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Martinez-Vega R, De La Mata NL, Kumarasamy N, Ly PS, Van Nguyen K, Merati TP, Pham TT, Lee MP, Choi JY, Ross JL, Ng OT. Durability of antiretroviral therapy regimens and determinants for change in HIV-1-infected patients in the TREAT Asia HIV Observational Database (TAHOD-LITE). Antivir Ther 2019; 23:167-178. [PMID: 28933705 DOI: 10.3851/imp3194] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND The durability of first-line regimen is important to achieve long-term treatment success for the management of HIV infection. Our analysis describes the duration of sequential ART regimens and identifies the determinants leading to treatment change in HIV-positive patients initiating in Asia. METHODS All HIV-positive adult patients initiating first-line ART in 2003-2013, from eight clinical sites among seven countries in Asia. Patient follow-up was to May 2014. Kaplan-Meier curves were used to estimate the time to second-line ART and third-line ART regimen. Factors associated with treatment durability were assessed using Cox proportional hazards model. RESULTS A total of 16,962 patients initiated first-line ART. Of these, 4,336 patients initiated second-line ART over 38,798 person-years (pys), a crude rate of 11.2 (95% CI 10.8, 11.5) per 100 pys. The probability of being on first-line ART increased from 83.7% (95% CI 82.1, 85.1%) in 2003-2005 to 87.9% (95% CI 87.1, 88.6%) in 2010-2013. Third-line ART was initiated by 1,135 patients over 8,078 pys, a crude rate of 14.0 (95% CI 13.3, 14.9) per 100 pys. The probability of continuing second-line ART significantly increased from 64.9% (95% CI 58.5, 70.6%) in 2003-2005 to 86.2% (95% CI 84.7, 87.6%) in 2010-2013. CONCLUSIONS Rates of discontinuation of first- and second-line regimens have decreased over the last decade in Asia. Subsequent regimens were of shorter duration compared to the first-line regimen initiated in the same year period. Lower CD4+ T-cell count and the use of suboptimal regimens were important factors associated with higher risk of treatment switch.
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Affiliation(s)
- Rosario Martinez-Vega
- Department of Infectious Diseases, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore
| | - Nicole L De La Mata
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.,Present address: Sydney School of Public Health, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia
| | | | - Penh Sun Ly
- National Center for HIV/AIDS, Dermatology & STDs, Phnom Penh, Cambodia
| | | | - Tuti P Merati
- Faculty of Medicine, Udayana University & Sanglah Hospital, Bali, Indonesia
| | - Thi Thanh Pham
- Infectious Disease Department, Bach Mai Hospital, Hanoi, Vietnam
| | - Man Po Lee
- Department of Medicine, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - Jun Yong Choi
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea
| | - Jeremy L Ross
- TREAT Asia, amfAR - The Foundation for AIDS Research, Bangkok, Thailand
| | - Oon Tek Ng
- Department of Infectious Diseases, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore
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Shamanna SB, Matta KK, Hamide A. Trends in Clinical Characteristics and Short-Term Outcome of HIV-Infected Patients at a Tertiary Care Hospital in South India. J Int Assoc Provid AIDS Care 2019; 17:2325958218795886. [PMID: 30187814 PMCID: PMC6748538 DOI: 10.1177/2325958218795886] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Limited information is available on changing trends in HIV positive patients treated with first-line antiretroviral therapy from India. Methods: The clinical characteristics and short-term outcome were compared between a retrospective group enrolled between January 2006 and March 2007 (06-07 group—100 patients) and a prospective group enrolled between February 2011 and March 2012 (10-12 group—85 patients). Results: Median age was 36 and 38 years in 06-07 and 10-12 groups, respectively. Median baseline CD4 count was 146 cells/mL3 in the 10-12 group, and it was not significantly different from that of 06-07 group. Tuberculosis was diagnosed 3 times more commonly in the 10-12 group. The retention proportion at the end of 10 months was 68% in the 10-12 group when compared to that of 59% in the 06-07 group. Conclusion: There was a trend toward improved outcome over the period of time, but the attrition rate remained high.
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Affiliation(s)
| | - Kiran Kumar Matta
- 1 Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Abdoul Hamide
- 1 Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Ayisi Addo S, Abdulai M, Yawson A, Baddoo AN, Zhao J, Workneh N, Okae I, Wiah E. Availability of HIV services along the continuum of HIV testing, care and treatment in Ghana. BMC Health Serv Res 2018; 18:739. [PMID: 30257660 PMCID: PMC6158882 DOI: 10.1186/s12913-018-3485-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 08/21/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Ghana has been providing HIV and AIDS services since the identification of the first case in 1986 and added highly active antiretroviral therapy to its comprehensive care in 2003.This study aimed at assessing availability of HIV services along the continuum of HIV care in Ghana. METHOD A cross sectional study was conducted among 172 (87%) of the total 197 ART canters in Ghana. Data was collected by self-administered questionnaire and analysed using STATA version 13. RESULTS Of the 172 health facilities surveyed, 165 (96%) were offering HIV testing Services (HTS) during the survey period. More than 90% of the surveyed facilities reported to offer Anti-Retroviral Treatment (ART), patient counselling, TB screening and Prevention of Mother to Child Transmission (PMTCT) services. Viral load and Early Infant Diagnosis (EID) and laboratory testing services were reported at 10 (5.8%) and 23 (13.4%) respectively. HIV testing services (HTS), PMTCT, ART, patient counselling and opportunistic infections (OI) prophylaxis services were offered at all Tertiary and Regional hospitals surveyed. EID sample collection and testing services was reported at 2 out of 27 (7.4%) of the Health Centre and/or clinics in Ghana. The common adherence assessment methodology being implemented varied by facilities which included: asking patients if they took their drugs 154 (89.5%), pill counting 131 (76.2%), use of follow-up visit 79(45.9%) and use of CD4 counts, viral loads and clinical manifestation 76 (44.2%). Challenges encountered by facilities included shortage of test reagents and drugs 122 (71%), 111 (65%) respectively and patient compliance 101 (59%). CONCLUSION This study showed ART services to be available in most facilities. Methods used to assess patients adherence varied across facilities. Shortage of test reagents and drugs, EID sample collection and testing were major challenges. A standardised approach to assessing patient's adherence is recommended. Measures should be put in place to ensure availability of HIV commodities at all levels.
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Affiliation(s)
| | | | - Alfred Yawson
- National AIDS/STI Control Programme, Ghana Health Service, Accra, Ghana
- Department of Biostatistics, School of Public Health, University of Ghana, Accra, Ghana
| | - Akosua N. Baddoo
- National AIDS/STI Control Programme, Ghana Health Service, Accra, Ghana
| | - Jinkou Zhao
- The Global Fund to fight AIDS TB and Malaria, Geneva, Switzerland
| | - Nibretie Workneh
- The Global Fund to fight AIDS TB and Malaria, Geneva, Switzerland
| | - Ivy Okae
- National AIDS/STI Control Programme, Ghana Health Service, Accra, Ghana
| | - Ekow Wiah
- National AIDS/STI Control Programme, Ghana Health Service, Accra, Ghana
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Tran BX, Nguyen LH, Vu GT, Fleming M, Latkin CA. Workability of patients with HIV/AIDS in Northern Vietnam: a societal perspective on the impact of treatment program. AIDS Care 2018; 30:1532-1537. [PMID: 30099883 DOI: 10.1080/09540121.2018.1510098] [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] [Indexed: 10/28/2022]
Abstract
In Vietnam, the antiretroviral therapy (ART) program has been widely scaled up across the country since 2005, and now covers treatment for about half the HIV population. However, limited data exist about the workability and productivity outcome of ART in Vietnam. We aim to assess the employment status and work productivity among HIV patients taking ART in Northern Vietnam. A cross-sectional study was conducted in Hanoi and Nam Dinh with 1133 participants taking ART at the selected clinics. The Work Productivity and Activity Impairment Questionnaire: General Health (WPAI-GH) was applied. We found that 23% of patients with HIV/AIDS reported overall work productivity loss, and 12% had activity impairment. Among those having a job, their monthly income, however, was significantly lower than national averages 2806 thousand VND vs. 4120 thousand VND). The average education level of participants was low, with only 41.61% having greater than secondary education. Health problems and lower CD4 cell counts decreased workability of the patients while having a more dependent family, being a smoker or having a later HIV stage was associated with being less likely to have a job. The rate of employment among HIV/AIDS patients in this study was high however incomes were substantially lower than average. This could be due to low education levels or social stigma regarding these patients. Vocational education programs and public awareness could empower the patients economically. Similarly, a number of social and behavioral problems were associated with decreasing the working rate and productivity. Addressing these health issues may improve productivity among patients.
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Affiliation(s)
- Bach Xuan Tran
- a Institute for Preventive Medicine and Public Health, Hanoi Medical University , Hanoi , Vietnam.,b Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA.,c Vietnam Young Physician Association , Hanoi , Vietnam
| | - Long Hoang Nguyen
- d Department of Public Health Sciences , Karolinska Institutet , Stockholm , Sweden
| | - Giang Thu Vu
- e Institute for Global Health Innovations, Duy Tan University , Da Nang , Vietnam
| | | | - Carl A Latkin
- b Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
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Chan BT, Pradeep A, Prasad L, Murugesan V, Chandrasekaran E, Kumarasamy N, Mayer KH, Tsai AC. Association between internalized stigma and depression among HIV-positive persons entering into care in Southern India. J Glob Health 2018; 7:020403. [PMID: 29302315 PMCID: PMC5735782 DOI: 10.7189/jogh.07.020403] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background In India, which has the third largest HIV epidemic in the world, depression and HIV–related stigma may contribute to high rates of poor HIV–related outcomes such as loss to care and lack of virologic suppression. Methods We analyzed data from a large HIV treatment center in southern India to estimate the burden of depressive symptoms and internalized stigma among Indian people living with HIV (PLHIV) entering into HIV care and to test the hypothesis that probable depression was associated with internalized stigma. We fitted modified Poisson regression models, adjusted for sociodemographic variables, with probable depression (PHQ–9 score ≥10 or recent suicidal thoughts) as the outcome variable and the Internalized AIDS–Related Stigma Scale (IARSS) score as the explanatory variable. Findings 521 persons (304 men and 217 women) entering into HIV care between January 2015 and May 2016 were included in the analyses. The prevalence of probable depression was 10% and the mean IARSS score was 2.4 (out of 6), with 82% of participants endorsing at least one item on the IARSS. There was a nearly two times higher risk of probable depression for every additional point on the IARSS score (Adjusted Risk Ratio: 1.83; 95% confidence interval, 1.56–2.14). Conclusions Depression and internalized stigma are highly correlated among PLHIV entering into HIV care in southern India and may provide targets for policymakers seeking to improve HIV–related outcomes in India.
