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Chapola JC, Lee F, Bula A, Rosenberg NE, Tseka J, Chagomerana M, Hosseinipour MC, Tang JHY. Knowledge and perceptions about Dolutegravir and Dolutegravir counselling: a qualitative study among women living with HIV. BMC Womens Health 2023; 23:478. [PMID: 37689628 PMCID: PMC10492391 DOI: 10.1186/s12905-023-02630-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 08/31/2023] [Indexed: 09/11/2023] Open
Abstract
INTRODUCTION In 2018, the Malawi Ministry of Health adopted the recommendation to switch first-line antiretroviral therapy (ART) from an efavirenz (EFV)-based to a dolutegravir (DTG)-based regimen. Little is known about patients' experience during this transition. We conducted a qualitative study to explore DTG-related counselling challenges among providers of HIV care and factors influencing regimen switching or non-switching among women living with HIV in Lilongwe, Malawi. METHODS Between February-July 2020, we recruited participants who took part in DTG counselling on reasons to switch, side effects, and benefits from two government health facilities providing HIV care: Area 18 health centre and Bwaila district hospital in Lilongwe, Malawi. We purposively sampled and interviewed 8 women living with HIV who remained on an EFV-based regimen after counselling, 10 women who switched to a DTG-based regimen, and 10 HIV care providers who provided counselling about ART switching. In-depth interviews were used to explore patient's perceptions of DTG, factors affecting the decision to switch, and both patient and provider experience with counselling. Interview data was coded for themes using inductive and deductive codes. Interviews were conducted until thematic saturation was achieved. Data matrices were used for analysis and thematic extraction. RESULTS Most women in both groups were well versed on DTG's potential side effects and felt well counselled on the benefits of switching, such as quicker viral load suppression. Many women associated DTG with birth defects and expressed concern. However, the primary reason for not switching was concern with how the new medication would be tolerated, especially when they were satisfied with their current regimen. Almost all providers expressed difficulty providing DTG counselling. Primary reasons included feeling inadequately trained and/or not having resources to use during counselling, such as diagrams or brochures. CONCLUSION DTG counselling was well accepted by women; however, some felt that their concerns were not fully addressed. Providers reflected this sentiment in that they did not feel adequately trained or well-equipped to provide adequate counselling. Training on counselling for new ART regimens should be intensified and utilize patient-centered educational materials to address the concerns raised by both patients and health care providers.
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Affiliation(s)
- John C Chapola
- University of North Carolina Project-Malawi, Lilongwe Private Bag A104, Lilongwe, Malawi.
| | - Fan Lee
- Duke University, Durham, NC, USA
| | - Agatha Bula
- University of North Carolina Project-Malawi, Lilongwe Private Bag A104, Lilongwe, Malawi
| | - Nora E Rosenberg
- University of North Carolina Project-Malawi, Lilongwe Private Bag A104, Lilongwe, Malawi
- Gilling's School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Jennifer Tseka
- University of North Carolina Project-Malawi, Lilongwe Private Bag A104, Lilongwe, Malawi
| | - Maganizo Chagomerana
- University of North Carolina Project-Malawi, Lilongwe Private Bag A104, Lilongwe, Malawi
- Gilling's School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Mina C Hosseinipour
- University of North Carolina Project-Malawi, Lilongwe Private Bag A104, Lilongwe, Malawi
- Division of Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Jennifer Hui-Yu Tang
- University of North Carolina Project-Malawi, Lilongwe Private Bag A104, Lilongwe, Malawi
