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Sharma K, Baghirova-Busang L, Abkenari S, Gulubane G, Rana C, Vuylsteke P, Marlink R, Gaolathe T, Masupe T. Breast cancer patient experiences in the Botswana health system: Is it time for patient navigators? J Cancer Policy 2023; 38:100449. [PMID: 37890667 DOI: 10.1016/j.jcpo.2023.100449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 10/24/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND New models of care are required to support women with breast cancer due to rising incidence and mortality in sub-Saharan Africa (SSA). This study gives voice to the experiences of advanced-stage breast cancer patients in the Botswana healthcare system, to guide improved service provision and the potential utility of patient navigator (PN) programs. METHODS focus group discussions (FGD) were conducted with advanced-stage breast cancer patients recruited from the oncology ward of the public Princess Marina Hospital located in Gaborone, Botswana. RESULTS FGDs included 7 female breast cancer patients and their 7 caregivers (2 male and 5 females). Findings fell into the following themes: experiences with cancer diagnosis, experiences with treatment, roles of caregivers, information needs, views on cancer resources, and attitudes towards cancer research. The study identified several barriers across the cascade of care for breast cancer patients in the Botswana health system. These correspond to challenges with timely diagnosis and comprehensive management and highlight community level barriers to achieving the targets of the WHO Global Breast Cancer initiative (GBCI). CONCLUSION The study findings suggest PN programs have the potential to bridge barriers identified in the Botswana healthcare system by improving communication, meeting information needs, providing emotional or practical support, and by addressing logistical barriers to cancer diagnosis and treatment in Botswana.
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Affiliation(s)
- Kirthana Sharma
- Rutgers Global Health Institute, Rutgers University, New Brunswick, NJ, USA; Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
| | - Leyla Baghirova-Busang
- Department of Family Medicine and Public Health, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Shaheen Abkenari
- Rutgers Global Health Institute, Rutgers University, New Brunswick, NJ, USA
| | - Godwill Gulubane
- Department of Family Medicine and Public Health, Faculty of Medicine, University of Botswana, Gaborone, Botswana; Botswana Ministry of Health, Gaborone, Botswana
| | - Charmi Rana
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Peter Vuylsteke
- Department of Internal Medicine, University of Botswana, Gaborone, Botswana; Botswana Rutgers Partnership for Health, Gaborone, Botswana
| | - Richard Marlink
- Rutgers Global Health Institute, Rutgers University, New Brunswick, NJ, USA; Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Tendani Gaolathe
- Department of Internal Medicine, University of Botswana, Gaborone, Botswana; Botswana Rutgers Partnership for Health, Gaborone, Botswana
| | - Tiny Masupe
- Department of Family Medicine and Public Health, Faculty of Medicine, University of Botswana, Gaborone, Botswana
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Sharma K, Mayer T, Li S, Qureshi S, Farooq F, Vuylsteke P, Ralefala T, Marlink R. Advancing oncology drug therapies for sub-Saharan Africa. PLOS Glob Public Health 2023; 3:e0001653. [PMID: 37368872 DOI: 10.1371/journal.pgph.0001653] [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] [Indexed: 06/29/2023]
Abstract
Cancer incidence is rising across sub-Saharan Africa (SSA), and is often characterized by late-stage presentation, early age of onset and poor survival. While a number of oncology drugs are now improving the length and quality of life for cancer patients in high-income countries, significant disparities in access to a range of oncology therapeutics exist for SSA. A number of challenges to drug access such as drug costs, lack of infrastructure and trained personnel must be urgently addressed to advance oncology therapies for SSA. We present a review of selected oncology drug therapies that are likely to benefit cancer patients with a focus on common malignancies in SSA. We collate available data from seminal clinical trials in high-income countries to highlight the potential for these therapeutics to improve cancer outcomes. In addition, we discuss the need to ensure access to drugs within the WHO Model List of Essential Medicines and highlight therapeutics that require consideration. Available and active oncology clinical trials in the region is tabulated, demonstrating the significant gaps in access to oncology drug trials across much of the region. We issue an urgent call to action to address drug access due to the predicted rise in cancer burden in the region in coming years.
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Affiliation(s)
- Kirthana Sharma
- Rutgers Global Health Institute, New Brunswick, New Jersey, United States of America
- Department of Medicine, Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States of America
| | - Tina Mayer
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, United States of America
| | - Sharon Li
- Rutgers Cancer Institute at University Hospital, New Jersey Medical School, Newark, New Jersey, United States of America
| | - Sadaf Qureshi
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, United States of America
| | - Faheem Farooq
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, United States of America
| | - Peter Vuylsteke
- Department of Internal Medicine, University of Botswana, Gaborone, Botswana
| | - Tlotlo Ralefala
- Department of Oncology, Princess Marina Hospital, Gaborone, Botswana
| | - Richard Marlink
- Rutgers Global Health Institute, New Brunswick, New Jersey, United States of America
- Department of Medicine, Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States of America
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Sharma K, Lebelonyane R, Ralefela T, Vuylsteke P, Antony R, Legwaila M, Leselwa T, Masupe T, Gaolathe T, Marlink R. Findings of a Nationwide Mixed-Methods Assessment of Cancer Care and Prevention Needs in Botswana. JCO Glob Oncol 2022. [DOI: 10.1200/go.22.45000] [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: 11/20/2022] Open
Abstract
PURPOSE High-level investment in cancer prevention and control in low- and middle-income countries is urgently needed to address the predicted surge in cancer incidence, yet few assessments of health systems have systematically identified gaps in infrastructure, training, and patient care in sub-Saharan Africa. In Botswana, we evaluated the current state of cancer care and prevention, to understand the strengths, weaknesses, and needs regarding the provision of comprehensive cancer services. METHODS The study evaluated four regional hospitals designated as cancer sites by the Botswana Ministry of Health and Wellness to decentralize cancer services. A multi-site, cross-sectional evaluation using qualitative and quantitative methods was conducted. Focus Group Discussions with cancer patients, cancer survivors, caregivers, the general population, and healthcare workers were analyzed for emergent themes. Quantitative surveys assessed knowledge, attitudes and practices of health workers and hospital management staff, and cancer service gaps at health facilities. RESULTS Knowledge gaps included low awareness of cancer signs and symptoms among the general population, poor knowledge of early detection and treatment among health workers, and caregivers lacked skills to support cancer patients. Cancer screening services, other than cervical screening, were limited in all sites. Diagnosis and treatment barriers included lack of specialized personnel, equipment, timely pathology services, and drug stockouts. There were low levels of confidence in cancer management, including chemotherapy, without support from oncologists. Providers reported low patient screening uptake due lack of access and patients reported fear of diagnosis. Health facilities did not routinely notify cancers to the national registry. Radiotherapy was limited to one private hospital in the capital. CONCLUSION Decentralization of cancer services to regions will require substantial capacity building at district hospitals to strengthen fragmented screening, early diagnosis and treatment services. Health provider training needs and infrastructure gaps were substantial, with low public awareness of cancer signs, symptoms and causes.
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Affiliation(s)
| | | | - Tlotlo Ralefela
- Princess Marina Hospital, Botswana Ministry of Health and Wellness, Gaborone, Botswana
| | | | - Reena Antony
- Rutgers Global Health Institute, New Brunswick, NJ
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Li S, Qureshi S, Antony R, Wilson K, Moumakwa R, Lebelonyane R, Gaolathe T, Shah M, Popli P, Chandar A, Kaur S, Marlink R, Mayer T, Vuylsteke P, Ralefala T. Abstract 84: Development and Implementation of a Case-based Virtual Training Program for Oncologic Emergencies in Botswana. Cancer Epidemiol Biomarkers Prev 2021. [DOI: 10.1158/1538-7755.asgcr21-84] [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] Open
Abstract
Abstract
Purpose: Oncologic emergencies contribute to a large proportion of morbidity and mortality for oncology patients, who present unique medical challenges due to disease and treatment complexities. Emergencies training of medical staff is important, particularly if there is high turnover. We describe the development and implementation of a program to enhance timely recognition and treatment of oncologic emergencies. Due to the COVID19 pandemic, sessions were conducted virtually.
Methods: Healthcare workers who normally care for oncology patients at Princess Marina Hospital (PMH) were invited to participate in a series of weekly virtual case-based lectures. Didactic content was developed between Botswana and Rutgers faculty and fellows to reflect specific management and resources available at PMH. Participation was through live chat case reviews and pre- and post- session questions. Feedback was elicited through Likert-scale surveys.
Results: An average of 19 participants (range 13-29) attended the training sessions. Average make-up per session were as follows: 16% physicians, 26% Medical Officers, 4% Internal Medicine Residents, 32% nurses, 21% other. Healthcare workers from Botswana were invited to participate in content preparation and presentation to their peers; 3 of 8 presentations were by Botswana personnel. Average pre-session test score was 70% (range 40-89%); post-session score was 82% (range 55-97%). In post sessions surveys, average confidence in diagnosis and recognition across emergencies was 84% (range 71-100%); average confidence in management was 81% (range 57-100%).
Conclusions: We describe the successful piloting of a case-based virtual training program in oncologic emergencies, which to our knowledge is the first of its kind. The program was adapted to the Botswana health care setting. Overall, confidence in diagnosis, recognition and management of oncologic emergencies appeared to increase after sessions. Plans are in place to expand the series to more sites within the country, most of which do not have dedicated oncology trained staff.
Citation Format: Sharon Li, Sadaf Qureshi, Reena Antony, Kara Wilson, Robert Moumakwa, Refeletswe Lebelonyane, Tendani Gaolathe, Mansi Shah, Pallvi Popli, Ashwin Chandar, Sukhdeep Kaur, Richard Marlink, Tina Mayer, Peter Vuylsteke, Tlotlo Ralefala. Development and Implementation of a Case-based Virtual Training Program for Oncologic Emergencies in Botswana [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 84.
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Affiliation(s)
- Sharon Li
- 1Rutgers Robert Wood Johnson Medical School,
| | | | | | | | | | | | - Tendani Gaolathe
- 3Botswana Ministry of Health and Wellness,
- 4University of Botswana,
- 5Princess Marina Hospital,
| | - Mansi Shah
- 6Rutgers Cancer Institute of New Jersey,
| | | | | | | | | | - Tina Mayer
- 6Rutgers Cancer Institute of New Jersey,
| | | | - Tlotlo Ralefala
- 3Botswana Ministry of Health and Wellness,
- 5Princess Marina Hospital,
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Nthobatsang K, Ncenga TL, Mwangi-Woto C, Wedu TJ, Gabatlhaolwe T, Moyo S, Marlink R, Kasvosve I, Gabaitiri L, Motswaledi MS. Lack of RH2 gene expression may have influenced the HIV pandemic in sub-Saharan Africa. AIDS 2021; 35:769-776. [PMID: 33394678 DOI: 10.1097/qad.0000000000002807] [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: 11/26/2022]
Abstract
OBJECTIVE To evaluate the association between the Rhesus system RH2-blood group expression and susceptibility to HIV infection, viral load, CD4+ cell count and rate of CD4+ decline. We also aimed to determine if a country's HIV prevalence may be predicted from its RH2 relative frequency. DESIGN Our previous studies did not find any HIV-infected RH2 homozygotes. Therefore, the current cross-sectional study analysed a larger sample to determine whether HIV-infection also occurs in homozygotes. We also conducted a cross-sectional analysis of RH2 expression in an HIV natural history cohort in Botswana. Lastly, we analysed published data from 60 countries around the world to interrogate the link between RH2 frequency and HIV prevalence. METHODS One thousand and six hundred anticoagulated blood samples (800 HIV-positive and 800 HIV-negative) were phenotyped for RH2 using serological methods. The proportion of RH2-positive samples was compared across categories of HIV status and odds ratios calculated. Mean viral load and CD4+ cell counts from a natural history cohort study were also compared across categories of RH2. Kaplan--Meier plots were generated for 4-year CD4+-decline to 350 cells/μl. RESULTS No RH2 homozygotes were found among HIV-positives. Moreover, RH2-negatives were 1.37 times more likely to be HIV-positive than heterozygotes (P = 0.02) and 33 times more likely than RH2 homozygotes (P = 0.01). RH2-positive patients showed significantly higher mean CD4+ cell counts (P < 0.0001), lower viral load (P = 0.024) and slower CD4+ decline (P = 0.038). CONCLUSION RH2 is potentially a critical host genetic factor determining susceptibility of any population to HIV infection, and probably transcends most other factors in importance for HIV risk of infection.
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Affiliation(s)
| | | | | | | | | | - Sikhulile Moyo
- University of Botswana
- Botswana-Harvard Research Laboratory, Gabarone, Botswana
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Popli P, Gutterman EM, Omene C, Ganesan S, Mills D, Marlink R. Receptor-Defined Breast Cancer in Five East African Countries and Its Implications for Treatment: Systematic Review and Meta-Analysis. JCO Glob Oncol 2021; 7:289-301. [PMID: 33591798 PMCID: PMC8081496 DOI: 10.1200/go.20.00398] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor-2 (HER2) are determinants of treatment and mortality for patients with breast cancer (BC). In East Africa, the estimated 5-year survival (37.7%) is far lower than the US average (90%). This meta-analysis investigates BC receptor subtypes within five East African countries to ascertain cross-country patterns and prioritize treatment needs. METHODS From a PubMed search, January 1, 1998-June 30, 2019, for all English-only BC articles for Ethiopia, Kenya, Rwanda, Tanzania, and Uganda, eligible studies had receptor distributions for female BC samples ≥ 30 patients. Outcomes were proportions of ER+, PR+, and HER2-positive (HER2+), and/or molecular subtypes. Data included study characteristics and mean or median patient age. Using metaprop, Stata 16, we estimated pooled proportions (ES) with 95% CIs and assessed heterogeneity. RESULTS Among 36 BC studies with receptor data, 21 met criteria. Weighted mean age was 47.5 years and median, 48. Overall ES were as follows: 55% for ER-positive (ER+) (95% CI, 47 to 62), 23% for HER2+ (95% CI, 20 to 26), and 27% for triple-negative BC (TNBC) (95% CI, 23 to 32). CONCLUSION We found differences between countries, for example, lower distribution of TNBC in Ethiopia (21%) compared with Uganda (35%). ER+, the dominant BC subtype overall at 55%, emphasizes the need to prioritize endocrine therapy. Overall proportions of HER2+ BC (with or without ER+ or PR+), 23%, approached proportions of TNBC, 27%, yet HER2 testing and treatment were infrequent. Testing and reporting of receptor subtypes would promote delivery of more effective treatment reducing the mortality disparity.
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Affiliation(s)
- Pallvi Popli
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | | | - Coral Omene
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Shridar Ganesan
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, Robert Wood Johnson Medical School, New Brunswick, NJ
| | | | - Richard Marlink
- Rutgers Global Health Institute, and Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
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Phinius BB, Anderson M, Bhebhe L, Baruti K, Manowe G, Choga WT, Mupfumi L, Mbangiwa T, Mudanga M, Moyo S, Marlink R, Blackard JT, Gaseitsiwe S. Increased Prevalence of Liver Fibrosis and HIV Viremia among Patients with HIV, HBV, and Tuberculosis in Botswana. Pathogens 2020; 9:pathogens9110950. [PMID: 33202597 PMCID: PMC7696587 DOI: 10.3390/pathogens9110950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/11/2020] [Accepted: 11/11/2020] [Indexed: 11/16/2022] Open
Abstract
People with concomitant human immunodeficiency virus (HIV) and tuberculosis (TB) have an increased risk of hepatotoxic reactions due to antiretroviral therapy (ART) and anti-TB therapy (ATT). Concomitant hepatitis B virus (HBV) in these patients may lead to poorer health outcomes. To assess liver enzyme levels and immune response in adults with HIV, HBV, and TB, data from 300 antiretroviral-naïve people living with HIV (PLWHIV) were analyzed. The prevalence of HIV/HBV (cHIV/HBV) and HIV/TB (cHIV/TB) was 28% (95% CI: 23.0–33.4) and 10% (95% CI: 6.8–14.0), respectively. HIV/HBV/TB (cHIV/HBV/TB) prevalence was 5.3% (95% CI: 3.1–8.5). There was a statistically significant difference between the groups of participants in HIV viral load (p = 0.004), hemoglobin levels (p = 0.025), and body mass index (p = 0.011). A larger proportion of cHIV/HBV/TB participants (37.5%) had an aspartate aminotransferase to platelet ratio index (APRI) score ≥0.5 (p = 0.013), a lower cutoff for significant liver fibrosis. Immunological non-responders (CD4+ T-cell count <20% gain and HIV viral load <400 copies/mL at 6 months) were observed in all groups except those with cHIV/TB. Our findings support the need to screen for infections that could cause excessive liver damage prior to ATT or ART initiation, such as HBV.
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Affiliation(s)
- Bonolo B. Phinius
- Research Laboratory, Botswana Harvard AIDS Institute Partnership, Gaborone 0000, Botswana; (B.B.P.); (M.A.); (L.B.); (K.B.); (G.M.); (W.T.C.); (L.M.); (T.M.); (M.M.); (S.M.)
| | - Motswedi Anderson
- Research Laboratory, Botswana Harvard AIDS Institute Partnership, Gaborone 0000, Botswana; (B.B.P.); (M.A.); (L.B.); (K.B.); (G.M.); (W.T.C.); (L.M.); (T.M.); (M.M.); (S.M.)
| | - Lynnette Bhebhe
- Research Laboratory, Botswana Harvard AIDS Institute Partnership, Gaborone 0000, Botswana; (B.B.P.); (M.A.); (L.B.); (K.B.); (G.M.); (W.T.C.); (L.M.); (T.M.); (M.M.); (S.M.)
| | - Kabo Baruti
- Research Laboratory, Botswana Harvard AIDS Institute Partnership, Gaborone 0000, Botswana; (B.B.P.); (M.A.); (L.B.); (K.B.); (G.M.); (W.T.C.); (L.M.); (T.M.); (M.M.); (S.M.)
