMCID: PMC5102414 DOI: 10.1371/journal.pone.0165528] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 10/13/2016] [Indexed: 12/20/2022] Open
Abstract
Background The Nigerian Antiretroviral therapy (ART) program started in 2004 and now ranks among the largest in Africa. However, nationally representative data on outcomes have not been reported. Methods We evaluated retrospective cohort data from a nationally representative sample of adults aged ≥15 years who initiated ART during 2004 to 2012. Data were abstracted from 3,496 patient records at 35 sites selected using probability-proportional-to-size (PPS) sampling. Analyses were weighted and controlled for the complex survey design. The main outcome measures were mortality, loss to follow-up (LTFU), and retention (the proportion alive and on ART). Potential predictors of attrition were assessed using competing risk regression models. Results At ART initiation, 66.4 percent (%) were females, median age was 33 years, median weight 56 kg, median CD4 count 161 cells/mm3, and 47.1% had stage III/IV disease. The percentage of patients retained at 12, 24, 36 and 48 months was 81.2%, 74.4%, 67.2%, and 61.7%, respectively. Over 10,088 person-years of ART, mortality, LTFU, and overall attrition (mortality, LTFU, and treatment stop) rates were 1.1 (95% confidence interval (CI): 0.7–1.8), 12.3 (95%CI: 8.9–17.0), and 13.9 (95% CI: 10.4–18.5) per 100 person-years (py) respectively. Highest attrition rates of 55.4/100py were witnessed in the first 3 months on ART. Predictors of LTFU included: lower-than-secondary level education (reference: Tertiary), care in North-East and South-South regions (reference: North-Central), presence of moderate/severe anemia, symptomatic functional status, and baseline weight <45kg. Predictor of mortality was WHO stage higher than stage I. Male sex, severe anemia, and care in a small clinic were associated with both mortality and LTFU. Conclusion Moderate/Advanced HIV disease was predictive of attrition; earlier ART initiation could improve program outcomes. Retention interventions targeting men and those with lower levels of education are needed. Further research to understand geographic and clinic size variations with outcome is warranted.
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Affiliation(s)
- Ibrahim Dalhatu
- Division of Global HIV/AIDS, Center for Global Health, U.S. Centers for Disease Control & Prevention, Abuja, Nigeria
| | - Dennis Onotu
- Division of Global HIV/AIDS, Center for Global Health, U.S. Centers for Disease Control & Prevention, Abuja, Nigeria
| | - Solomon Odafe
- Division of Global HIV/AIDS, Center for Global Health, U.S. Centers for Disease Control & Prevention, Abuja, Nigeria
- * E-mail:
| | - Oseni Abiri
- School of Biomedical Informatics, University of Texas, Houston, Texas, United States of America
| | - Henry Debem
- Division of Global HIV/AIDS, Center for Global Health, U.S. Centers for Disease Control & Prevention, Abuja, Nigeria
| | - Simon Agolory
- Division of Global HIV/AIDS, Center for Global Health, U.S. Centers for Disease Control & Prevention, Atlanta, Georgia, United States of America
| | - Ray W. Shiraishi
- Division of Global HIV/AIDS, Center for Global Health, U.S. Centers for Disease Control & Prevention, Atlanta, Georgia, United States of America
| | - Andrew F. Auld
- Division of Global HIV/AIDS, Center for Global Health, U.S. Centers for Disease Control & Prevention, Atlanta, Georgia, United States of America
| | - Mahesh Swaminathan
- Division of Global HIV/AIDS, Center for Global Health, U.S. Centers for Disease Control & Prevention, Atlanta, Georgia, United States of America
| | - Kainne Dokubo
- School of Biomedical Informatics, University of Texas, Houston, Texas, United States of America
| | - Evelyn Ngige
- National AIDS & STIs Control Program, Federal Ministry of Health, Abuja, Nigeria
| | - Chukwuemeka Asadu
- National AIDS & STIs Control Program, Federal Ministry of Health, Abuja, Nigeria
| | - Emmanuel Abatta
- National AIDS & STIs Control Program, Federal Ministry of Health, Abuja, Nigeria
| | - Tedd V. Ellerbrock
- Division of Global HIV/AIDS, Center for Global Health, U.S. Centers for Disease Control & Prevention, Atlanta, Georgia, United States of America
