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Du Toit S, Marlow M, Mawoyo T, Chideya Y, Laurenzi C, Kasu T, Ngorima-Mabhena N, Grimwood A, Fatti G. Benefits and challenges of community-based multi-month dispensing of antiretroviral treatment in Zimbabwe: A qualitative study from a cluster randomized trial. Health Soc Care Community 2022; 30:e2838-e2848. [PMID: 35064715 DOI: 10.1111/hsc.13727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 12/29/2021] [Accepted: 01/07/2022] [Indexed: 06/14/2023]
Abstract
Sub-Saharan Africa carries the highest burden of HIV, with approximately 70% of all people living with HIV (PLWH) globally living in this region. The provision of antiretroviral treatment (ART) significantly affects already overburdened health systems, which need to accommodate large volumes of ART patients while facing a shortage of professional health workers, infrastructure challenges and medical resources. Finding alternative ways to provide routine services to PLWH has become significantly more urgent. Multi-month dispensing (MMD) of ART aims to improve access to treatment for PLWH, while also improving the efficiency of the health system. This study explores the experienced benefits and challenges of community-based MMD in order to make recommendations for future implementation efforts. Twenty focus group discussions were conducted with members of community ART refill groups (CARGs) who received 3-monthly or 6-monthy MMD. Individual interviews were also conducted with health providers. All interviews and focus group discussions took place between April and June 2019 conducted by research nurses in English, Shona or Ndebele. Multiple benefits of community-based MMD were reported, including decreased congestion in health facilities, improved service delivery, decline in staff burnout and increased time availability for CARG members due to less time spent at clinics, improved ART adherence and social support experienced amongst members of CARGs. Identified challenges included the possibility of being exposed to HIV-related stigma when belonging to a CARG, and low levels of medical supplies and ART stock at clinics. Recommendations were made by CARG members and health care workers on how CARGs could be improved and sustained in the future. Results from this study show that the implementation of community-based MMD holds multiple benefits at an individual and health facility level. Future recommendations include evaluating the feasibility of MMD among other vulnerable populations.
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Affiliation(s)
- Stefani Du Toit
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Marguerite Marlow
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Tatenda Mawoyo
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Yeukai Chideya
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Christina Laurenzi
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | | | | | | | - Geoffrey Fatti
- Kheth'Impilo AIDS Free Living, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Peter IM, Deraney RN, Orango O, Philip T, Rosen B, Cu-Uvin S. Radical hysterectomy for operable early cervical cancer in HIV-positive and HIV-negative women in western Kenya. Int J Gynaecol Obstet 2019; 148:403-404. [PMID: 31628862 DOI: 10.1002/ijgo.13004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 09/19/2019] [Accepted: 10/17/2019] [Indexed: 11/07/2022]
Affiliation(s)
- Itsura M Peter
- Department of Reproductive Health, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Rachel N Deraney
- School of Public Health, Brown University, Providence, RI, USA.,Center for Biomedical Engineering, Brown University, Providence, RI, USA
| | - Omenge Orango
- Department of Reproductive Health, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Tonui Philip
- Department of Reproductive Health, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Barry Rosen
- Department of Gynecologic Oncologist, Oakland University William Beaumont, Rochester Hills, MI, USA
| | - Susan Cu-Uvin
- Department of Obstetrics and Gynecology, The Miriam Hospital, Brown University, Providence, RI, USA
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Zimmermann HML, Eekman SW, Achterbergh RCA, Schim van der Loeff MF, Prins M, de Vries HJC, Hoornenborg E, Davidovich U. Motives for choosing, switching and stopping daily or event-driven pre-exposure prophylaxis - a qualitative analysis. J Int AIDS Soc 2019; 22:e25389. [PMID: 31612621 PMCID: PMC6791997 DOI: 10.1002/jia2.25389] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 08/06/2019] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION In settings where both daily and event-driven pre-exposure prophylaxis (PrEP) are offered to men who have sex with men (MSM), a clear understanding of the motives to choose between the different dosing-regimens can facilitate more effective PrEP implementation. We therefore studied the motives for choosing for, switching between, and stopping daily or event-driven PrEP. METHODS We used data (August 2015-June 2017) from the prospective, longitudinal, open-label Amsterdam PrEP demonstration study, in which daily (dPrEP) and event-driven PrEP (edPrEP) were offered to 374 HIV-negative MSM and two transgender persons. Participants self-selected the preferred PrEP-regimen at baseline and could switch regimens at three-monthly follow-up visits. We measured motives for choosing PrEP-regimen at baseline and for switching and stopping PrEP at follow-up visits. Open- and closed-end items were combined and qualitatively analysed. RESULTS Choices of PrEP-regimens were determined by personal and contextual factors, involving the perceived self-efficacy concerning adherence, the risk-context, and the anticipated impact of PrEP on physical and sexual wellbeing. dPrEP was preferred because of the anticipated better adherence and the fear of side-effects relating to edPrEP re-initiations. Moreover, dPrEP was perceived to be more effective than edPrEP. Motives to choose edPrEP were the expected physical burden of dPrEP, anticipated side-effects of dPrEP, and fear to forget daily doses. Regarding the risk-context: dPrEP was preferred for unplanned and/or frequent sex, while edPrEP was chosen when risk was predictable and/or less frequent. While some chose for dPrEP to gain more sexual freedom, others chose for edPrEP to minimize sexual risk episodes. Changes in the above factors, such as changing risk patterns, changing relationships or changing physical conditions, resulted in switching regimens. Choices to stop PrEP were related to lower sexual risk, adherence issues and side-effects. CONCLUSIONS The great diversity of motives illustrates the importance of offering a choice of PrEP-regimens. In counselling of MSM starting PrEP, choices for PrEP-regimens may be addressed as a continuum of flexible and changeable options over time. This may help individuals choose the PrEP-regimen that best fits their current sexual context, priorities and personal capabilities and therefore will be more easily adhered to.
