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Pisa P, Kinge CW, Chasela C, Mothibi E, Thaung YM, Thwin HT, Aung NM, Chew KW, Gandhi MM, Clint C, Minior T, Lwin AA, Freiman MJ, Kyi KP, Sein YY, Marange F, van der Horst C, Mohamed S, Barralon M, Sanne I. Evaluation of GeneXpert and advanced biological laboratories UltraGene HCV diagnostic detection and performance against Roche real time PCR in Myanmar. J Clin Virol 2024; 171:105653. [PMID: 38408420 DOI: 10.1016/j.jcv.2024.105653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 02/06/2024] [Accepted: 02/10/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND Developing countries experience limited access to HCV laboratory tests for different reasons. Providing near to real-time HCV testing and results especially to at-risk populations including those in rural settings for timely initiation to treatment is key. Within a rural Myanmar setting, we compared HCV diagnostic detection and quantification of the GeneXpert, and Advanced Biological Laboratories UltraGene-HCV assays against the gold standard and reference method Roche real-time HCV in Myanmar. METHODS Blood samples from 158 high-risk individuals were assessed using three different methods at baseline. Results were checked for normality and log transformed. Log differences and bias between methods were calculated and correlated. Pearson's correlation coefficient was used to determine the association of HCV viral loads across all methods. The level of agreement with the standard method (Roche real time HCV) was assessed using Bland-Altman analyses. RESULTS There was a strong positive correlation coefficient between all three methods with GeneXpert and Roche having the strongest, r = 0.96, (p<0.001). Compared to Roche, ABL (mean difference, 95 % limits of agreement; -0.063 and -1.4 to 1.3 Log10IU/mL) and GeneXpert (mean difference, 95 % limits of agreement; -0.28 and -0.7 to 1.8 Log10IU/mL) showed a good level of agreement with the GeneXpert being slightly superior. CONCLUSION We demonstrate the excellent performance and no-inferiority, in terms of levels of agreements of both GeneXpert and ABL compared to the Roche platform and supporting the use of the POC assays as alternative a cost-effective methods in HCV detection and diagnosis in developing and low resource settings countries.
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Affiliation(s)
- Pedro Pisa
- Department of Strategic Information, Right to Care, Centurion, South Africa; Department of Human Nutrition, University of Pretoria, Faculty of Health Sciences, Pretoria, South Africa
| | - Constance Wose Kinge
- Department of Implementation Science, Right to Care, Centurion, South Africa; Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Charles Chasela
- Department of Implementation Science, Right to Care, Centurion, South Africa; Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Eula Mothibi
- Department of Implementation Science, Right to Care, Centurion, South Africa
| | | | - Hnin T Thwin
- Community Partners International, Yangon, Myanmar
| | - Nay M Aung
- Community Partners International, Yangon, Myanmar
| | - Kara W Chew
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Malini M Gandhi
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | | | | | - Aye A Lwin
- U.S. Agency for International Development, USA
| | - Morgan J Freiman
- Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar
| | - Khin P Kyi
- Myanmar Liver Foundation, Yangon, Myanmar
| | - Yi Y Sein
- Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar
| | | | | | - Sofiane Mohamed
- Advanced Biological Laboratories (ABL) SA.17, rue des Jardiniers, Luxembourg 1835
| | - Matthieu Barralon
- Advanced Biological Laboratories (ABL) SA.17, rue des Jardiniers, Luxembourg 1835
| | - Ian Sanne
- Clinical HIV Research Unit, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Lopes J, Grimwood A, Ngorima-Mabhena N, Tiam A, Tukei BB, Kasu T, Mahachi N, Mothibi E, Tukei V, Chasela C, Lombard C, Fatti G. Out-of-Facility Multimonth Dispensing of Antiretroviral Treatment: A Pooled Analysis Using Individual Patient Data From Cluster-Randomized Trials in Southern Africa. J Acquir Immune Defic Syndr 2021; 88:477-486. [PMID: 34506343 DOI: 10.1097/qai.0000000000002797] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 08/27/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Out-of-facility multi-month dispensing (MMD) is a differentiated service delivery model which provides antiretroviral treatment (ART) at intervals of up to 6 monthly in the community. Limited randomized evidence investigating out-of-facility MMD is available. We evaluated participant outcomes and compared out-of-facility MMD models using data from cluster-randomized trials in Southern Africa. SETTING Eight districts in Zimbabwe and Lesotho. METHODS Individual-level participant data from 2 cluster-randomized trials that included stable adults receiving ART at 60 facilities were pooled. Both trials had 3 arms: ART collected 3-monthly at healthcare facilities (3MF, control); ART provided three-monthly in community ART groups (CAGs) (3MC); and ART provided 6-monthly in either CAGs or on an individual provider-patient basis (6MC). Participant retention, viral suppression and incidence of unscheduled facility visits were compared. RESULTS Ten thousand one hundred thirty-six participants were included, 3817 (37.7%), 2893 (28.5%) and 3426 (33.8%) in arms 3MF, 3MC and 6MC, respectively. After 12 months, retention was non-inferior for 3MC (95.7%) vs. 3MF (95.0%) {adjusted risk difference (aRD) = 0.3 [95% confidence interval (CI): -0.8 to 1.4]}; and 6MC (95.1%) vs. 3MF [aRD = -0.2 (95% CI: -1.4 to 1.0)]. Retention was greater amongst intervention arm participants in CAGs versus 6MC participants not in CAGs, aRD = 1.5% (95% CI: 0.2% to 2.9%). Viral suppression was excellent (≥98%) and unscheduled facility visits were not increased in the intervention arms. CONCLUSIONS Three and 6-monthly out-of-facility MMD was non-inferior versus facility-based care for stable ART patients. Out-of-facility 6-monthly MMD should incorporate small group peer support whenever possible. CLINICALTRIAL REGISTRATION ClinicalTrials.gov NCT03238846 and NCT03438370.
