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Cheng F, Ford N, Wood A, Tracy R. Avocado Consumption and Markers of Inflammation: Results From The Multi-ethnic Study of Atherosclerosis (MESA). Curr Dev Nutr 2022. [PMCID: PMC9193639 DOI: 10.1093/cdn/nzac067.011] [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: 11/14/2022] Open
Abstract
Abstract
Objectives
Since an association of avocado consumption has been linked to a possible reduction in inflammation, we investigated associations between avocado consumption and markers of inflammation in a population-based multi-ethnic cohort (Multi-Ethnic Study of Atherosclerosis (MESA)).
Methods
A food frequency questionnaire (FFQ) at MESA exam 1 was used to capture avocado/guacamole consumption. To calculate daily servings of avocado/guacamole, we used both frequency and serving size data from the FFQ. We classified participants into three consumer groups: rare or never (daily serving ≤ 0.03; less than 1 per month), medium (0.03 < daily serving < 0.082; ∼1–2 per month), and heavy (0.082 ≤ daily serving; more than 2–3 per month). Inflammation was estimated by natural log-transformed inflammatory biomarkers (CRP, IL-2, IL-6, homocysteine, fibrinogen, TNF-a soluble receptors). We used multivariate linear regression models to assess associations while accounting for age, sex, race/ethnicity, educational level, income, energy intake, smoking status, physical activity, diet quality, body mass index, and diabetes type.
Results
Among 2,183 MESA participants, the average age and BMI were 60.8 y ± 10.2 and 28.3kg/m2 ± 5.2, respectively, and 46% of the sample were men. Participants has self-reported Hispanic (40.7%), Caucasian (36.8%), African-American (15.5%), and Chinese (7%) ancestries. Over 60% had higher than a high school education and 41.7% make $50,000 or more a year. 44% were categorized as rare of never, 31% as medium, and 25% as heavy avocado/guacamole consumers. When adjusted for relevant confounders, there were no significant differences among the three consumer groups for any inflammatory marker.
Conclusions
In this cross-sectional study, we did not find that consumption of avocado/guacamole was associated with levels of inflammatory markers.
Funding Sources
Supported by contracts HHSN268201500003I, N01-HC-95,159, N01-HC-95,160, N01-HC-95,161, N01-HC-95,162, N01-HC-95,163, N01-HC-95,164, N01-HC-95,165, N01-HC-95,166, N01-HC-95,167, N01-HC-95,168 and N01-HC-95,169 from NHLBI, and by grants UL1-TR-000,040, UL1-TR-001,079, and UL1-TR-001,420 from NCATS. The authors thank the other MESA investigators, staff, and participants for their valuable contributions. http://www.mesa-nhlbi.org provides a list of MESA investigators and institutions.
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Yu Z, Tamez M, Colon R, Rodriguez J, Hicks-Roof KK, Ford N, Mattei J, Sotres-Alvarez D, Van Horn L, Allison M, Talavera GA, Castañeda SF, Daviglus ML. Association of fruit and vegetable color with incident diabetes and cardiometabolic risk biomarkers in the United States Hispanic/Latino population. Nutr Diabetes 2022; 12:18. [PMID: 35411032 PMCID: PMC9001729 DOI: 10.1038/s41387-022-00197-0] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 03/13/2022] [Accepted: 03/24/2022] [Indexed: 12/25/2022] Open
Abstract
Background Color groups of fruits and vegetables (FV) are part of a healthy diet, but evidence for an association with cardiometabolic outcomes is inconsistent. Objective To examine the association between intake of FV of different colors with incident diabetes and cardiometabolic risk biomarkers among U.S. Hispanics/Latinos. Subjects/methods We used data from 9206 adults ages 18–74 years who were free of diabetes at baseline (2008–2011) and had follow-up data at visit 2 (2014–2017) in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), a multicenter, prospective cohort study of self-identified Hispanics/Latinos. Dietary intake was assessed using two 24 h recalls at baseline. FV were categorized into five color groups: green, white, yellow/orange, red/purple, and uncategorized. Diabetes was defined based on laboratory measures and self-reported antihyperglycemic medication. We used survey logistic regression models to evaluate the association between FV color groups and incident diabetes and survey linear regression models to evaluate the association of FV color groups with cardiometabolic risk biomarkers at visit 2. Results During ~6 years of follow-up, 970 incident cases of diabetes were documented. The red/purple FV color group was the least consumed (0.21 servings/day), whereas white FV were the most consumed (0.92 servings/day). For each serving of total FV intake, body mass index (BMI) was lower by 0.24% (p = 0.03) and insulin by 0.69% (p = 0.03). For each serving of red/purple FV intake, HDL was 1.59% higher (p = 0.04). For each serving of white FV intake (with potato), post-OGTT was 0.83% lower (p = 0.04) and triglycerides 1.43% lower (p = 0.04). There was no association between FV intake and incident diabetes. Conclusions Specific FV colors were associated with cardiometabolic benefits though the associations were of relatively small magnitudes. Dietary recommendations could consider varying colors of FV intake, especially white and red/purple color groups, for a healthy diet.
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Affiliation(s)
- Zhiping Yu
- Department of Nutrition and Dietetics, University of North Florida, Jacksonville, FL, USA.
| | - Martha Tamez
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Raymond Colon
- Department of Nutrition and Dietetics, University of North Florida, Jacksonville, FL, USA
| | - Judith Rodriguez
- Department of Nutrition and Dietetics, University of North Florida, Jacksonville, FL, USA
| | - Kristen K Hicks-Roof
- Department of Nutrition and Dietetics, University of North Florida, Jacksonville, FL, USA
| | - Nikki Ford
- Hass Avocado Board, Avocado Nutrition Center, Mission Viejo, CA, USA
| | - Josiemer Mattei
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Daniela Sotres-Alvarez
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Linda Van Horn
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Matthew Allison
- Department of Family Medicine, School of Medicine, University of California San Diego, San Diego, CA, USA
| | - Gregory A Talavera
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Sheila F Castañeda
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Martha L Daviglus
- Institute for Minority Health Research, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
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Cheng F, Ford N, Taylor M. Older Adults from NHANES 2011-2014 Who Consumed Avocado Have Better Global Cognition and Immediate and Delayed Memory Than Non-Consumers. J Acad Nutr Diet 2021. [DOI: 10.1016/j.jand.2021.08.090] [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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Reboussin DM, Kris-Etherton PM, Lichtenstein AH, Li Z, Sabate J, Matthan NR, Petersen K, Rajaram S, Vitolins M, Ford N. The design and rationale of a multi-center randomized clinical trial comparing one avocado per day to usual diet: The Habitual Diet and Avocado Trial (HAT). Contemp Clin Trials 2021; 110:106565. [PMID: 34496276 DOI: 10.1016/j.cct.2021.106565] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/27/2021] [Accepted: 09/03/2021] [Indexed: 11/25/2022]
Abstract
Excess visceral adiposity is associated with increased risk of diabetes and cardiovascular disease. In the U.S. approximately 60% of adults have visceral obesity. Despite high calorie and fat, small, well-controlled clinical studies suggest that avocado consumption has favorable effects on body weight and visceral adiposity. Additionally, short-term studies also suggest that consuming avocados increases satiety, hence, may decrease overall energy intake. The Habitual Diet and Avocado Trial HAT is a multi-center, randomized, controlled trial designed to test whether in a large, diverse cohort providing one avocado per day for consumption for six months compared to a habitual diet essentially devoid of avocados, will result in a decrease in visceral adiposity as measured by magnetic resonance imaging (MRI) in individuals with an increased waist circumference (WC). Additional outcome measures include hepatic lipid content, plasma lipid profiles, blood pressure and high sensitivity C-reactive protein. Inclusion criteria were increased WC and not currently eating more than two avocados per month. Major exclusion criteria were not eating or being allergic to avocados, and not willing or able to undergo MRI scans. From June 27, 2018 to March 4, 2020, 1008 participants were randomized at 4 clinics. The cohort was 72% women, 53% Non-Hispanic White, and had a mean age of 50 years. Follow-up was completed in October 2020 when 936 participants had final MRI scans. HAT will provide information on the effects of avocado consumption on visceral fat adiposity and cardiometabolic disease risk in a diverse sample of participants.