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Affiliation(s)
- Brian T Chan
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Amrose Pradeep
- Y. R. Gaitonde Centre for AIDS Research and Education, Chennai, India
| | - Lakshmi Prasad
- Y. R. Gaitonde Centre for AIDS Research and Education, Chennai, India
| | | | | | | | - Kenneth H Mayer
- Harvard Medical School, Boston, Massachusetts, USA.,Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Fenway Health, Boston, Massachusetts, USA
| | - Alexander C Tsai
- Harvard Medical School, Boston, Massachusetts, USA.,MGH Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA.,Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
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The challenges of ending AIDS in Asia: outcomes of the Thai National AIDS Universal Coverage Programme, 2000–2014. J Virus Erad 2017. [DOI: 10.1016/s2055-6640(20)30323-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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7
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Loss to Follow-up Trends in HIV-Positive Patients Receiving Antiretroviral Treatment in Asia From 2003 to 2013. J Acquir Immune Defic Syndr 2017; 74:555-562. [PMID: 28129256 DOI: 10.1097/qai.0000000000001293] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Over time, there has been a substantial improvement in antiretroviral treatment (ART) programs, including expansion of services and increased patient engagement. We describe time trends in, and factors associated with, loss to follow-up (LTFU) in HIV-positive patients receiving ART in Asia. METHODS Analysis included HIV-positive adults initiating ART in 2003-2013 at 7 ART programs in Asia. Patients LTFU had not attended the clinic for ≥180 days, had not died, or transferred to another clinic. Patients were censored at recent clinic visit, follow-up to January 2014. We used cumulative incidence to compare LTFU and mortality between years of ART initiation. Factors associated with LTFU were evaluated using a competing risks regression model, adjusted for clinical site. RESULTS A total of 8305 patients were included. There were 743 patients LTFU and 352 deaths over 26,217 person-years (pys), a crude LTFU, and mortality rate of 2.83 (2.64-3.05) per 100 pys and 1.34 (1.21-1.49) per 100 pys, respectively. At 24 months, the cumulative LTFU incidence increased from 4.3% (2.9%-6.1%) in 2003-05 to 8.1% (7.1%-9.2%) in 2006-09 and then decreased to 6.7% (5.9%-7.5%) in 2010-13. Concurrently, the cumulative mortality incidence decreased from 6.2% (4.5%-8.2%) in 2003-05 to 3.3% (2.8%-3.9%) in 2010-13. The risk of LTFU reduced in 2010-13 compared with 2006-09 (adjusted subhazard ratio = 0.73, 0.69-0.99). CONCLUSIONS LTFU rates in HIV-positive patients receiving ART in our clinical sites have varied by the year of ART initiation, with rates declining in recent years whereas mortality rates have remained stable. Further increases in site-level resources are likely to contribute to additional reductions in LTFU for patients initiating in subsequent years.
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Van Tam V, Cuong DD, Alfven T, Phuc HD, Chuc NTK, Hoa NP, Diwan V, Larsson M. HIV sero-discordance among married HIV patients initiating anti-retroviral therapy in northern Vietnam. AIDS Res Ther 2016; 13:39. [PMID: 27891160 PMCID: PMC5109648 DOI: 10.1186/s12981-016-0124-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 11/01/2016] [Indexed: 11/25/2022] Open
Abstract
Background In many countries in Asia, the HIV epidemic is in a concentrated phase, with high prevalence in certain risk groups, such as men who inject drugs. There is also a rapid increase of HIV among women. The latter might be due to high levels of sero-discordant couples and increasing transmission from male to female partners over time. Methods All adult married patients initiating antiretroviral treatment at four out-patient clinics in Quang Ninh province in north-eastern Vietnam between 2007 and 2009 were asked to participate in the study. Clinical information was extracted from patients’ records, and a structured questionnaire was used to collect social, demographic and economic data. Results Two hundred eighty-eight married patients for whom information on the HIV status of their spouse was available were included in the study. Overall, the sero-discordance rate was 58%. The sero-discordance rate was significantly higher among married males, 71% had spouses not infected, than married females, of whom 18% had spouses not infected. Other factors associated with a high rate of sero-discordance were injection drug use (IDU) history, tuberculosis (TB) history and the availability of voluntary counselling and testing (VCT) in residential locations. High sero-concordance was associated with college/university education. Conclusion The sero-discordance was significantly higher among married males than married females. Other factors also related to high sero-discordance were history of IDU, history of TB and the availability of VCT in residential locations. In contrast, college/university education and female sex were significantly related to low sero-discordance. To contain the increasing HIV prevalence among women, measures should be taken to prevent transmission among sero-discordant couples. Trial registration NCT01433601
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9
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Chan BT, Pradeep A, Prasad L, Murugesan V, Chandrasekaran E, Kumarasamy N, Mayer KH. Prevalence and correlates of psychosocial conditions among people living with HIV in southern India. AIDS Care 2016; 29:746-750. [PMID: 27643850 DOI: 10.1080/09540121.2016.1231887] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Psychosocial conditions such as depression, intimate partner violence (IPV), and history of childhood sexual abuse (CSA) have been associated with poor HIV-related outcomes. In India, which has the third largest HIV epidemic in the world, little is understood about the impact of psychosocial conditions on people living with HIV (PLHIV). We aimed to understand the prevalence and correlates of psychosocial conditions among PLHIV entering into HIV care at the Y.R. Gaitonde Centre for AIDS Research and Education in Chennai, India. Thirteen questions were added to the standard voluntary counseling and testing questionnaire, including the Patient Health Questionnaire-9 (a depression scale) and questions assessing for CSA and IPV. We fitted logistic regression models, stratified by gender, with psychosocial condition as the outcome of interest and substance use variables and socio-demographic variables as the correlates of interest. Three hundred and eighty-three persons were enrolled into the study; of these, 253 (66%) tested positive for HIV, including 149 men and 104 women, and were included in the models. More than one-quarter (28%) of the men and 19% of the women reported at least one psychosocial condition (probable depression, CSA, or IPV). In adjusted analysis, current alcohol use was associated with greater than two times higher odds of a psychosocial condition (Adjusted Odds Ratio = 2.24, 95% CI, 1.04-4.85) among men. In conclusion, we estimated the prevalence of probable depression, CSA, and IPV among PLHIV presenting for HIV care in southern India and found that, among male PLHIV, alcohol use was associated with a markedly higher odds of reporting a psychosocial condition. Further study is needed to characterize alcohol use among male PLHIV and the possible deleterious impact of psychosocial conditions and alcohol use on HIV-related outcomes in India.
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Affiliation(s)
- Brian T Chan
- a Division of Infectious Diseases , Brigham and Women's Hospital , Boston , MA , USA.,b Harvard Medical School , Boston , MA , USA
| | - Amrose Pradeep
- c Y. R. Gaitonde Centre for AIDS Research and Education , Chennai , India
| | - Lakshmi Prasad
- c Y. R. Gaitonde Centre for AIDS Research and Education , Chennai , India
| | | | | | | | - Kenneth H Mayer
- b Harvard Medical School , Boston , MA , USA.,d Division of Infectious Diseases , Beth Israel Deaconess Medical Center , Boston , MA , USA.,e Fenway Health , Boston , MA , USA
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Mungati M, Mhangara M, Dzangare J, Mugurungi O, Apollo T, Gonese E, Kilmarx PH, Chakanyuka-Musanhu CC, Shambira G, Tshimanga M. Results from implementing updated 2012 World Health Organization Guidance on early-warning indicators of HIV drug resistance in Zimbabwe. ACTA ACUST UNITED AC 2016; 2:85-91. [PMID: 29862318 DOI: 10.5430/jer.v2n2p85] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Objective This study evaluated the performance of sentinel sites in preventing the emergence of HIVDR using Early Warning Indicators (HIVDR EWI) survey. Methods Adult and paediatric patient data on: On time pill pick up, Retention in care, Pharmacy stock-outs, and Dispensing practices was collected. Information from pharmacy registers was verified using facility-held cards. This was a cross-sectional analysis of retrospectively collected data from 72 sites providing both adult and paediatric ART as well as two providing adult ART only. All data were entered into and analysed using a WHO EWI data abstraction electronic tool. Results Twenty-one percent of sites providing adult and 4.2% of sites providing paediatric ART managed to meet the target for on time pill pick up. Retention in care indicator was met by 48.7% (95% CI: 36.9-60.6) of sites. ARV stock-outs occurred in 81.1% (95% CI: 70-89.3) adult sites and 63.9% (95% CI: 50-78.6) paediatric sites. ARVs were appropriately dispensed by 86.5% (95% CI: 75.6-93.3) of adult sites and 84.7% (95% CI: 74.3-92.1) of paediatric sites. Conclusions Most sites had low performance in many indicators in this survey and failed to meet the recommended targets. Some policies such as the current buffer stock and storage outside Harare should be revised in order to improve site access to ARVs. The country should prioritize the provision of viral load testing services in all provinces. The electronic patient management system should be rolled out to all ART sites to improve patient tracking and monitoring by sites.