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Affiliation(s)
- Hanne ML Zimmermann
- Department of Infectious Diseases, Research and PreventionPublic Health Service of AmsterdamAmsterdamthe Netherlands
| | - Sanne W Eekman
- Department of Infectious Diseases, Research and PreventionPublic Health Service of AmsterdamAmsterdamthe Netherlands
| | - Roel CA Achterbergh
- Department of Infectious DiseasesPublic Health Service of AmsterdamSTI Outpatient ClinicAmsterdamthe Netherlands
| | - Maarten F Schim van der Loeff
- Department of Infectious Diseases, Research and PreventionPublic Health Service of AmsterdamAmsterdamthe Netherlands
- Department of Infectious DiseasesAmsterdam Institute for Infection and Immunity (AI&II)Amsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
| | - Maria Prins
- Department of Infectious Diseases, Research and PreventionPublic Health Service of AmsterdamAmsterdamthe Netherlands
- Department of Infectious DiseasesAmsterdam Institute for Infection and Immunity (AI&II)Amsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
| | - Henry JC de Vries
- Department of Infectious DiseasesPublic Health Service of AmsterdamSTI Outpatient ClinicAmsterdamthe Netherlands
- Department of DermatologyAmsterdam Institute for Infection and Immunity (AI&II)Amsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
| | - Elske Hoornenborg
- Department of Infectious Diseases, Research and PreventionPublic Health Service of AmsterdamAmsterdamthe Netherlands
- Department of Infectious DiseasesPublic Health Service of AmsterdamSTI Outpatient ClinicAmsterdamthe Netherlands
| | - Udi Davidovich
- Department of Infectious Diseases, Research and PreventionPublic Health Service of AmsterdamAmsterdamthe Netherlands
- Department of Infectious DiseasesAmsterdam Institute for Infection and Immunity (AI&II)Amsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
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Bock P, Gunst C, Maschilla L, Holtman R, Grobbelaar N, Wademan D, Dunbar R, Fatti G, Kruger J, Ford N, Hoddinott G, Meehan S. Retention in care and factors critical for effectively implementing antiretroviral adherence clubs in a rural district in South Africa. J Int AIDS Soc 2019; 22:e25396. [PMID: 31588668 PMCID: PMC6778813 DOI: 10.1002/jia2.25396] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 09/03/2019] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Differentiated models of care that include referral of antiretroviral treatment (ART) clients to adherence clubs are an important strategy to help clinics manage increased number of clients living with HIV in resource-constrained settings. This study reported on (i) clinical outcomes among ART clients attending community-based adherence clubs and (ii) experiences of adherence clubs and perceptions of factors key to successful adherence club implementation among clients and healthcare workers. METHODS A retrospective cohort analysis of routine data and a descriptive analysis of data collected through self-administered surveys completed by clients and healthcare workers were completed. Clients starting ART at the study clinic, between January 2014 and December 2015, were included in the cohort analysis and followed up until December 2016. The survey data were collected from August to September 2017. The primary outcome for the cohort analysis was a comparison of loss to follow-up (LTFU) between clients staying in clinic care and those referred to adherence clubs. Survey data reported on client experiences of and healthcare worker perceptions of adherence club care. RESULTS Cohort analysis reported on 465 participants, median baseline CD4 count 374 (IQR: 234 to 532) cells/μl and median follow-up time 20.7 (IQR 14.1 to 27.7) months. Overall, 202 (43.4%) participants were referred to an adherence club. LTFU was lower in those attending an adherence club (aHR =0.25, 95% CI: 0.11 to 0.56). This finding was confirmed on analysis restricted to those eligible for adherence club referral (aHR =0.28, 95% CI: 0.12 to 0.65). Factors highlighted as associated with successful adherence club implementation included: (i) referral of stable clients to the club, (ii) an ideal club size of ≥20 members, (iii) club services led by a counsellor (iv) using churches or community halls as venues (v) effective communication between all parties, and (vi) timely delivery of prepacked medication. CONCLUSIONS This study showed good clinical outcomes, positive patient experiences and healthcare worker perceptions of the adherence club model. Factors associated with successful adherence club implementation, highlighted in this study, can be used to guide implementers in the scale-up of adherence club services across varied high-burden settings.
