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Ferrer Campos P. The challenges of Chile to achieve control the HIV/AIDS pandemic the year 2030: A review. Medicine (Baltimore) 2024; 103:e38288. [PMID: 39058841 PMCID: PMC11272358 DOI: 10.1097/md.0000000000038288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 04/26/2024] [Indexed: 07/28/2024] Open
Abstract
Chile is contending with the highest rates of new human immunodeficiency virus (HIV) cases in both Latin America and globally, despite substantial ongoing investments in treatment. This comprehensive study, derived from PUBMED and Google searches, ANID data, and various organizational reports, highlights key areas for improvement. Over the past decade, Chile's annual infection rate has risen, signaling an urgent need for detailed analysis and effective solutions. The study includes 44 references, comprising 32 scientific articles and 12 reports from entities like the WHO and the Pan American Health Organization. Data was meticulously collected through diverse means, such as scientific congresses, meetings with authorities, and direct data requests. Fourteen critical points are identified for addressing the HIV epidemic in Chile, spanning from legislative reforms to enhanced prevention campaigns. Key recommendations include universal diagnosis, decentralized healthcare, the availability of self-tests, and a focus on mental health and the impact of migration. Despite Chile's strong economic indicators, factors such as inadequate sexual education, outdated legislation, and centralized diagnostic processes contribute to the persistent increase in new cases. The study underscores the pressing need for enhanced investment in prevention policies. Chile faces significant challenges in meeting the 90/90/90 targets, yet there is optimism in aiming for the 95/95/95 strategy by 2030. Achieving success requires a global commitment, an emphasis on prevention, and collaborative efforts among authorities, healthcare providers, and patients. Overcoming these identified barriers is essential for Chile to reach its ambitious goal and ultimately end the HIV epidemic.
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Affiliation(s)
- Pablo Ferrer Campos
- Molecular Medicine Laboratory, Hospital Clínico Universidad de Chile, Independencia, Santiago, Chile
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Tassembedo S, Mwiya M, Mennecier A, Kankasa C, Fao P, Molès JP, Kania D, Chunda-Liyoka C, Sakana BLD, D’Ottavi M, Taofiki AO, Rutagwera D, Wilfred-Tonga MM, Tylleskär T, Nagot N, Van de Perre P. Evaluation of the prevention of mother-to-child transmission of HIV programs at the second immunization visit in Burkina Faso and Zambia. AIDS 2024; 38:875-885. [PMID: 38181091 PMCID: PMC10994186 DOI: 10.1097/qad.0000000000003827] [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: 07/19/2023] [Revised: 11/20/2023] [Accepted: 12/12/2023] [Indexed: 01/07/2024]
Abstract
OBJECTIVE Our study aimed to assess the PMTCT indicators in Burkina Faso and Zambia using a patient-orientated innovative strategy based on the second visit in the Expanded Program on Immunization (EPI-2) visit at 6-8 weeks. DESIGN This was a cross sectional study. METHODS We assessed women attending EPI-2 at primary healthcare facilities in Burkina Faso and Zambia with their children about their exposure to PMTCT interventions. For women living with HIV (WLHIV), viral load was measured and their children were tested for HIV DNA using point of care devices. RESULTS Overall, 25 093 were enrolled from Burkina Faso and 8961 women from Zambia. Almost, all women attended at least one antenatal care visit. Among those aware of their HIV-positive status, 95.8 and 99.2% were on antiretroviral therapy (ART) in Burkina Faso and Zambia, respectively. Among WLHIV on ART, 75 and 79.2% achieved a viral load suppression (viral load <1000 copies/ml) in Burkina Faso and Zambia, respectively. Infant postnatal prophylaxis was administered from birth until EPI-2 to 60.9 and 89.7% of HIV-exposed children in Burkina Faso and Zambia, respectively. In Burkina Faso, only 60 of 192 (31.3%) of HIV-exposed children were sampled at day 42 for early infant diagnosis (EID) and 3 (1.6%) received a result by EPI-2. In Zambia, these figures were 879 of 1465 (64.0%) and 9.9% (145/1465), respectively for HIV-exposed children sampled at birth. CONCLUSION This evaluation strategy at EPI-2 visit could strengthen program monitoring and help identifying gaps to be addressed on the last mile towards elimination of MTCT of HIV.