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA
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Hunt GM, Yousif M, Levin L, Ledwaba J, Steegen K, Kufa T, Zwane H, Kalimashe M, Kana V, Aynalem G, Perlman J, Ayalew K, Kindra G, Diallo K, Carmona S, Sherman G, Raizes EJ. Resistance is common in paediatric patients failing ART in South Africa. J Antimicrob Chemother 2023; 78:1160-1167. [PMID: 37017009 PMCID: PMC10616358 DOI: 10.1093/jac/dkac443] [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: 07/25/2022] [Accepted: 12/05/2022] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND Minimal data exist on HIV drug resistance patterns and prevalence among paediatric patients failing ART in resource-limited settings. We assessed levels of HIV drug resistance in children with virological failure. METHODS This cross-sectional study, performed from March 2017 to March 2019 in South Africa, enrolled HIV-positive children aged ≤19 years, receiving ART through public health facilities with recent evidence suggestive of virological failure (at least one viral load ≥1000 copies/mL), across 45 randomly selected high-volume clinics from all nine provinces. Resistance genotyping was performed using next-generation sequencing technologies. Descriptive analysis taking into account survey design was used to determine outcomes. RESULTS Among 899 participants enrolled, the adjusted proportion of HIV drug resistance among children with virological failure was 87.5% (95% CI 83.0%-90.9%). Resistance to NNRTIs was detected in 77.4% (95% CI 72.5%-81.7%) of participants, and resistance to NRTIs in 69.5% (95% CI 62.9%-75.4%) of participants. Overall, resistance to PIs was detected in 7.7% (95% CI 4.4%-13.0%) of children. CONCLUSIONS HIV drug resistance was highly prevalent in paediatric patients failing ART in South Africa, with 9 in 10 patients harbouring resistance to NNRTIs and/or NRTIs. PI-based regimens are predicted to be highly efficacious in achieving virological suppression amongst patients failing NNRTI-based regimens. Scaling up resistance testing amongst patients would facilitate access to second- and third-line regimens in South Africa.
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Affiliation(s)
- Gillian M. Hunt
- Centre for HIV and STIs, National Institute for Communicable Diseases, Private Bag X4, Sandringham, Johannesburg 2131, South Africa
- Department of Virology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mukhlid Yousif
- Centre for HIV and STIs, National Institute for Communicable Diseases, Private Bag X4, Sandringham, Johannesburg 2131, South Africa
- Department of Virology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Leon Levin
- Right to Care, Johannesburg, South Africa
| | - Johanna Ledwaba
- Centre for HIV and STIs, National Institute for Communicable Diseases, Private Bag X4, Sandringham, Johannesburg 2131, South Africa
| | - Kim Steegen
- National Health Laboratory Services, Johannesburg, South Africa
- Department of Molecular Medicine and Haematology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Tendesayi Kufa
- Centre for HIV and STIs, National Institute for Communicable Diseases, Private Bag X4, Sandringham, Johannesburg 2131, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Hloniphile Zwane
- Centre for HIV and STIs, National Institute for Communicable Diseases, Private Bag X4, Sandringham, Johannesburg 2131, South Africa
| | - Monalisa Kalimashe
- Centre for HIV and STIs, National Institute for Communicable Diseases, Private Bag X4, Sandringham, Johannesburg 2131, South Africa
| | - Vibha Kana
- Centre for HIV and STIs, National Institute for Communicable Diseases, Private Bag X4, Sandringham, Johannesburg 2131, South Africa
| | - Getahun Aynalem
- Division of Global HIV and Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Pretoria, South Africa
| | - Jaclyn Perlman