- Department of Biological Sciences, Faculty of Sciences, University of Botswana, Gaborone 0000, Botswana
| | - Godiraone Manowe
- Research Laboratory, Botswana Harvard AIDS Institute Partnership, Gaborone 0000, Botswana; (B.B.P.); (M.A.); (L.B.); (K.B.); (G.M.); (W.T.C.); (L.M.); (T.M.); (M.M.); (S.M.)
| | - Wonderful T. Choga
- Research Laboratory, Botswana Harvard AIDS Institute Partnership, Gaborone 0000, Botswana; (B.B.P.); (M.A.); (L.B.); (K.B.); (G.M.); (W.T.C.); (L.M.); (T.M.); (M.M.); (S.M.)
- Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa
| | - Lucy Mupfumi
- Research Laboratory, Botswana Harvard AIDS Institute Partnership, Gaborone 0000, Botswana; (B.B.P.); (M.A.); (L.B.); (K.B.); (G.M.); (W.T.C.); (L.M.); (T.M.); (M.M.); (S.M.)
| | - Tshepiso Mbangiwa
- Research Laboratory, Botswana Harvard AIDS Institute Partnership, Gaborone 0000, Botswana; (B.B.P.); (M.A.); (L.B.); (K.B.); (G.M.); (W.T.C.); (L.M.); (T.M.); (M.M.); (S.M.)
- Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa
| | - Mbatshi Mudanga
- Research Laboratory, Botswana Harvard AIDS Institute Partnership, Gaborone 0000, Botswana; (B.B.P.); (M.A.); (L.B.); (K.B.); (G.M.); (W.T.C.); (L.M.); (T.M.); (M.M.); (S.M.)
- Department of Statistics, Faculty of Sciences, University of Botswana, Gaborone 0000, Botswana
| | - Sikhulile Moyo
- Research Laboratory, Botswana Harvard AIDS Institute Partnership, Gaborone 0000, Botswana; (B.B.P.); (M.A.); (L.B.); (K.B.); (G.M.); (W.T.C.); (L.M.); (T.M.); (M.M.); (S.M.)
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Richard Marlink
- Rutgers Global Health Institute, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ 08901, USA;
| | - Jason T. Blackard
- Division of Digestive Diseases, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA;
| | - Simani Gaseitsiwe
- Research Laboratory, Botswana Harvard AIDS Institute Partnership, Gaborone 0000, Botswana; (B.B.P.); (M.A.); (L.B.); (K.B.); (G.M.); (W.T.C.); (L.M.); (T.M.); (M.M.); (S.M.)
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
- Correspondence: ; Tel.: +267-3902671 (ext. 2216)
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Popli P, Shah MR, Ralefala TB, Toppmeyer D, Strair R, Lebelonyane R, Mompe A, Gaolathe T, Antony R, Marlink R, Mayer TM. Reducing Oncologic Disparities by Standardizing Cancer Care. JCO Glob Oncol 2020. [DOI: 10.1200/go.20.61000] [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: 11/20/2022] Open
Abstract
PURPOSE Shortages in oncology-trained health care providers pose a major challenge in low- and middle-income countries (LMICs) and contribute to delays in the diagnosis and treatment of cancer. Presently, the sole oncologist in the public sector at Princess Marina Hospital, Botswana’s largest oncology referral center, is overextended, causing medical officers to be the primary providers for patients with cancer. Medical officers do not possess formal oncology training, which can potentially lead to imprecise management and suboptimal treatment. In addition, there is no standardized patient interview process in the hematology clinic, leading to inadequately captured patient records. These realities highlight the need for the dissemination and implementation of evidence-based guidelines and intake forms to standardize the delivery of cancer care for practitioners with varying degrees of training. METHODS To serve as a reference for medical officers and oncologists, we reviewed clinical guidelines for the most prevalent cancers in Botswana, namely breast, cervical, prostate, colorectal, and head and neck cancer. We incorporated American Joint Committee on Cancer 8th edition staging criteria into the preexisting guidelines approved by Ministry of Health and Wellness Botswana. We further customized them on the basis of radiology, pathology, and pharmaceutical resource availability in Botswana. Finally, to streamline patient visits, we created intake forms to capture comprehensive hematology-pertinent information. As a quality improvement project, we will record the use and impact of these forms as a tool to standardize the medical records. RESULTS Standardized cancer care guidelines were updated and are under review by the Ministry of Health and Wellness Botswana before circulation. In addition, feedback regarding the new intake forms and their use is currently being recorded. CONCLUSION In low- and middle-income countries, the development of cancer-specific treatment guidelines optimizes disease management through incorporation of evidence-based, resource-adjusted recommendations for clinicians and may aid in reducing global oncologic disparities. As the next phase in the implementation of guidelines, we plan to develop quick-reference cancer pathways for use in public institutions without existing oncologic expertise.
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Affiliation(s)
- Pallvi Popli
- Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Mansi R. Shah
- Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ
| | | | | | - Roger Strair
- Rutgers-Cancer Institute of New Jersey, New Brunswick, NJ
| | | | | | | | - Reena Antony
- Rutgers University-Global Health Institute, New Brunswick, NJ
| | - Richard Marlink
- Rutgers University-Global Health Institute, New Brunswick, NJ
| | - Tina M. Mayer
- Rutgers-Cancer Institute of New Jersey, New Brunswick, NJ
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Popli P, Gutterman EM, Omene CO, Ganesan S, Marlink R. Breast cancer receptor subtypes in East Africa: A systematic review and meta-analysis. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e19074] [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: 11/20/2022] Open
Abstract
e19074 Background: Estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) are determinants of both treatment and mortality for patients with breast cancer (BC). With a mortality to incidence ratio of 0.51, mortality rates for breast cancer in East Africa are among the world’s highest. Building on a meta-analysis of BC receptor subtypes in sub-Saharan Africa (2014) and including all recently available PubMed literature, our meta-analysis aims to investigate the differences among receptor subtype distribution in five East African countries. Methods: Receptor distributions for female samples >30 in all BC articles for Ethiopia, Kenya, Rwanda, Tanzania and Uganda were obtained from PubMed, January 1, 1998 - June 30, 2019. Outcomes were proportions of ER+, PR+, and HER2+ and/or molecular subtypes. Data included study characteristics and mean/median patient age (weighted by observations). Using metaprop for STATA 16, we estimated pooled proportions (ES) with 95% confidence intervals (CI) and assessed I2 statistics for heterogeneity across studies. Results: Among 35 BC studies with receptor data, 21 met criteria. Overall, the weighted mean age was 47.5 years (SD 3.2) and median, 48. For ER+ (18 studies/n=2,875), the overall ES was 0.55 (95% CI 0.47, 0.62), I2 of 94.4%, p<0.001, ranging from 0.62 in Ethiopia (95% CI 0.52, 0.72) to 0.42 in Uganda (95%0.36, 0.49). For HER2+ (18 studies/n=2,689), the overall ES was 0.23 (95% CI 0.20, 0.26), I2 of 70.2%, p<0.001, and ranged from 0.27 in Ethiopia (95% CI 0.18, 0.36) to 0.21 in both Tanzania and Uganda (95% CI 0.13/0.14, 0.28). For triple negative (TN, 15 studies/n=2,510), the overall ES was 0.28 (95% CI 0.23, 0.32), I2 of 84.0%, p<0.001, varying from 0.21 in Ethiopia (95% CI 0.15, 0.27) to 0.46 in Tanzania (95% CI 0.32, 0.60). Conclusions: We found differences between countries, e.g. lower distribution of TN in Ethiopia (21%) compared to Uganda (35%) and Tanzania (46%), and high between-study heterogeneity. Consistent with former studies, ER+, 55%, was the dominant subtype, particularly in Ethiopia, Kenya and Rwanda, indicating the need to prioritize hormonal treatment. Overall rates of HER2 subtype, 23%, approached overall rates of TN, 28%, yet HER2 testing is often not performed due to the cost and unavailability of anti-HER2 therapy, hence this subtype often goes untreated. These findings highlight the benefit of testing and reporting of receptor subtypes at the country level to promote delivery of more effective treatment to reduce the mortality disparity.
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Affiliation(s)
- Pallvi Popli
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | | | | | | | - Richard Marlink
- Rutgers Global Health Institute, and Cancer Institute of New Jersey, New Brunswick, NJ
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Phinius BB, Anderson M, Bokete R, Mbangiwa T, Choga WT, Baruti K, Makhema J, Musonda R, Blackard JT, Essex M, Moyo S, Marlink R, Gaseitsiwe S. Incidence of hepatitis B virus infection among human immunodeficiency virus-infected treatment naïve adults in Botswana. Medicine (Baltimore) 2020; 99:e19341. [PMID: 32118769 PMCID: PMC7478615 DOI: 10.1097/md.0000000000019341] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 12/19/2022] Open
Abstract
Hepatitis B virus (HBV) and human immunodeficiency virus (HIV) coinfection is highest in sub-Saharan Africa and results in accelerated clinical outcomes compared with HBV or HIV mono-infection. HBV clearance rates are higher in healthy adults; however, in sub-Saharan Africa, there are limited data on clearance of incident HBV in HIV-infected adults. Therefore, we sought to estimate HBV incidence and HBV surface antigen (HBsAg) clearance in HIV-infected adults in Botswana.This was a retrospective longitudinal study of 442 HIV-1C infected treatment naïve patients enrolled in a previous Botswana Harvard AIDS Institute Partnership study. Archived plasma samples from 435 HIV-infected treatment naïve participants were screened for HBsAg and HBV core antibody (anti-HBc). HBsAg was evaluated annually over a 4-year period, and HBV deoxyribonucleic acid (DNA) levels of HBsAg-positive chronic and incident patients were quantified.Baseline median CD4+ T-cell count was 458 cells/μL [Q1, Q3: 373, 593], and median HIV viral load was 4.15 copies/mL [Q1, Q3: 3.46, 4.64]. Twenty two HBV incident cases occurred, representing an incidence of 3.6/100 person-years [95% CI: 2.2-5.6]. All incident HBV cases with a follow-up sample available for screening (13/22) cleared HBsAg. Detectable HBV viral loads among chronic and incident cases ranged between 5.15 × 10 to 1.4 × 10 IU/L and 1.80 × 10 to 1.7 × 10 IU/mL, respectively.We report high HBV incidence associated with elevated HBV DNA levels despite high CD4+ T-cell counts in HIV-infected patients in Botswana. These incidence cases represent a potential source of HBV transmission in the population. Scaling-up of HIV treatment strategies utilizing antiretroviral therapy regimens with anti-HBV activity coupled with screening for HBV infections in households of the HBsAg-positive cases is recommended.
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Affiliation(s)
| | - Motswedi Anderson
- Botswana Harvard AIDS Institute Partnership
- University of Botswana, Gaborone, Botswana
| | | | - Tshepiso Mbangiwa
- Botswana Harvard AIDS Institute Partnership
- Division of Immunology, Department of Pathology, University of Cape Town, South Africa
| | - Wonderful Tatenda Choga
- Botswana Harvard AIDS Institute Partnership
- Division of Immunology, Department of Pathology, University of Cape Town, South Africa
| | - Kabo Baruti
- Botswana Harvard AIDS Institute Partnership
- University of Botswana, Gaborone, Botswana
| | - Joseph Makhema
- Botswana Harvard AIDS Institute Partnership
- Harvard T.H. Chan School of Public Health AIDS Initiative, Boston, Massachusetts
| | - Rosemary Musonda
- Botswana Harvard AIDS Institute Partnership
- Harvard T.H. Chan School of Public Health AIDS Initiative, Boston, Massachusetts
| | | | - Max Essex
- Botswana Harvard AIDS Institute Partnership
- Harvard T.H. Chan School of Public Health AIDS Initiative, Boston, Massachusetts
| | - Sikhulile Moyo
- Botswana Harvard AIDS Institute Partnership
- Harvard T.H. Chan School of Public Health AIDS Initiative, Boston, Massachusetts
| | - Richard Marlink
- Botswana Harvard AIDS Institute Partnership
- Rutgers University, New Jersey, USA
| | - Simani Gaseitsiwe
- Botswana Harvard AIDS Institute Partnership
- Harvard T.H. Chan School of Public Health AIDS Initiative, Boston, Massachusetts
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Marlink R. Urgently Creating the Better in Global Health. Hastings Cent Rep 2019; 47:25-26. [PMID: 28940350 DOI: 10.1002/hast.765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In this issue of the Hastings Center Report, Govind Persad and Ezekiel Emanuel argue that "[t]he provision of cheaper, less effective health care is frequently the most effective way of promoting health and realizing the ethical values of utility, equality, and priority to the worst off." I agree that we should not let the perfect get in the way of the good, but just providing cheaper, less effective treatment for utilitarian or other reasons is not a comprehensive approach to global health. In my experience as an on-the-ground global health practitioner, the choice is never that simple. As time passes, dynamics evolve, and so should the responses to a global health problem. The goal of global health should be urgently improving responses toward better access to care and equity in health, without which the good may become the enemy of the better. In other words, there are places and times in which the approach Persad and Emanuel describe may be appropriate, but their recommendations fail to account for the realities of a population-level medical emergency and for the fact that once an emergency is initially or partially addressed in any setting, time can be the enemy, if it breeds complacency.
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Chandar A, Kaur S, Ralefala TB, Toppmeyer D, Philipp C, Marlink R, Antony R, DiGiacobbe M, Lebelonyane R, Gaolathe T, Mayer TM. Building international partnerships to improve global oncological care: Perspective from Rutgers-CINJ Global Oncology Fellowship Program. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.27_suppl.159] [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: 11/20/2022] Open
Abstract
159 Background: With cancer accounting for 1 in every 7 deaths worldwide and 60-70% of cancer deaths occurring in low- and middle-income countries, any advancement in cancer care should include understanding to alleviate structural inequalities that produce these global oncological disparities. Rutgers-Cancer Institute of New Jersey (R-CINJ) Oncology Fellowship program, through partnerships with Rutgers Global Health and University of Botswana (UB), established a global oncology program in 2018 to provide young oncologists in training with this educational opportunity. Aims included understanding challenges faced by cancer patients in Botswana, evaluating opportunities to improve oncology care at Princess Marina Hospital (PMH), scholarly collaborations, and exchange knowledge. Methods: In partnership with PMH, UB, and Ministry of Health and Wellness (MOHW), R-CINJ created a global oncology program consisting of a 1 month rotation at PMH in Gaborone, Botswana, as well as longitudinal research/quality improvement (QI) projects. Two 3rd year oncology fellows rotated with house officers and oncologist at PMH. Weekly video conferences facilitated communication during the elective. Projects continued throughout 3rd year of fellowship, in conjunction with programmatic meetings. Results: Fellows gained exposure to cancer care using limited resources. In working with PMH staff, mentorship was provided, QI ideas were shared, and organizational changes were implemented. Scholarly activity was undertaken to examine trends in chemotherapy utilization at PMH over a 12-month period to assess patterns of malignancy and issues with stock outs. Relationship between pathology at PMH, UB, and Rutgers-CINJ and Rutgers Biomedical Engineering was established to expand digital pathology services in Botswana. Conclusions: Our global oncology program is a successful start to an ongoing partnership to help improve cancer care in Botswana. Future directions include development of cancer protocols in Botswana, helping limit medication shortages, and establishing telemedicine based collaboration to assist with diagnosis and improve pathology turnaround time.
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Affiliation(s)
- Ashwin Chandar
- Rutgers-Cancer Institute of New Jersey, New Brunswick, NJ
| | - Sukhdeep Kaur
- Rutgers- Cancer Institute of New Jersey, Philadelphia, PA
| | | | | | - Claire Philipp
- Rutgers-Robert Wood Johnson Med School, New Brunswick, NJ
| | - Richard Marlink
- Rutgers University, Global Health Institute, New Brunswick, NJ
| | - Reena Antony
- Rutgers University, Global Health Institute, New Brunswick, NJ
| | | | | | | | - Tina M. Mayer
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
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Kaur S, Chandar A, Mayer TM, Toppmeyer D, Strair R, Marlink R, Antony R, DiGiacobbe M, Lebelonyane R, Gaolathe T, Ralefala TB. Evaluating the challenges of cancer care in Botswana: Chemotherapy utilization and stock outs. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e18309] [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: 11/20/2022] Open
Abstract
e18309 Background: As a significant percentage of cancer deaths are occurring in low- and middle-income countries, there is an unmet need in facilitating cancer care delivery in these countries. Data on stock-outs and shortages of cancer medicines in Botswana have been reported as one of the roots hindering treatment and potentially increasing mortality, with at least 40% of essential drugs being out of stock for at least 30 days in 2015. A methodologic approach was published in 2018 to forecast chemotherapy (CT) volume, however, this was based on incidence and prevalence data, using multiple estimated assumptions. To obtain objective data, we examined trends in CT utilization at Princess Marina Hospital (PMH), largest referral hospital in Botswana, over a 12-month period evaluating indications for CT, dosages, and potential issues with stock outs of essential medications. Here we present the 21 injectable essential CT utilized during this period. Methods: This is a retrospective analysis, with data collected from October 2017 to September 2018 from the log book which is used daily by the pharmacy at PMH to record CT preparations. Data was organized to reflect dosage of CT, regimen used, and its indication. Results: Over 1 year period, 21 injectable CT agents were utilized for cancer therapy, with common treated diseases being Kaposi Sarcoma, Gyn cancer, Breast cancer, and Lymphomas. The 10 most utilized agents are listed with the monthly dosage used. Conclusions: We hope to analyze trends in CT utilization based on the available stocks of drugs at PMH to help optimize plans for purchasing and storing medications, with goal of reducing stock outs. In addition, we will analyze treatment regimens used at PMH and compare to current standard of care CT in the US and Sub-Saharan Africa to optimize cancer pathway protocols used in Botswana. [Table: see text]
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Affiliation(s)
- Sukhdeep Kaur
- Rutgers-Cancer Institute of New Jersey, New Brunswick, NJ
| | - Ashwin Chandar
- Rutgers-Cancer Institute of New Jersey, New Brunswick, NJ
| | - Tina M. Mayer
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | | | - Roger Strair
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Richard Marlink
- Rutgers University, Global Health Institute, New Brunswick, NJ
| | - Reena Antony
- Rutgers University, Global Health Institute, New Brunswick, NJ
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Chandar A, Kaur S, Toppmeyer D, Ralefala TB, Strair R, Philipp C, Marlink R, Antony R, DiGiacobbe M, Lebelonyane R, Gaolathe T, Mayer TM. Building international partnerships to improve global oncological care: Perspective from Rutgers-CINJ Global Oncology Fellowship Program. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e18161] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e18161 Background: With cancer accounting for 1 in every 7 deaths worldwide and 60-70% of cancer deaths occurring in low- and middle-income countries, any advancement in cancer care should include understanding to alleviate structural inequalities that produce these global oncologic disparities. Rutgers-Cancer Institute of New Jersey (R-CINJ) Oncology Fellowship program, through partnerships with Rutgers Global Health and University of Botswana (UB), established a global oncology program in 2018 to provide young oncologists in training with this educational opportunity. Aims included understanding challenges faced by cancer patients in Botswana, evaluating opportunities to improve oncology care at Princess Marina Hospital (PMH), scholarly collaborations, and exchange knowledge. Methods: In partnership with PMH, UB, and Ministry of Health and Wellness (MOHW), R-CINJ created a global oncology program consisting of a 1 month rotation at PMH in Gaborone, Botswana, as well as longitudinal research/quality improvement (QI) projects. Two 3rd year oncology fellows rotated with house officers and oncologist at PMH. Weekly video conferences facilitated communication during the elective. Projects continued throughout 3rd year of fellowship, in conjunction with programmatic meetings. Results: Fellows gained exposure to cancer care using limited resources. In working with PMH staff, mentorship was provided, QI ideas were shared, and organizational changes were implemented. Scholarly activity was undertaken to examine trends in chemotherapy utilization at PMH over a 12-month period to assess patterns of malignancy and issues with stock outs. Relationship between pathology at PMH, UB, R-CINJ, and Rutgers Biomedical Engineering was established to expand digital pathology services in Botswana. Conclusions: Our global oncology program is a successful start to an ongoing partnership to help improve cancer care in Botswana. Future directions include development of cancer guidelines and protocols in Botswana, helping limit medication shortages, and establishing telemedicine based collaboration to assist with diagnosis and improve pathology turnaround time.
