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Mulenga LB, Hines JZ, Stafford KA, Dzekedzeke K, Sivile S, Lindsay B, Chola M, Ussery F, Patel HK, Abimiku A, Birhanu S, Minchella PA, Stevens T, Hanunka B, Chisenga T, Shibemba A, Fwoloshi S, Siame M, Mutukwa J, Chirwa L, Siwingwa M, Mulundu G, Agbakwuru C, Mapondera P, Detorio M, Agolory SG, Monze M, Bronson M, Charurat ME. Comparison of HIV prevalence, incidence, and viral load suppression in Zambia population-based HIV impact assessments from 2016 and 2021. AIDS 2024; 38:895-905. [PMID: 38227572 DOI: 10.1097/qad.0000000000003834] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
BACKGROUND The Zambian government has implemented a public health response to control the HIV epidemic in the country. Zambia conducted a population-based HIV impact assessment (ZAMPHIA) survey in 2021 to assess the status of the HIV epidemic to guide its public health programs. METHODS ZAMPHIA 2021 was a cross-sectional two-stage cluster sample household survey among persons aged ≥15 years conducted in Zambia across all 10 provinces. Consenting participants were administered a standardized questionnaire and whole blood was tested for HIV according to national guidelines. HIV-1 viral load (VL), recent HIV infection, and antiretroviral medications were tested for in HIV-seropositive samples. Viral load suppression (VLS) was defined as <1000 copies/ml. ZAMPHIA 2021 results were compared to ZAMPHIA 2016 for persons aged 15-59 years (i.e., the overlapping age ranges). All estimates were weighted to account for nonresponse and survey design. RESULTS During ZAMPHIA 2021, of 25 483 eligible persons aged ≥15 years, 18 804 (73.8%) were interviewed and tested for HIV. HIV prevalence was 11.0% and VLS prevalence was 86.2% overall, but was <80% among people living with HIV aged 15-24 years and in certain provinces. Among persons aged 15-59 years, from 2016 to 2021, HIV incidence declined from 0.6% to 0.3% ( P -value: 0.07) and VLS prevalence increased from 59.2% to 85.7% ( P -value: <0.01). DISCUSSION Zambia has made substantial progress toward controlling the HIV epidemic from 2016 to 2021. Continued implementation of a test-and-treat strategy, with attention to groups with lower VLS in the ZAMPHIA 2021, could support reductions in HIV incidence and improve overall VLS in Zambia.
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Affiliation(s)
- Lloyd B Mulenga
- Ministry of Health
- University Teaching Hospital
- University of Zambia, School of Medicine
| | - Jonas Z Hines
- U.S. Centers for Disease Control and Prevention, Lusaka, Zambia
| | - Kristen A Stafford
- Center for International Health, Education, and Biosecurity, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Kumbutso Dzekedzeke
- Center for International Health, Education, and Biosecurity, Maryland Global Initiatives Corporation-an affiliate of the University of Maryland, Baltimore, Lusaka, Zambia
| | | | - Brianna Lindsay
- Center for International Health, Education, and Biosecurity, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Mumbi Chola
- Center for International Health, Education, and Biosecurity, Maryland Global Initiatives Corporation-an affiliate of the University of Maryland, Baltimore, Lusaka, Zambia
| | - Faith Ussery
- U.S. Centers for Disease Control and Prevention, Atlanta, USA
| | - Hetal K Patel
- U.S. Centers for Disease Control and Prevention, Atlanta, USA
| | - Alash'le Abimiku
- Center for International Health, Education, and Biosecurity, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Sehin Birhanu
- U.S. Centers for Disease Control and Prevention, Atlanta, USA
| | | | - Thomas Stevens
- U.S. Centers for Disease Control and Prevention, Lusaka, Zambia
| | - Brave Hanunka
- U.S. Centers for Disease Control and Prevention, Lusaka, Zambia
| | | | | | | | | | | | | | - Mpanji Siwingwa
- University Teaching Hospital
- University of Zambia, School of Medicine
| | - Gina Mulundu
- University Teaching Hospital
- University of Zambia, School of Medicine
| | - Chinedu Agbakwuru
- Center for International Health, Education, and Biosecurity, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Prichard Mapondera
- Center for International Health, Education, and Biosecurity, Maryland Global Initiatives Corporation-an affiliate of the University of Maryland, Baltimore, Lusaka, Zambia
| | - Mervi Detorio
- U.S. Centers for Disease Control and Prevention, Atlanta, USA
| | - Simon G Agolory
- U.S. Centers for Disease Control and Prevention, Lusaka, Zambia
| | - Mwaka Monze
- Ministry of Health
- University Teaching Hospital
| | - Megan Bronson
- U.S. Centers for Disease Control and Prevention, Atlanta, USA
| | - Man E Charurat
- Center for International Health, Education, and Biosecurity, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
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Mine M, Stafford KA, Laws RL, Marima R, Lekone P, Ramaabya D, Makhaola K, Patel HK, Mapondera P, Wray-Gordon F, Agbakwuru C, Okui L, Matroos S, Onyadile E, Ngidi J, Abimiku A, Bagapi K, Nkomo B, Bodika SM, Kim KJ, Moloney M, Mitchell A, Ehoche A, Ussery FL, Hong SY, Keipeile S, Matlhaga M, Mathumo R, Selato R, Charurat ME, Voetsch AC. Progress towards the UNAIDS 95-95-95 targets in the Fifth Botswana AIDS Impact Survey (BAIS V 2021): a nationally representative survey. Lancet HIV 2024:S2352-3018(24)00003-1. [PMID: 38467135 DOI: 10.1016/s2352-3018(24)00003-1] [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: 05/11/2023] [Revised: 12/18/2023] [Accepted: 01/03/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND In 2014, UNAIDS set a goal to end the AIDS epidemic by achieving targets for the percentage of people living with HIV who were aware of their status, on antiretroviral therapy (ART), and virally suppressed. In 2020, these targets were revised to 95% for each measure (known as 95-95-95), to be reached among people living with HIV by 2025. We used data from the Fifth Botswana AIDS Impact Survey (BAIS V) to measure progress towards these testing and treatment targets in Botswana. METHODS BAIS V used a two-stage cluster design to obtain a nationally representative sample of people aged 15-64 years in Botswana. During March-August, 2021, 14 763 consenting participants were interviewed and tested for HIV in their households by survey teams. HIV-positive specimens were tested for viral load, presence of antiretroviral drugs, and recency of infection using the HIV-1 limiting antigen avidity enzyme immunoassay. Estimates of HIV-positive status and use of ART were based on self-report and the analysis of blood specimens for antiretroviral drugs. Viral load suppression was defined as an HIV RNA concentration of less than 1000 copies per mL. HIV incidence was calculated using the recent infection testing algorithm. Data were weighted to account for the complex survey design. FINDINGS The national HIV prevalence in Botswana among people aged 15-64 years was 20·8% and the annual incidence of HIV infection was 0·2%. 95·1% (men 93·0%, women 96·4%) of people living with HIV aged 15-64 years were aware of their status, 98·0% (men 97·2%, women 98·4%) of those aware were on ART, and 97·9% (men 96·6%, women 98·6%) of those on ART had viral load suppression. Among young people (aged 15-24 years) living with HIV, 84·5% were aware of their status, 98·5% of those aware were on ART, and 91·6% of those on ART had viral load suppression. The prevalance of viral load suppression among all people living with HIV was 91·8%, and varied by district-ranging from 85·3% in Gaborone to 100·0% in Selibe Phikwe. INTERPRETATION BAIS V is the first population-based survey worldwide to report the achievement of the UNAIDS 95-95-95 goals, both overall and among women. Strategies to reach undiagnosed men and young people, including young women, are needed. FUNDING US President's Emergency Plan for AIDS Relief.
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Affiliation(s)
| | - Kristen A Stafford
- Center for International Health, Education, and Biosecurity, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Rebecca L Laws
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Reson Marima
- Botswana University of Maryland School of Medicine Health Initiative (Bummhi), Gaborone, Botswana
| | - Phenyo Lekone
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Gaborone, Botswana
| | | | - Kgomotso Makhaola
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Gaborone, Botswana
| | - Hetal K Patel
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Prichard Mapondera
- Botswana University of Maryland School of Medicine Health Initiative (Bummhi), Gaborone, Botswana
| | - Floris Wray-Gordon
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Chinedu Agbakwuru
- Center for International Health, Education, and Biosecurity, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Lillian Okui
- Botswana University of Maryland School of Medicine Health Initiative (Bummhi), Gaborone, Botswana
| | | | | | | | - Alash'le Abimiku
- Center for International Health, Education, and Biosecurity, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Khuteletso Bagapi
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Gaborone, Botswana
| | | | - Stephane M Bodika
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kaylee J Kim
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Gaborone, Botswana
| | - Mirna Moloney
- Center for International Health, Education, and Biosecurity, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Andrew Mitchell
- Center for International Health, Education, and Biosecurity, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Akipu Ehoche
- Center for International Health, Education, and Biosecurity, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Faith L Ussery
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Steven Y Hong
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Gaborone, Botswana
| | - Stella Keipeile
- National AIDS and Health Promotion Agency, Gaborone, Botswana
| | | | - Rapetse Mathumo
- National AIDS and Health Promotion Agency, Gaborone, Botswana
| | - Robert Selato
- National AIDS and Health Promotion Agency, Gaborone, Botswana
| | - Manhattan E Charurat
- Center for International Health, Education, and Biosecurity, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Andrew C Voetsch
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Atlanta, GA, USA.
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Kibria GMA, Albrecht J, Lane W, Stafford KA, Jones L, Vesselinov R, Hirshon JM. Prevalence, trends, and factors associated with maternal autonomy regarding healthcare, finances, and mobility in Bangladesh: Analysis of Demographic and Health Surveys 1999-2018. PLOS Glob Public Health 2024; 4:e0002816. [PMID: 38306319 PMCID: PMC10836669 DOI: 10.1371/journal.pgph.0002816] [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] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/23/2023] [Indexed: 02/04/2024]
Abstract
Maternal autonomy is associated with improved healthcare utilization/outcomes for mothers and babies in low- and middle-income countries. We investigated the trends in the prevalence and factors associated with maternal autonomy in Bangladesh. This cross-sectional study analyzed the Bangladesh Demographic and Health Survey for 1999-00, 2004, 2007, 2011, 2014, and 2017-18. Maternal autonomy was defined as at least one decision-making ability regarding healthcare, large household purchases, and freedom of mobility. We included 15-49-year-old mothers with at least one live-birth in the past three years. We compared the samples based on the presence of autonomy and reported the trends in prevalence (95% confidence intervals (CIs)) across the survey years. Lastly, we performed multilevel logistic regression to report prevalence odds ratios (PORs) for the associated factors. Variables investigated as potential factors included maternal age, number of children, maternal education, paternal education, current work, religion, mass media exposure, wealth quintile, place and division of residence, and survey years. The prevalence of 'any' maternal autonomy was 72.0% (95% CI: 70.5-73.5) in 1999-00 and increased to 83.8% (95% CI: 82.7-84.9) in 2017-18. In adjusted analysis, mothers with older age, higher education, work outside the home, and mass media exposure had higher odds of autonomy than their counterparts (POR > 1, p < 0.05). For instance, compared to mothers without any formal education, the odds of autonomy were significantly (p < 0.001) higher among mothers with primary (adjusted POR: 1.2, 95% CI: 1.1-1.4), secondary (adjusted POR: 1.4, 95% CI: 1.2-1.6), and college/above (adjusted POR: 1.9, 95% CI: 1.6-2.2) education. While the level of maternal autonomy has increased, a substantial proportion still do not have autonomy. Expanding educational and earning opportunities may increase maternal autonomy. Further research should investigate other ways to improve it as well.
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Affiliation(s)
- Gulam Muhammed Al Kibria
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Jennifer Albrecht
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Wendy Lane
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Kristen A Stafford
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Laundette Jones
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Roumen Vesselinov
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Jon Mark Hirshon
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Baltimore VA Medical Center, Baltimore, Maryland, United States of America
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Blanco N, Lavoie MC, Ngeno C, Wangusi R, Jumbe M, Kimonye F, Ndaga A, Ndichu G, Makokha V, Awuor P, Momanyi E, Oyuga R, Nzyoka S, Mutisya I, Joseph R, Miruka F, Musingila P, Stafford KA, Lascko T, Ngunu C, Owino E, Kiplangat A, Abuya K, Koech E. Effects of Multi-Month Dispensing on Clinical Outcomes: Retrospective Cohort Analysis Conducted in Kenya. AIDS Behav 2024; 28:583-590. [PMID: 38127168 DOI: 10.1007/s10461-023-04247-1] [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: 12/02/2023] [Indexed: 12/23/2023]
Abstract
Multi-month dispensing (MMD) has been widely adopted by national HIV programs as a key strategy for improving the quality of HIV care and treatment services while meeting the unique needs of diverse client populations. We assessed the clinical outcomes of clients receiving MMD in Kenya by conducting a retrospective cohort study using routine programmatic data in 32 government health facilities in Kenya. We included clients who were eligible for multi-month antiretroviral therapy (ART) dispensing for ≥ 3 months (≥ 3MMD) according to national guidelines. The primary exposure was enrollment into ≥ 3MMD. The outcomes were lost to follow-up (LTFU) and viral rebound. Multilevel modified-Poisson regression models with robust standard errors were used to compare clinical outcomes between clients enrolled in ≥ 3MMD and those receiving ART dispensing for less than 3 months (< 3MMD). A total of 3,501 clients eligible for ≥ 3MMD were included in the analysis, of whom 65% were enrolled in ≥ 3MMD at entry into the cohort. There was no difference in LTFU of ≥ 180 days between the two types of care (aRR 1.1, 95% CI 0.7-1.6), while ≥ 3MMD was protective for viral rebound (aRR 0.1 95% CI 0.0-0.2). As more diverse client-focused service delivery models are being implemented, robust evaluations are essential to guide the implementation, monitor progress, and assess acceptability and effectiveness to deliver optimal people-centered care.
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Affiliation(s)
- Natalia Blanco
- Centre for International Health, Education, and Biosecurity (Ciheb), University of Maryland School of Medicine, Baltimore, USA.
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - M C Lavoie
- Centre for International Health, Education, and Biosecurity (Ciheb), University of Maryland School of Medicine, Baltimore, USA
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
- Division of Global Health Sciences, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - C Ngeno
- Center for International Health Education and Biosecurity (Ciheb), MGIC-an affiliate of the University of Maryland Baltimore, Nairobi, Kenya
| | - R Wangusi
- Center for International Health Education and Biosecurity (Ciheb), MGIC-an affiliate of the University of Maryland Baltimore, Nairobi, Kenya
| | - M Jumbe
- Center for International Health Education and Biosecurity (Ciheb), MGIC-an affiliate of the University of Maryland Baltimore, Nairobi, Kenya
| | - F Kimonye
- Center for International Health Education and Biosecurity (Ciheb), MGIC-an affiliate of the University of Maryland Baltimore, Nairobi, Kenya
| | - A Ndaga
- Center for International Health Education and Biosecurity (Ciheb), MGIC-an affiliate of the University of Maryland Baltimore, Nairobi, Kenya
| | - G Ndichu
- Center for International Health Education and Biosecurity (Ciheb), MGIC-an affiliate of the University of Maryland Baltimore, Nairobi, Kenya
| | - V Makokha
- Center for International Health Education and Biosecurity (Ciheb), MGIC-an affiliate of the University of Maryland Baltimore, Nairobi, Kenya
| | - P Awuor
- Center for International Health Education and Biosecurity (Ciheb), MGIC-an affiliate of the University of Maryland Baltimore, Nairobi, Kenya
| | - E Momanyi
- Center for International Health Education and Biosecurity (Ciheb), MGIC-an affiliate of the University of Maryland Baltimore, Nairobi, Kenya
| | - R Oyuga
- Center for International Health Education and Biosecurity (Ciheb), MGIC-an affiliate of the University of Maryland Baltimore, Nairobi, Kenya
| | - S Nzyoka
- Center for International Health Education and Biosecurity (Ciheb), MGIC-an affiliate of the University of Maryland Baltimore, Nairobi, Kenya
| | - I Mutisya
- Division of Global HIV & TB (DGHT), U.S. Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - R Joseph
- Center for International Health Education and Biosecurity (Ciheb), MGIC-an affiliate of the University of Maryland Baltimore, Nairobi, Kenya
| | - F Miruka
- Division of Global HIV & TB (DGHT), U.S. Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - P Musingila
- Division of Global HIV & TB (DGHT), U.S. Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - K A Stafford
- Centre for International Health, Education, and Biosecurity (Ciheb), University of Maryland School of Medicine, Baltimore, USA
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
- Division of Global Health Sciences, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - T Lascko
- Centre for International Health, Education, and Biosecurity (Ciheb), University of Maryland School of Medicine, Baltimore, USA
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - C Ngunu
- Nairobi Metropolitan Services Health Management Team, Nairobi, Kenya
| | - E Owino
- Migori County Health Management Team, Western, Kenya
| | - A Kiplangat
- Nairobi Metropolitan Services Health Management Team, Nairobi, Kenya
| | - K Abuya
- Kisii County Health Management Team, Western, Kenya
| | - E Koech
- Center for International Health Education and Biosecurity (Ciheb), MGIC-an affiliate of the University of Maryland Baltimore, Nairobi, Kenya
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Lavoie MCC, Koech E, Blanco N, Wangusi R, Jumbe M, Kimonye F, Ndaga A, Ndichu G, Makokha V, Awuor P, Momanyi E, Oyuga R, Nzyoka S, Mutisya I, Joseph R, Miruka F, Musingila P, Stafford KA, Lascko T, Ngunu C, Owino E, Kiplangat A, Kepha A, Ng'eno C. Factors associated with enrollment into differentiated service delivery model among adults with HIV in Kenya. AIDS 2023; 37:2409-2417. [PMID: 37707787 DOI: 10.1097/qad.0000000000003725] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
INTRODUCTION Differentiated service delivery (DSD) such as multimonth dispensing (MMD) aims to provide client-centered HIV services, while reducing the workload within health facilities. We assessed individual and facility factors associated with receiving more than three MMD and switching from ≥3MMD back to <3MMD in Kenya. METHODS We conducted a retrospective cohort study of clients eligible for DSD between July 2017 and December 2019. A random sample of clients eligible for DSD was selected from 32 randomly selected facilities located in Nairobi, Kisii, and Migori counties. We used a multilevel Poisson regression model to assess the factors associated with receiving ≥3MMD, and with switching from ≥3MMD back to <3MMD. RESULTS A total of 3501 clients eligible for ≥3MMD were included in our analysis: 1808 (51.6%) were receiving care in Nairobi County and the remaining 1693 (48.4%) in Kisii and Migori counties. Overall, 65% of clients were enrolled in ≥3MMD at the time of entry into the cohort. In the multivariable model, younger age (20-24; 25-29; 30-34 vs. 50 or more years) and switching ART regimen was significantly associated with a lower likelihood of ≥3MMD uptake. Factors associated with a higher likelihood of enrollment in ≥3MMD included receiving DTG vs. EFV-based ART regimen (aRR: 1.10; 95% confidence interval: 1.05-1.15). CONCLUSION Client-level characteristics are associated with being on ≥3MMD and the likelihood of switching from ≥3MMD to <3MMD. Monitoring DSD enrollment across different populations is critical to successfully implementing these models continually.
