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Lakoh S, Bangura MM, Adekanmbi O, Barrie U, Jiba DF, Kamara MN, Sesay D, Jalloh AT, Deen GF, Russell JBW, Egesimba G, Yendewa GA, Firima E. Impact of COVID-19 on the Utilization of HIV Testing and Linkage Services in Sierra Leone: Experience from Three Public Health Facilities in Freetown. AIDS Behav 2024; 28:1235-1243. [PMID: 37642824 PMCID: PMC10940454 DOI: 10.1007/s10461-023-04149-2] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2023] [Indexed: 08/31/2023]
Abstract
The COVID-19 pandemic adversely affected the delivery of essential health services globally. In this study, we aimed to assess the impact of the pandemic on HIV testing and linkage services at three public health facilities in Freetown, Sierra Leone. We conducted a retrospective study to assess the impact of COVID-19 on HIV testing and linkage to treatment services (HTS) at Connaught Hospital (CH-tertiary), Lumley Government Hospital (LGH-secondary) and George Brooke Community Health Center (GBC-primary) in Freetown. Statistical analyses were conducted in Stata (16.1, StataCorp LLC, College Station, TX). Intra-pandemic HTS (2020) and HTS during recovery (2021) were compared with pre-pandemic HTS (2019). Of the 8538 people tested for HIV in the three facilities, 4929 (57.5%) visited CH. Only 2249 people were tested for HIV in 2020 compared to 3825 in 2019 (difference: - 41.2%, P < 0.001). Fewer people were also tested in 2021 (difference: - 35.6% P < 0.001). The largest reductions in testing in 2020 occurred in women (- 47.7%), children under 15 (- 95.2%), married people (- 42.6%), and CH (- 46.2%). Overall, 1369 (16.0%) people were positive for HIV; CH (878, 17.9%), LGH (469, 15.6%) and GBC (22, 3.5%). The likelihood of a positive HIV test was 26% lower in 2020 than 2019 (PR 0.74; 95% CI 0.64-0.85; P < 0.001), but 16% higher in 2021 than 2019 (PR 1.16; 95% CI 1.03-1.30; P < 0.05). Of the 1369 HIV diagnosis, 526 (38.4%) were linked to care. We found significant disruptions in HIV testing and linkage services at different levels of service delivery during the COVID-19 pandemic, underscoring the need to strengthen essential health services during public health emergencies.
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Affiliation(s)
- Sulaiman Lakoh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Government of Sierra Leone, Ministry of Health and Sanitation, Freetown, Sierra Leone
- Sustainable Health Systems Sierra Leone, Freetown, Sierra Leone
| | - Moses M Bangura
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Olukemi Adekanmbi
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Umu Barrie
- Infectious Disease Research Network, Freetown, Sierra Leone
| | - Darlinda F Jiba
- Government of Sierra Leone, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Matilda N Kamara
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Daniel Sesay
- Government of Sierra Leone, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Abdulai Tejan Jalloh
- Government of Sierra Leone, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Gibrilla F Deen
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Government of Sierra Leone, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - James B W Russell
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Government of Sierra Leone, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Ginika Egesimba
- ICAP at Columbia University Mailman School of Public Health, Freetown, Sierra Leone
| | - George A Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Emmanuel Firima
- Division of Clinical Epidemiology, University Hospital Basel, Basel, Switzerland.
- Clinical Research Unit, Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland.
- University of Basel, Basel, Switzerland.
- Centre for Multidisciplinary Research and Innovation, Abuja, Nigeria.
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Amutuhaire W, Semitala FC, Kimera ID, Namugenyi C, Mulindwa F, Ssenyonjo R, Katwesigye R, Mugabe F, Mutungi G, Ssinabulya I, Schwartz JI, Katahoire AR, Musoke LS, Yendewa GA, Longenecker CT, Muddu M. Time to blood pressure control and predictors among patients receiving integrated treatment for hypertension and HIV based on an adapted WHO HEARTS implementation strategy at a large urban HIV clinic in Uganda. J Hum Hypertens 2024:10.1038/s41371-024-00897-3. [PMID: 38302611 DOI: 10.1038/s41371-024-00897-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 10/01/2023] [Accepted: 01/18/2024] [Indexed: 02/03/2024]
Abstract
In this cohort study, we determined time to blood pressure (BP) control and its predictors among hypertensive PLHIV enrolled in integrated hypertension-HIV care based on the World Health Organization (WHO) HEARTS strategy at Mulago Immunosuppression Clinic in Uganda. From August 2019 to March 2020, we enrolled hypertensive PLHIV aged [Formula: see text]18 years and initiated Amlodipine 5 mg mono-therapy for BP (140-159)/(90-99) mmHg or Amlodipine 5 mg/Valsartan 80 mg duo-therapy for BP ≥ 160/90 mmHg. Patients were followed with a treatment escalation plan until BP control, defined as BP < 140/90 mmHg. We used Cox proportional hazards models to identify predictors of time to BP control. Of 877 PLHIV enrolled (mean age 50.4 years, 62.1% female), 30% received mono-therapy and 70% received duo-therapy. In the monotherapy group, 66%, 88% and 96% attained BP control in the first, second and third months, respectively. For patients on duo-therapy, 56%, 83%, 88% and 90% achieved BP control in the first, second, third, and fourth months, respectively. In adjusted Cox proportional hazard analysis, higher systolic BP (aHR 0.995, 95% CI 0.989-0.999) and baseline ART tenofovir/lamivudine/efavirenz (aHR 0.764, 95% CI 0.637-0.917) were associated with longer time to BP control, while being on ART for >10 years was associated with a shorter time to BP control (aHR 1.456, 95% CI 1.126-1.883). The WHO HEARTS strategy was effective at achieving timely BP control among PLHIV. Additionally, monotherapy anti-hypertensive treatment for stage I hypertension is a viable option to achieve BP control and limit pill burden in resource limited HIV care settings.
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Affiliation(s)
- Willington Amutuhaire
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
| | | | | | | | - Frank Mulindwa
- Makerere University Infectious Diseases Institute, Kampala, Uganda
| | | | | | - Frank Mugabe
- Department of non-communicable diseases, Uganda Ministry of Health, Kampala, Uganda
| | - Gerald Mutungi
- Department of non-communicable diseases, Uganda Ministry of Health, Kampala, Uganda
| | | | - Jeremy I Schwartz
- Yale School of Medicine, Section of General Internal Medicine, Connecticut, CT, USA
| | - Anne R Katahoire
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Lewis S Musoke
- Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - George A Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Chris T Longenecker
- Department of Global Health and Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Martin Muddu
- Makerere University Joint AIDS Program (MJAP), Kampala, Uganda
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Yendewa GA, Khazan A, Jacobson JM. Risk Stratification of Advanced Fibrosis in Patients With Human Immunodeficiency Virus and Hepatic Steatosis Using the Fibrosis-4, Nonalcoholic Fatty Liver Disease Fibrosis, and BARD Scores. Open Forum Infect Dis 2024; 11:ofae014. [PMID: 38379565 PMCID: PMC10878060 DOI: 10.1093/ofid/ofae014] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 01/05/2024] [Indexed: 02/22/2024] Open
Abstract
Background Nonalcoholic fatty liver disease (NAFLD) and subsequent progression to fibrosis is increasingly prevalent in people with HIV (PWH). We used noninvasive methods to stratify risk and identify associated factors of advanced fibrosis in PWH with NAFLD. Methods We conducted a retrospective study of PWH in our clinic from 2005 to 2022. We used liver imaging or biopsy reports to identify cases of hepatic steatosis after excluding specified etiologies. We used the Fibrosis-4 (FIB-4), NAFLD Fibrosis (NFS), and body mass index, aspartate transaminase/alanine transaminase ratio, and diabetes score scores to stratify fibrosis. We used logistic regression to identify factors associated with advanced fibrosis. Results Among 3959 PWH in care, 1201 had available imaging or liver biopsies. After exclusions, 114 of 783 PWH had evidence of hepatic steatosis (14.6%). Most were male (71.1%), with a median age of 47 years, and median body mass index of 30.1 kg/m2. Approximately 24% had lean NAFLD (ie, body mass index < 25 kg/m2). Based on the FIB-4 and NFS, 34 (29.8%) and 36 (31.6%) had advanced fibrosis, whereas 1 in 4 had low risk of fibrosis based on FIB-4, NFS, and BARD scores. In adjusted analysis using FIB-4, advanced fibrosis was associated with age > 45 years (adjusted odds ratio, 6.29; 95% confidence interval, 1.93-20.50) and hypoalbuminemia (adjusted odds ratio, 9.45; 95% confidence interval, 2.45-32.52) in addition to elevated transaminases and thrombocytopenia, whereas using the NFS did not identify associations with advanced fibrosis. Conclusions We found 14.6% of PWH had NAFLD, with 1 in 3 having advanced fibrosis. Our study provides practical insights into fibrosis risk stratification in HIV primary care settings.
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Affiliation(s)
- George A Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Ana Khazan
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Jeffrey M Jacobson
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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Yendewa GA, Perez JA, Patil N, McComsey GA. Associations between post-acute sequelae of SARS-CoV-2, COVID-19 vaccination and HIV infection: a United States cohort study. Front Immunol 2024; 15:1297195. [PMID: 38318191 PMCID: PMC10838972 DOI: 10.3389/fimmu.2024.1297195] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 01/08/2024] [Indexed: 02/07/2024] Open
Abstract
Background People with HIV (PWH) are at higher risk of complications from acute COVID-19, but their risk of subsequent post-acute sequelae of SARS-CoV2 (PASC) remains unclear. Although vaccination is protective of PASC among survivors in the general population, its effectiveness in PWH has not been explored. Methods We used the TriNetX health research database to identify patients with and without HIV aged ≥18 years with confirmed SARS-CoV-2 between January 1, 2020 and July 20, 2023. We employed 1:1 propensity score matching to balance HIV and non-HIV cohorts based on demographics and key comorbidities. The primary outcomes accessed odds of PASC and mortality and secondary outcomes assessed odds of PASC and mortality by vaccination status. PASC was defined as new-onset conditions ≥ 28 days after COVID-19 diagnosis. We reported odd ratios (OR) of outcomes with 95% confidence intervals (CI), with statistical significance set at p < 0.05. Results Of 3,029,340 people with confirmed SARS-CoV-2 infection, 0.5% (n=13,214) were PWH, with 7.5% of PWH (n=989) vaccinated. After 28 days post-COVID-19, PWH had higher odds of mortality compared with their non-HIV counterparts (OR 1.22, 95% CI 1.06-1.40) and developing new-onset HTN (OR 1.18, 95% CI 1.03-1.36), heart disease (OR 1.35 95% CI 1.18-1.54), malignancy (OR 1.49, 95% CI 1.22-1.81), and mental disorders (OR 1.62, 95% CI 1.42-1.85). Furthermore, vaccinated PWH had significantly lower odds of death (OR 0.63, 95% CI 0.42-0.93) and new-onset PASC outcomes: DM (OR 0.65, 95% CI 0.43-0.99), heart disease (OR 0.58, 95% CI 0.4-0.85), mental disorders (OR 0.66, 95% CI 0.43-1.00), fatigue (OR 0.82, 95% CI 0.67-0.98), respiratory (OR 0.82, 95% CI 0.70-0.95) and gastrointestinal symptoms (OR 0.78, 95% CI 0.67-0.90). Conclusion HIV-positive status increased PASC odds, while COVID-19 vaccination reduced PASC and all-cause mortality risks in PWH.
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Affiliation(s)
- George A. Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, United States
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Jaime Abraham Perez
- Center for Clinical Research, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Nirav Patil
- Center for Clinical Research, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Grace A. McComsey
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, United States
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
- Center for Clinical Research, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
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Ghazzawi M, Babawo LS, Mohareb AM, James PB, Yendewa SA, Massaquoi SP, Cummings PE, Lakoh S, Salata RA, Yendewa GA. Impact of COVID-19 on hepatitis B screening in Sierra Leone: insights from a community pharmacy model of care. IJID Reg 2023; 9:7-13. [PMID: 37711649 PMCID: PMC10498170 DOI: 10.1016/j.ijregi.2023.08.006] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/07/2023] [Accepted: 08/09/2023] [Indexed: 09/16/2023]
Abstract
Objectives To assess the impact of COVID-19-related interruptions and seasonal patterns on hepatitis B virus (HBV) screening in a hyperendemic setting in Sierra Leone. Methods We conducted a retrospective study of HBV testing in a community pharmacy in Freetown, Sierra Leone, from October 01, 2019, through September 30, 2022. We compared participant characteristics using Pearson's chi-square test. We evaluated trends in HBV screening and diagnosis using one-way analysis of variance with Tukey's or Dunnett's post-test. Results Of 920 individuals screened, 161 had detectable HBV surface antigen (seroprevalence 17.5% [95% CI 14.9-20.4]). There was a 100% decrease in HBV screening during January-June of 2020; however, screening increased by 27% and 23% in the first and second years after COVID-19, respectively. Mean quarterly tests showed a significant upward trend: 55 ± 6 tests during January-March (baseline), 74 ± 16 tests during April-June, 101 ± 3 tests during July-September, and 107 ± 17 tests during October-December (one-way analysis of variance test for trend, F = 7.7, P = 0.0254) but not the mean quarterly number of people diagnosed with HBV (F = 0.34, P = 0.7992). Conclusion Community-based HBV screening dramatically improved following temporary disruptions related to COVID-19. Seasonal variation in HBV screening, but not HBV diagnosis, may have implications for HBV elimination efforts in Sierra Leone and other West African countries.