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Affiliation(s)
- More Mungati
- AIDS and TB Unit, Ministry of Health and Child Care, Harare, Zimbabwe.,Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe
| | - Mutsa Mhangara
- AIDS and TB Unit, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Janet Dzangare
- AIDS and TB Unit, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Owen Mugurungi
- AIDS and TB Unit, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Tsitsi Apollo
- AIDS and TB Unit, Ministry of Health and Child Care, Harare, Zimbabwe
| | | | - Peter H Kilmarx
- Centers for Disease Control and Prevention, Harare, Zimbabwe
| | | | - Gerald Shambira
- Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe
| | - Mufuta Tshimanga
- Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe
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De La Mata NL, Kumarasamy N, Khol V, Ng OT, Van Nguyen K, Merati TP, Pham TT, Lee MP, Durier N, Law M. Improved survival in HIV treatment programmes in Asia. Antivir Ther 2016; 21:517-527. [PMID: 26961354 DOI: 10.3851/imp3041] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2016] [Indexed: 01/26/2023]
Abstract
BACKGROUND Antiretroviral treatment (ART) for HIV-positive patients has expanded rapidly in Asia over the last 10 years. Our study aimed to describe the time trends and risk factors for overall survival in patients receiving first-line ART in Asia. METHODS We included HIV-positive adult patients who initiated ART between 2003-2013 (n=16,546), from seven sites across six Asia-Pacific countries. Patient follow-up was to May 2014. We compared survival for each country and overall by time period of ART initiation using Kaplan-Meier curves. Factors associated with mortality were assessed using Cox regression, stratified by site. We also summarized first-line ART regimens, CD4+ T-cell count at ART initiation, and CD4+ T-cell and HIV viral load testing frequencies. RESULTS There were 880 deaths observed over 54,532 person-years of follow-up, a crude rate of 1.61 (95% CI 1.51, 1.72) per 100 person-years. Survival significantly improved in more recent years of ART initiation. The survival probability at 4 years follow-up for those initiating ART in 2003-2005 was 92.1%, 2006-2009 was 94.3% and 2010-2013 was 94.5% (P<0.001). Factors associated with higher mortality risk included initiating ART in earlier time periods, older age, male sex, injecting drug use as HIV exposure and lower pre-ART CD4+ T-cell count. Concurrent with improved survival was increased tenofovir use, ART initiation at higher CD4+ T-cell counts and greater monitoring of CD4+ T-cells and HIV viral load. CONCLUSIONS Our results suggest that HIV-positive patients from Asia have improved survival in more recent years of ART initiation. This is likely a consequence of improvements in treatment, patient management and monitoring over time.
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Affiliation(s)
| | - Nagalingeswaran Kumarasamy
- Chennai Antiviral Research and Treatment Clinical Research Site (CART CRS), YRGCARE Medical Centre, VHS, Chennai, India
| | - Vohith Khol
- National Center for HIV/AIDS, Dermatology & STDs, Phnom Penh, Cambodia
| | - Oon Tek Ng
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
| | | | - Tuti Parwati Merati
- Department of Internal Medicine, Faculty of Medicine Udayana University & Sanglah Hospital, Bali, Indonesia
| | | | - Man Po Lee
- Department of Medicine, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - Nicolas Durier
- TREAT Asia, amfAR, The Foundation for AIDS Research, Bangkok, Thailand
| | - Matthew Law
- The Kirby Institute, UNSW Australia, Sydney, NSW, Australia
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Brief Report: Long-term Outcomes and Their Determinants in Patients on Antiretroviral Treatment in Ethiopia, 2005/6-2011/12: A Retrospective Cohort Study. J Acquir Immune Defic Syndr 2016; 70:414-9. [PMID: 26181823 DOI: 10.1097/qai.0000000000000753] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Antiretroviral treatment (ART) programs in many resource-limited settings have expanded treatment toward universal access. Ethiopia is one of the countries that has been scaling up ART toward universal access, but with very few data on long-term outcomes and their determinants. The objective of this study was to identify the level of long-term outcomes and their determinants in patients on ART in Ethiopia. METHODS A retrospective cohort study was conducted in 3 health facilities (2 hospitals and 1 health center) between July and September, 2014. Loss to follow-up, death, attrition, and retention were the primary outcomes. Data were collected from patient registers and medical records for the period 2005/6-2011/12. RESULTS A total of 11,731 patients were included in the study. The overall retention rate was 78 per 100 person-months. Retention rates were 82%, 74%, and 72% at 24, 60, and 84 months on ART, respectively. Retention was associated with male sex, adolescent age, marital status, advanced HIV disease, illiteracy, and peer-support services; however, long-term retention was associated independently with only male sex [with adjusted hazard ratio (aHR) 0.68 (0.56 to 0.77)], married patients [with aHR 0.62 (0.54 to 0.72)], and peer-support services [with aHR 1.62 (1.58 to 1.66)]. DISCUSSION AND CONCLUSIONS ART programs have lost most of their patients during the first 24 months on ART. It is, therefore, imperative that HIV/ART programs ensure people are tested, linked to care, and initiated on ART early. ART programs should also design and implement interventions, including peer-support services, which are targeted to male, adolescent, unmarried, and illiterate patients.
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Phanuphak N, Lo YR, Shao Y, Solomon SS, O'Connell RJ, Tovanabutra S, Chang D, Kim JH, Excler JL. HIV Epidemic in Asia: Implications for HIV Vaccine and Other Prevention Trials. AIDS Res Hum Retroviruses 2015; 31:1060-76. [PMID: 26107771 DOI: 10.1089/aid.2015.0049] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
An overall decrease of HIV prevalence is now observed in several key Asian countries due to effective prevention programs. The decrease in HIV prevalence and incidence may further improve with the scale-up of combination prevention interventions. The implementation of future prevention trials then faces important challenges. The opportunity to identify heterosexual populations at high risk such as female sex workers may rapidly wane. With unabating HIV epidemics among men who have sex with men (MSM) and transgender (TG) populations, an effective vaccine would likely be the only option to turn the epidemic. It is more likely that efficacy trials will occur among MSM and TG because their higher HIV incidence permits smaller and less costly trials. The constantly evolving patterns of HIV-1 diversity in the region suggest close monitoring of the molecular HIV epidemic in potential target populations for HIV vaccine efficacy trials. CRF01_AE remains predominant in southeast Asian countries and MSM populations in China. This relatively steady pattern is conducive to regional efficacy trials, and as efficacy warrants, to regional licensure. While vaccines inducing nonneutralizing antibodies have promise against HIV acquisition, vaccines designed to induce broadly neutralizing antibodies and cell-mediated immune responses of greater breadth and depth in the mucosal compartments should be considered for testing in MSM and TG. The rationale and design of efficacy trials of combination prevention modalities such as HIV vaccine and preexposure prophylaxis (PrEP) remain hypothetical, require high adherence to PrEP, are more costly, and present new regulatory challenges. The prioritization of prevention interventions should be driven by the HIV epidemic and decided by the country-specific health and regulatory authorities. Modeling the impact and cost-benefit may help this decision process.
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Affiliation(s)
| | - Ying-Ru Lo
- HIV, Hepatitis, and STI Unit, WHO Regional Office for the Western Pacific, Manila, Philippines
| | - Yiming Shao
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Sunil Suhas Solomon
- Johns Hopkins University School of Medicine, Baltimore, Maryland
- Y.R. Gaitonde Centre for AIDS Research and Education (YRG CARE), Chennai, India
| | - Robert J. O'Connell
- Department of Retrovirology, U.S. Army Medical Component, Armed Forces Institute of Medical Sciences (AFRIMS), Bangkok, Thailand
| | - Sodsai Tovanabutra
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - David Chang
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Jerome H. Kim
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Jean Louis Excler
- U.S. Military HIV Research Program, Bethesda, Maryland
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
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Pham QD, Wilson DP, Kerr CC, Shattock AJ, Do HM, Duong AT, Nguyen LT, Zhang L. Estimating the Cost-Effectiveness of HIV Prevention Programmes in Vietnam, 2006-2010: A Modelling Study. PLoS One 2015. [PMID: 26196290 PMCID: PMC4510535 DOI: 10.1371/journal.pone.0133171] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Introduction Vietnam has been largely reliant on international support in its HIV response. Over 2006-2010, a total of US$480 million was invested in its HIV programmes, more than 70% of which came from international sources. This study investigates the potential epidemiological impacts of these programmes and their cost-effectiveness. Methods We conducted a data synthesis of HIV programming, spending, epidemiological, and clinical outcomes. Counterfactual scenarios were defined based on assumed programme coverage and behaviours had the programmes not been implemented. An epidemiological model, calibrated to reflect the actual epidemiological trends, was used to estimate plausible ranges of programme impacts. The model was then used to estimate the costs per averted infection, death, and disability adjusted life-year (DALY). Results Based on observed prevalence reductions amongst most population groups, and plausible counterfactuals, modelling suggested that antiretroviral therapy (ART) and prevention programmes over 2006-2010 have averted an estimated 50,600 [95% uncertainty bound: 36,300–68,900] new infections and 42,600 [36,100–54,100] deaths, resulting in 401,600 [312,200–496,300] fewer DALYs across all population groups. HIV programmes in Vietnam have cost an estimated US$1,972 [1,447–2,747], US$2,344 [1,843–2,765], and US$248 [201–319] for each averted infection, death, and DALY, respectively. Conclusions Our evaluation suggests that HIV programmes in Vietnam have most likely had benefits that are cost-effective. ART and direct HIV prevention were the most cost-effective interventions in reducing HIV disease burden.