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Affiliation(s)
- Marie-Claude C Lavoie
- Division of Global Health Sciences, Department of Epidemiology and Public Health
- Institute of Human Virology
- Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Emily Koech
- Center for International Health, Education, and Biosecurity, MGIC-an affiliate of the University of Maryland Baltimore, Nairobi
| | - Natalia Blanco
- Institute of Human Virology
- Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Rebecca Wangusi
- Center for International Health, Education, and Biosecurity, MGIC-an affiliate of the University of Maryland Baltimore, Nairobi
| | - Marline Jumbe
- Center for International Health, Education, and Biosecurity, MGIC-an affiliate of the University of Maryland Baltimore, Nairobi
| | - Francis Kimonye
- Center for International Health, Education, and Biosecurity, MGIC-an affiliate of the University of Maryland Baltimore, Nairobi
| | - Angela Ndaga
- Center for International Health, Education, and Biosecurity, MGIC-an affiliate of the University of Maryland Baltimore, Nairobi
| | - Geofrey Ndichu
- Center for International Health, Education, and Biosecurity, MGIC-an affiliate of the University of Maryland Baltimore, Nairobi
| | - Violet Makokha
- Center for International Health, Education, and Biosecurity, MGIC-an affiliate of the University of Maryland Baltimore, Nairobi
| | - Patrick Awuor
- Center for International Health, Education, and Biosecurity, MGIC-an affiliate of the University of Maryland Baltimore, Nairobi
| | - Emmah Momanyi
- Center for International Health, Education, and Biosecurity, MGIC-an affiliate of the University of Maryland Baltimore, Nairobi
| | - Roseline Oyuga
- Center for International Health, Education, and Biosecurity, MGIC-an affiliate of the University of Maryland Baltimore, Nairobi
| | - Sarah Nzyoka
- Center for International Health, Education, and Biosecurity, MGIC-an affiliate of the University of Maryland Baltimore, Nairobi
| | - Immaculate Mutisya
- Division of Global HIV & TB (DGHT), U.S. Centers for Disease Control and Prevention (CDC), Kisumu
| | - Rachel Joseph
- Division of Global HIV & TB (DGHT), U.S. Centers for Disease Control and Prevention (CDC), Kisumu
| | - Fredrick Miruka
- Division of Global HIV & TB (DGHT), U.S. Centers for Disease Control and Prevention (CDC), Kisumu
| | - Paul Musingila
- Division of Global HIV & TB (DGHT), U.S. Centers for Disease Control and Prevention (CDC), Kisumu
| | - Kristen A Stafford
- Division of Global Health Sciences, Department of Epidemiology and Public Health
- Institute of Human Virology
- Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Taylor Lascko
- Institute of Human Virology
- Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Carol Ngunu
- Nairobi Metropolitan Services Health Management Team, Nairobi
| | | | | | - Abuya Kepha
- Kisii County Health Management Team, Western, Kenya
| | - Caroline Ng'eno
- Center for International Health, Education, and Biosecurity, MGIC-an affiliate of the University of Maryland Baltimore, Nairobi
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Currie DW, West CA, Patel HK, Favaloro J, Asiimwe F, Ndagije F, Silver R, Mugurungi O, Shang J, Ndongmo CB, Williams DB, Dzinotyiweyi E, Waruru A, Pasipamire M, Nuwagaba-Biribonwoha H, Dlamini S, McLeod N, Kayirangwa E, Rwibasira G, Minchella PA, Auld AF, Nyirenda R, Getaneh Y, Hailemariam AH, Tondoh-Koui I, Kohemun N, Mgomella GS, Njau PF, Kirungi WL, Dalhatu I, Stafford KA, Bodika SM, Ussery F, McCracken S, Stupp P, Brown K, Duong YT, Parekh BS, Voetsch AC. Risk Factors for Recent HIV Infections among Adults in 14 Countries in Africa Identified by Population-Based HIV Impact Assessment Surveys, 2015-2019. Emerg Infect Dis 2023; 29:2325-2334. [PMID: 37877591 PMCID: PMC10617335 DOI: 10.3201/eid2911.230703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023] Open
Abstract
Identifying persons who have newly acquired HIV infections is critical for characterizing the HIV epidemic direction. We analyzed pooled data from nationally representative Population-Based HIV Impact Assessment surveys conducted across 14 countries in Africa for recent infection risk factors. We included adults 15-49 years of age who had sex during the previous year and used a recent infection testing algorithm to distinguish recent from long-term infections. We collected risk factor information via participant interviews and assessed correlates of recent infection using multinomial logistic regression, incorporating each survey's complex sampling design. Compared with HIV-negative persons, persons with higher odds of recent HIV infection were women, were divorced/separated/widowed, had multiple recent sex partners, had a recent HIV-positive sex partner or one with unknown status, and lived in communities with higher HIV viremia prevalence. Prevention programs focusing on persons at higher risk for HIV and their sexual partners will contribute to reducing HIV incidence.
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Dalhatu I, Aniekwe C, Bashorun A, Abdulkadir A, Dirlikov E, Ohakanu S, Adedokun O, Oladipo A, Jahun I, Murie L, Yoon S, Abdu-Aguye MG, Sylvanus A, Indyer S, Abbas I, Bello M, Nalda N, Alagi M, Odafe S, Adebajo S, Ogorry O, Akpu M, Okoye I, Kakanfo K, Onovo AA, Ashefor G, Nzelu C, Ikpeazu A, Aliyu G, Ellerbrock T, Boyd M, Stafford KA, Swaminathan M. From Paper Files to Web-Based Application for Data-Driven Monitoring of HIV Programs: Nigeria's Journey to a National Data Repository for Decision-Making and Patient Care. Methods Inf Med 2023; 62:130-139. [PMID: 37247622 PMCID: PMC10462428 DOI: 10.1055/s-0043-1768711] [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: 06/09/2022] [Accepted: 01/13/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND Timely and reliable data are crucial for clinical, epidemiologic, and program management decision making. Electronic health information systems provide platforms for managing large longitudinal patient records. Nigeria implemented the National Data Repository (NDR) to create a central data warehouse of all people living with human immunodeficiency virus (PLHIV) while providing useful functionalities to aid decision making at different levels of program implementation. OBJECTIVE We describe the Nigeria NDR and its development process, including its use for surveillance, research, and national HIV program monitoring toward achieving HIV epidemic control. METHODS Stakeholder engagement meetings were held in 2013 to gather information on data elements and vocabulary standards for reporting patient-level information, technical infrastructure, human capacity requirements, and information flow. Findings from these meetings guided the development of the NDR. An implementation guide provided common terminologies and data reporting structures for data exchange between the NDR and the electronic medical record (EMR) systems. Data from the EMR were encoded in extensible markup language and sent to the NDR over secure hypertext transfer protocol after going through a series of validation processes. RESULTS By June 30, 2021, the NDR had up-to-date records of 1,477,064 (94.4%) patients receiving HIV treatment across 1,985 health facilities, of which 1,266,512 (85.7%) patient records had fingerprint template data to support unique patient identification and record linkage to prevent registration of the same patient under different identities. Data from the NDR was used to support HIV program monitoring, case-based surveillance and production of products like the monthly lists of patients who have treatment interruptions and dashboards for monitoring HIV test and start. CONCLUSION The NDR enabled the availability of reliable and timely data for surveillance, research, and HIV program monitoring to guide program improvements to accelerate progress toward epidemic control.
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Affiliation(s)
- Ibrahim Dalhatu
- United States Centers for Disease Control and Prevention, Abuja, Nigeria
| | - Chinedu Aniekwe
- United States Centers for Disease Control and Prevention, Abuja, Nigeria
| | | | - Alhassan Abdulkadir
- Center for International Health, Education and Biosecurity, University of Maryland, Baltimore, Abuja, Nigeria
| | - Emilio Dirlikov
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Stephen Ohakanu
- Center for International Health, Education and Biosecurity, Institute of Human Virology, University of Maryland School of Medicine, University of Maryland, Baltimore, Maryland, United States
| | - Oluwasanmi Adedokun
- Center for International Health, Education and Biosecurity, University of Maryland, Baltimore, Abuja, Nigeria
| | - Ademola Oladipo
- United States Centers for Disease Control and Prevention, Abuja, Nigeria
| | - Ibrahim Jahun
- United States Centers for Disease Control and Prevention, Abuja, Nigeria
| | - Lisa Murie
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Steven Yoon
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Mubarak G. Abdu-Aguye
- Center for International Health, Education and Biosecurity, University of Maryland, Baltimore, Abuja, Nigeria
| | - Ahmed Sylvanus
- Center for International Health, Education and Biosecurity, University of Maryland, Baltimore, Abuja, Nigeria
| | - Samuel Indyer
- Center for International Health, Education and Biosecurity, University of Maryland, Baltimore, Abuja, Nigeria
| | - Isah Abbas
- United States Centers for Disease Control and Prevention, Abuja, Nigeria
| | - Mustapha Bello
- United States Centers for Disease Control and Prevention, Abuja, Nigeria
| | - Nannim Nalda
- United States Centers for Disease Control and Prevention, Abuja, Nigeria
| | - Matthias Alagi
- United States Centers for Disease Control and Prevention, Abuja, Nigeria
| | - Solomon Odafe
- United States Centers for Disease Control and Prevention, Abuja, Nigeria
| | - Sylvia Adebajo
- Center for International Health, Education and Biosecurity, University of Maryland, Baltimore, Abuja, Nigeria
| | | | | | - Ifeanyi Okoye
- United States Department of Defense Walter Reed Program, Abuja, Nigeria
| | - Kunle Kakanfo
- United States Agency for International Development (USAID), Abuja, Nigeria
| | - Amobi Andrew Onovo
- United States Agency for International Development (USAID), Abuja, Nigeria
| | - Gregory Ashefor
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Abuja, Federal Capital Territory, Nigeria
| | | | | | - Gambo Aliyu
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Abuja, Federal Capital Territory, Nigeria
| | - Tedd Ellerbrock
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Mary Boyd
- United States Centers for Disease Control and Prevention, Abuja, Nigeria
| | - Kristen A. Stafford
- Center for International Health, Education and Biosecurity, Institute of Human Virology, University of Maryland School of Medicine, University of Maryland, Baltimore, Maryland, United States
| | - Mahesh Swaminathan
- United States Centers for Disease Control and Prevention, Abuja, Nigeria
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Lavoie MCC, Ehoche A, Blanco N, Ahmed El-Imam I, Oladipo A, Dalhatu I, Odafe S, Adebajo S, Ng AH, Rapoport L, Lawton JG, Obanubi C, Onotu D, Patel S, Ikpeazu A, Ashefor G, Adebobola B, Adetinuke Boyd M, Aliyu G, Stafford KA. Effect of Test and Treat on clinical outcomes in Nigeria: A national retrospective study. PLoS One 2023; 18:e0284847. [PMID: 37607206 PMCID: PMC10443836 DOI: 10.1371/journal.pone.0284847] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 04/10/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND In Nigeria, results from the pilot of the Test and Treat strategy showed higher loss to follow up (LTFU) among people living with HIV compared to before its implementation. The aim of this evaluation was to assess the effects of antiretroviral therapy (ART) initiation within 14 days on LTFU at 12 months and viral suppression. METHODS We conducted a retrospective cohort study using routinely collected de-identified patient-level data hosted on the Nigeria National Data Repository from 1,007 facilities. The study population included people living with HIV age ≥15. We used multivariable Cox proportional frailty hazard models to assess time to LTFU comparing ART initiation strategy and multivariable log-binomial regression for viral suppression. RESULTS Overall, 26,937 (38.13%) were LTFU at 12 months. Among individuals initiated within 14 days, 38.4% were LTFU by 12 months compared to 35.4% for individuals initiated >14 days (p<0.001). In the adjusted analysis, individuals who were initiated ≤14 days after HIV diagnosis had a higher hazard of being LTFU (aHR 1.15, 95% CI 1.10-1.20) than individuals initiated after 14 days of HIV diagnosis. Among individuals with viral load results, 86.2% were virally suppressed. The adjusted risk ratio for viral suppression among individuals who were initiated ≤14 days compared to >14 days was not statistically significant. CONCLUSION LTFU was higher among individuals who were initiated within 14 days compared to greater than 14 days after HIV diagnosis. There was no difference for viral suppression. The provision of early tailored interventions to support newly diagnosed people living may contribute to reducing LTFU.
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Affiliation(s)
- Marie-Claude C Lavoie
- Division of Global Health Sciences, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, United States of America
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Center for International Health Education and Biosecurity, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Akipu Ehoche
- Center for International Health Education and Biosecurity, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Natalia Blanco
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Center for International Health Education and Biosecurity, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Ibrahim Ahmed El-Imam
- Center for International Health Education and Biosecurity, MGIC-an Affiliate of the University of Maryland Baltimore, Abuja, Nigeria
| | - Ademola Oladipo
- Centers for Disease Control and Prevention, CGH/DGHT, Abuja, Nigeria
| | - Ibrahim Dalhatu
- Centers for Disease Control and Prevention, CGH/DGHT, Abuja, Nigeria
| | - Solomon Odafe
- Centers for Disease Control and Prevention, CGH/DGHT, Abuja, Nigeria
| | - Sylvia Adebajo
- Center for International Health Education and Biosecurity, MGIC-an Affiliate of the University of Maryland Baltimore, Abuja, Nigeria
| | - Alexia H Ng
- Centers for Disease Control and Prevention, CGH/DGHT, Abuja, Nigeria
| | - Laura Rapoport
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Center for International Health Education and Biosecurity, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Jonathan G Lawton
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Center for International Health Education and Biosecurity, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | | | - Denis Onotu
- Centers for Disease Control and Prevention, CGH/DGHT, Abuja, Nigeria
| | - Sadhna Patel
- Centers for Disease Control and Prevention, CGH/DGHT, Abuja, Nigeria
| | - Akudo Ikpeazu
- National AIDS and STI Control Programme-Federal Ministry of Health, Abuja, Federal Capital Territory, Nigeria
| | - Greg Ashefor
- National Agency for the Control of AIDS, Abuja, Nigeria
| | - Bashorun Adebobola
- National AIDS and STI Control Programme-Federal Ministry of Health, Abuja, Federal Capital Territory, Nigeria
| | | | - Gambo Aliyu
- National Agency for the Control of AIDS, Abuja, Nigeria
| | - Kristen A Stafford
- Division of Global Health Sciences, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, United States of America
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Center for International Health Education and Biosecurity, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
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9
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Aliyu GG, Lawton JG, Mitchell AB, Abimiku AG, Jelpe T, Bassey O, Riedel DJ, Swaminathan M, Chang JCW, DeVos JR, Patel H, Charurat ME, Stafford KA. Prevalence of HIV drug resistance in Nigeria: results from a cross-sectional, population-based survey of Nigerian adults with unsuppressed viral load. AIDS 2023; 37:333-339. [PMID: 36541644 DOI: 10.1097/qad.0000000000003413] [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] [Indexed: 12/24/2022]
Abstract
BACKGROUND HIV drug resistance (HIVDR) surveillance is an important tool to monitor threats to progress towards epidemic control. The characterization of HIVDR in Nigeria at the national level is needed to inform both clinical decisions and population-level HIV policy strategies. This study uses data obtained from the Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS) to describe the prevalence and distribution of HIVDR in Nigeria. METHODS NAIIS was a cross-sectional, population-based survey of households throughout Nigeria in 2018. NAIIS was designed to provide estimates of HIV prevalence and related health indicators from a nationally representative sample. The study population included participants aged 15-64 years who tested positive for HIV, had a viral load at least 1000 copies/ml, and had available HIV drug resistance genotypes. HIV isolates were genotyped to detect drug resistance mutations. Individual characteristics of study participants associated with HIVDR were identified using a weighted multivariable logistic regression model. RESULTS Of 1355 respondents with available HIV genotypes, 293 (19%) had evidence of drug-resistant mutations (DRMs) that conferred resistance to at least one antiretroviral drug. The majority of DRMs observed conferred resistance to NNRTIs (17.6%) and NRTIs (11.2%). HIVDR was associated with being ART-experienced, longer duration on ART, and lower CD4+ count but not sociodemographic characteristics. CONCLUSION The population level DRM prevalence in Nigeria was consistent with what would be expected in a mature HIV treatment landscape. The continued roll out of dolutegravir-anchored regimens should mitigate the impact of NNRTI resistance on population viral load suppression and progress towards epidemic control.
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Affiliation(s)
- Gambo G Aliyu
- National Agency for the Control of AIDS, Abuja, Nigeria
| | - Jonathan G Lawton
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
| | - Andrew B Mitchell
- Center for International Health, Education, and Biosecurity, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Alash'le G Abimiku
- Center for International Health, Education, and Biosecurity, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA.,Institute of Human Virology-Nigeria
| | - Tapdiyel Jelpe
- Division of Global HIV & TB, Department of Global Health, Centers for Disease Control and Prevention, Abuja, Nigeria
| | - Orji Bassey
- Division of Global HIV & TB, Department of Global Health, Centers for Disease Control and Prevention, Abuja, Nigeria
| | - David J Riedel
- Center for International Health, Education, and Biosecurity, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Mahesh Swaminathan
- Division of Global HIV & TB, Department of Global Health, Centers for Disease Control and Prevention, Abuja, Nigeria
| | - Joy Chih-Wei Chang
- International Laboratories Branch, Department of Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Joshua R DeVos
- International Laboratories Branch, Department of Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Hetal Patel
- International Laboratories Branch, Department of Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Man E Charurat
- Center for International Health, Education, and Biosecurity, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Kristen A Stafford
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD.,Center for International Health, Education, and Biosecurity, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
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10
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Iriemenam NC, Ige FA, Greby SM, Okunoye OO, Uwandu M, Aniedobe M, Nwaiwu SO, Mba N, Okoli M, William NE, Ehoche A, Mpamugo A, Mitchell A, Stafford KA, Thomas AN, Olaleye T, Akinmulero OO, Agala NP, Abubakar AG, Owens A, Gwyn SE, Rogier E, Udhayakumar V, Steinhardt LC, Martin DL, Okoye MI, Audu R. Comparison of one single-antigen assay and three multi-antigen SARS-CoV-2 IgG assays in Nigeria. J Clin Virol Plus 2023; 3:100139. [PMID: 36683611 PMCID: PMC9837382 DOI: 10.1016/j.jcvp.2023.100139] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 11/03/2022] [Accepted: 01/12/2023] [Indexed: 01/14/2023] Open
Abstract
Objectives Determining an accurate estimate of SARS-CoV-2 seroprevalence has been challenging in African countries where malaria and other pathogens are endemic. We compared the performance of one single-antigen assay and three multi-antigen SARS-CoV-2 IgG assays in a Nigerian population endemic for malaria. Methods De-identified plasma specimens from SARS-CoV-2 RT-PCR positive, dried blood spot (DBS) SARS-CoV-2 RT-PCR positive, and pre-pandemic negatives were used to evaluate the performance of the four SARS-CoV-2 assays (Tetracore, SARS2MBA, RightSign, xMAP). Results Results showed higher sensitivity with the multi-antigen (81% (Tetracore), 96% (SARS2MBA), 85% (xMAP)) versus the single-antigen (RightSign (64%)) SARS-CoV-2 assay. The overall specificities were 98% (Tetracore), 100% (SARS2MBA and RightSign), and 99% (xMAP). When stratified based on <15 days to ≥15 days post-RT-PCR confirmation, the sensitivities increased from 75% to 88.2% for Tetracore; from 93% to 100% for the SARS2MBA; from 58% to 73% for RightSign; and from 83% to 88% for xMAP. With DBS, there was no positive increase after 15-28 days for the three assays (Tetracore, SARS2MBA, and xMAP). Conclusion Multi-antigen assays performed well in Nigeria, even with samples with known malaria reactivity, and might provide more accurate measures of COVID-19 seroprevalence and vaccine efficacy.