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Affiliation(s)
- Ashwin Chandar
- Rutgers-Cancer Institute of New Jersey, New Brunswick, NJ
| | - Sukhdeep Kaur
- Rutgers-Cancer Institute of New Jersey, New Brunswick, NJ
| | | | | | - Roger Strair
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Claire Philipp
- Rutgers-Robert Wood Johnson Med School, New Brunswick, NJ
| | - Richard Marlink
- Rutgers University, Global Health Institute, New Brunswick, NJ
| | - Reena Antony
- Rutgers University, Global Health Institute, New Brunswick, NJ
| | | | | | | | - Tina M. Mayer
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
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Phinius BB, Bokete R, Anderson M, Mbangiwa T, Choga W, Moyo S, Musonda R, Marlink R, Gaseitsiwe S. PO 8481 HIGH HEPATITIS B VIRUS INCIDENCE AMONG HIV-1-INFECTED TREATMENT-NAIVE ADULTS IN BOTSWANA. BMJ Glob Health 2019. [DOI: 10.1136/bmjgh-2019-edc.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BackgroundHepatitis B virus (HBV) is one of the leading causes of death worldwide despite a moderately potent vaccine. HBV prevalence has been shown to be higher in patients infected with the human immunodeficiency virus (HIV), hence increased liver-related morbidity and mortality, as well as general poor health outcomes in HIV-HBV co-infection. We estimated the HBV incidence among HIV-1-infected treatment-naïve adults in a longitudinal cohort in Botswana.MethodsPlasma samples from 200 HIV-1C-infected treatment-naïve participants from a completed longitudinal cohort from 2004 to 2007 were screened for HBV surface antigen (HBsAg). HBsAg was assessed using Murex version 3 enzyme-linked immunosorbent assay as per manufacturer’s instructions at 4 timepoints, 12 months apart. We estimated HBV incidence with 95% confidence interval (CI). Cox proportional regression method was used to estimate hazard ratios [gender, age (≤35 or>35) years, CD4+ T cell count (≤450 or>450) cells/µL and HIV viral load suppression (≤400 or>400) copies/mL].ResultsThe median age of screened individuals was 32 years [Q1, Q3; 28, 40] and 83.5% [167/200] were female. Baseline median CD4+ T cell count was 466.35 cells/µL [Q1, Q3: 380.43, 605.75] and median HIV viral load was 13 450 copies/mL [Q1, Q3: 2365, 37 400]. The HBV incidence was 3.6/100 person-years [95% CI: 2.2–5.6]. There were no significant differences by gender, age, HIV viral load suppression and CD4+ T cell count.ConclusionWe report for the first time a high HBV incidence among HIV-infected adults in Botswana. HBV incidence was high in this population despite generally high CD4 +T cell counts and lower HIV viral loads. Early screening of HBV in HIV-infected individuals is vital and should be included in the national HIV treatment guidelines.
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Anderson M, Choga WT, Moyo S, Bell TG, Mbangiwa T, Phinius BB, Bhebhe L, Sebunya TK, Makhema J, Marlink R, Kramvis A, Essex M, Musonda RM, Blackard JT, Gaseitsiwe S. In Silico Analysis of Hepatitis B Virus Occult Associated Mutations in Botswana Using a Novel Algorithm. Genes (Basel) 2018; 9:genes9090420. [PMID: 30134551 PMCID: PMC6162659 DOI: 10.3390/genes9090420] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 08/16/2018] [Indexed: 02/06/2023] Open
Abstract
Occult hepatitis B infections (OBI) represent a reservoir of undiagnosed and untreated hepatitis B virus (HBV), hence the need to identify mutations that lead to this phenotype. Functionally characterizing these mutations by in vitro studies is time-consuming and expensive. To bridge this gap, in silico approaches, which predict the effect of amino acid (aa) variants on HBV protein function, are necessary. We developed an algorithm for determining the relevance of OBI-associated mutations using in silico approaches. A 3 kb fragment of subgenotypes A1 and D3 from 24 chronic HBV-infected (CHB) and 24 OBI participants was analyzed. To develop and validate the algorithm, the effects of 68 previously characterized occult-associated mutations were determined using three computational tools: PolyPhen2, SNAP2, and PROVEAN. The percentage of deleterious mutations (with impact on protein function) predicted were 52 (76.5%) by PolyPhen2, 55 (80.9%) by SNAP2, and 65 (95.6%) by PROVEAN. At least two tools correctly predicted 59 (86.8%) mutations as deleterious. To identify OBI-associated mutations exclusive to Botswana, study sequences were compared to CHB sequences from GenBank. Of the 43 OBI-associated mutations identified, 26 (60.5%) were predicted by at least two tools to have an impact on protein function. To our knowledge, this is the first study to use in silico approaches to determine the impact of OBI-associated mutations, thereby identifying potential candidates for functional analysis to facilitate mechanistic studies of the OBI phenotype.
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Affiliation(s)
- Motswedi Anderson
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.
- Faculty of Science, Department of Biological Sciences, University of Botswana, Gaborone, Botswana.
| | | | - Sikhulile Moyo
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
| | - Trevor Graham Bell
- Hepatitis Virus Diversity Research Unit (HVDRU), Faculty of Health Sciences, Department of Internal Medicine, School of Clinical Medicine, University of the Witwatersrand, Johannesburg 2050, South Africa.
| | - Tshepiso Mbangiwa
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.
- Faculty of Allied Health Sciences, University of Botswana, Gaborone, Botswana.
| | - Bonolo B Phinius
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.
| | - Lynette Bhebhe
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.
| | - Theresa K Sebunya
- Faculty of Science, Department of Biological Sciences, University of Botswana, Gaborone, Botswana.
| | - Joseph Makhema
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
| | - Richard Marlink
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
- Rutgers Global Health Institute, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ 08854, USA.
| | - Anna Kramvis
- Hepatitis Virus Diversity Research Unit (HVDRU), Faculty of Health Sciences, Department of Internal Medicine, School of Clinical Medicine, University of the Witwatersrand, Johannesburg 2050, South Africa.
| | - Max Essex
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
| | | | - Jason T Blackard
- College of Medicine, University of Cincinnati, Cincinnati, OH 45267, USA.
| | - Simani Gaseitsiwe
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
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Diphoko T, Gaseitsiwe S, Kasvosve I, Moyo S, Okatch H, Musonda R, Wainberg M, Makhema J, Marlink R, Novitsky V, Essex M. Prevalence of Rilpivirine and Etravirine Resistance Mutations in HIV-1 Subtype C-Infected Patients Failing Nevirapine or Efavirenz-Based Combination Antiretroviral Therapy in Botswana. AIDS Res Hum Retroviruses 2018; 34:667-671. [PMID: 29732907 PMCID: PMC6079649 DOI: 10.1089/aid.2017.0135] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 01/10/2023] Open
Abstract
Rilpivirine (RPV) and Etravirine (ETR) are approved second-generation non-nucleoside reverse transcriptase inhibitors (NNRTIs) for HIV treatment. There is a cross-resistance HIV mutation profile between first- and second-generation NNRTI drugs. We determined the prevalence of HIV-1 drug resistance mutations (DRMs) to RPV and ETR in Botswana. A total of 168 HIV-1 polymerase gene sequences from participants failing nevirapine (NVP)- or efavirenz (EFV)-containing regimens were analyzed for DRMs using the Stanford University HIV drug resistance database. Forty-one sequences were from an adult antiretroviral therapy (ART) study, the Tshepo study, and 127 from a prevention of mother-to-child transmission (PMTCT) study, the Mashi study, all conducted in Botswana. Prevalence of RPV and ETR highest DRM in the adult ART study (n = 41) were K101E (26.2%), E138A (23.8%), and Y181C (26.2%). The PMTCT cohort's (n = 127) high prevalence mutations were Y181C (15.7%), E138A (15%), and K101E (11%). A total of 42.9% and 3.2% of patients in the adult ART study and PMTCT study, respectively, had three or more NNRTI mutations at virologic failure. We identified HIV-1 mutations conferring resistance to RPV and ETR even though they have not been used in Botswana. Of concern was the high proportion of sequences from the adult ART study that displayed multiple DRMs; as the number of NNRTI mutations increases, the level of cross-resistance increases. It is plausible that patients displaying such profiles maybe at increased risk of failing second-generation NNRTI drugs, hence, calls for genotyping in patients with prior NVP or efavirenz exposure before prescription of RPV- or ETR-containing cART.
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Affiliation(s)
- Thabo Diphoko
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Department of Medical Laboratory Sciences, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana
| | - Simani Gaseitsiwe
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Harvard T.H. Chan School of Public Health, Department of Immunology and Infectious Diseases, Boston, Massachusetts
| | - Ishmael Kasvosve
- Department of Medical Laboratory Sciences, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana
| | - Sikhulile Moyo
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Harvard T.H. Chan School of Public Health, Department of Immunology and Infectious Diseases, Boston, Massachusetts
| | - Harriet Okatch
- Centre for Public Health Initiatives, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rosemary Musonda
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Harvard T.H. Chan School of Public Health, Department of Immunology and Infectious Diseases, Boston, Massachusetts
| | - Mark Wainberg
- Lady Davis Institute for Medical Research, McGill University, Montreal, Canada
| | - Joseph Makhema
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Harvard T.H. Chan School of Public Health, Department of Immunology and Infectious Diseases, Boston, Massachusetts
| | - Richard Marlink
- Rutgers Global Health Institute, Rutgers Biomedical and Health Sciences, Rutgers University, New Brunswick, New Jersey
| | - Vladimir Novitsky
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Harvard T.H. Chan School of Public Health, Department of Immunology and Infectious Diseases, Boston, Massachusetts
| | - Max Essex
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Harvard T.H. Chan School of Public Health, Department of Immunology and Infectious Diseases, Boston, Massachusetts
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Mupfumi L, Moyo S, Molebatsi K, Thami PK, Anderson M, Mogashoa T, Iketleng T, Makhema J, Marlink R, Kasvosve I, Essex M, Musonda RM, Gaseitsiwe S. Correction: Immunological non-response and low hemoglobin levels are predictors of incident tuberculosis among HIV-infected individuals on Truvada-based therapy in Botswana. PLoS One 2018; 13:e0198711. [PMID: 29856867 PMCID: PMC5983512 DOI: 10.1371/journal.pone.0198711] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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N'Guessan KF, Anderson M, Phinius B, Moyo S, Malick A, Mbangiwa T, Choga WT, Makhema J, Marlink R, Essex M, Musonda R, Gaseitsiwe S, Blackard JT. The Impact of Human Pegivirus on CD4 Cell Count in HIV-Positive Persons in Botswana. Open Forum Infect Dis 2017; 4:ofx222. [PMID: 29255726 PMCID: PMC5726461 DOI: 10.1093/ofid/ofx222] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 07/18/2017] [Accepted: 10/05/2017] [Indexed: 02/02/2023] Open
Abstract
Background Human pegiviruses (HPgV)-formerly known as hepatitis G virus or GB virus C (GBV-C)-are common single-stranded RNA viruses that may have a beneficial impact on slowing HIV disease progression. The data on HPgV in resource-limited regions such as Sub-Saharan Africa are scarce. Thus, we conducted the first study of HPgV in Botswana as part of a natural history study of HIV subtype C disease progression. Methods Plasma samples from 133 HIV-positive adults were evaluated for HPgV RNA, and the 5'UTR was sequenced to determine the HPgV genotype. Results HPgV RNA was detected in 41 (30.8%) individuals. While the presence of HPgV RNA had no impact on baseline HIV viral load, a significant difference in baseline CD4 cell count was observed. HPgV genotypes were determined for 27 individuals and included 5 individuals (18.5%) with genotype 1 and 22 (81.5%) with genotype 5. Baseline CD4 cell counts were significantly higher for persons infected with HPgV genotype 5 compared with genotype 1. Conclusions These data suggest that HPgV infection is common among HIV-positive individuals in Botswana and has a significant impact on CD4 cell count. This difference in CD4 cell count based on HPgV genotype suggests that HPgV genotype should be evaluated as a possible predictor of HIV disease progression and highlights the need for additional studies of this virus in resource-limited settings.
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Affiliation(s)
| | - Motswedi Anderson
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.,Department of Biological Sciences, Gaborone, Botswana
| | - Bonolo Phinius
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Sikhulile Moyo
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.,Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Alyyah Malick
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.,Harvard College, Cambridge, Massachusetts
| | - Tshepiso Mbangiwa
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.,School of Allied Health Professions, University of Botswana, Gaborone, Botswana
| | | | - Joseph Makhema
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.,Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Richard Marlink
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.,Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Max Essex
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.,Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Rosemary Musonda
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.,Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Simani Gaseitsiwe
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.,Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
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Ryan K, Anderson M, Gyurova I, Ambroggio L, Moyo S, Sebunya T, Makhema J, Marlink R, Essex M, Musonda R, Gaseitsiwe S, Blackard JT. High Rates of Occult Hepatitis B Virus Infection in HIV-Positive Individuals Initiating Antiretroviral Therapy in Botswana. Open Forum Infect Dis 2017; 4:ofx195. [PMID: 29062862 PMCID: PMC5641381 DOI: 10.1093/ofid/ofx195] [Citation(s) in RCA: 28] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 09/12/2017] [Indexed: 12/16/2022] Open
Abstract
Background Hepatitis B surface antigen (HBsAg)–negative but hepatitis B virus (HBV) DNA-positive infection—known as occult hepatitis B infection (OBI)—occurs in 1% to >15% of HIV-positive individuals in the United States and South Africa, respectively. However, there are no data on OBI from Botswana, a country known to be hyperendemic for chronic HBV infection and to have a significant HIV burden. Methods Two hundred seventy-two adults enrolled in an HIV treatment study of tenofovir/emtricitabine as the nucleoside backbone who were previously determined to be HBsAg negative were tested for HBV DNA at baseline and 1 year after initiation of highly active antiretroviral therapy (HAART). Results HBV DNA was detected in 72 of 272 (26.5%). Six individuals (8.3%) had HBV DNA levels greater than 200 IU/mL, and the highest viral load was 3280 IU/mL. Of 65 participants with OBI evaluated at 12 months after initiating HAART, only 1 (1.5%) had detectable HBV DNA. Conclusions Occult HBV infection is quite common in HIV-infected patients in Botswana, although its impact on the course of HIV disease progression is unknown. The suppression of occult HBV DNA levels by tenofovir/emtricitabine suggests an effective therapeutic option, although the long-term suppressive abilities remain unstudied.
