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Kumar V, Murali S, Goldberg J, Alonso B, Moretó-Planas L, Reid A, Harshana A, Burza S, Mahajan R. Antibiotic susceptibility patterns of pathogens isolated from hospitalized patients with advanced HIV disease (AHD) in Bihar, India. JAC Antimicrob Resist 2024; 6:dlad151. [PMID: 38170073 PMCID: PMC10759003 DOI: 10.1093/jacamr/dlad151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 12/11/2023] [Indexed: 01/05/2024] Open
Abstract
Objectives To describe the prevalence of common bacterial pathogens and antibiotic susceptibility patterns amongst advanced HIV disease (AHD) patients admitted between May 2019 and March 2021 to a Médecins Sans Frontières (MSF)-supported AHD inpatient unit in Bihar, India. Methods A retrospective analysis of routinely collected demographic, clinical and microbiological data. Antibacterial susceptibility testing was done by an accredited referral laboratory using the modified Kirby-Bauer disc diffusion method. Results A total of 238 isolates from 577 patients were identified through culture testing. Patient median (IQR) age was 38 (31-45) years, and 75% were male. Predominant sample types included blood (600; 38%), urine (266; 17%) and sputum (178; 11%). Of the isolated bacteria, Escherichia coli (80; 13.9%) was the most prevalent, followed by Klebsiella pneumonia (54; 9.4%), Pseudomonas aeruginosa (22; 3.8%), Klebsiella oxytoca (10; 1.7%), Proteus mirabilis (9; 1.6%), and Acinetobacter baumannii (7; 1.2%). The resistance pattern showed that most bacterial isolates were highly resistant to commonly prescribed antibiotics such as third-generation cephalosporins, fluoroquinolones and co-trimoxazole. Most pathogens were moderately resistant to antibiotics from the WHO Watch group, such as meropenem and piperacillin/tazobactam. In contrast, isolates were more susceptible to aminoglycosides, such as amikacin, gentamicin and nitrofurantoin. Conclusions In Bihar, inpatients with AHD displayed a concerning array of antibiotic-resistant infections. This study provides a starting point from which further work on antimicrobial resistance in this vulnerable cohort of patients can be conducted.
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Affiliation(s)
- Vikash Kumar
- Operational Centre Barcelona-Athens, Médecins Sans Frontières, New Delhi, India
| | - Shreyas Murali
- Operational Centre Barcelona-Athens, Médecins Sans Frontières, Patna, India
| | - Jacob Goldberg
- Medical Department, Médecins Sans Frontières, London, UK
| | - Beatriz Alonso
- Medical Department, Médecins Sans Frontières, London, UK
| | - Laura Moretó-Planas
- Operational Centre Barcelona-Athens, Médecins Sans Frontières, Barcelona, Spain
| | - Anthony Reid
- Opérationnel Research Unit, Médecins Sans Frontières, Luxembourg, Luxembourg
| | - Amit Harshana
- Operational Centre Barcelona-Athens, Médecins Sans Frontières, New Delhi, India
| | - Sakib Burza
- Operational Centre Barcelona-Athens, Médecins Sans Frontières, New Delhi, India
- London School of Hygiene and Tropical Medicine, London, UK
| | - Raman Mahajan
- Operational Centre Barcelona-Athens, Médecins Sans Frontières, New Delhi, India
- Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
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Albus SL, Harrison RE, Moudachirou R, Nanan-N’Zeth K, Haba B, Casas EC, Isaakidis P, Diallo A, Camara I, Doumbuya M, Sako FB, Cisse M. Poor outcomes among critically ill HIV-positive patients at hospital discharge and post-discharge in Guinea, Conakry: A retrospective cohort study. PLoS One 2023; 18:e0281425. [PMID: 36913379 PMCID: PMC10010544 DOI: 10.1371/journal.pone.0281425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 01/23/2023] [Indexed: 03/14/2023] Open
Abstract
INTRODUCTION Optimal management of critically ill HIV-positive patients during hospitalization and after discharge is not fully understood. This study describes patient characteristics and outcomes of critically ill HIV-positive patients hospitalized in Conakry, Guinea between August 2017 and April 2018 at discharge and 6 months post-discharge. METHODS We carried out a retrospective observational cohort study using routine clinical data. Analytic statistics were used to describe characteristics and outcomes. RESULTS 401 patients were hospitalized during the study period, 230 (57%) were female, median age was 36 (IQR: 28-45). At admission, 229 patients (57%) were on ART, median CD4 was 64 cells/mm3, 166 (41%) had a VL >1000 copies/ml, and 97 (24%) had interrupted treatment. 143 (36%) patients died during hospitalisation. Tuberculosis was the major cause of death for 102 (71%) patients. Of 194 patients that were followed after hospitalization a further 57 (29%) were lost-to-follow-up (LTFU) and 35 (18%) died, 31 (89%) of which had a TB diagnosis. Of all patients who survived a first hospitalisation, 194 (46%) were re-hospitalised at least once more. Amongst those LTFU, 34 (59%) occurred immediately after hospital discharge. CONCLUSION Outcomes for critically ill HIV-positive patients in our cohort were poor. We estimate that 1-in-3 patients remained alive and in care 6 months after their hospital admission. This study shows the burden of disease on a contemporary cohort of patients with advanced HIV in a low prevalence, resource limited setting and identifies multiple challenges in their care both during hospitalisation as well as during and after re-transitioning to ambulatory care.