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Affiliation(s)
| | - Lawrence S. Babawo
- Department of Nursing, School of Community Health Sciences, Njala University, Bo, Sierra Leone
| | - Amir M. Mohareb
- Center for Global Health, Massachusetts General Hospital, Boston, USA
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, USA
- Department of Medicine, Harvard Medical School, Boston, USA
| | - Peter B. James
- Faculty of Health, Southern Cross University, Lismore, Australia
| | | | | | | | - Sulaiman Lakoh
- Ministry of Health and Sanitation, Freetown, Sierra Leone
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Connaught Hospital, University of Sierra Leone Teaching Hospitals Complex, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Robert A. Salata
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, USA
| | - George A. Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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Song JW, Yang G, Kamara MN, Sun W, Guan Q, Barrie U, Jiba DF, Jalloh AT, Liu M, Tamba FK, Yendewa GA, Wang L, Zhao R, Lakoh S. HIV viral suppression at different thresholds and duration of treatment in the dolutegravir treatment era in Sierra Leone: a nationwide survey. Virol J 2023; 20:279. [PMID: 38031075 PMCID: PMC10687966 DOI: 10.1186/s12985-023-02245-2] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 11/18/2023] [Indexed: 12/01/2023] Open
Abstract
INTRODUCTION Viral load assessment for people living with HIV is key for monitoring treatment and achieving the 95-95-95. In this study, we aimed to assess the degree of viral suppression at different thresholds and treatment duration after the introduction of dolutegravir-based therapy in ten public hospitals in Sierra Leone. METHODS We used a cross-sectional study design to recruits patients aged 18 years or older between August 2022 and January 2023. Statistical analyses were performed using R-software. Logistic regression was used to assess factors independently associated with viral suppression. The level of significance was set at P < 0.05. RESULTS Of the 2,253 patients recruited, 1,720 (76%) were women and 1,705 (76%) were receiving a fixed dose combination of tenofovir, lamivudine and dolutegravir. The median age and duration of anti-retroviral therapy (ART) was 36.0 (IQR, 28.0-45.0) years and 40.9 (IQR, 14.4-79.6) months, respectively. Using a threshold of HIV RNA < 1000 copies/mL, 1,715 (88.4%) patients on ART for more than 6 months were virally suppressed. Viral suppression rates were higher with dolutegravir-based (1,277, 89.5%) than efavirenz-based (418, 86.2%) ART. HIV RNA was < 200 copies/mL in 1,643 (84.6%) patients or < 50 copies/mL in 1,487 (76.6%) patients or between 50 and 999 copies/mL in 228 (11.7%) patients. Viral suppression rates at different ART durations (months) were as follows: 84.2% (≤ 3), 88.8% (4-6), 90.9% (6-12), and 88.1% (> 12). Viral suppression rates were higher for patients aged 40 or older (40-50 years: aOR 2.05, 95%CI 1.41-3.04, P < 0.01; 50-60 years: aOR 2.51, 95%CI 1.53-4.35, P < 0.01; >60 years: aOR 2.69, 95%CI 1.28-6.63, P = 0.02). Men had 49% lower odds of viral suppression than women (aOR 0.50, 95% CI 0.38-0.67, P < 0.01). CONCLUSION We report a viral suppression rate of 88.4% among patients on treatment for at least 6 months, with higher rate of suppression with dolutegravir than efavirenz. Factors associated with virological suppression were age and gender, emphasizing the need for innovative differentiated ART delivery models to optimize viral suppression and achieve the 95% target.
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Affiliation(s)
- Jin-Wen Song
- Senior Department of Infectious Diseases, the Fifth Medical Center of PLA General Hospital, Beijing, China
- Tropical Infectious Disease Prevention and Control Center, Freetown, Sierra Leone
| | - Guang Yang
- Department of Clinical Laboratory, the Fifth Medical Center of PLA General Hospital, Beijing, China
- Tropical Infectious Disease Prevention and Control Center, Freetown, Sierra Leone
| | - Matilda N Kamara
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Wei Sun
- School of Public Health, Southern Medical University, Guangzhou, China
| | - Qun Guan
- The Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Umu Barrie
- Infectious Disease Research Network, Freetown, Sierra Leone
| | - Darlinda F Jiba
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Abdulai Tejan Jalloh
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Ming Liu
- Department of Clinical Laboratory, the Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Francis K Tamba
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - George A Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ligui Wang
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Rongtao Zhao
- Chinese PLA Center for Disease Control and Prevention, Beijing, China.
| | - Sulaiman Lakoh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone.
- Sustainable Health Systems Sierra Leone, Freetown, Sierra Leone.
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James PB, Yendewa GA, Bah AJ, Osborne A, Kpagoi SS, Margao EK, Kangbai J, Wardle J. Do disempowered childbearing women give birth at home in Sierra Leone? A secondary analysis of the 2019 Sierra Leone demographic health survey. BMC Pregnancy Childbirth 2023; 23:810. [PMID: 37993807 PMCID: PMC10664373 DOI: 10.1186/s12884-023-06126-y] [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: 09/02/2022] [Accepted: 11/14/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND A nationwide assessment of the link between women's empowerment and homebirth has not been fully examined in Sierra Leone. Our study examined the association between women's empowerment and homebirth among childbearing women in Sierra Leone using the 2019 Sierra Leone Demographic Health Survey (2019 SLDHS) data. METHOD We used the individual file (IR) of the 2019 SLDHS dataset for our analysis. A total of 7377 women aged 15-49 years who gave birth in the five years preceding the survey were included. Outcome variable was "home birth of their last child among women in the five years preceding the 2019 SLDHS. Women's empowerment parameters include women's knowledge level, economic participation, decision-making ability and power to refuse the idea of intimate partner violence. We used the complex sample command on SPSS version 28 to conduct descriptive and multivariate logistic regression analyses. RESULTS Three in every 20 women had home childbirth (n = 1177; 15.3%). Women with low [aOR 2.04; 95% CI 1.43-2.92] and medium [aOR 1.44; 95%CI 1.05-1.97] levels of knowledge had higher odds of giving birth at home compared to those with high levels of knowledge. Women who did not have power to refuse the idea of intimate partner violence against women were more likely to had given birth at home [aOR 1.38; 95% CI1.09-1.74]. In addition, women with no [aOR 2.71; 95% CI1.34-5.46) and less than four antenatal care visits [aOR 2.08; 95% CI:1.51-2.88] and for whom distance to a health facility was a major problem [aOR 1.95; 95% CI1.49-2.56] were more likely to have had a homebirth. However, no statistically significant association was observed between a women's decision-making power and home birth [aOR 1.11; 95% CI 0.86-1.41]. CONCLUSION Despite improvements in maternal health indicators, homebirth by unskilled birth attendants is still a public health concern in Sierra Leone. Women with low knowledge levels, who did not have power to refuse the idea of intimate partner violence against women, had less than four ANC visits and considered distance to a health facility as a major problem had higher odds of giving birth at home. Our findings reflect the need to empower women by improving their knowledge level through girl child and adult education, increasing media exposure, changing societal norms and unequal power relations that promote gender-based violence against women, and improving roads and transport infrastructure.
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Affiliation(s)
- Peter Bai James
- National Centre for Naturopathic Medicine, Faculty of Health, Southern Cross University, Lismore, Australia.
- Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.
| | - George A Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, 44106, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, 44106, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Abdulai Jawo Bah
- Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Institute for Global Health and Development, Queen Margaret University Edinburg, Musselburgh, Scotland, UK
| | - Augustus Osborne
- Department of Biological Sciences, School of Environmental Sciences, Njala University, Njala Campus, Njala, Sierra Leone
| | - Satta Sylvia Kpagoi
- Bo Government Hospital, Ministry of Health and Sanitation, Bo, Sierra Leone
- School of Community Health Sciences, Njala University, Bo Campus, Bo, Sierra Leone
| | - Emmanuel Kamanda Margao
- Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Jia Kangbai
- School of Community Health Sciences, Njala University, Bo Campus, Bo, Sierra Leone
- Faculty of Health Sciences and Disaster Management, Eastern Technical University of Sierra Leone, Kenema, Sierra Leone
| | - Jon Wardle
- National Centre for Naturopathic Medicine, Faculty of Health, Southern Cross University, Lismore, Australia
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Lakoh S, Vamboi PL, Ouédraogo AR, Adekanmbi O, Deen GF, Russell JBW, Sankoh-Hughes A, Kamara JB, Kanu JE, Yendewa GA, Firima E, Amaral AFS. High prevalence of TB multimorbidity among adults of a tertiary hospital in Sierra Leone: a cross-sectional study. BMC Res Notes 2023; 16:337. [PMID: 37974272 PMCID: PMC10655410 DOI: 10.1186/s13104-023-06476-y] [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: 12/14/2022] [Accepted: 08/25/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVE Tuberculosis (TB) is a leading cause of death globally, with approximately 1.5 million deaths in 2020. TB often coexists with chronic communicable and non-communicable diseases, but data to determine the extent of comorbid diseases are limited. In this study, we aimed to assess the prevalence of TB multimorbidity and its risk factors in a tertiary hospital in Sierra Leone. This is a cross-sectional study of 240 adults with microbiologically-confirmed TB at Connaught Hospital in Freetown, between March and May 2022. Logistic regression analysis was used to identify factors associated with TB multimorbidity. RESULTS The mean age of the patients was 37 years. More than two-thirds were males and about the same number had two or more chronic diseases. The most common were hypertension (47.9%) and diabetes (24.2%). Patients under 35 years of age were less likely to have TB multimorbidity (< 25 years: adjusted OR 0.07, 95%CI 0.01-0.6; 25-34 years: adjusted OR 0.2, 95%CI 0.01-0.9). We report a high prevalence of comorbid diseases among TB patients in the largest treatment center in Sierra Leone, with hypertension and diabetes being the most common. These findings support the current call for addressing comorbid non-communicable diseases in TB patients through integrated care.
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Affiliation(s)
- Sulaiman Lakoh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.
- Government of Sierra Leone, Ministry of Health and Sanitation, Freetown, Sierra Leone.
- Sustainable Health Systems Sierra Leone, Freetown, Sierra Leone.
| | - Patricia Lombeh Vamboi
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Abdoul Risgou Ouédraogo
- Division of Pulmonology, Training and Research Unit in Health Sciences, University Joseph KI-ZEBRO, Ouagadougou, Burkina Faso
| | - Olukemi Adekanmbi
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Gibrilla F Deen
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Government of Sierra Leone, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - James B W Russell
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Government of Sierra Leone, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Ahmed Sankoh-Hughes
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Joseph B Kamara
- Government of Sierra Leone, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Joseph Edwin Kanu
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - George A Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Emmanuel Firima
- Clinical Research Unit, Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- SolidarMed, Maseru, Lesotho
- Centre for Multidisciplinary Research and Innovation, Abuja, Nigeria
| | - André F S Amaral
- National Heart and Lung Institute, Imperial College London, London, UK
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9
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Jiba DF, Lakoh S, Wang S, Sun W, Barrie U, Kamara MN, Jalloh AT, Tamba FK, Yendewa GA, Song JW, Yang G. Sero-prevalence of syphilis infection among people living with HIV in Sierra Leone: a cross-sectional nationwide hospital-based study. BMC Infect Dis 2023; 23:762. [PMID: 37932713 PMCID: PMC10626761 DOI: 10.1186/s12879-023-08740-9] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 10/23/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Globally, there were an estimated 7.1 million new syphilis infections in 2020, with more than 30% of these new infections reported in African countries such as Sierra Leone. Despite this, there is no HIV-specific syphilis screening program in Sierra Leone. Thus, data are needed to inform public health practice. In this study, we aimed to determine the prevalence of syphilis seropositivity and factors associated with syphilis seropositivity among people living with HIV (PLHIV). METHODS A cross-sectional study was conducted at 10 health facilities in Sierra Leone, among adults with HIV, aged 18 years or older, from September 2022 to January 2023. Parameters of interest were collected including age, sex, marriage, antiretroviral therapy (ART) regimen, HIV viral load, duration of ART treatment, and hospital level of care. The syphilis antibody was detected by a rapid test based on immunochromatography assay. Data were analyzed using R-software version 4.2.3 (R Core Team, Vienna, Austria). Pearson's χ2 test, Fisher's exact test and Kruskal-Wallis H test were applied to assess the differences in syphilis seropositivity between groups as appropriate. Univariate logistic regression and multivariate logistic regression analysis was used to assess factors associated with syphilis seropositivity. The level of statistical significance was set at P < 0.05. RESULTS Of the 3082 PLHIV individuals in our study, 2294 (74.4%) were female and 2867 (93.0%) were receiving ART. With a median age of 36 years, 211 (6.8%, 95% CI 6.0-7.7) were positive for syphilis. The prevalence of syphilis was highest in people aged 60 years and over (21.1%, 95%CI 14.7-29.2), followed by people aged 50-60 years (15.5%, 95%CI 11.9-19.9) and in the widowed population (11.9%, 95%CI 8.9-15.8). There were no differences in syphilis seropositivity between gender, ART status, ART regimen, duration of ART, HIV viral load and hospital level of care. Older age (50-60 years: adjusted OR 3.49, 95%CI 2.09-5.85 P < 0.001; 60-100 years: adjusted OR 4.28, 95%CI 2.21-8.17, P < 0.001) was an independent predictor of seropositive syphilis. CONCLUSIONS We observed a high prevalence of syphilis among PLHIV. Older people and widowed population have higher syphilis seropositivity. Older age was an independent predictor of syphilis positivity. Therefore, we call for the integration of syphilis screening, treatment and prevention in HIV services.