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Affiliation(s)
- David M Reboussin
- Department of Biostatistics, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, N.C. 27157, USA.
| | - Penny M Kris-Etherton
- Department of Nutritional Sciences, Penn State University, 319 Chandlee Laboratory, University Park, PA 16802, USA.
| | - Alice H Lichtenstein
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, 711 Washington Street, Boston, MA 02111, USA,.
| | - Zhaoping Li
- Center for Human Nutrition, David Geffen School of Medicine, UCLA, 200 UCLA Medical Plaza, Suite B365, Los Angeles, CA 90095, USA,.
| | - Joan Sabate
- Center for Nutrition, Lifestyle and Disease Prevention, Loma Linda University School of Public Health, 24951 North Circle Drive, Loma Linda, CA 92350, USA.
| | - Nirupa R Matthan
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, 711 Washington Street, Boston, MA 02111, USA,.
| | - Kristina Petersen
- Department of Nutritional Sciences, Texas Tech University, P.O. Box 41270, Lubbock, TX 79409-1270, USA.
| | - Sujatha Rajaram
- Center for Nutrition, Lifestyle and Disease Prevention, Loma Linda University School of Public Health, 24951 North Circle Drive, Loma Linda, CA 92350, USA.
| | - Mara Vitolins
- Department of Epidemiology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, N.C. 27157, USA.
| | - Nikki Ford
- Hass Avocado Board, 25212 Marguerite Parkway, Suite 250, Mission Viejo, CA 92692, USA.
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Hargreaves S, Himmels J, Nellums LB, Biswas G, Gabrielli AF, Gebreselassie N, Zignol M, Schellenberg D, Norris SL, Ford N, Maher D. Identifying research questions for HIV, tuberculosis, tuberculosis-HIV, malaria, and neglected tropical diseases through the World Health Organization guideline development process: a retrospective analysis, 2008-2018. Public Health 2020; 187:19-23. [PMID: 32889228 PMCID: PMC7660115 DOI: 10.1016/j.puhe.2020.03.028] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/19/2020] [Accepted: 03/29/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES World Health Organization (WHO) guidelines for health programmes and healthcare delivery are the foundation of its technical leadership in public health and essential to decision-making globally. A key function of guideline development is to identify areas in which further evidence is needed because filling these gaps will lead to future improvements in population health. The objective of this study was to examine the knowledge gaps and research questions for addressing those gaps generated through the WHO guideline development process, with the goal of informing future strategies for improving and strengthening the guideline development process. STUDY DESIGN We did a systematic, retrospective analysis of research questions identified in the published guidelines. METHODS We analyzed guidelines published between January 1, 2008, and December 31, 2018, by the Communicable Diseases Cluster in five disease areas: tuberculosis (TB), HIV, malaria, TB-HIV, and neglected tropical diseases (NTDs). Research questions were extracted independently by two researchers. We analyzed the distribution of research questions by disease and by topic category and did a qualitative assessment of optimum practice for research question generation during the guideline development process. RESULTS A total of 48 guidelines were included: 26 on HIV, 1 on malaria, 11 on TB, 5 on TB/HIV, and 5 on NTDs. Overall, 36 (75%) guidelines encompassed a total of 360 explicit research questions; the remainder did not contain specific research questions. The number of research questions that focused on TB was 49, TB/HIV was 38, HIV was 250, and NTDs was 23. The number of research questions that focused on diagnosis was 43 (11.9%) of 360, prevention was 62 (17.2%), treatment was 103 (28.6%), good practice was 12 (3.3%), service delivery was 86 (23.8%), and other areas was 54 (15%). Research questions were often not formulated in a specific or actionable way and were hard to identify in the guideline. Examples of good practice identified by the review team involved the generation of specific and narrowly defined research questions, with accompanying recommendations for appropriate study design. CONCLUSIONS The WHO must strengthen its approach to identifying and presenting research questions during the guideline development process. Ensuring access to research questions is a key next step in adding value to the guideline development process.
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Affiliation(s)
- S Hargreaves
- Institute for Infection and Immunity, St George's, University of London, UK
| | - J Himmels
- Institute for Infection and Immunity, St George's, University of London, UK
| | - L B Nellums
- Institute for Infection and Immunity, St George's, University of London, UK
| | - G Biswas
- World Health Organization, Geneva, Switzerland
| | | | | | - M Zignol
- World Health Organization, Geneva, Switzerland
| | | | - S L Norris
- World Health Organization, Geneva, Switzerland
| | - N Ford
- World Health Organization, Geneva, Switzerland
| | - D Maher
- World Health Organization, Geneva, Switzerland.
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Williams N, Stephens J, Kress E, Frey E, Fugett S, Erdeljac P, Yager S, Holley E, Utendorf C, Ford N, Ubbing C, Overcash J, Ramaswamy B, Noonan A. Abstract P4-16-01: Feasibility of comprehensive geriatric assessment in an academic breast oncology clinic. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p4-16-01] [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: 11/16/2022]
Abstract
Abstract
Introduction: Adults age ≥65y constitute the majority of patients (pts) diagnosed with cancer. There is a gap in knowledge about the safest and most effect cancer treatments for older pts. At The Ohio State University, we have a longitudinal multidisciplinary geriatric clinic for adults ≥ 65 years of age diagnosed with breast cancer (BC). The clinic team consists of a physician, nurse practitioner, dietician, physical therapist, social worker nurse, and pharmacist. We evaluate the unique needs of older pts with breast cancer by completing a comprehensive geriatric assessment (CGA). Eligible patients are enrolled into OSU-16153 which is a is prospective cohort study of pts ≥65y with new diagnosis of BC to better understand complex health issues of this population, and to collect data to support future studies. Methods: Forty eight pts have completed the baseline questionnaires including demographics, lifestyle and health history and CGA. Summary statistics were used to describe the baseline characteristics. Results: The median age of patients enrolled in the study was 77 years (range 67-94), the mean BMI was 28, 50% (24/48) were Caucasian and 6% (3/48) were African American. Mobility was assessed mobility with the time get up and go (TGUG), mean 9.8 (SD=6.2) and grip strength, mean of 31. Cognitive limitations were screened with the blessed orientation memory concentration test, mean 3.9 (SD=5.0) and mini-cog, mean 3.6 (SD=1), malnutrition, mean 12.3 (SD=12.2) and depression, mean 1.6 (SD=2.4). Functional limitations were measured with Katz, mean 5.9 (SD=0.2), and Lawson, mean 7.8 (SD=0.8). Disease characteristics included 18% (9/48) Tis, 54% (26/48) T1, 21% (10/48) T2, 2%(1/48) T3, and 4% (2/48) T4 tumors, 65% (31/48) lymph node negative and 81% (39/48) estrogen positive (ER+),17% (8/48) ER negative and 4% (2/48) HER2 positive. Oncotype score was <25 in 19% (9/48) and >25 in 4% (2/48). Twelve percent (6/48) received adjuvant chemotherapy for triple negative or ER+ breast cancer with high oncotype with docetaxel/cytoxan and 4% received trastuzumab based therapy and they were able to complete all planned cycles. Two pts received chemotherapy based on results of CGA. Forty-two pts were eligible to receive endocrine therapy (ET); 3 pts with ductal carcinoma in-situ (DCIS) and 2 pts with invasive BC declined, 1 did not follow up after her initial visit. Five pts switched ET due to side effects. The 7 patients with invasive BC who declined or switched ET due to side effects all had an abnormal TGUG, 43% (3/7) had an impaired min-cog and 57% (4/7) had impaired hand grip. Conclusions: The majority of older adults have no functional deficits in ADL/IADL, have adequate mobility and grip strength and did not screen positive for cognitive limitations, depression or, malnutrition. Our data shows that the mobility and cognitive assessment of a CGA may serve as a predictor of toxicity from ET therapy and identify patients who are at risk for side effects and who may benefit from additional interventions. The majority of pts who received adjuvant chemotherapy and ET tolerated well. Our pilot data shows a CGA is feasible and that a CGA helped direct appropriate therapy.