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Affiliation(s)
- Sebastian Ludwig Albus
- Medecins Sans Frontieres, Guinea Mission, Operational Centre Bruxelles, Bruxelles, Belgium
- * E-mail:
| | - Rebecca E. Harrison
- Medecins Sans Frontieres, Guinea Mission, Operational Centre Bruxelles, Bruxelles, Belgium
| | - Ramzia Moudachirou
- Medecins Sans Frontieres, Guinea Mission, Operational Centre Bruxelles, Bruxelles, Belgium
| | - Kassi Nanan-N’Zeth
- Medecins Sans Frontieres, Guinea Mission, Operational Centre Bruxelles, Bruxelles, Belgium
| | - Benoit Haba
- Medecins Sans Frontieres, Guinea Mission, Operational Centre Bruxelles, Bruxelles, Belgium
| | - Esther C. Casas
- Medecins Sans Frontieres, Southern African Medical Unit, Cape Town, South Africa
| | - Petros Isaakidis
- Medecins Sans Frontieres, Southern African Medical Unit, Cape Town, South Africa
| | - Abdourahimi Diallo
- Medecins Sans Frontieres, Guinea Mission, Operational Centre Bruxelles, Bruxelles, Belgium
| | - Issiaga Camara
- Gamal Abdel Nasser University of Conakry Faculty of Medicine, Unite de Soins, Formation et de la Recherche (USFR), Conakry, Guinea
| | - Marie Doumbuya
- Gamal Abdel Nasser University of Conakry Faculty of Medicine, Unite de Soins, Formation et de la Recherche (USFR), Conakry, Guinea
| | - Fode Bangaly Sako
- Gamal Abdel Nasser University of Conakry Faculty of Medicine, Unite de Soins, Formation et de la Recherche (USFR), Conakry, Guinea
| | - Mohammed Cisse
- Gamal Abdel Nasser University of Conakry Faculty of Medicine Pharmacy and Odonto- Stomatology, Conakry, Guinea
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Chabikuli ON, Ditekemena JD, Sigwadhi LN, Mulenga A, Mboyo A, Bidashimwa D, Nachega JB. Advanced HIV Disease at Antiretroviral Therapy Initiation and Treatment Outcomes Among Children and Adolescents Compared to Adults Living With HIV in Kinshasa, Democratic Republic of the Congo. J Int Assoc Provid AIDS Care 2023; 22:23259582231221955. [PMID: 38146172 PMCID: PMC10752042 DOI: 10.1177/23259582231221955] [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: 06/16/2023] [Revised: 11/17/2023] [Accepted: 12/01/2023] [Indexed: 12/27/2023] Open
Abstract
Background: Little is known about advanced HIV disease (AHD) at antiretroviral therapy (ART) initiation among children and adolescents living with HIV (CALHIV) and related age disparities in the Democratic Republic of the Congo (DRC). Methods: We conducted a retrospective cohort analysis of routine program data collected among adults, adolescents, and children living with HIV in 6 health zones in Kinshasa, DRC from 2005 to 2020. Results: Thirty-two percent of those who initiated ART had AHD. Compared to adults, adolescents had a 15% higher risk of AHD (RR: 1.15; 95% CI: 1.08-1.21; P < .001). Despite their higher risk of AHD, adolescents had a lower risk of mortality (aSHR: 0.72; 95% CI: 0.52-0.99; P = .047) and lower cumulative death events versus adults (aSHR: 0.44; 95% CI: 0.34-0.59; P < .001). Conclusions: ADH at ART initiation is highly prevalent in Kinshasa, DRC, and adolescents are disproportionally impacted. There is a need to scale up high-impact HIV interventions targeting CALHIV.