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Affiliation(s)
- Darlinda F Jiba
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Sulaiman Lakoh
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Sustainable Health Systems Sierra Leone, Freetown, Sierra Leone
| | - Shuchao Wang
- Changchun Veterinary Institute, Chinese Academy of Agricultural Sciences, Changchun, China
| | - Wei Sun
- School of Public Health, Southern Medical University, Guangzhou, China
| | - Umu Barrie
- Infectious Disease Research Network, Freetown, Sierra Leone
| | - Matilda N Kamara
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Abdulai Tejan Jalloh
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Francis K Tamba
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - George A Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Jin-Wen Song
- Senior Department of Infectious Diseases, the Fifth Medical Centre of PLA General Hospital, Beijing, China.
| | - Guang Yang
- Department of Clinical Laboratory, the Fifth Medical Center of PLA General Hospital, Beijing, China.
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10
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Yendewa GA, James PB, Mohareb A, Barrie U, Massaquoi SPE, Yendewa SA, Ghazzawi M, Bockarie T, Cummings PE, Diallo IS, Johnson A, Vohnm B, Babawo LS, Deen GF, Kabba M, Sahr F, Lakoh S, Salata RA. Determinants of incomplete childhood hepatitis B vaccination in Sierra Leone, Liberia, and Guinea: Analysis of national surveys (2018-2020). Epidemiol Infect 2023; 151:e193. [PMID: 37920110 PMCID: PMC10728985 DOI: 10.1017/s0950268823001735] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/10/2023] [Accepted: 10/17/2023] [Indexed: 11/04/2023] Open
Abstract
Vaccination against hepatitis B virus (HBV) is effective at preventing vertical transmission. Sierra Leone, Liberia, and Guinea are hyperendemic West African countries; yet, childhood vaccination coverage is suboptimal, and the determinants of incomplete vaccination are poorly understood. We analyzed national survey data (2018-2020) of children aged 4-35 months to assess complete HBV vaccination (receiving 3 doses of the pentavalent vaccine) and incomplete vaccination (receiving <3 doses). Statistical analysis was conducted using the complex sample command in SPSS (version 28). Multivariate logistic regression was used to identify determinants of incomplete immunization. Overall, 11,181 mothers were analyzed (4,846 from Sierra Leone, 2,788 from Liberia, and 3,547 from Guinea). Sierra Leone had the highest HBV childhood vaccination coverage (70.3%), followed by Liberia (64.6%) and Guinea (39.3%). Within countries, HBV vaccination coverage varied by socioeconomic characteristics and healthcare access. In multivariate regression analysis, factors that were significantly associated with incomplete vaccination in at least one country included sex of the child, Muslim mothers, lower household wealth index, <4 antenatal visits, home delivery, and distance to health facility vaccination (all p < 0.05). Understanding and addressing modifiable determinants of incomplete vaccination will be essential to help achieve the 2030 viral hepatitis elimination goals.
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Affiliation(s)
- George A. Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Peter B. James
- Faculty of Health, Southern Cross University, Lismore, Australia
| | - Amir Mohareb
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Umaru Barrie
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | | | | | - Tahir Bockarie
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | | | | | - Ambulai Johnson
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Lawrence S. Babawo
- Department of Nursing, School of Community Health Sciences, Njala University, Bo Campus, Sierra Leone
| | - Gibrilla F. Deen
- Ministry of Health and Sanitation, Freetown, Sierra Leone
- Connaught Hospital, University of Sierra Leone Teaching Hospitals Complex, Ministry of Health and Sanitation, Freetown, Sierra Leone
- Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Mustapha Kabba
- Ministry of Health and Sanitation, Freetown, Sierra Leone
- Connaught Hospital, University of Sierra Leone Teaching Hospitals Complex, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Foday Sahr
- Ministry of Health and Sanitation, Freetown, Sierra Leone
- Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Sulaiman Lakoh
- Ministry of Health and Sanitation, Freetown, Sierra Leone
- Connaught Hospital, University of Sierra Leone Teaching Hospitals Complex, Ministry of Health and Sanitation, Freetown, Sierra Leone
- Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Robert A. Salata
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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11
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Cummings PE, Lakoh S, Yendewa SA, Massaquoi SPE, James PB, Sahr F, Deen GF, Salata RA, Gevao P, Yendewa GA. Understanding COVID-19 Vaccine Uptake and Hesitancy among People with HIV in Freetown, Sierra Leone: A Cross-Sectional Study. Vaccines (Basel) 2023; 11:1685. [PMID: 38006017 PMCID: PMC10674940 DOI: 10.3390/vaccines11111685] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/01/2023] [Accepted: 11/01/2023] [Indexed: 11/26/2023] Open
Abstract
People with HIV (PWH) incur a higher risk of COVID-19-related morbidity and mortality rates, yet less is known about COVID-19 vaccine uptake and hesitancy in this group. We conducted a cross-sectional study in Freetown, Sierra Leone, from April to June 2022, using the VAX scale, a validated instrument, to assess attitudes towards COVID-19 vaccination and calculate the hesitancy (VAX) scores. We used generalized linear models to identify the factors associated with vaccine hesitancy. Overall, 490 PWH were enrolled (71.4% female, median age: 38 years, median CD4 count: 412 cells/mm3). About 17.3% received ≥1 dose of a COVID-19 vaccine. The mean VAX score was 43.14 ± 7.05, corresponding to 59.9% participants being vaccine-hesitant. A preference for natural immunity (65.8%) and concerns about profiteering (64.4%) were the commonest reasons for hesitancy, followed by a mistrust of vaccine benefits (61.4%) and worries about future effects (48.0%). In the adjusted regression analysis, being a Muslim (β = 2.563, p < 0.001) and having an urban residence (β = 1.709, p = 0.010) were associated with greater vaccine hesitancy, while testing for COVID-19 was associated with reduced vaccine hesitancy (β = -3.417, p = 0.027). These findings underscore the importance of addressing vaccine hesitancy as a critical element boosting COVID-19 vaccine uptake among PWH.
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Affiliation(s)
- Peterlyn E. Cummings
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 00232, Sierra Leone; (P.E.C.); (S.L.); (F.S.); (G.F.D.); (P.G.)
| | - Sulaiman Lakoh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 00232, Sierra Leone; (P.E.C.); (S.L.); (F.S.); (G.F.D.); (P.G.)
- Connaught Hospital, University of Sierra Leone Teaching Hospitals Complex, Ministry of Health and Sanitation, Freetown 00232, Sierra Leone
- Ministry of Health and Sanitation, Freetown 00232, Sierra Leone; (S.A.Y.); (S.P.E.M.)
| | - Sahr A. Yendewa
- Ministry of Health and Sanitation, Freetown 00232, Sierra Leone; (S.A.Y.); (S.P.E.M.)
| | | | - Peter B. James
- Faculty of Health, Southern Cross University, Lismore, NSW 2480, Australia;
| | - Foday Sahr
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 00232, Sierra Leone; (P.E.C.); (S.L.); (F.S.); (G.F.D.); (P.G.)
- Connaught Hospital, University of Sierra Leone Teaching Hospitals Complex, Ministry of Health and Sanitation, Freetown 00232, Sierra Leone
| | - Gibrilla F. Deen
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 00232, Sierra Leone; (P.E.C.); (S.L.); (F.S.); (G.F.D.); (P.G.)
- Connaught Hospital, University of Sierra Leone Teaching Hospitals Complex, Ministry of Health and Sanitation, Freetown 00232, Sierra Leone
- Ministry of Health and Sanitation, Freetown 00232, Sierra Leone; (S.A.Y.); (S.P.E.M.)
| | - Robert A. Salata
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA;
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
| | - Pelema Gevao
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 00232, Sierra Leone; (P.E.C.); (S.L.); (F.S.); (G.F.D.); (P.G.)
- Republic of Sierra Leone Armed Forces, Department of Defense, Freetown 00232, Sierra Leone
| | - George A. Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA;
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
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12
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Lakoh S, Yi L, Russell JBW, Zhang J, Sevalie S, Zhao Y, Kanu JS, Liu P, Conteh SK, Williams CEE, Barrie U, Adekanmbi O, Jiba DF, Kamara MN, Sesay D, Deen GF, Okeibunor JC, Yendewa GA, Guo X, Firima E. High incidence of catheter-associated urinary tract infections and related antibiotic resistance in two hospitals of different geographic regions of Sierra Leone: a prospective cohort study. BMC Res Notes 2023; 16:301. [PMID: 37907960 PMCID: PMC10619308 DOI: 10.1186/s13104-023-06591-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 10/24/2023] [Indexed: 11/02/2023] Open
Abstract
OBJECTIVE Catheter-associated urinary tract infections (CAUTI) are common worldwide, but due to limited resources, its actual burden in low-income countries is unknown. Currently, there are gaps in knowledge about CAUTI due to lack of surveillance activities in Sierra Leone. In this prospective cohort study, we aimed to determine the incidence of CAUTI and associated antibiotic resistance in two tertiary hospitals in different regions of Sierra Leone. RESULTS The mean age of the 459 recruited patients was 48.8 years. The majority were females (236, 51.3%). Amongst the 196 (42.6%) catheterized patients, 29 (14.8%) developed CAUTI. Bacterial growth was reported in 32 (84%) patients. Escherichia coli (14, 23.7%), Klebsiella pneumoniae (10, 17.0%), and Klebsiella oxytoca (8, 13.6%) were the most common isolates. Most isolates were ESBL-producing Enterobacteriaceae (33, 56%) and WHO Priority 1 (Critical) pathogens (38, 71%). Resistance of K. pneumoniae, K. oxytoca, E. coli, and Proteus mirabilis was higher with the third-generation cephalosporins and penicillins but lower with carbapenems, piperacillin-tazobactam and amikacin. To reduce the high incidence of CAUTI and multi-drug resistance organisms, urgent action is needed to strengthen the microbiology diagnostic services and develop and implement catheter bundles that provide clear guidance for catheter insertion, care and removal.
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Affiliation(s)
- Sulaiman Lakoh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone.
- Sustainable Health Systems Sierra Leone, Freetown, Sierra Leone.
- Infectious Disease Research Network, Freetown, Sierra Leone.
| | - Le Yi
- Tropical Infectious Disease Prevention and Control Center, Freetown, Sierra Leone
| | - James B W Russell
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Juling Zhang
- Department of Clinical Laboratory, the Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100039, China
| | - Stephen Sevalie
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Sustainable Health Systems Sierra Leone, Freetown, Sierra Leone
- 34 Military Hospital, Freetown, Sierra Leone
| | - Yongkun Zhao
- Tropical Infectious Disease Prevention and Control Center, Freetown, Sierra Leone
| | - Joseph Sam Kanu
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Peng Liu
- Department of Emergency Medicine, the Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100039, China
| | - Sarah K Conteh
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Christine Ellen Elleanor Williams
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Umu Barrie
- Infectious Disease Research Network, Freetown, Sierra Leone
| | - Olukemi Adekanmbi
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Darlinda F Jiba
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Matilda N Kamara
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Daniel Sesay
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Gibrilla F Deen
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | | | - George A Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Xuejun Guo
- Tropical Infectious Disease Prevention and Control Center, Freetown, Sierra Leone.
| | - Emmanuel Firima
- Clinical Research Unit, Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- , SolidarMed, Maseru, Lesotho
- Centre for Multidisciplinary Research and Innovation, Abuja, Nigeria
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13
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Lakoh S, Williams CEE, Sevalie S, Russell JBW, Conteh SK, Kanu JS, Barrie U, Deen GF, Maruta A, Sesay D, Adekanmbi O, Jiba DF, Okeibunor JC, Yendewa GA, Firima E. Antibiotic use and consumption among medical patients of two hospitals in Sierra Leone: a descriptive report. BMC Infect Dis 2023; 23:737. [PMID: 37891476 PMCID: PMC10612171 DOI: 10.1186/s12879-023-08517-0] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 08/06/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Although one of the main drivers of antimicrobial resistance is inappropriate antibiotic prescribing, there are limited resources to support the surveillance of antibiotic consumption in low-income countries. In this study, we aimed to assess antibiotic use and consumption among medical patients of two hospitals in different geographic regions of Sierra Leone. METHODS This is a cross-sectional study of adult (18 years or older) patients receiving medical care at two hospitals (34 Military Hospital-MH and Makeni Government Hospital-MGH) between March 2021 and October 2021. After admission to the medical or intensive care unit, patients were sequentially recruited by a nurse from each hospital. Demographic and clinical characteristics and information on the dose of antibiotics, their routes, and frequency of administration and duration were collected using a questionnaire adapted from previous studies and encrypted in EpiCollect software (Epic, Verona WI). A physician reviews and verifies each completed questionnaire. Data analysis was done using STATA version 16. RESULTS The mean age of the 468 patients evaluated in this study was 48.6 years. The majority were women (241, 51.7%) and treated at MGH (245, 52.0%). Clinical diagnosis of bacterial infection was made in only 180 (38.5%) patients. Regardless of the diagnosis, most (442, 94.9%) patients received at least one antibiotic. Of a total 813 doses of antibiotics prescribed by the two hospitals, 424 (52.2%) were administered in MH. Overall, antibiotic consumption was 66.9 defined daily doses (DDDs) per 100 bed-days, with ceftriaxone being the most commonly used antibiotic (277, 34.1%). The ACCESS and WATCH antibiotics accounted for 18.9 DDDs per 100 bed-days (28.2%) and 48.0 DDDs per 100 bed-days (71.7%), respectively. None of the patients were prescribed a RESERVE antibiotics. The antibiotic consumption was lower in MH (61.3 DDDs per 100 bed-days) than MGH (76.5 DDDs per 100 bed-days). CONCLUSION Antibiotic consumption was highest with ceftriaxone, followed by levofloxacin and metronidazole. Given the high rate of consumption of antibiotics in the WATCH category of the AWaRe classification, there is a need to initiate surveillance of antibiotic consumption and establish hospital-based antibiotic stewardship in these settings.
