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Chasimpha S, dos Santos Silva I, Martei YM, Grover S, Cubasch H, McCormack V. Survival Disparities Between Patients with Breast Cancer With and Without HIV: A Research Framework. JCO Glob Oncol 2023; 9:e2200330. [PMID: 37075268 PMCID: PMC10281420 DOI: 10.1200/go.22.00330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 01/17/2023] [Accepted: 02/07/2023] [Indexed: 04/21/2023] Open
Affiliation(s)
- Steady Chasimpha
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Isabel dos Santos Silva
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Yehoda M. Martei
- Department of Medicine (Hematology-Oncology), University of Pennsylvania, Philadelphia, PA
| | - Surbhi Grover
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - Herbert Cubasch
- Department of Surgery, University of Witwatersrand, Johannesburg, South Africa
- Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Valerie McCormack
- Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer, Lyon, France
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Mundamshimu JS, Malale K, Kidenya BR, Gunda DW, Bwemelo L, Mwashiuya M, Omar SS, Mlowe N, Kiyumbi M, Ngocho JS, Balandya E, Sunguya B, Mshana SE, Mteta K, Bartlett J, Lyamuya E, Mmbaga BT, Kalluvya S. Failure to Attain HIV Viral Suppression After Intensified Adherence Counselling-What Can We Learn About Its Factors? Infect Drug Resist 2023; 16:1885-1894. [PMID: 37020794 PMCID: PMC10069435 DOI: 10.2147/idr.s393456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 03/06/2023] [Indexed: 03/31/2023] Open
Abstract
Background Introduction and expansion of antiretroviral therapy (ART) have turned the tide of HIV pandemic, thus helping people living with HIV (PLHIV) achieve viral suppression. This success may need to be complemented by intensified adherence counseling (IAC) to improve adherence to treatment. However, some PLHIV still face higher than acceptable viral loads despite being on treatment. Purpose We investigated the factors associated with the failure to suppress HIV viral load after three months of IAC sessions. Patients and Methods This cross-sectional study analyzed secondary data from PLHIV-attended care and treatment clinics in Mwanza between January 2018 and December 2019 who had unsuppressed VL after being on ART for at least six months. We identified PLHIV in first-line ART with viral load evaluation before receiving IAC and had viral load results done at 90 days after IAC. We conducted descriptive statistics to examine the magnitude of viral suppression. Wilcoxon signed-rank test used to compare the median viral load before and after IAC sessions, and logistic regressions predicted the factors associated with failure. Results This study included 212 subjects. After intervention, most participants 85.9% (182) had significantly improved adherence compared to baseline. More than half 75.5% (160) of the participants had viral suppression after the intervention. Participants aged 18-25 years (AOR = 5.6, 95% CI, 1.1-29.6), unstable client during ART initiation (AOR = 0.3, 95% CI, 0.13-0.62), and poor adherence to ART (AOR = 4, 95% CI, 1.3-12.3) remained the main predictors of virological failure after IAC intervention. Conclusion Even though virological suppression is influenced by ART adherence, the findings in this study have shown co-existence of other factors to be addressed. Unstable during ART initiation is a new factor identified in this study.
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Affiliation(s)
| | - Kija Malale
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Benson R Kidenya
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Daniel W Gunda
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Logious Bwemelo
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | | | | | - Neema Mlowe
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Magwa Kiyumbi
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - James S Ngocho
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Emmanuel Balandya
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Bruno Sunguya
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Stephen E Mshana
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Kien Mteta
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - John Bartlett
- Kilimanjaro Christian Medical University College, Mosh, Tanzania
- Duke Global Health Institute, Duke University Medical Center, Durham, NC, USA
| | - Eligius Lyamuya
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Blandina Theophil Mmbaga
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Samuel Kalluvya
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
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3
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Ntsekhe M, Baker JV. Cardiovascular Disease Among Persons Living With HIV: New Insights Into Pathogenesis and Clinical Manifestations in a Global Context. Circulation 2023; 147:83-100. [PMID: 36576956 DOI: 10.1161/circulationaha.122.057443] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Widespread use of contemporary antiretroviral therapy globally has transformed HIV disease into a chronic illness associated with excess risk for disorders of the heart and circulatory system. Current clinical care and research has focused on improving HIV-related cardiovascular disease outcomes, survival, and quality of life. In high-income countries, emphasis on prevention of atherosclerotic coronary artery disease over the past decade, including aggressive management of traditional risk factors and earlier initiation of antiretroviral therapy, has reduced risk for myocardial infarction among persons living with human immunodeficiency virus-1 infection. Still, across the globe, persons living with human immunodeficiency virus-1 infection on effective antiretroviral therapy treatment remain at increased risk for ischemic outcomes such as myocardial infarction and stroke relative to the persons without HIV. Unique features of HIV-related cardiovascular disease, in part, include the pathogenesis of coronary disease characterized by remodeling ectasia and unusual plaque morphology, the relative high proportion of type 2 myocardial infarction events, abnormalities of the aorta such as aneurysms and diffuse aortic inflammation, and HIV cerebrovasculopathy as a contributor to stroke risk. Literature over the past decade has also reflected a shift in the profile and prevalence of HIV-associated heart failure, with a reduced but persistent risk of heart failure with reduced ejection fraction and a growing risk of heart failure with preserved ejection fraction. Cardiac magnetic resonance imaging and autopsy data have emphasized the central importance of intramyocardial fibrosis for the pathogenesis of both heart failure with preserved ejection fraction and the increase in risk of sudden cardiac death. Still, more research is needed to better characterize the underlying mechanisms and clinical phenotype of HIV-associated myocardial disease in the current era. Across the different cardiovascular disease manifestations, a common pathogenic feature is that HIV-associated inflammation working through different mechanisms may amplify underlying pathology because of traditional risk and other host factors. The prevalence and phenotype of individual cardiovascular disease manifestations is ultimately influenced by the degree of injury from HIV disease combined with the profile of underlying cardiometabolic factors, both of which may differ substantially by region globally.
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Affiliation(s)
- Mpiko Ntsekhe
- Division of Cardiology, Institute of Infectious Diseases and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa (M.N.)
| | - Jason V Baker
- Division of Infectious Diseases, Hennepin Healthcare Research Institute, Minneapolis, MN (J.V.B.).,Department of Medicine, University of Minnesota, Minneapolis (J.V.B.)
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4
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Iseselo MK, Tarimo EAM, Sandstrom E, Kulane A. Awareness and willingness to use HIV oral pre-exposure prophylaxis among people who inject drugs in Dar es Salaam, Tanzania: A cross-sectional survey. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000776. [PMID: 36962766 PMCID: PMC10121179 DOI: 10.1371/journal.pgph.0000776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 10/31/2022] [Indexed: 11/23/2022]
Abstract
People who inject drugs (PWID) are at increased risk of HIV infection. Pre-exposure prophylaxis (PrEP) could help in HIV prevention among PWIDs. However, little is known about PrEP use among PWIDs in low and middle-income countries. This study reports the awareness of and willingness to use PrEP and the associated factors among PWID in Tanzania. A cross-sectional survey was conducted using respondent-driven sampling (RDS) to recruit PWIDs in Dar es Salaam, Tanzania. Data were collected using an interviewer-administered questionnaire. Chi-square statistical test was used during data analysis. The P-value of < 0.05 was used to ascertain the statistically significant relationship. IBM SPSS Statistics 25.0 was used to analyze the data. The analysis consisted of 260 PWIDs. The mean age of the respondents was 39.0 years with a standard deviation (SD) of ±7.5. Most of the respondents were male (n = 232, 89.2%) with primary education (n = 176, 67.7%). Despite the low awareness of PrEP (n = 42, 165.28%) in the study sample, the majority (n = 239, 91.9%) were willing to use PrEP. Both awareness of and willingness to use PrEP were associated with gender (p = .002 and p = < .001), awareness of HIV prevention programs(p = < .001 and p = .006), selling sex (p = .010 and p = .021), and frequency of condomless sexual intercourse (p = .029 and p = .025) respectively. In multivariable logistic regression, only gender(p = 0.046) was related to awareness of PrEP while awareness of HIV prevention programs (p = 0.009), the risk level of HIV infection(p = < .001), number of sexual partners(p = 0.046), and frequency of condomless sex(p = 0.032) were associated with willingness to use PrEP. Other factors were not statistically significant. Despite low awareness, PWIDs are highly willing to use PrEP. Future research should assess the acceptability of injectable PrEP for PWID, as their acquaintance with injection may make the formulation more practical.