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Affiliation(s)
- Otto Nzapfurundi Chabikuli
- Family Health International (FHI 360), Durham, NC, USA
- Public Health Program, Graduate School, Howard University, Washington, DC, USA
| | - John D. Ditekemena
- Family Health International (FHI 360), Kinshasa, Democratic Republic of the Congo
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Lovemore Nyasha Sigwadhi
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, Western Cape, South Africa
| | - Astrid Mulenga
- Family Health International (FHI 360), Kinshasa, Democratic Republic of the Congo
| | - Aimé Mboyo
- National AIDS Control Program, Kinshasa, Democratic Republic of the Congo
| | | | - Jean B. Nachega
- Departments of Epidemiology, Infectious Diseases and Microbiology and Center for Global Health, University of Pittsburgh School of Public Health, Pittsburgh, PA, USA
- Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health; Center for Global Health, Johns Hopkins University Baltimore, MD, USA
- Department of Medicine, Division of Infectious Diseases, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
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Burns R, Venables E, Odhoch L, Kocholla L, Wanjala S, Mucinya G, Bossard C, Wringe A. Slipping through the cracks: a qualitative study to explore pathways of HIV care and treatment amongst hospitalised patients with advanced HIV in Kenya and the Democratic Republic of the Congo. AIDS Care 2022; 34:1179-1186. [PMID: 34445917 DOI: 10.1080/09540121.2021.1966697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Advanced HIV causes substantial mortality in sub-Saharan Africa despite widespread antiretroviral therapy coverage. This paper explores pathways of care amongst hospitalised patients with advanced HIV in rural Kenya and urban Democratic Republic of the Congo, with a view to understanding their care-seeking trajectories and poor health outcomes. Thirty in-depth interviews were conducted with hospitalised patients with advanced HIV who had previously initiated first-line antiretroviral therapy, covering their experiences of living with HIV and care-seeking. Interviews were audio-recorded, transcribed and translated before being coded inductively and analysed thematically. In both settings, participants' health journeys were defined by recurrent, severe symptoms and complex pathways of care before hospitalisation. Patients were often hospitalised after multiple failed attempts to obtain adequate care at health centres. Most participants managed their ill-health with limited support networks, lived in fragile economic situations and often experienced stress and other mental health concerns. Treatment-taking was sometimes undermined by strict messaging around adherence that was delivered in health facilities. These findings reveal a group of patients who had "slipped through the cracks" of health systems and social support structures, indicating both missed opportunities for timely management of advanced HIV and the need for interventions beyond hospital and clinical settings.
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Affiliation(s)
- Rose Burns
- Epicentre, Médecins sans Frontières, Paris, France
| | - Emilie Venables
- Southern Africa Medical Unit: Médecins Sans Frontières, Cape Town, South Africa.,University of Cape Town, Cape Town, South Africa
| | | | - Lilian Kocholla
- Homabay County Teaching and Referral Hospital, Homa Bay, Kenya
| | | | - Gisele Mucinya
- Médecins Sans Frontières, Kinshasa, Democratic Republic of the Congo
| | | | - Alison Wringe
- London School of Hygiene and Tropical Medicine, London, UK
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Lofgren SM, Tsui S, Atuyambe L, Ankunda L, Komuhendo R, Wamala N, Sadiq A, Kirumira P, Srishyla D, Flynn A, Pastick KA, Meya DB, Nakasujja N, Porta C. Barriers to HIV care in Uganda and implications for universal test-and-treat: a qualitative study. AIDS Care 2021; 34:597-605. [PMID: 34314261 PMCID: PMC8792098 DOI: 10.1080/09540121.2021.1946000] [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: 10/20/2022]
Abstract
Achieving universal HIV test-and-treat will require targeted interventions for those with worse outcomes, including advanced HIV. We conducted qualitative, semi-structured interviews with healthcare workers (HCWs) and people living with HIV (PLWH) at 5 HIV clinics in Kampala, Uganda, to understand barriers to care. PLWH enrolled started/restarted on HIV treatment ≤3 months prior. PLWH were grouped as 1) "ART-experienced" or those restarted therapy after ≥12 months off, 2) ART naïve CD4 count <100 cells/uL "late presenters" or 3) ART naïve CD4 count >350 cells/uL "early presenters". In-depth interviews were conducted in Luganda, translated, and transcribed verbatim. Between May and August 2017, 58 PLWH and 20 HCWs were interviewed. High stigma and low social support emerged as themes among all as barriers to care. Alcohol abuse was a barrier for men. Fear of domestic violence and abandonment were barriers for women, limiting disclosure of their HIV status to their male partners. Clinic factors such as rapport with staff, distance, efficiency, and privacy impacted care. Future interventions to decrease delayed ART initiation should target stigma and social support. Assisted disclosure, contact tracing, and alcohol abuse treatment should be implemented. Strengthening client support, reducing wait times, and increasing privacy assurances would improve care-seeking behaviors.
