1
|
Dinagde DD, Afework HT, Wada HW, Negash MW. Level of HIV serodiscordance and associated factors among heterosexual couples in Ethiopia: A systematic review and meta-analysis. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003090. [PMID: 38900765 PMCID: PMC11189220 DOI: 10.1371/journal.pgph.0003090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 05/03/2024] [Indexed: 06/22/2024]
Abstract
HIV-related causes accounted for approximately 770,000 deaths globally in 2018. Globally, there were 1.7 million new infections, and approximately 37.9 million people were living with HIV by the end of 2018. According to the WHO 2018 study, the African Region was the most affected, with 25.7 million people living with HIV in 2018. In Africa, married and cohabiting couples have a high prevalence of HIV discordance, ranging from 3% to 20% in the general population. Therefore, it is crucial to understand the level of HIV serodiscordance among married couples in Ethiopia and the contributing factors. Studies were systematically searched, utilizing international databases such as PubMed, Google Scholar, Cochrane Library, and Embase. The level of quality of the included articles, which employed cross-sectional and cohort study designs, was evaluated using the New Castle Ottawa scale. The systematic review employed a random-effects approach, and statistical analysis was conducted using STATA version 17 software. The presence of statistical heterogeneity within the included studies was assessed using the I-squared statistic. The random-effects meta-analysis model was used to estimate the pooled level of HIV serodiscordance. The results were reported following the Preferred Reporting Item for Systematic Review and Meta-Analyses (PRISMA) guideline. A total of ten (10) observational studies were included in this review. The pooled level of HIV serodiscordance among married heterosexual couples in Ethiopia was found to be 11.4% (95% CI = 7% -15.7%). The results from the meta-analysis indicated a significant positive association between HIV serodiscordance and the variables studied. Specifically, consistently using condoms (OR = 1.82; 95% CI: 1.08-2.56), having a CD4 count of >200 cells/mm3 (OR = 1.45; 95% CI: 1.12-1.77), and having a premarital sexual relationship (OR = 1.93; 95% CI: 1.28-2.57) were strongly linked to couples' serodiscordance. To protect a seronegative partner in a serodiscordant relationship from acquiring HIV infection, it is crucial to implement preventive measures. These measures include providing comprehensive health education on the correct and consistent use of condoms, ensuring regular monitoring and care at an antiretroviral therapy (ART) clinic, and offering voluntary counseling and testing (VCT) services to both sexual partners.
Collapse
Affiliation(s)
- Dagne Deresa Dinagde
- Departments of Midwifery, College of Health Sciences, Mattu University, Mettu, Ethiopia
| | - Hana Tadesse Afework
- Departments of Midwifery, College of Health Sciences, Mizan Teppi University, Mizan Teppi, Ethiopia
| | - Habtamu Wana Wada
- Departments of Midwifery, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Meserat Workiye Negash
- Departments of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| |
Collapse
|
2
|
Ndlovu S, Ross A, Mulondo M. Interventions to improve young men's utilisation of HIV-testing services in KwaZulu-Natal, South Africa: perspectives of young men and health care providers. AFRICAN JOURNAL OF AIDS RESEARCH : AJAR 2023; 22:316-326. [PMID: 38117741 DOI: 10.2989/16085906.2023.2276897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 10/01/2023] [Indexed: 12/22/2023]
Abstract
Introduction: HIV-testing services (HTS) are an important point of entry to prevention and treatment of HIV in South Africa. Despite the availability of HTS across the region and in SA, the uptake among men remains low, especially young men residing in rural and peri-urban communities. This study aimed to explore interventions that could improve the uptake of HTS among young men in KwaZulu-Natal.Methods: A descriptive exploratory qualitative study was conducted in which 17 young men and two health care providers in Ladysmith were purposively and conveniently sampled. Data were collected through semi-structured interviews using WhatsApp and landline audio calls between September and December 2021 and thematically analysed.Results: An improvement in the health care provider attitudes and service delivery, establishment of adherence clubs for young people living with HIV, ensuring a diverse and balanced health care provider staff composition at primary health care facilities, and increased demand creation in spaces frequented by men are vital for enhancing access and utilisation of HTS among young men. Additionally, health care providers believe that the presence of male health care providers, investment in health education, prioritising men in the morning at the primary health care facilities, and the establishment of male clinics within communities as key factors in improving the uptake of HTS among young men.Conclusion: To attract and retain young men in HTS and in HIV treatment and care, several improvements at primary health care facilities need to be implemented. These should focus on addressing the specific needs and preferences of young men, ensuring their comfort and engagement in health care.
Collapse
Affiliation(s)
- Sithembiso Ndlovu
- Department of Family Medicine, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- Office of the Dean, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Andrew Ross
- Department of Family Medicine, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Mutshidzi Mulondo
- Office of the Dean, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| |
Collapse
|
3
|
Filiatreau LM, Mody A, Vo D, Bradley C, Ramakrishnan A, López J, O’Halloran J, Trolard A, Powderly WG, Geng EH. Leveraging CD4 Cell Count at Entry Into Care to Monitor Success of Human Immunodeficiency Virus Prevention, Treatment, and Public Health Programming in the Greater St Louis Area Between 2017 and 2020. Open Forum Infect Dis 2023; 10:ofad477. [PMID: 37799129 PMCID: PMC10549207 DOI: 10.1093/ofid/ofad477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/15/2023] [Indexed: 10/07/2023] Open
Abstract
CD4 cell count at entry into human immunodeficiency virus (HIV) care is a useful indicator of success of multiple steps in HIV public health programming. We demonstrate that CD4 cell count at care initiation was stable in St Louis between 2017 and 2019 but declined in 2020. Missouri efforts in the Ending the HIV Epidemic plan should focus on rapidly identifying individuals with undiagnosed HIV infection.
Collapse
Affiliation(s)
- Lindsey M Filiatreau
- Division of Infectious Diseases, School of Medicine, Washington University, St Louis, Missouri, USA
| | - Aaloke Mody
- Division of Infectious Diseases, School of Medicine, Washington University, St Louis, Missouri, USA
| | - Daniel Vo
- Division of Infectious Diseases, School of Medicine, Washington University, St Louis, Missouri, USA
| | - Cory Bradley
- Division of Infectious Diseases, School of Medicine, Washington University, St Louis, Missouri, USA
| | - Aditi Ramakrishnan
- Division of Infectious Diseases, School of Medicine, Washington University, St Louis, Missouri, USA
| | - Julia López
- Division of Infectious Diseases, School of Medicine, Washington University, St Louis, Missouri, USA
| | - Jane O’Halloran
- Division of Infectious Diseases, School of Medicine, Washington University, St Louis, Missouri, USA
| | - Anne Trolard
- Division of Infectious Diseases, School of Medicine, Washington University, St Louis, Missouri, USA
| | - William G Powderly
- Division of Infectious Diseases, School of Medicine, Washington University, St Louis, Missouri, USA
| | - Elvin H Geng
- Division of Infectious Diseases, School of Medicine, Washington University, St Louis, Missouri, USA
| |
Collapse
|
4
|
Grant‐McAuley W, Piwowar‐Manning E, Clarke W, Breaud A, Zewdie KB, Moore A, Ayles HM, Kosloff B, Shanaube K, Bock P, Meehan S, Maarman G, Fidler S, Hayes R, Donnell D, Eshleman SH. Population-level analysis of natural control of HIV infection in Zambia and South Africa: HPTN 071 (PopART). J Int AIDS Soc 2023; 26:e26179. [PMID: 37886843 PMCID: PMC10603557 DOI: 10.1002/jia2.26179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 09/20/2023] [Indexed: 10/28/2023] Open
Abstract
INTRODUCTION HIV controllers have low viral loads (VL) without antiretroviral treatment (ART). We evaluated viraemic control in a community-randomized trial conducted in Zambia and South Africa that evaluated the impact of a combination prevention intervention on HIV incidence (HPTN 071 [PopART]; 2013-2018). METHODS VL and antiretroviral (ARV) drug testing were performed using plasma samples collected 2 years after enrolment for 4072 participants who were HIV positive at the start of the study intervention. ARV drug use was assessed using a qualitative laboratory assay that detects 22 ARV drugs in five drug classes. Participants were classified as non-controllers if they had a VL ≥2000 copies/ml with no ARV drugs detected at this visit. Additional VL and ARV drug testing was performed at a second annual study visit to confirm controller status. Participants were classified as controllers if they had VLs <2000 with no ARV drugs detected at both visits. Non-controllers who had ARV drugs detected at either visit were excluded from the analysis to minimize potential confounders associated with ARV drug access and uptake. RESULTS The final cohort included 126 viraemic controllers and 766 non-controllers who had no ARV drugs detected. The prevalence of controllers among the 4072 persons assessed was 3.1% (95% confidence interval [CI]: 2.6%, 3.6%). This should be considered a minimum estimate, since high rates of ARV drug use in the parent study limited the ability to identify controllers. Among the 892 participants in the final cohort, controller status was associated with biological sex (female > male, p = 0.027). There was no significant association between controller status and age, study country or herpes simplex virus type 2 (HSV-2) status at study enrolment. CONCLUSIONS To our knowledge, this report presents the first large-scale, population-level study evaluating the prevalence of viraemic control and associated factors in Africa. A key advantage of this study was that a biomedical assessment was used to assess ARV drug use (vs. self-reported data). This study identified a large cohort of HIV controllers and non-controllers not taking ARV drugs, providing a unique repository of longitudinal samples for additional research. This cohort may be useful for further studies investigating the mechanisms of virologic control.
Collapse
Affiliation(s)
- Wendy Grant‐McAuley
- Department of PathologyJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | | | - William Clarke
- Department of PathologyJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Autumn Breaud
- Department of PathologyJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | | | | | - Helen Mary Ayles
- ZambartUniversity of Zambia School of Public HealthLusakaZambia
- Clinical Research DepartmentLondon School of Hygiene and Tropical MedicineLondonUK
| | - Barry Kosloff
- ZambartUniversity of Zambia School of Public HealthLusakaZambia
- Clinical Research DepartmentLondon School of Hygiene and Tropical MedicineLondonUK
| | - Kwame Shanaube
- ZambartUniversity of Zambia School of Public HealthLusakaZambia
| | - Peter Bock
- Desmond Tutu TB CenterDepartment of Paediatrics and Child HealthStellenbosch UniversityWestern CapeSouth Africa
| | - Sue‐Ann Meehan
- Desmond Tutu TB CenterDepartment of Paediatrics and Child HealthStellenbosch UniversityWestern CapeSouth Africa
| | - Gerald Maarman
- Centre for Cardio‐Metabolic Research in AfricaDivision of Medical PhysiologyFaculty of Medicine and Health SciencesStellenbosch UniversityWestern CapeSouth Africa
| | - Sarah Fidler
- Department of Infectious DiseaseImperial College LondonLondonUK
| | - Richard Hayes
- Department of Infectious Disease EpidemiologyLondon School of Hygiene and Tropical MedicineLondonUK
| | | | - Susan H. Eshleman
- Department of PathologyJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | | |
Collapse
|
5
|
Ortiz-Martínez Y, López-López MÁ, Ruiz-González CE, Turbay-Caballero V, Sacoto DH, Caldera-Caballero M, Bravo H, Sarmiento J, Rodriguez-Morales AJ. Willingness to receive COVID-19 vaccination in people living with HIV/AIDS from Latin America. Int J STD AIDS 2022; 33:652-659. [PMID: 35487200 PMCID: PMC9066237 DOI: 10.1177/09564624221091752] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Prior research has established some risk factors for an increased risk of severe disease and mortality from coronavirus disease 2019 (COVID-19). However, the impact of HIV infection on SARS-CoV-2 susceptibility and severity is a significant gap in the literature. In the same way, not many studies across the globe have analyzed the degree of vaccination willingness among people living with HIV/AIDS (PLWHA) and considerations regarding prioritizing this population during vaccination plans, particularly in developing countries. METHODS A descriptive-analytical cross-sectional study was conducted. Self-completed electronic surveys directed to PLWHA were performed via Twitter in February 2021, using accounts of HIV activists. RESULTS 460 (87.1%) participants were willing to be vaccinated with any COVID-19 vaccine. The reasons for that were listed as 1) the belief that vaccination prevents both the COVID-19 infection (81.3%) as well as being a spreader (52.2%); 2) having a high occupational risk of becoming infected with COVID-19 (22%); and 3) the belief that they would be at high risk of death because of COVID-19 (21.3%). Only 56 (10.6%) participants expressed hesitancy toward vaccination, and 12 (2.2%) stated they did not want to get vaccinated. CONCLUSIONS Our results may support the prioritization of people living with HIV during the implementation of vaccination plans in developing countries. New strategies should be adopted to overcome the hesitancy and unwillingness toward the COVID-19 vaccination, especially in populations with risk factors for severe disease.