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Affiliation(s)
- Nnaemeka C Iriemenam
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Abuja, Nigeria
| | - Fehintola A Ige
- Center for Human Virology and Genomics, Microbiology Department, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
| | - Stacie M Greby
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Abuja, Nigeria
| | - Olumide O Okunoye
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Abuja, Nigeria
| | - Mabel Uwandu
- Center for Human Virology and Genomics, Microbiology Department, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
| | - Maureen Aniedobe
- Center for Human Virology and Genomics, Microbiology Department, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
| | - Stephnie O Nwaiwu
- Center for Human Virology and Genomics, Microbiology Department, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
| | - Nwando Mba
- Nigeria Centre for Disease Control (NCDC), Gaduwa, FCT, Nigeria
| | - Mary Okoli
- Nigeria Centre for Disease Control (NCDC), Gaduwa, FCT, Nigeria
| | | | - Akipu Ehoche
- University of Maryland Center for International Health, Education, and Biosecurity (CIHEB), Maryland Global Initiatives Corporation (MGIC), FCT, Nigeria
| | - Augustine Mpamugo
- University of Maryland Center for International Health, Education, and Biosecurity (CIHEB), Maryland Global Initiatives Corporation (MGIC), FCT, Nigeria
| | - Andrew Mitchell
- Center for International Health, Education, and Biosecurity, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, USA
| | - Kristen A Stafford
- Center for International Health, Education, and Biosecurity, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, USA
| | - Andrew N Thomas
- International Research Center of Excellence, Institute of Human Virology, Abuja, Nigeria
| | - Temitope Olaleye
- International Research Center of Excellence, Institute of Human Virology, Abuja, Nigeria
| | - Oluwaseun O Akinmulero
- International Research Center of Excellence, Institute of Human Virology, Abuja, Nigeria
| | - Ndidi P Agala
- International Research Center of Excellence, Institute of Human Virology, Abuja, Nigeria
| | - Ado G Abubakar
- International Research Center of Excellence, Institute of Human Virology, Abuja, Nigeria
| | - Ajile Owens
- Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sarah E Gwyn
- Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Eric Rogier
- Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Venkatachalam Udhayakumar
- Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Laura C Steinhardt
- Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Diana L Martin
- Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - McPaul I Okoye
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Abuja, Nigeria
| | - Rosemary Audu
- Center for Human Virology and Genomics, Microbiology Department, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
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11
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Njie-Carr VPS, Zhu S, Stafford KA, Tong W, Plankey M, Sharma A, Milam J, Cohen M, Diaz MM, Rubtsova AA, Fischl MA, Konkle-Parker D, Gustafson D, Rubin LH. Intersectionality of Socioecological Factors Associated With Cognitive Function Among Older Women With HIV in the United States: A Structural Equation Model Analysis Using Data From the Women's Interagency HIV Study. J Assoc Nurses AIDS Care 2023; 34:83-95. [PMID: 36656093 PMCID: PMC10079306 DOI: 10.1097/jnc.0000000000000376] [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] [Indexed: 01/20/2023]
Abstract
ABSTRACT Increased life expectancy of people with HIV has health implications including the intersection of the long-term use of antiretroviral treatment, inflammatory events, and age-related immunosenescence. In a cross-sectional study utilizing using the Socio-Eecological Model, we identified pathways of cognitive function (CF) among 448 women with HIV, 50 years and older. A structural equation model showed the direct effects of mood (β = -0.25, p < .01), comorbidities (β = --0.13, p < .05), race (β = --0.13, p < .05), and abuse (β = 0.27, p < .001) on the latent variable CF. Substance and alcohol use, depressive symptoms, cigarette smoking, and the number of comorbidities are important considerations when designing interventions utilizing using a multi-level and intersectional lens to maximize positive CF outcomes.
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Affiliation(s)
| | - Shijun Zhu
- School of Nursing, University of Maryland, Baltimore, Maryland, USA
| | | | - Weiqun Tong
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Michael Plankey
- Division of Infectious Diseases, School of Medicine, Georgetown University, Washington, District of Columbia, USA
| | - Anjali Sharma
- Department of Medicine, College of Medicine, Albert Einstein University Bronx, New York, USA
| | - Joel Milam
- Department of Epidemiology and Biostatistics, Program in Public Health, Susan & Henry Samueli College of Health Sciences, University of California Irvine, Irvine, California, USA
| | - Mardge Cohen
- Boston Health Care for the Homeless Program, Chicago, Illinois, USA
| | - Monica M. Diaz
- Department of Neurology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Anna A. Rubtsova
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Margaret A. Fischl
- School of Medicine, University of Miami Health Systems, Miami, Florida, USA
| | - Deborah Konkle-Parker
- Schools of Nursing, Medicine, and Population Health Sciences, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Deborah Gustafson
- Department of Neurology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Leah H. Rubin
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
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12
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Chun HM, Abutu A, Milligan K, Ehoche A, Shiraishi RW, Odafe S, Dalhatu I, Onotu D, Okoye M, Oladipo A, Gwamna J, Ikpeazu A, Akpan NM, Ibrahim J, Aliyu G, Akanmu S, Boyd MA, Swaminathan M, Ellerbrock T, Stafford KA, Dirlikov E. Low-level viraemia among people living with HIV in Nigeria: a retrospective longitudinal cohort study. Lancet Glob Health 2022; 10:e1815-e1824. [PMID: 36400087 PMCID: PMC9711923 DOI: 10.1016/s2214-109x(22)00413-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 08/31/2022] [Accepted: 09/15/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND HIV transmission can occur with a viral load of at least 200 copies per mL of blood and low-level viraemia can lead to virological failure; the threshold level at which risk for virological failure is conferred is uncertain. To better understand low-level viraemia prevalence and outcomes, we analysed retrospective longitudinal data from a large cohort of people living with HIV on antiretroviral therapy (ART) in Nigeria. METHODS In this retrospective cohort study using previously collected longitudinal patient data, we estimated rates of virological suppression (≤50 copies per mL), low-level viraemia (51-999 copies per mL), virological non-suppression (≥1000 copies per mL), and virological failure (≥2 consecutive virological non-suppression results) among people living with HIV aged 18 years and older who initiated and received at least 24 weeks of ART at 1005 facilities in 18 Nigerian states. We analysed risk for low-level viraemia, virological non-suppression, and virological failure using log-binomial regression and mixed-effects logistic regression. FINDINGS At first viral load for 402 668 patients during 2016-21, low-level viraemia was present in 64 480 (16·0%) individuals and virological non-suppression occurred in 46 051 (11·4%) individuals. Patients with low-level viraemia had increased risk of virological failure (adjusted relative risk 2·20, 95% CI 1·98-2·43; p<0·0001). Compared with patients with virological suppression, patients with low-level viraemia, even at 51-199 copies per mL, had increased odds of low-level viraemia and virological non-suppression at next viral load; patients on optimised ART (ie, integrase strand transfer inhibitors) had lower odds than those on non-integrase strand transfer inhibitors for the same low-level viraemia range (eg, viral load ≥1000 copies per mL following viral load 400-999 copies per mL, integrase strand transfer inhibitor: odds ratio 1·96, 95% CI 1·79-2·13; p<0·0001; non-integrase strand transfer inhibitor: 3·21, 2·90-3·55; p<0·0001). INTERPRETATION Patients with low-level viraemia had increased risk of virological non-suppression and failure. Programmes should revise monitoring benchmarks and targets from less than 1000 copies per mL to less than 50 copies per mL to strengthen clinical outcomes and track progress to epidemic control. FUNDING None.
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Affiliation(s)
- Helen M Chun
- Division of Global HIV/TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Andrew Abutu
- Division of Global HIV/TB, Center for Global Health, Abuja, Federal Capital Territory, Nigeria
| | - Kyle Milligan
- Division of Global HIV/TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA; Peraton, Herndon, VA, USA
| | - Akipu Ehoche
- Center for International Health, Education, and Biosecurity, Maryland Global Initiatives Corporation-an affiliate of the University of Maryland Baltimore, Abuja, Federal Capital Territory, Nigeria
| | - Ray W Shiraishi
- Division of Global HIV/TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Solomon Odafe
- Division of Global HIV/TB, Center for Global Health, Abuja, Federal Capital Territory, Nigeria
| | - Ibrahim Dalhatu
- Division of Global HIV/TB, Center for Global Health, Abuja, Federal Capital Territory, Nigeria
| | - Dennis Onotu
- Division of Global HIV/TB, Center for Global Health, Abuja, Federal Capital Territory, Nigeria
| | - McPaul Okoye
- Division of Global HIV/TB, Center for Global Health, Abuja, Federal Capital Territory, Nigeria
| | - Ademola Oladipo
- Division of Global HIV/TB, Center for Global Health, Abuja, Federal Capital Territory, Nigeria
| | - Jerry Gwamna
- Division of Global HIV/TB, Center for Global Health, Abuja, Federal Capital Territory, Nigeria
| | - Akudo Ikpeazu
- National AIDS/STIs Control Programme (NASCP), Federal Ministry of Health, Abuja, Federal Capital Territory, Nigeria
| | - Nseobong M Akpan
- National AIDS/STIs Control Programme (NASCP), Federal Ministry of Health, Abuja, Federal Capital Territory, Nigeria
| | - Jahun Ibrahim
- Division of Program, Nigeria AIDS Control Agency, Abuja, Federal Capital Territory, Nigeria
| | - Gambo Aliyu
- Office of the Director General, Nigeria AIDS Control Agency, Abuja, Federal Capital Territory, Nigeria
| | - Sulaiman Akanmu
- Department of Hematology, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Mary A Boyd
- Division of Global HIV/TB, Center for Global Health, Abuja, Federal Capital Territory, Nigeria
| | - Mahesh Swaminathan
- Division of Global HIV/TB, Center for Global Health, Abuja, Federal Capital Territory, Nigeria
| | - Tedd Ellerbrock
- Division of Global HIV/TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kristen A Stafford
- Center for International Health, Education, and Biosecurity, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MA, USA
| | - Emilio Dirlikov
- Division of Global HIV/TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
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13
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Schmalzle SA, Viviano NA, Mohanty K, Palmeiro RM, Hoffmann JD, Sheth-Pandit N, Gruber-Baldini A, Stafford KA. People aging with HIV - protecting a population vulnerable to effects of COVID-19 and its control measures. AIDS Care 2022; 34:1355-1363. [PMID: 34949149 DOI: 10.1080/09540121.2021.2020208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Certain comorbidities known to increase the risk of poor outcomes in COVID-19 exist at higher rates in people with HIV; people aging with HIV (PAWH) face additional risk due to the association of advanced age with COVID-19 mortality. Cognitive and functional deficits and social barriers have been identified in cohorts of people aging with HIV. It is postulated that the COVID-19 pandemic potentially threatens PAWH disproportionately to the general population, both in mortality risk due to age and comorbidities, and in potential deleterious effects of policies that seek to drastically limit in-person interaction and access to healthcare systems. A description of and preliminary data from a demonstration project to improve geriatric assessments of people with HIV over age 50 in an urban HIV clinic are presented, in support of this theory. Advice is offered on key strategies utilized to continue to provide care to PAWH during the COVID-19 pandemic, including transition to telemedicine, vaccination, revision of staff roles, repurposing of funding, and a new reliance on available local resources.
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Affiliation(s)
- Sarah A Schmalzle
- Department of Medicine, Division of Infectious Disease, University of Maryland Medical Center, Baltimore, MD, USA.,Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Nicole A Viviano
- Division of Gerontology, Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Kareshma Mohanty
- Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Robyn M Palmeiro
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jennifer D Hoffmann
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Neha Sheth-Pandit
- Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, MD
| | - Ann Gruber-Baldini
- Division of Gerontology, Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Kristen A Stafford
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA.,Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
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14
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Mwango L, Toeque M, Lindsay B, Tembo K, Sakala H, Reggee S, Malunga SM, Kabwe M, Kafunda I, Olufunso A, Mwila A, Okuku J, Kancheya N, Nkwemu K, Mumba D, Hachaambwa L, Sheneberger R, Blanco N, Lavoie M, Stafford KA, Claassen CW. Reaching transgender populations in Zambia for HIV prevention and linkage to treatment using community-based service delivery. J Int AIDS Soc 2022; 25 Suppl 5:e25995. [PMID: 36225155 PMCID: PMC9557009 DOI: 10.1002/jia2.25995] [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: 01/11/2022] [Accepted: 07/30/2022] [Indexed: 11/07/2022] Open
Abstract
Introduction Transgender and gender‐diverse communities in Zambia are highly vulnerable and experience healthcare differently than cisgender persons. The University of Maryland, Baltimore (UMB) supports projects in Zambia to improve HIV case‐finding, linkage and antiretroviral treatment (ART) for Zambia's transgender community. We describe programme strategies and outcomes for HIV prevention, testing and ART linkage among transgender communities. Methods UMB utilizes a differentiated service delivery model whereby community health workers (CHWs) recruited from key populations (KPs) reach community members through a peer‐to‐peer approach, with the support of local transgender civil society organizations (CSOs) and community gatekeepers. Peer CHWs are trained and certified as HIV testers and psychosocial counsellors to offer counselling with HIV testing and prevention services in identified safe spaces. HIV‐negative people at risk of HIV infection are offered pre‐exposure prophylaxis (PrEP), while those who test positive for HIV are linked to ART services. CHWs collect data using the standardized facility and community tools and a dedicated DHIS2 database system. We conducted a descriptive analysis examining HIV testing and prevention outcomes using proportions and comparisons by time period and geographic strata. Results From October 2020 to June 2021, across Eastern, Lusaka, Western and Southern Provinces, 1860 transgender persons were reached with HIV prevention messages and services. Of these, 424 (23%) were tested for HIV and 78 (18%) tested positive. Of the 346 HIV‐negative persons, 268 (78%) eligible transgender individuals were initiated on PrEP. ART linkage was 97%, with 76 out of the 78 transgender individuals living with HIV initiating treatment. Programme strategies that supported testing and linkage included peer CHWs, social network strategy testing, same‐day ART initiation and local KP CSO support. Challenges included non‐transgender‐friendly environments, stigma and discrimination, the high transiency of the transgender community and the non‐availability of transgender‐specific health services, such as hormonal therapy. Conclusions Peer KP CHWs were able to reach many members of the transgender community, providing safe HIV testing, PrEP services and linkage to care. Focusing on community gatekeepers and CSOs to disburse health messages and employ welcoming strategies supported high linkage to both PrEP and ART for transgender people in Zambia.
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Affiliation(s)
| | - Mona‐Gekanju Toeque
- Maryland Global Initiatives Corporation ZambiaLusakaZambia,Center for International HealthEducationand BiosecurityUniversity of Maryland School of MedicineBaltimoreMarylandUSA
| | - Brianna Lindsay
- Maryland Global Initiatives Corporation ZambiaLusakaZambia,Center for International HealthEducationand BiosecurityUniversity of Maryland School of MedicineBaltimoreMarylandUSA
| | - Kalima Tembo
- Maryland Global Initiatives Corporation ZambiaLusakaZambia
| | - Henry Sakala
- Maryland Global Initiatives Corporation ZambiaLusakaZambia
| | | | | | | | - Ina Kafunda
- Maryland Global Initiatives Corporation ZambiaLusakaZambia
| | | | - Annie Mwila
- Division of Global HIV and TuberculosisU.S. Centers for Disease Control and PreventionLusakaZambia
| | - Jackson Okuku
- Division of Global HIV and TuberculosisU.S. Centers for Disease Control and PreventionLusakaZambia
| | - Nzali Kancheya
- Division of Global HIV and TuberculosisU.S. Centers for Disease Control and PreventionLusakaZambia
| | - Kennedy Nkwemu
- Division of Global HIV and TuberculosisU.S. Centers for Disease Control and PreventionLusakaZambia
| | | | - Lottie Hachaambwa
- Ciheb ZambiaLusakaZambia,Center for International HealthEducationand BiosecurityUniversity of Maryland School of MedicineBaltimoreMarylandUSA
| | - Robb Sheneberger
- Maryland Global Initiatives Corporation ZambiaLusakaZambia,Center for International HealthEducationand BiosecurityUniversity of Maryland School of MedicineBaltimoreMarylandUSA
| | - Natalia Blanco
- Center for International HealthEducationand BiosecurityUniversity of Maryland School of MedicineBaltimoreMarylandUSA
| | - Marie‐Claude Lavoie
- Center for International HealthEducationand BiosecurityUniversity of Maryland School of MedicineBaltimoreMarylandUSA
| | - Kristen A. Stafford
- Center for International HealthEducationand BiosecurityUniversity of Maryland School of MedicineBaltimoreMarylandUSA
| | - Cassidy W. Claassen
- Maryland Global Initiatives Corporation ZambiaLusakaZambia,Center for International HealthEducationand BiosecurityUniversity of Maryland School of MedicineBaltimoreMarylandUSA
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15
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Toeque MG, Lindsay B, Zulu PM, Hachaambwa L, Fwoloshi S, Chanda D, Stafford KA, Mupeta F, Siwingwa M, Mutinta M, Chirwa L, Riedel DJ, Claassen C, Mulenga L. Treatment-Experienced Patients on Third-Line Therapy: A Retrospective Cohort of Treatment Outcomes at the HIV Advanced Treatment Centre, University Teaching Hospital, Zambia. AIDS Res Hum Retroviruses 2022; 38:798-805. [PMID: 35778849 DOI: 10.1089/aid.2021.0208] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Antiretroviral therapy (ART) uptake continues to increase across sub-Saharan Africa and emergence of drug-resistant HIV mutations poses significant challenges to management of treatment-experienced patients with virologic failure. In Zambia, new third-line ART (TLART) guidelines including use of dolutegravir (DTG) were introduced in 2018. We assessed virologic suppression, immunologic response, and HIV drug-resistant mutations (DRMs) among patients on TLART at the University Teaching Hospital (UTH) in Lusaka, Zambia. We conducted a retrospective review of patients enrolled at UTH on TLART for >6 months between January 2010 and June 30, 2021. CD4 and HIV viral load (VL) at TLART initiation and post-initiation were assessed to determine virologic and immunologic outcomes. Regression analysis using bivariate and multivariate methods to describe baseline characteristics, virologic, and immunologic response to TLART was performed. A total of 345 patients met inclusion criteria; women comprised 57.6% (199/345) of the cohort. Median age at HIV diagnosis was 30 (interquartile range: 17.3-36.8). In 255 (73.8%) patients with at least two VLs, VL decreased from mean of 3.45 log10 copies/mL (standard deviation [SD]: 2.02) to 1.68 log10 copies/mL (SD: 1.79). Common ARVs prescribed included DTG (89.9%), tenofovir disoproxil fumarate (68.7%), and darunavir boosted with ritonavir (66.4%); 170 (49.3%) patients had genotypes; mutations consisted of 88.8% nucleoside reverse transcriptase inhibitor, 86.5% non-nucleoside reverse transcriptase inhibitor, and 55.9% protease inhibitor. VL suppression to <1,000 copies/mL was achieved in 225 (78.9%) patients. DRM frequency ranged from 56% to 89% depending on drug class. Treatment-experienced patients receiving TLART in Zambia achieved high rates of suppression despite high proportions of HIV mutations illustrating TLART effectiveness in the DTG era.