- Division of Global HIV and Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Pretoria, South Africa
| | - Kassahun Ayalew
- Division of Global HIV and Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Pretoria, South Africa
| | - Gurpreet Kindra
- Division of Global HIV and Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Pretoria, South Africa
| | - Karidia Diallo
- Division of Global HIV and Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Pretoria, South Africa
| | - Sergio Carmona
- National Health Laboratory Services, Johannesburg, South Africa
- Department of Molecular Medicine and Haematology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Gayle Sherman
- Centre for HIV and STIs, National Institute for Communicable Diseases, Private Bag X4, Sandringham, Johannesburg 2131, South Africa
- Department of Molecular Medicine and Haematology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Elliot J. Raizes
- Division of Global HIV and Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Aissatou A, Fokam J, Semengue ENJ, Takou D, Ka’e AC, Ambe CC, Nka AD, Djupsa SC, Beloumou G, Ciaffi L, Tchouaket MCT, Nayang ARM, Pabo WLT, Essomba RG, Halle EGE, Okomo MC, Bissek ACZK, Leke R, Boum Y, Mballa GAE, Montesano C, Perno CF, Colizzi V, Ndjolo A. Pre-existing immunity to SARS-CoV-2 before the COVID-19 pandemic era in Cameroon: A comparative analysis according to HIV-status. Front Immunol 2023; 14:1155855. [PMID: 37090738 PMCID: PMC10116492 DOI: 10.3389/fimmu.2023.1155855] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 02/27/2023] [Indexed: 03/10/2023] Open
Abstract
Background The lower burden of COVID-19 in tropical settings may be due to preexisting cross-immunity, which might vary according to geographical locations and potential exposure to other pathogens. We sought to assess the overall prevalence of SARS-CoV-2 antibodies and determine SARS-CoV-2 seropositivity according to HIV-status before the COVID-19 pandemic era. Methods A cross-sectional and comparative study was conducted at the Chantal BIYA International Reference Centre (CIRCB) on 288 stored plasma samples (163 HIV-positive versus 125 HIV-negative); all collected in 2017-2018, before the COVID-19 pandemic era. Abbott Panbio™ COVID-19 IgG/IgM assay was used for detecting SARS-CoV-2 immunoglobulin G (IgG) and M (IgM). Among people living with HIV (PLHIV), HIV-1 viral load and TCD4 cell count (LTCD4) were measured using Abbott Real Time PCR and BD FACSCalibur respectively. Statistical analyses were performed, with p<0.05 considered statistically significant. Results The median [IQR] age was 25 [15-38] years. Overall seropositivity to SARS-CoV-2 antibodies was 13.5% (39/288) of which 7.3% (21) was IgG, 7.3% (21) IgM and 1.0% (3) IgG/IgM. According to HIV-status in the study population, SARS-CoV-2 seropositivity was 11.0% (18/163) among HIV-positive versus 16.8% (21/125) among HIV-negative respectively, p=0.21. Specifically, IgG was 6.1% (10/163) versus 8.8% (11/125), p=0.26; IgM was 5.5% (9/163) versus 9.6%, (12/125), p=0.13 and IgG/IgM was 0.6% (1/163) versus 1.6% (2/125) respectively. Among PLHIV, SARS-CoV-2 seropositivity according to CD4 count was 9.2% (≥500 cells/µL) versus 1.8% (200-499 cells/µL), (OR=3.5; p=0.04) and 0.6% (<200 cells/µL), (OR=17.7; p<0.01). According to viral load, SARS-CoV-2 seropositivity was 6.7% (≥40 copies/mL) versus 4.9% (<40 copies/mL), (OR= 3.8; p<0.01). Conclusion Before COVID-19 in Cameroon, cross-reactive antibodies to SARS-CoV-2 were in circulation, indicating COVID-19 preexisting immunity. This preexisting immunity may contribute in attenuating disease severity in tropical settings like Cameroon. Of relevance, COVID-19 preexisting immunity is lower with HIV-infection, specifically with viral replication and poor CD4-cell count. As poor CD4-count leads to lower cross-reactive antibodies (regardless of viral load), people living with HIV appear more vulnerable to COVID-19 and should be prioritized for vaccination.