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Affiliation(s)
- Masunga K Iseselo
- Department of Clinical Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Department of Nursing Management, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Department of Global Public Health, Equity and Health Policy Research Group, Karolinska Institutet, Stockholm, Sweden
| | - Edith A M Tarimo
- Department of Nursing Management, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Eric Sandstrom
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Asli Kulane
- Department of Global Public Health, Equity and Health Policy Research Group, Karolinska Institutet, Stockholm, Sweden
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Temu TM, Wagoner J, Masyuko S, O’Connor A, Zifodya JS, Macharia P, Wanjalla CN, Mogaka JN, Chohan B, Omodi VM, Gervassi AL, Oyugi J, Page ST, Farquhar C, Polyak SJ. Central obesity is a contributor to systemic inflammation and monocyte activation in virally suppressed adults with chronic HIV in Kenya. AIDS 2021; 35:1723-1731. [PMID: 34033591 PMCID: PMC8373456 DOI: 10.1097/qad.0000000000002956] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/07/2021] [Accepted: 05/11/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Heightened systemic inflammation is common in obese individuals and persons with HIV (PWH) and is independently associated with an increased risk of cardiovascular diseases (CVDs). We investigated the combined effect of central obesity, a surrogate measure of visceral fat and HIV on circulating levels of inflammatory cytokines among Kenyan adults. DESIGN A cross-sectional study. METHODS We analysed and compared data from 287 virally suppressed PWH and 277 noninfected Kenyan adults, including biomarkers of gut epithelial dysfunction (intestinal fatty acid binding protein), monocyte activation (soluble CD163 and CD14) and inflammation [interleukin (IL)-1β, IL-6, TNF-α and hsCRP] by HIV/central obesity status (HIV-positive/obese, HIV-negative/obese, HIV-positive/nonobese and HIV-negative/nonobese). Central obesity was defined as waist circumference more than 80 cm for women and more than 94 cm for men. We assessed the association of HIV/obesity status with elevated biomarkers (>75th percentile) using logistic regression. RESULTS Median age for participants was 44 years and 37% were centrally obese. Levels of all biomarkers were higher among the HIV-positive/obese compared with the HIV-negative/nonobese (P < 0.05 for all comparisons). The HIV-positive/obese group had the greatest odds of having elevated inflammatory biomarkers compared with other groups even after adjustment of age, BMI and other conventional CVD risk factors (P < 0.05 for all). Additional adjustment for sCD163 in the multivariate model substantially attenuated the association for HIV-positive/obesity with IL-1β, IL-6 and TNF-α but not hsCRP. The contribution of HIV-positive/obesity to inflammation was independent of the degree of immunosuppression. CONCLUSION Central obesity is prevalent among virally suppressed African PWH and is associated with greater inflammation and monocyte activation independent of other comorbidities and HIV-specific factors.
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Affiliation(s)
- Tecla M. Temu
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Institute of Tropical Diseases, University of Nairobi, Nairobi, Kenya
| | - Jessica Wagoner
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Sarah Masyuko
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Ministry of Health, Nairobi, Kenya
| | - Aidan O’Connor
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Jerry S. Zifodya
- Department of Medicine, Tulane University, New Orleans, Los Angeles, USA
| | | | | | - Jerusha N. Mogaka
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Bhavna Chohan
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | | | | | - Julius Oyugi
- Institute of Tropical Diseases, University of Nairobi, Nairobi, Kenya
| | | | - Carey Farquhar
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Medicine
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Stephen J. Polyak
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
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Chen S, Ning Y, Tan Y, Lin X, Wang M. An interventional study on the influence of social and family support systems on the fertility pattern of HIV-infected women. Medicine (Baltimore) 2021; 100:e26027. [PMID: 34011110 PMCID: PMC8136991 DOI: 10.1097/md.0000000000026027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 04/26/2021] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES This study was designed to explore the influence of social and family support system on the fertility pattern of human immunodeficiency virus (HIV)-infected women. TRIAL DESIGN An interventional study including 70 participants. METHODS HIV-infected female participants treated from January 2015 to January 2019 were selected, randomly divided into 2 groups, with 35cases in each group. The experimental group was given complete social and family support, whereas the control group was given basic treatment only. Changes in fertility rate, fertility number, and fertility interval were compared between the 2 groups. We also compared the changes in the quality of life (QOL), Self-rating Anxiety Scale (SAS), and Self-rating Depression Scale (SDS) of the 2 groups of participants. RESULTS The fertility rate of the experimental group was 43.29%, and that of in the control group was 31.96%, and the childbearing age is mainly concentrated in the 20 to 29 years; the difference was statistically significant (P < .05). The mean number of births in the experimental group was (1.47 ± 0.61), which was significantly higher than that of in the control group (0.63 ± 0.22), and the difference was statistically significant (P < .05). The fertility interval of the experimental group was significantly lower than that of in the control group (2.65 ± 1.34 vs 3.77 ± 0.85), and the difference was statistically significant (P < .05). Before the intervention, there were no significant differences in the QOL scores, SAS, and SDS scores between the experimental group and the control group (P > 0.05). After intervention, the scores of QOL in the experimental group was significantly higher than those of in the control group (54.1 ± 1.7 vs 41.2 ± 2.5); the SAS and SDS scores of the experimental group were significantly lower than those of in the control group (39.3 ± 4.2 vs 56.1 ± 5.7; 32.2 ± 6.7 vs 51.9 ± 5.8), and the difference were statistically significant (P < .05). CONCLUSIONS Social and family support for female participants infected with HIV can improve the fertility rate of women to some extent, increase the number of births and shorten the interval between births, and can help relief the women's anxiety, depression, and other emotional problems, which is worthy of extensive application and promotion in the society.
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Than MW, Zaw NT, Minn K, Saw YM, Kiriya J, Jimba M, Win HH, Shibanuma A. Assessing depressive symptoms among people living with HIV in Yangon city, Myanmar: Does being a member of self-help group matter? PLoS One 2021; 16:e0248807. [PMID: 33735312 PMCID: PMC7971502 DOI: 10.1371/journal.pone.0248807] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 03/07/2021] [Indexed: 12/12/2022] Open
Abstract
Background While self-help groups have been formed among people living with HIV, few studies have been conducted to assess the role of self-help groups in mitigating depressive symptoms. This study investigated the association between self-help group membership and depressive symptoms among people living with HIV in Yangon, Myanmar. Methods In this cross-sectional study, data were collected from people living with HIV at three antiretroviral therapy clinics in 2017. Multiple logistic regression analyses were carried out to examine the associations between having self-help group membership and depressive symptoms. Three ART clinics were purposively selected based on the recommendation from the National AIDS Program in Myanmar. At these clinics, people living with HIV were recruited by a convenience sampling method. Results Among people living with HIV recruited in this study (n = 464), 201 (43.3%) were members of a self-help group. The membership was not associated with having depressive symptoms (adjusted odds ratio [AOR] 1.59, 95% confidence interval [CI] 0.98–2.59). Factors associated with having depressive symptoms were female (AOR 3.70, 95% CI 1.54–8.88) and lack of social support (AOR 0.97, 95% CI 0.96–0.98) among self-help group members, and female (AOR 3.47, 95% CI 1.70–7.09), lack of social support (AOR 0.98, 95% CI 0.97–0.99), and internalized stigma (AOR 1.28, 95% 1.08–1.53) among non-members. Conclusions This study did not find evidence on the association between membership in self-help groups and depressive symptoms among people living with HIV. Social support was a protective factor against depressive symptoms both self-help group members and non-members, although the level of social support was lower among members than non-members. The activities of self-help groups and care provided by the ART clinics should be strengthened to address mental health problems among people living with HIV in the study site.