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Affiliation(s)
- Peter Bock
- Desmond Tutu TB CentreDepartment of Paediatrics and Child HealthFaculty of Medicine and Health SciencesStellenbosch UniversityCape TownSouth Africa
| | - Colette Gunst
- Department of HealthWestern Cape GovernmentCape Winelands DistrictSouth Africa
- Division of Family Medicine and Primary Health CareFaculty of Medicine and Health SciencesStellenbosch UniversityCape TownSouth Africa
| | - Leonard Maschilla
- Department of HealthWestern Cape GovernmentCape Winelands DistrictSouth Africa
| | - Rory Holtman
- Department of HealthWestern Cape GovernmentCape TownSouth Africa
| | | | - Dillon Wademan
- Desmond Tutu TB CentreDepartment of Paediatrics and Child HealthFaculty of Medicine and Health SciencesStellenbosch UniversityCape TownSouth Africa
| | - Rory Dunbar
- Desmond Tutu TB CentreDepartment of Paediatrics and Child HealthFaculty of Medicine and Health SciencesStellenbosch UniversityCape TownSouth Africa
| | - Geoffrey Fatti
- Kheth’ Impilo AIDS Free LivingCape TownSouth Africa
- Division of Epidemiology and BiostatisticsDepartment of Global HealthFaculty of Medicine and Health SciencesStellenbosch UniversityCape TownSouth Africa
| | - James Kruger
- Department of HealthWestern Cape GovernmentCape TownSouth Africa
| | | | - Graeme Hoddinott
- Desmond Tutu TB CentreDepartment of Paediatrics and Child HealthFaculty of Medicine and Health SciencesStellenbosch UniversityCape TownSouth Africa
| | - Sue‐Ann Meehan
- Desmond Tutu TB CentreDepartment of Paediatrics and Child HealthFaculty of Medicine and Health SciencesStellenbosch UniversityCape TownSouth Africa
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Yotebieng M, Mpody C, Ravelomanana NLR, Tabala M, Malongo F, Kawende B, Ntangu P, Behets F, Okitolonda E. HIV viral suppression among pregnant and breastfeeding women in routine care in the Kinshasa province: a baseline evaluation of participants in CQI-PMTCT study. J Int AIDS Soc 2019; 22:e25376. [PMID: 31496051 PMCID: PMC6732557 DOI: 10.1002/jia2.25376] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 07/21/2019] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Published data on viral suppression among pregnant and breastfeeding women in routine care settings are scarce. Here, we report provincial estimates of undetectable and suppressed viral load among pregnant or breastfeeding women in HIV care in Kinshasa, Democratic Republic of Congo (DRC) and associated risk factors. METHODS This cross-sectional study was conducted as part of a baseline assessment for the CQI-PMTCT study: an ongoing cluster randomized trial to evaluate the effect of continuous quality interventions (CQI) on long-term ART outcomes among pregnant and breastfeeding women (NCT03048669). From November 2016 to June 2018, in each of the 35 Kinshasa provincial health zones (HZ), study teams visited the three busiest maternal and child health clinics, enrolled all HIV-positive pregnant or breastfeeding women (≤1 year post-delivery) receiving ART, and performed viral load testing. Log binomial models with generalized estimating equations to account for clustering at the HZ level, were used to estimate prevalence ratios comparing participants with undetected (<40 copies/mL) or suppressed (<1000 copies/mL) viral load across levels of individual and site characteristics. RESULTS Of the 1752 eligible women, 1623 had viral load results available, including 38% who had been on ART for <6 months and 74% were on tenofovir-lamivudine-efavirenz. Viral load was undetectable in 53% of women and suppressed in 62%. Among women who were on ART for ≥12 months, only 60% and 67% respectively, had undetectable or suppressed viral load. Viral load was undetectable in 53%, 48% and 58% of women testing during pregnancy, at delivery, and in postpartum respectively. In multivariable log binomial models, duration of ART >12 months, older age, being married, disclosure of HIV status, receiving care in an urban health zone or one supported by PEPFAR were all positively associated with viral suppression. CONCLUSIONS The observed high level of detectable viral load suggests that high ART coverage alone without substantial efforts to improve the quality of care for pregnant and breastfeeding women, will not be enough to achieve the goal of virtual elimination of vertical HIV transmission in high-burden and limited resources settings like DRC.
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Affiliation(s)
- Marcel Yotebieng
- Division of EpidemiologyCollege of Public HealthThe Ohio State UniversityColumbusOHUSA
| | - Christian Mpody
- Division of EpidemiologyCollege of Public HealthThe Ohio State UniversityColumbusOHUSA
| | - Noro LR Ravelomanana
- Division of EpidemiologyCollege of Public HealthThe Ohio State UniversityColumbusOHUSA
| | - Martine Tabala
- School of Public HealthThe University of KinshasaKinshasaDemocratic Republic of Congo
| | - Fathy Malongo
- School of Public HealthThe University of KinshasaKinshasaDemocratic Republic of Congo
| | - Bienvenu Kawende
- School of Public HealthThe University of KinshasaKinshasaDemocratic Republic of Congo
| | - Paul Ntangu
- National AIDS Control Program (PNLS)Provincial CoordinationKinshasaDemocratic Republic of Congo
| | - Frieda Behets
- Department of EpidemiologyGillings School of Global Public HealthThe University of North Carolina at Chapel HillChapel HillNCUSA
- Department of Social MedicineThe University of North Carolina at Chapel HillChapel HillNCUSA
| | - Emile Okitolonda
- School of Public HealthThe University of KinshasaKinshasaDemocratic Republic of Congo
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Justice AC, Tate JP. Ageing with and without HIV: will advanced age bring equity or greater disparity? J Int AIDS Soc 2019; 22:e25400. [PMID: 31571414 PMCID: PMC6769376 DOI: 10.1002/jia2.25400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 09/10/2019] [Indexed: 11/21/2022] Open
Affiliation(s)
- Amy C Justice