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Affiliation(s)
- Sulaiman Lakoh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, New England, Freetown, Sierra Leone.
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone.
- Sustainable Health Systems Sierra Leone, Freetown, Sierra Leone.
- Infectious Disease Research Network, Freetown, Sierra Leone.
| | - Christine Ellen Elleanor Williams
- College of Medicine and Allied Health Sciences, University of Sierra Leone, New England, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Stephen Sevalie
- College of Medicine and Allied Health Sciences, University of Sierra Leone, New England, Freetown, Sierra Leone
- Sustainable Health Systems Sierra Leone, Freetown, Sierra Leone
- 34 Military Hospital, Freetown, Sierra Leone
| | - James B W Russell
- College of Medicine and Allied Health Sciences, University of Sierra Leone, New England, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Sarah K Conteh
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Joseph Sam Kanu
- College of Medicine and Allied Health Sciences, University of Sierra Leone, New England, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Umu Barrie
- Infectious Disease Research Network, Freetown, Sierra Leone
| | - Gibrilla F Deen
- College of Medicine and Allied Health Sciences, University of Sierra Leone, New England, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Anna Maruta
- World Health Organization Country Office, Freetown, Sierra Leone
| | - Daniel Sesay
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Olukemi Adekanmbi
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Darlinda F Jiba
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | | | - George A Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Ohio, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, OH, Cleveland, USA
- Johns Hopkins Bloomberg School of Public Health, MD, Baltimore, USA
| | - Emmanuel Firima
- Department of Medicine, Clinical Research Unit, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- SolidarMed, Maseru, Lesotho
- Centre for Multidisciplinary Research and Innovation, Abuja, Nigeria
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14
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Yendewa GA, Kpaka RA, Sellu E, Yendewa SA, Massaquoi SPE, Cummings PE, Ghazzawi M, Barrie U, Dubé K, Lakoh S, James PB, Salata RA, Babawo LS. Perceived and Enacted HIV-Related Stigma in Eastern and Southern Sierra Leone: A Psychometric Study of an HIV Stigma Scale. medRxiv 2023:2023.07.07.23292152. [PMID: 37503110 PMCID: PMC10370221 DOI: 10.1101/2023.07.07.23292152] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Background HIV stigma continues to hinder the care of people with HIV (PWH), especially in low-resource settings. We aimed to adapt and validate a concise HIV stigma scale for perceived HIV stigma in Sierra Leone. Methods We enrolled participants in two HIV clinics in Eastern and Southern Sierra Leone in 2022. We assessed perceived stigma using a 12-item adaptation of Berger's HIV Stigma Scale and enacted stigma using select USAID indicators. We used ordinal logistic regression to identify predictors of perceived stigma and Pearson's correlation to examine associations between perceived and enacted stigma. Results 624 PWH were enrolled. The final adapted 6-item HIV stigma scale demonstrated acceptable internal consistency (Cronbach's α = 0.72) and a four-factor solution accounting for 84.8% of variance: concern about public attitude (2 items), personalized stigma (2 items), negative self-image (1 item), and disclosure concerns (1 item). The prevalence of perceived HIV stigma was 68.6%, with disclosure concerns as the most prominent contributor. Enacted HIV stigma was reported by only 6.7% of participants, with partner/spousal abandonment and workplace stigma being the most common discriminatory experiences. Employment (β = 0.525, p <0.001), residence in Eastern Sierra Leone (β = 3.215, p < 0.001), and experiencing enacted stigma (β = 0.804, p < 0.001) were significantly associated with perceived stigma. Having a family member or friend with HIV (β = -0.499, p < 0.001), and HIV disclosure (β = -0.710, p < 0.001) were protective against perceived stigma. Enacted stigma strongly correlated with partner abandonment and family isolation (r = 0.223, p < 0.001). Conclusion We found high levels of perceived HIV stigma, underscoring the need for targeted interventions to combat stigma and promote inclusivity for PWH in Sierra Leone.
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Affiliation(s)
- George A Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Edmond Sellu
- Department of Nursing, School of Community Health Sciences, Njala University, Bo Campus, Sierra Leone
| | - Sahr A Yendewa
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | | | | | | | - Umaru Barrie
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Karine Dubé
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, La Jolla, California, USA
- AntiViral Research Center, University of California San Diego, San Diego, California, USA
- Health Policy and Management, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Sulaiman Lakoh
- Ministry of Health and Sanitation, Freetown, Sierra Leone
- Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Connaught Hospital, University of Sierra Leone Teaching Hospitals Complex, Freetown, Sierra Leone
| | - Peter B James
- Faculty of Health, Southern Cross University, Lismore, Australia
| | - Robert A Salata
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Lawrence S Babawo
- Eastern Technical University, Kenema, Sierra Leone
- Department of Nursing, School of Community Health Sciences, Njala University, Bo Campus, Sierra Leone
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15
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Lakoh S, Kamara JB, Orefuwa E, Sesay D, Jiba DF, Adekanmbi O, Deen GF, Russell JBW, Bah AB, Kargbo MJ, Firima E, Yendewa GA, Denning DW. Prevalence and predictors of Aspergillus seropositivity and chronic pulmonary aspergillosis in an urban tertiary hospital in Sierra Leone: A cross-sectional study. PLoS Negl Trop Dis 2023; 17:e0011284. [PMID: 37459359 PMCID: PMC10374077 DOI: 10.1371/journal.pntd.0011284] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/27/2023] [Accepted: 05/14/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND In the World Health Organization Global Tuberculosis (TB) Report 2022, 37% of pulmonary TB patients were clinically diagnosed and thus many people were treated for TB without evidence of the disease. Probably the most common TB misdiagnosis is chronic pulmonary aspergillosis (CPA). In this study, we aimed to assess the prevalence and predictors of Aspergillus seropositivity and CPA in patients with chronic respiratory symptoms in an urban tertiary hospital in Sierra Leone. METHODOLOGY/PRINCIPAL FINDINGS We used a cross-sectional study design to recruit adults (≥18 years) from the Chest Clinic of Connaught Hospital, Freetown between November 2021 and July 2022. Aspergillus antibody was detected using LDBio Aspergillus IgM/IgG. Logistic regression was performed to assess the independent predictors of Aspergillus seropositivity and CPA. Of the 197 patients with chronic respiratory symptoms, 147 (74.6%) were male. Mean age was 47.1 ± 16.4 years. More than half (104, 52.8%) had been diagnosed with TB in the past, while 53 (26.9%) were on TB treatment at the time of recruitment. Fifty-two (26.4%) patients were HIV positive, 41 (20.8%) were seropositive for Aspergillus and 23 (11.6%) had CPA, 2 (3.8%) with current TB and 18 (17.3%) with past TB. Common radiologic abnormalities reported were localized fibrotic changes 62 (31.5%), consolidation 54 (27.4%), infiltrates 46 (23.4%), hilar adenopathy 40 (20.3%) and pleural effusion 35 (17.85) and thickening 23 (11.7%). Common symptoms were weight loss 144 (73.1%), cough 135 (68.5%), fever 117 (59.4%) and dyspnea 90 (45.7%). Current or past TB infection {aOR 3.52, 95% CI (1.46, 8.97); p = 0.005} was an independent predictor of Aspergillus seropositivity and CPA. CONCLUSIONS/SIGNIFICANCE We report a high prevalence of Aspergillus antibody seropositivity and CPA, underscoring the need to integrate the prevention and management of pulmonary fungal infections with TB services and asthma care in order to reduce unnecessary morbidity and mortality.
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Affiliation(s)
- Sulaiman Lakoh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
- Sustainable Health Systems Sierra Leone, Freetown, Sierra Leone
| | - Joseph B Kamara
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Emma Orefuwa
- Global Action For Fungal Infections, Geneva, Switzerland
| | - Daniel Sesay
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Darlinda F Jiba
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Olukemi Adekanmbi
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Gibrilla F Deen
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - James B W Russell
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Abubakarr Bailor Bah
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Maxwell Joseph Kargbo
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Emmanuel Firima
- Division of Clinical Epidemiology, University Hospital Basel, Basel, Switzerland
- Clinical Research Unit, Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Centre for Multidisciplinary Research and Innovation, Abuja, Nigeria
| | - George A Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States of America
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - David W Denning
- Global Action For Fungal Infections, Geneva, Switzerland
- Manchester Fungal Infection Group, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
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16
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Lakoh S, John-Cole V, Luke RD, Bell N, Russell JB, Mustapha A, Barrie U, Abiri OT, Coker JM, Kamara MN, Coker FJ, Adekanmbi O, Kamara IF, Fofanah BD, Jiba DF, Adeniji AO, Kenneh S, Deen GF, Moon TD, Yendewa GA, Firima E. Antibiotic use and consumption in Freetown, Sierra Leone: A baseline report of prescription stewardship in outpatient clinics of three tertiary hospitals. IJID Reg 2023; 7:43-51. [PMID: 37038468 PMCID: PMC10082370 DOI: 10.1016/j.ijregi.2023.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 02/14/2023] [Accepted: 02/15/2023] [Indexed: 02/22/2023]
Abstract
Objective As there are no country-representative data on bacterial sensitivities to guide antimicrobial stewardship (AMS) interventions, an AMS programme was established in the outpatient clinics of three tertiary hospitals in Freetown, Sierra Leone. Methods The study employed a cross-sectional design to collect antibiotic prescribing data from 370 pregnant women and lactating mothers, 314 children and 229 regular patients in the outpatient clinics of the Princess Christian Maternity Hospital (PCMH), Ola During Children's Hospital and Connaught Hospital (CH), respectively, in April 2022. All data were analysed using Stata Version 16. Results Of 913 patients, most were female (n=635, 69.5%), treated at PCMH (n=370, 40.5%) and had a bacterial infection (n=661, 72.4%). The indication for prescribing antibiotics was inappropriate in 252 (27.6%) patients. Of the 1236 prescriptions, 393 (31.8%) were made at CH. The duration of antibiotic use was not stated in 230 (18.6%) prescriptions. Overall antibiotic consumption was 55.3 defined daily doses per 1000 outpatient-days. Conclusion Gaps in antibiotic prescriptions were identified in the outpatient clinics of three national referral hospitals in Sierra Leone. In order to combat antimicrobial resistance, AMS interventions are needed to reduce the prescription of antibiotics for inappropriate indications or without specified duration.
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Affiliation(s)
- Sulaiman Lakoh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
- Sustainable Health Systems Sierra Leone, Freetown, Sierra Leone
- Infectious Disease Research Network, Freetown, Sierra Leone
| | - Valerie John-Cole
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Ronita D.C. Luke
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Nellie Bell
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - James B.W. Russell
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Ayeshatu Mustapha
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Umu Barrie
- Infectious Disease Research Network, Freetown, Sierra Leone
| | - Onome T. Abiri
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Joshua M. Coker
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Matilda N. Kamara
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Freddie J. Coker
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Olukemi Adekanmbi
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | | | | | - Darlinda F. Jiba
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Adetunji O. Adeniji
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
- Department of Obstetrics & Gynaecology, College of Health Sciences, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
| | - Sartie Kenneh
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Gibrilla F. Deen
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Troy D. Moon
- Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - George A. Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Emmanuel Firima
- Division Clinical Epidemiology, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
- SolidarMed, Maseru, Lesotho
- Centre for Multidisciplinary Research and Innovation, Abuja, Nigeria
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Amutuhaire W, Mulindwa F, Castelnuovo B, Brusselaers N, Schwarz JM, Edrisa M, Dujanga S, Salata RA, Yendewa GA. Prevalence of Cardiometabolic Disease Risk Factors in People With HIV Initiating Antiretroviral Therapy at a High-Volume HIV Clinic in Kampala, Uganda. Open Forum Infect Dis 2023; 10:ofad241. [PMID: 37351455 PMCID: PMC10284103 DOI: 10.1093/ofid/ofad241] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 04/27/2023] [Indexed: 06/24/2023] Open
Abstract
Background Cardiometabolic diseases are a leading cause of HIV-related morbidity and mortality, yet routine screening is not undertaken in high-burden countries. We aimed to assess the prevalence and risk factors of the metabolic syndrome (MetS) and its components in adult Ugandan people with HIV (PWH) initiating dolutegravir-based antiretroviral therapy (ART). Methods We conducted a cross-sectional study using baseline sociodemographic and clinical data of PWH aged ≥18 years enrolled in the Glucose metabolism changes in Ugandan HIV patients on Dolutegravir (GLUMED) study from January to October 2021. MetS was defined as having ≥3 of the following: abdominal obesity, hypertension (HTN), hyperglycemia, elevated triglycerides, and low high-density lipoprotein cholesterol. Multiple logistic regression was used to assess associations between potential risk factors and MetS and its components. Results Three hundred nine PWH were analyzed (100% ART-naïve, 59.2% female, median age 31 years, and median CD4 count 318 cells/mm3). The prevalence of MetS was 13.9%. The most common cardiometabolic condition was dyslipidemia (93.6%), followed by abdominal obesity (34.0%), hyperglycemia (18.4%), and HTN (8.1%). In adjusted analysis, MetS was associated with age >40 years (adjusted odds ratio [aOR], 3.33; 95% CI, 1.45-7.67) and CD4 count >200 cells/mm3 (aOR, 3.79; 95% CI, 1.23-11.63). HTN was associated with age >40 years (aOR, 2.96; 95% CI, 1.32-6.64), and dyslipidemia was associated with urban residence (aOR, 4.99; 95% CI, 1.35-18.53). Conclusions Cardiometabolic risk factors were common in this young Ugandan cohort of PWH initiating dolutegravir-based ART, underscoring the need for programmatic implementation of surveillance and management of comorbidities in Uganda and similar settings.
