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Fene F, Ríos-Blancas MJ, Lachaud J, Razo C, Lamadrid-Figueroa H, Liu M, Michel J, Thermidor R, Lozano R. Life expectancy, death, and disability in Haiti, 1990-2017: a systematic analysis from the Global Burden of Disease Study 2017. Rev Panam Salud Publica 2020; 44:e136. [PMID: 33165413 PMCID: PMC7603356 DOI: 10.26633/rpsp.2020.136] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 07/13/2020] [Indexed: 12/19/2022] Open
Abstract
Objective. To investigate the magnitude and distribution of the main causes of death, disability, and risk factors in Haiti. Methods. We conducted an ecological analysis, using data estimated from the Global Burden of Disease Study 2017 for the period 1990-2017, to present life expectancy (LE), healthy life expectancy (HALE) at under 1-year-old, cause-specific deaths, years of life lost (YLLs), years lived with disability (YLDs), disability adjusted life-years (DALYs), and risk factors associated with DALYs. Results. LE and HALE increased substantially in Haiti. People may hope to live longer in 2017, but in poor health. The Caribbean countries had significantly lower YLLs rates than Haiti for ischemic heart disease, stroke, lower respiratory infections, and diarrheal diseases. Road injuries were the leading cause of DALYs for people aged 5-14 years. Road injuries and HIV/AIDS were the leading causes of DALYs for men and women aged 15-49 years, respectively. Ischemic heart disease was the main cause of DALYs for people older than 50 years. Maternal and child malnutrition were the leading risk factors for DALYs in both sexes. Conclusion. Haiti faces a double burden of disease. Infectious diseases continue to be an issue, while non-communicable diseases have become a significant burden of disease. More attention must also be focused on the increase in worrying public health issues such as road injuries, exposure to forces of nature and HIV/AIDS in specific age groups. To address the burden of disease, sustained actions are needed to promote better health in Haiti and countries with similar challenges.
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Affiliation(s)
- Fato Fene
- National Institute of Public Health Cuernavaca Mexico National Institute of Public Health, Cuernavaca, Mexico
| | - María Jesús Ríos-Blancas
- National Institute of Public Health Cuernavaca Mexico National Institute of Public Health, Cuernavaca, Mexico
| | - James Lachaud
- St. Michael's Hospital Toronto Canada St. Michael's Hospital, Toronto, Canada
| | - Christian Razo
- Institute for Health Metrics and Evaluation Seattle United States of America Institute for Health Metrics and Evaluation, Seattle, United States of America
| | - Hector Lamadrid-Figueroa
- National Institute of Public Health Cuernavaca Mexico National Institute of Public Health, Cuernavaca, Mexico
| | - Michael Liu
- Harvard Medical School Boston United States of America Harvard Medical School, Boston, United States of America
| | - Jacob Michel
- Family Health International Port-au-Prince Haiti Family Health International, Port-au-Prince, Haiti
| | - Roody Thermidor
- Ministry of Public Health and Population Port-au-Prince Haiti Ministry of Public Health and Population, Port-au-Prince, Haiti
| | - Rafael Lozano
- Institute for Health Metrics and Evaluation Seattle United States of America Institute for Health Metrics and Evaluation, Seattle, United States of America
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6
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Slogrove AL, Schomaker M, Davies MA, Williams P, Balkan S, Ben-Farhat J, Calles N, Chokephaibulkit K, Duff C, Eboua TF, Kekitiinwa-Rukyalekere A, Maxwell N, Pinto J, Seage G, Teasdale CA, Wanless S, Warszawski J, Wools-Kaloustian K, Yotebieng M, Timmerman V, Collins IJ, Goodall R, Smith C, Patel K, Paul M, Gibb D, Vreeman R, Abrams EJ, Hazra R, Van Dyke R, Bekker LG, Mofenson L, Vicari M, Essajee S, Penazzato M, Anabwani G, Q. Mohapi E, N. Kazembe P, Hlatshwayo M, Lumumba M, Goetghebuer T, Thorne C, Galli L, van Rossum A, Giaquinto C, Marczynska M, Marques L, Prata F, Ene L, Okhonskaia L, Rojo P, Fortuny C, Naver L, Rudin C, Le Coeur S, Volokha A, Rouzier V, Succi R, Sohn A, Kariminia A, Edmonds A, Lelo