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Affiliation(s)
- Quang Duy Pham
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
- Department for Disease Control and Prevention, Pasteur Institute, Ho Chi Minh City, Vietnam
| | - David P. Wilson
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Cliff C. Kerr
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Andrew J. Shattock
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Hoa Mai Do
- Department of Health System, Hanoi School of Public Health, Hanoi, Vietnam
| | - Anh Thuy Duong
- Department of Planning and Finance, Vietnam Administration of HIV/AIDS Control, Hanoi, Vietnam
| | | | - Lei Zhang
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- * E-mail:
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Estimated age and gender profile of individuals missed by a home-based HIV testing and counselling campaign in a Botswana community. J Int AIDS Soc 2015; 18:19918. [PMID: 26028155 PMCID: PMC4450241 DOI: 10.7448/ias.18.1.19918] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 03/23/2015] [Accepted: 05/06/2015] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION It would be useful to understand which populations are not reached by home-based HIV-1 testing and counselling (HTC) to improve strategies aimed at linking these individuals to care and reducing rates of onward HIV transmission. METHODS We present the results of a baseline home-based HTC (HBHTC) campaign aimed at counselling and testing residents aged 16 to 64 for HIV in the north-eastern sector of Mochudi, a community in Botswana with about 44,000 inhabitants. Collected data were compared with population references for Botswana, the United Nations (UN) estimates based on the National Census data and the Botswana AIDS Impact Survey IV (BAIS-IV). Analyzed data and references were stratified by age and gender. RESULTS A total of 6238 age-eligible residents were tested for HIV-1; 1247 (20.0%; 95% CI 19.0 to 21.0%) were found to be HIV positive (23.7% of women vs. 13.4% of men). HIV-1 prevalence peaked at 44% in 35- to 39-year-old women and 32% in 40- to 44-year-old men. A lower HIV prevalence rate, 10.9% (95% CI 9.5 to 12.5%), was found among individuals tested for the first time. A significant gender gap was evident in all analyzed subsets. The existing HIV transmission network was analyzed by combining phylogenetic mapping and household structure. Between 62.4 and 71.8% of all HIV-positive individuals had detectable virus. When compared with the UN and BAIS-IV estimates, the proportion of men missed by the testing campaign (48.5%; 95% CI 47.0 to 50.0%) was significantly higher than the proportion of missed women (14.2%; 95% CI 13.2 to 15.3%; p<0.0001). The estimated proportion of missed men peaked at about 60% in the age group 30 to 39 years old. The proportions of missed women were substantially smaller, at approximately 28% within the age groups 30 to 34 and 45 to 49 years old. CONCLUSIONS The HBHTC campaign seems to be an efficient tool for reaching individuals who have never been tested previously in southern African communities. However, about half of men from 16 to 64 years old were not reached by the HBHTC, including about 60% of men between 30 and 40 years old. Alternative HTC strategies should be developed to bring these men to care, which will contribute to reduction of HIV incidence in communities.
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Fujita M, Poudel KC, Green K, Wi T, Abeyewickreme I, Ghidinelli M, Kato M, Vun MC, Sopheap S, San KO, Bollen P, Rai KK, Dahal A, Bhandari D, Boas P, Yaipupu J, Sirinirund P, Saonuam P, Duong BD, Nhan DT, Thu NTM, Jimba M. HIV service delivery models towards 'Zero AIDS-related Deaths': a collaborative case study of 6 Asia and Pacific countries. BMC Health Serv Res 2015; 15:176. [PMID: 25902708 PMCID: PMC4421992 DOI: 10.1186/s12913-015-0804-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Accepted: 03/19/2015] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND In the Asia-Pacific region, limited systematic assessment has been conducted on HIV service delivery models. Applying an analytical framework of the continuum of prevention and care, this study aimed to assess HIV service deliveries in six Asia and Pacific countries from the perspective of service availability, linking approaches and performance monitoring for maximizing HIV case detection and retention. METHODS Each country formed a review team that provided published and unpublished information from the national HIV program. Four types of continuum were examined: (i) service linkages between key population outreach and HIV diagnosis (vertical-community continuum); (ii) chronic care provision across HIV diagnosis and treatment (chronological continuum); (iii) linkages between HIV and other health services (horizontal continuum); and (iv) comprehensive care sites coordinating care provision (hub and heart of continuum). RESULTS Regarding the vertical-community continuum, all districts had voluntary counselling and testing (VCT) in all countries except for Myanmar and Vietnam. In these two countries, limited VCT availability was a constraint for referring key populations reached. All countries monitored HIV testing coverage among key populations. Concerning the chronological continuum, the proportion of districts/townships having antiretroviral treatment (ART) was less than 70% except in Thailand, posing a barrier for accessing pre-ART/ART care. Mechanisms for providing chronic care and monitoring retention were less developed for VCT/pre-ART process compared to ART process in all countries. On the horizontal continuum, the availability of HIV testing for tuberculosis patients and pregnant women was limited and there were sub-optimal linkages between tuberculosis, antenatal care and HIV services except for Cambodia and Thailand. These two countries indicated higher HIV testing coverage than other countries. Regarding hub and heart of continuum, all countries had comprehensive care sites with different degrees of community involvement. CONCLUSIONS The analytical framework was useful to identify similarities and considerable variations in service availability and linking approaches across the countries. The study findings would help each country critically adapt and adopt global recommendations on HIV service decentralization, linkages and integration. Especially, the findings would inform cross-fertilization among the countries and national HIV program reviews to determine county-specific measures for maximizing HIV case detection and retention.
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Affiliation(s)
- Masami Fujita
- World Health Organization Cambodia, P.O. Box 1217, , No. 177-179 Pasteur (St.51), Sangkat Chak Tomouk, Phnom Penh, Cambodia.
| | - Krishna C Poudel
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, USA.
| | | | - Teodora Wi
- World Health Organization, Geneva, Switzerland.
| | - Iyanthi Abeyewickreme
- Formerly World Health Organization Regional Office for South-East Asia, New Delhi, India.
| | - Massimo Ghidinelli
- Pan American Health Organization, World Health Organization Regional Office for the Americas, Washington, DC, USA.
| | | | - Mean Chhi Vun
- National Center for HIV/AIDS, Dermatology and STD, Ministry of Health, Phnom Penh, Cambodia.
| | - Seng Sopheap
- National Center for HIV/AIDS, Dermatology and STD, Ministry of Health, Phnom Penh, Cambodia.
| | - Khin Ohnmar San
- Formerly National AIDS Program, Ministry of Health, Nay Pyi Taw, Myanmar.
| | | | - Krishna Kumar Rai
- National Center for AIDS and STD Control, Ministry of Health, Kathmandu, Nepal.
| | - Atul Dahal
- World Health Organization, Kathmandu, Nepal.
| | | | - Peniel Boas
- STI, HIV and AIDS Surveillance Unit, Ministry of Health, Port Moresby, Papua New Guinea.
| | | | - Petchsri Sirinirund
- National AIDS Management Center, Ministry of Public Health, Bangkok, Thailand.
| | - Pairoj Saonuam
- National AIDS Management Center, Ministry of Public Health, Bangkok, Thailand.
| | - Bui Duc Duong
- Vietnam Authority of HIV/AIDS Control, Ministry of Health, Hanoi, Vietnam.
| | - Do Thi Nhan
- Vietnam Authority of HIV/AIDS Control, Ministry of Health, Hanoi, Vietnam.
| | | | - Masamine Jimba
- Department of Community and Global Health, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
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Allam RR, Murhekar MV, Bhatnagar T, Uthappa CK, Nalini C, Rewari BB, Mehendale SM. Predictors of immunological failure and determinants of suboptimal CD4 testing among adults with HIV on first-line antiretroviral therapy in Andhra Pradesh, India, 2008-2011. Trans R Soc Trop Med Hyg 2015; 109:325-33. [PMID: 25778736 DOI: 10.1093/trstmh/trv018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 02/12/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Failure of first-line antiretroviral therapy (ART) results in high morbidity and mortality. We identified the predictors of immunological failure and suboptimal CD4 testing among adult people living with HIV (PLHIV) initiated on first-line ART. METHODS The cohort of PLHIV aged ≥ 15 years initiated on first-line ART in Hyderabad city, Andhra Pradesh state, in 2008 was followed-up until 31 December 2011 or until death and/or lost to follow-up (LFU). We estimated cumulative incidence of immunological failure. We explored socio-demographic, clinical, pharmacological and immunological factors to identify the predictors of immunological failure and determinants of suboptimal CD4 testing (<2 tests/year). RESULTS Among the 1431 PLHIV, 275 (19.2%) died and 263 (18.4%) were LFU. Of the remaining 893 (62.3%) patients on follow-up, 193 (21.6%) experienced immunological failure; these patients were more likely to be males, illiterate, with a history of pulmonary TB while on ART and taking stavudine-based regimen. Incidence of suboptimal testing ranged between 41 and 60% over 4 years of follow-up. Suboptimal CD4 testing among PLHIV was associated with history of TB prior to initiation of ART and stage 3 and 4 of HIV disease at enrollment. CONCLUSIONS There was low immunological failure rate but high incidence of suboptimal CD4 testing. The ART centre staff needs to be more vigilant about 6-monthly CD4 testing for timely detection of immunological failure and appropriate case management.
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Affiliation(s)
- Ramesh R Allam
- National Institute of Epidemiology, Indian Council of Medical Research, Chennai, India SHARE India, Hyderabad, India
| | - Manoj V Murhekar
- National Institute of Epidemiology, Indian Council of Medical Research, Chennai, India
| | - Tarun Bhatnagar
- National Institute of Epidemiology, Indian Council of Medical Research, Chennai, India
| | | | | | - B B Rewari
- National AIDS Control Organization, New Delhi, India
| | - Sanjay M Mehendale
- National Institute of Epidemiology, Indian Council of Medical Research, Chennai, India
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Han N, Wright ST, O'Connor CC, Hoy J, Ponnampalavanar S, Grotowski M, Zhao HX, Kamarulzaman A. HIV and aging: insights from the Asia Pacific HIV Observational Database (APHOD). HIV Med 2014; 16:152-60. [PMID: 25407085 DOI: 10.1111/hiv.12188] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2014] [Indexed: 12/22/2022]
Abstract
OBJECTIVES The proportion of people living with HIV/AIDS in the ageing population (>50 years old) is increasing. We aimed to explore the relationship between older age and treatment outcomes in HIV-positive persons from the Asia Pacific region. METHODS Patients from the Australian HIV Observational Database (AHOD) and the TREAT Asia HIV Observational Database (TAHOD) were included in the analysis. We used survival methods to assess the association between older age and all-cause mortality, as well as time to treatment modification. We used regression analyses to evaluate changes in CD4 counts after combination antiretroviral therapy (cART) initiation and determined the odds of detectable viral load, up to 24 months of treatment. RESULTS A total of 7142 patients were included in these analyses (60% in TAHOD and 40% in AHOD), of whom 25% were >50 years old. In multivariable analyses, those aged > 50 years were at least twice as likely to die as those aged 30-39 years [hazard ratio (HR) for 50-59 years: 2.27; 95% confidence interval (CI) 1.34-3.83; HR for > 60 years: 4.28; 95% CI 2.42-7.55]. The effect of older age on CD4 count changes was insignificant (p-trend=0.06). The odds of detectable viral load after cART initiation decreased with age (p-trend=< 0.0001). The effect of older age on time to first treatment modification was insignificant (p-trend=0.21). We found no statistically significant differences in outcomes between AHOD and TAHOD participants for all endpoints examined. CONCLUSIONS The associations between older age and typical patient outcomes in HIV-positive patients from the Asia Pacific region are similar in AHOD and TAHOD. Our data indicate that 'age effects' traverse the resource-rich and resource-limited divide and that future ageing-related findings might be applicable to each setting.