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Affiliation(s)
- Willington Amutuhaire
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Frank Mulindwa
- Makerere University Infectious Diseases Institute, Kampala, Uganda
- Global Health Institute, Antwerp University, Antwerp, Belgium
| | | | - Nele Brusselaers
- Global Health Institute, Antwerp University, Antwerp, Belgium
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Jean-Marc Schwarz
- School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Mutebi Edrisa
- Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Robert A Salata
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - George A Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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Yendewa GA, Wang GM, James PB, Massaquoi SPE, Yendewa SA, Ghazawi M, Babawo LS, Ocama P, Russell JBW, Deen GF, Sahr F, Kabba M, Tatsuoka C, Lakoh S, Salata RA. Prevalence of Chronic Hepatitis B Virus Infection in Sierra Leone, 1997-2022: A Systematic Review and Meta-Analysis. Am J Trop Med Hyg 2023:tpmd220711. [PMID: 37217165 DOI: 10.4269/ajtmh.22-0711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 02/18/2023] [Indexed: 05/24/2023] Open
Abstract
Hepatitis B virus (HBV) infection is a major public health problem in Sierra Leone, yet reliable estimates of cases are lacking. This study aimed to provide an estimate of the national prevalence of chronic HBV infection in the general population and select groups in Sierra Leone. We used the electronic databases PubMed/MEDLINE, Embase, Scopus, ScienceDirect, Web of Science, Google Scholar, and African Journals Online to systematically review articles reporting hepatitis B infection surface antigen seroprevalence estimates in Sierra Leone during 1997-2022. We estimated pooled HBV seroprevalence rates and assessed potential sources of heterogeneity. Of 546 publications screened, 22 studies with a total sample size of 107,186 people were included in the systematic review and meta-analysis. The pooled prevalence of chronic HBV infection was 13.0% (95% CI, 10.0-16.0) (I2 = 99%; Pheterogeneity < 0.01). During the study period, the HBV prevalence rates were as follows: 17.9% (95% CI, 6.7-39.8) before 2015, 13.3% (95% CI, 10.4-16.9) during 2015-2019, and 10.7% (95% CI, 7.5-14.9) during 2020-2022. The use of the 2020-2022 HBV prevalence estimates corresponded to 870,000 cases of chronic HBV infection (uncertainty interval, 610,000-1,213,000), or approximately one in nine people. The highest HBV seroprevalence estimates were among adolescents aged 10-17 years (17.0%; 95% CI, 8.8-30.5), Ebola survivors (36.8%; 95% CI, 26.2-48.8), people living with HIV (15.9%; 95% CI, 10.6-23.0), and those in the Northern Province (19.0%; 95% CI, 6.4-44.7) and Southern Province (19.7%; 95% CI, 10.9-32.8) regions. These findings may help inform national HBV program implementation in Sierra Leone.
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Affiliation(s)
- George A Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
- Division of Infectious Diseases and HIV Medicine, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Gi-Ming Wang
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Peter B James
- Faculty of Health, Southern Cross University, Lismore, Australia
| | | | - Sahr A Yendewa
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | | | - Lawrence S Babawo
- Department of Nursing, School of Community Health Sciences, Njala University, Bo, Sierra Leone
| | - Ponsiano Ocama
- Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - James B W Russell
- Ministry of Health and Sanitation, Freetown, Sierra Leone
- Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Connaught Hospital, University of Sierra Leone Teaching Hospitals Complex, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Gibrilla F Deen
- Ministry of Health and Sanitation, Freetown, Sierra Leone
- Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Connaught Hospital, University of Sierra Leone Teaching Hospitals Complex, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Foday Sahr
- Ministry of Health and Sanitation, Freetown, Sierra Leone
- Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Mustapha Kabba
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Curtis Tatsuoka
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
- Centers for AIDS Research, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Sulaiman Lakoh
- Ministry of Health and Sanitation, Freetown, Sierra Leone
- Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Connaught Hospital, University of Sierra Leone Teaching Hospitals Complex, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Robert A Salata
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
- Division of Infectious Diseases and HIV Medicine, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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James PB, Gyasi RM, Kasilo OMJ, Wardle J, Bah AJ, Yendewa GA, Mwaka AD. The use of traditional medicine practitioner services for childhood illnesses among childbearing women: a multilevel analysis of demographic and health surveys in 32 sub-Saharan African countries. BMC Complement Med Ther 2023; 23:137. [PMID: 37120536 PMCID: PMC10148432 DOI: 10.1186/s12906-023-03972-3] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/25/2023] [Indexed: 05/01/2023] Open
Abstract
BACKGROUND Insights into the use of traditional medicine practitioners (TMP)-for common childhood diseases such as diarrhea and respiratory infections are important to understand the role of Traditional Medicine (TM) in reducing the increasing childhood morbidity and mortality in sub-Saharan Africa (SSA). However, a comprehensive picture of TMP utilisation and its associated factors for childhood illness in SSA is lacking. This study aimed to estimate the prevalence of the use of traditional medicine practitioner services to treat childhood illnesses among women with children under five years old and to identify individual and community-level factors associated with TMP use in SSA. METHODS The analysis used Demographic and Health Surveys (DHS) dataset collected between 2010 and 2021 among 353,463 under-fives children from 32 SSA countries. Our outcome variable was the use of TMP for childhood illness, defined as having diarrhoea or fever/cough or both. Using STATA v14, we employed the random effect meta-analysis to estimate the pooled prevalence of TMP use for childhood illness and a two-level multivariable multilevel modelling to determine the individual and community-level factors associated with consultation of a TMP. RESULTS Approximately [2.80% (95%CI: 1.88-3.90)] women who sought healthcare for childhood illnesses utilised the service of a TMP with the highest occurring in Cote d'Ivoire [16.3% (95%CI: 13.87-19.06)] and Guinea (13.80% (95%CI: 10.74-17.57)] but the lowest in Sierra Leone [0.10%(95%CI:0.01-1.61)]. Specifically, approximately [1.95% (95%CI: 1.33-2.68)] and [1.09% (95%CI:0.67-1.60)] of women sought the service of a TMP for childhood diarrhea and fever/cough, respectively. Women with no formal education [AOR = 1.62;95%CI:1.23-2.12], no media access [AOR = 1.19;95%CI:1.02-1.39), who lived in a male-headed household [AOR = 1.64;95%CI:1.27-2.11], without health insurance [AOR = 2.37;95%CI: 1.53-3.66], who considered it a problem getting permission to visit a health facility [AOR = 1.23;95%CI:1.03-1.47] and who perceived the size of their children at birth to be above average[AOR = 1.20;95%CI:1.03-1.41] had higher odds of using TMP for childhood illnesses. CONCLUSIONS Although the prevalence of TMP for childhood illnesses appeared low, our findings highlight that TMPs continue to play a critical role in managing childhood illnesses in SSA. It is essential that policymakers and service providers should incorporate the potential role of TMPs in the design, review and implementation of child health policies in SSA. Also, the interventions for curtailing childhood illnesses should be focused on the characteristics of women who use TMPs for childhood diseases identified in our study.
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Affiliation(s)
- Peter Bai James
- National Centre for Naturopathic Medicine, Faculty of Health, Southern Cross University, Lismore, NSW, 2480, Australia.
- Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.
| | - Razak M Gyasi
- National Centre for Naturopathic Medicine, Faculty of Health, Southern Cross University, Lismore, NSW, 2480, Australia
- African Population and Health Research Center (APHRC), Nairobi, Kenya
| | - Ossy Muganga Julius Kasilo
- WHO Regional Office for Africa, Universal Health Coverage Life Course Cluster, Brazzaville, Republic of Congo
| | - Jon Wardle
- National Centre for Naturopathic Medicine, Faculty of Health, Southern Cross University, Lismore, NSW, 2480, Australia
| | - Abdulai Jawo Bah
- Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Institute for Global Health and Development, Queen Margaret University Edinburg, Musselburgh, Scotland, UK
| | - George A Yendewa
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, 44106, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
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Yendewa GA, Sellu EJ, Kpaka RA, James PB, Yendewa SA, Cummings PE, Babawo LM, Massaquoi SP, Ghazawi M, Ocama P, Lakoh S, Babawo LS, Salata RA. Measuring Stigma Associated with Hepatitis B Virus Infection in Sierra Leone: Validation of an Abridged Berger HIV Stigma Scale. medRxiv 2023:2023.02.17.23286086. [PMID: 36824916 PMCID: PMC9949200 DOI: 10.1101/2023.02.17.23286086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
Stigma associated with hepatitis B virus (HBV) is common in endemic countries; however; instruments are lacking to accurately measure HBV-related stigma. We therefore aimed to develop and validate a concise instrument for measuring perceived HBV-related stigma in Sierra Leone. We enrolled 220 people living with HBV (PWHB) aged ≥ 18 years from August to November 2022. The initial Likert-scale instrument entailed 12 items adapted from Berger's HIV Stigma Scale. We included 4 additional items adapted from the USAID indicators for enacted stigma. The proposed scale's psychometric properties were assessed. After item reduction, the final HBV Stigma Scale consisted of 10 items and had good internal consistency (overall Cronbach's α = 0.74), discriminant and construct validity. Exploratory factor analysis produced a 3-dimensional structure accounting for 59.3% of variance: personalized stigma driven by public attitudes (6 items), negative self-image (2 items), and disclosure concerns (2 items). Overall, 72.8% of respondents reported perceived HBV stigma (mean score 29.11 ± 4.14) and a similar a proportion (73.6%) reported at least one instance of enacted stigma. In assessing criterion-related validity, perceived HBV-related stigma correlated strongly with enacted stigma (r = 0.556) and inversely with having family/friends with HBV (r = -0.059). The 10-item HBV Stigma Scale demonstrated good internal consistency and validity and is suitable for screening for HBV-related stigma in Sierra Leone. The psychometric properties of the scale can be optimized with item additions/modifications and confirmatory factor analysis. The scale may help in combating stigma as a barrier to achieving HBV global elimination goals.
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21
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Ghazzawi M, Yendewa SA, James PB, Massaquoi SP, Babawo LS, Sahr F, Deen GF, Kabba M, Ocama P, Lakoh S, Salata RA, Yendewa GA. Assessment of Knowledge, Stigmatizing Attitudes and Health-Seeking Behaviors Regarding Hepatitis B Virus Infection in a Pharmacy and Community Setting in Sierra Leone: A Cross-Sectional Study. Healthcare (Basel) 2023; 11:healthcare11020177. [PMID: 36673546 PMCID: PMC9859485 DOI: 10.3390/healthcare11020177] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/15/2022] [Accepted: 01/02/2023] [Indexed: 01/11/2023] Open
Abstract
Hepatitis B virus (HBV) is a major global health challenge. Emerging evidence suggests that poor knowledge and stigma are impacting HBV control efforts in sub-Saharan Africa (SSA), but their role is not well understood. We conducted a cross-sectional study of adults aged ≥18 years in a community and pharmacy setting in Freetown, Sierra Leone. A structured questionnaire was used to assess knowledge, stigmatizing attitudes and health-seeking behaviors regarding HBV. Logistic regression was used to identify predictors of HBV knowledge and related stigma. A total of 306 adult participants were enrolled (50.7% male, 7.5% HBV positive and 11.7% vaccinated). Overall, 52.2% had good HBV knowledge and 49.3% expressed a stigmatizing attitude towards people with HBV. Notwithstanding, 72.2% stated they would receive the HBV vaccine if offered, 80.4% would take anti-HBV medication and 78.8% would be willing to attend clinic regularly. Good HBV knowledge was associated with HBV positive status (aOR 4.41; p = 0.029) and being vaccinated against HBV (aOR 3.30; p = 0.034). HBV-related stigma was associated with secondary or higher level of education (aOR 2.36; p < 0.001), good HBV knowledge (aOR 2.05; p = 0.006) and pharmacy setting (aOR 1.74, p = 0.037). These findings suggest that education and stigma reduction may benefit HBV elimination efforts in SSA.
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Affiliation(s)
| | | | - Peter B. James
- Faculty of Health, Southern Cross University, Lismore, NSW 2480, Australia
| | | | - Lawrence S. Babawo
- Department of Nursing, School of Community Health Sciences, Njala University, Bo Campus, Freetown, Sierra Leone
| | - Foday Sahr
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Gibrilla F. Deen
- Ministry of Health and Sanitation, Freetown, Sierra Leone
- Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Mustapha Kabba
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Ponsiano Ocama
- Department of Medicine, College of Health Sciences, Makerere University, Kampala P.O. Box 7062, Uganda
| | - Sulaiman Lakoh
- Ministry of Health and Sanitation, Freetown, Sierra Leone
- Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Robert A. Salata
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
| | - George A. Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
- Correspondence: ; Tel.: +1-2168441988
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Lakoh S, Yi L, Russell JB, Zhang J, Sevalie S, Zhao Y, Kanu JS, Liu P, Conteh SK, Williams CEE, Barrie U, Sheku MG, Jalloh MB, Adekanmbi O, Jiba DF, Kamara MN, Deen GF, Okeibunor JC, Yendewa GA, Guo X, Firima E. The burden of surgical site infections and related antibiotic resistance in two geographic regions of Sierra Leone: a prospective study. Ther Adv Infect Dis 2022; 9:20499361221135128. [PMID: 36518726 PMCID: PMC9742716 DOI: 10.1177/20499361221135128] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 10/09/2022] [Indexed: 12/13/2022] Open
Abstract
Despite the prolongation of hospitalization, increase in morbidity, mortality and cost of care associated with both surgical site infections (SSIs) and antibiotic resistance, there are limited data on SSIs and antibiotic resistance to guide prevention strategies in Sierra Leone. This study assessed the burden of SSIs and related antibiotic resistance in the 34 Military Hospital (MH) and Makeni Government Hospital (MGH) located in two geographic regions of Sierra Leone using a prospective study design to collect data from adults aged 18 years or older. Of the 417 patients, 233 (55.9%) were enrolled in MGH. Most were women 294 (70.5%). The incidence rate of SSI was 5.5 per 1000 patient-days, and the cumulative incidence of SSI was 8.2%. Common bacteria isolated in MH were Escherichia coli (6,33.3%) and Pseudomonas aeruginosa (3,16.7%) and in MGH were P. aeruginosa (3,42.9%) and Proteus mirabilis (2,28.9%). Of the gram-negative bacteria, 40% were Extended-spectrum beta-lactamase-producing Enterobacteriaceae, 33% were Carbapenem-resistant P. aeruginosa and 10% were carbapenem-resistant Enterobacteriaceae. Although the incidence of SSIs in our study is lower than previously reported, the rate of antibiotic resistance reported in this study is high. Urgent action is needed to invest in the microbiology infrastructure to support SSI surveillance and prevention strategies.