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Affiliation(s)
- Mona-Gekanju Toeque
- Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, Maryland, USA.,Department of Infectious Diseases, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Brianna Lindsay
- Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, Maryland, USA.,Department of Infectious Diseases, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Paul Msanzya Zulu
- Division of Infectious Diseases, Department of Medicine, University of Zambia School of Medicine, Lusaka, Zambia.,Department of Infectious Disease, Adult Infectious Diseases Center, University Teaching Hospital, Lusaka, Zambia.,Zambia National Public Health Institute, Lusaka, Zambia
| | - Lottie Hachaambwa
- Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, Maryland, USA.,Department of Infectious Diseases, University of Maryland School of Medicine, Baltimore, Maryland, USA.,Division of Infectious Diseases, Department of Medicine, University of Zambia School of Medicine, Lusaka, Zambia.,Department of Infectious Disease, Adult Infectious Diseases Center, University Teaching Hospital, Lusaka, Zambia
| | - Sombo Fwoloshi
- Division of Infectious Diseases, Department of Medicine, University of Zambia School of Medicine, Lusaka, Zambia.,Department of Infectious Disease, Adult Infectious Diseases Center, University Teaching Hospital, Lusaka, Zambia.,Ministry of Health, Ndeke House, Lusaka, Zambia
| | - Duncan Chanda
- Division of Infectious Diseases, Department of Medicine, University of Zambia School of Medicine, Lusaka, Zambia.,Department of Infectious Disease, Adult Infectious Diseases Center, University Teaching Hospital, Lusaka, Zambia
| | - Kristen A Stafford
- Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, Maryland, USA.,Department of Infectious Diseases, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Francis Mupeta
- Division of Infectious Diseases, Department of Medicine, University of Zambia School of Medicine, Lusaka, Zambia.,Department of Infectious Disease, Adult Infectious Diseases Center, University Teaching Hospital, Lusaka, Zambia
| | - Mpanji Siwingwa
- Division of Infectious Diseases, Department of Medicine, University of Zambia School of Medicine, Lusaka, Zambia.,Department of Infectious Disease, Adult Infectious Diseases Center, University Teaching Hospital, Lusaka, Zambia
| | - Melody Mutinta
- Division of Infectious Diseases, Department of Medicine, University of Zambia School of Medicine, Lusaka, Zambia.,Department of Infectious Disease, Adult Infectious Diseases Center, University Teaching Hospital, Lusaka, Zambia
| | - Lameck Chirwa
- Division of Infectious Diseases, Department of Medicine, University of Zambia School of Medicine, Lusaka, Zambia.,Department of Infectious Disease, Adult Infectious Diseases Center, University Teaching Hospital, Lusaka, Zambia
| | - David J Riedel
- Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, Maryland, USA.,Department of Infectious Diseases, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Cassidy Claassen
- Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, Maryland, USA.,Department of Infectious Diseases, University of Maryland School of Medicine, Baltimore, Maryland, USA.,Division of Infectious Diseases, Department of Medicine, University of Zambia School of Medicine, Lusaka, Zambia.,Department of Infectious Disease, Adult Infectious Diseases Center, University Teaching Hospital, Lusaka, Zambia
| | - Lloyd Mulenga
- Division of Infectious Diseases, Department of Medicine, University of Zambia School of Medicine, Lusaka, Zambia.,Department of Infectious Disease, Adult Infectious Diseases Center, University Teaching Hospital, Lusaka, Zambia.,Ministry of Health, Ndeke House, Lusaka, Zambia
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16
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Olsen SH, Roh EJ, Syakayuwa T, Chola M, Agbakwuru C, Stafford KA, Stoebenau K, Dzekedzeke K, Charurat M. Confluence of crises: COVID-19, "gassings", blood draws and the continued importance of community engagement in Zambia. Health Promot Perspect 2022; 12:67-76. [PMID: 35854852 PMCID: PMC9277288 DOI: 10.34172/hpp.2022.09] [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: 01/18/2022] [Accepted: 03/24/2022] [Indexed: 11/09/2022] Open
Abstract
Background: Nationally representative, household-based, health-related surveys are an invaluable source of health information, but face implementation challenges. In sub-Saharan Africa, these challenges are exacerbated when surveys include the collection of biological specimens. In this study, we describe the potential implementation challenges identified during field practice leading up to the 2020 Zambia Population-based HIV Impact Assessment (ZAMPHIA) survey, and explore the role of two crises on community mistrust of, and apprehension to, participate in the survey. Methods: Using focus group methodology to better understand the influence of crises on ZAMPHIA participation, we conducted 12 focus group discussions (FGDs) in five districts across two provinces. FGDs were conducted with three purposively sampled study groups: recognized household heads, community leaders, and young adults aged 18-24 years. We used reflexive thematic analysis to develop themes from across the FGDs. Results: We identified two key themes: the ever-present threat a stranger posed to the community is enhanced by crises, and endorsement of community awareness through sensitization can mitigate outsider challenges in medical research. Conclusion: We argue that these crises emphasized underlying mistrust that can only be addressed with substantial investment in community engagement efforts to build trust and partnership in medical research endeavors. Our findings underline the importance of prioritizing community engagement through substantial investment in varied and extensive approaches to sensitization to facilitate community engagement toward community acceptance of ZAMPHIA and similar studies.
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Affiliation(s)
- Sara H Olsen
- Department of Behavioral and Community Health, University of Maryland School of Public Health, Maryland, USA
| | - Esther J Roh
- Department of Behavioral and Community Health, University of Maryland School of Public Health, Maryland, USA
| | - Tandwa Syakayuwa
- Center for International Health, Education, and Biosecurity, Zambia
| | - Mumbi Chola
- Center for International Health, Education, and Biosecurity, Zambia
| | - Chinedu Agbakwuru
- Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Maryland, USA
| | - Kristen A Stafford
- Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Maryland, USA.,Institute of Human Virology, University of Maryland School of Medicine, Maryland, USA
| | - Kirsten Stoebenau
- Department of Behavioral and Community Health, University of Maryland School of Public Health, Maryland, USA
| | | | - Manhattan Charurat
- Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Maryland, USA.,Institute of Human Virology, University of Maryland School of Medicine, Maryland, USA
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17
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Lavoie MCC, Blanco N, Keapoletswe K, Marima R, Ntwayagae OA, Sebina KB, Loeto P, Mogomotsi PG, Saleeb PG, Ndwapi N, Stafford KA. Testing modality associated with fast-track ART initiation in Botswana. Trop Med Int Health 2022; 27:537-543. [PMID: 35298082 DOI: 10.1111/tmi.13745] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim of this study was to identify community testing modalities associated with fast-track ART initiation in Botswana. METHODS We conducted a retrospective cohort study that included all Botswana citizens 15 years or older who were newly identified as HIV-positive from 1 May 2017 to 31 January 2019, in Mahalapye and Southern districts. We used Poisson regression with robust error variance and generalised linear mixed models to control for cluster effects to model risk of ART initiation within 7 and 30 days of HIV diagnosis, testing modality factors. RESULTS A total of 1436 individuals were newly identified HIV-positive, with men accounting for 60% across all testing modalities. 22% of all HIV-positive individuals were initiated on ART within 7 days. Clients diagnosed through index testing were more likely to be started on ART within 7 days (adjusted risk ratio [aRR] = 1.38, 95% CI 1.37-1.38) and 30 days (aRR = 1.17, 95% CI 1.09-1.26) than those diagnosed through mobile/outreach testing. CONCLUSIONS Community HIV testing can complement facility-based testing by reaching individuals who may be less likely to seek HIV services at a facility, such as men. Monitoring ART initiation by testing modalities is critical to identify the optimal ones and to guide continuous programme improvement.
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Affiliation(s)
- Marie-Claude C Lavoie
- Center for International Health, Education, and Biosecurity (Ciheb), Institute of Human Virology (IHV), University of Maryland Baltimore School of Medicine, Baltimore, Maryland, USA.,Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, USA
| | - Natalia Blanco
- Center for International Health, Education, and Biosecurity (Ciheb), Institute of Human Virology (IHV), University of Maryland Baltimore School of Medicine, Baltimore, Maryland, USA
| | - Koona Keapoletswe
- Botswana-University of Maryland School of Medicine Health Initiative (Bummhi) Gaborone, Gaborone, Botswana
| | - Reson Marima
- Botswana-University of Maryland School of Medicine Health Initiative (Bummhi) Gaborone, Gaborone, Botswana
| | - Ookeditse A Ntwayagae
- Botswana-University of Maryland School of Medicine Health Initiative (Bummhi) Gaborone, Gaborone, Botswana
| | - Kagiso B Sebina
- Botswana-University of Maryland School of Medicine Health Initiative (Bummhi) Gaborone, Gaborone, Botswana
| | - Peter Loeto
- Centers for Disease Control and Prevention, Gaborone, Botswana
| | - Panky G Mogomotsi
- Health Services Management, Ministry of Health and Wellness, Gaborone, Botswana
| | - Paul G Saleeb
- Center for International Health, Education, and Biosecurity (Ciheb), Institute of Human Virology (IHV), University of Maryland Baltimore School of Medicine, Baltimore, Maryland, USA
| | - Ndwapi Ndwapi
- Botswana-University of Maryland School of Medicine Health Initiative (Bummhi) Gaborone, Gaborone, Botswana
| | - Kristen A Stafford
- Center for International Health, Education, and Biosecurity (Ciheb), Institute of Human Virology (IHV), University of Maryland Baltimore School of Medicine, Baltimore, Maryland, USA.,Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, USA
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18
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Montebatsi M, Lavoie MCC, Blanco N, Marima R, Sebina K, Mangope J, Ntwayagae O, Whittington A, Letebele M, Lekone P, Hess KL, Thomas V, Ramaabya D, Ramotsababa M, Stafford KA, Ndwapi N. Improving same-day antiretroviral therapy in Botswana: effects of a multifaceted national intervention. AIDS 2022; 36:533-538. [PMID: 34873088 DOI: 10.1097/qad.0000000000003139] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In 2019, the Botswana Ministry of Health and Wellness (MOHW) implemented an HIV national Reboot program, which was needed for refocusing and intensifying efforts for achieving epidemic control. The strategies deployed as part of Reboot were reviewed and evaluated for their effect on same-day and within-seven-days (fast-track initiation) antiretroviral therapy (ART) initiation among adults newly identified with HIV. METHODS We conducted a retrospective cohort analysis of patients aged 18 years or older who were newly diagnosed with HIV from October 2018 to September 2019 across 41 health facilities. We used generalized linear mixed models, adjusting for clustering by facility, to assess the association of the Reboot with same-day or within-seven-days ART initiation (fast-track initiation). RESULTS From October 2018 to January 2019, 28% (636/2269) of newly diagnosed HIV patients were initiated the same day of diagnosis, and 56% (1260/2269) were initiated within seven days. Following the launch of Reboot (February to September 2019), 59% (2092/3553) were initiated the same day of diagnosis, and 77% (2752/3553) were initiated within seven days. Clients were 2.08 (adjusted risk ratio 95% confidence interval 1.79-2.43) times more likely to be initiated the same day of diagnosis and 1.39 (adjusted risk ratio 95% confidence interval 1.28-1.52) times more likely to be initiated within seven days than before Reboot after adjusting for sex and age. CONCLUSION In Botswana, a multifaceted national intervention improved timely ART initiation. Identifying and implementing different client-centered strategies to facilitate ART initiation is critical to preventing AIDS-related complications and prevent ongoing transmission.
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Affiliation(s)
- Milton Montebatsi
- Botswana-University of Maryland School of Medicine Health Initiative (Bummhi), Gaborone, Botswana
| | - Marie-Claude C Lavoie
- Center for International Health, Education, and Biosecurity, Institute of Human Virology-University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Natalia Blanco
- Center for International Health, Education, and Biosecurity, Institute of Human Virology-University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Reson Marima
- Botswana-University of Maryland School of Medicine Health Initiative (Bummhi), Gaborone, Botswana
| | - Kagiso Sebina
- Botswana-University of Maryland School of Medicine Health Initiative (Bummhi), Gaborone, Botswana
| | - Justin Mangope
- Botswana-University of Maryland School of Medicine Health Initiative (Bummhi), Gaborone, Botswana
| | - Ookeditse Ntwayagae
- Botswana-University of Maryland School of Medicine Health Initiative (Bummhi), Gaborone, Botswana
| | - Anna Whittington
- Center for International Health, Education, and Biosecurity, Institute of Human Virology-University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Mpho Letebele
- US Centers for Disease Control and Prevention, (CDC), CDC- Botswana
| | - Phenyo Lekone
- US Centers for Disease Control and Prevention, (CDC), CDC- Botswana
| | - Kristen L Hess
- US Centers for Disease Control and Prevention, (CDC), CDC- Botswana
| | - Vasavi Thomas
- US Centers for Disease Control and Prevention, (CDC), CDC- Botswana
| | - Dinah Ramaabya
- Botswana Ministry of Health and Wellness, (MOHW), Gaborone, Botswana
| | | | - Kristen A Stafford
- Center for International Health, Education, and Biosecurity, Institute of Human Virology-University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Ndwapi Ndwapi
- Botswana-University of Maryland School of Medicine Health Initiative (Bummhi), Gaborone, Botswana
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19
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Audu RA, Stafford KA, Steinhardt L, Musa ZA, Iriemenam N, Ilori E, Blanco N, Mitchell A, Hamada Y, Moloney M, Iwara E, Abimiku A, Ige FA, William NE, Igumbor E, Ochu C, Omoare AA, Okunoye O, Greby SM, Rangaka MX, Copas A, Dalhatu I, Abubakar I, McCracken S, Alagi M, Mba N, Anthony A, Okoye M, Okoi C, Ezechi OC, Salako BL, Ihekweazu C. Seroprevalence of SARS-CoV-2 in four states of Nigeria in October 2020: A population-based household survey. PLOS Glob Public Health 2022; 2:e0000363. [PMID: 36962359 PMCID: PMC10022353 DOI: 10.1371/journal.pgph.0000363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 05/31/2022] [Indexed: 04/25/2023]
Abstract
The observed epidemiology of SARS-CoV-2 in sub-Saharan Africa has varied greatly from that in Europe and the United States, with much lower reported incidence. Population-based studies are needed to estimate true cumulative incidence of SARS-CoV-2 to inform public health interventions. This study estimated SARS-CoV-2 seroprevalence in four selected states in Nigeria in October 2020. We implemented a two-stage cluster sample household survey in four Nigerian states (Enugu, Gombe, Lagos, and Nasarawa) to estimate age-stratified prevalence of SARS-CoV-2 antibodies. All individuals in sampled households were eligible for interview, blood draw, and nasal/oropharyngeal swab collection. We additionally tested participants for current/recent malaria infection. Seroprevalence estimates were calculated accounting for the complex survey design. Across all four states, 10,629 (96·5%) of 11,015 interviewed individuals provided blood samples. The seroprevalence of SARS-CoV-2 antibodies was 25·2% (95% CI 21·8-28·6) in Enugu State, 9·3% (95% CI 7·0-11·5) in Gombe State, 23·3% (95% CI 20·5-26·4) in Lagos State, and 18·0% (95% CI 14·4-21·6) in Nasarawa State. Prevalence of current/recent malaria infection ranged from 2·8% in Lagos to 45·8% in Gombe and was not significantly related to SARS-CoV-2 seroprevalence. The prevalence of active SARS-CoV-2 infection in the four states during the survey period was 0·2% (95% CI 0·1-0·4). Approximately eight months after the first reported COVID-19 case in Nigeria, seroprevalence indicated infection levels 194 times higher than the 24,198 officially reported COVID-19 cases across the four states; however, most of the population remained susceptible to COVID-19 in October 2020.
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Affiliation(s)
| | - Kristen A Stafford
- Center for International Health, Education and Biosecurity, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Laura Steinhardt
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Zaidat A Musa
- Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Nnaemeka Iriemenam
- Division of Global HIV/AIDS and Tuberculosis, Center for Global Health, United States Centers for Disease Control and Prevention, Abuja, Nigeria
| | - Elsie Ilori
- Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Natalia Blanco
- Center for International Health, Education and Biosecurity, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Andrew Mitchell
- Center for International Health, Education and Biosecurity, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Yohhei Hamada
- Institute for Global Health, University College London, London, United Kingdom
| | - Mirna Moloney
- Center for International Health, Education and Biosecurity, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Emem Iwara
- Center for International Health, Education and Biosecurity, University of Maryland, Baltimore, Abuja, Nigeria
| | - Alash'le Abimiku
- Center for International Health, Education and Biosecurity, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | | | | | - Ehimario Igumbor
- Nigeria Centre for Disease Control, Abuja, Nigeria
- School of Public Health, University of Western Cape, Cape Town, South Africa
| | - Chinwe Ochu
- Nigeria Centre for Disease Control, Abuja, Nigeria
| | | | - Olumide Okunoye
- Division of Global HIV/AIDS and Tuberculosis, Center for Global Health, United States Centers for Disease Control and Prevention, Abuja, Nigeria
| | - Stacie M Greby
- Division of Global HIV/AIDS and Tuberculosis, Center for Global Health, United States Centers for Disease Control and Prevention, Abuja, Nigeria
| | | | - Andrew Copas
- Institute for Global Health, University College London, London, United Kingdom
| | - Ibrahim Dalhatu
- Division of Global HIV/AIDS and Tuberculosis, Center for Global Health, United States Centers for Disease Control and Prevention, Abuja, Nigeria
| | - Ibrahim Abubakar
- Institute for Global Health, University College London, London, United Kingdom
| | - Stephen McCracken
- Division of Global HIV/AIDS and Tuberculosis, Center for Global Health, United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Matthias Alagi
- Division of Global HIV/AIDS and Tuberculosis, Center for Global Health, United States Centers for Disease Control and Prevention, Abuja, Nigeria
| | - Nwando Mba
- Nigeria Centre for Disease Control, Abuja, Nigeria
| | | | - McPaul Okoye
- Division of Global HIV/AIDS and Tuberculosis, Center for Global Health, United States Centers for Disease Control and Prevention, Abuja, Nigeria
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20
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Iriemenam NC, Mpamugo A, Ikpeazu A, Okunoye OO, Onokevbagbe E, Bassey OO, Tapdiyel J, Alagi MA, Meribe C, Ahmed ML, Ikwulono G, Aguolu R, Ashefor G, Nzelu C, Ehoche A, Ezra B, Obioha C, Baffa Sule I, Adedokun O, Mba N, Ihekweazu C, Charurat M, Lindsay B, Stafford KA, Ibrahim D, Swaminathan M, Yufenyuy EL, Parekh BS, Adebajo S, Abimiku A, Okoye MI. Evaluation of the Nigeria national HIV rapid testing algorithm. PLOS Glob Public Health 2022; 2:e0001077. [PMID: 36962660 PMCID: PMC10021713 DOI: 10.1371/journal.pgph.0001077] [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] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 10/07/2022] [Indexed: 11/07/2022]
Abstract
Human Immunodeficiency Virus (HIV) diagnosis remains the gateway to HIV care and treatment. However, due to changes in HIV prevalence and testing coverage across different geopolitical zones, it is crucial to evaluate the national HIV testing algorithm as false positivity due to low prevalence could be detrimental to both the client and the service delivery. Therefore, we evaluated the performance of the national HIV rapid testing algorithm using specimens collected from multiple HIV testing services (HTS) sites and compared the results from different HIV prevalence levels across the six geopolitical zones of Nigeria. The evaluation employed a dual approach, retrospective, and prospective. The retrospective evaluation focused on a desktop review of program data (n = 492,880) collated from patients attending routine HTS from six geopolitical zones of Nigeria between January 2017 and December 2019. The prospective component utilized samples (n = 2,895) collected from the field at the HTS and tested using the current national serial HIV rapid testing algorithm. These samples were transported to the National Reference Laboratory (NRL), Abuja, and were re-tested using the national HIV rapid testing algorithm and HIV-1/2 supplementary assays (Geenius to confirm positives and resolve discordance and multiplex assay). The retrospective component of the study revealed that the overall proportion of HIV positives, based on the selected areas, was 5.7% (28,319/492,880) within the study period, and the discordant rate between tests 1 and 2 was 1.1%. The prospective component of the study indicated no significant differences between the test performed at the field using the national HIV rapid testing algorithm and the re-testing performed at the NRL. The comparison between the test performed at the field using the national HIV rapid testing algorithm and Geenius HIV-1/2 supplementary assay showed an agreement rate of 95.2%, while that of the NRL was 99.3%. In addition, the comparison of the field results with HIV multiplex assay indicated a sensitivity of 96.6%, the specificity of 98.2%, PPV of 97.0%, and Kappa Statistic of 0.95, and that of the NRL with HIV multiplex assay was 99.2%, 99.4%, 99.0%, and 0.99, respectively. Results show that the Nigeria national serial HIV rapid testing algorithm performed very well across the target settings. However, the algorithm's performance in the field was lower than the performance outcomes under a controlled environment in the NRL. There is a need to target testers in the field for routine continuous quality improvement implementation, including refresher trainings as necessary.