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Affiliation(s)
- Abba Aissatou
- Laboratory of virology, Chantal BIYA International Reference Center for Research HIV/AIDS Prevention and Management, Yaoundé, Cameroon
- Serology Unit, Garoua Regional Health Centre, Garoua, Cameroon
| | - Joseph Fokam
- Laboratory of virology, Chantal BIYA International Reference Center for Research HIV/AIDS Prevention and Management, Yaoundé, Cameroon
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
- Laboratory Unit, Operations sections, National Public Health Emergency Operations Coordination Centre, Yaounde, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | - Ezechiel Ngoufack Jagni Semengue
- Laboratory of virology, Chantal BIYA International Reference Center for Research HIV/AIDS Prevention and Management, Yaoundé, Cameroon
- Department of Biology, University of Rome “Tor Vergata”, Rome, Italy
- Department of Science and Technology, Evangelical University of Cameroon, Bandjoun, Cameroon
| | - Désiré Takou
- Laboratory of virology, Chantal BIYA International Reference Center for Research HIV/AIDS Prevention and Management, Yaoundé, Cameroon
| | - Aude Christelle Ka’e
- Laboratory of virology, Chantal BIYA International Reference Center for Research HIV/AIDS Prevention and Management, Yaoundé, Cameroon
- Department of Biology, University of Rome “Tor Vergata”, Rome, Italy
| | - Collins Chenwi Ambe
- Laboratory of virology, Chantal BIYA International Reference Center for Research HIV/AIDS Prevention and Management, Yaoundé, Cameroon
- Department of General Medicine, Mvangan District Hospital, Mvangan, Cameroon
| | - Alex Durand Nka
- Laboratory of virology, Chantal BIYA International Reference Center for Research HIV/AIDS Prevention and Management, Yaoundé, Cameroon
- Department of Biology, University of Rome “Tor Vergata”, Rome, Italy
- Department of Science and Technology, Evangelical University of Cameroon, Bandjoun, Cameroon
| | - Sandrine Claire Djupsa
- Laboratory of virology, Chantal BIYA International Reference Center for Research HIV/AIDS Prevention and Management, Yaoundé, Cameroon
| | - Grâce Beloumou
- Laboratory of virology, Chantal BIYA International Reference Center for Research HIV/AIDS Prevention and Management, Yaoundé, Cameroon
| | - Laura Ciaffi
- Project Coordinator, National Agency for Research on AIDS and Viral Hepatitis, Yaounde, Cameroon
| | - Michel Carlos Tommo Tchouaket
- Laboratory of virology, Chantal BIYA International Reference Center for Research HIV/AIDS Prevention and Management, Yaoundé, Cameroon
- School of Health Sciences, Catholic University of Central Africa, Yaounde, Cameroon
| | - Audrey Rachel Mundo Nayang
- Laboratory of virology, Chantal BIYA International Reference Center for Research HIV/AIDS Prevention and Management, Yaoundé, Cameroon
| | - Willy Leroi Togna Pabo
- Laboratory of virology, Chantal BIYA International Reference Center for Research HIV/AIDS Prevention and Management, Yaoundé, Cameroon
| | - René Ghislain Essomba
- Laboratory Unit, Operations sections, National Public Health Emergency Operations Coordination Centre, Yaounde, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
- National Public Health Laboratory, Ministry of Public Health, Yaounde, Cameroon
| | | | - Marie-Claire Okomo
- Laboratory Unit, Operations sections, National Public Health Emergency Operations Coordination Centre, Yaounde, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
- National Public Health Laboratory, Ministry of Public Health, Yaounde, Cameroon
| | | | - Rose Leke
- Laboratory of virology, Chantal BIYA International Reference Center for Research HIV/AIDS Prevention and Management, Yaoundé, Cameroon
- The Biotechnology Center of the University of Yaounde I and the Ministry of Scientific Research, Yaounde, Cameroon
| | - Yap Boum
- Laboratory Unit, Operations sections, National Public Health Emergency Operations Coordination Centre, Yaounde, Cameroon
| | - Georges Alain Etoundi Mballa
- Laboratory Unit, Operations sections, National Public Health Emergency Operations Coordination Centre, Yaounde, Cameroon
- Division of Disease, Epidemic and Pandemic Control, Ministry of Public Health, Yaounde, Cameroon
| | - Carla Montesano
- Department of Biology, University of Rome “Tor Vergata”, Rome, Italy
| | | | - Vittorio Colizzi
- Laboratory of virology, Chantal BIYA International Reference Center for Research HIV/AIDS Prevention and Management, Yaoundé, Cameroon
- Department of Biology, University of Rome “Tor Vergata”, Rome, Italy
- Department of Science and Technology, Evangelical University of Cameroon, Bandjoun, Cameroon
| | - Alexis Ndjolo