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Affiliation(s)
| | | | - James B.W. Russell
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone,Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Juling Zhang
- Department of Clinical Laboratory, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Stephen Sevalie
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone,Sustainable Health Systems Sierra Leone,34 Military Hospital, Freetown, Sierra Leone
| | - Yongkun Zhao
- Tropical Infectious Disease Prevention and Control Center, Freetown, Sierra Leone
| | - Joseph Sam Kanu
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone,Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Peng Liu
- Department of Emergency Medicine, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Sarah K. Conteh
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Christine Ellen Elleanor Williams
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone,Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Umu Barrie
- Infectious Disease Research Network, Freetown, Sierra Leone
| | - Mohamed Gbessay Sheku
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Mohamed Boie Jalloh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone,34 Military Hospital, Freetown, Sierra Leone
| | - Olukemi Adekanmbi
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria,Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Darlinda F. Jiba
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Matilda N. Kamara
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Gibrilla F. Deen
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone,Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | | | - George A. Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA,Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Xuejun Guo
- Tropical Infectious Disease Prevention and Control Center, Freetown, Sierra Leone
| | - Emmanuel Firima
- Clinical Research Unit, Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland,University of Basel, Basel, Switzerland,SolidarMed, Old Europa, Lesotho,Centre for Multidisciplinary Research and Innovation, Abuja, Nigeria
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23
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Yendewa GA, Lakoh S, Jiba DF, Yendewa SA, Barrie U, Deen GF, Samai M, Jacobson JM, Sahr F, Salata RA. Hepatitis B Virus and Tuberculosis Are Associated with Increased Noncommunicable Disease Risk among Treatment-Naïve People with HIV: Opportunities for Prevention, Early Detection and Management of Comorbidities in Sierra Leone. J Clin Med 2022; 11:jcm11123466. [PMID: 35743539 PMCID: PMC9225550 DOI: 10.3390/jcm11123466] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/18/2022] [Accepted: 06/15/2022] [Indexed: 02/01/2023] Open
Abstract
Noncommunicable diseases (NCDs) are a growing public health concern in low- and middle-income countries and disproportionately affect people living with HIV (PWH). Hepatitis B virus (HBV) and tuberculosis (TB) coinfection are presumed risk factors in endemic settings; however, supporting evidence is conflicting. We analyzed baseline data of newly diagnosed PWH prospectively enrolled in the Sierra Leone HIV Cohort Study in Freetown, Sierra Leone, from March to September 2021. Logistic regression was used to identify associations between NCDs, HBV and TB. A total of 275 PWH aged ≥18 years were studied (55% female, median age 33 years, median CD4 307 cells/mm3, 15.3% HIV/HBV, 8.7% HIV/TB). NCDs were bimodally distributed, with 1 in 4 PWH clustered around liver disease (fibrosis/cirrhosis), diabetes/prediabetes and obesity/preobesity, while 1 in 8 had renal impairment or hypertension (HTN). Overall, 41.5% had ≥1 NCD, while 17.5% were multimorbid (≥2 NCDs). After adjusting for age, sex, sociodemographic factors and CD4 count, liver fibrosis/cirrhosis was strongly associated with HBV (aOR 8.80, 95% CI [2.46−31.45]; p < 0.001) and diabetes/prediabetes (aOR 9.89, 95% CI [1.14−85.67]; p < 0.037). TB independently predicted diabetes/prediabetes (aOR 7.34, 95% CI [1.87−28.74]; p < 0.004), while renal impairment was associated with proteinuria (aOR 9.34, 95% CI [2.01−43.78]; p < 0.004) and HTN (aOR 6.00, 95% CI [1.10−35.39]; p < 0.049). Our findings warrant the implementation of NCD-aware HIV programs for the prevention, early detection and management of comorbidities.
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Affiliation(s)
- George A. Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA; (J.M.J.); (R.A.S.)
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
- Correspondence:
| | - Sulaiman Lakoh
- Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone; (S.L.); (G.F.D.); (M.S.); (F.S.)
- Ministry of Health and Sanitation, Freetown, Sierra Leone; (D.F.J.); (S.A.Y.)
| | - Darlinda F. Jiba
- Ministry of Health and Sanitation, Freetown, Sierra Leone; (D.F.J.); (S.A.Y.)
| | - Sahr A. Yendewa
- Ministry of Health and Sanitation, Freetown, Sierra Leone; (D.F.J.); (S.A.Y.)
| | - Umu Barrie
- Infectious Disease Research Network, Freetown, Sierra Leone;
| | - Gibrilla F. Deen
- Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone; (S.L.); (G.F.D.); (M.S.); (F.S.)
- Ministry of Health and Sanitation, Freetown, Sierra Leone; (D.F.J.); (S.A.Y.)
| | - Mohamed Samai
- Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone; (S.L.); (G.F.D.); (M.S.); (F.S.)
- Ministry of Health and Sanitation, Freetown, Sierra Leone; (D.F.J.); (S.A.Y.)
| | - Jeffrey M. Jacobson
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA; (J.M.J.); (R.A.S.)
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
| | - Foday Sahr
- Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone; (S.L.); (G.F.D.); (M.S.); (F.S.)
- Ministry of Health and Sanitation, Freetown, Sierra Leone; (D.F.J.); (S.A.Y.)
| | - Robert A. Salata
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA; (J.M.J.); (R.A.S.)
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
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Lakoh S, Yendewa GA. Multidrug-resistant tuberculosis in Sierra Leone. The Lancet Global Health 2022; 10:e459-e460. [PMID: 35303445 PMCID: PMC8923690 DOI: 10.1016/s2214-109x(22)00045-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 01/26/2022] [Indexed: 11/24/2022] Open
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Ghazzawi M, James PB, Massaquoi SP, Yendewa SA, Salata RA, Yendewa GA. Factors Associated with HBsAg Seropositivity among Pregnant Women Receiving Antenatal Care at 10 Community Health Centers in Freetown, Sierra Leone: A Cross-Sectional Study. Pathogens 2022; 11:pathogens11020243. [PMID: 35215186 PMCID: PMC8874792 DOI: 10.3390/pathogens11020243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/07/2022] [Accepted: 02/10/2022] [Indexed: 11/20/2022] Open
Abstract
Hepatitis B (HBV) is a major public health threat in Sierra Leone. Pregnant women are disproportionately impacted, yet little is known about the epidemiology of HBV in this group. We conducted a cross-sectional study of pregnant women aged ≥16 years receiving antenatal care across 10 community health centers in Freetown from July to September 2021 to assess the prevalence and associated factors of HBsAg seropositivity. Logistic regression was used to identify the predictors of HBsAg seropositivity. In total, 394 pregnant women were screened. The mean age was 24.4 ± 4.9 years, 78.2% were married, and 47.2% were in the second trimester. Only 1% had received the HBV vaccine. The prevalence of HBsAg was 7.9%, while HIV was 5.8% and HIV/HBV co-infection was 0.3%. Regarding high-risk practices, 76.6% reported female genital circumcision, 41.9% ear piercing, 29.0% endorsed multiple sexual partners, and 23.6% reported sexually transmitted infections. In the logistic regression analysis, having a husband/partner with HBV (adjusted odds ratio (aOR): 6.54; 95% CI: [1.72–24.86]; p = 0.006) and residing in Central Freetown (aOR: 4.00; 95% CI: [1.46–11.00]; p = 0.007) were independently associated with HBsAg seropositivity. Our findings support the scaling up of HBV services to target pregnant women and their partners for screening and vaccination to help reduce mother-to-child transmission rates in Sierra Leone.
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Affiliation(s)
| | - Peter B. James
- Faculty of Health, Southern Cross University, Lismore, NSW 2480, Australia;
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Samuel P. Massaquoi
- Ministry of Health and Sanitation, Freetown, Sierra Leone; (S.P.M.); (S.A.Y.)
| | - Sahr A. Yendewa
- Ministry of Health and Sanitation, Freetown, Sierra Leone; (S.P.M.); (S.A.Y.)
| | - Robert A. Salata
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA;
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
| | - George A. Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA;
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
- Correspondence:
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26
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Yendewa GA, Perez JA, Schlick K, Tribout H, McComsey GA. Clinical Features and Outcomes of Coronavirus Disease 2019 Among People With Human Immunodeficiency Virus in the United States: A Multicenter Study From a Large Global Health Research Network (TriNetX). Open Forum Infect Dis 2021; 8:ofab272. [PMID: 34435074 PMCID: PMC8244788 DOI: 10.1093/ofid/ofab272] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 05/21/2021] [Indexed: 12/14/2022] Open
Abstract
Background Human immunodeficiency virus infection (HIV) is a presumed risk factor for severe coronavirus disease 2019 (COVID-19), yet little is known about COVID-19 outcomes in people with HIV (PWH). Methods We used the TriNetX database to compare COVID-19 outcomes of PWH and HIV-negative controls aged ≥18 years who sought care in 44 healthcare centers in the United States from January 1 to December 1, 2020. Outcomes of interest were rates of hospitalization (composite of inpatient non-intensive care [ICU] and ICU admissions), mechanical ventilation, severe disease (ICU admission or death), and 30-day mortality. Results Of 297 194 confirmed COVID-19 cases, 1638 (0.6%) were HIV-infected, with >83% on antiretroviral therapy (ART) and 48% virally suppressed. Overall, PWH were more commonly younger, male, African American or Hispanic, had more comorbidities, were more symptomatic, and had elevated procalcitonin and interleukin 6. Mortality at 30 days was comparable between the 2 groups (2.9% vs 2.3%, P = .123); however, PWH had higher rates hospitalization (16.5% vs 7.6%, P < .001), ICU admissions (4.2% vs 2.3%, P < .001), and mechanical ventilation (2.4% vs 1.6%, P < .005). Among PWH, hospitalization was independently associated with male gender, being African American, integrase inhibitor use, and low CD4 count; whereas severe disease was predicted by older age (adjusted odds ratio [aOR], 8.33; 95% confidence interval [CI], 1.06-50.00; P = .044) and CD4 <200 cells/mm3 (aOR, 8.33; 95% CI, 1.06-50.00; P = .044). Conclusions People with HIV had higher rates of poor COVID-19 outcomes but were not more at risk of death than their non-HIV-infected counterparts. Older age and low CD4 count predicted adverse outcomes.
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Affiliation(s)
- George A Yendewa
- Department of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.,Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Jaime Abraham Perez
- Center for Clinical Research, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Kayla Schlick
- Center for Clinical Research, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Heather Tribout
- Center for Clinical Research, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Grace A McComsey
- Center for Clinical Research, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.,Department of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.,Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio, USA.,Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
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27
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Lakoh S, Firima E, Jiba DF, Kamara MN, Gashau W, Deen GF, Adekanmbi O, Yendewa GA. Prevalence of sero-markers and non-invasive assessment of liver cirrhosis in patients with Hepatitis B virus infection in Freetown, Sierra Leone: a cross-sectional study. BMC Gastroenterol 2021; 21:320. [PMID: 34372775 PMCID: PMC8353767 DOI: 10.1186/s12876-021-01892-5] [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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/27/2021] [Indexed: 12/05/2022] Open
Abstract
Background Hepatitis B virus (HBV) is a major global health problem. Although sub-Saharan Africa has a high proportion of the global burden of HBV, the epidemiology and clinical features of HBV in this region are poorly characterized, and access to diagnostic and treatment services remain limited. Methods We conducted a retrospective study of HBV-infected children and adults of all age groups who were evaluated at public and private health facilities in Freetown, Sierra Leone between January 2017 and January 2019. We assessed their clinical presentation, HBV sero-markers, stages of liver disease, prevalence of cirrhosis by non-invasive tools, and the proportion of treatment eligible patients using the criteria recommended by the World Health Organization’s 2015 treatment guidelines for HBV. Logistic regression was used to identify predictors of liver cirrhosis. Results 163 HBV patients included in the study, with mean age 32.6 years and 65.0% (106) being males. Most (84.0%) were asymptomatic at presentation. The majority (69.9%) were classified as having HBeAg-negative chronic infection (or inactive HBsAg carrier phase), 24.5% were in the HBeAg-negative immune active phase, 3.1% had HBeAg positive hepatitis, and 2.5% were HBsAg negative. The median Aspartate aminotransferase to Platelet Ratio (APRI) and Fibrosis-4 (FIB-4) scores were 0.37 and 0.80, respectively. The prevalence of cirrhosis was 7.6% and 6.2%, estimated by the APRI and FIB-4 scores, respectively. About 20.0% of patients were eligible for treatment with antiviral agents. Based on APRI scores, the presence of any symptom [adjusted odds ratio (aOR) 20.0, 95% confidence interval (CI) (4.1–85.9); p < 0.001], elevated direct bilirubin [aOR 12.1, 95% CI (1.9–63.0); p = 0.003], and elevated total bilirubin [aOR 16.1, 95% CI (3.2–80.8); p = 0.001] were independent predictors of cirrhosis. Conclusion Although most patients with HBV infection were asymptomatic, the prevalence of liver cirrhosis and proportion of patients requiring antiviral treatment were substantial. This small study from a hyperendemic setting in Sierra Leone suggests that routine population-based screening may increase early detection and linkage of HBV patients to care before development of complications. Larger studies are needed to confirm our findings.