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Affiliation(s)
- Nnaemeka C Iriemenam
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Abuja, Federal Capital Territory, Nigeria
| | - Augustine Mpamugo
- Center for International Health, Education, and Biosecurity, Maryland Global Initiatives Corporation - an affiliate of the University of Maryland, Baltimore, Federal Capital Territory, Nigeria
| | - Akudo Ikpeazu
- Federal Ministry of Health, Abuja, Federal Capital Territory, Nigeria
| | - Olumide O Okunoye
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Abuja, Federal Capital Territory, Nigeria
| | - Edewede Onokevbagbe
- Center for International Health, Education, and Biosecurity, Maryland Global Initiatives Corporation - an affiliate of the University of Maryland, Baltimore, Federal Capital Territory, Nigeria
| | - Orji O Bassey
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Abuja, Federal Capital Territory, Nigeria
| | - Jelpe Tapdiyel
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Abuja, Federal Capital Territory, Nigeria
| | - Matthias A Alagi
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Abuja, Federal Capital Territory, Nigeria
| | - Chidozie Meribe
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Abuja, Federal Capital Territory, Nigeria
| | - Mukhtar L Ahmed
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Abuja, Federal Capital Territory, Nigeria
| | - Gabriel Ikwulono
- Federal Ministry of Health, Abuja, Federal Capital Territory, Nigeria
| | - Rose Aguolu
- National Agency for the Control of AIDS, Abuja, Federal Capital Territory, Nigeria
| | - Gregory Ashefor
- National Agency for the Control of AIDS, Abuja, Federal Capital Territory, Nigeria
| | - Charles Nzelu
- Federal Ministry of Health, Abuja, Federal Capital Territory, Nigeria
| | - Akipu Ehoche
- Center for International Health, Education, and Biosecurity, Maryland Global Initiatives Corporation - an affiliate of the University of Maryland, Baltimore, Federal Capital Territory, Nigeria
| | - Babatunde Ezra
- Center for International Health, Education, and Biosecurity, Maryland Global Initiatives Corporation - an affiliate of the University of Maryland, Baltimore, Federal Capital Territory, Nigeria
| | - Christine Obioha
- Center for International Health, Education, and Biosecurity, Maryland Global Initiatives Corporation - an affiliate of the University of Maryland, Baltimore, Federal Capital Territory, Nigeria
| | - Ibrahim Baffa Sule
- Center for International Health, Education, and Biosecurity, Maryland Global Initiatives Corporation - an affiliate of the University of Maryland, Baltimore, Federal Capital Territory, Nigeria
| | - Oluwasanmi Adedokun
- Center for International Health, Education, and Biosecurity, Maryland Global Initiatives Corporation - an affiliate of the University of Maryland, Baltimore, Federal Capital Territory, Nigeria
| | - Nwando Mba
- National Reference Laboratory, Nigeria Centers for Disease Control, Gaduwa, Federal Capital Territory, Nigeria
| | - Chikwe Ihekweazu
- National Reference Laboratory, Nigeria Centers for Disease Control, Gaduwa, Federal Capital Territory, Nigeria
| | - Manhattan Charurat
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Center for International Health, Education, and Biosecurity, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Brianna Lindsay
- Center for International Health, Education, and Biosecurity, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Kristen A Stafford
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Center for International Health, Education, and Biosecurity, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Dalhatu Ibrahim
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Abuja, Federal Capital Territory, Nigeria
| | - Mahesh Swaminathan
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Abuja, Federal Capital Territory, Nigeria
| | - Ernest L Yufenyuy
- International Laboratory Branch, Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Bharat S Parekh
- International Laboratory Branch, Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Sylvia Adebajo
- Center for International Health, Education, and Biosecurity, Maryland Global Initiatives Corporation - an affiliate of the University of Maryland, Baltimore, Federal Capital Territory, Nigeria
| | - Alash'le Abimiku
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - McPaul I Okoye
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Abuja, Federal Capital Territory, Nigeria
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21
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Bada FO, Stafford KA, Osawe S, Wilson E, Sam-Agudu NA, Chen H, Abimiku A, Campbell JD. Factors associated with receipt of a timely infant birth dose of hepatitis B vaccine at a tertiary hospital in North-Central Nigeria. PLOS Glob Public Health 2022; 2:e0001052. [PMID: 36962881 PMCID: PMC10021184 DOI: 10.1371/journal.pgph.0001052] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 08/18/2022] [Indexed: 11/18/2022]
Abstract
The World Health Organization recommends universal vaccination of medically stable infants with Hepatitis B vaccine within 24 hours of birth to prevent mother-to-child transmission of Hepatitis B virus (HBV) infection. However, the proportion of infants who receive a timely birth dose is extremely low in Nigeria. We reviewed the implementation of an infant HBV vaccine schedule at a single center and identified factors affecting the receipt of a timely birth dose of HBV vaccine. We conducted a retrospective cohort study utilizing data from the INFANT study, a 2013-2017 prospective cohort study of pregnant women with and without HIV and their infants We utilized bivariate and multivariable logistic regression to assess if maternal characteristics, or the day of the week on which the infant was born were significantly associated with timely receipt of a birth dose of HBV vaccine. Receipt of HBV vaccine on the day of birth or the following calendar day were considered a timely birth dose. Among 409 infants in our cohort, 133 infants (33%) received a timely birth dose of HBV vaccine. Only the day of the week on which infants were born was significant (p<0.0001): when compared to Friday, infants born Monday through Thursday had significantly higher odds of receiving a timely birth dose, while infants born on a Saturday or Sunday had similar (low) odds. We found no association between maternal age, education, marital status, HIV status, parity and mode of delivery, and infant receipt of a timely birth dose of HBV vaccine. National immunization programs could improve timely HBV birth dose rates by providing access to vaccine immediately following birth at all infant delivery venues on all days of the week. Where not possible, there should be rapid linkage to the nearest facility where HBV vaccination is immediately available.
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Affiliation(s)
- Florence O Bada
- Department of Epidemiology and Public Health, Graduate Program in Life Sciences, University of Maryland School of Medicine, Baltimore, MD, United States of America
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria
| | - Kristen A Stafford
- Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States of America
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Sophia Osawe
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria
- Plateau State Human Virology Research Center, Plateau State, Nigeria
| | - Eleanor Wilson
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Nadia A Sam-Agudu
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria
- Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Hegang Chen
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Alash'le Abimiku
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria
- Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - James D Campbell
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, United States of America
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22
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Anukam O, Blanco N, Jumare J, Lo J, Babatunde E, Odafe S, Onotu D, Ene U, Fagbamigbe J, Carpenter D, Rivadeneira ED, Omoigberale AI, Charurat M, Swaminathan M, Stafford KA. Outcomes of HIV Positive Children and Adolescents Initiated on Antiretroviral Treatment in Nigeria (2007-2016). J Int Assoc Provid AIDS Care 2022; 21:23259582221117009. [PMID: 35929105 PMCID: PMC9358598 DOI: 10.1177/23259582221117009] [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] [Indexed: 12/04/2022] Open
Abstract
Background: This manuscript aimed to examine treatment outcomes of HIV-positive children and adolescents. Methods: We retrospectively analyzed data of a sample of patients aged 0–19 years who initiated ART (October 2007–September 2016) in participating sites in 30 states and the Federal Capital Territory in Nigeria. Results: Among 4006 patients alive at the end of the follow up period, 138 (3.4%) were LTFU. Adolescents had a significantly higher risk of being LTFU than children aged 3–5 years (HR 2.47 [95% CI 1.40-4.34]). Patients with advanced disease had a significantly higher risk of being LTFU (Stage IV HR, 3.66 [95% CI: 2.00-6.68]). On average, optimal ART refill adherence was met by 67.3% of patients. Conclusion: Our findings suggest that focusing on preventing and managing advanced disease and interventions supporting adolescents when transferring to adult care is warranted.
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Affiliation(s)
| | | | | | - Julia Lo
- 12265University of Maryland, Baltimore, MD, USA
| | | | - Solomon Odafe
- Division of Global HIV & Tuberculosis, Center for Global Health, 1242Centers for Disease Control and Prevention, Abuja, Nigeria
| | - Dennis Onotu
- Division of Global HIV & Tuberculosis, Center for Global Health, 1242Centers for Disease Control and Prevention, Abuja, Nigeria
| | - Uzoma Ene
- Division of Global HIV & Tuberculosis, Center for Global Health, 1242Centers for Disease Control and Prevention, Abuja, Nigeria
| | - Johnson Fagbamigbe
- Division of Global HIV & Tuberculosis, Center for Global Health, 1242Centers for Disease Control and Prevention, Abuja, Nigeria
| | - Deborah Carpenter
- Division of Global HIV & Tuberculosis, Center for Global Health, 1242Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Emilia D Rivadeneira
- Division of Global HIV & Tuberculosis, Center for Global Health, 1242Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Austin I Omoigberale
- Paediatric Association of Nigeria, Abuja, Nigeria.,Department of Child Health, 251350University of Benin Teaching Hospital, Benin City, Nigeria
| | | | - Mahesh Swaminathan
- Division of Global HIV & Tuberculosis, Center for Global Health, 1242Centers for Disease Control and Prevention, Abuja, Nigeria
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23
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O'Neil PJ, Stafford KA, Ryscavage PA. Assessing risk factors for hypertension in young adults with perinatally acquired HIV infection: A case-control study. HIV Med 2021; 23:457-464. [PMID: 34725913 DOI: 10.1111/hiv.13199] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 04/28/2021] [Accepted: 10/10/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Although the risk of AIDS-associated diseases has declined dramatically with combination antiretroviral therapy (cART), the incidence rates of chronic non-AIDS-associated diseases in perinatally HIV-infected adults have risen and have not been well characterized. Both traditional and HIV-associated risk factors have been found to contribute to hypertension in non-perinatally HIV-infected adults; whether these same factors contribute to hypertension in perinatally infected adults is not known. The purpose of this study was to determine the socio-demographic, clinical, virological and immunological factors associated with systemic hypertension among a cohort of perinatally HIV-infected adolescents and young adults. METHODS We conducted a case-control study among a population of adults aged 18-35 years with perinatally acquired HIV infection receiving care at the University of Maryland Medical Center. Covariates assessed included traditional risk factors such as age, family history of hypertension, and smoking, as well as numerous HIV- and antiretroviral-associated covariates, including CD4 nadir. RESULTS Approximately 31% of the cohort met criteria for hypertension. There were no significant differences in the odds of most traditional or HIV-associated risk factors among perinatally HIV-infected adults with hypertension compared with those with no diagnosis of hypertension. Exposure to lopinavir/ritonavir was associated with greater odds of not having hypertension, while a concurrent diagnosis of chronic kidney disease (CKD) was associated with greater odds of having hypertension. CONCLUSIONS The results of this study suggest that most traditional and HIV-related risk factors do not appear to increase the odds of having hypertension in this cohort of individuals. The aetiology of hypertension in this population remains to be elucidated.
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Affiliation(s)
- Patrick J O'Neil
- Greater Lawrence Family Health Center, Lawrence, Massachusetts, USA
| | - Kristen A Stafford
- Institute of Human Virology, University of Maryland Medical School, Baltimore, Maryland, USA
| | - Patrick A Ryscavage
- Institute of Human Virology, University of Maryland Medical School, Baltimore, Maryland, USA
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24
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McIntyre AF, Mitchell A, Stafford KA, Nwafor SU, Lo J, Sebastian V, Schwitters AM, Swaminathan M, Dalhatu I, Charurat ME. Key population size estimation in Nigeria: applying Bayesian methods for the analysis of three-source capture-recapture data (Preprint). JMIR Public Health Surveill 2021; 8:e34555. [DOI: 10.2196/34555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 07/18/2022] [Accepted: 09/06/2022] [Indexed: 11/13/2022] Open
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25
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Koech E, Stafford KA, Mutysia I, Katana A, Jumbe M, Awuor P, Lavoie MC, Ngunu C, Riedel DJ, Ojoo S. Factors Associated with Loss to Follow-Up Among Patients Receiving HIV Treatment in Nairobi, Kenya. AIDS Res Hum Retroviruses 2021; 37:642-646. [PMID: 33913735 DOI: 10.1089/aid.2020.0292] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We investigated factors associated with loss to follow-up (LTFU) in 24 urban health facilities in Nairobi, Kenya. We conducted a retrospective analysis of routinely collected data to assess factors associated with LTFU in the period October 1, 2016, to June 30, 2017. LTFU was defined as no antiretroviral therapy (ART) refill for ≥90 days and no documentation of transfer, death, or treatment cessation in the patient chart, and if no lapse of ≥90 days between ART refills, patients were considered retained in care. Multivariable logistic regression modeling was used to compute odds ratios and 95% confidence interval (CI) for LTFU. Our analysis included 633 individuals who were LTFU and 13,098 individuals retained in care. Most participants (69.6%) were women, and median age was 33.0 years (interquartile range, 27.2-38.3 years). Median ART duration was shorter among those LTFU (0.4 years) than retained patients (2.5 years, p < .0001). Being male [adjusted odds ratio (aOR) 1.30; 95% CI: 1.04-1.63, p = .02], transferring into facilities while already receiving ART (aOR 11.58; 95% CI: 8.23-16.29, p < .0001), and having a shorter ART duration (<6 months) were associated with increased odds of LTFU. Patients who transferred into a facility while already receiving ART had the highest adjusted odds of being LTFU compared with those retained in care. In this urban and highly mobile population, transferring into facilities while already receiving ART was strongly associated with LTFU. Focusing programming efforts on patients transferring between urban clinics to identify reasons for transfer and potential barriers to treatment adherence could help improve patient outcomes. Supplementary case management and support may be needed to promote a seamless transition and ensure uninterrupted engagement in HIV care and treatment.
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Affiliation(s)
- Emily Koech
- Center for International Health, Education, and Biosecurity Kenya, University of Maryland, Nairobi, Kenya
| | - Kristen A. Stafford
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Immaculate Mutysia
- Division of Global HIV & TB, U.S. Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Abraham Katana
- Division of Global HIV & TB, U.S. Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Marline Jumbe
- Center for International Health, Education, and Biosecurity Kenya, University of Maryland, Nairobi, Kenya
| | - Patrick Awuor
- Center for International Health, Education, and Biosecurity Kenya, University of Maryland, Nairobi, Kenya
| | - Marie-Claude Lavoie
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | | | - David J. Riedel
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Sylvia Ojoo
- Center for International Health, Education, and Biosecurity Kenya, University of Maryland, Nairobi, Kenya
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26
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Zulu PM, Toeque MG, Hachaambwa L, Chirwa L, Fwoloshi S, Siwingwa M, Mbewe M, Rosser JI, Stafford KA, Lindsay B, Mulenga L, Claassen CW. Retrospective Review of Virologic and Immunologic Response in Treatment-Experienced Patients on Third-Line HIV Therapy in Lusaka, Zambia. J Int Assoc Provid AIDS Care 2021; 20:23259582211022463. [PMID: 34080454 PMCID: PMC8182176 DOI: 10.1177/23259582211022463] [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: 11/17/2022] Open
Abstract
Established antiretroviral therapy (ART) programs in sub-Saharan Africa have well-defined first-and second-line therapies but no standard third-line ART regimen. The impact of third-line ART on patients with multiclass-resistant HIV in resource-limited settings has not been well characterized. We conducted a retrospective review of patients on third-line ART at the University Teaching Hospital in Lusaka, Zambia. We assessed virologic and immunologic outcomes following 6 months of third-line therapy and found among those with a documented viral load, viral suppression (≤1000 copies/ml) at 24 weeks was 95% (63/66) with a mean increase in CD4 count of 116 cells/mm3 and viral suppression of 63% (63/100) by imputation of missing data. This study suggests that third-line therapy is clinically and virologically effective among patients with multiclass-resistance in a resource-limited setting in sub-Saharan Africa.
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Affiliation(s)
- Paul Msanzya Zulu
- Division of Infectious Diseases, Department of Medicine, University of Zambia School of Medicine, Lusaka, Zambia.,Adult Infectious Diseases Center, University Teaching Hospital, Lusaka, Zambia.,Zambia National Public Health Institute, Lusaka, Zambia
| | - Mona-Gekanju Toeque
- Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, MD, USA.,University of Maryland School of Medicine, Baltimore, MD, USA
| | - Lottie Hachaambwa
- Division of Infectious Diseases, Department of Medicine, University of Zambia School of Medicine, Lusaka, Zambia.,Adult Infectious Diseases Center, University Teaching Hospital, Lusaka, Zambia.,Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, MD, USA.,University of Maryland School of Medicine, Baltimore, MD, USA
| | - Lameck Chirwa
- Division of Infectious Diseases, Department of Medicine, University of Zambia School of Medicine, Lusaka, Zambia.,Adult Infectious Diseases Center, University Teaching Hospital, Lusaka, Zambia
| | - Sombo Fwoloshi
- Division of Infectious Diseases, Department of Medicine, University of Zambia School of Medicine, Lusaka, Zambia.,Adult Infectious Diseases Center, University Teaching Hospital, Lusaka, Zambia.,Ministry of Health, Ndeke House, Lusaka, Zambia
| | - Mpanji Siwingwa
- Division of Infectious Diseases, Department of Medicine, University of Zambia School of Medicine, Lusaka, Zambia.,Adult Infectious Diseases Center, University Teaching Hospital, Lusaka, Zambia
| | - Melody Mbewe
- Division of Infectious Diseases, Department of Medicine, University of Zambia School of Medicine, Lusaka, Zambia.,Adult Infectious Diseases Center, University Teaching Hospital, Lusaka, Zambia
| | - Joelle I Rosser
- Division of Infectious Diseases & Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Kristen A Stafford
- Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, MD, USA.,University of Maryland School of Medicine, Baltimore, MD, USA
| | - Brianna Lindsay
- Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, MD, USA.,University of Maryland School of Medicine, Baltimore, MD, USA
| | - Lloyd Mulenga
- Division of Infectious Diseases, Department of Medicine, University of Zambia School of Medicine, Lusaka, Zambia.,Adult Infectious Diseases Center, University Teaching Hospital, Lusaka, Zambia.,Ministry of Health, Ndeke House, Lusaka, Zambia
| | - Cassidy W Claassen
- Division of Infectious Diseases, Department of Medicine, University of Zambia School of Medicine, Lusaka, Zambia.,Adult Infectious Diseases Center, University Teaching Hospital, Lusaka, Zambia.,Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, MD, USA.,University of Maryland School of Medicine, Baltimore, MD, USA
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27
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Mohanty K, Cheung HW, Stafford KA, Riedel DJ. Care Outcomes in People Living with HIV and Cancer. Curr Treat Options Infect Dis 2021. [DOI: 10.1007/s40506-021-00252-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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28
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Mwango LK, Stafford KA, Blanco NC, Lavoie MC, Mujansi M, Nyirongo N, Tembo K, Sakala H, Chipukuma J, Phiri B, Nzangwa C, Mwandila S, Nkwemu KC, Saadani A, Mwila A, Herce ME, Claassen CW. Index and targeted community-based testing to optimize HIV case finding and ART linkage among men in Zambia. J Int AIDS Soc 2021; 23 Suppl 2:e25520. [PMID: 32589360 PMCID: PMC7319128 DOI: 10.1002/jia2.25520] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Current healthcare systems fail to provide adequate HIV services to men. In Zambia, 25% of adult men living with HIV were unaware of their HIV status in 2018, and 12% of those who were unaware of their HIV statu were not receiving antiretroviral therapy (ART) due to pervasive barriers to HIV testing services (HTS) and linkage to ART. To identify men and key and priority populations living with HIV in Zambia, and link them to care and treatment, we implemented the Community Impact to Reach Key and Underserved Individuals for Treatment and Support (CIRKUITS) project. We present HTS and ART linkage results from the first year of CIRKUITS. METHODS CIRKUITS aimed to reach beneficiaries by training, mentoring, and deploying community health workers to provide index testing services and targeted community HTS. Community leaders and workplace supervisors were engaged to enable workplace HTS for men. To evaluate the effects of these interventions, we collected age- and sex-disaggregated routinely collected programme data for the first 12 months of the project (October 2018 to September 2019) across 37 CIRKUITS-supported facilities in three provinces. We performed descriptive statistics and estimated index cascades for indicators of interest, and used Chi square tests to compare indicators by age, sex, and district strata. RESULTS Over 12 months, CIRKUITS tested 38,255 persons for HIV, identifying 10,974 (29%) new people living with HIV, of whom 10,239 (93%) were linked to ART. Among men, CIRKUITS tested 18,336 clients and identified 4458 (24%) as HIV positive, linked 4132 (93%) to ART. Men who tested HIV negative were referred to preventative services. Of the men found HIV positive, and 13.0% were aged 15 to 24 years, 60.3% were aged 25 to 39, 20.9% were aged 40 to 49 and 5.8% were ≥50 years old. Index testing services identified 2186 (49%) of HIV-positive men, with a positivity yield of 40% and linkage of 88%. Targeted community testing modalities accounted for 2272 (51%) of HIV-positive men identified, with positivity yield of 17% and linkage of 97%. CONCLUSIONS Index testing and targeted community-based HTS are effective strategies to identify men living with HIV in Zambia. Index testing results in higher yield, but lower linkage and fewer absolute men identified compared to targeted community-based HTS.