Citation Format: Nicole Williams, Julie Stephens, Elizabeth Kress, Erin Frey, Susan Fugett, Paige Erdeljac, Stephanie Yager, Erin Holley, Cari Utendorf, Nikki Ford, Caitln Ubbing, Jeanie Overcash, Bhuvaneswari Ramaswamy, Anne Noonan. Feasibility of comprehensive geriatric assessment in an academic breast oncology clinic [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P4-16-01.
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Affiliation(s)
- Nicole Williams
- 1The Ohio State University Wenxer Medical Center, Columbus, OH
| | - Julie Stephens
- 2The Ohio State Comprehensive Cancer Center, Columbus, OH
| | - Elizabeth Kress
- 3The Ohio State University Wexner Medical Center, Columbus, OH
| | - Erin Frey
- 1The Ohio State University Wenxer Medical Center, Columbus, OH
| | - Susan Fugett
- 3The Ohio State University Wexner Medical Center, Columbus, OH
| | - Paige Erdeljac
- 1The Ohio State University Wenxer Medical Center, Columbus, OH
| | - Stephanie Yager
- 1The Ohio State University Wenxer Medical Center, Columbus, OH
| | - Erin Holley
- 1The Ohio State University Wenxer Medical Center, Columbus, OH
| | - Cari Utendorf
- 1The Ohio State University Wenxer Medical Center, Columbus, OH
| | - Nikki Ford
- 1The Ohio State University Wenxer Medical Center, Columbus, OH
| | - Caitln Ubbing
- 1The Ohio State University Wenxer Medical Center, Columbus, OH
| | - Jeanie Overcash
- 1The Ohio State University Wenxer Medical Center, Columbus, OH
| | | | - Anne Noonan
- 1The Ohio State University Wenxer Medical Center, Columbus, OH
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Hamada Y, Ford N, Schenkel K, Getahun H. Three-month weekly rifapentine plus isoniazid for tuberculosis preventive treatment: a systematic review. Int J Tuberc Lung Dis 2019; 22:1422-1428. [PMID: 30606313 DOI: 10.5588/ijtld.18.0168] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Uptake of preventive treatment for tuberculosis (TB) remains poor. A 3-month regimen of rifapentine (RPT) plus isoniazid (INH) (3HP) could facilitate its scale-up. We conducted a systematic review to assess the effects of 3HP compared with daily 6- or 9-month INH monotherapy. METHODS We searched the following databases to identify randomised controlled trials: PubMed, Embase, the Web of Science, Cochrane Central Register of Controlled Trials, three ongoing trial registers and conference abstracts up to 24 January 2017. Where possible, we pooled data using a random-effects model. RESULTS Four studies were included. Of those, we included two studies that compared 3HP with daily 6- or 9-month INH (6/9H) among adults with human immunodeficiency virus (HIV) co-infection, one among HIV-negative adults and one among predominantly HIV-negative children and adolescents. Risk of active TB was not significantly different between 3HP and 6/9H (risk ratio [RR] 0.73, 95%CI 0.23-2.29, in adults with HIV; RR 0.44, 95%CI 0.18-1.07, in adults without HIV; RR 0.13, 95%CI 0.01-2.54, in children and adolescents). Risk of hepatotoxicity was significantly lower in the 3HP group among adults with HIV (RR 0.26, 95%CI 0.12-0.55) and those without HIV (RR 0.16, 95%CI 0.10-0.27). 3HP was also associated with a higher completion rate in all subgroups. CONCLUSIONS HP was shown to have a preventive effect similar to that of INH monotherapy, with fewer adverse events and higher completion rates. 3HP can contribute significantly to the scale-up of preventive treatment.
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Affiliation(s)
| | - N Ford
- Department of HIV, World Health Organization, Geneva, Switzerland
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Bock P, Nel K, Fatti G, Sloot R, Ford N, Voget J, Gunst C, Grobbelaar N, Louis F, Floyd S, Hayes R, Ayles H, Beyers N, Fidler S. Renal dysfunction by baseline CD4 cell count in a cohort of adults starting antiretroviral treatment regardless of CD4 count in the HIV Prevention Trials Network 071 [HPTN 071; Population Effect of Antiretroviral Therapy to Reduce HIV Transmission (PopART)] study in South Africa. HIV Med 2019; 20:392-403. [PMID: 30963667 PMCID: PMC6767782 DOI: 10.1111/hiv.12729] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2019] [Indexed: 01/05/2023]
Abstract
OBJECTIVES Renal dysfunction is a significant cause of morbidity and mortality among HIV-positive individuals. This study evaluated renal dysfunction in a cohort of adults who started antiretroviral treatment (ART) regardless of CD4 count at three Department of Health (DOH) clinics included in the HIV Prevention Trials Network 071 (HPTN 071) Population Effect of Antiretroviral Therapy to Reduce HIV Transmission (PopART) trial. METHODS A retrospective cohort analysis of routine data for HIV-positive individuals starting ART between January 2014 and November 2015 was completed. Incident renal dysfunction was defined as an estimated glomerular filtration rate (eEGFR) < 60 mL/min after ART initiation among individuals with a baseline (pre-ART) eGFR ≥ 60 mL/min. RESULTS Overall, 2423 individuals, with a median baseline CD4 count of 328 cells/μL [interquartile range (IQR) 195-468 cells/μL], were included in the analysis. Forty-seven individuals had a baseline eGFR < 60 mL/min. Among 1634 nonpregnant individuals started on a tenofovir-containing ART regimen and with a baseline eGFR ≥ 60 mL/min, 27 developed an eGFR < 60 mL/min on ART. Regression analysis showed lower odds of baseline eGFR < 60 mL/min at baseline CD4 counts of > 500 cells/μL [adjusted odds ratio (aOR) 0.29; 95% confidence interval (CI) 0.11-0.80], 351-500 cells/μL (aOR 0.22; 95% CI 0.08-0.59) and 201-350 (aOR 0.48; 95% CI: 0.24-0.97) compared with baseline CD4 counts < 200 cells/μL. CONCLUSIONS This study showed low rates of renal dysfunction at baseline and on ART, with lower rates of baseline renal dysfunction among individuals with baseline CD4 counts > 200 cells/μL. Strategies that use baseline characteristics, such as age, to identify individuals at high risk of renal dysfunction on ART for enhanced eGFR monitoring may be effective and should be the subject of future research.