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Affiliation(s)
- Myat Wint Than
- Department of Community and Global Health, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | | | - Kyi Minn
- Myanmar Health and Development Consortium, Yangon, Myanmar
| | - Yu Mon Saw
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Nagoya University Asian Satellite Campuses Institute, Nagoya, Japan
| | - Junko Kiriya
- Department of Community and Global Health, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Masamine Jimba
- Department of Community and Global Health, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Hla Hla Win
- Department of Preventive and Social Medicine, University of Medicine 1, Yangon, Myanmar
| | - Akira Shibanuma
- Department of Community and Global Health, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
- * E-mail:
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Hassan F, Renju J, Songo J, Chimukuche RS, Kalua T, McLean E, Luwanda L, Geubbels E, Seeley J, Moshabela M, Kajoka D, Wringe A. Implementation and experiences of integrated prevention of mother-to-child transmission services in Tanzania, Malawi and South Africa: A mixed methods study. Glob Public Health 2020; 16:201-215. [PMID: 33119433 PMCID: PMC7612851 DOI: 10.1080/17441692.2020.1839927] [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] [Indexed: 11/26/2022]
Abstract
Although integration of HIV and maternal health services is recommended by the World Health Organization, evidence to guide implementation is limited. We describe facility-level implementation of policies for integrating HIV care within maternal health services and explore experiences of service users and providers in rural Tanzania (Ifakara), South Africa (uMkhanyakude) and Malawi (Karonga). Policy in all countries included HIV testing during antenatal care (ANC), same-day antiretroviral therapy (ART) initiation for HIV-positive pregnant women, and postpartum referral to ART clinics, between six weeks (Malawi, South Africa) and two years after delivery (Tanzania). All facilities offered HIV testing within ANC, most commonly during the first visit. Although most women were comfortable with HIV testing, some felt that opting out would lead to sub-standard services. Some facilities conducted group post-test counselling for HIV-negative women, raising concerns of unintended HIV status disclosure. ART initiation was offered on the same day, the same room as an HIV diagnosis in >90% of facilities. Women’s worries around postpartum referral included having unknown providers, insufficient privacy and queues. Adoption and implementation of policies on integrated HIV and maternal health services varied across settings. Patients’ experiences of these policies may influence uptake and retention in care.
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Affiliation(s)
- Farida Hassan
- Health System, Impact Evaluation and Policy, Ifakara Health Institute, United Republic of Tanzania
| | - Jenny Renju
- Department of population studies, London School of Hygiene and Tropical Medicine, London, UK.,Department of Epidemiology and Biostatistics, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - John Songo
- Malawi Epidemiology and Intervention Research Unit, Karonga, Malawi
| | | | | | - Estelle McLean
- Department of population studies, London School of Hygiene and Tropical Medicine, London, UK.,Malawi Epidemiology and Intervention Research Unit, Karonga, Malawi
| | - Lameck Luwanda
- Health System, Impact Evaluation and Policy, Ifakara Health Institute, United Republic of Tanzania
| | - Eveline Geubbels
- Health System, Impact Evaluation and Policy, Ifakara Health Institute, United Republic of Tanzania
| | - Janet Seeley
- Department of population studies, London School of Hygiene and Tropical Medicine, London, UK.,Africa Health Research Institute, Durban, South Africa
| | - Mosa Moshabela
- Malawi Epidemiology and Intervention Research Unit, Karonga, Malawi.,School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Deborah Kajoka
- Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | - Alison Wringe
- Department of population studies, London School of Hygiene and Tropical Medicine, London, UK
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Androutsakos T, Schina M, Pouliakis A, Kontos A, Sipsas N, Hatzis G. Liver Fibrosis Assessment in a Cohort of Greek HIV Mono-Infected Patients by Non-Invasive Biomarkers. Curr HIV Res 2020; 17:173-182. [PMID: 31549590 DOI: 10.2174/1570162x17666190809153245] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 07/26/2019] [Accepted: 08/03/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Non-alcoholic Fatty Liver Disease (NAFLD) is common in HIV-infected individuals. Liver biopsy remains the gold-standard procedure for the diagnosis of liver fibrosis, but both Transient Elastography (TE) and Non-invasive Biomarkers (NIBMs) have emerged as alternatives. OBJECTIVES Our study's aim was to validate commonly used NIBMs for the assessment of liver fibrosis in a cohort of Greek HIV-mono-infected patients. METHODS Inclusion criteria were confirmed HIV-infection and age>18 years and exclusion criteria HBV or HCV seropositivity, liver disease other than NAFLD, alcohol abuse, ascites, transaminases levels>4xULN(upper limit of normal) and Body-Mass index(BMI)>40. Liver stiffness (LS) measurement with TE and thorough laboratory work up and medical history were acquired at study entry. FIB-4, APRI, NFS, BARD, Forns and Lok scores were calculated for each patient. RESULTS A total of 157 patients were eligible for this study. Significant liver fibrosis, compatible with Metavir score of F3-F4, was found in only 11(7%) patients. These findings were in accordance with those of the NIBMs; the BARD score constituting the only exception, allocating 102(65%) patients as having significant liver fibrosis. In order to obtain a balance between sensitivity and specificity new cut-offs for each NIBM were calculated; FIB-4 score yielded the best results, since by changing the cut-off to 1.49 a sensitivity and specificity balanced for both close to 85% was achieved. CONCLUSION Our findings suggest that NIBMs can be used for the evaluation of liver fibrosis in HIV mono-infected patients. New cut-offs for NIBMs should probably be calculated, to help distinguishing patients with significant from those with mild/no fibrosis.
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Affiliation(s)
- Theodoros Androutsakos
- Department of Pathophysiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Schina
- Liver unit, Euroclinic of Athens, Athens, Greece
| | - Abraham Pouliakis
- Second Department of Pathology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Nikolaos Sipsas
- Department of Pathophysiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Infectious Diseases Unit, Laiko General Hospital, Athens, Greece
| | - Gregorios Hatzis
- Department of Pathophysiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Luwanda LB, Vyas S, Songo J, Chimukuche RS, McLean E, Hassan F, Schouten E, Todd J, Geubbels E, Wringe A, Renju J. Assessing the implementation of facility-based HIV testing policies in Malawi, South Africa and Tanzania from 2013–2018: Findings from SHAPE-UTT study. Glob Public Health 2020; 16:241-255. [DOI: 10.1080/17441692.2020.1763420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
| | - Seema Vyas
- Department of Population Studies, London School of Hygiene and Tropical Medicine, London, UK
| | - John Songo
- Malawi Epidemiology and Intervention Research Unit, Karonga, Malawi
| | | | - Estelle McLean
- Department of Population Studies, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Jim Todd
- Department of Population Studies, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Alison Wringe
- Department of Population Studies, London School of Hygiene and Tropical Medicine, London, UK
| | - Jenny Renju
- Department of Population Studies, London School of Hygiene and Tropical Medicine, London, UK
- Department of Epidemiology and Biostatistics, Kilimanjaro Christian Medical University College, Moshi, Tanzania
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Thin K, Prum V, Johns B. The cost of HIV services at health facilities in Cambodia. PLoS One 2019; 14:e0216774. [PMID: 31141514 PMCID: PMC6541345 DOI: 10.1371/journal.pone.0216774] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 04/30/2019] [Indexed: 11/18/2022] Open
Abstract
Background Donor funding for HIV/AIDS services is declining in Cambodia, and domestic resources need to be mobilized to sustain and expand these services. However, the cost of delivering HIV/AIDS services is not well studied in Cambodia. This study aims to assess the costs of delivering HIV/AIDS services, identify the major components of costs, and sources of funding. Methods Four of the six highest HIV burden provinces were selected at random for this study. Within each province, four health centers and two hospitals were selected for detailed data collection. A mix of top-down and bottom-up methods were used to assess the costs for HIV testing and antiretroviral therapy (ART) from the provider perspective. We assessed the differences in the quantity and prices of inputs between health facilities of the same type to identify cost-drivers. Results The average cost per visit for HIV testing was $8.92 at health centers and $14.03 at referral hospitals. Differences in the number of visits per staff were the primary determinant of differences in the cost per visit. First-line ART costed about $250 per patient per year, and the number of patients per staff was an important cost driver. Second-line ART costed from $500 to $716 per patient per year, on average, across the types of facilities, with the quantity and mix of second-line antiretroviral drugs being an important cost driver. Inpatient care at referral and provincial hospitals in total represented less than 2 percent of costs of outpatient ART. Discussion Costs are similar to neighboring countries, but over 50% of the costs of ART are financed by donors. Cambodia now is scaling up social health insurance coverage; the data from this study could serve as one input when setting reimbursement rates for HIV/AIDS services to help ensure that providers are adequately reimbursed for their services.