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Affiliation(s)
- Kathleen Ryan
- University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Motswedi Anderson
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.,Department of Biological Sciences, University of Botswana, Gaborone, Botswana
| | - Ivayla Gyurova
- University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | - Sikhulile Moyo
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.,Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Teresa Sebunya
- Department of Biological Sciences, University of Botswana, Gaborone, Botswana
| | - Joseph Makhema
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.,Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Richard Marlink
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.,Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Max Essex
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.,Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Rosemary Musonda
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.,Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Simani Gaseitsiwe
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.,Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
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21
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Campa A, Baum MK, Bussmann H, Martinez SS, Farahani M, van Widenfelt E, Moyo S, Makhema J, Essex M, Marlink R. The effect of micronutrient supplementation on active TB incidence early in HIV infection in Botswana. Nutr Diet Suppl 2017; 2017:37-45. [PMID: 29187783 PMCID: PMC5703420 DOI: 10.2147/nds.s123545] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Coinfection with active tuberculosis (TB) is one of the leading causes of death in people living with HIV (PLWH) in Africa. This investigation explores the role of micronutrient supplementation in preventing active TB in PLWH. METHODS A randomized trial of nutritional supplementation was conducted among antiretroviral- naïve (without previous antiretroviral treatment [ART]) HIV-infected people in Botswana between 2004 and 2009. The study had a factorial design with four arms: the selenium (Se) alone arm, the multivitamins (MVT) alone arm that contained vitamin B complex and vitamins C and E, the combined Se+MVT group and the placebo group. Those participants with prior or current active TB were excluded, as were participants with advanced HIV disease (CD4 <250 cells/μL) or who had already qualified for ART. HIV-positive adults (N=878) were followed monthly for study pill dispensation, every 3 months for CD4 cell count and every 6 months for viral load during 24 months or until they were started on ART. RESULTS The participants' characteristics were not significantly different among the four groups at baseline. Supplementation with Se alone (hazard ratio =0.20, 95% confidence interval: 0.04, 0.95, P=0.043) and the two combined SE groups (Se and Se+MVT) had significantly lower risk of developing incident TB disease compared with placebo in multivariate adjusted models (hazard ratio=0.32, 95% confidence interval: 0.11, 0.93, P=0.036). Multivitamins alone did not affect the incidence of TB. Isoniazid preventive therapy was received by 12.2% of participants, a rate that was not significantly different among the four study arms (P=0.122) and the newly diagnosed cases. CONCLUSION Se supplementation, alone and with MVT, decreased the incidence of TB disease in PLWH who were ART-naïve. Supplementation with these micronutrients should be considered in HIV infection, prior to ART, in areas where TB and malnutrition are endemic.
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Affiliation(s)
- Adriana Campa
- Department of Dietetics and Nutrition, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Marianna K Baum
- Department of Dietetics and Nutrition, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | | | - Sabrina Sales Martinez
- Department of Dietetics and Nutrition, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | | | | | - Sikhulile Moyo
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- The Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Joseph Makhema
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Max Essex
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- The Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Richard Marlink
- The Harvard T.H. Chan School of Public Health, Boston, MA, USA
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22
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Xie W, Agniel D, Shevchenko A, Malov SV, Svitin A, Cherkasov N, Baum MK, Campa A, Gaseitsiwe S, Bussmann H, Makhema J, Marlink R, Novitsky V, Lee TH, Cai T, O'Brien SJ, Essex M. Genome-Wide Analyses Reveal Gene Influence on HIV Disease Progression and HIV-1C Acquisition in Southern Africa. AIDS Res Hum Retroviruses 2017; 33:597-609. [PMID: 28132517 DOI: 10.1089/aid.2016.0017] [Citation(s) in RCA: 11] [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: 11/12/2022] Open
Abstract
Sub-Saharan Africans infected with HIV-1C make up the largest AIDS patient population in the world and exhibit large heterogeneity in disease progression before initiating antiretroviral therapy. To identify host variants associated with HIV disease progression, we performed genome-wide association studies on a total of 556 treatment-naive HIV-infected individuals in Botswana. We characterized the pattern of HIV disease progression using a novel functional principal component analysis, which can better capture longitudinal CD4 and viral load (VL) trajectories. Two single-nucleotide polymorphisms (SNPs) near HCG22 (chr6, peak variant rs2535307, combined p = 3.72 × 10-7, minor allele as risky allele) and CCNG1 (chr5, peak variant kgp22385164, combined p = 1.88 × 10-6, minor allele as risky allele) were significantly associated with CD4 and VL dynamics. Inspection of SNPs in these gene regions in a third Botswana cohort (using GWATCH) also revealed a strong association of HCG22 with HIV-1C acquisition, suggesting that this region is associated with infection as well as disease progression. Our study uncovered two genetic regions that are significant and have specific effects on HIV-1C acquisition or progression in sub-Saharan Africans, and the result suggested new potential targets for AIDS prevention and treatment. In addition, our results also indicate the possibility of using genetic markers as HIV disease progression indicators in sub-Saharan Africans to prioritize fast progressors for antiretroviral treatment.
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Affiliation(s)
- Wen Xie
- Harvard T.H. Chan School of Public Health AIDS Initiative, Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Botswana Harvard AIDS Institute, Gaborone, Botswana
| | - Denis Agniel
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts
| | - Andrey Shevchenko
- Theodosius Dobzhansky Center for Genome Bioinformatics, St. Petersburg State University, St. Petersburg, Russia
| | - Sergey V. Malov
- Theodosius Dobzhansky Center for Genome Bioinformatics, St. Petersburg State University, St. Petersburg, Russia
- Department of Mathematics, St. Petersburg Electrotechnical University, St Petersburg, Russia
| | - Anton Svitin
- Theodosius Dobzhansky Center for Genome Bioinformatics, St. Petersburg State University, St. Petersburg, Russia
| | - Nikolay Cherkasov
- Theodosius Dobzhansky Center for Genome Bioinformatics, St. Petersburg State University, St. Petersburg, Russia
| | - Marianna K. Baum
- Department of Dietetics and Nutrition, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, Florida
| | - Adriana Campa
- Department of Dietetics and Nutrition, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, Florida
| | - Simani Gaseitsiwe
- Harvard T.H. Chan School of Public Health AIDS Initiative, Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Botswana Harvard AIDS Institute, Gaborone, Botswana
| | - Hermann Bussmann
- Harvard T.H. Chan School of Public Health AIDS Initiative, Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Botswana Harvard AIDS Institute, Gaborone, Botswana
| | - Joseph Makhema
- Harvard T.H. Chan School of Public Health AIDS Initiative, Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Botswana Harvard AIDS Institute, Gaborone, Botswana
| | - Richard Marlink
- Harvard T.H. Chan School of Public Health AIDS Initiative, Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Botswana Harvard AIDS Institute, Gaborone, Botswana
| | - Vladimir Novitsky
- Harvard T.H. Chan School of Public Health AIDS Initiative, Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Botswana Harvard AIDS Institute, Gaborone, Botswana
| | - Tun-Hou Lee
- Harvard T.H. Chan School of Public Health AIDS Initiative, Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Tianxi Cai
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Stephen J. O'Brien
- Theodosius Dobzhansky Center for Genome Bioinformatics, St. Petersburg State University, St. Petersburg, Russia
- Oceanographic Center, Nova Southeastern University, Ft. Lauderdale, Florida
| | - M. Essex
- Harvard T.H. Chan School of Public Health AIDS Initiative, Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Botswana Harvard AIDS Institute, Gaborone, Botswana
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23
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Moyo S, Kotokwe K, Mohammed T, Boleo C, Mupfumi L, Chishala S, Gaseitsiwe S, Tsalaile L, Bussmann H, Makhema J, Baum M, Marlink R, Engelbretch S, Essex M, Novitsky V. LOW FALSE RECENT RATE OF LIMITING ANTIGEN AVIDITY ASSAY COMBINED WITH HIV-1 RNA DATA IN BOTSWANA. BMJ Glob Health 2017. [DOI: 10.1136/bmjgh-2016-000260.88] [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: 11/04/2022] Open
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24
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Moyo S, Kotokwe KP, Mohammed T, Boleo C, Mupfumi L, Chishala S, Tsalaile L, Bussmann H, Gaseitsiwe S, Musonda R, Makhema J, Baum M, Marlink R, Engelbrecht S, Essex M, Novitsky V. Short Communication: Low False Recent Rate of Limiting Antigen-Avidity Assay Combined with HIV-1 RNA Data in Botswana. AIDS Res Hum Retroviruses 2017; 33:17-18. [PMID: 27481530 DOI: 10.1089/aid.2016.0127] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 01/24/2023] Open
Abstract
Cross-sectional estimation of HIV incidence could misclassify some established or chronic HIV infections as recent. Usually long-term nonprogressors, elite and viremic controllers, and individuals on ART contribute to misclassification. Local data on the false recent rate (FRR) could minimize misclassification during estimation of HIV incidence. To improve monitoring of HIV incidence, we estimated local FRR in Botswana. A total of 1,036 specimens from individuals infected for at least 1.5-2 years were sampled between 2004 and 2009 and tested using the limiting antigen (LAg)-avidity assay using a cutoff of 1.5 normalized optical density units. The FRR was 0.97% (10/1,036; 95% confidence interval [CI] 0.46-1.77). Four samples had HIV-1 RNA >1,000 cps/ml, giving an adjusted FRR of 0.39% (4/1,036; 95% CI 0.11-0.99). A combination of LAg and HIV-1 RNA load data resulted in FRR below 1% in the Botswana population.
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Affiliation(s)
- Sikhulile Moyo
- Division of Medical Virology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
- Botswana Harvard AIDS Institute, Gaborone, Botswana
| | | | | | | | - Lucy Mupfumi
- Botswana Harvard AIDS Institute, Gaborone, Botswana
| | - Samuel Chishala
- Division of Medical Virology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
- National Health Laboratory, Ministry of Health, Gaborone, Botswana
| | - Lesedi Tsalaile
- Division of Medical Virology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Hermann Bussmann
- Botswana Harvard AIDS Institute, Gaborone, Botswana
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Simani Gaseitsiwe
- Botswana Harvard AIDS Institute, Gaborone, Botswana
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Rosemary Musonda
- Botswana Harvard AIDS Institute, Gaborone, Botswana
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Joseph Makhema
- Botswana Harvard AIDS Institute, Gaborone, Botswana
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Marianna Baum
- Florida International University, College of Health and Urban Affairs, Miami, Florida
| | - Richard Marlink
- Botswana Harvard AIDS Institute, Gaborone, Botswana
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Susan Engelbrecht
- Division of Medical Virology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
- National Health Laboratory Services (NHLS), Tygerberg Coastal, South Africa
| | - Max Essex
- Botswana Harvard AIDS Institute, Gaborone, Botswana
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Vladimir Novitsky
- Botswana Harvard AIDS Institute, Gaborone, Botswana
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Anderson M, Gaseitsiwe S, Moyo S, Thami KP, Mohammed T, Setlhare D, Sebunya TK, Powell EA, Makhema J, Blackard JT, Marlink R, Essex M, Musonda RM. Slow CD4 + T-Cell Recovery in Human Immunodeficiency Virus/Hepatitis B Virus-Coinfected Patients Initiating Truvada-Based Combination Antiretroviral Therapy in Botswana. Open Forum Infect Dis 2016; 3:ofw140. [PMID: 27800524 PMCID: PMC5084712 DOI: 10.1093/ofid/ofw140] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [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: 06/03/2016] [Accepted: 06/21/2016] [Indexed: 12/21/2022] Open
Abstract
Background. Hepatitis B virus (HBV) and human immunodeficiency virus (HIV) coinfection has emerged as an important cause of morbidity and mortality. We determined the response to Truvada-based first-line combination antiretroviral therapy (cART) in HIV/HBV-coinfected verus HIV-monoinfected patients in Botswana. Methods. Hepatitis B virus surface antigen (HBsAg), HBV e antigen (HBeAg), and HBV deoxyribonucleic acid (DNA) load were determined from baseline and follow-up visits in a longitudinal cART cohort of Truvada-based regimen. We assessed predictors of HBV serostatus and viral suppression (undetectable HBV DNA) using logistic regression techniques. Results. Of 300 participants, 28 were HBsAg positive, giving an HIV/HBV prevalence of 9.3% (95% confidence interval [CI], 6.3–13.2), and 5 of these, 17.9% (95% CI, 6.1–36.9), were HBeAg positive. There was a reduced CD4+ T-cell gain in HIV/HBV-coinfected compared with HIV-monoinfected patients. Hepatitis B virus surface antigen and HBeAg loss was 38% and 60%, respectively, at 24 months post-cART initiation. The HBV DNA suppression rates increased with time on cART from 54% to 75% in 6 and 24 months, respectively. Conclusions. Human immunodeficiency virus/HBV coinfection negatively affected immunologic recovery compared with HIV-1C monoinfection. Hepatitis B virus screening before cART initiation could help improve HBV/HIV treatment outcomes and help determine treatment options when there is a need to switch regimens.
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Affiliation(s)
- Motswedi Anderson
- Botswana Harvard AIDS Institute Partnership; Department of Biological Sciences, University of Botswana, Gaborone
| | - Simani Gaseitsiwe
- Botswana Harvard AIDS Institute Partnership; Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Sikhulile Moyo
- Botswana Harvard AIDS Institute Partnership; Division of Medical Virology, Faculty of Medicine and Health Sciences, University of Stellenbosch, Tygerberg, South Africa
| | | | - Terence Mohammed
- Botswana Harvard AIDS Institute Partnership; Department of Biological Sciences, University of Botswana, Gaborone
| | | | - Theresa K Sebunya
- Department of Biological Sciences , University of Botswana , Gaborone
| | | | - Joseph Makhema
- Botswana Harvard AIDS Institute Partnership; Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | | | - Richard Marlink
- Botswana Harvard AIDS Institute Partnership; Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Max Essex
- Botswana Harvard AIDS Institute Partnership; Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Rosemary M Musonda
- Botswana Harvard AIDS Institute Partnership; Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