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Affiliation(s)
- P Bock
- Department of Paediatrics and Child HealthFaculty of Medicine and Health SciencesDesmond Tutu TB CentreStellenbosch UniversityCape TownSouth Africa
| | - K Nel
- Department of Paediatrics and Child HealthFaculty of Medicine and Health SciencesDesmond Tutu TB CentreStellenbosch UniversityCape TownSouth Africa
- City of Cape Town Health ServicesCape TownSouth Africa
| | - G Fatti
- Kheth’ Impilo, AIDS Free LivingCape TownSouth Africa
- Division of Epidemiology and BiostatisticsDepartment of Global HealthFaculty of Medicine and Health SciencesStellenbosch UniversityCape TownSouth Africa
| | - R Sloot
- Department of Paediatrics and Child HealthFaculty of Medicine and Health SciencesDesmond Tutu TB CentreStellenbosch UniversityCape TownSouth Africa
- Amsterdam Institute for Global Health and DevelopmentAmsterdamThe Netherlands
| | - N Ford
- Centre for Infectious Disease Epidemiology and ResearchUniversity of Cape TownCape TownSouth Africa
| | - J Voget
- Western Cape Department of HealthHIV/AIDS, STI & TB DirectorateCape TownSouth Africa
| | - C Gunst
- Faculty of Medicine and Health SciencesStellenbosch University Division of Family Medicine and Primary Health CareStellenbosch UniversityCape TownSouth Africa
- Western Cape Department of HealthCape Winelands DistrictBrewelskloof HospitalWorcesterSouth Africa
| | | | - F Louis
- Independent ConsultantCape TownSouth Africa
| | - S Floyd
- Department of Infectious Disease EpidemiologyLondon School of Hygiene and Tropical MedicineLondonUK
| | - R Hayes
- Department of Infectious Disease EpidemiologyLondon School of Hygiene and Tropical MedicineLondonUK
| | - H Ayles
- Department of Clinical ResearchLondon School of Hygiene and Tropical MedicineLondonUK
| | - N Beyers
- Department of Paediatrics and Child HealthFaculty of Medicine and Health SciencesDesmond Tutu TB CentreStellenbosch UniversityCape TownSouth Africa
| | - S Fidler
- Department of MedicineImperial College LondonLondonUK
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Overcash J, Ford N, Kress E, Ubbing C, Williams N. Comprehensive Geriatric Assessment as a Versatile Tool to Enhance the Care of the Older Person Diagnosed with Cancer. Geriatrics (Basel) 2019; 4:geriatrics4020039. [PMID: 31238518 PMCID: PMC6630523 DOI: 10.3390/geriatrics4020039] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 06/14/2019] [Accepted: 06/20/2019] [Indexed: 12/27/2022] Open
Abstract
The comprehensive geriatric assessment (CGA) is a versatile tool for the care of the older person diagnosed with cancer. The purpose of this article is to detail how a CGA can be tailored to Ambulatory Geriatric Oncology Programs (AGOPs) in academic cancer centers and to community oncology practices with varying levels of resources. The Society for International Oncology in Geriatrics (SIOG) recommends CGA as a foundation for treatment planning and decision-making for the older person receiving care for a malignancy. A CGA is often administered by a multidisciplinary team (MDT) composed of professionals who provide geriatric-focused cancer care. CGA can be used as a one-time consult for surgery, chemotherapy, or radiation therapy providers to predict treatment tolerance or as an ongoing part of patient care to manage malignant and non-malignant issues. Administrative support and proactive infrastructure planning to address scheduling, referrals, and provider communication are critical to the effectiveness of the CGA.
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Affiliation(s)
- Janine Overcash
- The College of Nursing, The Ohio State University, 1585 Neil Ave, Newton Hall, Columbus, OH 43201, USA.
| | - Nikki Ford
- Stephanie Spielman Comprehensive Breast Center, The Ohio State University, 1145 Olentangy River Road, Columbus, OH 43121, USA.
| | - Elizabeth Kress
- Stephanie Spielman Comprehensive Breast Center, The Ohio State University, 1145 Olentangy River Road, Columbus, OH 43121, USA.
| | - Caitlin Ubbing
- Stephanie Spielman Comprehensive Breast Center, The Ohio State University, 1145 Olentangy River Road, Columbus, OH 43121, USA.
| | - Nicole Williams
- Stephanie Spielman Comprehensive Breast Center, The Ohio State University, 1145 Olentangy River Road, Columbus, OH 43121, USA.
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Habiyambere V, Dongmo Nguimfack B, Vojnov L, Ford N, Stover J, Hasek L, Maggiore P, Low-Beer D, Pérez Gonzàlez M, Edgil D, Williams J, Kuritsky J, Hargreaves S, NeSmith T. Forecasting the global demand for HIV monitoring and diagnostic tests: A 2016-2021 analysis. PLoS One 2018; 13:e0201341. [PMID: 30231022 PMCID: PMC6145505 DOI: 10.1371/journal.pone.0201341] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [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: 08/02/2017] [Accepted: 07/13/2018] [Indexed: 12/31/2022] Open
Abstract
Introduction Despite considerable progress, just over half of the 37 million people eligible to start antiretroviral therapy (ART) have accessed treatment and millions of HIV-positive people still do not know their status. With demand for ART continuing to grow, meeting the ambitious 90-90-90 HIV treatment targets will depend on improved access to high-quality diagnostics to both diagnose infection and monitor treatment adherence in low and middle-income countries (LMICs). Robust projections of future demand for CD4, viral load (VL), HIV early-infant-diagnosis (EID) tests and HIV rapid diagnostic tests (RDTs) are needed as scale-up continues. Methods We estimate the current coverage for HIV diagnostics and project future demand to 2021 using a consolidated forecast using data on past coverage and current demand from a number of sources, from 130 predominantly LMIC countries. Results We forecast that the overall number of CD4 tests is expected to decline between now and 2021 as more countries adopt test-and-treat and shift to VL testing for patient monitoring. Our consolidated forecast projects a gradual decline in demand for CD4 tests to 16.6 million by 2021. We anticipate that demand for VL tests will increase to 28.5 million by 2021, reflecting the increasing number of people who will receive ART and the adoption of VL testing for patient monitoring. We expect that the demand for EID tests will grow more rapidly than in past years, driven by the implementation of testing at birth in programmes globally, in line with WHO guideline recommendations, doubling to 2.1 million tests by 2021. Demand for rapid diagnostic tests is also likely to increase, reaching 509 million tests by 2021. Discussion In order to achieve the ambitious 90-90-90 targets, it will be essential to maintain and improve access to CD4, VL, EID tests and RDTs. These projections provide insight into the global demand we can expect to see for these HIV monitoring and diagnostic tests, both in relation to historical trends, and the 90-90-90 targets. Our projections will better enable producers to ensure adequate supply, and to support procurement organisations in planning future funding and purchase plans to meet the anticipated demand. The findings highlight the ongoing need for governments and international funding bodies to prioritise improving capacity and access to HIV diagnostic and monitoring technologies in line with demand.
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Affiliation(s)
| | | | - L. Vojnov
- Department of HIV/AIDS, WHO, Geneva, Switzerland
| | - N. Ford
- Department of HIV/AIDS, WHO, Geneva, Switzerland
| | - J. Stover
- Avenir Health, Glastonbury, Connecticut, United States of America
| | - L. Hasek
- CHAI, Boston, Massachusetts, United States of America
| | - P. Maggiore
- CHAI, Boston, Massachusetts, United States of America
| | - D. Low-Beer
- Department of HIV/AIDS, WHO, Geneva, Switzerland
| | | | - D. Edgil
- USAID, Washington DC, United States of America
| | - J. Williams
- US CDC, Atlanta, Georgia, United States of America
| | - J. Kuritsky
- USAID, Washington DC, United States of America
| | - S. Hargreaves
- International Health Unit, Imperial College London, London, United Kingdom
| | - T. NeSmith
- US CDC, Atlanta, Georgia, United States of America
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Abstract
BACKGROUND: To reduce transmission and improve patient outcomes, rapid diagnosis and treatment of rifampicin-resistant tuberculosis (RR-TB) is required. OBJECTIVE: To conduct a systematic review and meta-analysis assessing time to treatment for RR-TB and variability using diagnostic testing methods and treatment delivery approach. DESIGN: Studies from 2000 to 2015 reporting time to second-line treatment initiation were selected from PubMed and published conference abstracts. RESULTS: From 53 studies, 83 cohorts (13 034 patients) were included. Overall weighted mean time to treatment from specimen collection was 81 days (95%CI 70–91), and was shorter with ambulatory (57 days, 95%CI 40–74) than hospital-based treatment (86 days, 95%CI 71–102). Time to treatment was shorter with genotypic susceptibility testing (38 days, 95%CI 27–49) than phenotypic testing (108 days, 95%CI 98–117). The mean percentage of diagnosed patients initiating treatment was 76% (95%CI 70–83, range 25–100). CONCLUSION: Time to second-line anti-tuberculosis treatment initiation is extremely variable across studies, and often unnecessarily long. Reduced delays are associated with genotypic testing and ambulatory treatment settings. Routine monitoring of the proportion of diagnosed patients initiating treatment and time to treatment are necessary to identify areas for intervention.