Collapse
Affiliation(s)
- Yeimer Ortiz-Martínez
- Department of Internal Medicine, 469618Universidad Industrial de Santander, Bucaramanga, Colombia.,Faculty of Health Sciences, 28000Universidad de Sucre, Sincelejo, Colombia
| | | | - Carlos E Ruiz-González
- Department of Internal Medicine, 469618Universidad Industrial de Santander, Bucaramanga, Colombia
| | | | - Daniel H Sacoto
- Faculty of Health Sciences, 27892Universidad del Azuay, Cuenca, Azuay, Ecuador.,Mayo Clinic, Rochester, MN, USA
| | | | - Heyman Bravo
- Faculty of Health Sciences, 28000Universidad de Sucre, Sincelejo, Colombia
| | - Jheinner Sarmiento
- Faculty of Health Sciences, 28000Universidad de Sucre, Sincelejo, Colombia
| | - Alfonso J Rodriguez-Morales
- Grupo de Investigación Biomedicina, Faculty of Medicine, 146887Fundación Universitaria Autónoma de las Américas, Pereira, Colombia
| |
Collapse
|
6
|
Shah GH, Maluantesa L, Etheredge GD, Waterfield KC, Ikhile O, Beni R, Engetele E, Mulenga A. HIV Viral Suppression among People Living with HIV on Antiretroviral Therapy in Haut-Katanga and Kinshasa Provinces of Democratic Republic of Congo. Healthcare (Basel) 2021; 10:healthcare10010069. [PMID: 35052234 PMCID: PMC8775118 DOI: 10.3390/healthcare10010069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/28/2021] [Accepted: 12/29/2021] [Indexed: 11/17/2022] Open
Abstract
Human immunodeficiency virus (HIV) infections and less-than-optimal care of people living with HIV (PLHIV) continue to challenge public health and clinical care organizations in the communities that are most impacted by HIV. In the era of evidence-based public health, it is imperative to monitor viral load (VL) in PLHIV according to global and national guidelines and assess the factors associated with variation in VL levels. Purpose: This study had two objectives—(a) to describe the levels of HIV VL in persons on antiretroviral therapy (ART), and (b) to analyze the significance of variation in VL by patients’ demographic and clinical characteristics, outcomes of HIV care, and geographic characteristics of HIV care facilities. Methods: The study population for this quantitative study was 49,460 PLHIV in the Democratic Republic of Congo (DRC) receiving ART from 241 CDC-funded HIV/AIDS clinics in the Haut-Katanga and Kinshasa provinces of the DRC. Analysis of variance (ANOVA) was performed, including Tamhane’s T2 test for pairwise comparisons using de-identified data on all patients enrolled in the system by the time the data were extracted for this study by the HIV programs in May 2019. Results: The VL was undetectable (<40 copies/mL) for 56.4% of the patients and 24.7% had VL between 40 copies/mL and less than 1000 copies per mL, indicating that overall, 81% had VL < 1000 and were virologically suppressed. The remaining 19% had a VL of 1000 copies/mL or higher. The mean VL was significantly (p < 0.001) higher for males than for females (32,446 copies/mL vs. 20,786, respectively), persons <15 years of age compared to persons of ages ≥ 15 years at the time of starting ART (45,753 vs. 21,457, respectively), patients who died (125,086 vs. 22,090), those who were lost to follow-up (LTFU) (69,882 vs. 20,018), those with tuberculosis (TB) co-infection (64,383 vs. 24,090), and those who received care from urban clinics (mean VL = 25,236) compared to rural (mean VL = 3291) or semi-rural (mean VL = 26,180) clinics compared to urban. WHO clinical stages and duration on ART were not statistically significant at p ≤ 0.05 in this cohort. Conclusions: The VL was >1000 copies/mL for 19% of PLHIV receiving ART, indicating that these CDC-funded clinics and programs in the Haut-Katanga and Kinshasa provinces of DRC have more work to do. Strategically designed innovations in services are desirable, with customized approaches targeting PLHIV who are younger, male, those LTFU, with HIV/TB co-infection, and those receiving care from urban clinics.
Collapse
Affiliation(s)
- Gulzar H. Shah
- Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA 30460, USA;
- Correspondence: ; Tel.: +1-(001)-912-478-2419
| | | | | | - Kristie C. Waterfield
- Department of Interdisciplinary Healthcare, University of North Georgia, Dahlonega, GA 30597, USA;
| | - Osaremhen Ikhile
- Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA 30460, USA;
| | - Roger Beni
- National AIDS Control Program (PNLS), HIV Program, Ministry of Health, Kinshasa, Congo;
| | | | | |
Collapse
|
7
|
Patel HK, Duong YT, Birhanu S, Dobbs T, Lupoli K, Moore C, Detorio M, Sleeman K, Manjengwa J, Wray-Gordon F, Yavo D, Jackson K, Domaoal RA, Yufenyuy EL, Vedapuri S, Ndongmo CB, Ogollah FM, Dzinamarira T, Rubinstein P, Sachathep KK, Metz M, Longwe H, Saito S, Brown K, Voetsch AC, Parekh BS. A Comprehensive Approach to Assuring Quality of Laboratory Testing in HIV Surveys: Lessons Learned From the Population-Based HIV Impact Assessment Project. J Acquir Immune Defic Syndr 2021; 87:S17-S27. [PMID: 34166309 DOI: 10.1097/qai.0000000000002702] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Conducting HIV surveys in resource-limited settings is challenging because of logistics, limited availability of trained personnel, and complexity of testing. We described the procedures and systems deemed critical to ensure high-quality laboratory data in the population-based HIV impact assessments and large-scale household surveys. METHODS Laboratory professionals were engaged in every stage of the surveys, including protocol development, site assessments, procurement, training, quality assurance, monitoring, analysis, and reporting writing. A tiered network of household, satellite laboratories, and central laboratories, accompanied with trainings, optimized process for blood specimen collection, storage, transport, and real-time monitoring of specimen quality, and test results at each level proved critical in maintaining specimen integrity and high-quality testing. A plausibility review of aggregate merged data was conducted to confirm associations between key variables as a final quality check for quality of laboratory results. RESULTS Overall, we conducted a hands-on training for 3355 survey staff across 13 surveys, with 160-387 personnel trained per survey on biomarker processes. Extensive training and monitoring demonstrated that overall, 99% of specimens had adequate volume and 99.8% had no hemolysis, indicating high quality. We implemented quality control and proficiency testing for testing, resolved discrepancies, verified >300 Pima CD4 instruments, and monitored user errors. Aggregate data review for plausibility further confirmed the high quality of testing. CONCLUSIONS Ongoing engagement of laboratory personnel to oversee processes at all levels of the surveys is critical for successful national surveys. High-quality population-based HIV impact assessments laboratory data ensured reliable results and demonstrated the impact of HIV programs in 13 countries.
Collapse
Affiliation(s)
- Hetal K Patel
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | | | - Sehin Birhanu
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | - Trudy Dobbs
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | - Kathryn Lupoli
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | - Carole Moore
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | - Mervi Detorio
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | - Katrina Sleeman
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | | | - Floris Wray-Gordon
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | - Daniel Yavo
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | - Keisha Jackson
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | - Robert A Domaoal
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | - Ernest L Yufenyuy
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | - Shanmugam Vedapuri
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | - Clement B Ndongmo
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | | | | | | | | | | | | | | | - Kristin Brown
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | - Andrew C Voetsch
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | - Bharat S Parekh
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| |
Collapse
|
8
|
Ekun OA, Fasela EO, Oladele DA, Liboro GO, Raheem TY. Risks of cardio-vascular diseases among highly active antiretroviral therapy (HAART) treated HIV seropositive volunteers at a treatment centre in Lagos, Nigeria. Pan Afr Med J 2021; 38:206. [PMID: 33995812 PMCID: PMC8106780 DOI: 10.11604/pamj.2021.38.206.26791] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 02/01/2021] [Indexed: 11/14/2022] Open
Abstract
Introduction highly active antiretroviral therapy (HAART) has led to a decline in HIV-induced morbidity and mortality in recent years. However, it has been opined that this has led to elevated risks of cardiovascular diseases (CVDs). This study assessed the risks of CVDs among HAART experienced individuals living with HIV. Methods a cross sectional study involving 196 adults consisting of 118 HAART experienced and 78 HAART naïve was conducted. Anthropometric and blood pressure measurements were recorded for all participants. Blood samples obtained from the volunteers were used to determine glucose, creatinine, HIV viral load, CD4 count and lipid profile using standard methods. Lipid ratios, atherogenic indices and QRISK3 risk score were calculated. Results the median CD4 lymphocyte, mean body mass index (BMI) and HDL-c in HAART experienced participants were higher (P<0.05) than HAART naive individuals. The QRISK3 risk score and creatinine were higher (p<0.05) among HAART experienced group. In HAART experienced group, the risk of hypertension, increased low-density lipoprotein (LDL-c), atherogenic index of plasma (AIP) and QRISK3 were 3.7, 2.0, 2.38 and 3.85 times (p<0.05) higher respectively than in HAART naive. Atherogenic coefficient (AC) increase was more prevalent among male (p<0.05) participants. Risk of chronic renal disease (eGFR), hypertension and CVD (as measured by QRISK3) was higher (p<0.05) among the female and older participants respectively. Conclusion the risk of CVDs and renal disease appeared to be higher among HAART experienced volunteers and older (>45 years) volunteers. The risk of renal disease appeared higher in females.
Collapse
Affiliation(s)
- Oloruntoba Ayodele Ekun
- Department of Medical Laboratory Science, College of Medicine, University of Lagos, Idi-araba, Lagos State, Nigeria
| | - Emmanuel Olusesan Fasela
- Department of Medical Laboratory Science, College of Medicine, University of Lagos, Idi-araba, Lagos State, Nigeria.,Clinical Diagnostic Laboratory, Nigerian Institute of Medical Research, Yaba, Lagos State, Nigeria
| | - David Ayoola Oladele
- Clinical Science Department, Nigerian Institute of Medical Research, Yaba, Lagos State, Nigeria
| | - Gideon Odemakpore Liboro
- Department of Medical Laboratory Science, College of Medicine, University of Lagos, Idi-araba, Lagos State, Nigeria.,Center for Human Virology and Genomics, Nigerian Institute of Medical Research, Yaba, Lagos State, Nigeria
| | - Toyosi Yekeen Raheem
- Clinical Diagnostic Laboratory, Nigerian Institute of Medical Research, Yaba, Lagos State, Nigeria
| |
Collapse
|
9
|
Shortened Tuberculosis Treatment for People with HIV in South Africa. A Model-based Evaluation and Cost-effectiveness Analysis. Ann Am Thorac Soc 2021; 17:202-211. [PMID: 31689133 DOI: 10.1513/annalsats.201905-418oc] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Rationale: Recent tuberculosis treatment trials failed to show that some 4-month (4m) regimens were noninferior to conventional 6-month (6m) regimens for a composite clinical outcome. Novel shortened regimens may still have important clinical and economic benefits in populations with high loss to follow-up (LTFU) and in subgroups such as people with human immunodeficiency virus.Objectives: To identify scenarios in which a novel 4m regimen would be preferred to a conventional 6m regimen for treatment of drug-susceptible tuberculosis in people with human immunodeficiency virus in South Africa, in terms of short-term and long-term clinical and economic outcomes.Methods: We used the Cost-Effectiveness of Preventing AIDS Complications-International microsimulation model to project outcomes modeled on participants in the OFLOTUB trial. For calibration purposes, we did a base case analysis by applying trial-informed parameters for the 4m/6m regimens, including monthly LTFU during treatment (0.68%/0.83%), average monthly tuberculosis recurrence (0.65%/0.31%), and monthly drug costs (U.S. dollars [USD]25.90/3.70). We then evaluated different scenarios and 4m regimen characteristics, varying key parameters, including LTFU (informed by observational cohort data), recurrence, and cost. We projected outcomes, including 2-year mortality and life expectancy. We conducted a cost-effectiveness analysis, evaluating the incremental cost-effectiveness ratio of a 4m versus 6m regimen.Results: In the base case model analysis, risk of the composite unfavorable outcome in the 4m/6m groups was 19.8%/15.9%, similar to the trial; projected life expectancies were 22.1/22.3 years. In analyses of alternative scenarios and 4m regimen characteristics, a 4m regimen yielded lower risk of the composite unfavorable outcome than the conventional 6m regimen if LTFU increased to greater than 3.5%/mo or if average recurrence after a 4m regimen decreased to less than 0.45%/mo, and it yielded higher life expectancy if LTFU was greater than 3.5%/mo or if recurrence was less than 0.5%/mo. A 4m regimen was not cost-effective in the base case but became cost-effective (incremental cost-effectiveness ratio <USD940/yr of life saved) in two-way sensitivity analysis; for example, if LTFU was greater than or equal to 5.3%/mo and either average recurrence was less than or equal to 0.5%/mo or drug cost was less than or equal to USD15/mo.Conclusions: A novel shortened tuberculosis treatment regimen could improve outcomes such as survival despite conferring a higher recurrence risk, particularly in settings where LTFU is higher than that seen in recent trials.