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Affiliation(s)
- John Lopes
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | | | | | - Appolinaire Tiam
- Elizabeth Glaser Pediatric AIDS Foundation, Washington DC, United States
| | | | | | - Nyika Mahachi
- Zimbabwe College of Public Health Physicians, Harare, Zimbabwe
| | - Eula Mothibi
- Right to Care/EQUIP Health, Centurion, South Africa
| | - Vincent Tukei
- Elizabeth Glaser Pediatric AIDS Foundation, Maseru, Lesotho
| | - Charles Chasela
- Right to Care/EQUIP Health, Centurion, South Africa
- Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; and
| | - Carl Lombard
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa
| | - Geoffrey Fatti
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Kheth'Impilo AIDS Free Living, Cape Town, South Africa
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Fatti G, Ngorima-Mabhena N, Chirowa F, Chirwa B, Takarinda K, Tafuma TA, Mahachi N, Chikodzore R, Nyadundu S, Ajayi CA, Mutasa-Apollo T, Mugurungi O, Mothibi E, Hoffman RM, Grimwood A. The effectiveness and cost-effectiveness of 3- vs. 6-monthly dispensing of antiretroviral treatment (ART) for stable HIV patients in community ART-refill groups in Zimbabwe: study protocol for a pragmatic, cluster-randomized trial. Trials 2018; 19:79. [PMID: 29378662 PMCID: PMC5789674 DOI: 10.1186/s13063-018-2469-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 01/14/2018] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Sub-Saharan Africa is the world region with the greatest number of people eligible to receive antiretroviral treatment (ART). Less frequent dispensing of ART and community-based ART-delivery models are potential strategies to reduce the load on overburdened healthcare facilities and reduce the barriers for patients to access treatment. However, no large-scale trials have been conducted investigating patient outcomes or evaluating the cost-effectiveness of extended ART-dispensing intervals within community ART-delivery models. This trial will assess the clinical effectiveness, cost-effectiveness and acceptability of providing ART refills on a 3 vs. a 6-monthly basis within community ART-refill groups (CARGs) for stable patients in Zimbabwe. METHODS In this pragmatic, three-arm, parallel, unblinded, cluster-randomized non-inferiority trial, 30 clusters (healthcare facilities and associated CARGs) are allocated using stratified randomization in a 1:1:1 ratio to either (1) ART refills supplied 3-monthly from the health facility (control arm), (2) ART refills supplied 3-monthly within CARGs, or (3) ART refills supplied 6-monthly within CARGs. A CARG consists of 6-12 stable patients who meet in the community to receive ART refills and who provide support to one another. Stable adult ART patients with a baseline viral load < 1000 copies/ml will be invited to participate (1920 participants per arm). The primary outcome is the proportion of participants alive and retained in care 12 months after enrollment. Secondary outcomes (measured at 12 and 24 months) are the proportions achieving virological suppression, average provider cost per participant, provider cost per participant retained, cost per participant retained with virological suppression, and average patient-level costs to access treatment. Qualitative research will assess the acceptability of extended ART-dispensing intervals within CARGs to both providers and patients, and indicators of potential facility-level decongestion due to the interventions will be assessed. DISCUSSION Cost-effective health system models that sustain high levels of patient retention are urgently needed to accommodate the large numbers of stable ART patients in sub-Saharan Africa. This will be the first trial to evaluate extended ART-dispensing intervals within a community-based ART distribution model, and results are intended to inform national and regional policy regarding their potential benefits to both the healthcare system and patients. TRIAL REGISTRATION ClinicalTrials.gov, ID: NCT03238846 . Registered on 27 July 2017.