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Affiliation(s)
- Linah K Mwango
- Maryland Global Initiatives Corporation Zambia, Lusaka, Zambia
| | - Kristen A Stafford
- Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, MD, USA.,Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA.,Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Natalia C Blanco
- Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, MD, USA.,Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Marie-Claude Lavoie
- Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, MD, USA.,Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Morley Mujansi
- Maryland Global Initiatives Corporation Zambia, Lusaka, Zambia
| | - Nasho Nyirongo
- Maryland Global Initiatives Corporation Zambia, Lusaka, Zambia
| | - Kalima Tembo
- Maryland Global Initiatives Corporation Zambia, Lusaka, Zambia
| | - Henry Sakala
- Maryland Global Initiatives Corporation Zambia, Lusaka, Zambia
| | | | - Beauty Phiri
- Maryland Global Initiatives Corporation Zambia, Lusaka, Zambia
| | - Carol Nzangwa
- Maryland Global Initiatives Corporation Zambia, Lusaka, Zambia
| | - Susan Mwandila
- Maryland Global Initiatives Corporation Zambia, Lusaka, Zambia
| | | | - Ahmed Saadani
- U.S. Center for Disease Control and Prevention, Lusaka, Zambia
| | - Annie Mwila
- U.S. Center for Disease Control and Prevention, Lusaka, Zambia
| | - Michael E Herce
- Institute for Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC, USA.,Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Cassidy W Claassen
- Maryland Global Initiatives Corporation Zambia, Lusaka, Zambia.,Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, MD, USA.,Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
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Lo J, Nwafor SU, Schwitters AM, Mitchell A, Sebastian V, Stafford KA, Ezirim I, Charurat M, McIntyre AF. Key Population Hotspots in Nigeria for Targeted HIV Program Planning: Mapping, Validation, and Reconciliation. JMIR Public Health Surveill 2021; 7:e25623. [PMID: 33616537 PMCID: PMC7939933 DOI: 10.2196/25623] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/31/2020] [Accepted: 01/02/2021] [Indexed: 11/13/2022] Open
Abstract
Background With the fourth highest HIV burden globally, Nigeria is characterized as having a mixed HIV epidemic with high HIV prevalence among key populations, including female sex workers, men who have sex with men, and people who inject drugs. Reliable and accurate mapping of key population hotspots is necessary for strategic placement of services and allocation of limited resources for targeted interventions. Objective We aimed to map and develop a profile for the hotspots of female sex workers, men who have sex with men, and people who inject drugs in 7 states of Nigeria to inform HIV prevention and service programs and in preparation for a multiple-source capture-recapture population size estimation effort. Methods In August 2018, 261 trained data collectors from 36 key population–led community-based organizations mapped, validated, and profiled hotspots identified during the formative assessment in 7 priority states in Nigeria designated by the United States President’s Emergency Plan for AIDS Relief. Hotspots were defined as physical venues wherein key population members frequent to socialize, seek clients, or engage in key population–defining behaviors. Hotspots were visited by data collectors, and each hotspot’s name, local government area, address, type, geographic coordinates, peak times of activity, and estimated number of key population members was recorded. The number of key population hotspots per local government area was tabulated from the final list of hotspots. Results A total of 13,899 key population hotspots were identified and mapped in the 7 states, that is, 1297 in Akwa Ibom, 1714 in Benue, 2666 in Cross River, 2974 in Lagos, 1550 in Nasarawa, 2494 in Rivers, and 1204 in Federal Capital Territory. The most common hotspots were those frequented by female sex workers (9593/13,899, 69.0%), followed by people who inject drugs (2729/13,899, 19.6%) and men who have sex with men (1577/13,899, 11.3%). Although hotspots were identified in all local government areas visited, more hotspots were found in metropolitan local government areas and state capitals. Conclusions The number of key population hotspots identified in this study is more than that previously reported in similar studies in Nigeria. Close collaboration with key population–led community-based organizations facilitated identification of many new and previously undocumented key population hotspots in the 7 states. The smaller number of hotspots of men who have sex with men than that of female sex workers and that of people who inject drugs may reflect the social pressure and stigma faced by this population since the enforcement of the 2014 Same Sex Marriage (Prohibition) Act, which prohibits engaging in intimate same-sex relationships, organizing meetings of gays, or patronizing gay businesses.
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Affiliation(s)
- Julia Lo
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States.,Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Samuel U Nwafor
- Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Abuja, Nigeria
| | - Amee M Schwitters
- Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Abuja, Nigeria
| | - Andrew Mitchell
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Victor Sebastian
- Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Abuja, Nigeria
| | - Kristen A Stafford
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States.,Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, MD, United States.,Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, United States
| | | | - Man Charurat
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States.,Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Anne F McIntyre
- Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States
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Gujaran S, Stafford KA, Riedel DJ. 948. The Changing Dynamics of Hospitalizations Among People Living with HIV Over Time. Open Forum Infect Dis 2020. [PMCID: PMC7777109 DOI: 10.1093/ofid/ofaa439.1134] [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] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
As antiretroviral therapy for HIV has become more successful, people living with HIV (PLWH) are aging. Nearly half (48%) of all PLWH in the U.S. are now ≥ 50 years old, and this proportion is expected to continue to grow. The aging population of PLWH offers new challenges to the healthcare system beyond HIV management, with increased risks for chronic comorbidities and other complications of aging. Few studies have examined the causes and outcomes of hospitalizations among PLWH or how these diagnoses have changed over time.
Methods
Using U.S. hospitalization data from 1993 to 2014 from the National Inpatient Sample, we compared the primary diagnosis at admission among PLWH to HIV-negative hospitalizations and how this changed over time. We also compared the mean age at admission, hospital length of stay, total charges, and hospital disposition.
Results
There were 654,783,064 hospitalizations recorded from 1993 - 2014, with 5,370,749 among PLWH (0.8%) and 649,412,315 among HIV-negative patients (99.2%). The mean age of PLWH on admission increased from 37.4 years in 1993 to 48.1 years in 2014 and was lower than HIV-negative patients every year (Figure 1). There was a significant decrease in the proportion of admissions with HIV as the primary diagnosis for PLWH between 1993 - 2014 (53.1% to 24.2%) with a corresponding increase in non-HIV diagnoses over that time (Figure 2). The proportions of primary admission diagnoses for HIV-Negative patients were largely unchanged over the period. Although mean hospital lengths of stay for PLWH decreased over time, they were consistently longer than HIV-negative patients (Figure 3). Similarly, mean total charges for PLWH increased over time but were consistently higher than those for HIV-negative patients (Figure 3). The proportion of PLWH who died during hospitalization declined from a peak of 8.8% in 1993 to 2.4% in 2014 while inpatient mortality among HIV-negative patients declined from 3.2% to 2.2% over the same time.
Figure 1. Trends of Mean Age for PLWH and HIV-Negative Admissions from 1993 – 2014
Figure 2. Trends of HIV vs. non-HIV as the Primary Admission Diagnoses for PLWH from 1993 – 2014
Figure 3. Trends of Length of Hospital Admission and Total Charges for PLWH and HIV-Negative Patients from 1993 – 2014
Conclusion
The primary admission diagnoses for PLWH has shifted from HIV to non-communicable causes as PLWH are living longer. PLWH are typically younger on admission and have longer and more expensive hospitalizations than HIV-negative patients.
Disclosures
All Authors: No reported disclosures
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Affiliation(s)
- Shruti Gujaran
- University of Maryland School of Medicine, Bethesda, Maryland
| | | | - David J Riedel
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland
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Theppote A, Nelson A, Stafford KA, Wilson E, Kottilil S, Kaplan R. 1060. Evaluation of ALT at Sustained Virologic Response (SVR) in Patients with Treated Hepatitis C Virus (HCV) Infection. Open Forum Infect Dis 2020. [PMCID: PMC7776739 DOI: 10.1093/ofid/ofaa439.1246] [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] [Indexed: 11/23/2022] Open
Abstract
Background With the advent of directly acting antiviral agents, HCV cure rates exceed 90% in real world studies with an excellent safety profile, but viral load tests of cure are expensive and may limit access to treatment, especially in resource-limited settings. Elevated alanine aminotransferase (ALT) has been shown to correlate with hepatocellular damage. Few studies have evaluated the use of ALT in direct acting antiviral (DAA) treated HCV patients post-treatment as a marker of treatment success. In this large retrospective cohort study, we evaluated the ability of serum ALT level at SVR to predict treatment outcome. Methods We collected baseline demographics, treatment characteristics, and outcomes of DAA-treated patients treated between January 2015 through January 2019 in the VA Maryland Healthcare System as standard of care, and patients in federally qualified health centers in Washington, DC treated between May and November 2015 in the ASCEND study (NCT02339038). Using the ASCEND study as a training set and VA data as the confirmatory set, receiver operating curves (ROC) were generated to determine the predictive value of ALT at SVR for treatment outcome. Results In total, 1415 patients were included, with 1010 patients from the VA and 405 from the ASCEND cohort. We found 96% (n=1360) of patients achieved SVR; < 4% (n =55) relapsed. Baseline demographics are in Table 1. The ALT at SVR were 21.19 IU/L (SD 13.98) and 17.89 IU/L (SD 11.62) in the VA and ASCEND data, respectively compared to 57.84 (SD 41.06) and 42.53 (SD 19.61) who relapsed. With the VA and ASCEND data combined, the mean ALT at SVR was 20.25 (SD 13.43) in comparison to an ALT of 53.11 (SD 36.33) for those patients who relapsed. ROC analysis revealed that ALT > 22 predicted an increased risk of relapse (Figure 1). Table 1:Characteristics of Subjects Completing Hepatitis C Treatment ![]()
Figure 1: ROC Curve ![]()
Conclusion In this real-world cohort, we found that ALT greater than 22 at SVR corresponded with an increased risk of relapse and was independent of variables previously associated with relapse, including HIV coinfection status, sex, treatment history, and fibrosis staging. Limiting HCV viral load testing to patients with ALT > 22 at SVR may reduce the overall burden of HCV treatment costs for the majority of HCV treated patients. Disclosures Shyam Kottilil, MD PhD, Arbutus Pharmaceuticals (Grant/Research Support)Gilead Sciences (Grant/Research Support)Merck Inc (Grant/Research Support, Advisor or Review Panel member)
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Affiliation(s)
- Amanda Theppote
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Amy Nelson
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland
| | | | - Eleanor Wilson
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland
| | | | - Roman Kaplan
- Baltimore VA Medical Healthcare Center, Baltimore, Maryland
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Emmanuel B, El-Kamary SS, Magder LS, Stafford KA, Charurat ME, Chairez C, McLaughlin M, Hadigan C, Prokunina-Olsson L, O'Brien TR, Masur H, Kottilil S. Metabolic Changes in Chronic Hepatitis C Patients Who Carry IFNL4-ΔG and Achieve Sustained Virologic Response With Direct-Acting Antiviral Therapy. J Infect Dis 2020; 221:102-109. [PMID: 31504644 DOI: 10.1093/infdis/jiz435] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 04/20/2019] [Accepted: 08/21/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Clearance of hepatitis C virus (HCV) results in rapid changes in metabolic parameters early in direct-acting antiviral (DAA) therapy. Long-term changes after sustained virologic response (SVR) remain unknown. METHODS We investigated longitudinal changes in metabolic and inflammatory outcomes in chronic hepatitis C (CHC) patients: low-density lipoprotein (LDL), high-density lipoprotein, triglycerides, alanine aminotransferase (ALT), and aspartate aminotransferase (AST) using a general linear model for repeated measurements at 5 clinical time points and by human immunodeficiency virus (HIV) coinfection and IFNL4 genotype. RESULTS The mean LDL increased markedly during DAA therapy (pre-DAA, 86.6 to DAA, 107.4 mg/dL; P < .0001), but then it decreased to 97.7 mg/dL by post-SVR year 1 (P < .001 compared with DAA; P = .0013 compared with SVR). In patients who carry the IFNL4-ΔG allele, mean LDL increased during treatment, then decreased at post-SVR year 1; however, in patients with TT/TT, genotype did not change during and after DAA treatment. The mean ALT and AST normalized rapidly between pre-DAA and DAA, whereas only mean ALT continued to decrease until post-SVR. Metabolic and inflammatory outcomes were similar by HIV-coinfection status. CONCLUSIONS Changes in LDL among CHC patients who achieved SVR differed by IFNL4 genotype, which implicates the interferon-λ4 protein in metabolic changes observed in HCV-infected patients.
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Affiliation(s)
- Benjamin Emmanuel
- Division of Clinical Care and Research, Institute of Human Virology, Baltimore, Maryland
| | | | | | - Kristen A Stafford
- Division of Clinical Care and Research, Institute of Human Virology, Baltimore, Maryland.,Department of Epidemiology and Public Health, Baltimore, Maryland
| | - Man E Charurat
- Department of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Cheryl Chairez
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland
| | - Mary McLaughlin
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland
| | - Colleen Hadigan
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland
| | | | - Thomas R O'Brien
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Henry Masur
- Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Shyam Kottilil
- Division of Clinical Care and Research, Institute of Human Virology, Baltimore, Maryland
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Tooker GM, Stafford KA, Nishioka J, Badros AZ, Riedel DJ. Intravesicular Cidofovir in the Treatment of BK Virus-Associated Hemorrhagic Cystitis Following Hematopoietic Stem Cell Transplantation. Ann Pharmacother 2019; 54:547-553. [PMID: 31876431 DOI: 10.1177/1060028019897896] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: BK virus hemorrhagic cystitis (BKV-HC) is a common complication following hematopoietic stem cell transplant (HSCT); optimal management remains uncertain. Supportive care (bladder irrigation and blood transfusions) and intravenous and intravesicular cidofovir have all been used with varying success. Objective: The purpose of this study was to determine the safety and effectiveness of intravesicular cidofovir for BKV-HC following HSCT. Methods: A retrospective analysis of all HSCT patients with BKV-HC prescribed intravesicular cidofovir from 2012 to 2017. Results: 33 patients were treated for BKV-HC. The median age was 50 years (range 23-73), and 18 (55%) were male. The median HC symptom severity was 2, with a median BK urine viral load pretreatment of 100,000,000 IU/mL. Patients received a median of 2 intravesicular treatments (range 1-7) at a dosage of 5 mg/kg per instillation. In all, 19 (59%) patients demonstrated complete clinical resolution of symptoms; 9 (28%) had a partial response; and 4 (13%) had no change in symptoms. Patients with a high pretreatment BK viral load (>100 million) and high HC grade (2-4) had a lower frequency of complete remission. The main side effect of intravesicular instillation was severe bladder spasms in 4 patients (12%). Conclusion and Relevance: This is the largest study of intravesicular cidofovir treatment of BKV HC reported to date; 88% of patients with BVK-HC achieved clinical improvement of symptoms with minimal side effects. Clinical trials of intravesicular cidofovir could provide further evidence for this treatment for BKV-HC.
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Affiliation(s)
- Graham M Tooker
- University of Maryland Medical Center Midtown Campus, Baltimore, MD, USA
| | | | | | - Ashraf Z Badros
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - David J Riedel
- University of Maryland School of Medicine, Baltimore, MD, USA
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O’Neil P, Ryscavage P, Stafford KA. 346. Factors Associated with Hypertension in Young Adults with Perinatally-Acquired HIV Infection: a Case–Control Study. Open Forum Infect Dis 2019. [PMCID: PMC6810400 DOI: 10.1093/ofid/ofz360.419] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background The incidence of systemic hypertension (HTN) among perinatally-HIV-infected (PHIV) patients appears to increase as they enter adulthood. Among non-perinatally HIV-infected adults both traditional and HIV-associated risk factors have been found to contribute to HTN. Whether these same factors contribute to HTN in PHIV is unknown. The purpose of this study was to determine the socio-demographic, clinical, virologic, and immunologic factors associated with HTN among a cohort of PHIV adolescents and young adults, aged ≥18 years. Methods We conducted a case–control study among a population of 160 PHIV adults with and without HTN who were receiving care at the University of Maryland and aged 18–35 years as of December 31, 2017. Covariates assessed included traditional risk factors such as age, family history of HTN, and smoking, as well as HIV- and antiretroviral-associated covariates. Results We identified 49 HTN cases (30.6%) and 111 (69.4%) controls. There were no significant differences in the odds of most traditional (age, gender, race, family history of HTN, tobacco, alcohol, and/or other drug use) or HIV-associated (CD4 nadir <100 cells/mm3, individual ART exposure, ART interruption) risk factors among PHIV adults with HTN compared with those with no diagnosis of HTN. Cases had lower odds of a history of treatment with lopinavir/ritonavir (LPV/r). Cases had 3.7 (95% CI 1.11, 12.56) times the odds of a prior diagnosis of chronic kidney disease (CKD) compared with controls after controlling for CD4 nadir and ARV treatment history. Conclusion The results of this study suggest that most traditional and HIV-related risk factors do not appear to increase the odds of having HTN in this PHIV cohort. However, HTN among PHIV may be driven in part by CKD, and a focus on the prevention and early management of CKD in this group may be necessary to prevent the development of HTN. Additionally, there may be as yet unidentified risk factors for HTN among PHIV which require further exploration. Given the large and growing population of PHIV entering adulthood worldwide, it is imperative to explore risk factors for and effects of HTN in large, diverse PHIV populations. Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Patrick O’Neil
- Greater Lawrence Family Health Center, Baltimore, Maryland
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Chua JV, Davis C, Nelson A, Lam KWJ, Mutumbi L, Stafford KA, Gilliam B, DeVico AL, Lewis GK, Sajadi MM. 2838. Safety and Immunogenicity of a gp120-CD4 Chimeric Subunit Vaccine: A Phase 1a Randomized Controlled Trial. Open Forum Infect Dis 2019. [PMCID: PMC6809108 DOI: 10.1093/ofid/ofz359.143] [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] [Indexed: 11/17/2022] Open
Abstract
Background A primary challenge for HIV vaccine development is to raise antiviral antibodies capable of recognizing highly variable viral antigens. The full-length single chain (FLSC) gp120-CD4 chimeric protein was designed to present a highly conserved CD4-induced HIV-1 envelope structure that evokes cross-reactive humoral responses (Figure 1). IHV01 is an FLSC subunit vaccine formulated in alum adjuvant. The safety and immunogenicity of IHV01 was evaluated in this first-in-human phase 1a trial. Methods This randomized, double-blind placebo-controlled study involved three dose-escalating cohorts (75 µg, 150 µg, and 300 µg doses). Eligible participants were HIV-1 uninfected healthy volunteers aged 18 to 45 years. Participants in each cohort were block randomized in groups of four in a 3:1 ratio to receive either vaccine or placebo. Intramuscular injections were given on weeks 0, 4, 8, and 24. Participants were followed for an additional 24 weeks after the last immunization. Crossreactive antibody binding titers against diverse HIV envelopes and antigens and specific CD4i epitopes on gp120 were assessed. Results Sixty-five volunteers were enrolled—49 vaccine and 16 placebo. Majority (81%) of vaccinations with IHV01 produced no localized or systemic reactions; no different from the control group. The overall incidence of adverse events (AEs) was not significantly different between groups. Majority (89%) of vaccine-related AEs were mild in severity. The most common vaccine-related AEs were injection site pain (31%), pruritus (10%), and headache (10%). There were no vaccine-related serious AE, discontinuation due to AE, or intercurrent HIV infection. By the final vaccination, all subjects in all cohorts had developed antibodies against IHV01; all placebo recipients were negative. The antibodies induced by IHV01 reacted with envelope antigens from diverse HIV-1 strains (Figure 2). Conclusion IHV01 vaccine was safe, well tolerated, and immunogenic in all doses tested. The vaccine raised broadly reactive humoral responses against multiple gp120 domains, transition state structures, and CD4i epitopes. ![]()
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Disclosures All Authors: No reported Disclosures.