- Veterans Affairs Connecticut Healthcare SystemWest HavenCTUSA
- School of MedicineYale UniversityNew HavenCTUSA
- School of Public HealthYale UniversityNew HavenCTUSA
| | - Janet P Tate
- Veterans Affairs Connecticut Healthcare SystemWest HavenCTUSA
- School of MedicineYale UniversityNew HavenCTUSA
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Polo ML, Ghiglione YA, Salido JP, Urioste A, Poblete G, Sisto AE, Martinez A, Rolón MJ, Ojeda DS, Cahn PE, Turk GJ, Laufer NL. Liver cirrhosis in HIV/HCV-coinfected individuals is related to NK cell dysfunction and exhaustion, but not to an impaired NK cell modulation by CD4 + T-cells. J Int AIDS Soc 2019; 22:e25375. [PMID: 31536177 PMCID: PMC6752153 DOI: 10.1002/jia2.25375] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 07/24/2019] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION HIV worsens HCV-related liver disease by accelerating fibrosis progression; however, progression rates are extremely variable among HIV/HCV-coinfected individuals. NK cells are associated with modulation of liver fibrosis and are profoundly altered during HCV and HIV infections. CD4+ T-cells modulate NK cell function, and are also affected by HIV infection. Here, we aim to characterize the association of hepatic fibrosis with both the phenotype and function of peripheral NK cells and their regulation by CD4+ T-cells, in HIV/HCV-coinfected individuals. METHODS Thirty-four HIV/HCV-coinfected individuals with minimal (n = 16) and advanced (n = 18) fibrosis (METAVIR F0/F1 and F4 scores respectively) and 20 healthy volunteers were enrolled. PBMC were obtained from peripheral blood samples and NK and CD4+ T-cells were isolated and analysed. NK cell phenotype (CD25, CD69, Nkp46, NKG2D, PD-1), degranulation (CD107a) and IFN-γ and TNF-α production, as well as CD4+ T-cell activation (CD69, CD25 and CD38) were measured by flow cytometry. CD4+ T-cell conditioned medium (CM) derived from F0/F1 or F4 individuals was assessed for IL-2 levels by ELISA. Modulation of NK cell functionality by these CMs was also analysed. RESULTS When comparing to NK cells from individuals with minimal fibrosis, degranulation and cytokine secretion by NK cells from subjects with F4 scores was significantly impaired, while PD-1 expression was augmented. On the one hand, neither the expression of activation markers nor IL-2 secretion was distinctly induced in CD4+ T-cells from subjects with F0/F1 or F4 METAVIR scores. Finally, NK cell degranulation and cytokine secretion were not differentially modulated by CD4+ T-cell CM, whether CD4+ T-cells derived from subjects with minimal or advanced fibrosis. CONCLUSIONS Low levels of NK and CD4+ T-cells in HIV/HCV-coinfected individuals with advanced liver fibrosis have been previously described. Here, we show that advanced liver fibrosis in coinfected individuals is associated to a defective function of NK cells and an increased expression of the exhaustion/senescence marker PD-1. This NK signature could not be attributed to changes in the ability of CD4+ T-cells to modulate NK cell function.
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Affiliation(s)
- María L Polo
- CONICET‐Universidad de Buenos AiresInstituto de Investigaciones Biomédicas en Retrovirus y Sida (INBIRS)Buenos AiresArgentina
| | - Yanina A Ghiglione
- CONICET‐Universidad de Buenos AiresInstituto de Investigaciones Biomédicas en Retrovirus y Sida (INBIRS)Buenos AiresArgentina
| | - Jimena P Salido
- CONICET‐Universidad de Buenos AiresInstituto de Investigaciones Biomédicas en Retrovirus y Sida (INBIRS)Buenos AiresArgentina
| | - Alejandra Urioste
- CONICET‐Universidad de Buenos AiresInstituto de Investigaciones Biomédicas en Retrovirus y Sida (INBIRS)Buenos AiresArgentina
| | - Gabriela Poblete
- Infectious Diseases UnitHospital General de Agudos “Dr. JA Fernández”Buenos AiresArgentina
| | - Alicia E Sisto
- Infectious Diseases UnitHospital General de Agudos “Dr. JA Fernández”Buenos AiresArgentina
| | - Ana Martinez
- Gastroenterology UnitHospital General de Agudos “Dr. JA Fernández”Buenos AiresArgentina
| | - María J Rolón
- Infectious Diseases UnitHospital General de Agudos “Dr. JA Fernández”Buenos AiresArgentina
| | - Diego S Ojeda
- CONICET‐Universidad de Buenos AiresInstituto de Investigaciones Biomédicas en Retrovirus y Sida (INBIRS)Buenos AiresArgentina
| | | | - Gabriela J Turk
- CONICET‐Universidad de Buenos AiresInstituto de Investigaciones Biomédicas en Retrovirus y Sida (INBIRS)Buenos AiresArgentina
| | - Natalia L Laufer
- CONICET‐Universidad de Buenos AiresInstituto de Investigaciones Biomédicas en Retrovirus y Sida (INBIRS)Buenos AiresArgentina
- Infectious Diseases UnitHospital General de Agudos “Dr. JA Fernández”Buenos AiresArgentina
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Fairlie L, Waitt C, Lockman S, Moorhouse M, Abrams EJ, Clayden P, Boffito M, Khoo S, Rees H, Cournil A, Venter WF, Serenata C, Chersich M. Inclusion of pregnant women in antiretroviral drug research: what is needed to move forwards? J Int AIDS Soc 2019; 22:e25372. [PMID: 31529598 PMCID: PMC6747006 DOI: 10.1002/jia2.25372] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 07/21/2019] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION To adequately ascertain drug safety and efficacy, drug trials need to include participants from all groups likely to receive the medication following approval. Pregnant women, however, are mostly excluded from trials, and women participating are often required to use highly effective contraception and taken off study product (even off study) if they conceive. There is little commercial incentive for including pregnant women in clinical trials, even when preclinical animal and human pharmacokinetic and safety data appear reassuring. With this conservative approach, large numbers of pregnant women are exposed to drug postlicensing with little known about drug safety and efficacy, and little done to systematically monitor outcomes of pregnancy exposure. DISCUSSION The article