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Mukudu H, Martinson N, Sartorius B, Coetzee J, Dietrich J, Mokgatswana K, Jewkes R, Gray GE, Dugas M, Béhanzin L, Guédou FA, Gagnon MP, Alary M, Rutakumwa R, Mbonye M, Kiwanuka T, Nakamanya S, Muhumuza R, Nalukenge W, Seeley J, Atujuna M, Wallace M, Brown B, Bekker LG, Newman PA, Harryparsad R, Olivier AJ, Jaspan HB, Wilson D, Dietrich J, Martinson N, Mukudu H, Mkhize N, Morris L, Cianci G, Dinh M, Hope T, Passmore JAS, Gray CM, Henrick BM, Yao XD, Rosenthal KL, Henrick BM, Yao XD, Drannik AG, Abimiku A, Rosenthal KL, Chanzu N, Mwanda W, Oyugi J, Anzala O, Mbow M, Jallow S, Thiam M, Davis A, Diouf A, Ndour CT, Seydi M, Dieye TN, Mboup S, Goodier M, Rilley E, Jaye A, Yao XD, Omange RW, Henrick BM, Lester RT, Kimani J, Ball TB, Plummer FA, Rosenthal KL, Béhanzin L, Guédou FA, Geraldo N, Mastétsé EG, Sossa JC, Zannou MD, Alary M, Osawe S, Okpokoro E, Okolo F, Umaru S, Abimiku R, Audu S, Datong P, Abimiku A, Nyange J, Olenja J, Mutua G, Jaoko W, Omosa-Manyonyi G, Farah B, Khaniri M, Anzala O, Cockcroft A, Tonkin K, Girish I, Mhati P, Cunningham A, Andersson N, Farah B, Indangasi J, Jaoko W, Mutua G, Khaniri M, Nyange J, Anzala O, Diphoko T, Gaseitsiwe S, Maiswe V, Iketleng T, Maruapula D, Bedi K, Moyo S, Musonda R, Wainberg M, Makhema J, Novitsky V, Marlink R, Essex M, Okoboi S, Ssali L, Kalibala S, Birungi J, Egessa A, Wangisi J, Okullu LJ, Bakanda C, Obare F, Boer IMSD, Semvua HH, van den Boogaard J, Kiwango KW, Ngowi KM, Nieuwkerk PT, Aarnoutse RE, Kiwelu I, Muro E, Kibiki GS, Datiri R, Choji G, Osawe S, Okpokoro E, Okolo F, Umaru S, Abimiku R, Audu S, Datong P, Abimiku A, Fomsgaard A, Karlsson I, Jensen KJ, Jensen SS, Leo-Hansen C, Jespersen S, Da Silva Té D, Rodrigues CM, da Silva ZJ, Janitzek CM, Gerstoft J, Kronborg G, Okpokoro E, Osawe S, Daitiri R, Choji G, Umaru S, Okolo F, Datong P, Abimiku A, Emily N, Joyce O, Robert LR, Anzala A, Viljoen K, Wendoh J, Kidzeru E, Karaoz U, Brodie E, Botha G, Mulder N, Gray C, Cameron W, Stintzi A, Jaspan H, Levett PN, Alexander D, Gulzar N, Grewal PS, Poon AFY, Brumme Z, Harrigan PR, Brooks JI, Sandstrom PA, Calvez S, Sanche SE, Scott JK, Swartz L, Kagee A, Lesch A, Kafaar Z, De Wet A, Okpokoro E, Osawe S, Daitiri R, Choji G, Umaru S, Okolo F, Datong P, Abimiku A, Dietrich J, Smith T, Cotton L, Hornschuh S, van der Watt M, Miller CL, Gray G, Smit J, Jaggernath M, Ndung’u T, Brockman M, Kaida A, Akolo M, Kimani J, Gelmon L, Chitwa M, Osero J, Cockcroft A, Marokoane N, Kgakole L, Maswabi B, Mpofu N, Ansari U, Andersson N, Nakinobe E, Miiro GM, Zalwango F, Nakiyingi-Miiro J, Kaleebu P, Semwanga JR, Nyanzi E, Musoke SN, Nakinobe E, Miiro G, Mbidde EK, Lutalo T, Kaleebu P, Handema R, Chianzu GP, Thiam M, Diagne-Gueye D, Ndiaye MK, Mbow M, Ndiaye BP, Traore I, Dia MC, Thomas G, Tour-Kane C, Mboup S, Jaye A, Nyanzi E, Mbidde EK, Kaleebu P, Mpendo J, Kimani J, Birungi J, Muyindike W, Kambugu A, Sebastian H, Ray H, Mike C, Bertin KJ, Modest M, Thiam M, Janha O, Davis A, Amambua-Ngwa A, Nwakanma DC, Mboup S, Jaye A, Jespersen S, Hønge BL, Esbjörnsson J, Medina C, Da Silva TÉ D, Correira FG, Laursen AL, Østergaard L, Andersen A, Aaby P, Erikstrup C, Wejse C, Dieye S, Sarr M, Sy H, Mbodj HD, Ndiaye M, Ndiaye A, Moussa S, Jaye A, Mboup S, Nyombi BM, Shao ER, Chilumba IB, Moyo S, Gaseitsiwe S, Musonda R, Datong P, Inyang B, Osawe S, Izang A, Cole C, Okolo F, Cameron B, Rosenthal K, Gray C, Jaspan H, Abimiku A, Seraise B, Andrea-Marobela K, Moyo S, Musonda R, Makhema J, Essex M, Gaseitsiwe S. Afri-Can Forum 2. BMC Infect Dis 2016; 16 Suppl 2:315. [PMID: 27410689 PMCID: PMC4943497 DOI: 10.1186/s12879-016-1466-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
A1 Introduction to the 2nd synchronicity forum of GHRI/CHVI-funded Canadian and African HIV prevention and vaccine teams O1 Voluntary medical male circumcision for prevention of heterosexual transmission of HIV in adult males in Soweto: What do indicators and incidence rate show? Hillary Mukudu, Neil Martinson, Benn Sartorius O2 Developing a peer-led community mobilization program for sex workers in Soweto: HIV risk and demographics Jenny Coetzee, Janan Dietrich, Kgaugelo Mokgatswana, Rachel Jewkes, Glenda E. Gray O3 Salient beliefs about adherence: A qualitative survey conducted as part of the demonstration study on "treatment as prevention" (TasP) and "pre-exposure prophylaxis" (PrEP) among female sex workers (FSWS) in Cotonou, Benin Marylène Dugas, Luc Béhanzin, Fernand A. Guédou, Marie-Pierre Gagnon, Michel Alary O4 Relative perception of risk as a driver of unsafe sexual practices among key populations: Cases of fisherfolk and women and their partners involved in multiple sexual partnerships in Uganda Rwamahe Rutakumwa, Martin Mbonye, Thadeus Kiwanuka, Sarah Nakamanya, Richard Muhumuza, Winfred Nalukenge, Janet Seeley O5 Exploring the acceptability of new biomedical HIV prevention technologies among MSM, adolescents and heterosexual adults in South Africa Millicent Atujuna, Melissa Wallace, Ben Brown, Linda Gail Bekker, Peter A. Newman O6 HIV-susceptible target cells in foreskins after voluntary medical male circumcision in South Africa Rushil Harryparsad, Abraham J. Olivier, Heather B. Jaspan, Douglas Wilson, Janan Dietrich, Neil Martinson, Hillary Mukudu, Nonhlanhla Mkhize, Lynn Morris, Gianguido Cianci, Minh Dinh, Thomas Hope, Jo-Ann S. Passmore, Clive M. Gray O7 HIV-1 proteins activate innate immune responses via TLR2 heterodimers Bethany M. Henrick, Xiao-Dan Yao, Kenneth L. Rosenthal, the INFANT Study Team O8 Characterization of an innate factor in human milk and mechanisms of action against HIV-1 Bethany M. Henrick, Xiao-Dan Yao, Anna G. Drannik, Alash’le Abimiku, Kenneth L. Rosenthal, the INFANT Study Team O9 Secretor status and susceptibility to HIV infections among female sex workers in Nairobi, Kenya Nadia Chanzu, Walter Mwanda, Julius Oyugi, Omu Anzala O10 Natural Killer cell recall responsiveness to Gag-HIV-1 peptides of HIV-1 exposed but uninfected subjects are associated with peripheral CXCR6+ NK cell subsets Moustapha Mbow, Sabelle Jallow, Moussa Thiam, Alberta Davis, Assane Diouf, Cheikh T. Ndour, Moussa Seydi, Tandakha N. Dieye, Souleymane Mboup, Martin Goodier, Eleanor Rilley, Assan Jaye O11 Profiles of resistance: Local innate mucosal immunity to HIV-1 in commercial sex workers Xiao-Dan Yao, RW. Omange, Bethany M. Henrick, Richard T. Lester, Joshua Kimani, T. Blake Ball, Francis A. Plummer, Kenneth L. Rosenthal O12 Early antiretroviral therapy and pre-exposure prophylaxis for HIV prevention among female sex workers in Cotonou, Benin: A demonstration project Luc Béhanzin, Fernand A. Guédou, Nassirou Geraldo, Ella Goma Mastétsé, Jerôme Charles Sossa, Marcel Djimon Zannou, Michel Alary O13 Building capacity for HIV prevention trials: Preliminary data from a Nigerian cohort of HIV exposed sero-negatives (HESN) Sophia Osawe, Evaezi Okpokoro, Felicia Okolo, Stephen Umaru, Rebecca Abimiku, Sam Audu, Pam Datong, Alash’le Abimiku O14 Equipping healthcare professionals with skills required for the conduct of clinical trials in an effort to build capacity. Lessons learned Jacquelyn Nyange, Joyce Olenja, Gaudensia Mutua, Walter Jaoko, Gloria Omosa-Manyonyi, Bashir Farah, Maureen Khaniri, Omu Anzala O15 Educational technology to support active learning for HIV researchers and planners Anne Cockcroft, Kendra Tonkin, Indu Girish, Puna Mhati, Ashley Cunningham, Neil Andersson O16 From Lake Kivu (Rwanda) and Lake Malawi (Tanzania) to the shores of Lake Victoria (Uganda): Strengthening laboratory capacity through Good Clinical Laboratory Practice training Bashir Farah, Jackton Indangasi, Walter Jaoko, Gaudensia Mutua, Maureen Khaniri, Jacquelyn Nyange, Omu Anzala O17 Rilpivirine and etravirine resistance mutations in HIV-1 subtype C infected patients on a non-nucleoside reverse transcriptase inhibitor-based combination antiretroviral therapy in Botswana Thabo Diphoko, Simani Gaseitsiwe, Victoria Maiswe, Thato Iketleng, Dorcas Maruapula, Keabetswe Bedi, Sikhulile Moyo, Rosemary Musonda, Mark Wainberg, Joseph Makhema, Vladimir Novitsky, Richard Marlink, Max Essex O18 From home-based HIV testing to initiation of treatment: The AIDS Support Organization (TASO) Experience with Home-based HIV Counselling and Testing (HBHCT) among Adolescents in Uganda, 2005-2011 Stephen Okoboi, Livingstone Ssali, Sam Kalibala, Josephine Birungi, Aggrey Egessa, Jonathan Wangisi, Lyavala Joanne Okullu, Celestin Bakanda, Francis Obare41 O19 Feasibility study on using real time medication monitoring among HIV infected and Tuberculosis patients in Kilimanjaro, Tanzania I. Marion Sumari-de Boer, Hadija H. Semvua, Jossy van den Boogaard, Krisanta W. Kiwango, Kennedy M. Ngowi, Pythia T. Nieuwkerk, Rob E. Aarnoutse, Ireen Kiwelu, Eva Muro, Gibson S. Kibiki O20 Deaths still among sero-discordant cohort in Nigeria despite Access to treatment Ruth Datiri, Grace Choji, Sophia Osawe, Evaezi Okpokoro, Felicia Okolo, Stephen Umaru, Rebecca Abimiku, Samuel Audu, Pam Datong, Alash’le Abimiku O21 Therapeutic HIV-1 vaccine trials in Denmark and Guinea-Bissau Fomsgaard A, Karlsson I, Jensen KJ, Jensen SS, Leo-Hansen C, Jespersen S, Da Silva Té D, Rodrigues CM, da Silva ZJ, Janitzek CM, Gerstoft J, Kronborg G, the WAPHIR Group O22 Willingness to participate in a HIV vaccine Trial among HIV exposed sero-negative (HESN) persons in Jos, Nigeria Evaezi Okpokoro, Sophia Osawe, Ruth Daitiri, Grace Choji, Stephen Umaru, Felicia Okolo, Pam Datong, Alash'le Abimiku O23 Clinical research volunteers’ perceptions and experiences of screening for enrolment at KAVI-Institute of Clinical Research, Kenya Nyariki Emily, Olenja Joyce, Lorway R. Robert, Anzala Anzala O24 Gut microbiome, HIV-exposure, and vaccine responses in South African infants Katie Viljoen, Jerome Wendoh, Elvis Kidzeru, Ulas Karaoz, Eoin Brodie, Gerrit Botha, Nicola Mulder, Clive Gray, William Cameron, Alain Stintzi, Heather Jaspan, for the INFANT study team O25 Analysis of HIV pol diversity in the concentrated HIV epidemic in Saskatchewan Paul N. Levett, David Alexander, Naveed Gulzar, Prabvir S. Grewal, Art F. Y. Poon, Zabrina Brumme, P. Richard Harrigan, James I. Brooks, Paul A. Sandstrom, Stryker Calvez, Stephen E. Sanche, Jamie K. Scott P1 Evaluating a HIV vaccine research community engagement programme at two HIV prevention research centres in the Western Cape Leslie Swartz, Ashraf Kagee, Anthea Lesch, Zuhayr Kafaar, Anneliese De Wet P2 Validating HIV acquisition risk score using a cohort HIV exposed sero-negative persons in a discordant relationship in Jos, Nigeria, West Africa Evaezi Okpokoro, Sophia Osawe, Ruth Daitiri, Grace Choji, Stephen Umaru, Felicia Okolo, Pam Datong, Alash'le Abimiku P3 Bridging the gap between adults and adolescents and youth adults (AYA) – Employing a youth-centred approach to investigate HIV risk among AYA in Soweto and Durban, South Africa Janan Dietrich, Tricia Smith, Laura Cotton, Stefanie Hornschuh, Martin van der Watt, Cari L. Miller, Glenda Gray, Jenni Smit, Manjeetha Jaggernath, Thumbi Ndung’u, Mark Brockman, Angela Kaida, on behalf of the AYAZAZI study teams P4 Neighbours to sex workers: A key population that has been ignored Maureen Akolo, Joshua Kimani, Prof Larry Gelmon, Michael Chitwa, Justus Osero P5 Young women’s access to structural support programmes in a district of Botswana Anne Cockcroft, Nobantu Marokoane, Leagajang Kgakole, Boikhutso Maswabi, Neo Mpofu, Umaira Ansari, Neil Andersson P6 Voices for action from peri-urban Ugandan students, teachers and parents on HIV/STI prevention: Qualitative research results Nakinobe Elizabeth, Miiro George Mukalazi, Zalwango Flavia, Nakiyingi-Miiro Jessica, Kaleebu Potiano P7 Engaging Social Media as an education tool on the fly: The use of Facebook for HIV and Ebola prevention and awareness amongst adolescents in Uganda John Ross Semwanga, Emily Nyanzi, Saidat Namuli Musoke, Elizabeth Nakinobe, George Miiro, Edward Katongole Mbidde, Tom Lutalo, Pontiano Kaleebu P8 Circulating HIV-1 subtypes among sexual minority populations in Zambia Ray Handema, Graham P. Chianzu P9 The Development of HIV Bio-bank resource management to support clinical trial and Intervention research: WAPHIR experience Moussa Thiam, Diabou Diagne-Gueye, Mame K. Ndiaye, Moustapha Mbow, Birahim P. Ndiaye, Ibrahima Traore, Mamadou C. Dia, Gilleh Thomas, Coumba Tour-Kane, Souleymane Mboup, Assan Jaye P10 Capacity building for clinical trials as a novel approach for scaling up HIV prevention research initiatives in East Africa: achievements and challenges Emily Nyanzi, Edward Katongole Mbidde, Pontiano Kaleebu, Juliet Mpendo, Joshua Kimani, Josephine Birungi, Winnie Muyindike, Andrew Kambugu P11 Community and media perspective of research; an advocacy workshop on HIV prevention research Hachizovu Sebastian, Handema Ray, Chaponda Mike, Kabuya Jean Bertin, Mulenga Modest P12 Development of a quantitative HIV-1 and HIV-2 real time PCR (qRT-PCR) viral load assay Moussa Thiam, Omar Janha, Alberta Davis, Alfred Amambua-Ngwa, Davis C. Nwakanma, Souleymane Mboup, Assan Jaye P13 Differential effects of sex in a West African Cohort of HIV-1, HIV-2 and HIV-1/2 dual infected patients: Men are worse off Sanne Jespersen, Bo Langhoff Hønge, Joakim Esbjörnsson, Candida Medina, David Da Silva TÉ, Faustino Gomes Correira, Alex Lund Laursen, Lars Østergaard, Andreas Andersen, Peter Aaby, Christian Erikstrup, Christian Wejse, for the Bissau HIV Cohort study group P14 HIV-infected adolescents in transition from pediatric to adult HIV care in Dakar, Senegal: sample characteristics and immunological and virological profiles Siry Dieye, Moussa Sarr, Haby Sy, Helene D Mbodj, Marianne Ndiaye, Amy Ndiaye, Seydi Moussa, Assan Jaye, Souleymane Mboup100 P15 Molecular characterization of vertically transmitted HIV-1 among children born to HIV-1 seropositive mothers in Northern Tanzania Balthazar M. Nyombi, Elichilia R. Shao, Innocent B. Chilumba, Sikhulile Moyo, Simani Gaseitsiwe, Rosemary Musonda P16 Breast-fed HIV-1 exposed infants play catch up. A preliminary report Pam Datong, Bucky Inyang, Sophia Osawe, Abel Izang, Chundung Cole, Felicia Okolo, Bill Cameron, Kenneth Rosenthal, Clive Gray, Heather Jaspan, Alash’le Abimiku, the INFANT study team P17 The frequency of N348I mutation in patient failing combination antiretroviral treatment In Botswana Boitumelo Seraise, Kerstin Andrea-Marobela, Sikhulile Moyo, Rosemary Musonda, Joseph Makhema, Max Essex, Simani Gaseitsiwe
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Doualla-Bell F, Gaseitsiwe S, Ndungú T, Modukanele M, Peter T, Novitsky V, Ndwapi N, Tendani G, Avalos A, Wester W, Bussmann H, Cardiello P, Marlink R, Moffat H, Thior I, Wainberg MA, Essex M. Mutations and Polymorphisms Associated with Antiretroviral Drugs in HIV-1C-Infected African Patients. ACTA ACUST UNITED AC 2016; 15:189-200. [PMID: 15457680 DOI: 10.1177/095632020401500402] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [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: 11/15/2022]
Abstract
To detect and characterize polymerase gene ( pol) polymorphisms and mutation patterns in HIV-1C-infected Batswana patients treated with reverse transcriptase inhibitors, samples from AIDS patients treated with highly active antiretroviral therapy (HAART) were sequenced for the region encompassing the entire HIV-1 protease (PR) and the first 335 amino acids of reverse transcriptase (RT). Amongst the 16 patients treated with antiretroviral (ARV) drugs, eight started HAART regimens containing didanosine, stavudine and nevirapine (ddI/d4T/NVP) or efavirenz (EFV) (arm A) while the others started with zidovudine (AZT) and lamivudine (3TC) given together as combivir (CBV) with either NVP or EFV as arm B. Arm B is the first line regimen currently provided by the Botswana ARV national programme. Greater efficacy, in terms of treatment duration, was observed in patients in arm B (14 months) as compared with patients in arm A (9 months); P<0.05, n=8. Appearance of the M184V mutation in the arm B patients coincided with a rebound of viral load (VL) (4.3 +0.1 log10 RNA copies/ml) and a significantly improved immunological parameter (ΔCD4=207.0 +48.1 cells/μl; P<0.05). Interestingly, patients developing the M184V mutation preferentially harboured polymorphisms Q174K and/or I178L located in close proximity to pol position 184. The M184V mutation occurred following a clear clinical benefit consisting of increased CD4 cell counts and lower plasma viral loads. Primary mutations known to be associated with NNRTI and NRTI resistance for HIV-1B were observed in 10 of the 16 treated patients.
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Affiliation(s)
- Florence Doualla-Bell
- Botswana-Harvard AIDS Institute Partnership for HIV Research and Education, Gaborone, Botswana
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Bussmann H, Novitsky V, Wester W, Peter T, Masupu K, Gabaitiri L, Kim S, Gaseitsiwe S, Ndungú T, Marlink R, Thior I, Essex M. HIV-1 Subtype C Drug-Resistance Background among ARV-Naive Adults in Botswana. ACTA ACUST UNITED AC 2016; 16:103-15. [PMID: 15889533 DOI: 10.1177/095632020501600203] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [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: 11/16/2022]
Abstract
Current HIV-1 antiretroviral (ARV) drug resistance knowledge is limited to HIV-1 subtype B (HIV-1B). We addressed whether unique genetic and phenotypic properties of HIV-1 subtype C (HIV-1C), southern Africa's most prevalent subtype, may foment earlier and/or distinct resistance mutations. Population-level HIV-1C genotypes were evaluated with respect to drug resistance prevalence before Botswana's public ARV treatment programme began. Viruses were genotyped from 11 representative districts of northern and southern Botswana, and consensus sequences from these 71 individuals and 51 previously reported sequences from HIV-positive blood donors were constructed. Phylogenetic analysis classified all 71 sequences but one, which exhibited pol gene mosaicism, as HIV-1C. The protease and reverse transcriptase coding region had no detectable known primary mutations associated with HIV-1B protease inhibitor (PI) drug resistance. Secondary mutations associated with PI drug resistance were found in all sequences. Several HIV-1C—specific polymorphic sites were found across the pol gene. Northern and southern Botswana viral sequences showed no significant differences from each other. Population genotyping shows that, without countrywide ARV treatment, HIV-1C—infected Batswana harbour virtually no primary mutations known to confer resistance to the three major HIV-1B ARV drug classes. Some secondary PI mutations and polymorphic sites in the protease enzyme necessitate continuous population monitoring, particularly after introduction of countrywide ARV treatment in Botswana. Although its PI resistance development rate and kinetics are not known, our data may suggest increased susceptibility and readiness of HIV-1C to develop resistance under drug pressure when the PI class of drugs is used.