Collapse
|
10
|
Head JR, Vos A, Blanton J, Müller T, Chipman R, Pieracci EG, Cleaton J, Wallace R. Environmental distribution of certain modified live-virus vaccines with a high safety profile presents a low-risk, high-reward to control zoonotic diseases. Sci Rep 2019; 9:6783. [PMID: 31043646 PMCID: PMC6494895 DOI: 10.1038/s41598-019-42714-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 04/05/2019] [Indexed: 01/25/2023] Open
Abstract
Oral vaccines aid immunization of hard to reach animal populations but often contain live-attenuated viruses that pose risks of reversion to virulence or residual pathogenicity. Human risk assessment is crucial prior to vaccine field distribution but there is currently no standardized approach. We mapped exposure pathways by which distribution of oral vaccines may result in inoculation into people and applied a Markov chain to estimate the number of severe adverse events. We simulated three oral rabies vaccination (ORV) campaigns: (1) first generation ORV (SAD-B19) in foxes, (2) SAD-B19 in dogs, and (3) third generation ORV (SPBN GASGAS) in dogs. The risk of SAD-B19-associated human deaths was predicted to be low (0.18 per 10 million baits, 95% CI: 0.08, 0.36) when distributed to foxes, but, consistent with international concern, 19 times greater (3.35 per 10 million baits, 95% CI: 2.83, 3.98) when distributed to dogs. We simulated no deaths from SPBN GAS-GAS. Human deaths during dog campaigns were particularly sensitive to dog bite rate, and during wildlife campaigns to animal consumption rate and human contact rate with unconsumed baits. This model highlights the safety of third generation rabies vaccines and serves as a platform for standardized approaches to inform risk assessments.
Collapse
Affiliation(s)
- Jennifer R Head
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA. .,Public Health Institute, San Francisco, CA, USA.
| | - Ad Vos
- IDT Biologika GmbH, 06861, Dessau, Rosslau, Germany
| | - Jesse Blanton
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Thomas Müller
- Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, WHO Collaborating Centre for Rabies Surveillance and Research, Greifswald, Insel Riems, Germany
| | - Richard Chipman
- Wildlife Services Rabies Management, Animal Plant and Health Inspection Service, United States Department of Agriculture, Concord, NH, USA
| | - Emily G Pieracci
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Julie Cleaton
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ryan Wallace
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| |
Collapse
|
11
|
Bassett IV, Forman LS, Govere S, Thulare H, Frank SC, Mhlongo B, Losina E. Test and Treat TB: a pilot trial of GeneXpert MTB/RIF screening on a mobile HIV testing unit in South Africa. BMC Infect Dis 2019; 19:110. [PMID: 30717693 PMCID: PMC6360783 DOI: 10.1186/s12879-019-3738-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 01/23/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Community-based GeneXpert MTB/RIF testing may increase detection of prevalent TB in the community and improve rates of TB treatment completion. METHODS We conducted a pilot randomized trial to evaluate the impact of GeneXpert screening on a mobile HIV testing unit. Adults (≥18y) underwent rapid HIV testing and TB symptom screening and were randomized to usual mobile unit care (providing sputum on the mobile unit sent out for GeneXpert testing) or the "Test & Treat TB" intervention with immediate GeneXpert testing. Symptomatic participants in usual care produced sputum that was sent for hospital-based GeneXpert testing; participants were contacted ~ 7 days later with results. In the "Test & Treat TB" intervention, HIV-infected or HIV-uninfected/TB symptomatic participants underwent GeneXpert testing on the mobile unit. GeneXpert+ participants received expedited TB treatment initiation, monthly SMS reminders and non-cash incentives. We assessed 6-month TB treatment outcomes. RESULTS 4815 were eligible and enrolled; median age was 27 years (IQR 22 to 35). TB symptoms included cough (5%), weight loss (4%), night sweats (4%), and fever (3%). 42% of eligible participants produced sputum (intervention: 56%; usual care: 26%). Seven participants tested GeneXpert+, six in the intervention (3%, 95% CI 1%, 5%) and one in usual care (1%, 95% CI 0%, 6%). 5 of 6 intervention participants completed TB treatment; the GeneXpert+ participant in usual care did not. CONCLUSION GeneXpert MTB/RIF screening on a mobile HIV testing unit is feasible. Yield for GeneXpert+ TB was low, however, the "Test & Treat TB" strategy led to high rates of TB treatment completion. TRIAL REGISTRATION This study was registered on November 21, 2014 at ClinicalTrials.gov ( NCT02298309 ).
Collapse
Affiliation(s)
- Ingrid V. Bassett
- Division of Infectious Disease, Massachusetts General Hospital, Boston, MA USA
- Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, 100 Cambridge Street, 16th Floor, Boston, MA 02114 USA
- Harvard University Center for AIDS Research (CFAR), Boston, MA USA
- Harvard Medical School, Boston, MA USA
| | - Leah S. Forman
- Data Coordinating Center, Boston University School of Public Health, Boston, MA USA
| | | | | | - Simone C. Frank
- Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, 100 Cambridge Street, 16th Floor, Boston, MA 02114 USA
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA USA
| | | | - Elena Losina
- Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, 100 Cambridge Street, 16th Floor, Boston, MA 02114 USA
- Harvard University Center for AIDS Research (CFAR), Boston, MA USA
- Harvard Medical School, Boston, MA USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA USA
- Division of Rheumatology, Department of Medicine, and Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, MA USA
| |
Collapse
|
12
|
Sivay MV, Fogel JM, Wang J, Zhang Y, Piwowar-Manning E, Clarke W, Breaud A, Blankson J, Hamilton EL, Kahn K, Selin A, Gomez-Olive FX, MacPhail C, Hughes JP, Pettifor A, Eshleman SH. Natural control of HIV infection in young women in South Africa: HPTN 068. HIV CLINICAL TRIALS 2018; 19:202-208. [PMID: 30522410 DOI: 10.1080/15284336.2018.1531534] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Some individuals control HIV replication without antiretroviral (ARV) therapy. OBJECTIVE To analyze viral suppression in young women in rural South Africa enrolled in a trial evaluating a behavioral intervention for HIV prevention. METHODS Plasma samples were obtained from women ages 13-24 (81 infected at enrollment, 164 seroconverters). ARV testing was performed using an assay that detects 20 ARV drugs. Women were classified as viremic controllers if they were virally suppressed for ≥12 months with no ARV drug use. RESULTS Samples from 216/245 (88.2%) women had no ARV drugs detected at their first HIV-positive visit. Thirty-four (15.7%) of the 216 women had a viral load <2,000 copies/mL. Fifteen of the 34 women were followed for ≥12 months; 12 were virally suppressed with no ARV drugs detected during follow-up. These women were classified as viremic controllers (overall: 12/216 = 5.6%). The median CD4 cell count at the first HIV-positive visit was higher among the 12 controllers than among the 204 women who were not using ARV drugs (759 vs. 549 cells/mm3, p = 0.02). Some women had a viral load <40 copies/mL at a single study visit, but none were classified as elite controllers (viral load <40 copies/mL for ≥12 months with no ARV drug use). CONCLUSIONS In this cohort, 5.6% of women who were not using ARV drugs had sustained viral suppression. This represents a minimum estimate of the frequency of viremic controllers in this cohort, since some women were not followed long enough to meet the criteria for classification.
Collapse
Affiliation(s)
- Mariya V Sivay
- a Department of Pathology , Johns Hopkins University School of Medicine , Baltimore , Maryland , USA
| | - Jessica M Fogel
- a Department of Pathology , Johns Hopkins University School of Medicine , Baltimore , Maryland , USA
| | - Jing Wang
- b Statistical Center for HIV/ AIDS Research & Prevention (SCHARP) , Seattle , Washington , USA
| | - Yinfeng Zhang
- a Department of Pathology , Johns Hopkins University School of Medicine , Baltimore , Maryland , USA
| | - Estelle Piwowar-Manning
- a Department of Pathology , Johns Hopkins University School of Medicine , Baltimore , Maryland , USA
| | - William Clarke
- a Department of Pathology , Johns Hopkins University School of Medicine , Baltimore , Maryland , USA
| | - Autumn Breaud
- a Department of Pathology , Johns Hopkins University School of Medicine , Baltimore , Maryland , USA
| | - Joel Blankson
- c Department of Medicine , Johns Hopkins University School of Medicine , Baltimore , Maryland , USA
| | - Erica L Hamilton
- d Science Facilitation Department , FHI 360 , Durham , North Carolina , USA
| | - Kathleen Kahn
- e MRC/Wits Rural Public Health and Health, Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa
| | - Amanda Selin
- f University of North Carolina at Chapel Hill, Carolina Population Center , Chapel Hill , North Carolina , USA
| | - F Xavier Gomez-Olive
- e MRC/Wits Rural Public Health and Health, Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa
| | - Catherine MacPhail
- e MRC/Wits Rural Public Health and Health, Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa.,g School of Health and Society , University of Wollongong , Wollongong , Australia
| | - James P Hughes
- h Department of Biostatistics , University of Washington , Seattle , Washington , USA
| | - Audrey Pettifor
- e MRC/Wits Rural Public Health and Health, Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa.,i Department of Epidemiology , University of North Carolina at Chapel Hill , Chapel Hill , North Carolina , USA
| | - Susan H Eshleman
- a Department of Pathology , Johns Hopkins University School of Medicine , Baltimore , Maryland , USA
| |
Collapse
|
13
|
Manoto SL, Lugongolo M, Govender U, Mthunzi-Kufa P. Point of Care Diagnostics for HIV in Resource Limited Settings: An Overview. MEDICINA (KAUNAS, LITHUANIA) 2018; 54:E3. [PMID: 30344234 PMCID: PMC6037236 DOI: 10.3390/medicina54010003] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 02/28/2018] [Accepted: 03/05/2018] [Indexed: 12/14/2022]
Abstract
Human immunodeficiency virus (HIV) is a global health problem. Early diagnosis, rapid antiretroviral therapy (ART) initiation and monitoring of viral load are the key strategies for effective HIV management. Many people in resource limited settings where timely access to medical care is a challenge and healthcare infrastructure is poor have no access to laboratory facilities and diagnosis is dependent on the presence of point of care (POC) devices. POC instruments have shown to be easy to operate, maintain and transport and can easily be operated by less skilled health workers. Additionally, POC tests do not require laboratory technicians to operate. POC devices have resulted in a growing number of people testing for HIV and thereby receiving treatment early. In recent years, there has been great improvement in the development of POC technologies for early HIV diagnosis, HIV viral load and cluster of differentiation 4 (CD4) measurement. This review discusses POC technologies that are currently available and in the pipeline for diagnosing and monitoring HIV. We also give an overview of the technical and commercialization challenges in POC diagnostics for HIV.