P, Ayaya S, Ongwen P, Jefferys LF, Phiri S, Mubiana-Mbewe M, Sawry S, Renner L, Sylla M, Abzug MJ, Levin M, Oleske J, Chernoff M, Traite S, Purswani M, Chadwick EG, Judd A, Leroy V. The epidemiology of adolescents living with perinatally acquired HIV: A cross-region global cohort analysis. PLoS Med 2018; 15:e1002514. [PMID: 29494593 PMCID: PMC5832192 DOI: 10.1371/journal.pmed.1002514] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 01/24/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Globally, the population of adolescents living with perinatally acquired HIV (APHs) continues to expand. In this study, we pooled data from observational pediatric HIV cohorts and cohort networks, allowing comparisons of adolescents with perinatally acquired HIV in "real-life" settings across multiple regions. We describe the geographic and temporal characteristics and mortality outcomes of APHs across multiple regions, including South America and the Caribbean, North America, Europe, sub-Saharan Africa, and South and Southeast Asia. METHODS AND FINDINGS Through the Collaborative Initiative for Paediatric HIV Education and Research (CIPHER), individual retrospective longitudinal data from 12 cohort networks were pooled. All children infected with HIV who entered care before age 10 years, were not known to have horizontally acquired HIV, and were followed up beyond age 10 years were included in this analysis conducted from May 2016 to January 2017. Our primary analysis describes patient and treatment characteristics of APHs at key time points, including first HIV-associated clinic visit, antiretroviral therapy (ART) start, age 10 years, and last visit, and compares these characteristics by geographic region, country income group (CIG), and birth period. Our secondary analysis describes mortality, transfer out, and lost to follow-up (LTFU) as outcomes at age 15 years, using competing risk analysis. Among the 38,187 APHs included, 51% were female, 79% were from sub-Saharan Africa and 65% lived in low-income countries. APHs from 51 countries were included (Europe: 14 countries and 3,054 APHs; North America: 1 country and 1,032 APHs; South America and the Caribbean: 4 countries and 903 APHs; South and Southeast Asia: 7 countries and 2,902 APHs; sub-Saharan Africa, 25 countries and 30,296 APHs). Observation started as early as 1982 in Europe and 1996 in sub-Saharan Africa, and continued until at least 2014 in all regions. The median (interquartile range [IQR]) duration of adolescent follow-up was 3.1 (1.5-5.2) years for the total cohort and 6.4 (3.6-8.0) years in Europe, 3.7 (2.0-5.4) years in North America, 2.5 (1.2-4.4) years in South and Southeast Asia, 5.0 (2.7-7.5) years in South America and the Caribbean, and 2.1 (0.9-3.8) years in sub-Saharan Africa. Median (IQR) age at first visit differed substantially by region, ranging from 0.7 (0.3-2.1) years in North America to 7.1 (5.3-8.6) years in sub-Saharan Africa. The median age at ART start varied from 0.9 (0.4-2.6) years in North America to 7.9 (6.0-9.3) years in sub-Saharan Africa. The cumulative incidence estimates (95% confidence interval [CI]) at age 15 years for mortality, transfers out, and LTFU for all APHs were 2.6% (2.4%-2.8%), 15.6% (15.1%-16.0%), and 11.3% (10.9%-11.8%), respectively. Mortality was lowest in Europe (0.8% [0.5%-1.1%]) and highest in South America and the Caribbean (4.4% [3.1%-6.1%]). However, LTFU was lowest in South America and the Caribbean (4.8% [3.4%-6.7%]) and highest in sub-Saharan Africa (13.2% [12.6%-13.7%]). Study limitations include the high LTFU rate in sub-Saharan Africa, which could have affected the comparison of mortality across regions; inclusion of data only for APHs receiving ART from some countries; and unavailability of data from high-burden countries such as Nigeria. CONCLUSION To our knowledge, our study represents the largest multiregional epidemiological analysis of APHs. Despite probable under-ascertained mortality, mortality in APHs remains substantially higher in sub-Saharan Africa, South and Southeast Asia, and South America and the Caribbean than in Europe. Collaborations such as CIPHER enable us to monitor current global temporal trends in outcomes over time to inform appropriate policy responses.