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Manabe YC, Worodria W, van Leth F, Mayanja-Kizza H, Traore AN, Ferro J, Pakker N, Frank M, Grobusch MP, Colebunders R, Cobelens F. Prevention of Early Mortality by Presumptive Tuberculosis Therapy Study: An Open Label, Randomized Controlled Trial. Am J Trop Med Hyg 2016; 95:1265-1271. [PMID: 27928077 DOI: 10.4269/ajtmh.16-0239] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 08/25/2016] [Indexed: 01/09/2023] Open
Abstract
Early mortality after initiation of antiretroviral therapy (ART) occurs in 9-39% of patients in sub-Saharan Africa. A significant proportion of deaths are attributable to tuberculosis (TB). Low baseline CD4 T-cell count and low body mass index (BMI) are strongly associated with early mortality. We hypothesized that initiation of ART concurrent with presumptive anti-TB chemotherapy in high-risk patients would reduce mortality within the first 6 months by treating unrecognized TB. From October 2011 to December 2012, ART-naive, smear-negative participants with a CD4 T-cell count < 50 cells/μL and BMI < 18 kg/m2 were randomly assigned to undergo either empiric four-drug anti-TB treatment followed 2 weeks later by efavirenz-based ART (N = 23) (ART + TB) or ART only (N = 20). This open-label, 1:1 randomized, controlled trial took place in Uganda, Mozambique, and Gabon and was stopped prematurely by the sponsor for slow recruitment. Overall, the 43 participants had a median CD4 of 22 (interquartile range [IQR]: 9-35) cells/μL and a median BMI of 17.5 (IQR: 16.6-18.0) kg/m2 The mortality was 14% (95% confidence interval [CI]: 5.3-27.9); two (10.0%) participants (ART-only group), and four (17.4%; ART + TB group). The associated hazard ratio (HR) for all-cause mortality was 1.6 (95% CI: 0.30-8.90). Despite limited enrollment, the study did not suggest that empiric TB treatment in severely immunosuppressed patients with low BMI decreased mortality and, had an HR in the opposite direction than expected. Notably, two participants in the ART + TB group died with autopsy-confirmed drug-induced hepatotoxicity. Improved TB diagnostics sensitive in immunosuppressed patients presenting late to care are urgently needed for more targeted interventions.
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Affiliation(s)
- Yukari C Manabe
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda. .,Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - William Worodria
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Frank van Leth
- Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - Harriet Mayanja-Kizza
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda.,Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Afsatou Ndama Traore
- Centre de Récherches Medicales en Lambaréné (CERMEL), Albert Schweitzer Hospital, Lambaréné, Gabon.,Department of Microbiology, University of Venda, Thohoyandou, South Africa
| | - Josefo Ferro
- Catholic University of Mozambique, Beira, Mozambique
| | - Nadine Pakker
- Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - Matthias Frank
- Centre de Récherches Medicales en Lambaréné (CERMEL), Albert Schweitzer Hospital, Lambaréné, Gabon.,Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Martin P Grobusch
- Centre de Récherches Medicales en Lambaréné (CERMEL), Albert Schweitzer Hospital, Lambaréné, Gabon.,Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany.,Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, University of Amsterdam, Amsterdam, The Netherlands
| | - Robert Colebunders
- Institute of Tropical Medicine, Antwerp, Belgium.,Global Health Institute, University of Antwerp, Belgium
| | - Frank Cobelens
- Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands.,KNCV Tuberculosis Foundation, The Hague, The Netherlands
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42