Collapse
Affiliation(s)
- Sello Lebohang Manoto
- National Laser Centre, Council for Scientific and Industrial Research, PO Box 395, Pretoria 0001, South Africa.
| | - Masixole Lugongolo
- National Laser Centre, Council for Scientific and Industrial Research, PO Box 395, Pretoria 0001, South Africa.
- College of Science, Engineering and Technology, Department of Physics, NB Pityana Building, University of South Africa, Science Campus, Florida 1710, South Africa.
| | | | - Patience Mthunzi-Kufa
- National Laser Centre, Council for Scientific and Industrial Research, PO Box 395, Pretoria 0001, South Africa.
- College of Science, Engineering and Technology, Department of Physics, NB Pityana Building, University of South Africa, Science Campus, Florida 1710, South Africa.
| |
Collapse
|
14
|
Osler M, Hilderbrand K, Goemaere E, Ford N, Smith M, Meintjes G, Kruger J, Govender NP, Boulle A. The Continuing Burden of Advanced HIV Disease Over 10 Years of Increasing Antiretroviral Therapy Coverage in South Africa. Clin Infect Dis 2018; 66:S118-S125. [PMID: 29514233 PMCID: PMC5850025 DOI: 10.1093/cid/cix1140] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Antiretroviral treatment (ART) has been massively scaled up to decrease human immunodeficiency virus (HIV)-related morbidity, mortality, and HIV transmission. However, despite documented increases in ART coverage, morbidity and mortality have remained substantial. This study describes trends in the numbers and characteristics of patients with very advanced HIV disease in the Western Cape, South Africa. Methods Annual cross-sectional snapshots of CD4 distributions were described over 10 years, derived from a province-wide cohort of all HIV patients receiving CD4 cell count testing in the public sector. Patients with a first CD4 count <50 cells/µL in each year were characterized with respect to prior CD4 and viral load testing, ART access, and retention in ART care. Results Patients attending HIV care for the first time initially constituted the largest group of those with CD4 count <50 cells/µL, dropping proportionally over the decade from 60.9% to 26.7%. By contrast, the proportion who were ART experienced increased from 14.3% to 56.7%. In patients with CD4 counts <50 cells/µL in 2016, 51.8% were ART experienced, of whom 76% could be confirmed to be off ART or had recent viremia. More than half who were ART experienced with a CD4 count <50 cells/µL in 2016 were men, compared to approximately one-third of all patients on ART in the same year. Conclusions Ongoing HIV-associated morbidity now results largely from treatment-experienced patients not being in continuous care or not being fully virologically suppressed. Innovative interventions to retain ART patients in effective care are an essential priority for the ongoing HIV response.
Collapse
Affiliation(s)
- Meg Osler
- Centre for Infectious Diseases, Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town
| | - Katherine Hilderbrand
- Centre for Infectious Diseases, Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town
- Médecins Sans Frontières, Southern African Medical Unit, Cape Town, South Africa
| | - Eric Goemaere
- Centre for Infectious Diseases, Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town
- Médecins Sans Frontières, Southern African Medical Unit, Cape Town, South Africa
| | - Nathan Ford
- Centre for Infectious Diseases, Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town
- HIV Department, World Health Organization, Geneva
| | - Mariette Smith
- Centre for Infectious Diseases, Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town
- Department of Health, Provincial Government of the Western Cape
| | - Graeme Meintjes
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town
- Department of Medicine, University of Cape Town and Groote Schuur Hospital
| | - James Kruger
- Department of Health, Provincial Government of the Western Cape
| | - Nelesh P Govender
- Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases, National Health Laboratory Service
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Andrew Boulle
- Centre for Infectious Diseases, Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town
- Department of Health, Provincial Government of the Western Cape
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town
| |
Collapse
|
15
|
He L, Yang J, Ma Q, Zhang J, Xu Y, Xia Y, Chen W, Wang H, Zheng J, Jiang J, Luo Y, Xu K, Zhang X, Xia S, Pan X. Reduction in HIV community viral loads following the implementation of a "Treatment as Prevention" strategy over 2 years at a population-level among men who have sex with men in Hangzhou, China. BMC Infect Dis 2018; 18:62. [PMID: 29390979 PMCID: PMC5796494 DOI: 10.1186/s12879-017-2927-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 12/17/2017] [Indexed: 11/11/2022] Open
Abstract
Background Previous studies have shown that the increased coverage of antiretroviral therapy (ART) could reduce the community viral load (CVL) and reduce the occurrence of new HIV infections. However, the impact on the reduction of HIV transmission among men who have sex with men (MSM) is much less certain. The frequency of HIV infections in MSM have been rapidly increasing in recent years in Hangzhou, China. The “Treatment as Prevention” strategy was implemented at a population-level for HIV-infected MSM from January 2014 to June 2016 in Hangzhou; it aimed to increase the ART coverage, reduce the CVL, and reduce HIV transmission. Methods We investigated a subset of MSM diagnosed with HIV pre- and post-implementation of the strategy, using random sampling methods. Viral load (VL) testing was performed for all enrolled individuals; the lower limits of detection were 20 and 50 copies/mL. The data on infections were collected from the national epidemiology database of Hangzhou. Logistic regression analyses were conducted to identify factors associated with the differences in social demographic characteristics and available VL data. Results The ART coverage increased from 60.7% (839/1383) during the pre-implementation period to 92.3% (2183/2365) during the post-implementation period in Hangzhou. A total of 940 HIV-infected MSM were selected for inclusion in this study: 490 (52.1%) and 450 (47.9%) MSM in the pre- and post-implementation periods, respectively. In total, 89.5% (841/940) of patients had data available on VL rates. The mean CVL was 579 copies/mL pre-implementation and this decreased to 33 copies/mL post-implementation (Kruskal-Wallis < 0.001). The mean CVL decreased for all variables investigated post-implementation of the treatment strategy (P < 0.05). The undetectable VL (≤400 copies/mL) rate pre-implementation period was 50.0% which increased to 84.7% post-implementation (P < 0.001). The mean CVL at the county level significantly decreased in each county post-implementation (Kruskal-Wallis < 0.05). Conclusion Our study confirmed a population-level association between increased ART coverage and decreased mean CVL; overall 84.7% of HIV infected MSM had an undetectable VL and were no longer infectious.
Collapse
Affiliation(s)
- Lin He
- Zhejiang Provincial Center for Disease Control and Prevention, No. 3399 Bin Sheng Road, Binjiang District, Hangzhou, Zhejiang Province, People's Republic of China
| | - Jiezhe Yang
- Zhejiang Provincial Center for Disease Control and Prevention, No. 3399 Bin Sheng Road, Binjiang District, Hangzhou, Zhejiang Province, People's Republic of China
| | - Qiaoqin Ma
- Zhejiang Provincial Center for Disease Control and Prevention, No. 3399 Bin Sheng Road, Binjiang District, Hangzhou, Zhejiang Province, People's Republic of China
| | - Jiafeng Zhang
- Zhejiang Provincial Center for Disease Control and Prevention, No. 3399 Bin Sheng Road, Binjiang District, Hangzhou, Zhejiang Province, People's Republic of China
| | - Yun Xu
- Zhejiang Provincial Center for Disease Control and Prevention, No. 3399 Bin Sheng Road, Binjiang District, Hangzhou, Zhejiang Province, People's Republic of China
| | - Yan Xia
- Zhejiang Provincial Center for Disease Control and Prevention, No. 3399 Bin Sheng Road, Binjiang District, Hangzhou, Zhejiang Province, People's Republic of China
| | - Wanjun Chen
- Zhejiang Provincial Center for Disease Control and Prevention, No. 3399 Bin Sheng Road, Binjiang District, Hangzhou, Zhejiang Province, People's Republic of China
| | - Hui Wang
- Zhejiang Provincial Center for Disease Control and Prevention, No. 3399 Bin Sheng Road, Binjiang District, Hangzhou, Zhejiang Province, People's Republic of China
| | - Jinlei Zheng
- Zhejiang Provincial Center for Disease Control and Prevention, No. 3399 Bin Sheng Road, Binjiang District, Hangzhou, Zhejiang Province, People's Republic of China
| | - Jun Jiang
- Zhejiang Provincial Center for Disease Control and Prevention, No. 3399 Bin Sheng Road, Binjiang District, Hangzhou, Zhejiang Province, People's Republic of China
| | - Yan Luo
- Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Ke Xu
- Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Xingliang Zhang
- Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Shichang Xia
- Zhejiang Provincial Center for Disease Control and Prevention, No. 3399 Bin Sheng Road, Binjiang District, Hangzhou, Zhejiang Province, People's Republic of China.
| | - Xiaohong Pan
- Zhejiang Provincial Center for Disease Control and Prevention, No. 3399 Bin Sheng Road, Binjiang District, Hangzhou, Zhejiang Province, People's Republic of China.
| |
Collapse
|
16
|
Walensky RP, Borre ED, Bekker LG, Hyle EP, Gonsalves GS, Wood R, Eholié SP, Weinstein MC, Anglaret X, Freedberg KA, Paltiel AD. Do Less Harm: Evaluating HIV Programmatic Alternatives in Response to Cutbacks in Foreign Aid. Ann Intern Med 2017; 167:618-629. [PMID: 28847013 PMCID: PMC5675810 DOI: 10.7326/m17-1358] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Resource-limited nations must consider their response to potential contractions in international support for HIV programs. OBJECTIVE To evaluate the clinical, epidemiologic, and budgetary consequences of alternative HIV program scale-back strategies in 2 recipient nations, the Republic of South Africa (RSA) and Côte d'Ivoire (CI). DESIGN Model-based comparison between current standard (CD4 count at presentation of 0.260 × 109 cells/L, universal antiretroviral therapy [ART] eligibility, and 5-year retention rate of 84%) and scale-back alternatives, including reduced HIV detection, no ART or delayed initiation (when CD4 count is <0.350 × 109 cells/L), reduced investment in retention, and no viral load monitoring or second-line ART. DATA SOURCES Published RSA- and CI-specific estimates of the HIV care continuum, ART efficacy, and HIV-related costs. TARGET POPULATION HIV-infected persons, including future incident cases. TIME HORIZON 5 and 10 years. PERSPECTIVE Modified societal perspective, excluding time and productivity costs. OUTCOME MEASURES HIV transmissions and deaths, years of life, and budgetary outlays (2015 U.S. dollars). RESULTS OF BASE-CASE ANALYSIS At 10 years, scale-back strategies increase projected HIV transmissions by 0.5% to 19.4% and deaths by 0.6% to 39.1%. Strategies can produce budgetary savings of up to 30% but no more. Compared with the current standard, nearly every scale-back strategy produces proportionally more HIV deaths (and transmissions, in RSA) than savings. When the least harmful and most efficient alternatives for achieving budget cuts of 10% to 20% are applied, every year of life lost will save roughly $900 in HIV-related outlays in RSA and $600 to $900 in CI. RESULTS OF SENSITIVITY ANALYSIS Scale-back programs, when combined, may result in clinical and budgetary synergies and offsets. LIMITATION The magnitude and details of budget cuts are not yet known, nor is the degree to which other international partners might step in to restore budget shortfalls. CONCLUSION Scaling back international aid to HIV programs will have severe adverse clinical consequences; for similar economic savings, certain programmatic scale-back choices result in less harm than others. PRIMARY FUNDING SOURCE National Institutes of Health and Steve and Deborah Gorlin MGH Research Scholars Award.