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Affiliation(s)
- R Boyd
- Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa, Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - N Ford
- Centre for Infectious Disease Research, University of Cape Town, Cape Town, South Africa
| | - P Padgen
- College of Global Public Health, New York University, New York, New York, USA
| | - H Cox
- Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
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12
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Overcash J, Ford N, Erdeljac HP, Fugett S, Knauss B, Kress E, Utendorf C, Noonan A. Comprehensive Geriatric Assessment in Oncology: Best Practices in Caring for Older Patients. J Adv Pract Oncol 2018; 9:640-644. [PMID: 31186985 PMCID: PMC6505667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
CASE STUDY Michele Green received the results of her breast cancer biopsy last week. Before surgery for infiltrating ductal carcinoma to her left breast, Michele was advised to meet with the members of the Senior Adult Oncology Program (SAOP) at the cancer center. A phone call from a nurse explained that the 2-hour visit with the SAOP would include meetings with many providers, such as a physical therapist, a social worker, a dietitian, a pharmacist, a nurse practitioner, and an oncologist to undergo a comprehensive geriatric assessment. Driving to her appointment, Michele wondered why her visit would take so long and why she had to see so many people. At 81 years old, Michele maintains her physical fitness and has never really been sick. She continues to work each week at the university and engages in an active social life. What could a team possibly find? Walking past the many examination rooms, Michele began to feel despair that she was now a "cancer patient."
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Affiliation(s)
- Janine Overcash
- College of Nursing, The Ohio State University, Columbus, Ohio;
| | - Nikki Ford
- Stefanie Spielman Comprehensive Breast Center, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio;
| | - H. Paige Erdeljac
- Stefanie Spielman Comprehensive Breast Center, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio;
| | - Susan Fugett
- Stefanie Spielman Comprehensive Breast Center, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio;
| | - Brittany Knauss
- Stefanie Spielman Comprehensive Breast Center, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio;
| | - Elizabeth Kress
- Stefanie Spielman Comprehensive Breast Center, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio;
| | - Cari Utendorf
- Stefanie Spielman Comprehensive Breast Center, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio;
| | - Anne Noonan
- Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
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13
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Habiyambere V, Dongmo Nguimfack B, Vojnov L, Ford N, Stover J, Hasek L, Maggiore P, Low-Beer D, Pérez Gonzàlez M, Edgil D, Williams J, Kuritsky J, Hargreaves S, NeSmith T. Forecasting the global demand for HIV monitoring and diagnostic tests: A 2016-2021 analysis. PLoS One 2018. [PMID: 30231022 DOI: 10.1371/journal.pone.020134] [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] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
INTRODUCTION Despite considerable progress, just over half of the 37 million people eligible to start antiretroviral therapy (ART) have accessed treatment and millions of HIV-positive people still do not know their status. With demand for ART continuing to grow, meeting the ambitious 90-90-90 HIV treatment targets will depend on improved access to high-quality diagnostics to both diagnose infection and monitor treatment adherence in low and middle-income countries (LMICs). Robust projections of future demand for CD4, viral load (VL), HIV early-infant-diagnosis (EID) tests and HIV rapid diagnostic tests (RDTs) are needed as scale-up continues. METHODS We estimate the current coverage for HIV diagnostics and project future demand to 2021 using a consolidated forecast using data on past coverage and current demand from a number of sources, from 130 predominantly LMIC countries. RESULTS We forecast that the overall number of CD4 tests is expected to decline between now and 2021 as more countries adopt test-and-treat and shift to VL testing for patient monitoring. Our consolidated forecast projects a gradual decline in demand for CD4 tests to 16.6 million by 2021. We anticipate that demand for VL tests will increase to 28.5 million by 2021, reflecting the increasing number of people who will receive ART and the adoption of VL testing for patient monitoring. We expect that the demand for EID tests will grow more rapidly than in past years, driven by the implementation of testing at birth in programmes globally, in line with WHO guideline recommendations, doubling to 2.1 million tests by 2021. Demand for rapid diagnostic tests is also likely to increase, reaching 509 million tests by 2021. DISCUSSION In order to achieve the ambitious 90-90-90 targets, it will be essential to maintain and improve access to CD4, VL, EID tests and RDTs. These projections provide insight into the global demand we can expect to see for these HIV monitoring and diagnostic tests, both in relation to historical trends, and the 90-90-90 targets. Our projections will better enable producers to ensure adequate supply, and to support procurement organisations in planning future funding and purchase plans to meet the anticipated demand. The findings highlight the ongoing need for governments and international funding bodies to prioritise improving capacity and access to HIV diagnostic and monitoring technologies in line with demand.
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Affiliation(s)
| | | | - L Vojnov
- Department of HIV/AIDS, WHO, Geneva, Switzerland
| | - N Ford
- Department of HIV/AIDS, WHO, Geneva, Switzerland
| | - J Stover
- Avenir Health, Glastonbury, Connecticut, United States of America
| | - L Hasek
- CHAI, Boston, Massachusetts, United States of America
| | - P Maggiore
- CHAI, Boston, Massachusetts, United States of America
| | - D Low-Beer
- Department of HIV/AIDS, WHO, Geneva, Switzerland
| | | | - D Edgil
- USAID, Washington DC, United States of America
| | - J Williams
- US CDC, Atlanta, Georgia, United States of America
| | - J Kuritsky
- USAID, Washington DC, United States of America
| | - S Hargreaves
- International Health Unit, Imperial College London, London, United Kingdom
| | - T NeSmith
- US CDC, Atlanta, Georgia, United States of America
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Maman D, Ben-Farhat J, Chilima B, Masiku C, Salumu L, Ford N, Mendiharat P, Szumilin E, Masson S, Etard JF. Factors associated with HIV status awareness and Linkage to Care following home based testing in rural Malawi. Trop Med Int Health 2016; 21:1442-1451. [PMID: 27714902 DOI: 10.1111/tmi.12772] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [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: 12/31/2022]
Abstract
OBJECTIVE HIV diagnosis and linkage to care are the main barriers in Africa to achieving the UNAIDS 90-90-90 targets. We assessed HIV-positive status awareness and linkage to care among survey participants in Chiradzulu District, Malawi. METHOD Nested cohort study within a population-based survey of persons aged 15-59 years between February and May 2013. Participants were interviewed and tested for HIV (and CD4 if found HIV-positive) in their homes. Multivariable regression was used to determine factors associated with HIV-positive status awareness prior to the survey and subsequent linkage to care. RESULTS Of 8277 individuals eligible for the survey, 7270 (87.8%) participated and were tested for HIV. The overall HIV prevalence was 17.0%. Among HIV-positive participants, 77.0% knew their status and 72.8% were in care. Women (adjusted odds ratio [aOR] 6.5, 95% CI 3.2-13.1) and older participants (40-59 vs. 15-29 years, aOR 10.1, 95% CI 4.0-25.9) were more likely to be aware of their positive status. Of those newly diagnosed, 47.5% were linked to care within 3 months. Linkage to care was higher among older participants (40-59 vs. 15-29, adjusted hazard ratio [aHR] 3.39, 95% CI 1.83-6.26), women (aHR 1.73, 95% CI 1.12-2.67) and those eligible for ART (aHR 1.61, 95% CI 1.03-2.52). CONCLUSIONS In settings with high levels of HIV awareness, home-based testing remains an efficient strategy to diagnose and link to care. Men were less likely to be diagnosed, and when diagnosed to link to care, underscoring the need for a gender focus in order to achieve the 90-90-90 targets.