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Maman D, Ben-Farhat J, Chilima B, Masiku C, Salumu L, Ford N, Mendiharat P, Szumilin E, Masson S, Etard JF. Factors associated with HIV status awareness and Linkage to Care following home based testing in rural Malawi. Trop Med Int Health 2016; 21:1442-1451. [PMID: 27714902 DOI: 10.1111/tmi.12772] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE HIV diagnosis and linkage to care are the main barriers in Africa to achieving the UNAIDS 90-90-90 targets. We assessed HIV-positive status awareness and linkage to care among survey participants in Chiradzulu District, Malawi. METHOD Nested cohort study within a population-based survey of persons aged 15-59 years between February and May 2013. Participants were interviewed and tested for HIV (and CD4 if found HIV-positive) in their homes. Multivariable regression was used to determine factors associated with HIV-positive status awareness prior to the survey and subsequent linkage to care. RESULTS Of 8277 individuals eligible for the survey, 7270 (87.8%) participated and were tested for HIV. The overall HIV prevalence was 17.0%. Among HIV-positive participants, 77.0% knew their status and 72.8% were in care. Women (adjusted odds ratio [aOR] 6.5, 95% CI 3.2-13.1) and older participants (40-59 vs. 15-29 years, aOR 10.1, 95% CI 4.0-25.9) were more likely to be aware of their positive status. Of those newly diagnosed, 47.5% were linked to care within 3 months. Linkage to care was higher among older participants (40-59 vs. 15-29, adjusted hazard ratio [aHR] 3.39, 95% CI 1.83-6.26), women (aHR 1.73, 95% CI 1.12-2.67) and those eligible for ART (aHR 1.61, 95% CI 1.03-2.52). CONCLUSIONS In settings with high levels of HIV awareness, home-based testing remains an efficient strategy to diagnose and link to care. Men were less likely to be diagnosed, and when diagnosed to link to care, underscoring the need for a gender focus in order to achieve the 90-90-90 targets.
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Affiliation(s)
- D Maman
- Epicentre, Médecins Sans Frontières, Paris, France.
| | - J Ben-Farhat
- Epicentre, Médecins Sans Frontières, Paris, France
| | - B Chilima
- Community Health Sciences Unit, Malawi Ministry of Health, Lilongwe, Malawi
| | - C Masiku
- Médecins Sans Frontières, Lilongwe, Malawi
| | - L Salumu
- Médecins Sans Frontières, Paris, France
| | - N Ford
- Department of HIV/AIDS, World Health Organization, Geneva, Switzerland.,Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | | | | | - S Masson
- Epicentre, Médecins Sans Frontières, Paris, France
| | - J F Etard
- Epicentre, Médecins Sans Frontières, Paris, France.,UMI 233, Institut de Recherche pour le Développement, Montpellier, France
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43
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Mahande MJ, Phimemon RN, Ramadhani HO. Factors associated with changes in uptake of HIV testing among young women (aged 15-24) in Tanzania from 2003 to 2012. Infect Dis Poverty 2016; 5:92. [PMID: 27595846 PMCID: PMC5011841 DOI: 10.1186/s40249-016-0180-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 08/04/2016] [Indexed: 11/25/2022] Open
Abstract
Background This study explored the factors associated with changes in HIV testing uptake among young women in Tanzania, based on an analysis of data from the 2003–2004 Tanzania HIV/AIDS Indicator Survey, and the 2007–2008 and 2011–2012 Tanzania HIV/AIDS and Malaria Indicator Surveys. Methods The study population consisted of young women aged 15–24 years at the time of the survey. Multivariate decomposition analysis was used to assess factors associated with changes in HIV testing uptake between the 2003–2004 and 2007–2008 surveys, and between the 2007–2008 and 2011–2012 surveys. Results HIV testing uptake among the study population was 7 % in 2003–2004, 31 % in 2007–2008 and 40 % in 2011–2012. The time period of the survey had a substantial effect on the uptake of HIV testing independent of other covariates. The characteristics that were significantly associated with a higher chance of HIV testing uptake across the surveys were age (20–24), education level (primary and secondary), ever being married, having at least one lifetime sexual partner, having a sexually transmitted infection or associated symptoms, and receiving antenatal care. Conclusions Changes in the study participants’ characteristics in the 2003–2004 survey compared with the 2007–2008 survey were associated with a decrease in HIV testing uptake. Comparing the 2007–2008 survey with the 2011–2012 survey shows that the changes in the participants’ characteristics contributed to 22 % of the changes in HIV testing uptake, while 78 % of the changes were attributed to coefficients. Electronic supplementary material The online version of this article (doi:10.1186/s40249-016-0180-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Michael J Mahande
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania.