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Affiliation(s)
- Kouland Thin
- Health Division, Swiss Development Cooperation, Phnom Penh, Cambodia
- * E-mail:
| | - Virak Prum
- Department of Geography, Royal University of Phnom Penh, Phnom Penh, Cambodia
| | - Benjamin Johns
- International Development Division, Abt Associates, Inc., Bethesda, Maryland, United States
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Raberahona M, Lidamahasolo Z, Andriamamonjisoa J, Andriananja V, Andrianasolo RL, Rakotoarivelo RA, Randria MJDD. Knowledge, attitudes, perception and practices regarding antiretroviral therapy among HIV-infected adults in Antananarivo, Madagascar: a cross-sectional survey. BMC Health Serv Res 2019; 19:341. [PMID: 31138303 PMCID: PMC6537363 DOI: 10.1186/s12913-019-4173-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 05/20/2019] [Indexed: 01/05/2023] Open
Abstract
Background Adherence to antiretroviral therapy (ART) may be influenced by knowledge, perception and perception regarding ART. The purpose of this study was to assess knowledge, attitude/perception and practice regarding ART among people living with HIV/AIDS (PLHIV). Methods We conducted a cross-sectional survey to assess knowledge, attitudes, perception and practices ART in PLHIV. The survey was suggested to all PLHIV of at least 18 years old and who were on ART for at least 1 month. PLHIV who were unable to answer questions correctly and those who did not complete the survey for any reason were excluded. Results During the study period, 234 PLHIV were included. Participants were mostly men (75.2%). The median age was 33 years (IQR: 27–41). The median time since HIV diagnosis was 25 months (IQR: 9–56) and the median duration of ART was 18 months (IQR: 8–48). 87.6% had an overall good knowledge of ART. However, only 3.2% knew the name of their ART, 31.2% were aware that ART should be taken at a fixed time and 17.1% knew how to take ART in relation to food intake. 75.6% of participants had an overall positive attitude/perception of ART. However, 10.7% were convinced that other methods were more effective than ART for treating HIV and 42.7% thought that taking ART was shameful. The assessment of practices showed that in case of missed dose, 48.3% of participants routinely skipped this dose instead of trying to take it as soon as possible. In multivariate analysis, good knowledge of ART was independently associated with high level of education (aOR: 4.7, IC95%: 1.6–13.7, p = 0.004) and disclosure of HIV status (aOR: 2.7, IC95%: 1.1–6.6, p = 0.029). Conclusions This study showed an overall good knowledge and a predominantly positive attitude/perception of ART. However, accurate knowledge of ART intake was insufficient and the stigma associated with taking ART remained very present. Furthermore, very heterogeneous practices may reflect lack of instruction given by the physician regarding ART intake. Electronic supplementary material The online version of this article (10.1186/s12913-019-4173-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mihaja Raberahona
- Infectious Diseases Department, University Hospital Joseph Raseta Befelatanana, Antananarivo, Madagascar.
| | - Zinara Lidamahasolo
- Department of Pharmacy, Faculty of Medicine, University of Antananarivo, Antananarivo, Madagascar
| | | | - Volatiana Andriananja
- Infectious Diseases Department, University Hospital Joseph Raseta Befelatanana, Antananarivo, Madagascar
| | | | | | - Mamy Jean de Dieu Randria
- Infectious Diseases Department, University Hospital Joseph Raseta Befelatanana, Antananarivo, Madagascar.,Faculty of Medicine, University of Antananarivo, Antananarivo, Madagascar
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Effect of age at initiation of antiretroviral therapy on treatment outcomes; A retrospective cohort study at a large HIV clinic in southwestern Uganda. PLoS One 2018; 13:e0201898. [PMID: 30110364 PMCID: PMC6093656 DOI: 10.1371/journal.pone.0201898] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 07/24/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The prevalence of HIV infection among older persons is increasing yet older age at initiation of antiretroviral therapy (ART) may be associated with poorer treatment outcomes including mortality. However, majority of these studies have been done in the western world and there is limited data in resource limited settings. Our study used routinely collected health facility data to assess trends in age at initiation of ART, the effect of age at ART initiation on mortality and immunological response at a large urban hospital in south western Uganda. METHODS We conducted a retrospective records review of patients attending the HIV clinic at Mbarara Regional Referral Hospital in western Uganda. We retrieved records for 8,533 patients who started ART between January 2006 and December 2012. Their data had been collected and stored as part of the larger International Epidemiological Database for the Evaluation of AIDS (IeDEA). Age was stratified into three categories namely; 18-34 (young adults), 35-49 (mid-age) and 50 years or older (older adults). Survival analysis procedures with Kaplan-Meier's plots were used to calculate the survival probability with mortality as the endpoint and Poisson regression analysis used to determine the adjusted relative risks (RR) of mortality. RESULTS The proportion of young adults and patients at WHO stage I initiating ART increased steadily over the 7-year period. Older age at ART initiation (> = 50 years) was associated with a higher risk of mortality with adjusted relative risk (RR) at 1.63, (95% CI 1.26-2.11) compared to younger age. Male gender, WHO stages III and IV, lower CD4 count and lower body mass index were also all independently and significantly associated with higher risk for mortality. Older adults also had a poorer immunological response RR = 1.79 (95% CI 0.89-3.58) but was not statistically significant. CONCLUSIONS Following ART initiation, older adults compared to the young, have a higher risk of mortality. This age group should be targeted first for 'screen and treat' approach. Optimization of ART treatment regimens for this age group is also required to reduce mortality and improve immunological response.
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The impact of implementing a Xpert MTB/RIF algorithm on drug-sensitive pulmonary tuberculosis: a retrospective analysis. Epidemiol Infect 2017; 146:246-255. [DOI: 10.1017/s0950268817002746] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
SUMMARYXpert MTB/RIF (Xpert) is the preferred first-line test for all persons with tuberculosis (TB) symptoms in South Africa in line with a diagnostic algorithm. This study evaluates pre- and post-implementation trends in diagnostic practices for drug-sensitive, pulmonary TB in adults in an operational setting, following the introduction of the Xpert-based algorithm. We retrospectively analysed data from the national TB database for Greater Tzaneen sub-district, Limpopo Province. Trends in a number of cases, diagnosis and outcome and characteristics associated with death are reported. A total of 8407 cases were treated from 2008 until 2015, with annual cases registered decreasing by 31·7% over that time period (from 1251 to 855 per year). After implementation of Xpert, 69·9% of cases were diagnosed by Xpert, 29·4% clinically, 0·6% by smear microscopy and 0·1% by culture. Cases with a recorded microbiological test increased from 76·2% to 96·4%. Cases started on treatment without confirmation, but with a negative microbiological test increased from 7·1% to 25·7%. Case fatality decreased from 15·0% to 9·8%, remaining consistently higher in empirically treated groups, regardless of HIV status. Implementation of the algorithm coincided with a reduced number of TB cases treated and improved coverage of microbiological testing; however, a substantial proportion of cases continued to start treatment empirically.
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15
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From policy to practice: exploring the implementation of antiretroviral therapy access and retention policies between 2013 and 2016 in six sub-Saharan African countries. BMC Health Serv Res 2017; 17:758. [PMID: 29162065 PMCID: PMC5698969 DOI: 10.1186/s12913-017-2678-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 11/03/2017] [Indexed: 11/13/2022] Open
Abstract
Background Understanding the implementation of 2013 World Health Organization (WHO) consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection at the facility level provides important lessons for the roll-out of future HIV policies. Methods A national policy review was conducted in six sub-Saharan African countries to map the inclusion of the 2013 WHO HIV treatment recommendations. Twenty indicators of policy adoption were selected to measure ART access (n = 12) and retention (n = 8). Two sequential cross-sectional surveys were conducted in facilities between 2013/2015 (round 1) and 2015/2016 (round 2) from ten health and demographic surveillance sites in Kenya, Malawi, South Africa, Tanzania, Uganda and Zimbabwe. Using standardised questionnaires, facility managers were interviewed. Descriptive analyses were used to assess the change in the proportion of facilities that implemented these policy indicators between rounds. Results Although, expansion of ART access was explicitly stated in all countries’ policies, most lacked policies that enhanced retention. Overall, 145 facilities were included in both rounds. The proportion of facilities that initiated ART at CD4 counts of 500 or less cells/μL increased between round 1 and 2 from 12 to 68%, and facilities initiating patients on 2013 WHO recommended ART regimen increased from 42 to 87%. There were no changes in the proportion of facilities reporting stock-outs of first-line ART in the past year (18 to 11%) nor in the provision of three-month supply of ART (43 to 38%). None of the facilities provided community-based ART delivery. Conclusion The increase in ART initiation CD4 threshold in most countries, and substantial improvements made in the provision of WHO recommended first-line ART regimens demonstrates that rapid adoption of WHO recommendations is possible. However, improved logistics and resources and/or changes in policy are required to further minimise ART stock-outs and allow lay cadres to dispense ART in the community. Increased efforts are needed to offer longer durations between clinic visits, a strategy purported to improve retention. These changes will be important as countries move to implement the revised 2015 WHO guidelines to initiate all HIV positive people onto ART regardless of their immune status. Electronic supplementary material The online version of this article (10.1186/s12913-017-2678-1) contains supplementary material, which is available to authorized users.