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Affiliation(s)
- D Maman
- Epicentre, Médecins Sans Frontières, Paris, France.
| | - J Ben-Farhat
- Epicentre, Médecins Sans Frontières, Paris, France
| | - B Chilima
- Community Health Sciences Unit, Malawi Ministry of Health, Lilongwe, Malawi
| | - C Masiku
- Médecins Sans Frontières, Lilongwe, Malawi
| | - L Salumu
- Médecins Sans Frontières, Paris, France
| | - N Ford
- Department of HIV/AIDS, World Health Organization, Geneva, Switzerland.,Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | | | | | - S Masson
- Epicentre, Médecins Sans Frontières, Paris, France
| | - J F Etard
- Epicentre, Médecins Sans Frontières, Paris, France.,UMI 233, Institut de Recherche pour le Développement, Montpellier, France
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15
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Isaakidis P, Casas EC, Das M, Tseretopoulou X, Ntzani EE, Ford N. Treatment outcomes for HIV and MDR-TB co-infected adults and children: systematic review and meta-analysis. Int J Tuberc Lung Dis 2015; 19:969-78. [DOI: 10.5588/ijtld.15.0123] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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16
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Smith J, Ford N, Austin K, Clinton S, Erdman J. A Role for
BCO1
Beyond Carotenoid Metabolism: Effects on Androgen Status and Prostatic Homeostasis. FASEB J 2015. [DOI: 10.1096/fasebj.29.1_supplement.32.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Joshua Smith
- Division of Nutritional SciencesUniversity of Illinois at Urbana‐ChampaignUrbanaILUnited States
| | - Nikki Ford
- NutritionResearch Hass Avocado BoardIrvineCAUnited States
| | - Kathryn Austin
- Division of Nutritional SciencesUniversity of Illinois at Urbana‐ChampaignUrbanaILUnited States
| | - Steven Clinton
- The James Cancer Hospital and Comprehensive Cancer CenterThe Ohio State UniversityColumbusOHUnited States
| | - John Erdman
- Division of Nutritional SciencesUniversity of Illinois at Urbana‐ChampaignUrbanaILUnited States
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O'Brien DP, Ford N, Vitoria M, Christinet V, Comte E, Calmy A, Stienstra Y, Eholie S, Asiedu K. Management of BU-HIV co-infection. Trop Med Int Health 2014; 19:1040-7. [DOI: 10.1111/tmi.12342] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- D. P. O'Brien
- Manson Unit; Médecins Sans Frontières; London UK
- Department of Infectious Diseases; Barwon Health; Geelong Vic. Australia
- Department of Medicine and Infectious Diseases; Royal Melbourne Hospital; University of Melbourne; Melbourne Vic. Australia
| | - N. Ford
- HIV Department; World Health Organisation; Geneva Switzerland
| | - M. Vitoria
- HIV Department; World Health Organisation; Geneva Switzerland
| | - V. Christinet
- Department of HIV; University Hospitals of Geneva; Geneva Switzerland
| | - E. Comte
- Medical Unit; Médecins Sans Frontières; Geneva Switzerland
| | - A. Calmy
- Department of HIV; University Hospitals of Geneva; Geneva Switzerland
| | - Y. Stienstra
- Department of Internal Medicine and Infectious Diseases; University Medical Center; University of Groningen; Groningen The Netherlands
| | - S. Eholie
- Unit of Tropical and Infectious Diseases; Treichville University Teaching Hospital; Abidjan Côte d'Ivoire
| | - K. Asiedu
- Department of Control of Neglected Tropical Diseases; World Health Organisation; Geneva Switzerland
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18
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Abouei E, Ford N. SU-E-I-59: Image Quality and Dose Measurement for Partial Cone-Beam CT. Med Phys 2014. [DOI: 10.1118/1.4888009] [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: 11/07/2022] Open
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19
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Stinson K, Ford N, Cox V, Boulle A. Patients Lost to Care Are More Likely to be Viremic Than Patients Still in Care. Clin Infect Dis 2014; 58:1344-5. [DOI: 10.1093/cid/ciu072] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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20
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Garone DB, Conradie K, Patten G, Cornell M, Goemaere W, Kunene J, Kerschberger B, Ford N, Boulle A, Van Cutsem G. High rate of virological re-suppression among patients failing second-line antiretroviral therapy following enhanced adherence support: A model of care in Khayelitsha, South Africa. South Afr J HIV Med 2013. [DOI: 10.4102/sajhivmed.v14i4.52] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Objective. To describe and evaluate the outcomes of a support programme for patients with virological failure while receiving second-line antiretroviral therapy (ART) in South Africa.Method. We described a comprehensive medical and counselling patient support programme for patients receiving secondline ART and with two consecutive viral loads (VLs) >1 000 copies/ml. Patients with >3 months follow-up and at least one VL measurement after inclusion in the programme were eligible for analysis.Results. Of 69 patients enrolled in the programme, 40 had at least one follow-up VL and no known drug resistance at enrolment; 27 (68%) of these re-suppressed while remaining on second-line ART following enhanced adherence support. The majority (18/27; 67%) achieved re-suppression within the first 3 months in the programme. Five patients with diagnosed second-line drug resistance achieved viral re-suppression (<400 copies/ml) after being switched to third-line ART. Seven patients (7/40; 18%) did not achieve viral re-suppression after 9 months in the programme: 6 with known adherence problems (4 without drug resistance on genotype) and 1 with a VL <1 000 copies/ml. Overall, 3 patients (4%) died, 3 (4%) were lost to follow-up and 2 (3%) were transferred out.Conclusion. Our experience from a routine programme demonstrates that with targeted adherence support, the majority of patients who were viraemic while receiving second-line ART returned to an undetectable VL within 3 months. By increasing the time receiving second-line ART and decreasing the need for genotypes and/or third-line ART, this intervention may reduce costs.
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21
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Zachariah R, Ford N, Draguez B, Yun O, Reid T. Conducting operational research within a non governmental organization: the example of Medecins Sans Frontieres. Int Health 2013; 2:1-8. [PMID: 24037043 DOI: 10.1016/j.inhe.2009.12.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Like many other non governmental organizations (NGOs) that provide assistance to vulnerable populations living in difficult and resource-limited settings, Médecins Sans Frontières (MSF) is confronted with situations for which proven, effective interventions are often lacking and/or where there is need for strong advocacy for improving medical care. As a result, MSF has become an important contributor to health research, and has dedicated resources to guide operational research by establishing its own Ethics Review Board, an innovation fund, an online publications repository and by regularly contributing to major scientific conferences. However, this increased research activity has led to concern that priorities and resources may be diverted away from the essential mandate of care provision for NGOs. In response, this article discusses the potential role operational research can play within medical NGOs such as MSF, and highlights the relevance of operational research, the essential elements of developing it within the organisation and some of the perceived barriers and solutions.
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Affiliation(s)
- R Zachariah
- Médecins Sans Frontières, Medical Department (Brussels Operational Centre- Operational Research), 68 Rue de Gasperich, L-1617, Luxembourg
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22
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Cooke GS, Lemoine M, Thursz M, Gore C, Swan T, Kamarulzaman A, DuCros P, Ford N. Viral hepatitis and the Global Burden of Disease: a need to regroup. J Viral Hepat 2013; 20:600-1. [PMID: 23910643 DOI: 10.1111/jvh.12123] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- G S Cooke
- Infectious Diseases, Imperial College, London, UK.