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Affiliation(s)
- N Han
- Beijing Ditan Hospital, Capital Medical University, Beijing, China
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Thida A, Tun STT, Zaw SKK, Lover AA, Cavailler P, Chunn J, Aye MM, Par P, Naing KW, Zan KN, Shwe M, Kyaw TT, Waing ZH, Clevenbergh P. Retention and risk factors for attrition in a large public health ART program in Myanmar: a retrospective cohort analysis. PLoS One 2014; 9:e108615. [PMID: 25268903 PMCID: PMC4182661 DOI: 10.1371/journal.pone.0108615] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 09/01/2014] [Indexed: 11/28/2022] Open
Abstract
Background The outcomes from an antiretroviral treatment (ART) program within the public sector in Myanmar have not been reported. This study documents retention and the risk factors for attrition in a large ART public health program in Myanmar. Methods A retrospective analysis of a cohort of adult patients enrolled in the Integrated HIV Care (IHC) Program between June 2005 and October 2011 and followed up until April 2012 is presented. The primary outcome was attrition (death or loss-follow up); a total of 10,223 patients were included in the 5-year cumulative survival analysis. Overall 5,718 patients were analyzed for the risk factors for attrition using both logistic regression and flexible parametric survival models. Result The mean age was 36 years, 61% of patients were male, and the median follow up was 13.7 months. Overall 8,564 (84%) patients were retained in ART program: 750 (7%) were lost to follow-up and 909 (9%) died. During the 3 years follow-up, 1,542 attritions occurred over 17,524 person years at risk, giving an incidence density of 8.8% per year. The retention rates of participants at 12, 24, 36, 48 and 60 months were 86, 82, 80, 77 and 74% respectively. In multivariate analysis, being male, having high WHO staging, a low CD4 count, being anaemic or having low BMI at baseline were independent risk factors for attrition; tuberculosis (TB) treatment at ART initiation, a prior ART course before program enrollment and literacy were predictors for retention in the program. Conclusion High retention rate of IHC program was documented within the public sector in Myanmar. Early diagnosis of HIV, nutritional support, proper investigation and treatment for patients with low CD4 counts and for those presenting with anaemia are crucial issues towards improvement of HIV program outcomes in resource-limited settings.
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Affiliation(s)
- Aye Thida
- The Union Office in Myanmar, International Union Against Tuberculosis and Lung Disease, Mandalay, Myanmar
- * E-mail:
| | - Sai Thein Than Tun
- The Union Office in Myanmar, International Union Against Tuberculosis and Lung Disease, Mandalay, Myanmar
| | - Sai Ko Ko Zaw
- The Union Office in Myanmar, International Union Against Tuberculosis and Lung Disease, Mandalay, Myanmar
| | - Andrew A. Lover
- Infectious Diseases Programme, Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | | | - Jennifer Chunn
- Maths and Statistics Help Centre, James Cook University, Singapore
| | - Mar Mar Aye
- Medical Care Division, Department of Health, Mandalay, Myanmar
| | - Par Par
- Medical Care Division, Department of Health, Mandalay, Myanmar
| | - Kyaw Win Naing
- Medical Care Division, Department of Health, Mandalay, Myanmar
| | - Kaung Nyunt Zan
- Medical Care Division, Department of Health, Mandalay, Myanmar
| | - Myint Shwe
- National AIDS Program, Department of Health, Nay Pyi Taw, Myanmar
| | - Thar Tun Kyaw
- Disease Control Division, Department of Health, Nay Pyi Taw, Myanmar
| | - Zaw Htoon Waing
- The Union Office in Myanmar, International Union Against Tuberculosis and Lung Disease, Mandalay, Myanmar
| | - Philippe Clevenbergh
- The Union Office in Myanmar, International Union Against Tuberculosis and Lung Disease, Mandalay, Myanmar
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Lo YR, Kato M, Phanuphak N, Fujita M, Duc DB, Sopheap S, Pendse R, Yu D, Wu Z, Chariyalertsak S. Challenges and potential barriers to the uptake of antiretroviral-based prevention in Asia and the Pacific region. Sex Health 2014; 11:126-36. [DOI: 10.1071/sh13094] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2013] [Accepted: 03/11/2014] [Indexed: 01/06/2023]
Abstract
Evidence has emerged over the past few years on the effectiveness of antiretroviral-based prevention technologies to prevent (i) HIV transmission while decreasing morbidity and mortality in HIV-infected persons, and (ii) HIV acquisition in HIV-uninfected individuals through pre-exposure prophylaxis (PrEP). Only few of the planned studies on treatment as prevention (TasP) are conducted in Asia. TasP might be more feasible and effective in concentrated rather than in generalised epidemics, as resources for HIV testing and antiretroviral treatment could focus on confined and much smaller populations than in the generalised epidemics observed in sub-Saharan Africa. Several countries such as Cambodia, China, Thailand and Vietnam, are now paving the way to success. Similar challenges arise for both TasP and PrEP. However, the operational issues for PrEP are amplified by the need for frequent retesting and ensuring adherence. This paper describes challenges for the implementation of antiretroviral-based prevention and makes the case that TasP and PrEP implementation research in Asia is much needed to provide insights into the feasibility of these interventions in populations where firm evidence of ‘real world’ effectiveness is still lacking.
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Conseil A, Mounier-Jack S, Rudge JW, Coker R. Assessing the effects of HIV/AIDS and TB disease control programmes on health systems in low- and middle-income countries of Southeast Asia: a semi-systematic review of the literature. Public Health 2013; 127:1063-73. [PMID: 24275033 DOI: 10.1016/j.puhe.2013.09.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 09/23/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To systematically review the literature on if and how HIV/AIDS and TB programmes have impacted on general healthcare systems in Association of Southeast Asian Nations (ASEAN) countries. METHODS Medline, Embase, Global Health and CINHAL were searched for English language literature published between 1st January 2003 and 31st March 2011. Papers included had to focus on: HIV and/or TB control programmes; the low- and-middle-income ASEAN countries; and factors related to any health systems functions. The effects were examined along six system functions: Stewardship and Governance; Financing; Planning; Service Delivery; Monitoring and Evaluation; and Demand Generation. A comprehensive thematic analytical tool aligned with the above six health systems functions was developed to support data extraction and analysis. FINDINGS 88 papers met the inclusion criteria. Most programme effects highlighted were related with health service delivery. The other five health system functions were seldom scrutinized, and each covered by less than a quarter of papers. Overall 69% of effects highlighted were positive effects whereas 31% were negative. CONCLUSION There was a paucity of robust evidence. Effects on health systems were rarely a focus of research protocols but more often a minor component in the Results/Discussion sections. Particular attention should be paid by Global Health Initiatives to the negative effects that emerged from this study, such as the development of parallel systems, specific incentives not available to the general health systems, and lack of integration of services with private healthcare providers.
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Affiliation(s)
- A Conseil
- Department of Global Health Development, Faculty of Public Health Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK.
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Zhu H, Napravnik S, Eron JJ, Cole SR, Ma Y, Wohl DA, Dou Z, Zhang Y, Liu Z, Zhao D, Yu L, Liu X, Cohen MS, Zhang F. Decreasing excess mortality of HIV-infected patients initiating antiretroviral therapy: comparison with mortality in general population in China, 2003-2009. J Acquir Immune Defic Syndr 2013; 63:e150-7. [PMID: 23572014 DOI: 10.1097/qai.0b013e3182948d82] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate excess mortality across calendar time comparing HIV-infected patients receiving combination antiretroviral therapy (cART) with the general Chinese population. METHODS Patients receiving free cART through the National Free Antiretroviral Therapy Program (NFATP) between January 1, 2003, and December 31, 2009, were included. Observed mortality rates, excess mortality rates, and standardized mortality ratios were calculated by calendar periods. Factors associated with excess mortality across calendar time were evaluated in multivariable Poisson regression models. RESULTS Among 64,836 HIV-infected patients, the observed and excess mortality rates in 2003-2004 were 9.5 deaths per 100 person-years [95% confidence interval (CI): 8.8 to 10.2] and 9.1 (95% CI: 8.5 to 9.8); in 2008-2009, these decreased to 5.6 (95% CI: 5.4 to 5.8) and 5.2 (95% CI: 5.0 to 5.4), respectively. The adjusted excess hazard ratio (eHR) for 2003-2004 in comparison to 2008-2009 was 1.27 (95% CI: 1.11 to 1.45). Patients initiating cART at CD4 cell counts <50 cells per microliter in comparison with ≥350 cells per microliter had an adjusted eHR of 9.92 (95% CI: 8.59 to 11.44). Patients starting cART at older ages also had greater excess mortality with an eHR of 1.63 (95% CI: 1.47 to 1.82) comparing ages ≥45 to 18-29 years. Standardized mortality ratio results were consistent with those for excess mortality. CONCLUSIONS Substantial decreases in excess mortality were observed from 2003 to 2009 in China among HIV-infected patients receiving free cART. However, mortality among HIV-infected patients remained higher than the general Chinese population. As more efficacious first- and second-line cART regimens become increasingly available to Chinese HIV-infected patients, further reductions in overall and excess mortality are likely.