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Affiliation(s)
- Joel V Chua
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Charles Davis
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Amy Nelson
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Ka Wing J Lam
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Lydiah Mutumbi
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland
| | | | - Bruce Gilliam
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Anthony L DeVico
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland
| | - George K Lewis
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Mohammad M Sajadi
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland
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Abstract
The World Health Organization recommended removing all CD4 requirements for initiation of
antiretroviral therapy (ART) in resource-limited settings. We examined the pre-ART period
to identify and assess factors associated with outcomes of pre-ART care. Four modes of
transition out of pre-ART care were considered. Beta estimates from the competing risks
Cox models were used to investigate whether the effects of covariates differed by mode of
transition. Median CD4 counts at entry showed no meaningful change over time. Advanced
disease progression and presence of opportunistic infections were significant predictors
of pre-ART mortality. Men were more likely to die before initiating ART, transfer to
another facility, or be lost to follow-up than were women. Removing CD4 thresholds is not
likely to substantially reduce program mortality prior to ART initiation unless and until
patients enroll earlier in disease progression. Care programs should focus on diagnosis
and treatment of opportunistic infections to reduce pre-ART mortality.
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Affiliation(s)
- Kristen A Stafford
- 1 Division of Clinical Care & Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Tuhuma Tulli
- 3 The Palladium Group, Dar es Salaam, United Republic of Tanzania
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Stafford KA, Odafe SF, Lo J, Ibrahim R, Ehoche A, Niyang M, Aliyu GG, Gobir B, Onotu D, Oladipo A, Dalhatu I, Boyd AT, Ogorry O, Ismail L, Charurat M, Swaminathan M. Evaluation of the clinical outcomes of the Test and Treat strategy to implement Treat All in Nigeria: Results from the Nigeria Multi-Center ART Study. PLoS One 2019; 14:e0218555. [PMID: 31291273 PMCID: PMC6619660 DOI: 10.1371/journal.pone.0218555] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 06/04/2019] [Indexed: 12/30/2022] Open
Abstract
In December 2016, the Nigerian Federal Ministry of Health updated its HIV guidelines to a Treat All approach, expanding antiretroviral therapy (ART) eligibility to all individuals with HIV infection, regardless of CD4+ cell count, and recommending ART be initiated within two weeks of HIV diagnosis (i.e., the Test and Treat strategy). The Test and Treat policy was first piloted in 32 local government areas (LGAs). The primary objective of this study was to evaluate the clinical outcomes of adult patients initiated on ART within two weeks of HIV diagnosis during this pilot. We conducted a retrospective cohort analysis of patients who initiated ART within two weeks of new HIV diagnosis between October 2015 and September 2016 in eight randomly selected LGAs participating in the Test and Treat pilot study. 2,652 adults were newly diagnosed and initiated on ART within two weeks of HIV diagnosis. Of these patients, 8% had documentation of a 12-month viral load measurement, and 13% had documentation of a six-month viral load measurement. Among Test and Treat patients with a documented viral load, 79% were suppressed (≤400 copies/ml) at six months and 78% were suppressed at 12 months. By 12 months post-ART initiation, 34% of the patients who initiated ART under the Test and Treat strategy were lost to follow-up. The median CD4 cell count among patients initiating ART within two weeks of HIV diagnosis was 323 cells/mm3 (interquartile range, 161–518). While randomized controlled trials have demonstrated that Test and Treat strategies can improve patient retention and increase viral suppression compared to standard of care, these findings indicate that the effectiveness of Test and Treat in some settings may be far lower than the efficacy demonstrated in randomized controlled trials. Significant attention to the way Test and Treat strategies are implemented, monitored, and improved particularly related to early retention, can help expand access to ART for all patients.
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Affiliation(s)
- Kristen A. Stafford
- Department of Epidemiology and Public Health, University of Maryland, Baltimore, Maryland, United States of America
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- * E-mail:
| | - Solomon F. Odafe
- Centers for Disease Control and Prevention, CGH/DGHT, Abuja, Nigeria
| | - Julia Lo
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Ramat Ibrahim
- Maryland Global Initiatives Corporation, Abuja, Nigeria
| | - Akipu Ehoche
- Maryland Global Initiatives Corporation, Abuja, Nigeria
| | - Mercy Niyang
- Maryland Global Initiatives Corporation, Abuja, Nigeria
| | - Gambo G. Aliyu
- Department of Epidemiology and Public Health, University of Maryland, Baltimore, Maryland, United States of America
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Bola Gobir
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Maryland Global Initiatives Corporation, Abuja, Nigeria
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Dennis Onotu
- Centers for Disease Control and Prevention, CGH/DGHT, Abuja, Nigeria
| | - Ademola Oladipo
- Centers for Disease Control and Prevention, CGH/DGHT, Abuja, Nigeria
| | - Ibrahim Dalhatu
- Centers for Disease Control and Prevention, CGH/DGHT, Abuja, Nigeria
| | - Andrew T. Boyd
- Centers for Disease Control and Prevention, CGH/DGHT, Atlanta, Georgia, United States of America
| | | | - Lawal Ismail
- Walter Reed Army Institute of Research, Military HIV Research Program, Abuja, Nigeria
| | - Manhattan Charurat
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
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Emmanuel B, El-Kamary SS, Magder LS, Stafford KA, Charurat ME, Poonia B, Chairez C, McLaughlin M, Hadigan C, Masur H, Kottilil S. Immunological recovery in T-cell activation after sustained virologic response among HIV positive and HIV negative chronic Hepatitis C patients. Hepatol Int 2019; 13:270-276. [PMID: 30835046 PMCID: PMC10900133 DOI: 10.1007/s12072-019-09941-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 02/19/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Rapid decreases in activated CD4+ and CD8+ (HLA-DR + and CD38+ co-expressed) T-lymphocytes have been described within 1-2 weeks of initiating direct-acting antiviral (DAA) therapy among chronic Hepatitis C (CHC) patients. However, it is not known whether these changes are maintained past sustained virologic response (SVR), particularly in those who are HIV/HCV-coinfected. METHODS We investigated the changes in immune parameters of T-lymphocytes from pre-DAA therapy to post-SVR among HIV negative and HIV positive patients with CHC. Repeated measurements of activated CD4+ and CD8+ T cells were analyzed by flow cytometry at pre-DAA therapy, DAA therapy, end of treatment, SVR, and post-SVR. A general linear model for repeated measurements was used to estimate the mean outcome at each timepoint and change between timepoints. RESULTS HCV-monoinfected (n = 161) and HIV/HCV-coinfected (n = 59) patients who achieved SVR with DAA therapy were predominately middle aged, male, black, and non-cirrhotic. At pre-DAA therapy, HCV-monoinfected patients had significantly higher CD4+ T cells and CD4+:CD8+ T-cell ratio, while significantly lower CD8+ and activated CD4+ and CD8+ T cells compared to HIV/HCV-coinfected patients (p < 0.0001). HCV-monoinfected and HIV/HCV-coinfected patients had a significant mean decrease from pre-DAA therapy to post-SVR year 1 for activated CD4+ (HCV-monoinfected: 4.8-3.9%, p < 0.0001; HIV/HCV-coinfected: 6.6-4.5%, p < 0.0001) and activated CD8+ T cells (HCV-monoinfected V: 13.8-11.8%, p = 0.0002; HIV/HCV-coinfected: 18.0-12.4%, p < 0.0001). CONCLUSION This longitudinal study showed CHC patients treated with DAA therapy had continued decrease of T-lymphocytes from start of DAA therapy to after achievement of SVR suggesting improvement as HCV clearance normalizes activated T-cell phenotype.
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Affiliation(s)
- Benjamin Emmanuel
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, 725 W. Lombard Street, Baltimore, MD, 21201, USA
| | - Samer S El-Kamary
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, USA
| | - Laurence S Magder
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, USA
| | - Kristen A Stafford
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, 725 W. Lombard Street, Baltimore, MD, 21201, USA
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, USA
| | - Man E Charurat
- Department of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, USA
| | - Bhawna Poonia
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, 725 W. Lombard Street, Baltimore, MD, 21201, USA
| | - Cheryl Chairez
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, USA
| | - Mary McLaughlin
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, USA
| | - Colleen Hadigan
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, USA
| | - Henry Masur
- Clinical Center, National Institutes of Health, Bethesda, USA
| | - Shyam Kottilil
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, 725 W. Lombard Street, Baltimore, MD, 21201, USA.
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Andronescu L, Zulu PM, Jackson SS, Hachaambwa L, Claassen CW, Stafford KA. The association between gender and HIV viral suppression on third-line therapy in Zambia: a retrospective cohort study. Int J STD AIDS 2019; 30:453-459. [PMID: 30999831 DOI: 10.1177/0956462418817645] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patient's gender may impact pharmacokinetics and play a role in viral suppression. Existing literature has focused on treatment-naïve patients and produced inconclusive results, often implicating differences in adherence as the driver of gender-based outcome differences. The present analysis assessed whether viral suppression on third-line HIV treatment among a closely followed population differs by gender. A retrospective cohort study of patients on third-line HIV treatment was initiated at the HIV Advanced Treatment Centre in Lusaka, Zambia between January 2012 and December 2015. The association between gender and viral suppression was assessed using log binomial regression adjusted for core drug, number of drug mutations, and baseline viral load. Of the 80 included patients (56% female; median age: 40 years), 50 (62%) were virally suppressed at six months. After adjustment, females were less likely to be virologically suppressed at six months on third-line treatment compared to male HIV patients (relative risk 0.82, 95% confidence interval: 0.56, 1.20). Our data suggest that women were less likely to be suppressed following six months of third-line therapy compared to men; however, the difference was not statistically significant. Larger studies are needed to determine whether women are at increased risk of viral failure on third-line therapy compared to men.
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Affiliation(s)
- Liana Andronescu
- 1 Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Paul M Zulu
- 2 University of Zambia School of Medicine, Lusaka, Zambia.,3 Maryland Global Initiatives Corporation, University of Maryland School of Medicine, Lusaka, Zambia.,4 Division of Clinical Care and Research, Institute of Human Virology, Baltimore, MD, USA
| | - Sarah S Jackson
- 1 Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Lottie Hachaambwa
- 2 University of Zambia School of Medicine, Lusaka, Zambia.,3 Maryland Global Initiatives Corporation, University of Maryland School of Medicine, Lusaka, Zambia.,4 Division of Clinical Care and Research, Institute of Human Virology, Baltimore, MD, USA
| | - Cassidy W Claassen
- 2 University of Zambia School of Medicine, Lusaka, Zambia.,3 Maryland Global Initiatives Corporation, University of Maryland School of Medicine, Lusaka, Zambia.,4 Division of Clinical Care and Research, Institute of Human Virology, Baltimore, MD, USA
| | - Kristen A Stafford
- 1 Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA.,4 Division of Clinical Care and Research, Institute of Human Virology, Baltimore, MD, USA
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Jackson SS, Harris AD, Magder LS, Stafford KA, Johnson JK, Miller LG, Calfee DP, Thom KA. Bacterial burden is associated with increased transmission to health care workers from patients colonized with vancomycin-resistant Enterococcus. Am J Infect Control 2019; 47:13-17. [PMID: 30268592 DOI: 10.1016/j.ajic.2018.07.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 07/12/2018] [Accepted: 07/12/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Health care workers (HCWs) are significant vectors for transmission of multidrug-resistant organisms among patients in intensive care units (ICUs). We studied ICU patients on contact precautions, colonized with vancomycin-resistant Enterococcus (VRE), to assess whether bacterial burden is associated with transmission to HCWs' gloves or gowns, a surrogate outcome for transmission to subsequent patients. METHODS From this prospective cohort study, we analyzed 96 VRE-colonized ICU patients and 5 HCWs per patient. We obtained samples from patients' perianal area, skin, and stool to assess bacterial burden and cultured HCWs' gloves and gowns for VRE after patient care. RESULTS Seventy-one of 479 (15%) HCW-patient interactions led to contamination of HCWs' gloves or gowns with VRE. HCW contamination was associated with VRE burden on the perianal swab (odds ratio [OR], 1.37; 95% confidence interval [CI], 1.19, 1.57), skin swabs (OR, 2.14; 95% CI, 1.51, 3.02), and in stool (OR, 1.95; 95% CI, 1.39, 2.72). Compared with colonization with Enterococcus faecalis, colonization with Enterococcus faecium was associated with higher bacterial burden and higher odds of transmission to HCWs. CONCLUSIONS We show that ICU patients with higher bacterial burden are more likely to transmit VRE to HCWs. These findings have implications for VRE decolonization and other infection control interventions.
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Odafe S, Stafford KA, Gambo A, Onotu D, Swaminathan M, Dalhatu I, Ene U, Ademola O, Mukhtar A, Ramat I, Akipu E, Debem H, Boyd AT, Sunday A, Gobir B, Charurat ME. Health Workers' Perspectives on the Outcomes, Enablers, and Barriers to the Implementation of HIV "Test and Treat" Guidelines in Abuja, Nigeria. J AIDS HIV Treat 2019; 1:33-45. [PMID: 32328591 PMCID: PMC7179071] [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] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
We evaluated health workers' perspectives on the implementation of the 2016 HIV "Test and Treat" guidelines in Nigeria. Using semi-structured interviews, qualitative data was collected from twenty health workers meeting inclusion criteria in six study sites. Data exploration was conducted using thematic content analysis. Participants perceived that the "Test and Treat" guidelines improved care for PLHIV, though they also perceived possible congested clinics. Perceived key factors enabling guidelines use were perceived patient benefits, availability of policy document and trainings. Perceived key barriers to guidelines use were poverty among patients, inadequate human resources and stock-outs of HIV testing kits. Further improvements in uptake of guidelines could be achieved by effecting an efficient supply chain system for HIV testing kits, and improved guidelines distribution and capacity building prior to implementation. Additionally, implementing differentiated approaches that decongest clinics, and programs that economically empower patients, could improve guidelines use, as Nigeria scales "Test and Treat" nationwide.
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Affiliation(s)
- Solomon Odafe
- Division of Global HIV/AIDS, Centre for Global Health, U.S. Centers for Disease Control & Prevention, Abuja, Nigeria,Correspondence should be addressed to Solomon Odafe;
| | - Kristen A. Stafford
- Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, USA
| | - Aliyu Gambo
- Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, USA
| | - Dennis Onotu
- Division of Global HIV/AIDS, Centre for Global Health, U.S. Centers for Disease Control & Prevention, Abuja, Nigeria
| | - Mahesh Swaminathan
- Division of Global HIV/AIDS, Centre for Global Health, U.S. Centers for Disease Control & Prevention, Abuja, Nigeria
| | - Ibrahim Dalhatu
- Division of Global HIV/AIDS, Centre for Global Health, U.S. Centers for Disease Control & Prevention, Abuja, Nigeria
| | - Uzoma Ene
- Division of Global HIV/AIDS, Centre for Global Health, U.S. Centers for Disease Control & Prevention, Abuja, Nigeria
| | - Oladipo Ademola
- Division of Global HIV/AIDS, Centre for Global Health, U.S. Centers for Disease Control & Prevention, Abuja, Nigeria
| | - Ahmed Mukhtar
- Division of Global HIV/AIDS, Centre for Global Health, U.S. Centers for Disease Control & Prevention, Abuja, Nigeria
| | - Ibrahim Ramat
- Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, USA
| | - Ehoche Akipu
- Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, USA
| | - Henry Debem
- Division of Global HIV/AIDS, Centre for Global Health, U.S. Centers for Disease Control & Prevention, Abuja, Nigeria
| | - Andrew T. Boyd
- Division of Global HIV/AIDS, Centre for Global Health, U.S. Centers for Disease Control & Prevention, Atlanta, USA
| | - Aboje Sunday
- National AIDS & STIs Control Program, Federal Ministry of Health, Abuja, Nigeria
| | - Bola Gobir
- Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, USA
| | - Man E. Charurat
- Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, USA
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Cheung H, Stafford KA, Riedel DJ. 2243. Improving HIV Outcomes Among HIV-Infected Patients Diagnosed with Cancer and Followed in an Integrated, Multidisciplinary, Infectious Disease/Cancer Clinic. Open Forum Infect Dis 2018. [PMCID: PMC6252559 DOI: 10.1093/ofid/ofy210.1896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Patients dually diagnosed with HIV and cancer have poorer outcomes compared with general cancer patients. HIV management in the setting of cancer is complicated by multiple specialist involvement, drug–drug interactions, and overlapping drug toxicities. Past studies of HIV-infected patients noted improved virologic suppression, CD4 counts, and adherence with access to multidisciplinary services. A multidisciplinary clinic (HIV specialists (doctors and nurses), pharmacists, social workers, etc.) embedded in the University’s Outpatient Cancer Center starting in late 2011 sought to improve virologic suppression and care coordination for dually diagnosed patients. Methods HIV outcomes for patients seen in the multidisciplinary clinic (≥2 visits) from 2012 to 2016 (N = 51) were compared with a historical cohort seen from 2007 to 2011 (N = 565). Results In the pre- vs. post-integration cohorts, the median age at cancer diagnosis was 51 vs. 46 years (range 24–76, P = 0.01), 78% vs. 72% were male (P = 0.37), and 86% vs. 73% were African American (P = 0.04). 53% in the post- cohort had stage IV disease vs. 32% in the pre- cohort. In both cohorts, less than half were on HIV therapy at the time of cancer diagnosis (42% pre- and 43% post-, P = 0.91). Baseline median CD4 count at cancer diagnosis in the post-cohort was lower (171, IQR 70–310) than the pre- cohort (274, IQR 120–462; P = 0.20), and baseline median HIV viral load was higher (post-16,802 vs. pre-1,985). Viral suppression at cancer diagnosis was similar (42% pre- vs. 40% post-), but at study end, 75% of patients in the post-cohort had viral suppression vs. 63% in the pre-cohort (P = 0.09). Patients followed in the integrated clinic were 1.41 (95% CI, 0.91, 3.53) times more likely to be virally suppressed at end of follow-up compared with patients from the pre-integration cohort. Conclusion HIV-infected patients who received care at the multidisciplinary, integrated HIV clinic were more likely to be virally suppressed at the end of study follow-up compared with patients who received HIV care at the medical center prior to HIV clinic incorporation. Integrating HIV care into Cancer Centers may improve HIV treatment outcomes for these dually diagnosed, medically fragile, and complicated patients. Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Helen Cheung
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Kristen A Stafford
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - David J Riedel
- Infectious Disease, Institute of Human Virology and University of Maryland School of Medicine, Baltimore, Maryland
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Kibria GMA, Swasey K, Choudhury A, Burrowes V, Stafford KA, Uddin SMI, Mirbolouk M, Sharmeen A, Kc A, Mitra DK. The new 2017 ACC/AHA guideline for classification of hypertension: changes in prevalence of hypertension among adults in Bangladesh. J Hum Hypertens 2018; 32:608-616. [PMID: 29899377 PMCID: PMC6487869 DOI: 10.1038/s41371-018-0080-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 05/21/2018] [Accepted: 05/21/2018] [Indexed: 12/21/2022]
Abstract
We analyzed the Bangladesh Demographic and Health Survey 2011 data to examine absolute differences in hypertension prevalence according to the hypertension definition of the "2017 American College of Cardiology/American Heart Association (2017 ACC/AHA) Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults" and "Seventh Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC7)" 2003 guidelines. Among 7839 participants ≥35 years, the JNC7 and 2017 ACC/AHA classified 25.7% (95% confidence interval (CI): 24.5-27.0%) and 48.0% (95% CI: 46.4-49.7%) people hypertensive, respectively. The JNC7 prevalence was 19.4% (95% CI: 18.0-21.0%) among males and 31.9% (95% CI: 30.1-33.6%) among females. The prevalence was 41.4% (95% CI: 39.4-43.5%) among males and 54.5% (95% CI: 52.4-56.4%) among females as per the 2017 ACC/AHA guideline. From JNC7 to 2017 ACC/AHA, the overall difference in prevalence was 22.3% (95% CI: 19.8-24.8%). Males and females had similar differences, 22.0% (95% CI: 18.3-25.7%) and 22.6% (95% CI: 19.4-26.0%), respectively. As per the 2017 ACC/AHA guideline, >50% prevalence was observed among people with body mass index ≥25 kg/m2, college-level education, co-morbid diabetes, richest wealth quintile, females, age ≥55 years, urban residence, or living in Khulna, Rangpur or Dhaka divisions; the absolute difference was >20% in most categories. We found a substantial increase in the prevalence of hypertension due to change in blood pressure thresholds as per the 2017 ACC/AHA guideline. We recommend conducting more comprehensive population-based studies to estimate the recent burden of hypertension in Bangladesh. Future studies should estimate similar prevalence in other countries.