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Affiliation(s)
| | - Amy L. Slogrove
- Center for Infectious Diseases Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Michael Schomaker
- Center for Infectious Diseases Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Mary-Ann Davies
- Center for Infectious Diseases Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Paige Williams
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Suna Balkan
- Epicentre, Médecins Sans Frontières, Paris, France
| | | | - Nancy Calles
- Baylor International Pediatric AIDS Initiative, Texas Children’s Hospital-USA, Houston, Texas, United States of America
| | | | - Charlotte Duff
- MRC Clinical Trials Unit at University College London, London, United Kingdom
| | - Tanoh François Eboua
- Yopougon University Hospital, University Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire
| | | | - Nicola Maxwell
- Center for Infectious Diseases Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Jorge Pinto
- School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - George Seage
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Chloe A. Teasdale
- ICAP at Columbia University Mailman School of Public Health, New York, New York, United States of America
| | - Sebastian Wanless
- Baylor International Pediatric AIDS Initiative, Texas Children’s Hospital-USA, Houston, Texas, United States of America
| | - Josiane Warszawski
- Inserm (French Institute of Health and Medical Research), CESP UMR Villejuif, France
| | - Kara Wools-Kaloustian
- Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Marcel Yotebieng
- College of Public Health, Ohio State University, Columbus, Ohio, United States of America
| | - Venessa Timmerman
- Center for Infectious Diseases Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Intira J. Collins
- MRC Clinical Trials Unit at University College London, London, United Kingdom
| | - Ruth Goodall
- MRC Clinical Trials Unit at University College London, London, United Kingdom
| | - Colette Smith
- MRC Clinical Trials Unit at University College London, London, United Kingdom
| | - Kunjal Patel
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Mary Paul
- Baylor International Pediatric AIDS Initiative, Texas Children’s Hospital-USA, Houston, Texas, United States of America
| | - Diana Gibb
- MRC Clinical Trials Unit at University College London, London, United Kingdom
| | - Rachel Vreeman
- Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Elaine J. Abrams
- ICAP at Columbia University Mailman School of Public Health, New York, New York, United States of America
| | - Rohan Hazra
- National Institute of Child Health and Human Development (NICHD), US National Institutes of Health, Rockville, Maryland, United States of America
| | - Russell Van Dyke
- Tulane University, New Orleans, Louisiana, United States of America
| | - Linda-Gail Bekker
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Lynne Mofenson
- Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, United States of America
| | | | | | | | - Gabriel Anabwani
- Baylor International Pediatric AIDS Initiative, Gaborone, Botswana
| | - Edith Q. Mohapi
- Baylor International Pediatric AIDS Initiative, Maseru, Lesotho
| | - Peter N. Kazembe
- Baylor International Pediatric AIDS Initiative, Lilongwe, Malawi
| | | | - Mwita Lumumba
- Baylor International Pediatric AIDS Initiative, Mbeya, Tanzania
| | | | - Claire Thorne
- Institute of Child Health, University College London, London, United Kingdom
| | - Luisa Galli
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Annemarie van Rossum
- Erasmus MC University Medical Center Rotterdam-Sophia Children’s Hospital, Rotterdam, the Netherlands
| | | | - Magdalena Marczynska
- Medical University of Warsaw, Hospital of Infectious Diseases in Warsaw, Warsaw, Poland
| | | | | | | | - Liubov Okhonskaia
- Republican Hospital of Infectious Diseases, St Petersburg, Russian Federation
| | | | - Claudia Fortuny
- Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Lars Naver
- Karolinska University Hospital, Stockholm, Sweden
| | | | - Sophie Le Coeur
- Institut de Recherche pour le Développement (IRD) 174/PHPT, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
- Institut National d'Etudes Démograhiques (Ined), F-75020 Paris, France
| | - Alla Volokha
- Shupyk National Medical Academy of Postgraduate Education, Kiev, Ukraine
| | | | - Regina Succi
- Universidade Federal de São Paulo, São Paulo, Brazil
| | | | | | - Andrew Edmonds
- Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Patricia Lelo
- Pediatric Hospital Kalembe Lembe, Lingwala, Kinshasa, Democratic Republic of Congo
| | - Samuel Ayaya
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Patricia Ongwen
- Family AIDS Care and Education Services, Kenya Medical Research Institute, Kisumu, Kenya
| | | | - Sam Phiri
- Lighthouse Trust Clinic, Lilongwe, Malawi
| | | | - Shobna Sawry
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Harriet Shezi Children’s Clinic, Chris Hani Baragwanath Hospital, Johannesburg, South Africa
| | - Lorna Renner
- University of Ghana School of Medicine and Dentistry, Accra, Ghana
| | | | - Mark J. Abzug
- University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado, United States of America
| | - Myron Levin