| | - Rune N Phimemon
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania.,Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Habib O Ramadhani
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania.,Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
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44
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Nel J, Smith MR. Exploring the Interaction between Comorbid Psychiatric and Medical Diagnoses: The Potential Impact of Borderline Personality Disorder on Adherence to Highly Active Antiretroviral Therapy (HAART). SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2016. [DOI: 10.1177/008124630603600403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
It is well documented that patient adherence to medical advice and prescription medication is suboptimal. While the reasons for non-compliance are varied and complex, it is essential that they be expounded to facilitate the efficacy of medical interventions. In no other illness is this more pertinent than with the human immunodeficiency virus (HIV). Highly active antiretroviral therapy (HAART) has become the first line of treatment for HIV, but stringent adherence is a prerequisite for therapeutic efficacy. As with other treatments, adherence to HAART is problematic. One factor that may play a significant role is if the patient has a comorbid psychiatric illness. This article provides a theoretical exposition of how a patient with Borderline Personality Disorder (BPD) might suffer innumerable exigencies with adherence as a hypothesised function of the individual properties of his or her illness that is likely to be compounded when the properties interact with one another.
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Affiliation(s)
- Jonathan Nel
- Department of Psychology, Stellenbosch University, Private Bag X1, Matieland, 7602, South Africa
| | - Mario R. Smith
- Department of Psychology, Stellenbosch University, South Africa
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45
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Luma HN, Mbatchou Ngahane BH, Mapoure YN, Mengjo NB, Temfack E, Joko HA, Asongalem EA, Koulla-Shiro S. Cross-sectional assessment of three commonly used measures of adherence to combination antiviral therapy in a resource limited setting. Int J STD AIDS 2016; 28:69-76. [PMID: 26748336 DOI: 10.1177/0956462415627394] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Nowadays, global coverage of combination antiretroviral therapy (cART) has increased due to a continuous process to scale up access. This increase has potentially transformed HIV-infection from a fatal to a chronic disease: a transformation only possible if the prescribed medications are taken accordingly. We therefore evaluated optimal adherence to cART by three commonly used methods: visual analogue scale (VAS), four days recall (FDR) and clinic attendance (CA) for the last six months in 301 HIV-infected patients on cART for at least six months at the Douala General Hospital, Cameroon. Optimal adherence was defined to be greater than or equal to the 95th percentile estimate of each method. We found that 70.8% of our study population was female. The mean age was 40.8 years (SD 10.5) and 85% were on first line cART. Median CD4 count was 397 cells/ml (252-559). Optimal adherence by VAS, FDR and CA, was 68.1%, 83.4%, and 73.4%, respectively. VAS and FDR inter-correlated strongly (Pearson's Chi square coefficient, r = 0.58, p < 0.001). Higher CD4 count above 200 cells/ml was associated with optimal adherence by CA (Adjusted Odds Ratio [AOR]:2.6 (95% CI: 1.2-5.3, p < 0.001)). As high optimal adherence to cART is associated with good clinical outcome in HIV patients, simple methods such as the VAS for evaluating adherence, should be integrated to the HIV clinic of the Douala General Hospital.