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Affiliation(s)
- Sarah M Lofgren
- University of Minnesota, Division of Infectious Diseases and International Medicine, Department of Medicine, Minneapolis, MN, USA.,Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Sharon Tsui
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Lynn Atuyambe
- Makerere University, School of Public Health, Kampala, Uganda
| | - Leander Ankunda
- Makerere University, School of Public Health, Kampala, Uganda
| | | | - Nathan Wamala
- Makerere University, School of Public Health, Kampala, Uganda
| | - Alisat Sadiq
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Paul Kirumira
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Diksha Srishyla
- University of Minnesota, School of Public Health, Minneapolis, MN, USA
| | - Andrew Flynn
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Katelyn A Pastick
- Infectious Diseases Institute, Makerere University, Kampala, Uganda.,University of Minnesota, School of Medicine, Minneapolis, MN, USA
| | - David B Meya
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Noeline Nakasujja
- Infectious Diseases Institute, Makerere University, Kampala, Uganda.,Makerere University, Department of Psychiatry, Kampala, Uganda
| | - Carolyn Porta
- University of Minnesota, School of Public Health, Minneapolis, MN, USA
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Sumbi EM, Venables E, Harrison R, Garcia M, Iakovidi K, van Cutsem G, Chalachala JL. "It's a secret between us": a qualitative study on children and care-giver experiences of HIV disclosure in Kinshasa, Democratic Republic of Congo. BMC Public Health 2021; 21:313. [PMID: 33549066 PMCID: PMC7866707 DOI: 10.1186/s12889-021-10327-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 01/25/2021] [Indexed: 11/17/2022] Open
Abstract
Background It is estimated that 64,000 children under 15 years of age are living with HIV in the Democratic Republic of Congo (DRC). Non-disclosure – in which the child is not informed about their HIV status - is likely to be associated with poor outcomes during adolescence including increased risk of poor adherence and retention, and treatment failure. Disclosing a child’s HIV status to them can be a difficult process for care-givers and children, and in this qualitative study we explored child and care-giver experiences of the process of disclosing, including reasons for delay. Methods A total of 22 in-depth interviews with care-givers and 11 in-depth interviews with HIV positive children whom they were caring for were conducted in one health-care facility in the capital city of Kinshasa. Care-givers were purposively sampled to include those who had disclosed to their children and those who had not. Care-givers included biological parents, grandmothers, siblings and community members and 86% of them were female. Interviews were conducted in French and Lingala. All interviews were translated and/or transcribed into French before being manually coded. Thematic analysis was conducted. Verbal informed consent/assent was taken from all interviewees. Results At the time of interview, the mean age of children and care-givers was 17 (15–19) and 47 (21–70) years old, respectively. Many care-givers had lost family members due to HIV and several were HIV positive themselves. Reasons for non-disclosure included fear of stigmatisation; wanting to protect the child and not having enough knowledge about HIV or the status of the child to disclose. Several children had multiple care-givers, which also delayed disclosure, as responsibility for the child was shared. In addition, some care-givers were struggling to accept their own HIV status and did not want their child to blame them for their own positive status by disclosing to them. Conclusions Child disclosure is a complex process for care-givers, health-care workers and the children themselves. Care-givers may require additional psycho-social support to manage disclosure. Involving multiple care-givers in the care of HIV positive children could offer additional support for disclosure. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10327-5.