- University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado, United States of America
| | - James Oleske
- Rutgers New Jersey Medical School, Newark, New Jersey, United States of America
| | - Miriam Chernoff
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Shirley Traite
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Murli Purswani
- Bronx-Lebanon Hospital Center (Icahn School of Medicine at Mount Sinai), Bronx, New York, United States of America
| | - Ellen G. Chadwick
- Feinberg School of Medicine, Northwestern University, Evanston, Illinois, United States of America
| | - Ali Judd
- MRC Clinical Trials Unit at University College London, London, United Kingdom
- * E-mail: (AJ); (VL)
| | - Valériane Leroy
- Inserm (French Institute of Health and Medical Research), UMR 1027 Université Toulouse 3, Toulouse, France
- * E-mail: (AJ); (VL)
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7
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Tiam A, Gill MM, Hoffman HJ, Isavwa A, Mokone M, Foso M, Safrit JT, Mofenson LM, Tylleskär T, Guay L. Conventional early infant diagnosis in Lesotho from specimen collection to results usage to manage patients: Where are the bottlenecks? PLoS One 2017; 12:e0184769. [PMID: 29016634 PMCID: PMC5634554 DOI: 10.1371/journal.pone.0184769] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 08/30/2017] [Indexed: 11/18/2022] Open
Abstract
Introduction Early infant diagnosis is an important step in identifying children infected with HIV during the perinatal period or in utero. Multiple factors contribute to delayed antiretroviral treatment initiation for HIV-infected children, including delays in the early infant HIV diagnosis cascade. Methods We conducted a retrospective study to evaluate early infant diagnosis turnaround times in Lesotho. Trained staff reviewed records of HIV-exposed infants (aged-6-8 weeks) who received an HIV test during 2011. Study sites were drawn from Highlands, Foothills and Lowlands regions of Lesotho. Central laboratory database data were linked to facility and laboratory register information. Turnaround time geometric means (with 95% CI) were calculated and compared by region using linear mixed models. Results 1,187 individual infant records from 25 facilities were reviewed. Overall, early infant diagnosis turnaround time was 61.7 days (95%CI: 55.3–68.7). Mean time from specimen collection to district laboratory was 14 days (95%CI: 12.1–16.1); from district to central laboratory, 2 days (95%CI 0.8–5.2); results from central laboratory to district hospital, 23.3 days (95%CI: 18.7–29.0); from district hospital to health facility, 3.2 days (95%CI 1.9–5.5); and from health facility to caregiver, 10.4 days (95%CI, 7.9–13.5). Mean times from specimen transfer to the central laboratory and for result transfer from central laboratory to district hospital were significantly shorter in the Lowlands Region (0.9 and 16.2 days, respectively), compared to Highlands Region (6.0 [P = 0.030] and 34.3 days [P = 0.0099]. Turnaround time from blood draw to receipt of results was significantly shorter for HIV infected infants compared to HIV uninfected infants [p = 0.0036] at an average of 47.1 days (95%CI: 38.9–56.9) and 62 days (95%CI: 55.9–68.7) respectively. Of 47 HIV-infected infants, 36 were initiated on antiretroviral therapy at an average of 1.3 days (95%CI: 0.3, 5.7) after caregiver received the result. Conclusion HIV-infected infants received results earlier and were rapidly initiated on antiretroviral therapy once the result was delivered to caregiver. However, average early infant diagnosis turnaround time was two months; the longest period of delay was transfer of results from central laboratory to district hospital. Turnaround time of results based on geographical regions or between hospitals and health centres varied but did not reach statistical significance.
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Affiliation(s)
- Appolinaire Tiam
- Centre for International Health, University of Bergen, Bergen, Norway
- Medical and Scientific Affairs, Elizabeth Glaser Pediatric AIDS Foundation, Maseru, Lesotho
- * E-mail: ,
| | - Michelle M. Gill
- Research, Elizabeth Glaser Pediatric AIDS Foundation, Washington DC, United States of America
| | - Heather J. Hoffman
- Milken Institute School of Public Health, George Washington University, Washington DC, United States of America
| | - Anthony Isavwa
- Medical and Scientific Affairs, Elizabeth Glaser Pediatric AIDS Foundation, Maseru, Lesotho
| | - Mafusi Mokone
- Medical and Scientific Affairs, Elizabeth Glaser Pediatric AIDS Foundation, Maseru, Lesotho
| | - Matokelo Foso
- Medical and Scientific Affairs, Elizabeth Glaser Pediatric AIDS Foundation, Maseru, Lesotho
| | - Jeffrey T. Safrit
- Research Alliances, International AIDS Vaccine Initiative, New York, New York, United States of America
| | - Lynne M. Mofenson
- Research, Elizabeth Glaser Pediatric AIDS Foundation, Washington DC, United States of America
| | | | - Laura Guay
- Research, Elizabeth Glaser Pediatric AIDS Foundation, Washington DC, United States of America
- Milken Institute School of Public Health, George Washington University, Washington DC, United States of America
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