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Affiliation(s)
- Hermann Bussmann
- Botswana-Harvard School of Public Health AIDS Initiative Partnership, Gaborone, Botswana
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Auld AF, Blain M, Ekra KA, Kouakou JS, Ettiègne-Traoré V, Tuho MZ, Mohamed F, Shiraishi RW, Sabatier J, Essombo J, Adjorlolo-Johnson G, Marlink R, Ellerbrock TV. Wide Variations in Compliance with Tuberculosis Screening Guidelines and Tuberculosis Incidence between Antiretroviral Therapy Facilities - Côte d'Ivoire. PLoS One 2016; 11:e0157059. [PMID: 27275742 PMCID: PMC4898722 DOI: 10.1371/journal.pone.0157059] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 12/21/2015] [Accepted: 05/24/2016] [Indexed: 12/22/2022] Open
Abstract
Background In Côte d’Ivoire, tuberculosis (TB) is a common cause of death among HIV-infected antiretroviral therapy (ART) enrollees. Ivorian guidelines recommend screening for TB and initiation of TB treatment before ART initiation. Compliance with these guidelines can help reduce TB-related mortality during ART and possibly nosocomial TB transmission. Methods and Findings In a retrospective cohort study among 3,682 randomly selected adults (≥15 years old) starting ART during 2004–2007 at 34 randomly selected facilities, documentation of TB screening completion, prevalence of active TB at ART initiation, and incidence of TB during ART were evaluated. At ART initiation, median age was 36 years, 67% were female, and median CD4 count was 135 cells/μL. Among all 3,682 enrollees, 73 (2%) were on TB treatment at the time of referral to the ART facility. Among the 3,609 not on TB treatment, 1,263 (36%) were documented to receive some TB screening before ART initiation; 21% were screened for cough, 21% for weight loss, 18% for fever, 18% for TB contacts, and 12% for night sweats. Among the 1,263 screened, 111 (11%) were diagnosed with TB and started TB treatment before ART. No associations between patient characteristics and probability of being screened were noted. However, documentation of TB screening completion before ART varied widely by ART facility from 0–100%. TB incidence during ART was 3.0 per 100 person-years but varied widely by ART facility from 0/100 person-year to 13.1/100 person-years. Conclusions Screening for TB before ART initiation was poorly documented. Facility-level variations in TB screening documentation suggest facility-level factors, such as investment in training programs, might determine documentation practices. Targeting under-performing ART facilities with improvement activities is needed. Variations among facilities in TB incidence warrant further research. These incidence variations could reflect differences between facilities in TB screening, diagnostic tests, documentation practices, or TB risk possibly related to infection control practices or local community TB incidence.
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Affiliation(s)
- Andrew F. Auld
- Division of Global HIV & Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
| | - Michela Blain
- Division of Global HIV & Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Kunomboa Alexandre Ekra
- Division of Global HIV & Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Abidjan, Côte d’Ivoire
| | | | - Virginie Ettiègne-Traoré
- Ministry of Health, National Program for Medical Care of Persons Living with HIV/AIDS, Abidjan, Côte d’Ivoire
| | - Moise Zanga Tuho
- Ministry of Health, National Program for Medical Care of Persons Living with HIV/AIDS, Abidjan, Côte d’Ivoire
| | - Fayama Mohamed
- Elizabeth Glaser Pediatric AIDS Foundation, Abidjan, Côte d’Ivoire
- Directorate General of Budget and Finance, Department of Economy and Finance, Abidjan, Côte d’Ivoire
| | - Ray W. Shiraishi
- Division of Global HIV & Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jennifer Sabatier
- Division of Global HIV & Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Joseph Essombo
- Elizabeth Glaser Pediatric AIDS Foundation, Abidjan, Côte d’Ivoire
| | | | - Richard Marlink
- Elizabeth Glaser Pediatric AIDS Foundation, Los Angeles, California, United States of America
| | - Tedd V. Ellerbrock
- Division of Global HIV & Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Farahani M, Novitsky V, Wang R, Bussmann H, Moyo S, Musonda RM, Moeti T, Makhema JM, Essex M, Marlink R. Prognostic Value of HIV-1 RNA on CD4 Trajectories and Disease Progression Among Antiretroviral-Naive HIV-Infected Adults in Botswana: A Joint Modeling Analysis. AIDS Res Hum Retroviruses 2016; 32:573-8. [PMID: 26830351 DOI: 10.1089/aid.2015.0348] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 11/12/2022] Open
Abstract
Although HIV-1 RNA levels are measured at the time of initial diagnosis, the results are not used for the clinical follow-up of the patients. This study evaluates the prognostic value of the baseline HIV-1 RNA levels (above or below 10,000 copies/ml) on rate of disease progression, among antiretroviral therapy (ART)-naive patients in Botswana. A prospective cohort of 436 HIV-infected ART-naive adults with baseline CD4 > 400 cells/mm(3) were followed quarterly for 5 years in an urban clinic in Botswana. Baseline HIV-1 RNA levels and longitudinal CD4(+) T-cell count data were analyzed, using mixed-effects regression jointly modeled with the times to a composite endpoint defined by AIDS-defining clinical conditions or death. During 1,547 person-years (PYs) follow-up time, 106 individuals became eligible for ART initiation (incidence rate: 0.07 PYs) and 6 participants died of AIDS-related illness. There were 203 (47%) individuals with baseline HIV-1 RNA <10,000 copies/ml and 233 (53%) individuals with baseline RNA >10,000 copies/ml. The slope of the predicted CD4 trajectory for individuals with baseline HIV-1 RNA >10,000 copies/ml is 30% steeper than that for those with baseline RNA <10,000. The hazard of reaching the composite endpoint for the individuals with baseline HIV-1 RNA >10,000 copies/ml was 2.3 (95% confidence interval: 1.5-3.0) times higher than that for those with baseline HIV-1 RNA <10,000 copies/ml. CD4 decline in individuals with HIV-1 RNA >10,000 copies/ml is much faster than that in those with RNA <10,000. The elevated HIV-1 RNA can be used as a marker to identify individuals at risk of faster disease progression.
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Affiliation(s)
- Mansour Farahani
- 1 Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health , Boston, Massachusetts
| | - Vladimir Novitsky
- 1 Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health , Boston, Massachusetts
- 2 Botswana Harvard AIDS Institute , Gaborone, Botswana
| | - Rui Wang
- 1 Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health , Boston, Massachusetts
- 3 Harvard Medical School , Boston, Massachusetts
| | - Hermann Bussmann
- 1 Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health , Boston, Massachusetts
- 2 Botswana Harvard AIDS Institute , Gaborone, Botswana
| | | | | | | | - Joseph M Makhema
- 1 Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health , Boston, Massachusetts
- 2 Botswana Harvard AIDS Institute , Gaborone, Botswana
| | - Max Essex
- 1 Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health , Boston, Massachusetts
- 2 Botswana Harvard AIDS Institute , Gaborone, Botswana
| | - Richard Marlink
- 1 Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health , Boston, Massachusetts
- 2 Botswana Harvard AIDS Institute , Gaborone, Botswana
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Iketleng T, Moyo S, Gaseitsiwe S, Nyombi B, Mitchell RM, Makhema J, Baum MK, Marlink R, Essex M, Musonda R. Plasma Cytokine Levels in Chronic Asymptomatic HIV-1 Subtype C Infection as an Indicator of Disease Progression in Botswana: A Retrospective Case Control Study. AIDS Res Hum Retroviruses 2016; 32:364-9. [PMID: 26414751 DOI: 10.1089/aid.2015.0163] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
HIV infects cells of the immune system causing immune activation and proliferation of immune cells, leading to alteration of production and activity of a number of cytokines. These changes in cytokine levels can affect the immune function, and have the potential to directly impact the course of HIV disease. We characterized plasma cytokine concentration profiles in HIV-1 subtype C chronically infected, antiretroviral therapy (ART)-naive participants to establish their influence on disease progression and viremia. Plasma levels of interleukin (IL)-1α, IL-7, IL-12p40, granulocyte macrophage-colony-stimulating factor (GM-CSF), and interferon (IFN)-γ were quantified in samples from 60 treatment-naive participants in the placebo arm of the completed Micronutrient-HIV disease progressions study, "Dikotlana" (2004-2009) in Gaborone, Botswana. Participants were stratified into progressors (P) and nonprogressors (NP) based on their rates of CD4(+) T cell depletion during the study period. Nonprogressors were those who had <1% CD4(+) T cell depletion at 24 months postenrollment. Progressors were defined as those with CD4(+) T cell depletion of >15% at 24 months postenrollment. Cytokine levels were compared between P and NP using the Mann-Whitney U-test. Logistic regression analysis was used to determine if cytokines predicted disease progression. Correlations of cytokines with CD4(+) T cell counts and viral loads were determined by the Spearman rank test. Median baseline CD4(+) T cell counts were 453 (Q1, Q3; 401, 592) and 479 (Q1, Q3; 401-592) for nonprogressors and progressors, respectively. Nonprogressors had a higher viral set point than progressors. IL-12p40 levels were significantly higher in the P than in NP at enrollment and 24 months (p < 0.05). Levels of IL-1α, IL-7, IFN-γ, and GM-CSF did not differ significantly between the two groups. Except for IL-12p40, which displayed an inverse correlation with CD4(+) T cell counts and a direct correlation with viral load, all other cytokines showed no correlations. IL-12p40 was found to be the most significant predictor of progression and its production was most likely driven by HIV replication products as evidenced by its direct correlation with viral load. In chronic HIV-1 subtype C infection, CD4(+) T cell counts and plasma cytokine levels may not necessarily evolve in parallel, suggesting the involvement of other factors in determining the rates of CD4(+) T cell depletion.
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Affiliation(s)
- Thato Iketleng
- Botswana-Harvard School of Public Health AIDS Initiative Partnership for HIV Research and Education (BHP), Gaborone, Botswana
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Sikhulile Moyo
- Botswana-Harvard School of Public Health AIDS Initiative Partnership for HIV Research and Education (BHP), Gaborone, Botswana
| | - Simani Gaseitsiwe
- Botswana-Harvard School of Public Health AIDS Initiative Partnership for HIV Research and Education (BHP), Gaborone, Botswana
- Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts
| | - Balthazar Nyombi
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | | | - Joseph Makhema
- Botswana-Harvard School of Public Health AIDS Initiative Partnership for HIV Research and Education (BHP), Gaborone, Botswana
- Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts
| | - Marianna K. Baum
- Florida International University, R. Stempel College of Public Health and Social Work, University Park, Miami, Florida
| | - Richard Marlink
- Botswana-Harvard School of Public Health AIDS Initiative Partnership for HIV Research and Education (BHP), Gaborone, Botswana
- Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts
| | - Max Essex
- Botswana-Harvard School of Public Health AIDS Initiative Partnership for HIV Research and Education (BHP), Gaborone, Botswana
- Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts
| | - Rosemary Musonda
- Botswana-Harvard School of Public Health AIDS Initiative Partnership for HIV Research and Education (BHP), Gaborone, Botswana
- Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts
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Ahmed S, Bärnighausen T, Daniels N, Marlink R, Roberts MJ. How providers influence the implementation of provider-initiated HIV testing and counseling in Botswana: a qualitative study. Implement Sci 2016; 11:18. [PMID: 26864321 PMCID: PMC4750298 DOI: 10.1186/s13012-015-0361-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 12/17/2015] [Indexed: 11/10/2022] Open
Abstract
Background Understanding the motivations and perspectives of providers in following guidance and evidence-based policies can contribute to the evidence on how to better implement and deliver care, particularly in resource-constrained settings. This study explored how providers’ attitudes and behaviors influenced the implementation of an intervention, provider-initiated HIV testing and counseling, in primary health care settings in Botswana. Methods Using a grounded-theory approach, we purposively selected and interviewed 45 providers in 15 facilities in 3 districts and inductively analyzed data for themes and patterns. Results We found that nurses across facilities and districts were largely resistant to offering and delivering provider-initiated testing and counseling for HIV (PITC) for three reasons: (1) they felt they were overworked and had no time, (2) they felt it was not their job, and (3) they were afraid to counsel patients, particularly fearing a positive HIV test. These factors were largely related to health system constraints that affected the capacity of providers to do their job. An important underlying themes emerged: nurses and lay counselors were unsatisfied with pay and career prospects, which made them unmotivated to work in general. Variations were seen by urban and rural areas: nurses in urban areas felt generally overworked and PITC was seen as contributing to the workload. While nurses in rural areas did not feel overworked, they felt that PITC was not their job and they were unmotivated because of general unhappiness with their rural posts. Conclusions The attitudes and behaviors of providers and barriers they faced played a critical role in whether and how PITC was being implemented in Botswana. Provider factors should be considered in the improvement of existing PITC programs and design of new ones. Addressing constraints faced by providers can do more to improve supply of human resources than merely recruiting more providers.
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Affiliation(s)
- Shahira Ahmed
- Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.
| | - Till Bärnighausen
- Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA. .,Africa Centre for Population Health, University of KwaZulu-Natal, KwaZulu-Natal, South Africa.
| | - Norman Daniels
- Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.
| | - Richard Marlink
- Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.
| | - Marc J Roberts
- Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.
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Farahani M, Mulinder H, Farahani A, Marlink R. Prevalence and distribution of non-AIDS causes of death among HIV-infected individuals receiving antiretroviral therapy: a systematic review and meta-analysis. Int J STD AIDS 2016; 28:636-650. [DOI: 10.1177/0956462416632428] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [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: 01/04/2023]
Abstract
The advent of antiretroviral therapy has significantly improved AIDS-related morbidity and mortality. Yet, among people living with HIV, deaths due to non-AIDS-defining illnesses have been on the rise. The objective of this study was to provide information about the global prevalence and distribution of non-AIDS causes of death in the last ten years among people living with HIV receiving antiretroviral therapy, by income levels of countries. We used broad search terms in Google Scholar, PubMed, and EMBASE to identify all studies that investigated the cause of death among people living with HIV receiving antiretroviral therapy, published after January 1, 2005. References were also identified from review articles and reference lists. Inclusion criteria were English language, the study’s end date was after 2005, all patients were HIV-positive, at least two-thirds of the patients were receiving antiretroviral therapy, at least one patient died of non-AIDS causes of death. Titles, abstracts, and articles were reviewed by at least two independent readers. Of 2951 titles identified in our original search, 151 articles were selected for further screening. We identified 19 studies meeting our full criteria, with patients from 55 different nations. Pooled non-AIDS causes of death prevalence estimates in high-income countries were 53.0% (95% confidence interval, 43.6–62.3), in developing countries 34.0% (95% confidence interval, 20.3–49.1), and in sub-Saharan countries 18.5% (95% confidence interval, 13.8–23.7). Statistically significant variation was noted within and between categories. Our findings show that a significant number of people living with HIV across the world die from cardiovascular disease, non-AIDS malignancies, and liver disease. There is a global need for further scrutiny in all regions to improve preventive measures and early detection according to distinct causes of death patterns.
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Affiliation(s)
| | - Holly Mulinder
- Texas Tech University Health Sciences Center, School of Medicine, Lubbock, TX, USA
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Baum MK, Campa A, Page JB, Lai S, Tsalaile L, Martinez SS, Burns P, Williams O, Li Y, van Widenfelt E, Bussmann H, Sikhulele M, Makhema J, Essex M, Marlink R. Recruitment, Follow-Up and Characteristics of HIV Infected Adults who Use Illicit Drugs in Southern Africa. ACTA ACUST UNITED AC 2015; 1. [PMID: 26855969 DOI: 10.21767/2471-853x.10007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/25/2022]
Abstract
BACKGROUND With one of the worst HIV prevalence rates in the world, Botswana has made great strides in addressing AIDS. Nevertheless, to fully contain the epidemic, outreach to marginalized groups, including illicit drug users, is critical. OBJECTIVE To conduct targeted outreach within an intervention trial to recruit HIV-infected drug users and assess HIV disease and nutritional status. METHOD Recruitment strategies included safeguarding confidentiality, involving ocal health-care professionals, advertising, and participation incentives. Urine toxicology, CD4 cell count, HIV viral load, blood chemistry, plasma micronutrients, dietary history, drug use and morbidity were assessed for two years. RESULTS Targeted outreach identified 138 HIV-infected persons who used marijuana; 18.1% had CD4 cell counts ≤ 350 cells/μL and 39.9% had low BMI. Eligible marijuana users (N=52) had significantly lower BMI (21.8 3.7 vs. 24.3 ± 5.3 kg/m2, P=0.001), higher HIV viral load (4.36 ± 0.89 vs. 4.09 ± 0.89 log10, P=0.018), and higher kilocalorie intake (1924 ± 1055 vs. 1620 ± 926 Kcalories, P=0.025) than those who did not use marijuana (N=748) with similar CD4 cell count. Marijuana users ≥ 40 years old had more opportunistic diseases (P=0.020) than non-users of the same age. Benzodiazepine use was detected among 57 participants and they had higher BMI than marijuana users (24.4 ± 6.8 vs. 21.8 ± 3.7 kg/m2, P= 0.017). CONCLUSION A population stigmatized by illicit drug use and HIV-infection can be brought into a clinical research setting in Africa. HIV-infected marijuana users were at a risk for higher HIV viral load, lower BMI and more comorbidities than nonusers. Outreach to this marginalized group is important for containing the HIV epidemic.