focuses on antiretrovirals for treating and preventing HIV, and presents potential approaches which could extend to other therapeutic areas, to obtaining adequate and timely data to inform use of these drugs in this population. Most importantly the pregnancy risk profile of investigational agents can be systematically stratified from low to high risk, based on guidelines from regulatory bodies. This stratification can determine the progress through preclinical work with animals and non-pregnant women to opportunistic studies among women who become pregnant on a clinical trial or within routine clinical treatment. Stratification can include pregnant women in clinical trials, concurrent with Phase II/III trials in non-pregnant adults, and ultimately to postmarketing surveillance for outcomes in pregnant women and their infants. Each step can be enabled by clear criteria from international and local regulatory bodies on progression through study phases, standardized protocols for collecting relevant data, collaborative data sharing, pregnancy outcomes surveillance systems supported by committed funding for these endeavours. CONCLUSIONS A formalized step-wise approach to including pregnant women in antiretroviral drug research should become the new norm. Systematic implementation of this approach would yield more timely and higher quality pregnancy dosing, safety and efficacy data. Through more vigorous action, regulatory bodies could responsibly overcome reluctance to include pregnant women in drug trials. Funders, researchers and programme implementers need to be galvanized to progressively include pregnant women in research - the use of newer, more effective drugs in women is at stake (349).
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Affiliation(s)
- Lee Fairlie
- Wits Reproductive Health and HIV InstituteFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Catriona Waitt
- Department of Molecular and Clinical PharmacologyUniversity of LiverpoolLiverpoolUnited Kingdom
- Infectious Diseases InstituteMakerere University College of Health SciencesKampalaUganda
| | - Shahin Lockman
- Brigham and Women's HospitalHarvard T.H. Chan School of Public HealthBostonMAUSA
| | - Michelle Moorhouse
- Wits Reproductive Health and HIV InstituteFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Elaine J. Abrams
- ICAP at Columbia UniversityMailman School of Public Health and Vagelos College of Physicians and SurgeonsColumbia UniversityNew YorkNYUSA
| | | | | | - Saye Khoo
- Department of Molecular and Clinical PharmacologyUniversity of LiverpoolLiverpoolUnited Kingdom
| | - Helen Rees
- Wits Reproductive Health and HIV InstituteFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Amandine Cournil
- Unité Mixte Internationale 233Institut de Recherche pour le DéveloppementU1175‐INSERMUniversity of MontpellierMontpellierFrance
| | - Willem Francois Venter
- Wits Reproductive Health and HIV InstituteFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Celicia Serenata
- Wits Reproductive Health and HIV InstituteFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Matthew Chersich
- Wits Reproductive Health and HIV InstituteFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
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Reisner SL, Moore CS, Asquith A, Pardee DJ, Sarvet A, Mayer G, Mayer KH. High risk and low uptake of pre-exposure prophylaxis to prevent HIV acquisition in a national online sample of transgender men who have sex with men in the United States. J Int AIDS Soc 2019; 22:e25391. [PMID: 31536171 PMCID: PMC6752156 DOI: 10.1002/jia2.25391] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 08/06/2019] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Trans masculine people who have sex with cisgender ("cis") men ("trans MSM") may be at-risk for HIV infection when they have cis MSM partners or share needles for hormone or recreational drug injection. Limited data are available characterizing indications and uptake of pre-exposure prophylaxis (PrEP) in trans MSM. The aim of this study was to assess PrEP indication and uptake as a means of primary HIV prevention for adult trans MSM in the U.S. METHODS Between November and December 2017, a national convenience sample of trans MSM in the U.S. (n = 857) was recruited using participatory methodologies and completed an online survey of demographics, HIV risk, PrEP, behavioural and psychosocial factors. Self-reported receptive anal sex or frontal/vaginal sex (with or without a condom) with a cis male sex partner in past six months was an eligibility criterion. A multivariable logistic regression procedure was used to model PrEP indications (yes/no) per an interpretation of U.S. Centers of Disease Control and Prevention recommendations among those without HIV (n = 843). RESULTS The diverse sample was 4.9% Black; 22.1% Latinx ethnicity; 28.4% non-binary gender identity; 32.6% gay-identified; 82.7% on testosterone. Overall, 84.1% had heard of PrEP. Of these, 33.3% reported lifetime PrEP use (21.8% current and 11.5% past). Based on HIV behavioural risk profiles in the last six months, 55.2% of respondents had indications for PrEP. In a multivariable model, factors associated with PrEP indication included where met sex partners, not having sex exclusively with cismen, higher perceived HIV risk, greater number of partners and high cis male partner stigma (all p < 0.05). DISCUSSION The majority of trans MSM in this sample had a PrEP indication. Stigma was associated with risk for HIV acquisition and represents a critical target for HIV biobehavioural prevention interventions for trans MSM, who appear to be underutilizing PrEP. CONCLUSIONS Results from this study support the full inclusion of trans MSM in HIV biobehavioural prevention efforts. Public health interventions and programmes are needed to reach trans MSM that attend to general MSM risk factors as well as to vulnerabilities specific to trans MSM, including the context of stigma from cis male sexual partners.