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23
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Deman P, Atwal P, Duzenli C, Thakur Y, Ford N. SU-E-I-10: Dose Measurement Methodology for Dental Cone-Beam CT. Med Phys 2013. [DOI: 10.1118/1.4814110] [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: 11/07/2022] Open
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24
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Smith J, Ford N, Clinton SK, Erdman JW. Dietary carotenoids may reduce testicular steroidogenesis through HMG‐CoA reductase in mice with altered carotenoid metabolism. FASEB J 2013. [DOI: 10.1096/fasebj.27.1_supplement.32.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Josh Smith
- Division of Nutritional SciencesUniversity of Illinois at Urbana‐ChampaignUrbanaIL
| | - Nikki Ford
- Department of Nutritional SciencesUniversity of Texas at AustinAustinTX
| | - Steven K Clinton
- The James Cancer Hospital and The Comprehensive Cancer CenterThe Ohio State UniversityColumbusOH
| | - John W Erdman
- Division of Nutritional SciencesUniversity of Illinois at Urbana‐ChampaignUrbanaIL
- Department of Food Science and Human NuritionUniversity of Illinois at Urbana‐ChampaignUrbanaIL
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25
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Toczek A, Cox H, du Cros P, Cooke G, Ford N. Strategies for reducing treatment default in drug-resistant tuberculosis: systematic review and meta-analysis [Review article]. Int J Tuberc Lung Dis 2013; 17:299-307. [DOI: 10.5588/ijtld.12.0537] [Citation(s) in RCA: 104] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- A. Toczek
- Faculty of Medicine, Imperial College London, UK
| | - H. Cox
- Médecins Sans Frontières, Cape Town, South Africa; Centre for Infectious Disease Epidemiology and Research, University of Cape Town, South Africa
| | - P. du Cros
- Manson Unit, Médecins Sans Frontières, London, UK
| | - G. Cooke
- Faculty of Medicine, Imperial College London, UK; Africa Centre for Health and Population Studies, University of KwaZulu-Natal, South Africa
| | - N. Ford
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, South Africa; Manson Unit, Médecins Sans Frontières, London, UK
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26
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Ford N, Maher D. Editorial: Making sure that clinical trial results make a difference: operational research and the hierarchy of evidence. Trop Med Int Health 2013; 18:504-5. [DOI: 10.1111/tmi.12075] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- N. Ford
- Médecins sans Frontiéres; Geneva; Switzerland
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27
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Besada D, Van Cutsem G, Goemaere E, Ford N, Bygrave H, Lynch S. The case for Option B and Optional B+: Ensuring that South Africa’s commitment to eliminating mother-to-child transmission of HIV becomes a reality. South Afr J HIV Med 2012. [DOI: 10.4102/sajhivmed.v13i4.112] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
In a previous issue of the Southern African Journal of HIV Medicine, Pillay and Black summarised the trade-offs of the safety of efavirenz use in pregnancy (Pillay P, Black V. Safety, strength and simplicity of efavirenz in pregnancy. Southern African Journal of HIV Medicine 2012;13(1):28-33.). Highlighting the benefits of the World Health Organization’s proposed options for the prevention of mother-to-child transmission (PMTCT) of HIV, the authors argued that the South African government should adopt Option B as national PMTCT policy and pilot projects implementing Option B+ as a means of assessing the individual- and population-level effect of the intervention. We echo this call and further propose that the option to remain on lifelong antiretroviral therapy, effectively adopting PMTCT Option B+, be offered to pregnant women following the cessation of breastfeeding, for their own health, following the provision of counselling on associated benefits and risks. Here we highlight the benefits of Options B and B+.
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28
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Cox H, Ford N. Linezolid for the treatment of complicated drug-resistant tuberculosis: a systematic review and meta-analysis. Int J Tuberc Lung Dis 2012; 16:447-54. [PMID: 22325685 DOI: 10.5588/ijtld.11.0451] [Citation(s) in RCA: 110] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Current treatment for drug-resistant tuberculosis (DR-TB) is inadequate, and outcomes are significantly poorer than for drug-susceptible TB, particularly for patients previously treated with second-line drugs, treatment failures or extensively drug-resistant (XDR-) TB patients (complicated DR-TB). Linezolid is not recommended for routine DR-TB treatment due to the lack of efficacy data, but is suggested for patients where adequate second-line regimens are difficult to design. OBJECTIVE To conduct a systematic review and meta-analysis to assess existing evidence of efficacy and safety of linezolid for DR-TB treatment. METHODS We searched PubMed, Embase and abstracts from World Conferences of The Union for studies published through February 2011. We included all studies in which linezolid was given systematically to DR-TB patients and where treatment outcomes were reported. RESULTS A total of 11 studies were included in our review, representing 148 patients. The pooled proportion for treatment success was 67.99% (95%CI 58.00-78.99, τ2 129.42). There were no significant differences in success comparing daily linezolid dose (≤600 vs. >600 mg) and mean linezolid duration (≤7 vs. >7 months). The pooled estimate for the frequency of any adverse events was 61.48% (95%CI 40.15-82.80), with 36.23% (95%CI 20.67-51.79) discontinuing linezolid due to adverse events. CONCLUSION Treatment success with linezolid was equal to or better than that commonly achieved for uncomplicated DR-TB, and better than previous reports for previously treated patients and those with XDR-TB. While data are limited, linezolid appears be a useful drug, albeit associated with significant adverse events, and should be considered in the treatment of complicated DR-TB.
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Affiliation(s)
- H Cox
- Médecins Sans Frontières, Khayelitsha, Cape Town, South Africa.
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Hepple P, Ford N, McNerney R. Microscopy compared to culture for the diagnosis of tuberculosis in induced sputum samples: a systematic review [Review article]. Int J Tuberc Lung Dis 2012; 16:579-88. [DOI: 10.5588/ijtld.11.0617] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- P. Hepple
- Manson Unit, Médecins Sans Frontières, London, UK; Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - N. Ford
- Médecins Sans Frontières, Geneva, Switzerland; Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - R. McNerney
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
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van den Akker T, Bemelmans M, Ford N, Jemu M, Diggle E, Scheffer S, Zulu I, Akesson A, Shea J. HIV care need not hamper maternity care: a descriptive analysis of integration of services in rural Malawi. BJOG 2012; 119:431-8. [PMID: 22251303 DOI: 10.1111/j.1471-0528.2011.03229.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the use of reproductive health care and incidence of paediatric HIV infection during the expansion of antiretroviral therapy and services for the prevention of mother-to-child transmission in rural Malawi, and the influence of integration of these HIV-related services into general health services. DESIGN Descriptive analysis. SETTING Thyolo District, with a population of 600,000, an HIV prevalence of 21% and a total fertility rate of 5.7 in 2004. POPULATION Women attending reproductive health services care in 2005 and 2010. METHODS Review of facility records and databases for routine monitoring. MAIN OUTCOME MEASURES Use of antenatal, intrapartum, postpartum, family planning and sexually transmitted infection services; incidence of HIV infection in infants born to mothers who received prevention of mother-to-child transmission care. RESULTS There was a marked increase in the uptake of perinatal care: pregnant women in 2010 were 50% more likely to attend at least one antenatal visit (RR 1.50, 95% CI 1.48-1.51); were twice as likely to deliver at a healthcare facility (RR 2.05, 95% CI 2.01-2.08); and were more than four times as likely to present for postpartum care (RR 4.40, 95% CI 4.25-4.55). Family planning consultations increased by 40% and the number of women receiving treatment for sexually transmitted infections doubled. Between 2007 and 2010, the number of HIV-exposed infants who underwent testing for HIV went up from 421 to 1599/year, and the proportion testing positive decreased from 13.3 to 5.0%; infants were 62% less likely to test HIV positive (RR 0.38, 95% CI 0.27-0.52). CONCLUSIONS During the expansion and integration of HIV care, the use of reproductive health services increased and the outcomes of infants born to HIV-infected mothers improved. HIV care may be successfully integrated into broader reproductive health services.
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Affiliation(s)
- T van den Akker
- Thyolo District Health Office, Ministry of Health, Thyolo, Malawi.