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Affiliation(s)
- Geoffrey Fatti
- Kheth'Impilo AIDS Free Living, 11th floor, Metlife Centre, 7 Walter Sisulu Ave, Cape Town, 8000, South Africa.
| | | | - Frank Chirowa
- Kheth'Impilo AIDS Free Living, 7 Albany Road, Alexandra Park, Harare, Zimbabwe
| | - Benson Chirwa
- Kheth'Impilo AIDS Free Living, 7 Albany Road, Alexandra Park, Harare, Zimbabwe
| | - Kudakwashe Takarinda
- International Union against Tuberculosis and Lung Disease, Paris, France.,AIDS and TB Department, Zimbabwe Ministry of Health and Child Care, 2nd Floor, Mkwati Building, Corner Livingstone Avenue and 5th Street, Harare, Zimbabwe
| | - Taurayi A Tafuma
- FHI360-Zimbabwe, 65 Whitwell Rd, Borrowdale West, Harare, Zimbabwe
| | | | - Rudo Chikodzore
- Zimbabwe Ministry of Health and Child Care, Matabeleland South Provincial Medical Directorate, First Floor New Government Complex, Third Avenue, Gwanda, Zimbabwe
| | - Simon Nyadundu
- Zimbabwe Ministry of Health and Child Care, Midlands Provincial Medical Directorate, Gweru, Zimbabwe
| | - Charles A Ajayi
- Health, Population and Nutrition Office, United States Agency for International Development- Zimbabwe, 1 Pascoe Avenue, Belgravia, Harare, Zimbabwe
| | - Tsitsi Mutasa-Apollo
- AIDS and TB Department, Zimbabwe Ministry of Health and Child Care, 2nd Floor, Mkwati Building, Corner Livingstone Avenue and 5th Street, Harare, Zimbabwe.,College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Owen Mugurungi
- AIDS and TB Department, Zimbabwe Ministry of Health and Child Care, 2nd Floor, Mkwati Building, Corner Livingstone Avenue and 5th Street, Harare, Zimbabwe
| | - Eula Mothibi
- Kheth'Impilo AIDS Free Living, 11th floor, Metlife Centre, 7 Walter Sisulu Ave, Cape Town, 8000, South Africa
| | - Risa M Hoffman
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine, University of California, 10833 Le Conte Ave 37-121 CHS, Los Angeles, CA, 90095, USA
| | - Ashraf Grimwood
- Kheth'Impilo AIDS Free Living, 11th floor, Metlife Centre, 7 Walter Sisulu Ave, Cape Town, 8000, South Africa
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Fatti G, Mothibi E, Shaikh N, Grimwood A. Improved long-term antiretroviral treatment outcomes amongst patients receiving community-based adherence support in South Africa. AIDS Care 2016; 28:1365-72. [PMID: 27251459 DOI: 10.1080/09540121.2016.1191605] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Retaining high levels of patients in care who are virally suppressed over long treatment periods has been an important challenge for antiretroviral treatment (ART) programmes in sub-Saharan Africa, the region having the highest HIV burden globally. Clinic-linked community-based adherence support (CBAS) programmes provide home-based adherence and psychosocial support for ART patients. However, there is little evidence of their longer-term impact. This study assessed the effectiveness of CBAS after eight years of ART. CBAS workers are lay healthcare personnel providing regular adherence and psychosocial support for ART patients and their households through home visits addressing household challenges affecting adherence. A multicentre cohort study using routinely collected data was undertaken at six public ART sites in a high HIV-prevalence South African district. Patient retention, loss to follow-up (LTFU), viral suppression and CD4 cell restoration were compared between patients with and without CBAS, using competing-risks regression, linear mixed models and log-binomial regression. 3861 patients were included, of whom 1616 (41.9%) received CBAS. Over 14,792 patient-years of observation, the cumulative incidence of LTFU was 37.3% and 46.2% amongst patients with and without CBAS, respectively, following 8 years of ART; adjusted subhazard ratio (CBAS vs. no CBAS) = 0.74 (95% CI: 0.66-0.84; P < .0001). Amongst patients on ART for 6.5-8 years, proportions not achieving viral suppression were 11.4% and 19.4% in patients with and without CBAS, respectively; adjusted risk ratio = 0.47 (95% CI: 0.26-0.86; P = .015). Annual CD4 cell increases from baseline were 62.8 cells/µL/year and 51.5 cells/µL/year amongst patients with and without CBAS, respectively, after 6.5 years or more (P = .034). After adjustment, annual CD4 cell recovery was 15.1 cells/µL/year (95% CI: 2.7-27.6) greater in CBAS patients (P = .017). ART patients who received CBAS had improved long-term patient retention, viral suppression and immunological restoration. CBAS is an intervention that can improve longer-term ART programme outcomes in resource-limited settings.