- Laboratory of virology, Chantal BIYA International Reference Center for Research HIV/AIDS Prevention and Management, Yaoundé, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
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Ngoufack Jagni Semengue E, Santoro MM, Ndze VN, Ka'e AC, Yagai B, Nka AD, Dambaya B, Takou D, Teto G, Fabeni L, Colizzi V, Perno CF, Ceccherini-Silberstein F, Fokam J. HIV-1 integrase resistance associated mutations and the use of dolutegravir in Sub-Saharan Africa: A systematic review and meta-analysis. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000826. [PMID: 36962573 PMCID: PMC10021461 DOI: 10.1371/journal.pgph.0000826] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 09/12/2022] [Indexed: 11/12/2022]
Abstract
As sub-Saharan Africa (SSA) countries are transitioning to dolutegravir (DTG)-based ART, baseline data are required for optimal monitoring of therapeutic response. In this frame, we sought to generate up-to-date evidence on the use of integrase-strand transfer inhibitors (INSTI) and associated drug resistance mutations (DRMs) within SSA. In this systematic review and meta-analysis, we included randomized and non-randomized trials, cohort-studies, cross-sectional studies, and case-reports published on INSTI or integrase DRMs in SSA. We included studies of patients exposed to DTG, raltegravir (RAL) or elvitegravir (EVG). Primary outcomes were "the rate of virological control (VC:<50copies/ml)" and "the presence of DRMs" on INSTI-based regimens among patients in SSA. We synthesised extracted data using subgroup analysis, and random effect models were used where appropriate. Additional analyses were conducted to assess study heterogeneity. We identified 1,916 articles/citations through database searches, of which 26 were included in the analysis pertaining to 5,444 patients (mean age: 37±13 years), with 67.62% (3681/5444) female. Specifically, 46.15% (12/26) studies focused on DTG, 26.92% (7/26) on RAL, 23.08% (6/26) on both DTG and RAL, and 3.85% (1/26) on EVG. We found an increasing use of DTG overtime (0% before 2018 to 100% in 2021). Median treatment duration under INSTI-based regimens was 12 [9-36] months. Overall, the rate of VC was 88.51% [95%CI: 73.83-97.80] with DTG vs. 82.49% [95%CI: 55.76-99.45] and 96.55% [95%CI: 85.7-100.00] with RAL and EVG, respectively. In univariate analysis, VC with DTG-containing vs. other INSTI-regimens was significantly higher (OR = 1.44 [95%CI: 1.15-1.79], p = 0.0014). Among reported DRMs at failure, the only DTG resistance-mutations were G118R and R263K. In SSA, DTG presents a superiority effect in VC compared to other INSTIs. Nonetheless, the early detection of INSTI-DRMs calls for sentinel surveillance for a successful transition and a sustained efficacy of DTG in SSA. PROSPERO Registration Number: CRD42019122424.
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Affiliation(s)
- Ezechiel Ngoufack Jagni Semengue
- Chantal Biya International Reference Center for Research on HIV/AIDS Prevention and Management, Yaoundé, Cameroon
- Evangelical University of Cameroon, Bandjoun, Cameroon
- University of Rome "Tor Vergata", Rome, Italy
| | | | | | - Aude Christelle Ka'e
- Chantal Biya International Reference Center for Research on HIV/AIDS Prevention and Management, Yaoundé, Cameroon
- Evangelical University of Cameroon, Bandjoun, Cameroon
- Doctoral School of Microbiology, Immunology, Infectious Diseases and Transplants, MIMIT, University of Rome "Tor Vergata", Rome, Italy
| | - Bouba Yagai
- Chantal Biya International Reference Center for Research on HIV/AIDS Prevention and Management, Yaoundé, Cameroon
| | - Alex Durand Nka
- Chantal Biya International Reference Center for Research on HIV/AIDS Prevention and Management, Yaoundé, Cameroon
- Evangelical University of Cameroon, Bandjoun, Cameroon
- University of Rome "Tor Vergata", Rome, Italy
| | - Beatrice Dambaya
- Chantal Biya International Reference Center for Research on HIV/AIDS Prevention and Management, Yaoundé, Cameroon
| | - Desiré Takou
- Chantal Biya International Reference Center for Research on HIV/AIDS Prevention and Management, Yaoundé, Cameroon
| | - Georges Teto
- Chantal Biya International Reference Center for Research on HIV/AIDS Prevention and Management, Yaoundé, Cameroon
| | - Lavinia Fabeni
- Laboratory of Virology, National Institute for Infectious Diseases "Lazzaro Spallanzani" -IRCCS, Rome, Italy
| | - Vittorio Colizzi
- Chantal Biya International Reference Center for Research on HIV/AIDS Prevention and Management, Yaoundé, Cameroon
- Evangelical University of Cameroon, Bandjoun, Cameroon
- University of Rome "Tor Vergata", Rome, Italy