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Affiliation(s)
- Sari L Reisner
- The Fenway InstituteFenway HealthBostonMAUSA
- Department of PediatricsBoston Children's HospitalHarvard Medical SchoolBostonMAUSA
- Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMAUSA
| | | | | | | | - Aaron Sarvet
- Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMAUSA
| | - Gal Mayer
- Gilead Sciences, Inc.Foster CityCAUSA
| | - Kenneth H Mayer
- The Fenway InstituteFenway HealthBostonMAUSA
- Department of MedicineHarvard Medical SchoolBostonMAUSA
- Global Population HealthHarvard T.H. Chan School of Public HealthBostonMAUSA
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10
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Mannell J, Willan S, Shahmanesh M, Seeley J, Sherr L, Gibbs A. Why interventions to prevent intimate partner violence and HIV have failed young women in southern Africa. J Int AIDS Soc 2019; 22:e25380. [PMID: 31441229 PMCID: PMC6706780 DOI: 10.1002/jia2.25380] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 07/31/2019] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Adolescent girls and young women aged 15 to 24 years have some of the highest HIV incidence rates globally, with girls two to four times more likely to be living with HIV than their male peers. High levels of intimate partner violence (IPV) experienced by this age group is a significant risk factor for HIV acquisition. While behavioural interventions to prevent IPV and HIV in southern Africa have seen some success in reducing self-reported experiences of IPV, these interventions have largely failed to achieve similar outcomes for young women. DISCUSSION We identify three main reasons for the failure of IPV/HIV interventions for many young women in southern Africa. First, interventions are usually developed without the meaningful involvement of both young women and young men. Youth input into research design is largely focused on user testing or consultation of targeted groups, involving relatively low levels of participation. Second, interventions are focused on addressing individual risk factors rather than broader social and structural contexts of being a young woman. "Risk factor" interventions, rather than supporting women's agency, can pose a major barrier for supporting changes in behaviour among young women because they often fail to dislodge well-entrenched gender and age-related inequalities. Third, current intervention models have not adequately accounted for changes in gender norms and relationships across southern Africa. Individuals are getting married later in life (or not at all), new technologies are transforming romantic interactions and opening new opportunities for violence, and discussions about women's rights are both challenging gender inequalities and reinforcing them. CONCLUSIONS In order to move beyond the status quo of current approaches, and to support real innovation, IPV/HIV prevention interventions need to be co-developed with youth as part of a meaningful participatory process of research, intervention design, youth involvement in development and implementation. This process of co-development needs to be radical and break with the current focus on adapting existing interventions to meet the needs of young people, which are not well understood and often do not directly reflect their priorities. Broader social contexts and compound lenses are needed to avoid narrow approaches and to accommodate evolving norms.
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Affiliation(s)
| | - Samantha Willan
- Gender and Health Research UnitSouth African Medical Research CouncilPretoriaSouth Africa
| | - Maryam Shahmanesh
- Institute for Global HealthUniversity College LondonLondonUK
- Africa Health Research InstituteKwaZulu‐NatalSouth Africa
| | - Janet Seeley
- Institute for Global HealthUniversity College LondonLondonUK
- Department of Global Health and DevelopmentLondon School of Hygiene and Tropical MedicineLondonUK
| | - Lorraine Sherr
- Institute for Global HealthUniversity College LondonLondonUK
| | - Andrew Gibbs
- Gender and Health Research UnitSouth African Medical Research CouncilPretoriaSouth Africa
- Centre for Rural HealthSchool of Nursing and Public HealthUniversity of KwaZulu‐NatalDurbanSouth Africa
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11
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Bochner AF, Meacham E, Mhungu N, Manyanga P, Petracca F, Muserere C, Gonese G, Makunike B, Wazara B, Gwanzura C, Nyika P, Levine R, Mutasa‐Apollo T, Balachandra S, Wiktor SZ. The rollout of Community ART Refill Groups in Zimbabwe: a qualitative evaluation. J Int AIDS Soc 2019; 22:e25393. [PMID: 31454178 PMCID: PMC6711352 DOI: 10.1002/jia2.25393] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 08/09/2019] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Community ART Refill Groups (CARGs) are an antiretroviral therapy (ART) delivery model where clients voluntarily form into groups, and a group member visits the clinic to collect ART for all group members. In late 2016, Zimbabwe began a nationwide rollout of the CARG model. We conducted a qualitative evaluation to assess the perceived effects of this new national service delivery model. METHODS In March-June 2018, we visited ten clinics implementing the CARG model across five provinces of Zimbabwe and conducted a focus group discussion with healthcare workers and in-depth interviews with three ART clients per clinic. Clinics had implemented the CARG model for approximately one year. All discussions were audio recorded, transcribed, and translated into English, and thematic coding was performed by two independent analysts. RESULTS In focus groups, healthcare workers described that CARGs made ART distribution faster and facilitated client tracking in the community. They explained that their reduced workload allowed them to provide better care to those clients who did visit the clinic, and they felt that the CARG model should be sustained in the future. CARG members reported that by decreasing the frequency of clinic visits, CARGs saved them time and money, reducing previous barriers to collecting ART and improving adherence. CARG members also valued the emotional and informational support that they received from other members of their CARG, further improving adherence. Multiple healthcare workers did express concern that CARG members with diseases that begin with minor symptoms, such as tuberculosis, may not seek treatment at the clinic until the disease has progressed. CONCLUSIONS We found that healthcare workers and clients overwhelmingly perceive CARGs as beneficial. This evaluation demonstrates that the CARG model can be successfully implemented on a national scale. These early results suggest that CARGs may be able to simultaneously improve clinical outcomes and reduce the workload of healthcare workers distributing ART.