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Affiliation(s)
- Marianna K Baum
- Florida International University, Robert Stempel College of Public Health and Social Work, Miami, Florida, USA
| | - Adriana Campa
- Florida International University, Robert Stempel College of Public Health and Social Work, Miami, Florida, USA
| | - J Bryan Page
- University of Miami, School of Medicine, Miami, Florida, USA
| | - Shenghan Lai
- Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
| | | | - Sabrina Sales Martinez
- Florida International University, Robert Stempel College of Public Health and Social Work, Miami, Florida, USA
| | - Patricia Burns
- Harvard School of Public Health, Boston, Massachusetts, USA
| | - O'Dale Williams
- Florida International University, Robert Stempel College of Public Health and Social Work, Miami, Florida, USA
| | - Yinghui Li
- Florida International University, Robert Stempel College of Public Health and Social Work, Miami, Florida, USA
| | | | | | | | | | - Myron Essex
- Harvard School of Public Health, Boston, Massachusetts, USA
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Auld AF, Shiraishi RW, Mbofana F, Couto A, Fetogang EB, El-Halabi S, Lebelonyane R, Pilatwe PT, Hamunime N, Okello V, Mutasa-Apollo T, Mugurungi O, Murungu J, Dzangare J, Kwesigabo G, Wabwire-Mangen F, Mulenga M, Hachizovu S, Ettiegne-Traore V, Mohamed F, Bashorun A, Nhan DT, Hai NH, Quang TH, Van Onacker JD, Francois K, Robin EG, Desforges G, Farahani M, Kamiru H, Nuwagaba-Biribonwoha H, Ehrenkranz P, Denison JA, Koole O, Tsui S, Torpey K, Mukadi YD, van Praag E, Menten J, Mastro TD, Hamilton CD, Abiri OO, Griswold M, Pierre E, Xavier C, Alfredo C, Jobarteh K, Letebele M, Agolory S, Baughman AL, Mutandi G, Preko P, Ryan C, Ao T, Gonese E, Herman-Roloff A, Ekra KA, Kouakou JS, Odafe S, Onotu D, Dalhatu I, Debem HH, Nguyen DB, Yen LN, Abdul-Quader AS, Pelletier V, Williams SG, Behel S, Bicego G, Swaminathan M, Dokubo EK, Adjorlolo-Johnson G, Marlink R, Lowrance D, Spira T, Colebunders R, Bangsberg D, Zee A, Kaplan J, Ellerbrock TV. Lower Levels of Antiretroviral Therapy Enrollment Among Men with HIV Compared with Women - 12 Countries, 2002-2013. MMWR Morb Mortal Wkly Rep 2015; 64:1281-6. [PMID: 26605861 DOI: 10.15585/mmwr.mm6446a2] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Equitable access to antiretroviral therapy (ART) for men and women with human immunodeficiency virus (HIV) infection is a principle endorsed by most countries and funding bodies, including the U.S. President's Emergency Plan for AIDS (acquired immunodeficiency syndrome) Relief (PEPFAR) (1). To evaluate gender equity in ART access among adults (defined for this report as persons aged ≥15 years), 765,087 adult ART patient medical records from 12 countries in five geographic regions* were analyzed to estimate the ratio of women to men among new ART enrollees for each calendar year during 2002-2013. This annual ratio was compared with estimates from the Joint United Nations Programme on HIV/AIDS (UNAIDS)(†) of the ratio of HIV-infected adult women to men in the general population. In all 10 African countries and Haiti, the most recent estimates of the ratio of adult women to men among new ART enrollees significantly exceeded the UNAIDS estimates for the female-to-male ratio among HIV-infected adults by 23%-83%. In six African countries and Haiti, the ratio of women to men among new adult ART enrollees increased more sharply over time than the estimated UNAIDS female-to-male ratio among adults with HIV in the general population. Increased ART coverage among men is needed to decrease their morbidity and mortality and to reduce HIV incidence among their sexual partners. Reaching more men with HIV testing and linkage-to-care services and adoption of test-and-treat ART eligibility guidelines (i.e., regular testing of adults, and offering treatment to all infected persons with ART, regardless of CD4 cell test results) could reduce gender inequity in ART coverage.
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Farahani M, Price N, El-Halabi S, Mlaudzi N, Keapoletswe K, Lebelonyane R, Fetogang EB, Chebani T, Kebaabetswe P, Masupe T, Gabaake K, Auld A, Nkomazana O, Marlink R. Variation in attrition at subnational level: review of the Botswana National HIV/AIDS Treatment (Masa) programme data (2002-2013). Trop Med Int Health 2015; 21:18-27. [PMID: 26485172 DOI: 10.1111/tmi.12623] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the variation in all-cause attrition [mortality and loss to follow-up (LTFU)] among HIV-infected individuals in Botswana by health district during the rapid and massive scale-up of the National Treatment Program. METHODS Analysis of routinely collected longitudinal data from 226 030 patients who received ART through the Botswana National HIV/AIDS Treatment Program across all 24 health districts from 2002 to 2013. A time-to-event analysis was used to measure crude mortality and loss to follow-up rates (LTFU). A marginal structural model was used to evaluate mortality and LTFU rates by district over time, adjusted for individual-level risk factors (e.g. age, gender, baseline CD4, year of treatment initiation and antiretroviral regimen). RESULTS Mortality rates in the districts ranged from the lowest 1.0 (95% CI 0.9-1.1) in Selibe-Phikwe, to the highest 5.0 (95% CI 4.0-6.1), in Mabutsane. There was a wide range of overall LTFU across districts, including rates as low as 4.6 (95% CI 4.4-4.9) losses per 100 person-years in Ngamiland, and 5.9 (95% CI 5.6-6.2) losses per 100 person-years in South East district, to rates as high as 25.4 (95% CI 23.08-27.89) losses per 100 person-years in Mabutsane and 46.3 (95% CI 43.48-49.23) losses per 100 person-years in Okavango. Even when known risk factors for mortality and LTFU were adjusted for, district was a significant predictor of both mortality and LTFU rates. CONCLUSION We found statistically significant variation in attrition (mortality and LTFU) and data quality among districts. These findings suggest that district-level contextual factors affect retention in treatment. Further research needs to investigate factors that can potentially cause this variation.
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Affiliation(s)
| | - Natalie Price
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | | | | | | | | | | | | | | | | | - Andrew Auld
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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Abstract
The social construction of womanhood in Africa can be said to have two central defining elements: being a wife and being a mother. The interplay between HIV and these elements is not well understood outside of prevention efforts. We conducted a qualitative study of womanhood in Botswana; specifically the sexual and reproductive lives of women living with HIV. Twelve focus-group discussions were held with 61 women, with a median age of 35, taking anti-retroviral therapy. Major themes describing womanhood, before and after HIV diagnosis, were identified using grounded theory strategies. Findings illustrate that womanhood is synonymous with motherhood and that women are expected to have sex in order to please a partner. HIV was said to create a barrier to fulfilling these expectations as it caused anxiety over disclosing one's HIV status and/or infecting the partner. The sense of pride and dignity that traditionally accompanied pregnancy was said to be lost and a common refrain was concern about passing HIV to an unborn child, having pregnancy complications or advancing HIV infection. Fear, shame and stigma play a large role in these negative perceptions. Interventions to address stigma, societal views of women and the integration of holistic family planning into HIV care are needed.
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Affiliation(s)
- Michelle Marian Schaan
- a School of Nursing and Public Health , University of Kwazulu Natal , Durban , South Africa
| | - Myra Taylor
- a School of Nursing and Public Health , University of Kwazulu Natal , Durban , South Africa
| | | | - Richard Marlink
- c Department of Immunology and Infectious Diseases , Harvard School of Public Health , Boston , USA
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Schaan MM, Taylor M, Marlink R. Reproductive behaviour among women on antiretroviral therapy in Botswana: mismatched pregnancy plans and contraceptive use. Afr J AIDS Res 2015; 13:305-11. [PMID: 25388984 DOI: 10.2989/16085906.2014.952654] [Citation(s) in RCA: 7] [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] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Understanding pregnancy planning and contraceptive use is important in preventing unplanned/unwanted pregnancies among women on antiretroviral therapy (ART). Through a cross-sectional survey of 155 women living with HIV on ART in Botswana (mean age = 36), bivariate/multivariate analyses were used to identify and understand pregnancy planning and contraceptive use. Women who did not plan to have a child (n = 85) were older, less educated, had more children and worried about stigmatisation from family and healthcare workers (HCWs). Multivariate analyses found age (OR:3.41; CI:1.57-7.45; p = 0.002); perceived stigmatisation from family and healthcare workers (OR:3.62; CI:1.47-8.96; p = 0.005); and believing it is irresponsible for women living with HIV to want a child (OR:2.40; CI:1.10-5.24; p = 0.028) to be significantly associated with not planning to have a child. Although reported condom use among 85 women who did not plan to have a child was nearly 90%, a total of 26 of these women (34%) believed they did not have control over condom use. Lack of contraception was reported by 6 women who did not plan a child; this, coupled with the lack of control over condom use, puts unmet need for contraception at 38%. Most women reported feeling comfortable talking with HCWs about contraceptives. However, almost a quarter of the women indicated they were infrequently advised about contraceptives at ART clinics. This study found discordance between pregnancy planning and contraceptive use among women on ART. Lack of control over condom use coupled with low hormonal contraceptive use creates unmet need for contraception and increases the risk of unwanted pregnancies. Regular clinic visits for women on ART present excellent opportunities to address contraceptive needs in a considerate and comprehensive manner.
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Affiliation(s)
- Michelle M Schaan
- a University of Kwazulu-Natal , Department of Public Health Medicine , 236 George Campbell Building, Howard College Campus, King George V Avenue, Durban , 4041 South Africa
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Martinez S, Campa A, Marlink R, Makhema J, Huffman F, Williams OD, Baum M. Bacterial Translocation and Obesity in Antiretroviral (ARV)‐Naïve HIV+ Adults in Botswana. FASEB J 2015. [DOI: 10.1096/fasebj.29.1_supplement.lb408] [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)
- Sabrina Martinez
- R. Stempel College of Public Health & Social Work Florida International UniversityFLUnited States
| | - Adriana Campa
- R. Stempel College of Public Health & Social Work Florida International UniversityFLUnited States
| | | | | | - Fatma Huffman
- R. Stempel College of Public Health & Social Work Florida International UniversityFLUnited States
| | - O. Dale Williams
- R. Stempel College of Public Health & Social Work Florida International UniversityFLUnited States
| | - Marianna Baum
- R. Stempel College of Public Health & Social Work Florida International UniversityFLUnited States
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Auld AF, Agolory SG, Shiraishi RW, Wabwire-Mangen F, Kwesigabo G, Mulenga M, Hachizovu S, Asadu E, Tuho MZ, Ettiegne-Traore V, Mbofana F, Okello V, Azih C, Denison JA, Tsui S, Koole O, Kamiru H, Nuwagaba-Biribonwoha H, Alfredo C, Jobarteh K, Odafe S, Onotu D, Ekra KA, Kouakou JS, Ehrenkranz P, Bicego G, Torpey K, Mukadi YD, van Praag E, Menten J, Mastro T, Hamilton CD, Swaminathan M, Dokubo EK, Baughman AL, Spira T, Colebunders R, Bangsberg D, Marlink R, Zee A, Kaplan J, Ellerbrock TV. Antiretroviral therapy enrollment characteristics and outcomes among HIV-infected adolescents and young adults compared with older adults--seven African countries, 2004-2013. MMWR Morb Mortal Wkly Rep 2014; 63:1097-103. [PMID: 25426651 PMCID: PMC5779521] [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] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Although scale-up of antiretroviral therapy (ART) since 2005 has contributed to declines of about 30% in the global annual number of human immunodeficiency (HIV)-related deaths and declines in global HIV incidence, estimated annual HIV-related deaths among adolescents have increased by about 50% and estimated adolescent HIV incidence has been relatively stable. In 2012, an estimated 2,500 (40%) of all 6,300 daily new HIV infections occurred among persons aged 15-24 years. Difficulty enrolling adolescents and young adults in ART and high rates of loss to follow-up (LTFU) after ART initiation might be contributing to mortality and HIV incidence in this age group, but data are limited. To evaluate age-related ART retention challenges, data from retrospective cohort studies conducted in seven African countries among 16,421 patients, aged ≥15 years at enrollment, who initiated ART during 2004-2012 were analyzed. ART enrollment and outcome data were compared among three groups defined by age at enrollment: adolescents and young adults (aged 15-24 years), middle-aged adults (aged 25-49 years), and older adults (aged ≥50 years). Enrollees aged 15-24 years were predominantly female (81%-92%), commonly pregnant (3%-32% of females), unmarried (54%-73%), and, in four countries with employment data, unemployed (53%-86%). In comparison, older adults were more likely to be male (p<0.001), employed (p<0.001), and married, (p<0.05 in five countries). Compared with older adults, adolescents and young adults had higher LTFU rates in all seven countries, reaching statistical significance in three countries in crude and multivariable analyses. Evidence-based interventions to reduce LTFU for adolescent and young adult ART enrollees could help reduce mortality and HIV incidence in this age group.
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Affiliation(s)
- Andrew F. Auld
- Division of Global HIV/AIDS, Center for Global Health, CDC,Corresponding author: Andrew F. Auld, , 404-639-8997
| | | | | | - Fred Wabwire-Mangen
- Infectious Diseases Institute, Makerere University College of Health Sciences, Uganda
| | | | | | | | | | | | | | | | | | | | | | - Sharon Tsui
- Social and Behavioral Health Sciences, FHI 360, Washington, DC
| | - Olivier Koole
- Institute of Tropical Medicine, Department of Clinical Sciences, Belgium
| | - Harrison Kamiru
- International Center for AIDS Care and Treatment Programs-Columbia University, New York, NY
| | | | - Charity Alfredo
- Division of Global HIV/AIDS, Center for Global Health, CDC, Mozambique
| | - Kebba Jobarteh
- Division of Global HIV/AIDS, Center for Global Health, CDC, Mozambique
| | - Solomon Odafe
- Division of Global HIV/AIDS, Center for Global Health, CDC, Nigeria
| | - Dennis Onotu
- Division of Global HIV/AIDS, Center for Global Health, CDC, Nigeria
| | - Kunomboa A. Ekra
- Division of Global HIV/AIDS, Center for Global Health, CDC, Côte d’Ivoire
| | - Joseph S. Kouakou
- Division of Global HIV/AIDS, Center for Global Health, CDC, Côte d’Ivoire
| | - Peter Ehrenkranz
- Division of Global HIV/AIDS, Center for Global Health, CDC, Swaziland
| | - George Bicego
- Division of Global HIV/AIDS, Center for Global Health, CDC, Swaziland
| | | | | | | | - Joris Menten
- Institute of Tropical Medicine, Department of Clinical Sciences, Belgium
| | - Timothy Mastro
- Global Health, Population and Nutrition, FHI 360, Durham, NC
| | | | | | | | | | - Thomas Spira
- Division of Global HIV/AIDS, Center for Global Health, CDC
| | - Robert Colebunders
- Institute of Tropical Medicine, Department of Clinical Sciences, Belgium
| | | | | | - Aaron Zee
- Division of Global HIV/AIDS, Center for Global Health, CDC
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Auld AF, Tuho MZ, Ekra KA, Kouakou J, Shiraishi RW, Adjorlolo-Johnson G, Marlink R, Ellerbrock TV. Tuberculosis in human immunodeficiency virus-infected children starting antiretroviral therapy in Côte d'Ivoire. Int J Tuberc Lung Dis 2014; 18:381-7. [PMID: 24670690 DOI: 10.5588/ijtld.13.0395] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [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
SETTING In Côte d'Ivoire, more than 2000 human immunodeficiency virus (HIV) infected children aged <15 years were started on antiretroviral therapy (ART) during 2004-2008. OBJECTIVES To estimate tuberculosis (TB) incidence and determinants among ART enrollees. DESIGN A nationally representative retrospective cohort study among 2110 children starting ART during 2004-2008 at 29 facilities. RESULTS At ART initiation, the median age was 5.1 years; 82% had World Health Organization Stage III/IV, median CD4% was 11%, 42% were severely undernourished (weight-for-age Z-score [WAZ] <-3), and 150 (7%) were taking anti-tuberculosis treatment. Documentation of TB screening before ART declined from 63% to 46% during 2004-2008. Children taking anti-tuberculosis treatment at ART enrollment had a lower median CD4% (9.0% vs. 11.0%, P = 0.037) and a higher prevalence of WAZ <-3 (59% vs. 40%, P < 0.001). Among children considered TB-free at ART enrollment, TB incidence was 6.28/100 child-years during days 0-90 of ART, declining to 0.56/100 child-years after 180 days. Children with one unit higher WAZ at ART enrollment had 13% lower TB incidence (adjusted HR 0.87, 95%CI 0.77-1.00, P= 0.047). CONCLUSIONS Ensuring clinician compliance with TB screening before ART and ensuring earlier ART initiation before children suffer from advanced HIV disease and nutritional compromise might reduce TB morbidity during ART.
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Affiliation(s)
- A F Auld
- Division of Global HIV/AIDS, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - M Z Tuho
- Ministry of Health, National Programme for Medical Care of Persons Living with HIV/AIDS, Abidjan, Côte d'Ivoire
| | - K A Ekra
- Division of Global HIV/AIDS, CDC, Abidjan, Côte d'Ivoire
| | - J Kouakou
- Division of Global HIV/AIDS, CDC, Abidjan, Côte d'Ivoire
| | - R W Shiraishi
- Division of Global HIV/AIDS, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | | | - R Marlink
- Elizabeth Glaser Pediatric AIDS Foundation, Los Angeles, California, USA
| | - T V Ellerbrock
- Division of Global HIV/AIDS, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
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Auld AF, Ekra KA, Shiraishi RW, Tuho MZ, Kouakou JS, Mohamed F, Ettiègne-Traoré V, Sabatier J, Essombo J, Adjorlolo-Johnson G, Marlink R, Ellerbrock TV. Temporal trends in treatment outcomes for HIV-1 and HIV-2-infected adults enrolled in Côte d'Ivoire's national antiretroviral therapy program. PLoS One 2014; 9:e98183. [PMID: 24866468 PMCID: PMC4035349 DOI: 10.1371/journal.pone.0098183] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [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: 03/04/2014] [Accepted: 04/25/2014] [Indexed: 12/13/2022] Open
Abstract
Background In Côte d'Ivoire during 2004–2007, numbers of ART enrollees increased from <5,000 to 36,943. Trends in nationally representative ART program outcomes have not yet been reported. Methodology/Principal Findings We conducted a retrospective chart review to assess trends in patient characteristics and attrition [death or loss to follow-up (LTFU)] over time, among a nationally representative sample of 3,682 adults (≥15 years) initiating ART during 2004–2007 at 34 health facilities. Among ART enrollees during 2004–2007, median age was 36, the proportion female was 67%, the proportion HIV-2-infected or dually HIV-1&2 reactive was 5%, and median baseline CD4+ T-cell (CD4) count was 135 cells/µL. Comparing cohorts initiating ART in 2004 with cohorts initiating ART in 2007, median baseline weight declined from 55 kg to 52 kg (p = 0.008) and the proportion weighing <45 kg increased from 17% to 22% (p = 0.014). During 2004–2007, pharmacy-based estimates of the percentage of new ART enrollees ≥95% adherent to ART declined from 74% to 60% (p = 0.026), and twelve-month retention declined from 86% to 69%, due to increases in 12-month mortality from 2%–4% and LTFU from 12%–28%. In univariate analysis, year of ART initiation was associated with increasing rates of both LTFU and mortality. Controlling for baseline CD4, weight, adherence, and other risk factors, year of ART initiation was still strongly associated with LTFU but not mortality. In multivariate analysis, weight <45 kg and adherence <95% remained strong predictors of LTFU and mortality. Conclusions During 2004–2007, increasing prevalence among ART enrollees of measured mortality risk factors, including weight <45 kg and ART adherence <95%, might explain increases in mortality over time. However, the association between later calendar year and increasing LTFU is not explained by risk factors evaluated in this analysis. Undocumented transfers, political instability, and patient dissatisfaction with crowded facilities might explain increasing LTFU.