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Affiliation(s)
- Souleymane Tassembedo
- Infectious Disease Research Programme, Centre MURAZ/National Institute of Public Health, Bobo-Dioulasso, Burkina Faso
- Pathogenesis and Control of Chronic and Emerging Infections, Univ. Montpellier, Inserm, EFS, Univ. Antilles, Montpellier, France
| | - Mwiya Mwiya
- Pediatric center of excellence, University Teaching Hospitals, Lusaka, Zambia
| | - Anais Mennecier
- Pathogenesis and Control of Chronic and Emerging Infections, Univ. Montpellier, Inserm, EFS, Univ. Antilles, Montpellier, France
| | - Chipepo Kankasa
- Pediatric center of excellence, University Teaching Hospitals, Lusaka, Zambia
| | - Paulin Fao
- Infectious Disease Research Programme, Centre MURAZ/National Institute of Public Health, Bobo-Dioulasso, Burkina Faso
| | - Jean Pierre Molès
- Pathogenesis and Control of Chronic and Emerging Infections, Univ. Montpellier, Inserm, EFS, Univ. Antilles, Montpellier, France
| | - Dramane Kania
- Infectious Disease Research Programme, Centre MURAZ/National Institute of Public Health, Bobo-Dioulasso, Burkina Faso
| | | | | | - Morgana D’Ottavi
- Pathogenesis and Control of Chronic and Emerging Infections, Univ. Montpellier, Inserm, EFS, Univ. Antilles, Montpellier, France
| | - Ajani Ousmane Taofiki
- Infectious Disease Research Programme, Centre MURAZ/National Institute of Public Health, Bobo-Dioulasso, Burkina Faso
| | - David Rutagwera
- Pediatric center of excellence, University Teaching Hospitals, Lusaka, Zambia
| | | | - Thorkild Tylleskär
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Nicolas Nagot
- Pathogenesis and Control of Chronic and Emerging Infections, Univ. Montpellier, Inserm, EFS, Univ. Antilles, Montpellier, France
| | - Philippe Van de Perre
- Pathogenesis and Control of Chronic and Emerging Infections, Univ. Montpellier, Inserm, EFS, Univ. Antilles, Montpellier, France
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Kankasa C, Mennecier A, Sakana BLD, Molès JP, Mwiya M, Chunda-Liyoka C, D'Ottavi M, Tassembedo S, Wilfred-Tonga MM, Fao P, Rutagwera D, Matoka B, Kania D, Taofiki OA, Tylleskär T, Van de Perre P, Nagot N. Optimised prevention of postnatal HIV transmission in Zambia and Burkina Faso (PROMISE-EPI): a phase 3, open-label, randomised controlled trial. Lancet 2024; 403:1362-1371. [PMID: 38484756 DOI: 10.1016/s0140-6736(23)02464-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 10/18/2023] [Accepted: 11/01/2023] [Indexed: 04/08/2024]
Abstract
BACKGROUND Transmission through breastfeeding accounts for more than half of the unacceptably high number of new paediatric HIV infections worldwide. We hypothesised that, in addition to maternal antiretroviral therapy (ART), extended postnatal prophylaxis with lamivudine, guided by point-of-care assays for maternal viral load, could reduce postnatal transmission. METHODS We did a phase 3, open-label, randomised controlled trial at four health-care facilities in Zambia and four health-care facilities in Burkina Faso. Mothers with HIV and their breastfed infants without HIV attending the second visit of the Expanded Programme of Immunisation (EPI-2; infant age 6-8 weeks) were randomly assigned 1:1 to intervention or control groups. In the intervention group, maternal viral load was measured using Xpert HIV viral load assay at EPI-2 and at 6 months, with results provided immediately. Infants whose mothers had a viral load of 1000 copies per mL or higher were started on lamivudine syrup twice per day for 12 months or 1 month after breastfeeding discontinuation. The control group followed national guidelines for prevention of postnatal transmission of HIV. The primary outcome assessed by modified intention to treat was infant HIV infection at age 12 months, with HIV DNA point-of-care testing at 6 months and at 12 months. This trial is registered with ClinicalTrials.gov (NCT03870438). FINDINGS Between Dec 12, 2019 and Sept 30, 2021, 34 054 mothers were screened for HIV. Among them, 1506 mothers with HIV and their infants without HIV, including 1342 mother and infant pairs from Zambia and 164 from Burkina Faso, were eligible and randomly assigned 1:1 to the intervention (n=753) or control group (n=753). At baseline, the median age of the mothers was 30·6 years (IQR 26·0-34·7), 1480 (98·4%) of 1504 were receiving ART, and 169 (11·5%) of 1466 had a viral load ≥1000 copies/mL. There was one case of HIV transmission in the intervention group and six in the control group, resulting in a transmission incidence of 0·19 per 100 person-years (95% CI 0·005-1·04) in the intervention group and 1·16 per 100 person-years (0·43-2·53) in the control group, which did not reach statistical significance (p=0·066). HIV-free survival and serious adverse events were similar in both groups. INTERPRETATION Our intervention, initiated at EPI-2 and based on extended single-drug postnatal prophylaxis guided by point-of-care maternal viral load could be an important strategy for paediatric HIV elimination. FUNDING The EDCTP2 programme with the support of the UK Department of Health & Social Care.