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Affiliation(s)
| | - Emilie Venables
- Southern Africa Medical Unit, Médecins Sans Frontières, Main Road, Observatory, Cape Town, South Africa. .,Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
| | - Rebecca Harrison
- Médecins Sans Frontières, Kinshasa, Democratic Republic of Congo
| | - Mariana Garcia
- Southern Africa Medical Unit, Médecins Sans Frontières, Main Road, Observatory, Cape Town, South Africa
| | - Kleio Iakovidi
- Southern Africa Medical Unit, Médecins Sans Frontières, Main Road, Observatory, Cape Town, South Africa
| | - Gilles van Cutsem
- Southern Africa Medical Unit, Médecins Sans Frontières, Main Road, Observatory, Cape Town, South Africa
| | - Jean Lambert Chalachala
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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7
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Exavery A, Charles J, Barankena A, Kuhlik E, Mubyazi GM, Tani K, Ally A, Minja E, Koler A, Kikoyo L, Jere E. ART use and associated factors among HIV positive caregivers of orphans and vulnerable children in Tanzania. BMC Public Health 2020; 20:1251. [PMID: 32807138 PMCID: PMC7433360 DOI: 10.1186/s12889-020-09361-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 08/09/2020] [Indexed: 11/29/2022] Open
Abstract
Background Utilization of antiretroviral therapy (ART) is crucial for better health outcomes among people living with the human immunodeficiency virus (PLHIV). Nearly 30% of the 1.6 million PLHIV in Tanzania are not on treatment. Since HIV positive status is the only eligibility criterion for ART use, it is critical to understand the obstacles to ART access and uptake to reach universal coverage of ART among PLHIV. For the caregivers of orphans and vulnerable children (OVC) LHIV and not on ART, attempts to identify them and ensure that they initiate and continue using ART is critical for their wellbeing and their ability to care for their children. Methods Data are from the community-based, United States Agency for International Development (USAID)-funded Kizazi Kipya project that aims at scaling up the uptake of HIV/AIDS and other health and social services by orphans and vulnerable children (OVC) and their caregivers. HIV positive caregivers of OVC who were enrolled in the USAID Kizazi Kipya project between January 2017 and June 2018 were included in this cross-sectional study. The caregivers were drawn from 11 regions: Arusha, Iringa, Katavi, Kigoma, Mara, Mbeya, Morogoro, Ruvuma, Simiyu, Singida, and Tanga. The outcome variable was ART status (either using or not), which was enquired of each OVC caregiver LHIV at enrollment. Data analysis involved multivariable analysis using random-effects logistic regression to identify correlates of ART use. Results In total, 74,999 caregivers living with HIV with mean age of 44.4 years were analyzed. Of these, 96.4% were currently on ART at enrollment. In the multivariable analysis, ART use was 30% lower in urban than in rural areas (adjusted odds ratio (OR) = 0.70, 95% confidence interval (CI) 0.61–0.81). Food security improved the odds of being on ART (OR = 1.29, 95% CI 1.15–1.45). Disabled caregivers were 42% less likely than non-disabled ones to be on ART (OR = 0.58, 95% CI 0.45–0.76). Male caregivers with health insurance were 43% more likely than uninsured male caregivers to be on ART (OR = 1.43, 95% CI 1.11–1.83). Caregivers aged 40–49 years had 18% higher likelihood of being on ART than the youngest ones. Primary education level was associated with 26% increased odds of being on ART than no education (OR = 1.26, 95% CI 1.13–1.41). Conclusions Although nearly all the caregivers LHIV in the current study were on ART (96.4%), more efforts are needed to achieve universal coverage. The unreached segments of the population LHIV, even if small, may lead to worse health outcomes, and also spur further spread of the HIV epidemic due to unachieved viral suppression. Targeting caregivers in urban areas, food insecure households, who are uninsured, and those with mental or physical disability can improve ART coverage among caregivers LHIV.
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Affiliation(s)
| | | | | | - Erica Kuhlik
- Pact, Inc., 1828 L St NW Suite 300, Washington, DC, 20036, USA
| | - Godfrey M Mubyazi
- National Institute for Medical Research (NIMR), P.O Box 9653, Dar es Salaam, Tanzania
| | | | - Amal Ally
- Pact, P.O. Box 6348, Dar es Salaam, Tanzania
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