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Affiliation(s)
- Hao Zhu
- *Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC; †Division of Treatment and Care, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China; ‡Division of Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, NC; and §Division of Infectious Diseases, Beijing Ditan Hospital Capital Medical University, Beijing, China
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Poudel KC, Palmer PH, Jimba M, Mizoue T, Kobayashi J, Poudel-Tandukar K. Coinfection with Hepatitis C Virus among HIV-Positive People in the Kathmandu Valley, Nepal. ACTA ACUST UNITED AC 2013; 13:277-83. [DOI: 10.1177/2325957413500989] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Previous research has studied the rate of hepatitis C virus (HCV) coinfection among HIV-positive people regardless of their antiretroviral therapy (ART) status. Our objectives were to measure the seroprevalence of HCV both in HIV-positive people receiving ART and in those not receiving ART and to describe the characteristics of coinfected people in the Kathmandu Valley, Nepal. Methods: We conducted a cross-sectional survey of 319 HIV-positive people residing in the Kathmandu Valley, Nepal. We screened the participants’ serum samples for HCV antibodies using the Latex Photometric Immunoassay based on third-generation assay. Results: A total of 138 (43.3%) participants were HCV positive. The prevalence of HCV coinfection was 96.2% (125 of 130) among participants with lifetime injection drug use (IDU). Among participants not receiving ART, the coinfection rate was 58.1% (50 of 86) compared with 37.8% (88 of 233) among those receiving ART. In multivariable analysis, participants who reported lifetime IDU and were current smokers were more likely to have HCV coinfection. The adjusted odds ratio (AOR) of HCV coinfection for ART was decreased, although it was not statistically significant (AOR = 0.45; 95% confidence interval = 0.13-1.48). Conclusion: The high prevalence of HCV coinfection among both individuals receiving ART and those not receiving ART suggests that screening for HCV among HIV-positive people would be useful, in particular, for those with lifetime IDU and soon after their HIV diagnosis.
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Affiliation(s)
- Krishna C. Poudel
- Department of Public Health, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Paula H. Palmer
- School of Community and Global Health, Claremont Graduate University, Claremont, CA, USA
| | - Masamine Jimba
- Department of Community and Global Health, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Tetsuya Mizoue
- Department of Epidemiology and Prevention, National Center for Global Health and Medicine, Tokyo, Japan
| | - Jun Kobayashi
- Bureau of International Medical Cooperation, National Center for Global Health and Medicine, Tokyo, Japan
- Department of Global Health, School of Health Sciences, University of the Ryukyus, Okinawa, Japan
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Alvarez-Uria G, Naik PK, Pakam R, Midde M. Factors associated with attrition, mortality, and loss to follow up after antiretroviral therapy initiation: data from an HIV cohort study in India. Glob Health Action 2013; 6:21682. [PMID: 24028937 PMCID: PMC3773168 DOI: 10.3402/gha.v6i0.21682] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 08/22/2013] [Accepted: 08/23/2013] [Indexed: 01/08/2023] Open
Abstract
Background Studies from sub-Saharan Africa have shown high incidence of attrition due to mortality or loss to follow-up (LTFU) after initiating antiretroviral therapy (ART). India is the third largest country in the world in terms of HIV infected people, but predictors of attrition after ART initiation are not well known. Design We describe factors associated with attrition, mortality, and LTFU in 3,159 HIV infected patients who initiated ART between 1 January 2007 and 4 November 2011 in an HIV cohort study in India. The study included 6,852 person-years with a mean follow-up of 2.17 years. Results After 5 years of follow-up, the estimated cumulative incidence of attrition was 37.7%. There was no significant difference between attrition due to mortality and attrition due to LTFU. Having CD4 counts <100 cells/µl and being homeless [adjusted hazard ratio (aHR) 3.1, 95% confidence interval (CI) 2.6–3.8] were associated with a higher risk of attrition, and female gender (aHR 0.64, 95% CI 0.6–0.8) was associated with a reduced risk of attrition. Living near a town (aHR 0.82, 95% CI 0.7–0.999) was associated with a reduced risk of mortality. Being single (aHR 1.6, 95% CI 1.2–2.3), illiteracy (aHR 1.3, 95% CI 1.1–1.6), and age <25 years (aHR 1.3, 95% CI 1–1.8) were associated with an increased risk of LTFU. Although the cumulative incidence of attrition in patients diagnosed with tuberculosis after ART initiation was 47.4%, patients who started anti-tuberculous treatment before ART had similar attrition to patients without tuberculosis (36 vs. 35.2%, P=0.19) after four years of follow-up. Conclusions In this cohort study, the attrition was similar to the one found in sub-Saharan Africa. Earlier initiation of ART, improving the diagnosis of tuberculosis before initiating ART, and giving more support to those patients at higher risk of attrition could potentially reduce the mortality and LTFU after ART initiation.
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Affiliation(s)
- Gerardo Alvarez-Uria
- Department of Infectious Diseases, Rural Development Trust Hospital, Bathalapalli, India;
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Rilpivirine resistance-associated mutations among antiretroviral-naive patients infected with HIV-1 in Asia. J Acquir Immune Defic Syndr 2013; 62:e98-100. [PMID: 23924642 DOI: 10.1097/qai.0b013e31827a34b2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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An HIV Vaccine for South-East Asia-Opportunities and Challenges. Vaccines (Basel) 2013; 1:348-66. [PMID: 26344118 PMCID: PMC4494230 DOI: 10.3390/vaccines1030348] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 07/25/2013] [Accepted: 08/05/2013] [Indexed: 11/17/2022] Open
Abstract
Recent advances in HIV vaccine development along with a better understanding of the immune correlates of risk have emerged from the RV144 efficacy trial conducted in Thailand. Epidemiological data suggest that CRF01_AE is still predominant in South-East Asia and is spreading in China with a growing number of circulating recombinant forms due to increasing human contact, particularly in large urban centers, tourist locations and in sites of common infrastructure. A vaccine countering CRF01_AE is a priority for the region. An Asia HIV vaccine against expanding B/E or BCE recombinant forms should be actively pursued. A major challenge that remains is the conduct of efficacy trials in heterosexual populations in this region. Men who have sex with men represent the main target population for future efficacy trials in Asia. Coupling HIV vaccines with other prevention modalities in efficacy trials might also be envisaged. These new avenues will only be made possible through the conduct of large-scale efficacy trials, interdisciplinary teams, international collaborations, and strong political and community commitments.
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Translation of biomedical prevention strategies for HIV: prospects and pitfalls. J Acquir Immune Defic Syndr 2013; 63 Suppl 1:S12-25. [PMID: 23673881 DOI: 10.1097/qai.0b013e31829202a2] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Early achievements in biomedical approaches for HIV prevention included physical barriers (condoms), clean injection equipment (both for medical use and for injection drug users), blood and blood product safety, and prevention of mother-to-child transmission. In recent years, antiretroviral drugs to reduce the risk of transmission (when the infected person takes the medicines; treatment as prevention) or reduce the risk of acquisition (when the seronegative person takes them; preexposure prophylaxis) have proven to be efficacious. Circumcision of men has also been a major tool relevant for higher prevalence regions such as sub-Saharan Africa. Well-established prevention strategies in the control of sexually transmitted diseases and tuberculosis are highly relevant for HIV (ie, screening, linkage to care, early treatment, and contact tracing). Unfortunately, only slow progress is being made in some available HIV-prevention strategies such as family planning for HIV-infected women who do not want more children and prevention of mother-to-child HIV transmission. Current studies seek to integrate strategies into approaches that combine biomedical, behavioral, and structural methods to achieve prevention synergies. This review identifies the major biomedical approaches demonstrated to be efficacious that are now available. We also highlight the need for behavioral risk reduction and adherence as essential components of any biomedical approach.
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Wright S, Boyd MA, Yunihastuti E, Law M, Sirisanthana T, Hoy J, Pujari S, Lee MP, Petoumenos K. Rates and factors associated with major modifications to first-line combination antiretroviral therapy: results from the Asia-Pacific region. PLoS One 2013; 8:e64902. [PMID: 23840312 PMCID: PMC3696001 DOI: 10.1371/journal.pone.0064902] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Accepted: 04/18/2013] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND In the Asia-Pacific region many countries have adopted the WHO's public health approach to HIV care and treatment. We performed exploratory analyses of the factors associated with first major modification to first-line combination antiretroviral therapy (ART) in resource-rich and resource-limited countries in the region. METHODS We selected treatment naive HIV-positive adults from the Australian HIV Observational Database (AHOD) and the TREAT Asia HIV Observational Database (TAHOD). We dichotomised each country's per capita income into high/upper-middle (T-H) and lower-middle/low (T-L). Survival methods stratified by income were used to explore time to first major modification of first-line ART and associated factors. We defined a treatment modification as either initiation of a new class of antiretroviral (ARV) or a substitution of two or more ARV agents from within the same ARV class. RESULTS A total of 4250 patients had 961 major modifications to first-line ART in the first five years of therapy. The cumulative incidence (95% CI) of treatment modification was 0.48 (0.44-0.52), 0.33 (0.30-0.36) and 0.21 (0.18-0.23) for AHOD, T-H and T-L respectively. We found no strong associations between typical patient characteristic factors and rates of treatment modification. In AHOD, relative to sites that monitor twice-yearly (both CD4 and HIV RNA-VL), quarterly monitoring corresponded with a doubling of the rate of treatment modifications. In T-H, relative to sites that monitor once-yearly (both CD4 and HIV RNA-VL), monitoring twice-yearly corresponded to a 1.8 factor increase in treatment modifications. In T-L, no sites on average monitored both CD4 & HIV RNA-VL concurrently once-yearly. We found no differences in rates of modifications for once- or twice-yearly CD4 count monitoring. CONCLUSIONS Low-income countries tended to have lower rates of major modifications made to first-line ART compared to higher-income countries. In higher-income countries, an increased rate of RNA-VL monitoring was associated with increased modifications to first-line ART.