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Affiliation(s)
- Gulam Muhammed Al Kibria
- Department of Epidemiology and Public Health, School of Medicine, University of Maryland Baltimore, Baltimore, MD, 21201, USA.
| | - Krystal Swasey
- Department of Epidemiology and Public Health, School of Medicine, University of Maryland Baltimore, Baltimore, MD, 21201, USA
| | - Allysha Choudhury
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Vanessa Burrowes
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Kristen A Stafford
- Department of Epidemiology and Public Health, School of Medicine, University of Maryland Baltimore, Baltimore, MD, 21201, USA
| | | | | | - Atia Sharmeen
- School of Community Health and Policy, Morgan State University, Baltimore, MD, 21251, USA
| | - Angela Kc
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Dipak K Mitra
- Department of Public Health, North South University, Dhaka, 1229, Bangladesh
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Kibria GMA, Swasey K, KC A, Mirbolouk M, Sakib MN, Sharmeen A, Chadni MJ, Stafford KA. Estimated Change in Prevalence of Hypertension in Nepal Following Application of the 2017 ACC/AHA Guideline. JAMA Netw Open 2018; 1:e180606. [PMID: 30646022 PMCID: PMC6324293 DOI: 10.1001/jamanetworkopen.2018.0606] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 04/14/2018] [Indexed: 12/17/2022] Open
Abstract
Importance The 2017 American College of Cardiology/American Heart Association (ACC/AHA) Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults lowered the systolic and diastolic blood pressure thresholds for hypertension to 130 and 80 mm Hg, respectively. This represents a reduction of 10 mm Hg in both systolic and diastolic blood pressure levels used to define hypertension compared with previous guidelines, such as the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7). Objectives To estimate the prevalence of hypertension among adults aged 18 years or older in Nepal per the 2017 ACC/AHA guideline and to determine the absolute difference in hypertension prevalence comparing the 2017 ACC/AHA and JNC 7 guidelines. Design, Setting, and Participants The cross-sectional analysis used data from the population-based 2016 Nepal Demographic and Health Survey. Data were collected from June 2016 to January 2017 using a multistage stratified sampling procedure that was applied in urban and rural areas, using wards as the primary sampling units. Individuals aged 15 years or older from selected households were interviewed. The survey had an overall response rate of approximately 97%. Main Outcomes and Measures The primary outcome was the prevalence of hypertension. Blood pressure was measured 3 times for each participant with 5-minute intervals between. Hypertension was present if blood pressure was greater than or equal to 130/80 mm Hg for the 2017 ACC/AHA guideline, and greater than or equal to 140/90 mm Hg for the JNC 7 guideline. Results Among 13 519 participants (median [interquartile range] age, 38 [26-53] years; 7821 [57.9%] female), 44.2% (95% CI, 43.4%-45.0%; n = 5977) had hypertension according to the 2017 ACC/AHA guideline compared with 21.2% (95% CI, 20.5%-21.9%; n = 2869) by the JNC 7 guideline. The new prevalence was associated with an absolute increase of 23.0% (95% CI, 22.3%-23.7%) from the JNC 7 guideline. When estimating the proportion of hypertension by background characteristics, the new 2017 ACC/AHA guideline definition increased the prevalence to 50% or greater for some categories, with the highest prevalence among those with a body mass index (calculated as weight in kilograms divided by height in meters squared) greater than or equal to 30 (71.6%; 95% CI, 67.7%-75.3%) and between 25 and 29.9 (62.1%; 95% CI, 60.1%-64.1%). Conclusions and Relevance For adults in Nepal, the new 2017 ACC/AHA guideline reveals a greater estimated prevalence of hypertension compared with the JNC 7 guideline. Because of the public health significance of hypertension, higher prevalence rates confirm the importance of developing effective prevention and control methods in this country.
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Affiliation(s)
- Gulam Muhammed Al Kibria
- Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore
| | - Krystal Swasey
- Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore
| | - Angela KC
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | | | | | - Atia Sharmeen
- School of Community Health and Policy, Morgan State University, Baltimore, Maryland
| | - Mahmuda Jahan Chadni
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Kristen A. Stafford
- Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore
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Riedel DJ, Stafford KA, Memiah P, Coker M, Baribwira C, Sebeza J, Karorero E, Nsanzimana S, Morales F, Redfield RR. Patient-level outcomes and virologic suppression rates in HIV-infected patients receiving antiretroviral therapy in Rwanda. Int J STD AIDS 2018; 29:861-872. [PMID: 29621951 DOI: 10.1177/0956462418761695] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The Rwanda national HIV program has been successful at scaling up antiretroviral therapy (ART) to achieve universal access. The AIDSRelief Model of Care focuses on four key principles: (1) earlier initiation of ART; (2) use of durable, highly-potent, and sequence-friendly first-line ART regimens; (3) early detection of treatment failure; and (4) provision of community-based care and support to ensure optimal adherence and follow up/engagement in care. We conducted a retrospective cohort study of randomly-selected HIV-infected patients at AIDSRelief-supported sites using a stratified, random sample of 583 adults (>15 years) who initiated ART from 30 June 2008 to 1 February 2010. At ART initiation, the median patient age was 38 years, and 67% were female. The baseline median CD4+ cell count was 309 cells/mm3. Overall virologic suppression was 91%. Married/ever married status (adjusted prevalence odds ratio [aPOR] 3.75, 95% confidence interval [CI] 1.30-10.78) and self-reported adherence ≥95% in the past month (aPOR 2.76, 95% CI 1.00-7.62) were significantly associated with viral suppression in the multivariable model. Excellent virologic outcomes were achieved in Rwandan AIDSRelief sites utilizing the AIDSRelief Model of Care during the scale-up of ART in the country.
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Affiliation(s)
- David J Riedel
- 1 Institute of Human Virology and Division of Infectious Diseases, University of Maryland, School of Medicine, Baltimore, MD, USA
| | - Kristen A Stafford
- 1 Institute of Human Virology and Division of Infectious Diseases, University of Maryland, School of Medicine, Baltimore, MD, USA.,2 University of Maryland School of Medicine Department of Epidemiology and Public Health, Baltimore, MD, USA
| | - Peter Memiah
- 3 University of West Florida, Department of Public Health, Clinical and Health Sciences, University of West Florida, Pensacola, FL, USA
| | - Modupe Coker
- 4 Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Cyprien Baribwira
- 5 Institute of Human Virology, University of Maryland School of Medicine, Kigali, Rwanda
| | - Jackson Sebeza
- 5 Institute of Human Virology, University of Maryland School of Medicine, Kigali, Rwanda
| | - Eva Karorero
- 5 Institute of Human Virology, University of Maryland School of Medicine, Kigali, Rwanda
| | - Sabin Nsanzimana
- 6 Rwanda Biomedical Center, Institute of HIV Disease Prevention and Control, Kigali, Rwanda
| | | | - Robert R Redfield
- 1 Institute of Human Virology and Division of Infectious Diseases, University of Maryland, School of Medicine, Baltimore, MD, USA
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Stafford KA, Magder LS, Hungerford LL, Guralnik JM, El-Kamary SS, Baumgarten M, Redfield RR. Immunologic response to antiretroviral therapy by age among treatment-naive patients in Sub-Saharan Africa. AIDS 2018; 32:25-34. [PMID: 29028658 DOI: 10.1097/qad.0000000000001663] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To estimate the association between age at antiretroviral therapy (ART) initiation and immunologic response over time by stratum of baseline CD4 cell counts. DESIGN Retrospective cohort analysis of data pooled from four President's Emergency Plan for AIDS Relief funded countries in Sub-Saharan Africa. METHODS General linear models were used to estimate the mean CD4 cell count by age group within groups defined by baseline CD4 cell count. Kaplan-Meier methods were used to estimate time to achieving a CD4 cell count of at least 500 cells/μl by age group and stratified by baseline CD4 cell count. RESULTS A total of 126 672 previously treatment-naive patients provided 466 482 repeated CD4 cell count measurements over 4 years of ART. The median baseline CD4 cell count for all age groups was less than 200 cells/μl. Patients aged 30-39, 40-49, 50-59, and 60 and older at ART initiation had significantly lower mean CD4 cell counts in most strata and at most time points than those 20-29 years old. Compared with those 20-29, all older age groups had a significantly longer time to, and lower rate of, achieving a CD4 cell count of 500 cells. CONCLUSION Age is associated with the magnitude of CD4 cell gain and the amount of time it takes to gain cells at different levels of baseline CD4 cell count. The delay in achieving a robust immune response could have significant implications for the risk of tuberculosis reactivation as well as comorbidities associated with age in the management of older HIV-infected patients.
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Stafford KA, Rikhtegaran Tehrani Z, Saadat S, Ebadi M, Redfield RR, Sajadi MM. Long-term follow-up of elite controllers: Higher risk of complications with HCV coinfection, no association with HIV disease progression. Medicine (Baltimore) 2017; 96:e7348. [PMID: 28658155 PMCID: PMC5500077 DOI: 10.1097/md.0000000000007348] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
To estimate the effect of hepatitis C virus (HCV) coinfection on the development of complications and progression of human immunodeficiency virus (HIV) disease among HIV-infected elite controllers.Single-center retrospective cohort. Kaplan-Meier methods, prevalence ratios, and Cox proportional-hazards models were used.In all, 55 HIV-infected elite controllers were included in this study. Among them, 45% were HIV/HCV coinfected and 55% were HIV mono-infected. Median follow-up time for the cohort was 11 years. Twenty-five patients experienced a complication and 16 lost elite controller status during the study period. HCV coinfected patients were 4.78 times (95% confidence interval 1.50-15.28) more likely to develop complications compared with HIV mono-infected patients. There was no association between HCV coinfection status and loss of elite control (hazard ratio 0.75, 95% confidence interval 0.27-2.06).Hepatitis C virus coinfection was significantly associated with the risk of complications even after controlling for sex, injecting drug use, and older age. HCV coinfected patients had higher levels of cellular activation while also having similar levels of lipopolysaccharide and soluble CD14. HCV coinfection was not associated with loss of elite controller status. Taken together, this suggests that HCV coinfection does not directly affect HIV replication dynamics or natural history, but that it may act synergistically with HIV to produce a greater number of associated complications. Continued follow-up will be needed to determine whether HCV cure through the use of direct-acting antivirals among HIV/HCV coinfected elite controllers will make the risk for complications among these patients similar to their HIV mono-infected counterparts.
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Affiliation(s)
- Kristen A. Stafford
- Institute of Human Virology
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
| | | | - Saman Saadat
- Institute of Human Virology
- Hamadan University of Medical Sciences, Hamedan, Hamadan Province, Iran
| | | | | | - Mohammad M. Sajadi
- Institute of Human Virology
- Department of Medicine, Baltimore VA Medical Center, Baltimore, MD
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Riedel DJ, Stafford KA, Vadlamani A, Redfield RR. Virologic and Immunologic Outcomes in HIV-Infected Patients with Cancer. AIDS Res Hum Retroviruses 2017; 33:482-489. [PMID: 27824263 DOI: 10.1089/aid.2016.0181] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Achievement and maintenance of virologic suppression after cancer diagnosis have been associated with improved outcomes in HIV-infected patients, but few studies have analyzed the virologic and immunologic outcomes after a cancer diagnosis. All HIV-infected patients with a diagnosis of cancer between 2000 and 2011 in an urban clinic population in Baltimore, MD, were included for review. HIV-related outcomes (HIV-1 RNA viral load and CD4 cell count) were abstracted and compared for patients with non-AIDS-defining cancers (NADCs) and AIDS-defining cancers (ADCs). Four hundred twelve patients with baseline CD4 or HIV-1 RNA viral load data were analyzed. There were 122 (30%) diagnoses of ADCs and 290 (70%) NADCs. Patients with NADCs had a higher median age (54 years vs. 43 years, p < .0001) and a higher frequency of hepatitis C coinfection (52% vs. 36%, p = .002). The median baseline CD4 was lower for patients with ADCs (137 cells/mm3 vs. 314 cells/mm3) and patients with NADCs were more likely to be suppressed at cancer diagnosis (59% vs. 25%) (both p < .0001). The median CD4 for patients with NADCs was significantly higher than patients with ADCs at 6 and 12 months after diagnosis and higher at 18 and 24 months, but not significantly. Patients with an NADC had 2.19 times (95% CI 1.04-4.62) the adjusted odds of being suppressed at 12 months and 2.17 times the odds (95% CI 0.92-5.16) at 24 months compared to patients with an ADC diagnosis. For patients diagnosed with ADCs and NADCs in this urban clinic setting, both virologic suppression and immunologic recovery improved over time. Patients with NADCs had the highest odds of virologic suppression in the 2 years following cancer diagnosis.
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Affiliation(s)
- David J. Riedel
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Kristen A. Stafford
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Aparna Vadlamani
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Robert R. Redfield
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland
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Pavani G, Zintner SM, Ivanciu L, Small JC, Stafford KA, Szeto JH, Margaritis P. One amino acid in mouse activated factor VII defines its endothelial protein C receptor (EPCR) binding and modulates its EPCR-dependent hemostatic activity in vivo. J Thromb Haemost 2017; 15:507-512. [PMID: 28035745 DOI: 10.1111/jth.13607] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 06/02/2016] [Indexed: 11/26/2022]
Abstract
Essentials The lack of factor (F) VIIa-endothelial protein C receptor (EPCR) binding in mice is unresolved. A single substitution of Leu4 to Phe in mouse FVIIa (mFVIIa) enables its interaction with EPCR. mFVIIa with a Phe4 shows EPCR binding-dependent enhanced hemostatic function in vivo vs. mFVIIa. Defining the FVIIa-EPCR interaction in mice allows for further investigating its biology in vivo. SUMMARY Background Human activated factor VII (hFVIIa), which is used in hemophilia treatment, binds to the endothelial protein C (PC) receptor (EPCR) with unclear hemostatic consequences. Interestingly, mice lack the activated FVII (FVIIa)-EPCR interaction. Therefore, to investigate the hemostatic consequences of this interaction in hemophilia, we previously engineered a mouse FVIIa (mFVIIa) molecule that bound mouse EPCR (mEPCR) by using three substitutions from mouse PC (mPC), i.e. Leu4→Phe, Leu8→Met, and Trp9→Arg. The resulting molecule, mFVIIa-FMR, modeled the EPCR-binding properties of hFVIIa and showed enhanced hemostatic capacity in hemophilic mice versus mFVIIa. These data implied a role of EPCR in the action of hFVIIa in hemophilia treatment. However, the substitutions in mFVIIa-FMR only broadly defined the sequence determinants for its mEPCR interaction and enhanced function in vivo. Objectives To determine the individual contributions of mPC Phe4, Met8 and Arg9 to the in vitro/in vivo properties of mFVIIa-FMR. Methods The mEPCR-binding properties of single amino acid variants of mFVIIa or mPC at position 4, 8 or 9 were investigated. Results and conclusions Phe4 in mFVIIa or mPC was solely critical for interaction with mEPCR. In hemophilic mice, administration of mFVIIa harboring a Phe4 resulted in a 1.9-2.5-fold increased hemostatic capacity versus mFVIIa that was EPCR binding-dependent. This recapitulated previous observations made with triple-mutant mFVIIa-FMR. As Leu8 is crucial for hFVIIa-EPCR binding, we describe the sequence divergence of this interaction in mice, now allowing its further characterization in vivo. We also illustrate that modulation of the EPCR-FVIIa interaction may lead to improved FVIIa therapeutics.
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Affiliation(s)
- G Pavani
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - S M Zintner
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - L Ivanciu
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- The Raymond G. Perelman Center for Cellular and Molecular Therapeutics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- The University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - J C Small
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - K A Stafford
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - J H Szeto
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - P Margaritis
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- The Raymond G. Perelman Center for Cellular and Molecular Therapeutics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- The University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
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Fantry LE, Nowak RG, Fisher LH, Cullen NR, Yimgang DP, Stafford KA, Riedel DJ, Kang M, Innis EK, Riner A, Wang EW, Charurat ME. Colonoscopy Findings in HIV-Infected Men and Women from an Urban U.S. Cohort Compared with Non-HIV-Infected Men and Women. AIDS Res Hum Retroviruses 2016; 32:860-7. [PMID: 27329286 DOI: 10.1089/aid.2015.0322] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION As HIV-infected patients live longer, non-AIDS-defining cancers are now a major cause of morbidity and mortality. The purpose of this study was to compare the prevalence, type, and location of colorectal neoplastic lesions found on colonoscopy in HIV-infected patients from an urban U.S. cohort with non-HIV-infected patients. METHODS We collected clinical data and colonoscopy findings on 263 HIV-infected patients matched with 657 non-HIV-infected patients on age, race, and sex. Frequency distributions and descriptive statistics were used to characterize the study population. The primary exposure was HIV infection, and the primary outcome was any adenoma or adenocarcinoma. Logistic regression models were used to estimate odds ratios with 95% confidence intervals (CIs). RESULTS Participants were primarily African American and 40% were women. HIV-infected patients were less likely to have any neoplastic lesions (21.3% vs. 27.7%, p < .05), adenoma (20.5% vs. 27.1%, p = .04), tubular adenomas >10 mm (0.4% vs. 2.9%, p = .02), and serrated adenomas (0.0% vs.2.6%, p = <.01). There was a nonsignificant increased prevalence of adenocarcinoma in HIV-infected individuals compared with non-HIV-infected individuals (1.5% vs. 0.8%, p = .29). The lower prevalence of any adenoma remained after controlling for age, sex, smoking status, body-mass index, and diabetes mellitus [adjusted odds ratio (aOR), 0.61; 95% CI, 0.43-0.88]. HIV-infected patients had a lower prevalence of colorectal neoplastic lesions, including high-risk adenomas, than non-HIV-infected patients. CONCLUSIONS Our findings suggest that HIV infection in a primarily African American population is associated with a lower prevalence of colorectal adenomas, but not adenocarcinoma, found by colonoscopy.
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Affiliation(s)
- Lori E. Fantry
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Rebecca G. Nowak
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Lydia H. Fisher
- Rocky Mountain Infectious Disease Specialists, Denver, Colorado
| | | | - Doris Prisca Yimgang
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Kristen A. Stafford
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - David J. Riedel
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Minji Kang
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Ellen K. Innis
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Andrea Riner
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Elizabeth W. Wang
- Department of Medicine, Geisinger Medical Center, Danville, Pennsylvania
| | - Manhattan E. Charurat
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
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