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Affiliation(s)
- Chipepo Kankasa
- Department of Paediatrics and Child Health, University Teaching Hospital, Lusaka, Zambia
| | - Anaïs Mennecier
- Pathogenesis and Control of Chronic and Emerging Infections, Montpellier University, INSERM, EFS, CHU Montpellier, Montpellier, France
| | - Beninwendé L D Sakana
- Infectious Disease Research Programme, Centre MURAZ/National Institute of Public Health, Bobo-Dioulasso, Burkina Faso
| | - Jean-Pierre Molès
- Pathogenesis and Control of Chronic and Emerging Infections, Montpellier University, INSERM, EFS, CHU Montpellier, Montpellier, France
| | - Mwiya Mwiya
- Department of Paediatrics and Child Health, University Teaching Hospital, Lusaka, Zambia
| | | | - Morgana D'Ottavi
- Pathogenesis and Control of Chronic and Emerging Infections, Montpellier University, INSERM, EFS, CHU Montpellier, Montpellier, France
| | - Souleymane Tassembedo
- Infectious Disease Research Programme, Centre MURAZ/National Institute of Public Health, Bobo-Dioulasso, Burkina Faso
| | - Maria M Wilfred-Tonga
- Department of Paediatrics and Child Health, University Teaching Hospital, Lusaka, Zambia
| | - Paulin Fao
- Infectious Disease Research Programme, Centre MURAZ/National Institute of Public Health, Bobo-Dioulasso, Burkina Faso
| | - David Rutagwera
- Department of Paediatrics and Child Health, University Teaching Hospital, Lusaka, Zambia
| | - Beauty Matoka
- Department of Paediatrics and Child Health, University Teaching Hospital, Lusaka, Zambia
| | - Dramane Kania
- Infectious Disease Research Programme, Centre MURAZ/National Institute of Public Health, Bobo-Dioulasso, Burkina Faso
| | - Ousmane A Taofiki
- Infectious Disease Research Programme, Centre MURAZ/National Institute of Public Health, Bobo-Dioulasso, Burkina Faso
| | - Thorkild Tylleskär
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Philippe Van de Perre
- Pathogenesis and Control of Chronic and Emerging Infections, Montpellier University, INSERM, EFS, CHU Montpellier, Montpellier, France
| | - Nicolas Nagot
- Pathogenesis and Control of Chronic and Emerging Infections, Montpellier University, INSERM, EFS, CHU Montpellier, Montpellier, France.