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Affiliation(s)
- Aaron F Bochner
- International Training and Education Center for Health (I‐TECH)Department of Global HealthUniversity of WashingtonSeattleWAUSA
| | - Elizabeth Meacham
- International Training and Education Center for Health (I‐TECH)Department of Global HealthUniversity of WashingtonSeattleWAUSA
| | - Nathan Mhungu
- International Training and Education Center for Health (I‐TECH)HarareZimbabwe
| | - Phibion Manyanga
- International Training and Education Center for Health (I‐TECH)HarareZimbabwe
| | - Frances Petracca
- International Training and Education Center for Health (I‐TECH)Department of Global HealthUniversity of WashingtonSeattleWAUSA
| | - Claudios Muserere
- International Training and Education Center for Health (I‐TECH)HarareZimbabwe
| | - Gloria Gonese
- International Training and Education Center for Health (I‐TECH)HarareZimbabwe
| | - Batsirai Makunike
- International Training and Education Center for Health (I‐TECH)HarareZimbabwe
| | - Blessing Wazara
- International Training and Education Center for Health (I‐TECH)HarareZimbabwe
| | | | - Ponesai Nyika
- U.S. Centers for Disease Control and PreventionHarareZimbabwe
| | - Ruth Levine
- International Training and Education Center for Health (I‐TECH)Department of Global HealthUniversity of WashingtonSeattleWAUSA
| | | | | | - Stefan Z Wiktor
- International Training and Education Center for Health (I‐TECH)Department of Global HealthUniversity of WashingtonSeattleWAUSA
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12
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Rojas Castro D, Delabre RM, Molina J. Give PrEP a chance: moving on from the "risk compensation" concept. J Int AIDS Soc 2019; 22 Suppl 6:e25351. [PMID: 31468693 PMCID: PMC6715948 DOI: 10.1002/jia2.25351] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 06/24/2019] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION While bio-behavioural interventions (BIs) for sexually transmitted infections (STIs) and HIV prevention have shown their effectiveness (e.g. treatment for syphilis, HPV vaccination or pre-exposure prophylaxis [PrEP]), they have also aroused major concerns regarding behavioural changes that could counteract their benefit. Risk compensation (RC) fears concerning BIs in the HIV/STIs prevention field are intimately linked to representations, judgements and social control on sexual behaviour. With an increasing number of PrEP studies describing a rise in STIs due to RC, this paper argues for a shift away from the focus on RC and proposes a more constructive approach to respond to the needs of people living with HIV and populations most at risk. DISCUSSION The concept of RC, stemming from road safety and derived from economic theory, relies on rational theoretical models of human behaviour. Although widely applied in several contexts its use has been reasonably questioned. Major methodological issues regarding RC have been raised within HIV/AIDS literature. Although behavioural changes (e.g. condomless sex and number of sexual partners) are often erroneously assimilated with RC, there is no evidence that behavioural changes have undermined the effectiveness of previous and current BIs. Still, PrEP has not escaped RC concerns. Increases in condomless sex within the context of growing uptake of PrEP signals a continued need for integrated and innovative HIV and STI prevention strategies and a comprehensive sexual health approach. Routine HIV/STI testing, peer-led counselling, and identification of sexual health needs within the PrEP model of care could become a gold standard in the sexual health field for all populations. CONCLUSIONS RC remains a frequent argument against the availability and provision of prevention methods for vulnerable populations. Individuals should be able to benefit from the full panel of BIs options available, to find and adapt methods according to their needs. Current, past and future PrEP users, with other stakeholders, may provide valuable insight into innovative solutions and programmes to control HIV and other STIs.