- Chair of Biotechnology-UNESCO, University of Rome "Tor Vergata", Rome, Italy
| | - Carlo-Federico Perno
- Chantal Biya International Reference Center for Research on HIV/AIDS Prevention and Management, Yaoundé, Cameroon
- Bambino Gesu Children's Hospital, Rome, Italy
| | - Francesca Ceccherini-Silberstein
- University of Rome "Tor Vergata", Rome, Italy
- Doctoral School of Microbiology, Immunology, Infectious Diseases and Transplants, MIMIT, University of Rome "Tor Vergata", Rome, Italy
| | - Joseph Fokam
- Chantal Biya International Reference Center for Research on HIV/AIDS Prevention and Management, Yaoundé, Cameroon
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
- National HIV Drug Resistance Working Group, Ministry of Public Health, Yaounde, Cameroon
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Dambaya B, Fokam J, Ngoufack ES, Takou D, Santoro MM, Této G, Beloumou GA, Mouafo LCM, Kamgaing N, Sosso SM, Billong SC, Njom Nlend AE, Sobze MS, Nkenfou C, Koki PN, Njiokou F, Colizzi V, Perno CF, Ndjolo A. HIV-1 Drug Resistance and Genetic Diversity among Vertically Infected Cameroonian Children and Adolescents. EXPLORATORY RESEARCH AND HYPOTHESIS IN MEDICINE 2020; 000:1-9. [DOI: 10.14218/erhm.2019.00031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Community and activists demand for tenofovir/emtricitabine or lamivudine/dolutegravir and routine viral load testing. Curr Opin HIV AIDS 2020; 14:7-12. [PMID: 30451698 DOI: 10.1097/coh.0000000000000515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Since the beginning of the HIV epidemic, informed communities have demanded and fought for access to life-saving treatment. The last several years have seen interesting developments in this area - particularly with respect to the switch to dolutegravir (DTG)-based regimens and scale-up of routine viral load testing (RVLT), and how these directly and indirectly impact issues of treatment optimization, HIV drug resistance, and sexual and reproductive health. In this review, we present recent advances in antiretroviral treatment and monitoring in the context of how treatment education and community demand for them. RECENT FINDINGS The latest developments with DTG and RVLT highlight underlying issues for global health systems that need to be addressed - including drug surveillance, supply chain management, and comprehensive care linkages - and the importance of community engagement in such issues. SUMMARY Decisions about treatment must be grounded in informed community demand, and should exist in the context of optimal care and treatment across the entire HIV cascade. Informed advocacy is essential for people living with HIV and their communities, so that they benefit from existing and future therapeutic advances. Research is needed on the importance of community demand across the HIV treatment cascade.
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Hubbard J, Kakwesa G, Nyirenda M, Mwambene J, Bardon A, Balakasi K, Dovel K, Kalua T, Hoffman RM. Towards the third 90: improving viral load testing with a simple quality improvement program in health facilities in Malawi. Int Health 2019; 11:215-220. [PMID: 30383224 DOI: 10.1093/inthealth/ihy083] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 08/31/2018] [Accepted: 09/18/2018] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Viral load (VL) scale-up efforts have largely focused on laboratory systems, with less attention on facility-level strengthening of staff who facilitate VL testing. To address this gap we implemented a quality improvement (QI) program at 13 health facilities in central and southern Malawi. METHODS QI program tools focused on patient and provider VL knowledge and clarification of site-level roles and responsibilities, including the designation of a VL 'focal person' to oversee all VL activities. T-tests were used to compare differences in VL testing before (November 2016-April 2017) and after (May 2017-November 2017) the intervention. RESULTS The mean number of VL tests performed significantly increased after implementation of the QI program. Overall there was a 164% increase in the mean number of routine VL tests performed per month (p<0.001). Increased VL testing was sustained during the 6 months of follow-up. CONCLUSIONS A simple QI program focused on improving VL knowledge among patients and providers, and clarifying staff roles at a facility level increased VL testing over a 6-month period. Further investigation is needed on whether this program can be scaled in different settings across sub-Saharan Africa and on the duration of follow-up required for sustained improvements in VL testing.