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16
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McLean E, Renju J, Wamoyi J, Bukenya D, Ddaaki W, Church K, Zaba B, Wringe A. 'I wanted to safeguard the baby': a qualitative study to understand the experiences of Option B+ for pregnant women and the potential implications for 'test-and-treat' in four sub-Saharan African settings. Sex Transm Infect 2017; 93:sextrans-2016-052972. [PMID: 28736391 PMCID: PMC5739848 DOI: 10.1136/sextrans-2016-052972] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 03/24/2017] [Accepted: 04/03/2017] [Indexed: 11/04/2022] Open
Abstract
Objective To explore what influences on engagement with Option B+ in four sub-Saharan African settings. Methods In-depth interviews were conducted in 2015, with 22 HIV-positive women who had been pregnant since Option B+ was available, and 15 healthcare workers (HCWs) involved in HIV service delivery. Participants were purposely selected from four health and demographic surveillance sites in Malawi, Tanzania and Uganda. A thematic content analysis was conducted to investigate what influenced engagement with Option B+. Results Feeling ‘ready’ was key to pregnant women accepting antiretroviral treatment (ART) on the same day as diagnosis at antenatal clinic; this was influenced by previous knowledge of HIV-positive status, interactions with HCWs and relationship with their partners. The desire to protect their unborn infant was the main issue that motivated women to initiate treatment, temporarily over-riding barriers to starting ART. Many HCWs recognised that pressurising women into starting ART may lead them to stop treatment following delivery. However, their own responsibility to protect the infant sometimes drove HCWs to use strong persuasive techniques to initiate pregnant women onto ART as early as possible, occasionally causing women to disengage. Conclusions Protecting the baby superseded feelings of unpreparedness for lifelong ART and may explain poor retention observed in Option B+ programmes. Women may benefit from more time to accept their status, and counselling on the long-term value of ART beyond the pregnancy and breastfeeding period. Strategies to promote readiness for same-day initiation of lifelong treatment are urgently needed, and may provide important lessons for universal test-and-treat implementation.
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Affiliation(s)
- Estelle McLean
- Malawi Epidemiology and Intervention Research Unit, Karonga, Malawi.,Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Jenny Renju
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Joyce Wamoyi
- National Institute for Medical Research, Mwanza, Tanzania
| | - Dominic Bukenya
- Medical Research Council/Uganda Virus Research Institute Research Unit on AIDS, Entebbe, Uganda
| | | | - Kathryn Church
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Basia Zaba
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Alison Wringe
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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17
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McRobie E, Wringe A, Nakiyingi-Miiro J, Kiweewa F, Lutalo T, Nakigozi G, Todd J, Eaton JW, Zaba B, Church K. HIV policy implementation in two health and demographic surveillance sites in Uganda: findings from a national policy review, health facility surveys and key informant interviews. Implement Sci 2017; 12:47. [PMID: 28381264 PMCID: PMC5382427 DOI: 10.1186/s13012-017-0574-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 03/16/2017] [Indexed: 01/02/2023] Open
Abstract
Background Successful HIV testing, care and treatment policy implementation is essential for realising the reductions in morbidity and mortality those policies are designed to target. While adoption of new HIV policies is rapid, less is known about the facility-level implementation of new policies and the factors influencing this. Methods We assessed implementation of national policies about HIV testing, treatment and retention at health facilities serving two health and demographic surveillance sites (HDSS) (10 in Kyamulibwa, 14 in Rakai). Ugandan Ministry of Health HIV policy documents were reviewed in 2013, and pre-determined indicators were extracted relating to the content and nature of guidance on HIV service provision. Facility-level policy implementation was assessed via a structured questionnaire administered to in-charge staff from each health facility. Implementation of policies was classified as wide (≥75% facilities), partial (26–74% facilities) or minimal (≤25% facilities). Semi-structured interviews were conducted with key informants (policy-makers, implementers, researchers) to identify factors influencing implementation; data were analysed using the Framework Method of thematic analysis. Results Most policies were widely implemented in both HDSS (free testing, free antiretroviral treatment (ART), WHO first-line regimen as standard, Option B+). Both had notable implementation gaps for policies relating to retention on treatment (availability of nutritional supplements, support groups or isoniazid preventive therapy). Rakai implemented more policies relating to provision of antiretroviral treatment than Kyamulibwa and performed better on quality of care indicators, such as frequency of stock-outs. Factors facilitating implementation were donor investment and support, strong scientific evidence, low policy complexity, phased implementation and effective planning. Limited human resources, infrastructure and health management information systems were perceived as major barriers to effective implementation. Conclusions Most HIV policies were widely implemented in the two settings; however, gaps in implementation coverage prevail and the value of ensuring complete coverage of existing policies should be considered against the adoption of new policies in regard to resource needs and health benefits.
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Affiliation(s)
- Ellen McRobie
- Imperial College London, Norfolk Place, London, W2 1PG, UK.
| | - Alison Wringe
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | | | | | - Tom Lutalo
- Rakai Health Sciences Program, Entebbe, Uganda
| | | | - Jim Todd
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | | | - Basia Zaba
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Kathryn Church
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
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18
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Ramadhani HO, Muiruri C, Maro VP, Omondi M, Mushi JB, Lirhunde ES, Bartlett JA. Association of knowledge on ART line of treatment, scarcity of treatment options and adherence. BMC Health Serv Res 2016; 16:265. [PMID: 27416836 PMCID: PMC4946134 DOI: 10.1186/s12913-016-1483-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 06/17/2016] [Indexed: 11/18/2022] Open
Abstract
Background Adherence to Antiretroviral Therapy (ART) is critical piece in the management of HIV infected patients. Despite the benefits of ART, non-adherence to ART persists. This study explores association between patient’s knowledge of the ART line of treatment, availability of future treatment options and adherence. Methods A cross sectional survey of HIV infected adolescent and adults was conducted. Cumulative optimal and sub-optimal adherence was defined as percentage adherence of ≥ 95 % and < 95 %, respectively. Binomial regression models were used to assess the association of patient’s knowledge of the ART line of treatment, availability of future treatment options and adherence. Results Of the 402 patients reviewed, 101 (25.1 %) patients knew their ART line of treatment and were aware that future treatment options are limited. Compared to those who were not aware of the ART line of treatment and/or scarcity of future treatment options, those who were aware were more likely to be adherent (adjusted prevalence ratio [APR], 1.1; 95 % CI, 1.0–1.3). Conclusion The study reports knowledge of patient’s ART line of treatment and future treatment options is important indicator of adherence to ART. Although majority of the patients did not have the knowledge, those who had the knowledge demonstrated to be more adherent. It is critical for the physicians/health care providers in these settings to clearly educate patients about ART line of treatment and limited availability of future treatment options as such information is likely to influence individual behavior and improve patient’s adherence to ART.