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Protik A, Ford N. SU-E-I-08: Impact of Adaptive Statistical Iterative Reconstruction on Paediatric CT Protocols. Med Phys 2011. [DOI: 10.1118/1.3611580] [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: 11/07/2022] Open
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Ford N, Yip K, Yohan D, Holdsworth D, Drangova M. TH-C-220-06: Optimization of a Retrospective Respiratory-Gated Micro-Computed Tomography Technique for Free-Breathing Rats. Med Phys 2011. [DOI: 10.1118/1.3613549] [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: 11/07/2022] Open
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Curtis CE, Ford N, Marriott JF, Wilson KA, Langley CA. Proton pump inhibitor prescribing following endoscopic diagnosis in a district general hospital. International Journal of Pharmacy Practice 2011. [DOI: 10.1111/j.2042-7174.2002.tb00644.x] [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: 11/27/2022]
Abstract
Abstract
Focal points
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Affiliation(s)
- C E Curtis
- Pharmacy Department, Queen's Hospital, Belvedere Road, Burton on Trent, Staffordshire DE13 0RB, England
| | - N Ford
- Pharmacy Department, Queen's Hospital, Belvedere Road, Burton on Trent, Staffordshire DE13 0RB, England
| | - J F Marriott
- Pharmacy Practice Research Group, School of Pharmacy, Aston University, Aston Triangle, Birmingham B4 7ET, England
| | - K A Wilson
- Pharmacy Practice Research Group, School of Pharmacy, Aston University, Aston Triangle, Birmingham B4 7ET, England
| | - C A Langley
- Pharmacy Practice Research Group, School of Pharmacy, Aston University, Aston Triangle, Birmingham B4 7ET, England
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Ford N. Managing intensive care. Nurs N Z 2010; 16:17. [PMID: 20684111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Ford N, Zachariah R, Mills E, Upshur R. Defining the Limits of Emergency Humanitarian Action: Where, and How, to Draw the Line? Public Health Ethics 2009. [DOI: 10.1093/phe/php026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Foster K, Ford N. TH-C-BRC-07: An Investigation of the Effect of Micro-CT Radiation Dose On Tumor Growth in Mice. Med Phys 2009. [DOI: 10.1118/1.3182621] [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: 11/07/2022] Open
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Zachariah R, Ford N, Philips M, Draguez B, Harries A. Reply to: What about health system strengthening and internal brain drain? Trans R Soc Trop Med Hyg 2009. [DOI: 10.1016/j.trstmh.2009.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Zachariah R, Ford N, Philips M, Lynch S, Massaquoi M, Janssens V, Harries AD. Task shifting in HIV/AIDS: opportunities, challenges and proposed actions for sub-Saharan Africa. Trans R Soc Trop Med Hyg 2008; 103:549-58. [PMID: 18992905 DOI: 10.1016/j.trstmh.2008.09.019] [Citation(s) in RCA: 255] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2008] [Revised: 09/26/2008] [Accepted: 09/26/2008] [Indexed: 10/21/2022] Open
Abstract
Sub-Saharan Africa is facing a crisis in human health resources due to a critical shortage of health workers. The shortage is compounded by a high burden of infectious diseases; emigration of trained professionals; difficult working conditions and low motivation. In particular, the burden of HIV/AIDS has led to the concept of task shifting being increasingly promoted as a way of rapidly expanding human resource capacity. This refers to the delegation of medical and health service responsibilities from higher to lower cadres of health staff, in some cases non-professionals. This paper, drawing on Médecins Sans Frontières' experience of scaling-up antiretroviral treatment in three sub-Saharan African countries (Malawi, South Africa and Lesotho) and supplemented by a review of the literature, highlights the main opportunities and challenges posed by task shifting and proposes specific actions to tackle the challenges. The opportunities include: increasing access to life-saving treatment; improving the workforce skills mix and health-system efficiency; enhancing the role of the community; cost advantages and reducing attrition and international 'brain drain'. The challenges include: maintaining quality and safety; addressing professional and institutional resistance; sustaining motivation and performance and preventing deaths of health workers from HIV/AIDS. Task shifting should not undermine the primary objective of improving patient benefits and public health outcomes.
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Affiliation(s)
- R Zachariah
- Médecins Sans Frontières, Medical Department, Brussels Operational Center, Rue de Gasperich, Luxembourg.
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Boulle A, Hilderbrand K, Menten J, Coetzee D, Ford N, Matthys F, Boelaert M, Van der Stuyft P. Exploring HIV risk perception and behaviour in the context of antiretroviral treatment: results from a township household survey. AIDS Care 2008; 20:771-81. [DOI: 10.1080/09540120701660387] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- A. Boulle
- a School of Public Health and Family Medicine , University of Cape Town , Cape Town , South Africa
| | - K. Hilderbrand
- a School of Public Health and Family Medicine , University of Cape Town , Cape Town , South Africa
- b Institute of Tropical Medicine , Antwerp , Belgium
- c Médecins Sans Frontières , Cape Town , South Africa
| | - J. Menten
- b Institute of Tropical Medicine , Antwerp , Belgium
| | - D. Coetzee
- a School of Public Health and Family Medicine , University of Cape Town , Cape Town , South Africa
| | - N. Ford
- c Médecins Sans Frontières , Cape Town , South Africa
| | - F. Matthys
- b Institute of Tropical Medicine , Antwerp , Belgium
| | - M. Boelaert
- b Institute of Tropical Medicine , Antwerp , Belgium
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Caudron JM, Ford N, Henkens M, Macé C, Kiddle-Monroe R, Pinel J. Substandard medicines in resource-poor settings: a problem that can no longer be ignored. Trop Med Int Health 2008; 13:1062-72. [PMID: 18631318 DOI: 10.1111/j.1365-3156.2008.02106.x] [Citation(s) in RCA: 154] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The circulation of substandard medicines in the developing world is a serious clinical and public health concern. Problems include under or over concentration of ingredients, contamination, poor quality ingredients, poor stability and inadequate packaging. There are multiple causes. Drugs manufactured for export are not regulated to the same standard as those for domestic use, while regulatory agencies in the less-developed world are poorly equipped to assess and address the problem. A number of recent initiatives have been established to address the problem, most notably the WHO pre-qualification programme. However, much more action is required. Donors should encourage their partners to include more explicit quality requirements in their tender mechanisms, while purchasers should insist that producers and distributors supply drugs that comply with international quality standards. Governments in rich countries should not tolerate the export of substandard pharmaceutical products to poor countries, while developing country governments should improve their ability to detect substandard medicines.
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Affiliation(s)
- J-M Caudron
- Médecins Sans Frontières, Geneva, Switzerland, and AEDES Fondation, Brussels, Belgium.
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Janssens B, Van Damme W, Raleigh B, Gupta J, Khem S, Soy Ty K, Vun M, Ford N, Zachariah R. Offering integrated care for HIV/AIDS, diabetes and hypertension within chronic disease clinics in Cambodia. Bull World Health Organ 2007; 85:880-5. [PMID: 18038079 DOI: 10.2471/blt.06.036574] [Citation(s) in RCA: 123] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2007] [Accepted: 04/16/2007] [Indexed: 11/27/2022] Open
Abstract
PROBLEM In Cambodia, care for people with HIV/AIDS (prevalence 1.9%) is expanding, but care for people with type II diabetes (prevalence 5-10%), arterial hypertension and other treatable chronic diseases remains very limited. APPROACH We describe the experience and outcomes of offering integrated care for HIV/AIDS, diabetes and hypertension within the setting of chronic disease clinics. LOCAL SETTING Chronic disease clinics were set up in the provincial referral hospitals of Siem Reap and Takeo, 2 provincial capitals in Cambodia. RELEVANT CHANGES At 24 months of care, 87.7% of all HIV/AIDS patients were alive and in active follow-up. For diabetes patients, this proportion was 71%. Of the HIV/AIDS patients, 9.3% had died and 3% were lost to follow-up, while for diabetes this included 3 (0.1%) deaths and 28.9% lost to follow-up. Of all diabetes patients who stayed more than 3 months in the cohort, 90% were still in follow-up at 24 months. LESSONS LEARNED Over the first three years, the chronic disease clinics have demonstrated the feasibility of integrating care for HIV/AIDS with non-communicable chronic diseases in Cambodia. Adherence support strategies proved to be complementary, resulting in good outcomes. Services were well accepted by patients, and this has had a positive effect on HIV/AIDS-related stigma. This experience shows how care for HIV/AIDS patients can act as an impetus to tackle other common chronic diseases.
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Affiliation(s)
- B Janssens
- Médecins Sans Frontières, Phnom Penh, Cambodia.
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Affiliation(s)
- N Ford
- Caroline Chisholm Centre for Health Ethics, East Melbourne, Australia
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von Schoen Angerer T, Wilson D, Ford N, Kasper T. Access and activism: the ethics of providing antiretroviral therapy in developing countries. AIDS 2002; 15 Suppl 5:S81-90. [PMID: 11816178 DOI: 10.1097/00002030-200100005-00011] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Affiliation(s)
- N Ford
- Drugs for Neglected Disease Group/Médecins Sans Frontières, Geneva, Switzerland
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Affiliation(s)
- N Ford
- Médecins Sans Frontières, 124-32 Clerkenwell Road, EC1R 5DJ, London, UK.
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