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Fatti G, Mothibi E, Meintjes G, Grimwood A. Antiretroviral treatment outcomes amongst older adults in a large multicentre cohort in South Africa. PLoS One 2014; 9:e100273. [PMID: 24949879 PMCID: PMC4065012 DOI: 10.1371/journal.pone.0100273] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 05/23/2014] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Increasing numbers of patients are starting antiretroviral treatment (ART) at advanced age or reaching advanced age while on ART. We compared baseline characteristics and ART outcomes of older adults (aged ≥55 years) vs. younger adults (aged 25-54 years) in routine care settings in South Africa. METHODS A multicentre cohort study of ART-naïve adults starting ART at 89 public sector facilities was conducted. Mortality, loss to follow-up (LTFU), immunological and virological outcomes until five years of ART were compared using competing-risks regression, generalised estimating equations and mixed-effects models. RESULTS 4065 older adults and 86,006 younger adults were included. There were more men amongst older adults; 44.7% vs. 33.4%; RR = 1.34 (95% CI: 1.29-1.39). Mortality after starting ART was substantially higher amongst older adults, adjusted sub-hazard ratio (asHR) = 1.44 over 5 years (95% CI: 1.26-1.64), particularly for the period 7-60 months of treatment, asHR = 1.73 (95% CI: 1.44-2.10). LTFU was lower in older adults, asHR = 0.87 (95% CI: 0.78-0.97). Achievement of virological suppression was greater in older adults, adjusted odds ratio = 1.42 (95% CI: 1.23-1.64). The probabilities of viral rebound and confirmed virological failure were both lower in older adults, adjusted hazard ratios = 0.69 (95% CI: 0.56-0.85) and 0.64 (95% CI: 0.47-0.89), respectively. The rate of CD4 cell recovery (amongst patients with continuous viral suppression) was 25 cells/6 months of ART (95% CI: 17.3-33.2) lower in older adults. CONCLUSIONS Although older adults had better virological outcomes and reduced LTFU, their higher mortality and slower immunological recovery warrant consideration of age-specific ART initiation criteria and management strategies.
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Affiliation(s)
| | | | - Graeme Meintjes
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town, Cape Town, South Africa
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Department of Medicine, Imperial College, London, United Kingdom
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Boulle A, Bock P, Osler M, Cohen K, Channing L, Hilderbrand K, Mothibi E, Zweigenthal V, Slingers N, Cloete K, Abdullah F. Antiretroviral therapy and early mortality in South Africa. Bull World Health Organ 2008; 86:678-87. [PMID: 18797643 DOI: 10.2471/blt.07.045294] [Citation(s) in RCA: 106] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2007] [Accepted: 11/27/2007] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To describe province-wide outcomes and temporal trends of the Western Cape Province antiretroviral treatment (ART) programme 5 years since inception, and to demonstrate the utility of the WHO monitoring system for ART. METHODS The treatment programme started in 2001 through innovator sites. Rapid scaling-up of ART provision began early in 2004, located predominantly in primary-care facilities. Data on patients starting ART were prospectively captured into facility-based registers, from which monthly cross-sectional activity and quarterly cohort reports were aggregated. Retention in care, mortality, loss to follow-up and laboratory outcomes were calculated at 6-monthly durations on ART. FINDINGS By the end of March 2006, 16 234 patients were in care. The cohort analysis included 12 587 adults and 1709 children. Women accounted for 70% of adults enrolled. After 4 and 3 years on ART respectively, 72.0% of adults (95% confidence interval, CI: 68.0-75.6) and 81.5% (95% CI: 75.7-86.1) of children remained in care. The percentage of adults starting ART with CD4 counts less than 50 cells/microl fell from 51.3% in 2001 to 21.5% in 2005, while mortality at 6 months fell from 12.7% to 6.6%, offset in part by an increase in loss to follow-up (reaching 4.7% at 6 months in 2005). Over 85% of adults tested had viral loads below 400 copies/ml at 6-monthly durations until 4 years on ART. CONCLUSION The location of care in primary-care sites in this programme was associated with good retention in care, while the scaling-up of ART provision was associated with reduced early mortality.
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Affiliation(s)
- Andrew Boulle
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
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