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Affiliation(s)
- Julie Hubbard
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at the University of California Los Angeles, 10833 Le Conte Avenue, 37-121 CHS, Los Angeles, CA, USA.,Partners in Hope/EQUIP
| | | | | | | | - Ashley Bardon
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at the University of California Los Angeles, 10833 Le Conte Avenue, 37-121 CHS, Los Angeles, CA, USA.,Partners in Hope/EQUIP
| | | | - Kathryn Dovel
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at the University of California Los Angeles, 10833 Le Conte Avenue, 37-121 CHS, Los Angeles, CA, USA.,Partners in Hope/EQUIP
| | - Thokozani Kalua
- Ministry of Health, Department of HIV and AIDS, Area 3, Lilongwe, Malawi
| | - Risa M Hoffman
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at the University of California Los Angeles, 10833 Le Conte Avenue, 37-121 CHS, Los Angeles, CA, USA
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Sikombe K, Hantuba C, Musukuma K, Sharma A, Padian N, Holmes C, Czaicki N, Simbeza S, Somwe P, Bolton-Moore C, Sikazwe I, Geng E. Accurate dried blood spots collection in the community using non-medically trained personnel could support scaling up routine viral load testing in resource limited settings. PLoS One 2019; 14:e0223573. [PMID: 31622394 PMCID: PMC6797100 DOI: 10.1371/journal.pone.0223573] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 09/24/2019] [Indexed: 12/20/2022] Open
Abstract
Regular plasma HIV-RNA testing for persons living with HIV on antiretroviral therapy (ART) is now the global standard, but as many as 60% of persons in Africa today on ART do not have access to standard laboratory HIV-RNA assays. As a result, patients in Zambia often receive treatment without any means of determining true virologic failure, which poses a risk of premature switch of ART regimens and widespread HIV drug resistance. Dry blood spots (DBS) on the other hand require unskilled personnel and less complex storage supply chain so are ideal to capture viral-load results from HIV patients outside clinic settings. We assess collection of DBS in the community using non-medically trained personnel (NMP) and documented challenges. We trained 23 NMP to collect DBS from lost to follow-up (LTFU) patients in 4 rural and urban Zambian districts. We developed a phlebotomy box to transport DBS without contamination at ambient temperature and concomitant training and standard operating procedures. We evaluated this through field observations, bi-weekly meetings, reports, and staff meetings. The laboratory assessed DBS quality for testing validity. We attempted to collect DBS from 357 participants in the community. Though individual reasons for refusal from the remaining 37% were not collected, NMPs reported privacy concerns, awkward box-size which drew attention in the community and fears of undisclosed uses of samples related to witchcraft and circulating narratives about past research. Successful DBS collection was not associated with patient gender, age, time on ART, enrolment CD4, facility. DBS viral-load collection by NMP is feasible in Zambia. Our training approach and assessments of NMP not part of the health system can be extended to patients by giving them more responsibility to manage their own differentiated care groups. Concerted efforts that compare collection of DBS by NMP to those collected by skilled-medical personnel are needed.