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Affiliation(s)
- Henry N Luma
- 1 Internal Medicine Unit, Douala General Hospital, Douala, Cameroon.,2 Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Bertrand H Mbatchou Ngahane
- 1 Internal Medicine Unit, Douala General Hospital, Douala, Cameroon.,3 Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Yacouba N Mapoure
- 1 Internal Medicine Unit, Douala General Hospital, Douala, Cameroon.,3 Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Neville B Mengjo
- 4 Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Elvis Temfack
- 1 Internal Medicine Unit, Douala General Hospital, Douala, Cameroon.,5 Paris Descartes University, Paris, France
| | - Henry A Joko
- 1 Internal Medicine Unit, Douala General Hospital, Douala, Cameroon
| | - Emmanuel A Asongalem
- 2 Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Sinata Koulla-Shiro
- 2 Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
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Rachlis B, Cole DC, van Lettow M, Escobar M. Survival functions for defining a clinical management Lost To Follow-Up (LTFU) cut-off in Antiretroviral Therapy (ART) program in Zomba, Malawi. BMC Med Inform Decis Mak 2016; 16:52. [PMID: 27150958 PMCID: PMC4857410 DOI: 10.1186/s12911-016-0290-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 04/30/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While, lost to follow-up (LTFU) from antiretroviral therapy (ART) can be considered a catch-all category for patients who miss scheduled visits or medication pick-ups, operational definitions and methods for defining LTFU vary making comparisons across programs challenging. Using weekly cut-offs, we sought to determine the probability that an individual would return to clinic given that they had not yet returned in order to identify the LTFU cut-off that could be used to inform clinical management and tracing procedures. METHODS Individuals who initiated ART with Dignitas International supported sites (n = 22) in Zomba, Malawi between January 1 2007-June 30 2010 and were ≥ 1 week late for a follow-up visit were included. Lateness was categorized using weekly cut-offs from ≥1 to ≥26 weeks late. At each weekly cut-off, the proportion of patients who returned for a subsequent follow-up visit were identified. Cumulative Distribution Functions (CDFs) were plotted to determine the probability of returning as a function of lateness. Hazard functions were plotted to demonstrate the proportion of patients who returned each weekly interval relative to those who had yet to return. RESULTS In total, n = 4484 patients with n = 7316 follow-up visits were included. The number of included follow-up visits per patient ranged from 1-10 (median: 1). Both the CDF and hazard function demonstrated that after being ≥9 weeks late, the proportion of new patients who returned relative to those who had yet to return decreased substantially. CONCLUSIONS We identified a LTFU definition useful for clinical management. The simple functions plotted here did not require advanced statistical expertise and were created using Microsoft Excel, making it a particularly practical method for HIV programs in resource-constrained settings.
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Affiliation(s)
- Beth Rachlis
- The Ontario HIV Treatment Network, Toronto, Canada
- Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Donald C Cole
- Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Monique van Lettow
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
- Dignitas International, Zomba, Malawi.
| | - Michael Escobar
- Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Closer to 90-90-90. The cascade of care after 10 years of ART scale-up in rural Malawi: a population study. J Int AIDS Soc 2016; 19:20673. [PMID: 26894388 PMCID: PMC4760102 DOI: 10.7448/ias.19.1.20673] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 12/16/2015] [Accepted: 01/12/2016] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION The antiretroviral therapy (ART) programme supported by Médecins Sans Frontières in the rural Malawian district of Chiradzulu was one of the first in sub-Saharan Africa to scale up ART delivery in 2002. After more than a decade of continuous involvement, we conducted a population survey to evaluate the cascade of care, including population viral load, in the district. METHODS A cross-sectional household-based survey was conducted between February and May 2013. Using a multistage cluster sampling method, we recruited all individuals aged 15 to 59 years living in 4125 randomly selected households. Each consenting individual was interviewed and tested for HIV at home. All participants who tested positive had their CD4 count and viral load measured. The LAg-Avidity assay was used to distinguish recent from long-term infections. Viral suppression was defined as a viral load below 1000 copies/mL. RESULTS Of 8271 individuals eligible for the study, 7269 agreed to participate and were tested for HIV (94.1% inclusion for women and 80.3% for men). Overall HIV prevalence and incidence were 17.0% (95% CI 16.1 to 17.9) and 0.39 new cases per 100 person-years (95% CI 0.0 to 0.77), respectively. Coverage at the other steps along the HIV care cascade was as follows: 76.7% (95% CI 74.4 to 79.1) had been previously diagnosed, 71.2% (95% CI 68.6 to 73.6) were under care and 65.8% (95% CI 62.8 to 68.2) were receiving ART. Finally, the proportion of participants who were HIV positive with a viral load ≤ 1000 copies/mL reached 61.8% (95% CI 59.0 to 64.5). CONCLUSIONS This study demonstrates that a high level of population viral suppression and low incidence can be achieved in high HIV prevalence and resource-limited settings.