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Affiliation(s)
- Habib O Ramadhani
- Kilimanjaro Christian Medical Centre (KCMC), P.O Box 3010, Moshi, Kilimanjaro, Tanzania. .,Kilimanjaro Christian Medical University College, Moshi, Tanzania.
| | | | - Venance P Maro
- Kilimanjaro Christian Medical Centre (KCMC), P.O Box 3010, Moshi, Kilimanjaro, Tanzania
| | | | | | | | - John A Bartlett
- Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, Durham, NC, USA.,Duke Global health Institute, Durham, NC, USA
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Mee P, Kahn K, Kabudula C, Wagner R, Gómez-Olivé FX, Madhavan S, Collinson MA, Tollman S, Byass P. The development of a localised HIV epidemic and the associated excess mortality burden in a rural area of South Africa. Glob Health Epidemiol Genom 2016; 1:e7. [PMID: 29302331 PMCID: PMC5738674 DOI: 10.1017/gheg.2016.3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 02/12/2016] [Accepted: 02/16/2016] [Indexed: 01/25/2023] Open
Abstract
The human immunodeficiency virus (HIV) epidemic in South Africa rapidly developed into a major pandemic. Here we analyse the development of the epidemic in a rural area of the country. The data used were collected between 1992 and 2013 in a longitudinal population survey, the Agincourt Health and Demographic Surveillance Study, in the northeast of the country. Throughout the period of study mortality rates were similar in all villages, suggesting that there were multiple index cases evenly spread geographically. These were likely to have been returning migrant workers. For those aged below 39 years the HIV mortality rate was higher for women, above this age it was higher for men. This indicates the protective effect of greater access to HIV testing and treatment among older women. The recent convergence of mortality rates for Mozambicans and South Africans indicates that the former refugee population are being assimilated into the host community. More than 60% of the deaths occurring in this community between 1992 and 2013 could be attributed directly or indirectly to HIV. Recently there has been an increasing level of non-HIV mortality which has important implications for local healthcare provision. This study demonstrates how evidence from longitudinal analyses can support healthcare planning.
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Affiliation(s)
- P. Mee
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden
- Department of Population Health, Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London,UK
| | - K. Kahn
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden
- International Network for the Demographic Evaluation of Populations and Their Health (INDEPTH) Network, Accra, Ghana
| | - C.W. Kabudula
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- International Network for the Demographic Evaluation of Populations and Their Health (INDEPTH) Network, Accra, Ghana
| | - R.G. Wagner
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden
- International Network for the Demographic Evaluation of Populations and Their Health (INDEPTH) Network, Accra, Ghana
| | - F. X. Gómez-Olivé
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- International Network for the Demographic Evaluation of Populations and Their Health (INDEPTH) Network, Accra, Ghana
| | - S. Madhavan
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of African-American Studies, University of Maryland-College Park, College Park, MD, USA
| | - Mark A. Collinson
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden
- International Network for the Demographic Evaluation of Populations and Their Health (INDEPTH) Network, Accra, Ghana
| | - S.M. Tollman
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden
- International Network for the Demographic Evaluation of Populations and Their Health (INDEPTH) Network, Accra, Ghana
| | - P. Byass
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden
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Reniers G, Wamukoya M, Urassa M, Nyaguara A, Nakiyingi-Miiro J, Lutalo T, Hosegood V, Gregson S, Gómez-Olivé X, Geubbels E, Crampin AC, Wringe A, Waswa L, Tollman S, Todd J, Slaymaker E, Serwadda D, Price A, Oti S, Nyirenda MJ, Nabukalu D, Nyamukapa C, Nalugoda F, Mugurungi O, Mtenga B, Mills L, Michael D, McLean E, McGrath N, Martin E, Marston M, Maquins S, Levira F, Kyobutungi C, Kwaro D, Kasamba I, Kanjala C, Kahn K, Kabudula C, Herbst K, Gareta D, Eaton JW, Clark SJ, Church K, Chihana M, Calvert C, Beguy D, Asiki G, Amri S, Abdul R, Zaba B. Data Resource Profile: Network for Analysing Longitudinal Population-based HIV/AIDS data on Africa (ALPHA Network). Int J Epidemiol 2016; 45:83-93. [PMID: 26968480 DOI: 10.1093/ije/dyv343] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2015] [Indexed: 11/14/2022] Open
Affiliation(s)
- Georges Reniers
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa,
| | | | - Mark Urassa
- Tazama Project, Tanzania National Institute for Medical Research, Mwanza, Tanzania
| | - Amek Nyaguara
- Kenya Medical Research Institute and the Centers for Disease Control, Kisumu, Kenya
| | | | - Tom Lutalo
- Rakai Health Sciences Program, Uganda Virus Research Institute, Rakai, Uganda
| | - Vicky Hosegood
- Africa Centre for Population Health, Mtubatuba, South Africa, Department of Social Statistics and Demography, Southampton University, Southampton, UK
| | - Simon Gregson
- Manicaland Centre for Public Health Research, Harare, Zimbabwe, Department of Infectious Disease Epidemiology, Imperial College, London, UK
| | - Xavier Gómez-Olivé
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Amelia C Crampin
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK, Malawi Epidemiology and Intervention Research Unit, Lilongwe, UK
| | - Alison Wringe
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Laban Waswa
- MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda
| | - Stephen Tollman
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Centre for Global Health Research, Umea° University, Umea°, Sweden
| | - Jim Todd
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Emma Slaymaker
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - David Serwadda
- Rakai Health Sciences Program, Uganda Virus Research Institute, Rakai, Uganda, School of Public Health, Makerere University, Kampala, Uganda
| | - Alison Price
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK, Malawi Epidemiology and Intervention Research Unit, Lilongwe, UK
| | - Samuel Oti
- African Population and Health Research Center, Nairobi, Kenya
| | - Moffat J Nyirenda
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK, Malawi Epidemiology and Intervention Research Unit, Lilongwe, UK
| | - Dorean Nabukalu
- Rakai Health Sciences Program, Uganda Virus Research Institute, Rakai, Uganda
| | - Constance Nyamukapa
- Manicaland Centre for Public Health Research, Harare, Zimbabwe, Department of Infectious Disease Epidemiology, Imperial College, London, UK
| | - Fred Nalugoda
- Rakai Health Sciences Program, Uganda Virus Research Institute, Rakai, Uganda
| | - Owen Mugurungi
- Manicaland Centre for Public Health Research, Harare, Zimbabwe, Zimbabwe Ministry of Health and Child Care, Harare, Zimbabwe
| | - Baltazar Mtenga
- Tazama Project, Tanzania National Institute for Medical Research, Mwanza, Tanzania
| | - Lisa Mills
- Kenya Medical Research Institute and the Centers for Disease Control, Kisumu, Kenya, Division of HIV/AIDS Prevention, CDC, Atlanta GA, USA and
| | - Denna Michael
- Tazama Project, Tanzania National Institute for Medical Research, Mwanza, Tanzania
| | - Estelle McLean
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK, Malawi Epidemiology and Intervention Research Unit, Lilongwe, UK
| | - Nuala McGrath
- Africa Centre for Population Health, Mtubatuba, South Africa, Department of Social Statistics and Demography, Southampton University, Southampton, UK
| | - Emmanuel Martin
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, UK
| | - Milly Marston
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Sewe Maquins
- Kenya Medical Research Institute and the Centers for Disease Control, Kisumu, Kenya
| | | | | | - Daniel Kwaro
- Kenya Medical Research Institute and the Centers for Disease Control, Kisumu, Kenya
| | - Ivan Kasamba
- MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda
| | - Chifundo Kanjala
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Kathleen Kahn
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Centre for Global Health Research, Umea° University, Umea°, Sweden
| | - Chodziwadziwa Kabudula
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Kobus Herbst
- Africa Centre for Population Health, Mtubatuba, South Africa
| | - Dickman Gareta
- Africa Centre for Population Health, Mtubatuba, South Africa
| | - Jeffrey W Eaton
- Department of Infectious Disease Epidemiology, Imperial College, London, UK
| | - Samuel J Clark
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Department of Sociology, University of Washington, Seattle WA, USA
| | - Kathryn Church
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Menard Chihana
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, UK
| | - Clara Calvert
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Donatien Beguy
- African Population and Health Research Center, Nairobi, Kenya
| | - Gershim Asiki
- MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda
| | - Shamte Amri
- Ifakara Health Institute, Dar-Es-Salaam, Tanzania
| | | | - Basia Zaba
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Crampin AC, Kayuni N, Amberbir A, Musicha C, Koole O, Tafatatha T, Branson K, Saul J, Mwaiyeghele E, Nkhwazi L, Phiri A, Price AJ, Mwagomba B, Mwansambo C, Jaffar S, Nyirenda MJ. Hypertension and diabetes in Africa: design and implementation of a large population-based study of burden and risk factors in rural and urban Malawi. Emerg Themes Epidemiol 2016; 13:3. [PMID: 26839575 PMCID: PMC4736489 DOI: 10.1186/s12982-015-0039-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 12/04/2015] [Indexed: 02/01/2023] Open
Abstract
Background The emerging burden of cardiovascular disease and diabetes in sub-Saharan Africa threatens the gains made in health by the major international effort to combat infectious diseases. There are few data on distribution of risk factors and outcomes in the region to inform an effective public health response. A comprehensive research programme is being developed aimed at accurately documenting the burden and drivers of NCDs in urban and rural Malawi; to design and test intervention strategies. The programme includes population surveys of all people aged 18 years and above, linking individuals with newly diagnosed hypertension and diabetes to healthcare and supporting clinical services. The successes, challenges and lessons learnt from the programme to date are discussed. Results Over 20,000 adults have been recruited in rural Karonga and urban Lilongwe. The urban population is significantly younger and wealthier than the rural population. Employed urban individuals, particularly males, give particular recruitment challenges; male participation rates were 80.3 % in the rural population and 43.6 % in urban, whilst female rates were 93.6 and 75.6 %, respectively. The study is generating high quality data on hypertension, diabetes, lipid abnormalities and risk factors. Conclusions It is feasible to develop large scale studies that can reliably inform the public health approach to diabetes, cardiovascular disease and other NCDs in Sub-Saharan Africa. It is essential for studies to capture both rural and urban populations to address disparities in risk factors, including age structure. Innovative approaches are needed to address the specific challenge of recruiting employed urban males.