Collapse
Affiliation(s)
- Rochelle P Walensky
- From Massachusetts General Hospital, Brigham and Women's Hospital, Harvard University Center for AIDS Research, Harvard Medical School, Harvard T.H. Chan School of Public Health, and Boston University School of Public Health, Boston, Massachusetts; Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa; Centre Hospitalier Universitaire de Treichville and Treichville University Hospital, Abidjan, Côte d'Ivoire; University of Bordeaux, Bordeaux, France; and Yale School of Public Health, New Haven, Connecticut
| | - Ethan D Borre
- From Massachusetts General Hospital, Brigham and Women's Hospital, Harvard University Center for AIDS Research, Harvard Medical School, Harvard T.H. Chan School of Public Health, and Boston University School of Public Health, Boston, Massachusetts; Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa; Centre Hospitalier Universitaire de Treichville and Treichville University Hospital, Abidjan, Côte d'Ivoire; University of Bordeaux, Bordeaux, France; and Yale School of Public Health, New Haven, Connecticut
| | - Linda-Gail Bekker
- From Massachusetts General Hospital, Brigham and Women's Hospital, Harvard University Center for AIDS Research, Harvard Medical School, Harvard T.H. Chan School of Public Health, and Boston University School of Public Health, Boston, Massachusetts; Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa; Centre Hospitalier Universitaire de Treichville and Treichville University Hospital, Abidjan, Côte d'Ivoire; University of Bordeaux, Bordeaux, France; and Yale School of Public Health, New Haven, Connecticut
| | - Emily P Hyle
- From Massachusetts General Hospital, Brigham and Women's Hospital, Harvard University Center for AIDS Research, Harvard Medical School, Harvard T.H. Chan School of Public Health, and Boston University School of Public Health, Boston, Massachusetts; Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa; Centre Hospitalier Universitaire de Treichville and Treichville University Hospital, Abidjan, Côte d'Ivoire; University of Bordeaux, Bordeaux, France; and Yale School of Public Health, New Haven, Connecticut
| | - Gregg S Gonsalves
- From Massachusetts General Hospital, Brigham and Women's Hospital, Harvard University Center for AIDS Research, Harvard Medical School, Harvard T.H. Chan School of Public Health, and Boston University School of Public Health, Boston, Massachusetts; Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa; Centre Hospitalier Universitaire de Treichville and Treichville University Hospital, Abidjan, Côte d'Ivoire; University of Bordeaux, Bordeaux, France; and Yale School of Public Health, New Haven, Connecticut
| | - Robin Wood
- From Massachusetts General Hospital, Brigham and Women's Hospital, Harvard University Center for AIDS Research, Harvard Medical School, Harvard T.H. Chan School of Public Health, and Boston University School of Public Health, Boston, Massachusetts; Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa; Centre Hospitalier Universitaire de Treichville and Treichville University Hospital, Abidjan, Côte d'Ivoire; University of Bordeaux, Bordeaux, France; and Yale School of Public Health, New Haven, Connecticut
| | - Serge P Eholié
- From Massachusetts General Hospital, Brigham and Women's Hospital, Harvard University Center for AIDS Research, Harvard Medical School, Harvard T.H. Chan School of Public Health, and Boston University School of Public Health, Boston, Massachusetts; Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa; Centre Hospitalier Universitaire de Treichville and Treichville University Hospital, Abidjan, Côte d'Ivoire; University of Bordeaux, Bordeaux, France; and Yale School of Public Health, New Haven, Connecticut
| | - Milton C Weinstein
- From Massachusetts General Hospital, Brigham and Women's Hospital, Harvard University Center for AIDS Research, Harvard Medical School, Harvard T.H. Chan School of Public Health, and Boston University School of Public Health, Boston, Massachusetts; Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa; Centre Hospitalier Universitaire de Treichville and Treichville University Hospital, Abidjan, Côte d'Ivoire; University of Bordeaux, Bordeaux, France; and Yale School of Public Health, New Haven, Connecticut
| | - Xavier Anglaret
- From Massachusetts General Hospital, Brigham and Women's Hospital, Harvard University Center for AIDS Research, Harvard Medical School, Harvard T.H. Chan School of Public Health, and Boston University School of Public Health, Boston, Massachusetts; Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa; Centre Hospitalier Universitaire de Treichville and Treichville University Hospital, Abidjan, Côte d'Ivoire; University of Bordeaux, Bordeaux, France; and Yale School of Public Health, New Haven, Connecticut
| | - Kenneth A Freedberg
- From Massachusetts General Hospital, Brigham and Women's Hospital, Harvard University Center for AIDS Research, Harvard Medical School, Harvard T.H. Chan School of Public Health, and Boston University School of Public Health, Boston, Massachusetts; Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa; Centre Hospitalier Universitaire de Treichville and Treichville University Hospital, Abidjan, Côte d'Ivoire; University of Bordeaux, Bordeaux, France; and Yale School of Public Health, New Haven, Connecticut
| | - A David Paltiel
- From Massachusetts General Hospital, Brigham and Women's Hospital, Harvard University Center for AIDS Research, Harvard Medical School, Harvard T.H. Chan School of Public Health, and Boston University School of Public Health, Boston, Massachusetts; Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa; Centre Hospitalier Universitaire de Treichville and Treichville University Hospital, Abidjan, Côte d'Ivoire; University of Bordeaux, Bordeaux, France; and Yale School of Public Health, New Haven, Connecticut
| |
Collapse
|
17
|
Brawner BM, Guthrie B, Stevens R, Taylor L, Eberhart M, Schensul JJ. Place Still Matters: Racial/Ethnic and Geographic Disparities in HIV Transmission and Disease Burden. J Urban Health 2017; 94:716-729. [PMID: 28879489 PMCID: PMC5610132 DOI: 10.1007/s11524-017-0198-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Neighborhood-level structural interventions are needed to address HIV/AIDS in highly affected areas. To develop these interventions, we need a better understanding of contextual factors that drive the pandemic. We used multinomial logistic regression models to examine the relationship between census tract of current residence and mode of HIV transmission among HIV-positive cases. Compared to the predominantly white high HIV prevalence tract, both the predominantly black high and low HIV prevalence tracts had greater odds of transmission via injection drug use and heterosexual contact than male-to-male sexual contact. After adjusting for current age, gender, race/ethnicity, insurance status, and most recently recorded CD4 count, there was no statistically significant difference in mode of HIV transmission by census tract. However, heterosexual transmission and injection drug use remain key concerns for underserved populations. Blacks were seven times more likely than whites to have heterosexual versus male-to-male sexual contact. Those who had Medicaid or were uninsured (versus private insurance) were 23 and 14 times more likely, respectively, to have injection drug use than male-to-male sexual contact and 10 times more likely to have heterosexual contact than male-to-male sexual contact. These findings can inform larger studies for the development of neighborhood-level structural interventions.
Collapse
Affiliation(s)
- Bridgette M Brawner
- Department of Family and Community Health, University of Pennsylvania School of Nursing, 418 Curie Blvd., Room 419, Philadelphia, PA, USA.
| | - Barbara Guthrie
- Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
| | - Robin Stevens
- Department of Family and Community Health, University of Pennsylvania School of Nursing, 418 Curie Blvd., Room 419, Philadelphia, PA, USA
| | - Lynne Taylor
- Biostatistics Analysis Center, University of Pennsylvania, Philadelphia, PA, USA
| | | | | |
Collapse
|
18
|
Huerga H, Shiferie F, Grebe E, Giuliani R, Farhat JB, Van-Cutsem G, Cohen K. A comparison of self-report and antiretroviral detection to inform estimates of antiretroviral therapy coverage, viral load suppression and HIV incidence in Kwazulu-Natal, South Africa. BMC Infect Dis 2017; 17:653. [PMID: 28969607 PMCID: PMC5623964 DOI: 10.1186/s12879-017-2740-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 09/14/2017] [Indexed: 11/10/2022] Open
Abstract
Background Accurately identifying individuals who are on antiretroviral therapy (ART) is important to determine ART coverage and proportion on ART who are virally suppressed. ART is also included in recent infection testing algorithms used to estimate incidence. We compared estimates of ART coverage, viral load suppression rates and HIV incidence using ART self-report and detection of antiretroviral (ARV) drugs and we identified factors associated with discordance between the methods. Methods Cross-sectional population-based survey in KwaZulu-Natal, South Africa. Individuals 15–59 years were eligible. Interviews included questions about ARV use. Rapid HIV testing was performed at the participants’ home. Blood specimens were collected for ARV detection, LAg-Avidity HIV incidence testing and viral load quantification in HIV-positive individuals. Multivariate logistic regression models were used to identify socio-demographic covariates associated with discordance between self-reported ART and ARV detection. Results Of the 5649 individuals surveyed, 1423 were HIV-positive. Median age was 34 years and 76.3% were women. ART coverage was estimated at 51.4% (95%CI:48.5–54.3), 53.1% (95%CI:50.2–55.9) and 56.1% (95%CI:53.5–58.8) using self-reported ART, ARV detection and both methods combined (classified as ART exposed if ARV detected and/or ART reported) respectively. ART coverage estimates using the 3 methods were fairly similar within sex and age categories except in individuals aged 15–19 years: 33.3% (95%CI:23.3–45.2), 33.8% (95%CI:23.9–45.4%) and 44.3% (95%CI:39.3–46.7) using self-reported ART, ARV detection and both methods combined. Viral suppression below 1000cp/mL in individuals on ART was estimated at 89.8% (95%CI:87.3–91.9), 93.1% (95%CI:91.0–94.8) and 88.7% (95%CI:86.2–90.7) using self-reported ART, ARV detection and both methods combined respectively. HIV incidence was estimated at 1.4 (95%CI:0.8–2.0) new cases/100 person-years when employing no measure of ARV use, 1.1/100PY (95%CI:0.6–1.7) using self-reported ART, and 1.2/100PY (95%CI:0.7–1.7) using ARV detection. In multivariate analyses, individuals aged 15–19 years had a higher risk of discordance on measures of ARV exposure (aOR:9.4; 95%CI:3.9–22.8), while migrants had a lower risk (aOR:0.3; 95%CI:0.1–0.6). Conclusions In KwaZulu-Natal, the method of identifying ARV use had little impact on estimates of ART coverage, viral suppression rate and HIV incidence. However, discordant results were more common in younger individuals. This may skew estimates of ART coverage and viral suppression, particularly in adolescent surveys. Electronic supplementary material The online version of this article (10.1186/s12879-017-2740-y) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
| | | | - Eduard Grebe
- South African DST-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa
| | - Ruggero Giuliani
- Medical Department, Médecins Sans Frontières, Cape Town, South Africa
| | | | - Gilles Van-Cutsem
- Medical Department, Médecins Sans Frontières, Cape Town, South Africa.,Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Karen Cohen
- Division of Clinical Pharmacology, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
19
|
Abstract
Purpose of review More point-of-care (POC) diagnostic tests are becoming available for HIV diagnosis and treatment in resource-limited settings. These novel technologies have the potential to foster decentralized HIV care and treatment for the benefit of clinical laboratories, HIV clinics, and HIV-infected patients. There continue to be many business, technological, and operational challenges that limit product development and regulatory approval, which limits products available for the required operational and cost-effectiveness studies and delays policy adoption and implementation. Recent findings Although the rapid HIV diagnostic test has been widely successful, the pathways for POC CD4+ cell count and HIV viral load assay analyzers have been more challenging. We describe significant hurdles for product development, approval, and implementation, which include the business case, technical development, clinical impact, and integrating laboratory and clinical networks. Summary The objective of this review is to highlight the obstacles for developing and implementing appropriate strategies for POC HIV testing assays to improve the clinical services for HIV-infected patients in resource-limited settings.