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Trends and determinants of survival for over 200 000 patients on antiretroviral treatment in the Botswana National Program: 2002-2013. AIDS 2016; 30:477-85. [PMID: 26636931 PMCID: PMC4711385 DOI: 10.1097/qad.0000000000000921] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objectives: To determine the incidence and risk factors of mortality for all HIV-infected patients receiving antiretroviral treatment at public and private healthcare facilities in the Botswana National HIV/AIDS Treatment Programme. Design: We studied routinely collected data from 226 030 patients enrolled in the Botswana National HIV/AIDS Treatment Programme from 2002 to 2013. Methods: A person-years (P-Y) approach was used to analyse all-cause mortality and follow-up rates for all HIV-infected individuals with documented antiretroviral therapy initiation dates. Marginal structural modelling was utilized to determine the effect of treatment on survival for those with documented drug regimens. Sensitivity analyses were performed to assess the robustness of our results. Results: Median follow-up time was 37 months (interquartile range 11–75). Mortality was highest during the first 3 months after treatment initiation at 11.79 (95% confidence interval 11.49–12.11) deaths per 100 P-Y, but dropped to 1.01 (95% confidence interval 0.98–1.04) deaths per 100 P-Y after the first year of treatment. Twelve-month mortality declined from 7 to 2% of initiates during 2002–2012. Tenofovir was associated with lower mortality than stavudine and zidovudine. Conclusion: The observed mortality rates have been declining over time; however, mortality in the first year, particularly first 3 months of antiretroviral treatment, remains a distinct problem. This analysis showed lower mortality with regimens containing tenofovir compared with zidovudine and stavudine. CD4+ cell count less than 100 cells/μl, older age and being male were associated with higher odds of mortality.
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Benzekri NA, Sambou J, Diaw B, Sall EHI, Sall F, Niang A, Ba S, Ngom Guèye NF, Diallo MB, Hawes SE, Seydi M, Gottlieb GS. High Prevalence of Severe Food Insecurity and Malnutrition among HIV-Infected Adults in Senegal, West Africa. PLoS One 2015; 10:e0141819. [PMID: 26529509 PMCID: PMC4631507 DOI: 10.1371/journal.pone.0141819] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Accepted: 10/13/2015] [Indexed: 12/31/2022] Open
Abstract
Background Malnutrition and food insecurity are associated with increased mortality and poor clinical outcomes among people living with HIV/AIDS; however, the prevalence of malnutrition and food insecurity among people living with HIV/AIDS in Senegal, West Africa is unknown. The objective of this study was to determine the prevalence and severity of food insecurity and malnutrition among HIV-infected adults in Senegal, and to identify associations between food insecurity, malnutrition, and HIV outcomes. Methods We conducted a cross-sectional study at outpatient clinics in Dakar and Ziguinchor, Senegal. Data were collected using participant interviews, anthropometry, the Household Food Insecurity Access Scale, the Individual Dietary Diversity Scale, and chart review. Results One hundred and nine HIV-1 and/or HIV-2 participants were enrolled. The prevalence of food insecurity was 84.6% in Dakar and 89.5% in Ziguinchor. The prevalence of severe food insecurity was 59.6% in Dakar and 75.4% in Ziguinchor. The prevalence of malnutrition (BMI <18.5) was 19.2% in Dakar and 26.3% in Ziguinchor. Severe food insecurity was associated with missing clinic appointments (p = 0.01) and not taking antiretroviral therapy due to hunger (p = 0.02). Malnutrition was associated with lower CD4 cell counts (p = 0.01). Conclusions Severe food insecurity and malnutrition are highly prevalent among HIV-infected adults in both Dakar and Ziguinchor, and are associated with poor HIV outcomes. Our findings warrant further studies to determine the root causes of malnutrition and food insecurity in Senegal, and the short- and long-term impacts of malnutrition and food insecurity on HIV care. Urgent interventions are needed to address the unacceptably high rates of malnutrition and food insecurity in this population.