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Affiliation(s)
- Amelia Catharine Crampin
- Karonga Prevention Study, Karonga, Malawi ; London School of Hygiene and Tropical Medicine, London, UK
| | | | - Alemayehu Amberbir
- Karonga Prevention Study, Karonga, Malawi ; London School of Hygiene and Tropical Medicine, London, UK
| | | | - Olivier Koole
- Karonga Prevention Study, Karonga, Malawi ; London School of Hygiene and Tropical Medicine, London, UK
| | | | - Keith Branson
- London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | - Amos Phiri
- Karonga Prevention Study, Karonga, Malawi
| | - Alison Jane Price
- Karonga Prevention Study, Karonga, Malawi ; London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Shabbar Jaffar
- London School of Hygiene and Tropical Medicine, London, UK
| | - Moffat Joha Nyirenda
- Karonga Prevention Study, Karonga, Malawi ; London School of Hygiene and Tropical Medicine, London, UK
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Abstract
OBJECTIVE To estimate the impact of antiretroviral therapy (ART) on population-wide adult life expectancy. STUDY DESIGN A population-based open cohort study with repeated HIV status measurements and registration of vital events in Southwestern Uganda (1991-2012). METHODS Nonparametric survival analysis techniques are used for estimating trends in the adult life expectancy of the general population (aged 15 and above), the adult life expectancy by HIV status, and the adult life expectancy deficit. The life expectancy deficit is estimated as the difference between overall life expectancy and life expectancy of the HIV-negative population. All estimates are disaggregated by sex. RESULTS Between 1991-1993 and 2009-2012, population-wide adult life expectancy increased from 39.3 [95% confidence interval (CI): 35.9-42.8] to 56.1 years (95% CI: 54.0-58.5) in women, and from 38.6 (95% CI: 35.4-42.1) to 51.4 years (95% CI: 49.2-53.7) in men. Most of the adult life expectancy gains coincide with the introduction of ART in 2004; as evidenced by an increase in the adult life expectancy of people living with HIV between 2000-2002 and 2009-2012 of 22.9 and 20.0 years for women and men, respectively. Over the whole period of observation, the adult life expectancy deficit associated with HIV decreased from 16.1 (95% CI: 12.7-19.8) to 6.0 years (95% CI: 4.1-7.8) among women, and from 16.0 (95% CI: 12.1-19.9) to 2.8 years (95% CI: 1.2-4.6) among men. CONCLUSION Population-wide life expectancy increased substantially, largely driven by reductions in HIV-related mortality. Women have gained more adult life years than men since the introduction of ART, but the burden of HIV in terms of the life years lost is still larger for women than it is for men.
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23
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Kessler J, Ruggles K, Patel A, Nucifora K, Li L, Roberts MS, Bryant K, Braithwaite RS. Targeting an alcohol intervention cost-effectively to persons living with HIV/AIDS in East Africa. Alcohol Clin Exp Res 2015; 39:2179-88. [PMID: 26463727 PMCID: PMC5651989 DOI: 10.1111/acer.12890] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 08/26/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND In the current report, we ask if targeting a cognitive behavioral therapy (CBT)-based intervention aimed at reducing hazardous alcohol consumption to HIV-infected persons in East Africa would have a favorable value at costs that are feasible for scale-up. METHODS Using a computer simulation to inform HIV prevention decisions in East Africa, we compared 4 different strategies for targeting a CBT intervention-(i) all HIV-infected persons attending clinic; (ii) only those patients in the pre-antiretroviral therapy (ART) stages of care; (iii) only those patients receiving ART; and (iv) only those patients with detectable viral loads (VLs) regardless of disease stage. We define targeting as screening for hazardous alcohol consumption (e.g., using the Alcohol Use Disorders Identification Test and offering the CBT intervention to those who screen positive). We compared these targeting strategies to a null strategy (no intervention) or a hypothetical scenario where an alcohol intervention was delivered to all adults regardless of HIV status. RESULTS An intervention targeted to HIV-infected patients could prevent 18,000 new infections, add 46,000 quality-adjusted life years (QALYs), and yield an incremental cost-effectiveness ratio of $600/QALY compared to the null scenario. Narrowing the prioritized population to only HIV-infected patients in pre-ART phases of care results in 15,000 infections averted, the addition of 21,000 QALYs and would be cost-saving, while prioritizing based on an unsuppressed HIV-1 VL test results in 8,300 new infections averted, adds 6,000 additional QALYs, and would be cost-saving as well. CONCLUSIONS Our results suggest that targeting a cognitive-based treatment aimed at reducing hazardous alcohol consumption to subgroups of HIV-infected patients provides favorable value in comparison with other beneficial strategies for HIV prevention and control in this region. It may even be cost-saving under certain circumstances.
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Affiliation(s)
- Jason Kessler
- Department of Population Health, NYU School of Medicine, New York, New York
| | - Kelly Ruggles
- Department of Population Health, NYU School of Medicine, New York, New York
| | - Anik Patel
- Department of Population Health, NYU School of Medicine, New York, New York
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kimberly Nucifora
- Department of Population Health, NYU School of Medicine, New York, New York
| | - Lifeng Li
- Department of Population Health, NYU School of Medicine, New York, New York
| | - Mark S Roberts
- Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Kendall Bryant
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland
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24
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Church K, Kiweewa F, Dasgupta A, Mwangome M, Mpandaguta E, Gómez-Olivé FX, Oti S, Todd J, Wringe A, Geubbels E, Crampin A, Nakiyingi-Miiro J, Hayashi C, Njage M, Wagner RG, Ario AR, Makombe SD, Mugurungi O, Zaba B. A comparative analysis of national HIV policies in six African countries with generalized epidemics. Bull World Health Organ 2015; 93:457-67. [PMID: 26170503 PMCID: PMC4490813 DOI: 10.2471/blt.14.147215] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 12/16/2014] [Accepted: 01/23/2015] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To compare national human immunodeficiency virus (HIV) policies influencing access to HIV testing and treatment services in six sub-Saharan African countries. METHODS We reviewed HIV policies as part of a multi-country study on adult mortality in sub-Saharan Africa. A policy extraction tool was developed and used to review national HIV policy documents and guidelines published in Kenya, Malawi, South Africa, Uganda, the United Republic of Tanzania and Zimbabwe between 2003 and 2013. Key informant interviews helped to fill gaps in findings. National policies were categorized according to whether they explicitly or implicitly adhered to 54 policy indicators, identified through literature and expert reviews. We also compared the national policies with World Health Organization (WHO) guidance. FINDINGS There was wide variation in policies between countries; each country was progressive in some areas and not in others. Malawi was particularly advanced in promoting rapid initiation of antiretroviral therapy. However, no country had a consistently enabling policy context expected to increase access to care and prevent attrition. Countries went beyond WHO guidance in certain areas and key informants reported that practice often surpassed policy. CONCLUSION Evaluating the impact of policy differences on access to care and health outcomes among people living with HIV is challenging. Certain policies will exert more influence than others and official policies are not always implemented. Future research should assess the extent of policy implementation and link these findings with HIV outcomes.