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Atun R, Jaffar S, Nishtar S, Knaul FM, Barreto ML, Nyirenda M, Banatvala N, Piot P. Improving responsiveness of health systems to non-communicable diseases. Lancet 2013; 381:690-7. [PMID: 23410609 DOI: 10.1016/s0140-6736(13)60063-x] [Citation(s) in RCA: 183] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Sarna A, Sebastian M, Bachani D, Sogarwal R, Battala M. Pretreatment loss-to-follow-up after HIV diagnosis from 27 counseling and testing centers across India: findings from a cohort study. J Int Assoc Provid AIDS Care 2013; 13:223-31. [PMID: 23418205 DOI: 10.1177/1545109712469686] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Individuals testing HIV positive were interviewed at testing centers, followed prospectively and interviewed again when they registered at referral antiretroviral therapy (ART) centers (ARTCs). Those who did not register at ARTCs were traced and interviewed in the community. A total of 1057 newly diagnosed people living with HIV (PLHIV; 52% women; mean age, 34.7 years) were recruited. A total of 73.5% of PLHIV registered at referral ARTCs within 60 days, 17.9% did not register and were interviewed in the community, and 8.6% were not interviewed. The 2 main reasons cited for not registering were a perception of good health (30%) and work/family engagements (22%). Single clients (adjusted relative risk [ARR]: 1.54; 95% confidence interval [CI]: 1.02-2.34), participants who had not disclosed their HIV status (ARR: 2.32; 95%CI: 1.77-3.05), participants who knew a PLHIV (ARR: 1.89; 95% CI: 1.41-2.53), and participants from laborer households (ARR: 2.66; 95%CI:1.15-6.15) were more likely to not register. In conclusion, the majority of newly diagnosed PLHIV do reach ARTCs. Disclosure concerns and a perception of good health prevent PLHIV from accessing services.
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Affiliation(s)
- Avina Sarna
- HIV and AIDS Program, Population Council, New Delhi, India
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Bastard M, Soulinphumy K, Phimmasone P, Saadani AH, Ciaffi L, Communier A, Phimphachanh C, Ecochard R, Etard JF. Women experience a better long-term immune recovery and a better survival on HAART in Lao People's Democratic Republic. BMC Infect Dis 2013; 13:27. [PMID: 23339377 PMCID: PMC3556135 DOI: 10.1186/1471-2334-13-27] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Accepted: 01/16/2013] [Indexed: 12/02/2022] Open
Abstract
Background In April 2003, Médecins Sans Frontières launched an HIV/AIDS programme to provide free HAART to HIV-infected patients in Laos. Although HIV prevalence is estimated as low in this country, it has been increasing in the last years. This work reports the first results of an observational cohort study and it aims to identify the principal determinants of the CD4 cells evolution and to assess mortality among patients on HAART. Methods We performed a retrospective database analysis on patients initiated on HAART between 2003 and 2009 (CD4<200cells/μL or WHO stage 4). We excluded from the analysis patients who were less than 16 years old and pregnant women. To explore the determinants of the CD4 reconstitution, a linear mixed model was adjusted. To identify typical trajectories of the CD4 cells, a latent trajectory analysis was carried out. Finally, a Cox proportional-hazards model was used to reveal predictors of mortality on HAART including appointment delay greater than 1 day. Results A total of 1365 patients entered the programme and 913 (66.9%) received an HAART with a median CD4 of 49 cells/μL [IQR 15–148]. High baseline CD4 cell count and female gender were associated with a higher CD4 level over time. In addition, this gender difference increased over time. Two typical latent CD4 trajectories were revealed showing that 31% of women against 22% of men followed a high CD4 trajectory. In the long-term, women were more likely to attend appointments without delay. Mortality reached 6.2% (95% CI 4.8-8.0%) at 4 months and 9.1% (95% CI 7.3-11.3%) at 1 year. Female gender (HR=0.17, 95% CI 0.07-0.44) and high CD4 trajectory (HR=0.19, 95% CI 0.08-0.47) were independently associated with a lower death rate. Conclusions Patients who initiated HAART were severely immunocompromised yielding to a high early mortality. In the long-term on HAART, women achieved a better CD4 cells reconstitution than men and were less likely to die. This study highlights important differences between men and women regarding response to HAART and medical care, and questions men’s compliance to treatment.
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Fujita M, Poudel KC, Do Thi N, Bui Duc D, Nguyen Van K, Green K, Nguyen Thi Minh T, Kato M, Jacka D, Cao Thi Thanh T, Nguyen Thanh L, Jimba M. A new analytical framework of 'continuum of prevention and care' to maximize HIV case detection and retention in care in Vietnam. BMC Health Serv Res 2012; 12:483. [PMID: 23272730 PMCID: PMC3576318 DOI: 10.1186/1472-6963-12-483] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Accepted: 11/24/2012] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The global initiative 'Treatment 2.0' calls for expanding the evidence base of optimal HIV service delivery models to maximize HIV case detection and retention in care. However limited systematic assessment has been conducted in countries with concentrated HIV epidemic. We aimed to assess HIV service availability and service connectedness in Vietnam. METHODS We developed a new analytical framework of the continuum of prevention and care (COPC). Using the framework, we examined HIV service delivery in Vietnam. Specifically, we analyzed HIV service availability including geographical distribution and decentralization and service connectedness across multiple services and dimensions. We then identified system-related strengths and constraints in improving HIV case detection and retention in care. This was accomplished by reviewing related published and unpublished documents including existing service delivery data. RESULTS Identified strengths included: decentralized HIV outpatient clinics that offer comprehensive care at the district level particularly in high HIV burden provinces; functional chronic care management for antiretroviral treatment (ART) with the involvement of people living with HIV and the links to community- and home-based care; HIV testing and counseling integrated into tuberculosis and antenatal care services in districts supported by donor-funded projects, and extensive peer outreach networks that reduce barriers for the most-at-risk populations to access services. Constraints included: fragmented local coordination mechanisms for HIV-related health services; lack of systems to monitor the expansion of HIV outpatient clinics that offer comprehensive care; underdevelopment of pre-ART care; insufficient linkage from HIV testing and counseling to pre-ART care; inadequate access to HIV-related services in districts not supported by donor-funded projects particularly in middle and low burden provinces and in mountainous remote areas; and no systematic monitoring of referral services. CONCLUSIONS Our COPC analytical framework was instrumental in identifying system-related strengths and constraints that contribute to HIV case detection and retention in care. The national HIV program plans to strengthen provincial programming by re-defining various service linkages and accelerate the transition from project-based approach to integrated service delivery in line with the 'Treatment 2.0' initiative.
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Affiliation(s)
- Masami Fujita
- World Health Organization Cambodia Office, No. 177-179 Pasteur (St.51) (corner 254) Sangkat Chak Tomouk, P.O. Box 1217, , Phnom Penh, Cambodia
| | - Krishna C Poudel
- Department of Public Health, School of Public Health and Health Sciences, University of Massachusetts Amherst, 316 Arnold House, 715 North Pleasant St, Amherst, MA, 01003-9304, USA
| | - Nhan Do Thi
- Vietnam Authority of HIV/AIDS Control, Ministry of Health Vietnam, 135/3 Nui Truc, Ba Dinh, Hanoi, Vietnam
| | - Duong Bui Duc
- Vietnam Authority of HIV/AIDS Control, Ministry of Health Vietnam, 135/3 Nui Truc, Ba Dinh, Hanoi, Vietnam
| | - Kinh Nguyen Van
- National Hospital of Tropical Diseases, 78 Giai Phong Street, Hanoi, Vietnam
| | - Kimberly Green
- FHI 360, Demmco House, 1st Dzorwulu Crescent, Accra, Ghana
| | - Thu Nguyen Thi Minh
- World Health Organization Vietnam Office, 63 Tran Hung Dao, Hoan Kiem District, P.O. Box 52, Hanoi, Vietnam
| | - Masaya Kato
- World Health Organization Vietnam Office, 63 Tran Hung Dao, Hoan Kiem District, P.O. Box 52, Hanoi, Vietnam
| | - David Jacka
- World Health Organization Vietnam Office, 63 Tran Hung Dao, Hoan Kiem District, P.O. Box 52, Hanoi, Vietnam
| | - Thuy Cao Thi Thanh
- National Hospital of Tropical Diseases, 78 Giai Phong Street, Hanoi, Vietnam
| | - Long Nguyen Thanh
- Vietnam Authority of HIV/AIDS Control, Ministry of Health Vietnam, 135/3 Nui Truc, Ba Dinh, Hanoi, Vietnam
| | - Masamine Jimba
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
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Tran DA, Shakeshaft A, Ngo AD, Rule J, Wilson DP, Zhang L, Doran C. Structural barriers to timely initiation of antiretroviral treatment in Vietnam: findings from six outpatient clinics. PLoS One 2012; 7:e51289. [PMID: 23240013 PMCID: PMC3519823 DOI: 10.1371/journal.pone.0051289] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 11/01/2012] [Indexed: 11/18/2022] Open
Abstract
In Vietnam, premature mortality due to AIDS-related conditions is commonly associated with late initiation to antiretroviral therapy (ART). This study explores reasons for late ART initiation among people living with HIV (PLHIV) from the perspectives of health care providers and PLHIV. The study was undertaken in six clinics from five provinces in Vietnam. Baseline CD4 counts were collected from patient records and grouped into three categories: very late initiators (≤100 cells/mm(3) CD4), late initiators (100-200 cells/mm(3)) and timely initiators (200-350 cells/mm(3)). Thirty in-depth interviews with patients who started ART and 15 focus group discussions with HIV service providers were conducted and thematic analysis of the content performed. Of 934 patients, 62% started ART very late and 11% initiated timely treatment. The proportion of patients for whom a CD4 count was obtained within six months of their HIV diagnosis ranged from 22% to 72%. The proportion of patients referred to ART clinics by voluntary testing and counselling centres ranged from 1% to 35%. Structural barriers to timely ART initiation were poor linkage between HIV testing and HIV care and treatment services, lack of patient confidentiality and a shortage of HIV/AIDS specialists. If Vietnam's treatment practice is to align with WHO recommendations then the connection between voluntary counselling and testing service and ART clinics must be improved. Expansion and decentralization of HIV/AIDS services to allow implementation at the community level increased task sharing between doctors and nurses to overcome limited human resources, and improved patient confidentiality are likely to increase timely access to HIV treatment services for more patients.