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Affiliation(s)
- Noelle A. Benzekri
- Department of Medicine, University of Washington, Seattle, WA, United States of America
- * E-mail:
| | | | - Binetou Diaw
- Centre Hospitalier Universitaire de Fann, Dakar, Sénégal
| | | | - Fatima Sall
- Centre Hospitalier Universitaire de Fann, Dakar, Sénégal
| | | | - Selly Ba
- Centre Hospitalier Universitaire de Fann, Dakar, Sénégal
| | | | | | - Stephen E. Hawes
- Department of Global Health, University of Washington, Seattle, WA, United States of America
- Department of Epidemiology, University of Washington, Seattle, WA, United States of America
| | - Moussa Seydi
- Centre Hospitalier Universitaire de Fann, Dakar, Sénégal
| | - Geoffrey S. Gottlieb
- Department of Medicine, University of Washington, Seattle, WA, United States of America
- Department of Global Health, University of Washington, Seattle, WA, United States of America
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Mulu A, Maier M, Liebert UG. Low Incidence of HIV-1C Acquired Drug Resistance 10 Years after Roll-Out of Antiretroviral Therapy in Ethiopia: A Prospective Cohort Study. PLoS One 2015; 10:e0141318. [PMID: 26512902 PMCID: PMC4626118 DOI: 10.1371/journal.pone.0141318] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 10/07/2015] [Indexed: 11/20/2022] Open
Abstract
The emergence of HIV-1 drug resistance mutations has mainly been linked to the duration and composition of antiretroviral treatment (ART), as well as the level of adherence. This study reports the incidence and pattern of acquired antiretroviral drug resistance mutations and long-term outcomes of ART in a prospective cohort from Northwest Ethiopia. Two hundred and twenty HIV-1C infected treatment naïve patients were enrolled and 127 were followed-up for up to 38 months on ART. ART initiation and patients’ monitoring was based on the WHO clinical and immunological parameters. HIV viral RNA measurement and drug resistance genotyping were done at baseline (N = 160) and after a median time of 30 (IQR, 27–38) months on ART (N = 127). Viral suppression rate (HIV RNA levels ≤ 400 copies/ml) after a median time of 30 months on ART was found to be 88.2% (112/127), which is in the range for HIV drug resistance prevention suggested by WHO. Of those 15 patients with viral load >400 copies/ml, six harboured one or more drug resistant associated mutations in the reverse transcriptase (RT) region. Observed NRTIs resistance associated mutations were the lamivudine-induced mutation M184V (n = 4) and tenofovir associated mutation K65R (n = 1). The NNRTIs resistance associated mutations were K103N (n = 2), V106M, Y181S, Y188L, V90I, K101E and G190A (n = 1 each). Thymidine analogue mutations and major drug resistance mutations in the protease (PR) region were not detected. Most of the patients (13/15) with virologic failure and accumulated drug resistance mutations had not met the WHO clinical and/or immunological failure criteria and continued the failing regimen. The incidence and pattern of acquired antiretroviral drug resistance mutations is lower and less complex than previous reports from sub Saharan Africa countries. Nevertheless, the data suggest the need for virological monitoring and resistance testing for early detection of failure. Moreover, adherence reinforcement will contribute to improving overall treatment outcomes.
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Affiliation(s)
- Andargachew Mulu
- Institute of Virology, Faculty of Medicine, Leipzig University, Leipzig, Germany
- Department of Microbiology, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- * E-mail:
| | - Melanie Maier
- Institute of Virology, Faculty of Medicine, Leipzig University, Leipzig, Germany
| | - Uwe Gerd Liebert
- Institute of Virology, Faculty of Medicine, Leipzig University, Leipzig, Germany
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