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Mohammed O, Alemayehu E, Debash H, Belete MA, Gedefie A, Tilahun M, Ebrahim H, Gebretsadik Weldehanna D. Dyslipidemia among HIV-infected patients in Ethiopia: a systematic review and meta-analysis. BMC Infect Dis 2024; 24:27. [PMID: 38166636 PMCID: PMC10763320 DOI: 10.1186/s12879-023-08910-9] [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: 08/04/2023] [Accepted: 12/13/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Dyslipidemia is responsible for more than half of the global ischemic heart disease (IHD) and more than 4 million deaths annually. Assessing the prevalence of dyslipidemia can be crucial in predicting the future disease development and possible intervention strategies. Therefore, this systematic review and meta-analysis was aimed at assessing the pooled prevalence of dyslipidemia in HIV-infected patients. METHODS Electronic databases such as EMBASE, Google Scholar, PubMed, Web of Science, ResearchGate, Cochrane Library, and Science Direct were searched for articles and grey literature. All relevant studies found until our search period of May 24, 2023 were included. The Newcastle-Ottawa Quality Assessment Scale was used to assess the quality of the included studies. The data were extracted in Microsoft Excel. The STATA version 14 software was used to conduct the meta-analysis. I2 and Cochran's Q test were employed to assess the presence of heterogeneity between studies. Due to the presence of heterogeneity, a random effect model was used. The publication bias was assessed using the symmetry of the funnel plot and Egger's test statistics. Moreover, subgroup analysis, and sensitivity analysis were also done. RESULTS A total of nine studies that reported the prevalence of dyslipidemia were included. The overall pooled prevalence of dyslipidemia among HIV-infected patients in Ethiopia was 67.32% (95% CI = 61.68%-72.96%). Furthermore, the overall pooled estimates of dyslipidemia among ART-taking and treatment-naïve HIV-infected patients were 69.74% (95% CI: 63.68-75.8, I2 = 87.2) and 61.46% (95% CI: 45.40-77.52, I2 = 90.3), respectively. Based on lipid profile fractionations, the pooled estimates for high total cholesterol (TC) were 39.08% (95% CI: 31.16-46.99), high triglycerides were 38.73% (95% CI: 28.58-48.88), high low density lipoprotein (LDL-c) was 28.40% (95% CI: 17.24-39.56), and low high density lipoprotein (HDL-c) was 39.42% (95% CI: 30.47-48.38). CONCLUSION More than two-thirds of HIV-infected patients experienced dyslipidemia. Therefore, it's critical to regularly evaluate lipid alterations in HIV-infected patients in order to prevent the onset of atherosclerosis and other cardiovascular problems.
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Affiliation(s)
- Ousman Mohammed
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia.
| | - Ermiyas Alemayehu
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Habtu Debash
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Melaku Ashagrie Belete
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Alemu Gedefie
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Mihret Tilahun
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Hussen Ebrahim
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Daniel Gebretsadik Weldehanna
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Pandey P, Roy A, Bhadoria AS. National viral hepatitis control program in India: Call for update. J Family Med Prim Care 2023; 12:1755-1758. [PMID: 38024898 PMCID: PMC10657081 DOI: 10.4103/jfmpc.jfmpc_1455_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 09/07/2023] [Accepted: 09/08/2023] [Indexed: 12/01/2023] Open
Abstract
Viral hepatitis is a serious yet manageable and preventable public health menace that infects about 3 million of people and leads to 1.1 million deaths worldwide every year. An acute episode of viral hepatitis usually subsides on its own, however, if not intervened timely, chronic infection puts people at risk of cirrhosis, liver cancer, and eventually death. In 2015, the global community allied to tackle viral hepatitis, as a result of which combating viral hepatitis target was included in the sustainable development goals (SDGs), and the World Health Organisation (WHO) constituted the first-ever global health sector strategy on viral hepatitis for 2016 to 2021 which is also renewed recently. Conforming to the global commitment, India launched the National Viral Hepatitis Control Program in the year 2018 with the aim to eliminate viral hepatitis as a public health threat by the year 2030. In the Subsequent years, WHO and various other international societies have released updated recommendations with respect to vaccination, prevention of mother-to-child transmission, strategies to increase testing uptake including self-testing, newer diagnostics including point of care and reflex testing approaches, simplified treatment algorithms, expanded treatment eligibility criteria, and simplified service delivery models. With the program being in its fifth year of implementation, there is a need to revamp the operational guidelines based on various global evidence-based advancements in order to attain the ambitious elimination goal by 2030.
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Affiliation(s)
- Pragya Pandey
- Department of Community and Family Medicine, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarkhand, India
| | - Akash Roy
- Department of Hepatology, Institute of Gastrosciences and Liver Transplantation, Apollo Multispeciality Hospitals, Kolkata, West Bengal, India
| | - Ajeet Singh Bhadoria
- Department of Community and Family Medicine, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarkhand, India
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Ochieng WO. Economics of point-of-care infant HIV tests. Lancet HIV 2023; 10:e278-e279. [PMID: 37149290 DOI: 10.1016/s2352-3018(23)00053-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 03/01/2023] [Indexed: 05/08/2023]
Affiliation(s)
- Walter O Ochieng
- Office of the Director, Global Health Center, US Centers for Disease Control and Prevention, Atlanta, GA, USA.
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