Collapse
|
20
|
Grobler A, Cawood C, Khanyile D, Puren A, Kharsany ABM. Progress of UNAIDS 90-90-90 targets in a district in KwaZulu-Natal, South Africa, with high HIV burden, in the HIPSS study: a household-based complex multilevel community survey. Lancet HIV 2017; 4:e505-e513. [PMID: 28779855 DOI: 10.1016/s2352-3018(17)30122-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 06/09/2017] [Accepted: 06/13/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND With the goal of eliminating new HIV infections, UNAIDS set the ambitious 90-90-90 targets to be achieved by 2020. We assessed whether these targets are being met among participants of the HIV Incidence Provincial Surveillance System (HIPSS) in a high-burden district of South Africa. METHODS We used data from a HIPSS household-based, cross-sectional survey of HIV prevalence and incidence done in the uMgungundlovu district, KwaZulu-Natal, in 2014 and 2015. In randomly selected enumeration areas, 50 households were drawn systematically along a serpentine pattern from a random start point. One eligible individual in each household was asked to provide blood for HIV testing and to complete a questionnaire. If a household refused to participate, the house next to it was approached. Eligible participants were aged 15-49 years, lived in the household, were not planning to move away, and spoke English or Zulu. Viral load was measured in samples positive for HIV. We also assessed participants' HIV linkage to care and treatment. Data were population weighted to allow for multilevel sampling and non-response. FINDINGS 9812 participants were enrolled, 3547 men (36%) and 6265 women (64%). Overall, 504 of 1014 men (estimate 52%, 95% CI 47-56) and 1833 of 2955 women (65%, 62-67) who were HIV positive knew their HIV status. Of those who knew, 344 of 522 men (69%, 63-75) and 1254 of 1845 women (70%, 68-73) were taking ART. Among recipients of ART, 294 of 341 men (85%, 80-90) and 1117 of 1249 women (90%, 87-92) had viral loads less than 1000 copies per mL. Among all HIV-positive participants, 427 of 1014 men (44%, 39-49) and 1680 of 2955 women (58%, 55-61) had viral loads lower than 1000 copies per mL. INTERPRETATION No UNAIDS 90-90-90 targets had been met in our study population. Major campaigns are needed to increase HIV testing, especially among men, and to ensure all HIV-positive patients are taking ART. FUNDING Centers for Disease Control and Prevention and the US Presidents Emergency Plan for AIDS Relief (PEPFAR).
Collapse
Affiliation(s)
- Anneke Grobler
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa; Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, VIC, Australia.
| | - Cherie Cawood
- Epicentre AIDS Risk Management (Pty) Limited, Paarl, South Africa
| | - David Khanyile
- Epicentre AIDS Risk Management (Pty) Limited, Paarl, South Africa
| | - Adrian Puren
- Centre for HIV and STIs, National Institute for Communicable Diseases, National Health Laboratory Service (NICD/NHLS), Johannesburg, South Africa; Division of Virology, School of Pathology, University of Witwatersrand, Johannesburg, South Africa
| | - Ayesha B M Kharsany
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
| |
Collapse
|
21
|
Khoza-Shangase K, Jade Van Rie K. Pathological vestibular symptoms presenting in a group of adults with HIV/AIDS in Johannesburg, South Africa. S Afr J Infect Dis 2017. [DOI: 10.1080/23120053.2016.1216816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Katijah Khoza-Shangase
- Department of Speech Pathology and Audiology, School of Human and Community Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Kayla Jade Van Rie
- Department of Speech Pathology and Audiology, School of Human and Community Development, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
22
|
Petersen M, Balzer L, Kwarsiima D, Sang N, Chamie G, Ayieko J, Kabami J, Owaraganise A, Liegler T, Mwangwa F, Kadede K, Jain V, Plenty A, Brown L, Lavoy G, Schwab J, Black D, van der Laan M, Bukusi EA, Cohen CR, Clark TD, Charlebois E, Kamya M, Havlir D. Association of Implementation of a Universal Testing and Treatment Intervention With HIV Diagnosis, Receipt of Antiretroviral Therapy, and Viral Suppression in East Africa. JAMA 2017; 317:2196-2206. [PMID: 28586888 PMCID: PMC5734234 DOI: 10.1001/jama.2017.5705] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
IMPORTANCE Antiretroviral treatment (ART) is now recommended for all HIV-positive persons. UNAIDS has set global targets to diagnose 90% of HIV-positive individuals, treat 90% of diagnosed individuals with ART, and suppress viral replication among 90% of treated individuals, for a population-level target of 73% of all HIV-positive persons with HIV viral suppression. OBJECTIVE To describe changes in the proportions of HIV-positive individuals with HIV viral suppression, HIV-positive individuals who had received a diagnosis, diagnosed individuals treated with ART, and treated individuals with HIV viral suppression, following implementation of a community-based testing and treatment program in rural East Africa. DESIGN, SETTING, AND PARTICIPANTS Observational analysis based on interim data from 16 rural Kenyan (n = 6) and Ugandan (n = 10) intervention communities in the SEARCH Study, an ongoing cluster randomized trial. Community residents who were 15 years or older (N = 77 774) were followed up for 2 years (2013-2014 to 2015-2016). HIV serostatus and plasma HIV RNA level were measured annually at multidisease health campaigns followed by home-based testing for nonattendees. All HIV-positive individuals were offered ART using a streamlined delivery model designed to reduce structural barriers, improve patient-clinician relationships, and enhance patient knowledge and attitudes about HIV. MAIN OUTCOMES AND MEASURES Primary outcome was viral suppression (plasma HIV RNA<500 copies/mL) among all HIV-positive individuals, assessed at baseline and after 1 and 2 years. Secondary outcomes included HIV diagnosis, ART among previously diagnosed individuals, and viral suppression among those who had initiated ART. RESULTS Among 77 774 residents (male, 45.3%; age 15-24 years, 35.1%), baseline HIV prevalence was 10.3% (7108 of 69 283 residents). The proportion of HIV-positive individuals with HIV viral suppression at baseline was 44.7% (95% CI, 43.5%-45.9%; 3464 of 7745 residents) and after 2 years of intervention was 80.2% (95% CI, 79.1%-81.2%; 5666 of 7068 residents), an increase of 35.5 percentage points (95% CI, 34.4-36.6). After 2 years, 95.9% of HIV-positive individuals had been previously diagnosed (95% CI, 95.3%-96.5%; 6780 of 7068 residents); 93.4% of those previously diagnosed had received ART (95% CI, 92.8%-94.0%; 6334 of 6780 residents); and 89.5% of those treated had achieved HIV viral suppression (95% CI, 88.6%-90.3%; 5666 of 6334 residents). CONCLUSIONS AND RELEVANCE Among individuals with HIV in rural Kenya and Uganda, implementation of community-based testing and treatment was associated with an increased proportion of HIV-positive adults who achieved viral suppression, along with increased HIV diagnosis and initiation of antiretroviral therapy. In these communities, the UNAIDS population-level viral suppression target was exceeded within 2 years after program implementation. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01864683.
Collapse
Affiliation(s)
- Maya Petersen
- School of Public Health, University of California, Berkeley
| | - Laura Balzer
- University of California, San Francisco
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | | | - Norton Sang
- Kenya Medical Research Institute, Nairobi, Kenya
| | | | - James Ayieko
- Kenya Medical Research Institute, Nairobi, Kenya
| | - Jane Kabami
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | | | | | | | - Kevin Kadede
- Kenya Medical Research Institute, Nairobi, Kenya
| | | | | | | | - Geoff Lavoy
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Joshua Schwab
- School of Public Health, University of California, Berkeley
| | | | | | | | | | | | | | - Moses Kamya
- Infectious Diseases Research Collaboration, Kampala, Uganda
- Makerere University, Kampala, Uganda
| | | |
Collapse
|
23
|
Who Needs to Be Targeted for HIV Testing and Treatment in KwaZulu-Natal? Results From a Population-Based Survey. J Acquir Immune Defic Syndr 2017; 73:411-418. [PMID: 27243903 PMCID: PMC5172512 DOI: 10.1097/qai.0000000000001081] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Supplemental Digital Content is Available in the Text. Introduction: Identifying gaps in HIV testing and treatment is essential to design specific strategies targeting those not accessing HIV services. We assessed the prevalence and factors associated with being HIV untested, unaware, untreated, and virally unsuppressed in KwaZulu-Natal, South Africa. Methods: Cross-sectional population-based survey. People aged 15–59 years were eligible. Interviews, HIV testing, and blood collection for antiretroviral drug presence test, CD4, and viral load were done at the participants' home. Results: Of the 5649 individuals included, 81.4% (95% CI: 79.8 to 82.9) had previously been tested. HIV prevalence was 25.2%. HIV-positivity awareness rate was 75.2% (95% CI: 72.9 to 77.4). Of all unaware, 73.3% of people were aged <35 years and 68.7% were women. Antiretroviral therapy coverage was 75.0% (95% CI: 72.0 to 77.8) among those eligible for treatment (CD4 < 350, PMTCT-B) and 53.1% (95% CI: 50.4 to 55.7) among all HIV-positive individuals. Viral load was <1000 copies per milliliter in 57.1% of all HIV-positive individuals. Although 66.3% and 71.7% of people with viral load ≥1000 copies per milliliter were people aged <35 years and women respectively, men had 4.4, 1.8, 1.6, and 1.7 times the odds of being untested, unaware, untreated, and virally unsuppressed. In addition, people with more than 1 sexual partner had 1.3, 2.2, and 1.9 times the odds of being untested, unaware, and untreated. Conclusions: The majority of HIV-positive people unaware of their status, untreated, and virally unsuppressed were individuals aged <35 years and women. However, men were disproportionately untested, unaware HIV positivity, untreated, and virally unsuppressed. In this context, HIV testing and treatment should be prioritized to target young people and women, whereas novel strategies are necessary to reach men.
Collapse
|
24
|
Walensky RP, Borre ED, Bekker LG, Resch SC, Hyle EP, Wood R, Weinstein MC, Ciaranello AL, Freedberg KA, Paltiel AD. The Anticipated Clinical and Economic Effects of 90-90-90 in South Africa. Ann Intern Med 2016; 165:325-33. [PMID: 27240120 PMCID: PMC5012932 DOI: 10.7326/m16-0799] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 global treatment target aims to achieve 73% virologic suppression among HIV-infected persons worldwide by 2020. OBJECTIVE To estimate the clinical and economic value of reaching this ambitious goal in South Africa, by using a microsimulation model of HIV detection, disease, and treatment. DESIGN Modeling of the "current pace" strategy, which simulates existing scale-up efforts and gradual increases in overall virologic suppression from 24% to 36% in 5 years, and the UNAIDS target strategy, which simulates 73% virologic suppression in 5 years. DATA SOURCES Published estimates and South African survey data on HIV transmission rates (0.16 to 9.03 per 100 person-years), HIV-specific age-stratified fertility rates (1.0 to 9.1 per 100 person-years), and costs of care ($11 to $31 per month for antiretroviral therapy and $20 to $157 per month for routine care). TARGET POPULATION South African HIV-infected population, including incident infections over the next 10 years. PERSPECTIVE Modified societal perspective, excluding time and productivity costs. TIME HORIZON 5 and 10 years. INTERVENTION Aggressive HIV case detection, efficient linkage to care, rapid treatment scale-up, and adherence and retention interventions toward the UNAIDS target strategy. OUTCOME MEASURES HIV transmissions, deaths, years of life saved, maternal orphans, costs (2014 U.S. dollars), and cost-effectiveness. RESULTS OF BASE-CASE ANALYSIS Compared with the current pace strategy, over 5 years the UNAIDS target strategy would avert 873 000 HIV transmissions, 1 174 000 deaths, and 726 000 maternal orphans while saving 3 002 000 life-years; over 10 years, it would avert 2 051 000 HIV transmissions, 2 478 000 deaths, and 1 689 000 maternal orphans while saving 13 340 000 life-years. The additional budget required for the UNAIDS target strategy would be $7.965 billion over 5 years and $15.979 billion over 10 years, yielding an incremental cost-effectiveness ratio of $2720 and $1260 per year of life saved, respectively. RESULTS OF SENSITIVITY ANALYSIS Outcomes generally varied less than 20% from base-case outcomes when key input parameters were varied within plausible ranges. LIMITATION Several pathways may lead to 73% overall virologic suppression; these were examined in sensitivity analyses. CONCLUSION Reaching the 90-90-90 HIV suppression target would be costly but very effective and cost-effective in South Africa. Global health policymakers should mobilize the political and economic support to realize this target. PRIMARY FUNDING SOURCE National Institutes of Health and the Steve and Deborah Gorlin MGH Research Scholars Award.