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Affiliation(s)
- Andrew F. Auld
- Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
| | - Kunomboa A. Ekra
- Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Abidjan, Côte d'Ivoire
| | - Ray W. Shiraishi
- Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Moise Z. Tuho
- National Program for Medical Care of Persons Living with HIV/AIDS, Ministry of Health, Abidjan, Côte d'Ivoire
| | | | - Fayama Mohamed
- Elizabeth Glaser Pediatric AIDS Foundation, Abidjan, Côte d'Ivoire
- Department of Economy and Finance, Directorate General of Budget and Finance, Abidjan, Côte d'Ivoire
| | - Virginie Ettiègne-Traoré
- National Program for Medical Care of Persons Living with HIV/AIDS, Ministry of Health, Abidjan, Côte d'Ivoire
| | - Jennifer Sabatier
- Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Joseph Essombo
- Elizabeth Glaser Pediatric AIDS Foundation, Abidjan, Côte d'Ivoire
| | | | - Richard Marlink
- Elizabeth Glaser Pediatric AIDS Foundation, Los Angeles, California, United States of America
| | - Tedd V. Ellerbrock
- Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Luisi S, Campa A, Martinez S, Bussmann H, Farahani M, Makhema J, Marlink R, Baum M. Zinc deficiency facilitates disease progression in early HIV infected adults in Botswana (804.26). FASEB J 2014. [DOI: 10.1096/fasebj.28.1_supplement.804.26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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)
- Sonya Luisi
- Dietetics and Nutrition Florida International UniversityMiamiFLUnited States
| | - Adriana Campa
- Dietetics and Nutrition Florida International UniversityMiamiFLUnited States
| | - Sabrina Martinez
- Dietetics and Nutrition Florida International UniversityMiamiFLUnited States
| | | | - Mansour Farahani
- Harvard School of Public Health Harvard UniversityBostonMAUnited States
| | - Joseph Makhema
- Botswana Harvard AIDS Institute PartnershipGabaroneBotswana
| | - Richard Marlink
- Harvard School of Public Health Harvard UniversityBostonMAUnited States
| | - Marianna Baum
- Dietetics and Nutrition Florida International UniversityMiamiFLUnited States
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Moyo S, LeCuyer T, Wang R, Gaseitsiwe S, Weng J, Musonda R, Bussmann H, Mine M, Engelbrecht S, Makhema J, Marlink R, Baum MK, Novitsky V, Essex M. Evaluation of the false recent classification rates of multiassay algorithms in estimating HIV type 1 subtype C incidence. AIDS Res Hum Retroviruses 2014; 30:29-36. [PMID: 23937344 DOI: 10.1089/aid.2013.0055] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Laboratory cross-sectional assays are useful for the estimation of HIV incidence, but are known to misclassify individuals with long-standing infection as recently infected. The false recent rate (FRR) varies widely across geographic areas; therefore, accurate estimates of HIV incidence require a locally defined FRR. We determined FRR for Botswana, where HIV-1 subtype C infection is predominant, using the BED capture enzyme immunoassay (BED), a Bio-Rad Avidity Index (BAI) assay (a modification of the Bio-Rad HIV1/2+O EIA), and two multiassay algorithms (MAA) that included clinical data. To estimate FRR, stored blood samples from 512 antiretroviral (ARV)-naive HIV-1 subtype C-infected individuals from a prospective cohort in Botswana were tested at 18-24 months postenrollment. The following FRR mean (95% CI) values were obtained: BED 6.05% (4.15-8.48), BAI 5.57% (3.70-8.0), BED-BAI 2.25% (1.13-4.0), and a combination of BED-BAI with CD4 (>200) and viral load (>400) threshold 1.43% (0.58-2.93). The interassay agreement between BED and BAI was 92.8% (95% CI, 90.1-94.5) for recent/long-term classification. Misclassification was associated with viral suppression for BED [adjusted OR (aOR) 10.31; p=0.008], BAI [aOR 9.72; p=0.019], and MAA1 [aOR 16.6; p=0.006]. Employing MAA can reduce FRR to <2%. A local FRR can improve cross-sectional HIV incidence estimates.
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Affiliation(s)
- Sikhulile Moyo
- Botswana–Harvard AIDS Institute Partnership, Gaborone, Botswana
- Division of Medical Virology, University of Stellenbosch, Stellenbosch, South Africa
| | - Tessa LeCuyer
- Botswana–Harvard AIDS Institute Partnership, Gaborone, Botswana
- Washington State University College of Veterinary Medicine, Pullman, Washington
| | - Rui Wang
- Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts
- Division of Sleep Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Simani Gaseitsiwe
- Botswana–Harvard AIDS Institute Partnership, Gaborone, Botswana
- Department of Immunology and Infectious Diseases, Harvard School of Public Health AIDS Initiative, Harvard School of Public Health, Boston, Massachusetts
| | - Jia Weng
- Division of Sleep Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Rosemary Musonda
- Botswana–Harvard AIDS Institute Partnership, Gaborone, Botswana
- Department of Immunology and Infectious Diseases, Harvard School of Public Health AIDS Initiative, Harvard School of Public Health, Boston, Massachusetts
| | - Hermann Bussmann
- Botswana–Harvard AIDS Institute Partnership, Gaborone, Botswana
- Department of Immunology and Infectious Diseases, Harvard School of Public Health AIDS Initiative, Harvard School of Public Health, Boston, Massachusetts
| | - Madisa Mine
- Botswana–Harvard AIDS Institute Partnership, Gaborone, Botswana
- National Health Laboratory and Botswana-Harvard HIV Reference Laboratory, Gaborone, Botswana
| | - Susan Engelbrecht
- Division of Medical Virology, University of Stellenbosch, Stellenbosch, South Africa
- National Health Laboratory Service, Cape Town, South Africa
| | - Joseph Makhema
- Botswana–Harvard AIDS Institute Partnership, Gaborone, Botswana
- Department of Immunology and Infectious Diseases, Harvard School of Public Health AIDS Initiative, Harvard School of Public Health, Boston, Massachusetts
| | - Richard Marlink
- Botswana–Harvard AIDS Institute Partnership, Gaborone, Botswana
- Department of Immunology and Infectious Diseases, Harvard School of Public Health AIDS Initiative, Harvard School of Public Health, Boston, Massachusetts
| | - Marianna K. Baum
- R. Stempel College of Public Health and Social Work, Florida International University, University Park, Miami, Florida
| | - Vladimir Novitsky
- Botswana–Harvard AIDS Institute Partnership, Gaborone, Botswana
- Department of Immunology and Infectious Diseases, Harvard School of Public Health AIDS Initiative, Harvard School of Public Health, Boston, Massachusetts
| | - M. Essex
- Botswana–Harvard AIDS Institute Partnership, Gaborone, Botswana
- Department of Immunology and Infectious Diseases, Harvard School of Public Health AIDS Initiative, Harvard School of Public Health, Boston, Massachusetts
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Farahani M, Vable A, Lebelonyane R, Seipone K, Anderson M, Avalos A, Chadborn T, Tilahun H, Roumis D, Moeti T, Musuka G, Busang L, Gaolathe T, Malefho KCS, Marlink R. Outcomes of the Botswana national HIV/AIDS treatment programme from 2002 to 2010: a longitudinal analysis. Lancet Glob Health 2013; 2:e44-50. [PMID: 25104635 DOI: 10.1016/s2214-109x(13)70149-9] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Short-term mortality rates among patients with HIV receiving antiretroviral therapy (ART) in sub-Saharan Africa are higher than those recorded in high-income countries, but systematic long-term comparisons have not been made because of the scarcity of available data. We analysed the effect of the implementation of Botswana's national ART programme, known as Masa, from 2002 to 2010. METHODS The Masa programme started on Jan 21, 2002. Patients who were eligible for ART according to national guidelines had their data collected prospectively through a clinical information system developed by the Botswana Ministry of Health. A dataset of all available electronic records for adults (≥18 years) who had enrolled by April 30, 2010, was extracted and sent to the study team. All data were anonymised before analysis. The primary outcome was mortality. To assess the effect of loss to follow-up, we did a series of sensitivity analyses assuming varying proportions of the population lost to follow-up to be dead. FINDINGS We analysed the records of 126,263 patients, of whom 102,713 had documented initiation of ART. Median follow-up time was 35 months (IQR 14-56), with a median of eight follow-up visits (4-14). 15,270 patients were deemed lost to follow-up by the end of the study. 63% (78,866) of the study population were women; median age at baseline was 34 years for women (IQR 29-41) and 38 years for men (33-45). 10,230 (8%) deaths were documented during the 9 years of the study. Mortality was highest during the first 3 months after treatment initiation at 12·8 deaths per 100 person-years (95% CI 12·4-13·2), but decreased to 1·16 deaths per 100 person-years (1·12-1·2) in the second year of treatment, and to 0·15 deaths per 100 person-years (0·09-0·25) over the next 7 years of follow-up. In each calendar year after the start of the Masa programme in 2002, average CD4 cell counts at enrolment increased (from 101 cells/μL [IQR 44-156] in 2002, to 191 cells/μL [115-239] in 2010). In each year, the proportion of the total enrolled population who died in that year decreased, from 63% (88 of 140) in 2002, to 0·8% (13 of 1599) in 2010. A sensitivity analysis assuming that 60% of the population lost to follow-up had died gave 3000 additional deaths, increasing overall mortality from 8% to 11-13%. INTERPRETATION The Botswana national HIV/AIDS treatment programme reduced mortality among adults with HIV to levels much the same as in other low-income or middle-income countries. FUNDING The African Comprehensive HIV/AIDS Partnerships.
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Affiliation(s)
| | - Anusha Vable
- Harvard School of Public Health, Boston, MA, USA
| | | | | | | | | | | | | | - Danae Roumis
- Harvard School of Public Health, Boston, MA, USA
| | - Themba Moeti
- African Comprehensive HIV/AIDS Partnerships, Gaborone, Botswana
| | - Godfrey Musuka
- African Comprehensive HIV/AIDS Partnerships, Gaborone, Botswana
| | - Lesego Busang
- African Comprehensive HIV/AIDS Partnerships, Gaborone, Botswana
| | | | | | - Richard Marlink
- Harvard School of Public Health, Boston, MA, USA; Botswana-Harvard Partnership, Gaborone, Botswana
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Baum MK, Campa A, Lai S, Sales Martinez S, Tsalaile L, Burns P, Farahani M, Li Y, van Widenfelt E, Page JB, Bussmann H, Fawzi WW, Moyo S, Makhema J, Thior I, Essex M, Marlink R. Effect of micronutrient supplementation on disease progression in asymptomatic, antiretroviral-naive, HIV-infected adults in Botswana: a randomized clinical trial. JAMA 2013; 310:2154-63. [PMID: 24281460 PMCID: PMC4347896 DOI: 10.1001/jama.2013.280923] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Micronutrient deficiencies occur early in human immunodeficiency virus (HIV) infection, and supplementation with micronutrients may be beneficial; however, its effectiveness has not been investigated early in HIV disease among adults who are antiretroviral therapy (ART) naive. OBJECTIVE To investigate whether long-term micronutrient supplementation is effective and safe in delaying disease progression when implemented early in adults infected with HIV subtype C who are ART-naive. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial of supplementation with either daily multivitamins (B vitamins and vitamins C and E), selenium alone, or multivitamins with selenium vs placebo in a factorial design for 24 months. The study was conducted in 878 patients infected with HIV subtype C with a CD4 cell count greater than 350/μL who were not receiving ART at Princess Marina Hospital in Gaborone, Botswana, between December 2004 and July 2009. INTERVENTIONS Daily oral supplements of B vitamins and vitamins C and E, selenium alone, or multivitamins plus selenium, compared with placebo. MAIN OUTCOMES AND MEASURES Reaching a CD4 cell count less than 200/μL until May 2008; after this date, reaching a CD4 cell count of 250/μL or less, consistent with the standard of care in Botswana for initiation of ART at the time of the study. RESULTS There were 878 participants enrolled and randomized into the study. All participants were ART-naive throughout the study. In intent-to-treat analysis, participants receiving the combined supplement of multivitamins plus selenium had a significantly lower risk vs placebo of reaching CD4 cell count 250/μL or less (adjusted hazard ratio [HR], 0.46; 95% CI, 0.25-0.85; P = .01; absolute event rate [AER], 4.79/100 person-years; censoring rate, 0.92; 17 events; placebo AER, 9.22/100 person-years; censoring rate, 0.85; 32 events). Multivitamins plus selenium in a single supplement, vs placebo, also reduced the risk of secondary events of combined outcomes for disease progression (CD4 cell count ≤250/μL, AIDS-defining conditions, or AIDS-related death, whichever occurred earlier [adjusted HR, 0.56; 95% CI, 0.33-0.95; P = .03; AER, 6.48/100 person-years; censoring rate, 0.90; 23 events]). There was no effect of supplementation on HIV viral load. Multivitamins alone and selenium supplementation alone were not statistically different from placebo for any end point. Reported adverse events were adjudicated as unlikely to be related to the intervention, and there were no notable differences in incidence of HIV-related and health-related events among study groups. CONCLUSIONS AND RELEVANCE In ART-naive HIV-infected adults, 24-month supplementation with a single supplement containing multivitamins and selenium was safe and significantly reduced the risk of immune decline and morbidity. Micronutrient supplementation may be effective when started in the early stages of HIV disease.
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Affiliation(s)
- Marianna K Baum
- Florida International University, R. Stempel College of Public Health and Social Work, Miami
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Retshabile G, Kisanga ER, Gaseitsiwe S, Moyo SM, Bussmann H, Makhema J, Essex M, Marlink R, Musonda R. O15.1 Sub-Optimal CD4 T-Cell Recovery in HIV-1 Subtype C Patients on Antiretroviral Therapy: A Search For Predictive Biomarkers and Baseline Characteristics. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0167] [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: 11/03/2022]
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48
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Luisi S, Campa A, Martinez SS, Makhema J, Bussmann H, Farahani M, Marlink R, Baum MK. Higher Body Mass Index, Lean Body Mass and Fat Mass Obtained by Bioimpedance are Associated with Slower HIV Disease Progression in Asymptomatic HIV+ Adults. FASEB J 2013. [DOI: 10.1096/fasebj.27.1_supplement.619.6] [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)
- Sonya Luisi
- R. Stempel College of Public Health and Social WorkFlorida International UniversityMiamiFL
| | - Adriana Campa
- R. Stempel College of Public Health and Social WorkFlorida International UniversityMiamiFL
| | - Sabrina Sales Martinez
- R. Stempel College of Public Health and Social WorkFlorida International UniversityMiamiFL
| | | | | | | | | | - Marianna K Baum
- R. Stempel College of Public Health and Social WorkFlorida International UniversityMiamiFL
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Adjorlolo-Johnson G, Wahl Uheling A, Ramachandran S, Strasser S, Kouakou J, Tindyebwa D, Alons C, Neluheni T, Lee S, Marlink R. Scaling up pediatric HIV care and treatment in Africa: clinical site characteristics associated with favorable service utilization. J Acquir Immune Defic Syndr 2013; 62:e7-e13. [PMID: 22955053 DOI: 10.1097/qai.0b013e3182706401] [Citation(s) in RCA: 13] [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: 11/25/2022]
Abstract
BACKGROUND To improve pediatric enrollment and retention in HIV treatment programs in Africa, we examined factors associated with service utilization within the Elizabeth Glaser Pediatric AIDS Foundation program in Côte d'Ivoire, Mozambique, South Africa, Tanzania and Zambia. METHODS We retrospectively reviewed characteristics of clinical sites providing HIV treatment services within our program. For each site, favorable pediatric program outcomes were defined as a cumulative number or percentage of pediatric enrollment in care or antiretroviral therapy (ART) more than the pooled median value or an attrition rate less than 10%. We compared proportions of sites with favorable outcomes among those with or without selected characteristics. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were determined using logistic regression analyses, accounting for potential confounding factors. RESULTS Over 4 years, 33,331 children were enrolled, including 18,255 on ART, across 220 sites. Characteristics associated with favorable pediatric enrollment were nutritional support (aOR = 8.9; CI: 2.8 to 28.4), linkages with associations of people living with HIV (aOR = 4.2; CI: 1.8 to 9.5), early infant diagnosis (aOR = 3.3; CI: 1.5 to 7.1), and on-site prevention of mother-to-child transmission services (aOR = 3.1; CI: 1.0 to 11.1). Similarly, linkages with people living with HIV, early infant diagnosis, and prevention of mother-to-child transmission were associated with high proportion of children on ART younger than 2 years of age. Home-based care was associated with low pediatric attrition rates (aOR = 2.9; CI: 1.4 to 5.8). CONCLUSIONS Certain site characteristics were associated with favorable pediatric enrollment and retention in our program. Expanding these characteristics to improve pediatric HIV treatment in Africa warrants further evaluation.
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Farahani M, Roumis D, Mahal A, Holmes M, Moalosi G, Molomo C, Marlink R. Effects of AIDS-related disability on workforce participation and earned income in Botswana: A quasi-experimental evaluation. Health (London) 2013. [DOI: 10.4236/health.2013.53055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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