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Affiliation(s)
- Sulaiman Lakoh
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Switzerland. .,Department of Medicine, University of Sierra Leone Teaching Hospitals Complex, Freetown, Switzerland.
| | - Emmanuel Firima
- Clinical Research Unit, Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Darlinda F Jiba
- Department of Medicine, University of Sierra Leone Teaching Hospitals Complex, Freetown, Switzerland
| | - Matilda N Kamara
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Switzerland
| | - Wadzani Gashau
- Department of Medicine, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
| | - Gibrilla F Deen
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Switzerland.,Department of Medicine, University of Sierra Leone Teaching Hospitals Complex, Freetown, Switzerland
| | - Olukemi Adekanmbi
- Department of Medicine, University of Ibadan, Ibadan, Nigeria.,Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - George A Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, MD, USA.,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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28
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Lakoh S, Jiba DF, Vandy AO, Poveda E, Adekanmbi O, Murray MJS, Deen GF, Sahr F, Hoffmann CJ, Jacobson JM, Salata RA, Yendewa GA. Assessing eligibility for differentiated service delivery, HIV services utilization and virologic outcomes of adult HIV-infected patients in Sierra Leone: a pre-implementation analysis. Glob Health Action 2021; 14:1947566. [PMID: 34404330 PMCID: PMC8381912 DOI: 10.1080/16549716.2021.1947566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Indexed: 11/05/2022] Open
Abstract
Background There are limited data to help guide implementation of differentiated HIV service delivery (DSD) in resource-limited settings in sub-Saharan Africa. Objectives This pre-implementation study sought to assess the proportion of patients eligible for DSD and HIV services utilization, as well as risk factor analysis of virologic failure in Sierra Leone. Methods We conducted a retrospective study of adult HIV-infected patients aged 18 years and older receiving care at the largest HIV treatment center in Sierra Leone 2019–2020. Multiple logistic regression was used to identify predictors of virologic failure. Results Of 586 unique patients reviewed, 210 (35.8%) qualified as ‘stable’ for antiretroviral therapy (ART) delivery. There was high utilization of certain HIV service programs (e.g. HIV status disclosure to partners (83%) and treatment ‘buddy’ program participation (62.8%)), while other service programs (e.g. partner testing and community HIV support group participation) had low utilization (<50%). Of 429 patients with available viral load, 277 (64.6%) were virologically suppressed. In the multivariate logistic regression analysis of risk factors of virologic failure, CD4 < 350 cells/mm3 (p = 0.009), atazanavir-based ART (p = 0.032), once monthly versus once two- or three-monthly ART dispensing (p = 0.028), history of ART switching (p = 0.02), poor adherence (p = 0.001) and not having received adherence support (p < 0.001) were independent predictors of virologic failure. Conclusion Approximately one in three HIV-infected patients on ART were eligible for DSD. We identified gaps in HIV care (i.e. low partner testing, treatment ‘buddy’, program participation and a substantially high rate of virologic failure) that need to be addressed in preparation for full implementation of DSD in Sierra Leone.
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Affiliation(s)
- Sulaiman Lakoh
- Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.,Ministry of Health and Sanitation, Freetown, Sierra Leone
| | | | - Alren O Vandy
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Eva Poveda
- Group of Virology and Pathogenesis, Galicia Sur Health Research Institute (IIS Galicia Sur)-Complexo Hospitalario Universitario De Vigo, SERGAS-UVigo, Spain
| | - Olukemi Adekanmbi
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria.,Department of Medicine, University College Hospital, Ibadan, Nigeria
| | | | - Gibrilla F Deen
- Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.,Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Foday Sahr
- Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.,Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Christopher J Hoffmann
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.,Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Jeffrey M Jacobson
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.,Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Robert A Salata
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.,Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - George A Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.,Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.,Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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29
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Yendewa GA, Sahr F, Lakoh S, Ruiz M, Patiño L, Tabernilla A, Deen GF, Sesay M, Salata RA, Poveda E. Prevalence of drug resistance mutations among ART-naive and -experienced HIV-infected patients in Sierra Leone. J Antimicrob Chemother 2020; 74:2024-2029. [PMID: 30989237 PMCID: PMC6587425 DOI: 10.1093/jac/dkz134] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 02/27/2019] [Accepted: 03/06/2019] [Indexed: 11/15/2022] Open
Abstract
Objectives The aim of this study was to assess the prevalence of HIV drug resistance (HIVDR) in HIV-infected ART-naive and -experienced patients in Sierra Leone. Patients and methods We conducted a cross-sectional study of HIV-positive adults aged ≥18 years at Connaught Hospital in Freetown, Sierra Leone in November 2017. Sequencing was performed in the reverse transcriptase, protease and integrase regions, and interpreted using the Stanford HIVDR database and WHO 2009 mutation list. Results Two hundred and fifteen HIV-infected patients were included (64 ART naive and 151 ART experienced). The majority (66%) were female, the median age was 36 years and the median ART exposure was 48 months. The majority (83%) were infected with HIV-1 subtype CRF02_AG. In the ART-naive group, the pretreatment drug resistance (PDR) prevalence was 36.7% (14.2% to NRTIs and 22.4% to NNRTIs). The most prevalent PDR mutations were K103N (14.3%), M184V (8.2%) and Y181C (4.1%). In the ART-experienced group, 64.4% harboured resistance-associated mutations (RAMs) and the overall prevalence of RAMs to NRTIs and NNRTIs was 85.2% (52/61) and 96.7% (59/61), respectively. The most prevalent RAMs were K103N (40.7%), M184V (28.8%), D67N (15.3%) and T215I/F/Y (15.3%). Based on the genotypic susceptibility score estimates, 22.4% of ART-naive patients and 56% of ART-experienced patients were not susceptible to first-line ART used in Sierra Leone. Conclusions A high prevalence of circulating NRTI- and NNRTI-resistant variants was observed in ART-naive and -experienced HIV-1-infected patients in Sierra Leone. This necessitates the implementation of HIVDR surveillance programmes to inform national ART guidelines for the treatment and monitoring of HIV-infected patients in Sierra Leone.
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Affiliation(s)
- George A Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Foday Sahr
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Sulaiman Lakoh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Marta Ruiz
- Group of Virology and Pathogenesis, Galicia Sur Health Research Institute (IIS Galicia Sur)-Complexo Hospitalario Universitario de Vigo, SERGAS-UVigo, Vigo, Spain
| | - Lucia Patiño
- Group of Virology and Pathogenesis, Galicia Sur Health Research Institute (IIS Galicia Sur)-Complexo Hospitalario Universitario de Vigo, SERGAS-UVigo, Vigo, Spain
| | - Andrés Tabernilla
- Group of Virology and Pathogenesis, Galicia Sur Health Research Institute (IIS Galicia Sur)-Complexo Hospitalario Universitario de Vigo, SERGAS-UVigo, Vigo, Spain
| | - Gibrilla F Deen
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Momodu Sesay
- National HIV/AIDS Secretariat, Freetown, Sierra Leone
| | - Robert A Salata
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Eva Poveda
- Group of Virology and Pathogenesis, Galicia Sur Health Research Institute (IIS Galicia Sur)-Complexo Hospitalario Universitario de Vigo, SERGAS-UVigo, Vigo, Spain
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Lakoh S, Jiba DF, Adekanmbi O, Poveda E, Sahr F, Deen GF, Foray LM, Gashau W, Hoffmann CJ, Salata RA, Yendewa GA. Diagnosis and treatment outcomes of adult tuberculosis in an urban setting with high HIV prevalence in Sierra Leone: A retrospective study. Int J Infect Dis 2020; 96:112-118. [PMID: 32339724 DOI: 10.1016/j.ijid.2020.04.038] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 04/15/2020] [Accepted: 04/17/2020] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To assess the diagnosis, treatment outcomes, and predictors of mortality in adult tuberculosis (TB) patients in an urban setting with a high HIV prevalence. METHODS A retrospective study was conducted of adult TB patients aged ≥15 years who were treated at Connaught Hospital in Freetown, Sierra Leone from January through December 2017. Multivariate logistic regression was used to identify predictors of mortality. RESULTS Of 1127 TB cases notified in 2017, 1105 (98%) were tested for HIV, yielding a TB/HIV co-infection rate of 32.0%. Only HIV-tested cases (n=1105) were included in the final analysis. The majority were male (69.3%), aged 25-34 years (29.2%), and had pulmonary TB (96.3%). Treatment outcomes were as follows: 29.0% cured, 29.0% completed, 0.5% treatment failure, 24.2% lost to follow-up, 12.8% transferred/not evaluated, and 4.5% died. The majority of deaths (80.0%, 40/50) occurred within 2 months of TB treatment initiation. Age 65 years or older (adjusted odds ratio 3.48, 95% confidence interval 1.15-10.56; p=0.027) and HIV-positive status (adjusted odds ratio 3.50, 95% confidence interval 1.72-7.12; p=0.001) were independent predictors of mortality. CONCLUSIONS Suboptimal TB treatment outcomes were observed in Sierra Leone in 2017. More local and international action is warranted to help achieve the 2035 global TB elimination targets.
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Affiliation(s)
- Sulaiman Lakoh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone; Department of Medicine, University of Sierra Leone Teaching Hospitals Complex, Freetown, Sierra Leone.
| | - Darlinda F Jiba
- Department of Medicine, University of Sierra Leone Teaching Hospitals Complex, Freetown, Sierra Leone
| | - Olukemi Adekanmbi
- College of Medicine, University of Ibadan, Ibadan, Nigeria; Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Eva Poveda
- Group of Virology and Pathogenesis, Galicia Sur Health Research Institute, Complexo Hospitalario Universitario de Vigo, SERGAS-Vigo, Vigo, Spain
| | - Foday Sahr
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Gibrilla F Deen
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone; Department of Medicine, University of Sierra Leone Teaching Hospitals Complex, Freetown, Sierra Leone
| | - Lynda M Foray
- National TB and Leprosy Control Programme, Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Wadzani Gashau
- College of Medical Sciences, University of Maiduguri, Maiduguri, Nigeria
| | | | - Robert A Salata
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA; Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - George A Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA; Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Yendewa GA, Sahr F, Aguilera A, Lakoh S, Sesay M, Deen GF, Patiño L, Poveda E, Salata RA. Seroprevalence of Hepatitis B, Hepatitis C, and Human T-Cell Lymphotropic Virus Infections in HIV-Infected Patients in Sierra Leone. Am J Trop Med Hyg 2020; 100:1521-1524. [PMID: 30938283 DOI: 10.4269/ajtmh.18-1001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
HIV coinfection with hepatitis B virus (HBV), hepatitis C virus (HCV), and human T-cell lymphotropic viruses 1 and 2 (HTLV-1 and HTLV-2) is common because of shared transmission routes. There is no published data on the prevalence of these infections in people living with HIV in Sierra Leone. We conducted a cross-sectional study of 211 HIV-positive patients aged ≥ 18 years in Freetown, Sierra Leone, in November 2017. Plasma samples were analyzed using the chemiluminescent microparticle immunoassay (Architect System, Abbott ARCHITECT Analyzer, Abbott Park, IL. The majority were female (63.5%), with median age 36 years (interquartile range [IQR]: 32-44) and median CD4 count of 396 cells/µL (IQR: 214-534). Sixty patients (28.4%) were newly diagnosed and antiretroviral therapy (ART) naive; 151 patients (71.6%) were ART experienced. The prevalence of the hepatitis B surface antigen (HBsAg), total anti-hepatitis B core antibody, and anti-HCV was 21.7%, 82.9%, and 4.3%, respectively. No cases of HTLV-1 or HTLV-2 were detected. Male gender (P = 0.004) and CD4 < 350 cells/µL (P = 0.017) were associated with the HBsAg positive status.