Collapse
|
25
|
Level of viral suppression and the cascade of HIV care in a South African semi-urban setting in 2012. AIDS 2016; 30:2107-16. [PMID: 27163707 DOI: 10.1097/qad.0000000000001155] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE In 2012, 7 years after the introduction of antiretroviral treatment (ART) in the South African township of Orange Farm, we measured the proportion of HIV-positive people who were virally suppressed, especially among high-risk groups (women 18-29 years and men 25-34 years). DESIGN A community-based cross-sectional representative survey was conducted among 3293 men and 3473 women. METHODS Study procedures included a face-to-face interview and collection of blood samples that were tested for HIV, 11 antiretroviral drugs and HIV-viral load. RESULTS HIV prevalence was 17.0% [95% confidence interval: 15.7-18.3%] among men and 30.1% [28.5-31.6%] among women. Overall, 59.1% [57.4-60.8%] of men and 79.5% [78.2-80.9%] of women had previously been tested for HIV. When controlling for age, circumcised men were more likely to have been tested compared with uncircumcised men (66.1 vs 53.6%; P < 0.001). Among HIV+, 21.0% [17.7-24.6%] of men and 30.5% [27.7-33.3%] of women tested positive for one or more antiretroviral drugs. Using basic calculations, we estimated that, between 2005 and 2012, ART programs prevented between 46 and 63% of AIDS-related deaths in the community. Among antiretroviral-positive, 91.9% [88.7-94.3%] had viral suppression (viral load <400 copies/ml). The proportion of viral suppression among HIV+ was 27.0% [24.3-29.9%] among women and 17.5% [14.4-20.9%] among men. These proportions were lower among the high-risk groups: 15.6% [12.1-19.7%] among women and 8.4% [5.0-13.1%] among men. CONCLUSION In Orange Farm, between 2005 and 2012, ART programs were suboptimal and, among those living with HIV, the proportion with viral suppression was still low, especially among the young age groups. However, our study showed that, in reality, antiretroviral drugs are highly effective in viral suppression at an individual level.
Collapse
|
26
|
Su S, Chen X, Mao L, He J, Wei X, Jing J, Zhang L. Superior Effects of Antiretroviral Treatment among Men Who have Sex with Men Compared to Other HIV At-Risk Populations in a Large Cohort Study in Hunan, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13030283. [PMID: 27005640 PMCID: PMC4808946 DOI: 10.3390/ijerph13030283] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 01/28/2016] [Accepted: 02/19/2016] [Indexed: 02/08/2023]
Abstract
This study assesses association between CD4 level at initiation of antiretroviral treatment (ART) on subsequent treatment outcomes and mortality among people infected with HIV via various routes in Hunan province, China. Over a period of 10 years, a total of 7333 HIV-positive patients, including 553 (7.5%) MSM, 5484 (74.8%) heterosexuals, 1164 (15.9%) injection drug users (IDU) and 132 (1.8%) former plasma donors (FPD), were recruited. MSM substantially demonstrated higher initial CD4 cell level (242, IQR 167-298) than other populations (Heterosexuals: 144 IQR 40-242, IDU: 134 IQR 38-224, FPD: 86 IQR 36-181). During subsequent long-term follow up, the median CD4 level in all participants increased significantly from 151 cells/mm³ (IQR 43-246) to 265 cells/mm³ (IQR 162-380), whereas CD4 level in MSM remained at a high level between 242 and 361 cells/mm³. Consistently, both cumulative immunological and virological failure rates (10.4% and 26.4% in 48 months, respectively) were the lowest in MSM compared with other population groups. Survival analysis indicated that initial CD4 counts ≤ 200 cells/mm³ (AHR = 3.14; CI, 2.43-4.06) significantly contributed to HIV-related mortality during treatment. Timely diagnosis and treatment of HIV patients are vital for improving CD4 level and health outcomes.
Collapse
Affiliation(s)
- Shu Su
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC 3004, Australia.
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC 3004, Australia.
| | - Xi Chen
- Hunan Provincial Center for Disease Control and Prevention, Changsha 410005, Hunan, China.
| | - Limin Mao
- Center for Social Research in Health, Faculty of Arts and Social Science at the University of New South Wales, Sydney, NSW 2052, Australia.
| | - Jianmei He
- Hunan Provincial Center for Disease Control and Prevention, Changsha 410005, Hunan, China.
| | - Xiuqing Wei
- Hunan Provincial Center for Disease Control and Prevention, Changsha 410005, Hunan, China.
| | - Jun Jing
- Comprehensive AIDS Research Center, Tsinghua University, Beijing 100084, China.
| | - Lei Zhang
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC 3004, Australia.
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC 3004, Australia.
- Comprehensive AIDS Research Center, Tsinghua University, Beijing 100084, China.
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC 3004, Australia.
| |
Collapse
|
27
|
Closer to 90-90-90. The cascade of care after 10 years of ART scale-up in rural Malawi: a population study. J Int AIDS Soc 2016; 19:20673. [PMID: 26894388 PMCID: PMC4760102 DOI: 10.7448/ias.19.1.20673] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 12/16/2015] [Accepted: 01/12/2016] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION The antiretroviral therapy (ART) programme supported by Médecins Sans Frontières in the rural Malawian district of Chiradzulu was one of the first in sub-Saharan Africa to scale up ART delivery in 2002. After more than a decade of continuous involvement, we conducted a population survey to evaluate the cascade of care, including population viral load, in the district. METHODS A cross-sectional household-based survey was conducted between February and May 2013. Using a multistage cluster sampling method, we recruited all individuals aged 15 to 59 years living in 4125 randomly selected households. Each consenting individual was interviewed and tested for HIV at home. All participants who tested positive had their CD4 count and viral load measured. The LAg-Avidity assay was used to distinguish recent from long-term infections. Viral suppression was defined as a viral load below 1000 copies/mL. RESULTS Of 8271 individuals eligible for the study, 7269 agreed to participate and were tested for HIV (94.1% inclusion for women and 80.3% for men). Overall HIV prevalence and incidence were 17.0% (95% CI 16.1 to 17.9) and 0.39 new cases per 100 person-years (95% CI 0.0 to 0.77), respectively. Coverage at the other steps along the HIV care cascade was as follows: 76.7% (95% CI 74.4 to 79.1) had been previously diagnosed, 71.2% (95% CI 68.6 to 73.6) were under care and 65.8% (95% CI 62.8 to 68.2) were receiving ART. Finally, the proportion of participants who were HIV positive with a viral load ≤ 1000 copies/mL reached 61.8% (95% CI 59.0 to 64.5). CONCLUSIONS This study demonstrates that a high level of population viral suppression and low incidence can be achieved in high HIV prevalence and resource-limited settings.
Collapse
|
28
|
Ying R, Granich RM, Gupta S, Williams BG. CD4 Cell Count: Declining Value for Antiretroviral Therapy Eligibility. Clin Infect Dis 2016; 62:1022-8. [PMID: 26826372 DOI: 10.1093/cid/civ1224] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 12/16/2015] [Indexed: 01/09/2023] Open
Abstract
Antiretroviral therapy (ART) policy for people living with human immunodeficiency virus (HIV) has historically been based on clinical indications, such as opportunistic infections and CD4 cell counts. Studies suggest that CD4 counts early in HIV infection do not predict relevant public health outcomes such as disease progression, mortality, and HIV transmission in people living with HIV. CD4 counts also vary widely within individuals and among populations, leading to imprecise measurements and arbitrary ART initiation. To capture the clinical and preventive benefits of treatment, the global HIV response now focuses on increasing HIV diagnosis and ART coverage. CD4 counts for ART initiation were necessary when medications were expensive and had severe side effects, and when the impact of early ART initiation was unclear. However, current evidence suggests that although CD4 counts may still play a role in guiding clinical care to start prophylaxis for opportunistic infections, CD4 counts should cease to be required for ART initiation.
Collapse
Affiliation(s)
- Roger Ying
- Weill Cornell Medical College, Cornell University, New York, New York
| | - Reuben M Granich
- International Association of Providers of AIDS Care, Washington D.C
| | - Somya Gupta
- International Association of Providers of AIDS Care, Washington D.C
| | - Brian G Williams
- South African Department of Science and Technology/National Research Foundation Centre of Excellence in Epidemiological Modelling and Analysis, Stellenbosch University Wits Reproductive Health and HIV Research Institute, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
29
|
Kessler J, Nucifora K, Li L, Uhler L, Braithwaite S. Impact and Cost-Effectiveness of Hypothetical Strategies to Enhance Retention in Care within HIV Treatment Programs in East Africa. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2015; 18:946-955. [PMID: 26686778 PMCID: PMC4696404 DOI: 10.1016/j.jval.2015.09.2940] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 08/21/2015] [Accepted: 09/18/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES Attrition from care among HIV infected patients can lead to poor clinical outcomes. Our objective was to evaluate hypothetical interventions seeking to improve retention-in-care (RIC) for HIV-infected patients in East Africa, asking whether they could offer favorable value compared to earlier ART initiation. METHODS We used a micro-simulation model to analyze two RIC focused strategies within an East African HIV treatment program--"risk reduction," defined as intervention(s) that decrease the risk of attrition from care; and "outreach," defined as interventions that find patients and relink them with care. We compared this to earlier ART treatment as a measure of the potential health benefits forgone (e.g., opportunity cost). RESULTS Reducing attrition by 40% at an average cost of $10 per person remains a less efficient use of resources compared to ensuring full access to ART (cost- effectiveness ratio $1300 vs $3700) for ART eligible patients. An outreach intervention had limited clinical benefit in our simulation. If intervention costs are <$10 per person, however, an intervention able to achieve a 40% (or greater) reduction in attrition may be a cost-effective next implementation option following implementation of earlier ART treatment. CONCLUSIONS Our results suggest that programs should consider retention focused programs once they have already achieved high degrees of ART coverage among eligible patients. It is important that decision makers understand the epidemiology and associated outcomes of those patients who are classified as lost to follow up in their systems prior to implementation in order to achieve the highest value.
Collapse
Affiliation(s)
- Jason Kessler
- Department of Population Health, New York University School of Medicine, New York, NY, USA.
| | - Kimberly Nucifora
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Lingfeng Li
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Lauren Uhler
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Scott Braithwaite
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| |
Collapse
|
30
|
Plasma viraemia in HIV-positive pregnant women entering antenatal care in South Africa. J Int AIDS Soc 2015; 18:20045. [PMID: 26154734 PMCID: PMC4495612 DOI: 10.7448/ias.18.1.20045] [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: 01/29/2015] [Revised: 05/07/2015] [Accepted: 06/01/2015] [Indexed: 11/08/2022] Open
Abstract
Introduction Plasma HIV viral load (VL) is the principle determinant of mother-to-child HIV transmission (MTCT), yet there are few data on VL in populations of pregnant women in sub-Saharan Africa. We examined the distribution and determinants of VL in HIV-positive women seeking antenatal care (ANC) in Cape Town, South Africa. Methods Consecutive HIV-positive pregnant women making their first antenatal clinic visit were recruited into a cross-sectional study of viraemia in pregnancy, including a brief questionnaire and specimens for VL testing and CD4 cell enumeration. Results & discussion Overall 5551 pregnant women sought ANC during the study period, of whom 1839 (33%) were HIV positive and 1521 (85%) were included. Approximately two-thirds of HIV-positive women in the sample (n=947) were not on antiretrovirals at the time of the first ANC visit, and the remainder (38%, n=574) had initiated antiretroviral therapy (ART) prior to conception. For women not on ART, the median VL was 3.98 log10 copies/mL; in this group, the sensitivity of CD4 cell counts ≤350 cells/µL in detecting VL>10,000 copies/mL was 64% and this increased to 78% with a CD4 threshold of ≤500 cells/µL. Among women on ART, 78% had VL<50 copies/mL and 13% had VL >1000 copies/mL at the time of their ANC visit. Conclusions VL >10,000 copies/mL was commonly observed in women not on ART with CD4 cell counts >350 cells/µL, suggesting that CD4 cell counts may not be adequately sensitive in identifying women at greatest risk of MTCT. A large proportion of women entering ANC initiated ART before conception, and in this group more than 10% had VL>1000 copies/mL despite ART use. VL monitoring during pregnancy may help to identify pregnancies that require additional clinical attention to minimize MTCT risk and improve maternal and child health outcomes.