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Affiliation(s)
- Kathryn Church
- Department of Population Health, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, England
| | - Francis Kiweewa
- Makerere University School of Public Health, Kampala, Uganda
| | - Aisha Dasgupta
- Department of Population Health, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, England
| | - Mary Mwangome
- Ifakara Health Institute, Ifakara, United Republic of Tanzania
| | | | - Francesc Xavier Gómez-Olivé
- Agincourt, Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Samuel Oti
- African Population Health Research Center, Nairobi, Kenya
| | - Jim Todd
- London School of Hygiene & Tropical Medicine, London, England
| | - Alison Wringe
- Department of Population Health, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, England
| | | | - Amelia Crampin
- London School of Hygiene & Tropical Medicine, London, England
| | | | | | | | - Ryan G Wagner
- Agincourt, Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | | | - Basia Zaba
- Department of Population Health, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, England
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Musubire AK, Meya DB, Lukande R, Kambugu A, Bohjanen PR, Boulware DR. Gastrointestinal cryptococcoma - Immune reconstitution inflammatory syndrome or cryptococcal relapse in a patient with AIDS? Med Mycol Case Rep 2015; 8:40-3. [PMID: 25870787 PMCID: PMC4389205 DOI: 10.1016/j.mmcr.2015.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Revised: 03/11/2015] [Accepted: 03/23/2015] [Indexed: 11/23/2022] Open
Abstract
The introduction of antiretroviral therapy (ART) may lead to unusual paradoxical and unmasking presentations of opportunistic infections. Intra-abdominal cryptococcosis is a rare manifestation of Cryptococcus. We present the case of an HIV-infected patient on ART, with a history of cryptococcal meningitis who presented with subacute, worsening abdominal pain during immune recovery. This evolved into chronic abdominal pain, with thickened bowel, and abdominal lymphadenopathy, while receiving empiric tuberculosis treatment. At 6-months, he developed intestinal perforation due to a histologically confirmed cryptococcoma.
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Affiliation(s)
- Abdu K Musubire
- Infectious Disease Institute, College of health Sciences, Makerere University, Kampala, Uganda ; Department of Medicine, School of Medicine, College of Health Sciences, Makerere University and Mulago Hospital, Kampala, Uganda
| | - David B Meya
- Infectious Disease Institute, College of health Sciences, Makerere University, Kampala, Uganda ; Division of Infectious Diseases & International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN, USA ; Department of Medicine, School of Medicine, College of Health Sciences, Makerere University and Mulago Hospital, Kampala, Uganda
| | - Robert Lukande
- Department of Pathology, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Andrew Kambugu
- Infectious Disease Institute, College of health Sciences, Makerere University, Kampala, Uganda ; Division of Infectious Diseases & International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Paul R Bohjanen
- Division of Infectious Diseases & International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - David R Boulware
- Division of Infectious Diseases & International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
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Mee P, Collinson MA, Madhavan S, Kabudula C, Gómez-Olivé FX, Kahn K, Tollman SM, Hargreaves J, Byass P. Determinants of the risk of dying of HIV/AIDS in a rural South African community over the period of the decentralised roll-out of antiretroviral therapy: a longitudinal study. Glob Health Action 2014; 7:24826. [PMID: 25416322 PMCID: PMC4245451 DOI: 10.3402/gha.v7.24826] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 10/22/2014] [Accepted: 10/23/2014] [Indexed: 01/09/2023] Open
Abstract
Background Antiretroviral treatment (ART) has significantly reduced HIV mortality in South Africa. The benefits have not been experienced by all groups. Here we investigate the factors associated with these inequities. Design This study was located in a rural South African setting and used data collected from 2007 to 2010, the period when decentralised ART became available. Approximately one-third of the population were of Mozambican origin. There was a pattern of repeated circular migration between urban areas and this community. Survival analysis models were developed to identify demographic, socioeconomic, and spatial risk factors for HIV mortality. Results Among the study population of 105,149 individuals, there were 2,890 deaths. The HIV/TB mortality rate decreased by 27% between 2007–2008 and 2009–2010. For other causes of death, the reduction was 10%. Bivariate analysis found that the HIV/TB mortality risk was lower for: those living within 5 km of the Bhubezi Community Health Centre; women; young adults; in-migrants with a longer period of residence; permanent residents; and members of households owning motorised transport, holding higher socioeconomic positions, and with higher levels of education. Multivariate modelling showed, in addition, that those with South Africa as their country of origin had an increased risk of HIV/TB mortality compared to those with Mozambican origins. For males, those of South African origin, and recent in-migrants, the risk of death associated with HIV/TB was significantly greater than that due to other causes. Conclusions In this community, a combination of factors was associated with an increased risk of dying of HIV/TB over the period of the roll-out of ART. There is evidence for the presence of barriers to successful treatment for particular sub-groups in the population, which must be addressed if the recent improvements in population-level mortality are to be maintained.
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Affiliation(s)
- Paul Mee
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Umeå Centre for Global Health Research, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden; Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK;
| | - Mark A Collinson
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Umeå Centre for Global Health Research, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden; International Network for the Demographic Evaluation of Populations and Their Health (INDEPTH) Network, Accra, Ghana
| | - Sangeetha Madhavan
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of African-American Studies, University of Maryland-College Park, College Park, MD, USA
| | - Chodziwadziwa Kabudula
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; International Network for the Demographic Evaluation of Populations and Their Health (INDEPTH) Network, Accra, Ghana
| | - Francesc Xavier Gómez-Olivé
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; International Network for the Demographic Evaluation of Populations and Their Health (INDEPTH) Network, Accra, Ghana
| | - Kathleen Kahn
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Umeå Centre for Global Health Research, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden; International Network for the Demographic Evaluation of Populations and Their Health (INDEPTH) Network, Accra, Ghana
| | - Stephen M Tollman
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Umeå Centre for Global Health Research, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden; International Network for the Demographic Evaluation of Populations and Their Health (INDEPTH) Network, Accra, Ghana
| | - James Hargreaves
- Department of Social and Environmental Health Research, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Peter Byass
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; WHO Collaborating Centre for Verbal Autopsy, Umeå Centre for Global Health Research, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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27
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Abstract
Background: Joint United Nations Programme on HIV/AIDS (UNAIDS) and Murray et al. have both produced sets of estimates for worldwide HIV incidence, prevalence and mortality. Understanding differences in these estimates can strengthen the interpretation of each. Methods: We describe differences in the two sets of estimates. Where possible, we have drawn on additional published data to which estimates can be compared. Findings: UNAIDS estimates that there were 6 million more people living with HIV (PLHIV) in 2013 (35 million) compared with the Murray et al. estimates (29 million). Murray et al. estimate that new infections and AIDS deaths have declined more gradually than does UNAIDS. Just under one third of the difference in PLHIV is in Africa, where Murray et al. have relied more on estimates of adult mortality trends than on data on survival times. Another third of the difference is in North America, Europe, Central Asia and Australasia. Here Murray et al. estimates of new infections are substantially lower than the number of new HIV/AIDS diagnoses reported by countries, whereas published UNAIDS estimate tend to be greater. The remaining differences are in Latin America and Asia where the data upon which the UNAIDS methods currently rely are more sparse, whereas the mortality data leveraged by Murray et al. may be stronger. In this region, however, anomalies appear to exist between the both sets of estimates and other data. Interpretation: Both estimates indicate that approximately 30 million PLHIV and that antiretroviral therapy has driven large reductions in mortality. Both estimates are useful but show instructive discrepancies with additional data sources. We find little evidence to suggest that either set of estimates can be considered systematically more accurate. Further work should seek to build estimates on as wide a base of data as possible.
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Todd J, Slaymaker E, Zaba B, Mahy M, Byass P. Measuring HIV-related mortality in the first decade of anti-retroviral therapy in sub-Saharan Africa. Glob Health Action 2014; 7:24787. [PMID: 24852247 PMCID: PMC4032059 DOI: 10.3402/gha.v7.24787] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Jim Todd
- London School of Hygiene and Tropical Medicine, Keppel Street, WC1E 7HT, London, UK
| | - Emma Slaymaker
- London School of Hygiene and Tropical Medicine, Keppel Street, WC1E 7HT, London, UK
| | - Basia Zaba
- London School of Hygiene and Tropical Medicine, Keppel Street, WC1E 7HT, London, UK
| | - Mary Mahy
- Epidemiology Section, UNAIDS, Geneva, Umeå Centre for Global Health Research, Department of Public
| | - Peter Byass
- Health and Clinical Medicine, Umeå University, Umeå, Sweden
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