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Affiliation(s)
- George A Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio.,Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio.,Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Foday Sahr
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Antonio Aguilera
- Department of Microbiology, Complexo Hospitalario Universitario Santiago and University of Santiago, Santiago de Compostela, Spain
| | - Sulaiman Lakoh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Momodu Sesay
- National HIV/AIDS Secretariat, Freetown, Sierra Leone
| | - Gibrilla F Deen
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Lucia Patiño
- Group of Virology and Pathogenesis, Galicia Sur Health Research Institute (Instituto de Investigación Sanitaria Galicia Sur)-Complexo Hospitalario Universitario de Vigo, SERGAS-UVigo, Vigo, Spain
| | - Eva Poveda
- Group of Virology and Pathogenesis, Galicia Sur Health Research Institute (Instituto de Investigación Sanitaria Galicia Sur)-Complexo Hospitalario Universitario de Vigo, SERGAS-UVigo, Vigo, Spain
| | - Robert A Salata
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio.,Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
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Lakoh S, Jiba DF, Kanu JE, Poveda E, Salgado-Barreira A, Sahr F, Sesay M, Deen GF, Sesay T, Gashau W, Salata RA, Yendewa GA. Causes of hospitalization and predictors of HIV-associated mortality at the main referral hospital in Sierra Leone: a prospective study. BMC Public Health 2019; 19:1320. [PMID: 31638941 PMCID: PMC6805411 DOI: 10.1186/s12889-019-7614-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 09/12/2019] [Indexed: 01/15/2023] Open
Abstract
Background HIV infection is a growing public health problem in Sierra Leone and the wider West Africa region. The countrywide HIV prevalence was estimated at 1.7% (67,000 people), with less than 30% receiving life-saving ART in 2016. Thus, HIV-infected patients tend to present to health facilities late, with high mortality risk. Methods We conducted a prospective study of HIV inpatients aged ≥15 years at Connaught Hospital in Freetown—the main referral hospital in Sierra Leone—from July through September 2017, to assess associated factors and predictors of HIV-related mortality. Results One hundred seventy-three HIV inpatients were included, accounting for 14.2% (173/1221) of all hospital admissions during the study period. The majority were female (59.5%, 70/173), median age was 34 years, with 51.4% (89/173) of them diagnosed with HIV infection for the first time during the current hospitalization. The most common admitting diagnoses were anemia (48%, 84/173), tuberculosis (24.3%, 42/173), pneumonia (17.3%, 30/173) and diarrheal illness (15.0%, 26/173). CD4 count was obtained in 64.7% (112/173) of patients, with median value of 87 cells/μL (IQR 25–266), and was further staged as severe immunosuppression: CD4 < 100 cells/μL (50%, 56/112); AIDS: CD4 < 200 cells/μL (69.6%, 78/112); and late-stage HIV disease: CD4 < 350 cells/μL (83%, 93/112). Fifty-two patients (30.1%, 52/173) died during hospitalization, 23% (12/52) of them within the first week. The leading causes of death were anemia (23.1%, 12/52), pneumonia (19.2%, 10/52), diarrheal illness (15.4%, 8/52) and tuberculosis (13.6%, 7/52). Neurological symptoms, i.e., loss of consciousness (p = 0.04) and focal limb weakness (p = 0.04); alcohol use (p = 0.01); jaundice (p = 0.02); cerebral toxoplasmosis (p = 0.01); and tuberculosis (p = 0.04) were significantly associated with mortality; however, only jaundice (AOR 0.11, 95% CI [0.02–0.65]; p = 0.01) emerged as an independent predictor of mortality. Conclusion HIV-infected patients account for a substantial proportion of admissions at Connaught Hospital, with a high morbidity and in-hospital mortality burden. These findings necessitate the implementation of specific measures to enhance early HIV diagnosis and expand treatment access to all HIV-infected patients in Sierra Leone.
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Affiliation(s)
- Sulaiman Lakoh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Darlinda F Jiba
- Department of Medicine, University of Sierra Leone Teaching Hospitals Complex, Freetown, Sierra Leone
| | - Joseph E Kanu
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Eva Poveda
- Group of Virology and Pathogenesis, Galicia Sur Health Research Institute (IIS Galicia Sur)-Complexo Hospitalario Universitario de Vigo, SERGAS-UVigo, Vigo, Spain
| | - Angel Salgado-Barreira
- Methodology and Statistics Unit, Galicia Sur Health Research Institute (IIS Galicia Sur)-Complexo Hospitalario Universitario de Vigo, SERGAS-UVigo, Vigo, Spain
| | - Foday Sahr
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Momodu Sesay
- National HIV/AIDS Secretariat, Freetown, Sierra Leone
| | - Gibrilla F Deen
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Tom Sesay
- National AIDS Control Programme, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Wadzani Gashau
- Department of Medicine, University of Sierra Leone Teaching Hospitals Complex, Freetown, Sierra Leone
| | - Robert A Salata
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - George A Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA. .,Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA. .,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Yendewa GA, Griffiss JM, Jacobs MR, Fulton SA, O'Riordan MA, Gray WA, Proskin HM, Winkle P, Salata RA. A two-part phase 1 study to establish and compare the safety and local tolerability of two nasal formulations of XF-73 for decolonisation of Staphylococcus aureus: A previously investigated 0.5mg/g viscosified gel formulation versus a modified formulation. J Glob Antimicrob Resist 2019; 21:171-180. [PMID: 31600598 DOI: 10.1016/j.jgar.2019.09.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 08/19/2019] [Accepted: 09/27/2019] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Successful decolonisation of nasal Staphylococcus aureus (SA) carriage by mupirocin is limited by increasing drug resistance. This randomised, open-label, phase 1 study compared the safety and local tolerability of two nasal formulations of XF-73, a novel porphyrinic antibacterial with rapid intrinsic activity against SA. METHODS The study was performed in 60 healthy adults. In Part 1, eight non-SA carriers were randomised to groups of four subjects each and were treated with XF-73 concentrations of 0.5mg/g 2% gel or 2.0mg/g 2% gel. In Part 2, 52 persistent SA carriers were randomised to groups of 13 subjects each and were treated with XF-73 concentrations of 0.5mg/g 2% gel, 2.0mg/g 2% gel, 0.5mg/g 4% gel or 4% viscosified placebo gel. Plasma pharmacokinetic and pharmacodynamic studies were performed. Antistaphylococcal activity was assessed as the presence/absence of SA and by quantification of colonisation using a semiquantitative scale (SA score). RESULTS 56 subjects (8/8 from Part 1 and 48/52 from Part 2) completed the study, with 47/60 comprising the pharmacokinetic population and 48/60 the pharmacodynamic population. There was no measurable systemic absorption of XF-73. XF-73 treatment was associated with rapid reduction in SA score in all subjects. The most common treatment-emergent adverse events (TEAEs) were rhinorrhoea and nasal dryness (15.5% each in Parts 1 and 2). TEAEs were mild and resolved spontaneously. CONCLUSION XF-73 was well tolerated with minimal side effects at doses of 0.5mg/g 2% gel and 2.0mg/g 2% gel. These findings support further development of XF-73.
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Affiliation(s)
- George A Yendewa
- Department of Medicine and Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA.
| | | | - Michael R Jacobs
- Department of Pathology, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Scott A Fulton
- Department of Medicine and Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Mary Ann O'Riordan
- Department of Pediatrics, Case Western Reserve University, Cleveland, OH, USA
| | - Wesley A Gray
- Department of Pediatrics, University of Toledo, Toledo, OH, USA
| | - Howard M Proskin
- Howard M. Proskin and Associates, Incorporated, Rochester, NY, USA
| | | | - Robert A Salata
- Department of Medicine and Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
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Yendewa GA, Poveda E, Lakoh S, Yendewa SA, Jiba DF, Salgado-Barreira A, Sahr F, Salata RA. High Prevalence of Late-Stage Disease in Newly Diagnosed Human Immunodeficiency Virus Patients in Sierra Leone. Open Forum Infect Dis 2018; 5:ofy208. [PMID: 30191158 PMCID: PMC6121223 DOI: 10.1093/ofid/ofy208] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 08/20/2018] [Indexed: 01/27/2023] Open
Abstract
A high prevalence of late-stage disease (75.4%) and severe immunosuppression (23.3%) was observed in 155 newly diagnosed human immunodeficiency virus patients in Freetown, Sierra Leone during August to November 2017. Within the late-stage diagnosis group, a significantly high proportion of patients reported fever (84.2% vs 65.2%; P = .01), weight loss (82.2% vs 63.5%; P = .01), and malaise (89.7% vs 71.7%; P = .05). Fever was identified as the only independent predictor of late-stage disease in this study.
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Affiliation(s)
- George A Yendewa
- Department of Medicine, Case Western Reserve University, Cleveland, Ohio.,Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Ohio.,Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Eva Poveda
- Group of Virology and Pathogenesis, Galicia Sur Health Research Institute (IIS Galicia Sur)-Complexo Hospitalario Universitario de Vigo, SERGAS-UVigo, Spain
| | - Sulaiman Lakoh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown
| | - Sahr A Yendewa
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown
| | - Darlinda F Jiba
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown
| | - Angel Salgado-Barreira
- Methodology and Statistics Unit, Galicia Sur Health Research Institute (IIS Galicia Sur)-Complexo Hospitalario Universitario de Vigo, SERGAS-UVigo, Spain
| | - Foday Sahr
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown.,34 Military Hospital, Republic of Sierra Leone Armed Forces, Freetown
| | - Robert A Salata
- Department of Medicine, Case Western Reserve University, Cleveland, Ohio.,Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Ohio
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Abstract
Sierra Leone is a low-income West African country that has dealt with waves of economic, political, and public health challenges in its recent past, including a decade-long brutal civil war and the Ebola epidemic of 2014-2016. The HIV/AIDS epidemic, which has raged on in the country since 1987, has long been characterized as stable. The latest UNAIDS report estimates a countrywide HIV prevalence rate of 1.7% in 2016 among adults aged 15-49 years. However, there are indications that the epidemic may be in fact escalating and unless arrested urgently, has the potential to deteriorate into a major public health emergency. Although there are high levels of HIV awareness among adults (over 94%), uptake in voluntary HIV testing has remained low (<30%), and under one-third (29%) of the country's 60,000 people living with HIV/AIDS were on antiretroviral therapy in 2015. This review attempts to address the paucity of scientific information on the subject by presenting the historical and epidemiological background to the HIV/AIDS epidemic in Sierra Leone. Other aspects of the HIV/AIDS epidemic in Sierra Leone are examined, including routine HIV screening and diagnosis, linkage to and retention in HIV care, clinical characteristics and molecular epidemiology, treatment coverage, and prevention strategies. Finally, we identify four key areas of challenge that are hampering current efforts attempting to bring the epidemic under control, and perspective is offered on the way forward.
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Affiliation(s)
- George A Yendewa
- Department of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Eva Poveda
- Group of Virology and Pathogenesis, Galicia Sur Health Research Institute (IIS Galicia Sur)-Complexo Hospitalario Universitario de Vigo, SERGAS-UVigo, Spain
| | - Sahr A Yendewa
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Foday Sahr
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- 34 Military Hospital, Republic of Sierra Leone Armed Forces, Freetown, Sierra Leone
| | - Miguel E Quiñones-Mateu
- Department of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Department of Pathogenesis, Case Western Reserve University, Cleveland, Ohio, USA
- Center for AIDS Research at Case Western University/University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Robert A Salata
- Department of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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Yendewa GA. New insights from IeDEA and COHERE on global trends in CD4 counts at ART initiation. AIDS Rev 2018; 20:174-175. [PMID: 30264829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- George A Yendewa
- Division of Infectious Diseases and HIV Medicine Case Western Reserve University School of Medicine Cleveland, Ohio, USA
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Yendewa GA, Salata RA. Ready for HIV Dual Therapy? - New Data from International HIV/AIDS Society 2017. AIDS Rev 2017; 19:167-172. [PMID: 29019353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The introduction of combination antiretroviral therapy (ART) in the 1990s has fundamentally transformed the landscape of HIV medicine, greatly improved disease morbidity and mortality, and reduced transmission rates across all demographic groups. Central to this success was the idea that to achieve best disease outcomes and minimize the development of drug resistance, at least three antiretroviral agents should be used for HIV treatment. This therapeutic strategy is a core tenet of HIV medicine, backed by incontrovertible scientific evidence, and made easy to deploy by the high compliance levels with once-daily coformulations, which have generally been well tolerated. However, there has been increasing support for a paradigm shift toward dual therapy in recent years, particularly during the maintenance therapy phase of treatment. This concept advocates that once virologic suppression has been achieved with at least three antiretroviral drugs during the treatment initiation phase, a switch to a two-drug regimen should be possible. The results of Phase III of the SWORD trials (Llibre et al., Abstract 44LB) and LAMIDOL trial (Joly et al., Abstract 458) presented at the 2017. Conference on Retroviruses and Opportunistic Infections earlier this year seemed to lend support this hypothesis. More new evidence was recently presented at the 2107 International HIV/AIDS Society (IAS) meeting in Paris that adds to the growing body of evidence in favor of a two-drug regimen approach in maintenance therapy. The LATTE-2 study (Eron et al., Abstract 5628) was of major interest because of the exciting new therapeutic options that long-acting injectable antiretroviral agents may bring in the near future. However, more than that, the findings of comparable response between a traditional three-drug oral regimen and a novel injectable two-drug regimen at 96 weeks were quite noteworthy. In this Phase II, multicenter open-label study of 286 HIV-infected ARTnaïve patients, once-daily oral cabotegravir/abacavir/lamivudine achieved virologic suppression in 84% of study participants. In comparison, 87% in the injectable cabotegravir/rilpivirine once every 4-weekly group and 94% in injectable cabotegravir/rilpivirine once every 8-weekly group remained suppressed at 96 weeks. Crucially, no drug resistance mutations were seen in study participants who remained on their regimen. While the idea of a two-drug regimen has been entertained for maintenance therapy, there may be little willingness to push this further into the area of antiretroviral treatment initiation, for the justifiable concerns that exist around the emergence of drug resistance. Despite this, new data presented at the IAS 2017 showed that the idea is not without merit. In a proof of concept, the ACTG A5353 single-arm pilot study of 120 treatment naïve HIV-infected participants with high viral load (VL ≥1000 and >500,000 copies/mL), showed that once-daily dolutegravir/lamivudine had virologic efficacy of 90% at 24 weeks, with 96% of the as-treated study population achieving VL >50 copies/mL (Taiwo et al., Abstract MOAB0107LB). The regimen was well tolerated, with no reported drug resistance mutations while on treatment. There are many real-world advantages to a two-drug regimen approach, among them lower costs (crucial in resource-limited settings where affordability may be a limiting factor), fewer adverse effects or drug toxicities, and possibly improved compliance. These are all important considerations, given that improved mortality now means patients are going to stay on ART treatment for much longer than previously seen. But how the two-drug regimen approach will hold up against firmly held norms and tradition is far from clear, and it is almost certain that the understandable nervousness that surrounds this idea will continue to last. Until the case for the two-drug regimen approach is made more convincingly in ongoing and future trials, the "three or more" rule will reign, not only as the orthodoxy but also as the cornerstone of good clinical practice.
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Affiliation(s)
- George A Yendewa
- Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Robert A Salata
- Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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