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Affiliation(s)
| | - Cardinal Hantuba
- Centre for Infectious Diseases Research in Zambia, Lusaka, Zambia
| | - Kalo Musukuma
- Centre for Infectious Diseases Research in Zambia, Lusaka, Zambia
| | - Anjali Sharma
- Centre for Infectious Diseases Research in Zambia, Lusaka, Zambia
| | - Nancy Padian
- Division of Epidemiology, University of California, Berkeley, Berkeley, California, United States of America
| | - Charles Holmes
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Center for Global Health and Quality, Georgetown University, Washington, District of Columbia, United States of America
| | - Nancy Czaicki
- Centre for Infectious Diseases Research in Zambia, Lusaka, Zambia
- Division of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, California, United States of America
| | - Sandra Simbeza
- Centre for Infectious Diseases Research in Zambia, Lusaka, Zambia
| | - Paul Somwe
- Centre for Infectious Diseases Research in Zambia, Lusaka, Zambia
| | - Carolyn Bolton-Moore
- Centre for Infectious Diseases Research in Zambia, Lusaka, Zambia
- Division of Infectious Diseases, University of Alabama, Birmingham, Alabama, United States of America
| | - Izukanji Sikazwe
- Centre for Infectious Diseases Research in Zambia, Lusaka, Zambia
| | - Elvin Geng
- Division of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, California, United States of America
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9
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Ngo-Giang-Huong N, Aghokeng AF. HIV Drug Resistance in Resource-limited Countries: Threat for HIV Elimination. EClinicalMedicine 2019; 9:3-4. [PMID: 31143873 PMCID: PMC6510715 DOI: 10.1016/j.eclinm.2019.03.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 03/19/2019] [Indexed: 11/30/2022] Open
Affiliation(s)
- Nicole Ngo-Giang-Huong
- IRD UMI 174-PHPT-Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Avelin F Aghokeng
- IRD UMR 224, CNRS 5290, MIVEGEC, Université de Montpellier, Montpellier, France
- Centre international de recherches médicales de Franceville (CIRMF), Département de virologie, Franceville, Gabon
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10
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Ismail N, Ismail F, Omar SV, Blows L, Gardee Y, Koornhof H, Onyebujoh PC. Drug resistant tuberculosis in Africa: Current status, gaps and opportunities. Afr J Lab Med 2018; 7:781. [PMID: 30568900 PMCID: PMC6295755 DOI: 10.4102/ajlm.v7i2.781] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 09/12/2018] [Indexed: 11/24/2022] Open
Abstract
Background The World Health Organization End TB Strategy targets for 2035 are ambitious and drug resistant tuberculosis is an important barrier, particularly in Africa, home to over a billion people. Objective We sought to review the current status of drug resistant tuberculosis in Africa and highlight key areas requiring improvement. Methods Available data from 2016 World Health Organization global tuberculosis database were extracted and analysed using descriptive statistics. Results The true burden of drug resistant tuberculosis on the continent is poorly described with only 51% of countries having a formal survey completed. In the absence of this data, modelled estimates were used and reported 92 629 drug resistant tuberculosis cases with 42% of these occurring in just two countries: Nigeria and South Africa. Of the cases estimated, the majority of patients (70%) were not notified, representing ‘missed cases’. Mortality among patients with multi-drug resistant tuberculosis was 21%, and was 43% among those with extensively drug resistant tuberculosis. Policies on the adoption of new diagnostic tools was poor and implementation was lacking. A rifampicin result was available for less than 10% of tuberculosis cases in 23 of 47 countries. Second-line drug resistance testing was available in only 60% of countries. The introduction of the short multi-drug resistant tuberculosis regimen was a welcome development, with 40% of countries having implemented it in 2016. Bedaquiline has also been introduced in several countries. Conclusion Drug resistant tuberculosis is largely missed in Africa and this threatens prospects to achieve the 2035 targets. Urgent efforts are required to confirm the true burden of drug resistant tuberculosis in Africa. Adoption of new tools and drugs is essential if the 2035 targets are to be met.
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Affiliation(s)
- Nazir Ismail
- Center for Tuberculosis, National Institute for Communicable Diseases, National Health Laboratory Services, Johannesburg, South Africa.,Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa.,Department of Internal Medicine, University of Witwatersrand, Johannesburg, South Africa
| | - Farzana Ismail
- Center for Tuberculosis, National Institute for Communicable Diseases, National Health Laboratory Services, Johannesburg, South Africa.,Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa
| | - Shaheed V Omar
- Center for Tuberculosis, National Institute for Communicable Diseases, National Health Laboratory Services, Johannesburg, South Africa
| | - Linsay Blows
- Center for Tuberculosis, National Institute for Communicable Diseases, National Health Laboratory Services, Johannesburg, South Africa
| | - Yasmin Gardee
- Center for Tuberculosis, National Institute for Communicable Diseases, National Health Laboratory Services, Johannesburg, South Africa
| | - Hendrik Koornhof
- Center for Tuberculosis, National Institute for Communicable Diseases, National Health Laboratory Services, Johannesburg, South Africa
| | - Philip C Onyebujoh
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
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