Collapse
|
31
|
Wong NS, Wong KH, Wong PKH, Lee SS. Incorporation of Estimated Community Viral Load Before HIV Diagnosis for Enhancing Epidemiologic Investigations: A Comparison Between Men Who Have Sex With Men and Heterosexual Men in Hong Kong. Asia Pac J Public Health 2015; 27:756-64. [PMID: 26041836 DOI: 10.1177/1010539515589340] [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] [Indexed: 11/16/2022]
Abstract
Currently, no studies have specifically incorporated population-level viral load measures for analyzing temporal trends of HIV infection in the Asia Pacific. With the use of longitudinal data from 950 HIV-infected heterosexual male and 1331 men who have sex with men managed at a major HIV clinic in Hong Kong between 1985 and 2012, viral load changes at population levels were compared. We back-calculated seroconversion year of each diagnosed patient and estimated the population-level viral load under the framework recommended by the Centers for Disease Control and Prevention. Full community viral load, a newly designed measure incorporating diagnosed and undiagnosed HIV-infected patients, was 3 to 8 times higher than community viral load derived from diagnosed patients only. The growth curve of full community viral load was 5 years ahead of other viral load measures, the shape of which lent support to the phenomenon of local transmission of men who have sex with men but not among heterosexual male in the predominantly Chinese HIV community in Hong Kong.
Collapse
Affiliation(s)
- Ngai Sze Wong
- The Chinese University of Hong Kong, Shatin, Hong Kong, People's Republic of China
| | - Ka Hing Wong
- Department of Health, Hong Kong Special Administrative Region Government, Hong Kong, People's Republic of China
| | - Philip K H Wong
- Department of Health, Hong Kong Special Administrative Region Government, Hong Kong, People's Republic of China
| | - Shui Shan Lee
- The Chinese University of Hong Kong, Shatin, Hong Kong, People's Republic of China
| |
Collapse
|
32
|
Wilson D, Taaffe J, Fraser-Hurt N, Gorgens M. The economics, financing and implementation of HIV treatment as prevention: what will it take to get there? AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2015; 13:109-19. [PMID: 25174628 DOI: 10.2989/16085906.2014.943254] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The 2013 Lancet Commission Report, Global Health 2035, rightly pointed out that we are at a unique place in history where a "grand convergence" of health initiatives to reduce both infectious diseases, and child and maternal mortality--diseases that still plague low income countries--would yield good returns in terms of development and health outcomes. This would also be a good economic investment. Such investments would support achieving health goals of reducing under-five (U5) mortality to 16 per 1000 live births, reducing deaths due to HIV/AIDS to 8 per 100,000 population, and reducing annual TB deaths to 4 per 100,000 population. Treatment as prevention (TasP) holds enormous potential in reducing HIV transmission, and morbidity and mortality associated with HIV/AIDS--and therefore contributing to Global Health 2035 goals. However, TasP requires large financial investments and poses significant implementation challenges. In this review, we discuss the potential effectiveness, financing and implementation of TasP. Overall, we conclude that TasP shows great promise as a cost-effective intervention to address the dual aims of reducing new HIV infections and reducing the global burden of HIV-related disease. Successful implementation will be no easy feat, though. The dramatic increases in the numbers of persons who need antiretroviral therapy (ART) under a TasP approach will pose enormous challenges at all stages of the HIV treatment cascade: HIV diagnosis, antiretroviral (ARV) initiation, ARV adherence and retention, and increased drug resistance with long-term enrolment on ART. Overcoming these implementation challenges will require targeted implementation, not focusing exclusively on TasP, most-at-risk population (MARP)-friendly services for key populations, integrating services, task shifting, more efficient programme management, balancing supply and demand, integration into universal health coverage efforts, demand creation, improved ART retention and adherence strategies, the use of incentives to improve HIV treatment outcomes and reduce unit costs, continued operational research and tapping into technological innovations.
Collapse
|
33
|
Wilson D, Fraser N. Who pays and why? Costs, effectiveness, and feasibility of HIV treatment as prevention. Clin Infect Dis 2015; 59 Suppl 1:S28-31. [PMID: 24926029 DOI: 10.1093/cid/ciu300] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Treatment as prevention (TasP) has been added to the toolbox of human immunodeficiency virus (HIV) prevention technologies, and countries are at different stages of TasP deployment. In this article we review some of the cost implications and summarize effectiveness data from different settings. Also, we reflect on the affordability and feasibility of programmatic deployment as well as the multiple challenges of maintaining service quality while HIV treatment programs grow in size and complexity. We conclude that in low-resource settings, TasP progress will be very incremental with progressively earlier treatment initiation while working within the capacity and resource constraints of the respective healthcare systems. In the long-term, feasibility will rely on complementary interventions to reduce new HIV infections, such as male circumcision, and on demand creation for early treatment uptake as well as adherence. TasP holds potential for moving us closer to the global goal of ending AIDS.
Collapse
|
34
|
Clouse K, Hanrahan CF, Bassett J, Fox MP, Sanne I, Van Rie A. Impact of systematic HIV testing on case finding and retention in care at a primary care clinic in South Africa. Trop Med Int Health 2014; 19:1411-9. [PMID: 25244155 DOI: 10.1111/tmi.12387] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Systematic, opt-out HIV counselling and testing (HCT) may diagnose individuals at lower levels of immunodeficiency but may impact loss to follow-up (LTFU) if healthier people are less motivated to engage and remain in HIV care. We explored LTFU and patient clinical outcomes under two different HIV testing strategies. METHODS We compared patient characteristics and retention in care between adults newly diagnosed with HIV by either voluntary counselling and testing (VCT) plus targeted provider-initiated counselling and testing (PITC) or systematic HCT at a primary care clinic in Johannesburg, South Africa. RESULTS One thousand one hundred and forty-four adults were newly diagnosed by VCT/PITC and 1124 by systematic HCT. Two-thirds of diagnoses were in women. Median CD4 count at HIV diagnosis (251 vs. 264 cells/μl, P = 0.19) and proportion of individuals eligible for antiretroviral therapy (ART) (67.2% vs. 66.7%, P = 0.80) did not differ by HCT strategy. Within 1 year of HIV diagnosis, half were LTFU: 50.5% under VCT/PITC and 49.6% under systematic HCT (P = 0.64). The overall hazard of LTFU was not affected by testing policy (aHR 0.98, 95%CI: 0.87-1.10). Independent of HCT strategy, males, younger adults and those ineligible for ART were at higher risk of LTFU. CONCLUSIONS Implementation of systematic HCT did not increase baseline CD4 count. Overall retention in the first year after HIV diagnosis was low (37.9%), especially among those ineligible for ART, but did not differ by testing strategy. Expansion of HIV testing should coincide with effective strategies to increase retention in care, especially among those not yet eligible for ART at initial diagnosis.
Collapse
Affiliation(s)
- Kate Clouse
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | | | | | | | | | | |
Collapse
|
35
|
Interventions to improve or facilitate linkage to or retention in pre-ART (HIV) care and initiation of ART in low- and middle-income settings--a systematic review. J Int AIDS Soc 2014; 17:19032. [PMID: 25095831 PMCID: PMC4122816 DOI: 10.7448/ias.17.1.19032] [Citation(s) in RCA: 199] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 05/26/2014] [Accepted: 06/11/2014] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Several approaches have been taken to reduce pre-antiretroviral therapy (ART) losses between HIV testing and ART initiation in low- and middle-income countries, but a systematic assessment of the evidence has not yet been undertaken. The aim of this systematic review is to assess the potential for interventions to improve or facilitate linkage to or retention in pre-ART care and initiation of ART in low- and middle-income settings. METHODS An electronic search was conducted on Medline, Embase, Global Health, Web of Science and conference databases to identify studies describing interventions aimed at improving linkage to or retention in pre-ART care or initiation of ART. Additional searches were conducted to identify on-going trials on this topic, and experts in the field were contacted. An assessment of the risk of bias was conducted. Interventions were categorized according to key domains in the existing literature. RESULTS A total of 11,129 potentially relevant citations were identified, of which 24 were eligible for inclusion, with the majority (n=21) from sub-Saharan Africa. In addition, 15 on-going trials were identified. The most common interventions described under key domains included: health system interventions (i.e. integration in the setting of antenatal care); patient convenience and accessibility (i.e. point-of-care CD4 count (POC) testing with immediate results, home-based ART initiation); behaviour interventions and peer support (i.e. improved communication, patient referral and education) and incentives (i.e. food support). Several interventions showed favourable outcomes: integration of care and peer supporters increased enrolment into HIV care, medical incentives increased pre-ART retention, POC CD4 testing and food incentives increased completion of ART eligibility screening and ART initiation. Most studies focused on the general adult patient population or pregnant women. The majority of published studies were observational cohort studies, subject to an unclear risk of bias. CONCLUSIONS Findings suggest that streamlining services to minimize patient visits, providing adequate medical and peer support, and providing incentives may decrease attrition, but the quality of the current evidence base is low. Few studies have investigated combined interventions, or assessed the impact of interventions across the HIV cascade. RESULTS from on-going trials investigating POC CD4 count testing, patient navigation, rapid ART initiation and mobile phone technology may fill the quality of evidence gap. Further high-quality studies on key population groups are required, with interventions informed by previously reported barriers to care.
Collapse
|
36
|
Engagement in HIV care among Kenyan adults and adolescents: results from a national population-based survey. J Acquir Immune Defic Syndr 2014; 66 Suppl 1:S98-105. [PMID: 24732825 DOI: 10.1097/qai.0000000000000119] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Increasing access to care and treatment for HIV-infected persons is a goal in Kenya's response to the HIV epidemic. Using data from the second Kenya AIDS Indicator Survey (KAIS 2012), we describe coverage of services received among adults and adolescents who were enrolled in HIV care. METHODS KAIS 2012 was a population-based survey that collected information from persons aged 15-64 years that included self-reported HIV status, and for persons reporting HIV infection, use of HIV care and antiretroviral therapy (ART). Blood specimens were collected and tested for HIV. HIV-positive specimens were tested for CD4 counts and viral load. RESULTS Among 363 persons who reported HIV infection, 93.4% [95% confidence interval (CI): 87.2 to 99.6] had ever received HIV care. Among those receiving HIV care, 96.3% (95% CI: 94.1 to 98.4) were using cotrimoxazole prophylaxis, and 74.6% (95% CI: 69.0 to 80.2) were receiving ART. A lower proportion of persons in care and not on ART reported using cotrimoxazole (89.5%, 95% CI: 82.5 to 96.5 compared with 98.6%, 95% CI: 97.1 to 100) and had a CD4 count measurement done (72.9%, 95% CI: 64.0 to 81.9 compared with 90.0%, 95% CI: 82.8 to 97.3) than persons in care and on ART, respectively. Among persons in care and not on ART, 23.2% (95% CI: 6.8 to 39.7) had CD4 counts ≤350 cells per microliter. Viral suppression was observed in 75.3% (95% CI: 68.7 to 81.9) of persons on ART. CONCLUSIONS Linkage and retention in care are high among persons with known HIV infection. However, improvements in care for the pre-ART population are needed. Viral suppression rates were comparable to developed settings.
Collapse
|
37
|
Burns DN, DeGruttola V, Pilcher CD, Kretzschmar M, Gordon CM, Flanagan EH, Duncombe C, Cohen MS. Toward an endgame: finding and engaging people unaware of their HIV-1 infection in treatment and prevention. AIDS Res Hum Retroviruses 2014; 30:217-24. [PMID: 24410300 PMCID: PMC3938938 DOI: 10.1089/aid.2013.0274] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Epidemic modeling suggests that a major scale-up in HIV treatment could have a dramatic impact on HIV incidence. This has led both researchers and policymakers to set a goal of an "AIDS-Free Generation." One of the greatest obstacles to achieving this objective is the number of people with undiagnosed HIV infection. Despite recent innovations, new research strategies are needed to identify, engage, and successfully treat people who are unaware of their infection.
Collapse
Affiliation(s)
- David N Burns
- 1 Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health , Bethesda, Maryland
| | | | | | | | | | | | | | | |
Collapse
|