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Affiliation(s)
- Dam Anh Tran
- National Drug and Alcohol Research Centre, the University of New South Wales, Sydney, Australia
- Kirby Institute, the University of New South Wales, Sydney, Australia
- * E-mail: (DAT); (LZ)
| | - Anthony Shakeshaft
- National Drug and Alcohol Research Centre, the University of New South Wales, Sydney, Australia
| | - Anh Duc Ngo
- School of Population Health, the University of South Australia, Adelaide, Australia
| | - John Rule
- School of Public Health, the University of New South Wales, Sydney, Australia
| | - David P. Wilson
- Kirby Institute, the University of New South Wales, Sydney, Australia
| | - Lei Zhang
- Kirby Institute, the University of New South Wales, Sydney, Australia
- * E-mail: (DAT); (LZ)
| | - Christopher Doran
- The University of Newcastle, Hunter Medical Research Institute, New South Wales, Australia
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Nitayaphan S, Ngauy V, O'Connell R, Excler JL. HIV epidemic in Asia: optimizing and expanding vaccine development. Expert Rev Vaccines 2012; 11:805-19. [PMID: 22913258 DOI: 10.1586/erv.12.49] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The recent evidence in Thailand for protection from acquisition of HIV through vaccination in a mostly heterosexual population has generated considerable hope. Building upon these results and the analysis of the correlates of risk remains among the highest priorities. Improved vaccine concepts including heterologous prime-boost regimens, improved proteins with potent adjuvants and new vectors expressing mosaic antigens may soon enter clinical development to assess vaccine efficacy in men who have sex with men. Identifying heterosexual populations with sufficient HIV incidence for the conduct of efficacy trials represents perhaps the main challenge in Asia. Fostering translational research efforts in Asian countries may benefit from the development of master strategic plans and program management processes.
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Affiliation(s)
- Sorachai Nitayaphan
- Royal Thai Army Component, Armed Forces Research Institute of Medical Sciences, 315/6 Rajvithi Road, Bangkok 10400, Thailand
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Tran BX, Nguyen NPT. Patient satisfaction with HIV/AIDS care and treatment in the decentralization of services delivery in Vietnam. PLoS One 2012; 7:e46680. [PMID: 23071611 PMCID: PMC3465274 DOI: 10.1371/journal.pone.0046680] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Accepted: 09/03/2012] [Indexed: 12/02/2022] Open
Abstract
Objective We evaluated the patient satisfaction with HIV/AIDS care and treatment and its determinants across levels of health service administration in Vietnam. Methods We interviewed 1016 patients at 7 hospitals and health centers in three epicenters, including Hanoi, Hai Phong, and Ho Chi Minh City. The Satisfaction with HIV/AIDS Treatment Interview Scale (SATIS) was developed, and 3 dimensions were constructed using factor analysis, namely “Quality and Convenience”; “Availability and Responsiveness”; and “Competence of health care workers”. Results In a band score of (0; 10), the mean scores of all domains were large; it was the highest in “Competence of health workers” (9.34±0.84), and the lowest in “Quality and Convenience” (9.03±1.04). The percentages of respondents completely satisfied with overall service quality and treatment outcomes were 42.4% and 18.8%, respectively. In multivariate analysis, factors related to higher satisfaction included female sex, older age, and living with spouses or partners. Meanwhile, lower satisfaction was found among patients who were attending provincial and district clinics; in the richest group; had higher CD4 count; and drug users. Conclusion This study highlights the importance of improving the quality of HIV/AIDS services at the provincial and district clinics. Potential strategies include capacity building for health workers, integrative service delivery, engagements of family members in treatment supports, and additional attention and comprehensive care for drug users with HIV/AIDS.
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Affiliation(s)
- Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.
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Abstract
HIV has now become a manageable chronic disease. However, the treatment outcomes may get hampered by suboptimal adherence to ART. Adherence optimization is a concrete reality in the wake of 'universal access' and it is imperative to learn lessons from various studies and programmes. This review examines current literature on ART scale up, treatment outcomes of the large scale programmes and the role of adherence therein. Social, behavioural, biological and programme related factors arise in the context of ART adherence optimization. While emphasis is laid on adherence, retention of patients under the care umbrella emerges as a major challenge. An in-depth understanding of patients' health seeking behaviour and health care delivery system may be useful in improving adherence and retention of patients in care continuum and programme. A theoretical framework to address the barriers and facilitators has been articulated to identify problematic areas in order to intervene with specific strategies. Empirically tested objective adherence measurement tools and approaches to assess adherence in clinical/ programme settings are required. Strengthening of ART programmes would include appropriate policies for manpower and task sharing, integrating traditional health sector, innovations in counselling and community support. Implications for the use of theoretical model to guide research, clinical practice, community involvement and policy as part of a human rights approach to HIV disease is suggested.
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Affiliation(s)
- Seema Sahay
- National AIDS Research Institute, Bhosari, Pune, India.
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Cuong DD, Thorson A, Sönnerborg A, Hoa NP, Chuc NTK, Phuc HD, Larsson M. Survival and causes of death among HIV-infected patients starting antiretroviral therapy in north-eastern Vietnam. ACTA ACUST UNITED AC 2011; 44:201-8. [DOI: 10.3109/00365548.2011.631937] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Implementing operational research to scale-up access to antiretroviral therapy for HIV infection: lessons learned from the Cameroonian experience. Curr Opin HIV AIDS 2011; 6:239-44. [PMID: 21537170 DOI: 10.1097/coh.0b013e3283478757] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Given the lack of evidence on how to best design and implement antiretroviral therapy (ART) scaling-up policies, operational research has seen a surge in interest. There is, however, little published information on the contribution of operational research in ART programs' implementation or in improvement of associated outcomes. The article focuses therefore on how operational research may contribute to such improvements and what the key enabling factors are for its integration into program frameworks. RECENT FINDINGS One of the most systematic operational research linked to a national ART program on the African continent was conducted in Cameroon between 2006 and 2010. Along with operational research carried out elsewhere in Africa, it helped demonstrate that a strategy of decentralizing HIV care can increase treatment coverage and improve early access to care, while maintaining good clinical outcomes. Multipartnership between local researchers, national authorities, healthcare professionals and the civil society is the key enabling factor for the relevance of operational research and the translation of its results into policy and practice. SUMMARY In spite of a dramatic increase in access to ART during recent years in low-income countries, the fight against HIV remains a failure in terms of the goal of breaking the pandemic dynamic. Operational research is needed more than ever to face this challenge.
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Long-term immunological outcomes in treated HIV-infected individuals in high-income and low-middle income countries. Curr Opin HIV AIDS 2011; 6:258-65. [PMID: 21546834 DOI: 10.1097/coh.0b013e3283476c72] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE OF REVIEW To summarize the recent findings on long-term (at least 3-4 years) immunological responses to combination antiretroviral therapy (cART) and to compare and contrast the findings between cohorts from high-income and low-middle income countries (LMICs). RECENT FINDINGS Cohort studies from high-income settings suggest that a majority of treated HIV-infected patients who maintain suppressed HIV viremia experience a gradual increase in CD4 cell counts for several years to normal levels. However, those who start cART at CD4 cell counts less than 200 cells/μl (as opposed to CD4 cell counts>200 cells/μl) spend several more years below the safe CD4 cell count threshold of 500 cells/μl. Cohorts from LMICs also report persistent improvements in CD4+ cell counts over first 4-5 years of follow-up. However, low-CD4 cell counts (<200 cells/μl) at the start of cART, high early mortality, and loss to follow-up in LMICs settings suggest that the observed optimistic responses may be affected by survivorship bias and should be cautiously interpreted as the optimal, rather than an average, response in LMICs populations. SUMMARY LMICs cohorts report similar immunological responses to cART as high-income countries in first 4-5 years of follow-up. Sustaining success in these settings is dependent on timely access to first-line and future cART options, efforts to reduce loss to follow-up, and implementation of treatment guidelines. Cohorts from LMICs are encouraged to continue improving treatment programs and to continue reporting outcomes over the next decade, as surveillance for potential future blunting in responses.
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Poudel KC, Fujita M, Green K, Poudel-Tandukar K, Jimba M. Non-communicable diseases in southeast Asia. Lancet 2011; 377:2004-5; author reply 2005. [PMID: 21665034 DOI: 10.1016/s0140-6736(11)60864-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Cauchon E, Falgueyret JP, Auger A, Melnyk RA. A high-throughput continuous assay for screening and characterization of inhibitors of HIV reverse-transcriptase DNA polymerase activity. ACTA ACUST UNITED AC 2011; 16:518-24. [PMID: 21474837 DOI: 10.1177/1087057111402201] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The authors have devised a continuous fluorescence-based assay to measure HIV reverse transcriptase (RT) polymerase activity for both high-throughput screening (HTS) and mechanistic characterization of inhibitors. The designed substrate is composed of a recessed DNA primer annealed to a DNA template that is labeled at the 5'-terminus with a donor fluorophore (AlexaFluor 488). RT-catalyzed incorporation of an acceptor-labeled deoxyuridine (dUTP-AlexaFluor 555) at the 3'-terminus of the fully extended DNA primer juxtaposes donor and acceptor fluorophores, resulting in robust fluorescence resonance energy transfer that can be monitored kinetically in real time. The assay is sensitive, permitting the use of low enzyme concentrations (<0.5 nM), and can be miniaturized for use in 384-well HTS mode. The authors further show that this assay is capable of evaluating inhibitor mechanism of action by confirming the binding mechanism of a set of nonnucleoside RT inhibitors. Given the versatility and the lack of requirement for costly platforms or radioactivity, this assay may serve to accelerate and streamline the discovery and characterization process for future antiviral agents.
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Affiliation(s)
- Elizabeth Cauchon
- Department of In Vitro Sciences, Merck Frosst Centre for Therapeutic Research, 16711 Trans Canada Highway, Kirkland, Quebec, Canada
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