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Affiliation(s)
- Daniela Rojas Castro
- Coalition PLUSCommunity‐based Research LaboratoryPantinFrance
- Aix Marseille UnivINSERM, IRD, SESSTIMSciences Economiques & Sociales de la Santé & Traitement de l'Information MédicaleMarseilleFrance
| | | | - Jean‐Michel Molina
- Department of Infectious DiseasesHôpital Saint‐LouisAssistance Publique Hôpitaux de ParisParisFrance
- INSERM, UMR 941Université de Paris Diderot Paris 7Sorbonne Paris CitéParisFrance
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13
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Youn B, Shireman TI, Lee Y, Galárraga O, Wilson IB. Trends in medication adherence in HIV patients in the US, 2001 to 2012: an observational cohort study. J Int AIDS Soc 2019; 22:e25382. [PMID: 31441221 PMCID: PMC6706701 DOI: 10.1002/jia2.25382] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 07/31/2019] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Adherence to antiretroviral therapy (ART) is essential to reduce HIV-related morbidity and mortality as well as the risk of virological failure and HIV transmission. We determined the trends in ART adherence during the periods of therapeutic advances, wider use of ART and greater attention to ART adherence. To understand the general trends in medication adherence, we compared ART adherence with medications for other common chronic conditions. METHODS A retrospective cohort study using Medicaid claims between 2001 and 2012 from 14 US states with the highest HIV prevalence. Medicaid is the largest source of care for HIV patients in the US. We identified Medicaid beneficiaries with HIV who initiated ART between 2001 and 2010 (n=23,343). Comparison groups included (1) HIV- persons who initiated a statin, angiotensin-converting enzyme inhibitor or angiotensin receptor blocker (ACEI/ARB), or metformin and (2) HIV+ persons who initiated these control medications while on and not on ART. We estimated adjusted odds of >90% medication implementation during the two years following initiation. RESULTS The proportion of HIV+ persons with >90% ART implementation increased from 33.5% in those who initiated in 2001 to 46.4% in 2005 and 52.4% in 2010. ART initiators in 2007 to 2010 had 53% increased odds of >90% implementation compared to those in 2001 to 2003 (adjusted OR 1.53, 99% CI: 1.34 to 1.75). Older age, male, White race, newer ART regimens and absence of substance use indicators were also associated with increased odds of >90% ART implementation. No or minimal improvements were found in the implementation of control medications in HIV- persons. For HIV- persons, the adjusted ORs comparing 2007-2010 to 2001-2003 were 1.06, 1.01 and 1.19 for statins, ACEI/ARB, metformin respectively. HIV+ persons who were on ART had, on average, 15.0 (SD: 4.2) and 16.1 (SD: 3.4) percentage points higher >90% implementation rates of concurrent statins, ACEI/ARB or metformin compared to HIV- persons and HIV+ persons who were not on ART respectively. CONCLUSIONS Adherence to ART substantially improved between 2001 and 2012. Nevertheless, the absolute rates of >90% implementation were low for all groups examined. Substantial disparities by age, sex and race were present, drawing attention to the need to continue to enhance medication adherence. Further studies are required to examine whether these trends and disparities persist in the most recent period.
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Affiliation(s)
- Bora Youn
- Department of Health Services, Policy & PracticeBrown University School of Public HealthProvidenceRIUSA
| | - Theresa I Shireman
- Department of Health Services, Policy & PracticeBrown University School of Public HealthProvidenceRIUSA
| | - Yoojin Lee
- Department of Health Services, Policy & PracticeBrown University School of Public HealthProvidenceRIUSA
| | - Omar Galárraga
- Department of Health Services, Policy & PracticeBrown University School of Public HealthProvidenceRIUSA
| | - Ira B Wilson
- Department of Health Services, Policy & PracticeBrown University School of Public HealthProvidenceRIUSA
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14
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Mwatelah R, McKinnon LR, Baxter C, Abdool Karim Q, Abdool Karim SS. Mechanisms of sexually transmitted infection-induced inflammation in women: implications for HIV risk. J Int AIDS Soc 2019; 22 Suppl 6:e25346. [PMID: 31468677 PMCID: PMC6715949 DOI: 10.1002/jia2.25346] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 06/20/2019] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Globally, sexually transmitted infections (STI) affect >300 million people annually, and are a major cause of sexual and reproductive health complications in women. In this commentary, we describe how STIs interact with the immune and non-immune cells, both within and below the cervicovaginal mucosal barrier, to cause inflammation, which in turn has been associated with increased HIV acquisition risk. DISCUSSION STIs have a major impact on the female genital mucosa, which is an important biological and physical barrier that forms the first line of defence against invading microorganisms such as HIV. Pattern recognition of STI pathogens, by receptors expressed either on the cell surface or inside the cell, typically triggers inflammation at the mucosal barrier. The types of mucosal responses vary by STI, and can be asymptomatic or culminate in the formation of discharge, ulcers and/or warts. While the aim of this response is to clear the invading microbes, in many cases these responses are either evaded or cause pathology that impairs barrier integrity and increases HIV access to target cells in the sub-mucosa. In addition, innate responses to STIs can result in an increased number of immune cells, including those that are the primary targets of HIV, and may contribute to the association between STIs and increased susceptibility to HIV acquisition. Many of these cells are mediators of adaptive immunity, including tissue-resident cells that may also display innate-like functions. Bacterial vaginosis (BV) is another common cause of inflammation, and evidence for multiple interactions between BV, STIs and HIV suggest that susceptibility to these conditions should be considered in concert. CONCLUSIONS STIs and other microbes can induce inflammation in the genital tract, perturbing the normal robust function of the mucosal barrier against HIV. While the impact of STIs on the mucosal immune system and HIV acquisition is often under-appreciated, understanding their interactions of the infections with the immune responses play an important role in improving treatment and reducing the risk of HIV acquisition. The frequent sub-clinical inflammation associated with STIs underscores the need for better STI diagnostics to reverse the immunological consequences of infection.
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Affiliation(s)
- Ruth Mwatelah
- Department of Medical Microbiology and Infectious DiseasesUniversity of ManitobaWinnipegCanada
| | - Lyle R McKinnon
- Department of Medical Microbiology and Infectious DiseasesUniversity of ManitobaWinnipegCanada
- Centre for the AIDS Programme of Research in South Africa (CAPRISA)University of KwaZulu‐NatalDurbanSouth Africa
| | - Cheryl Baxter
- Centre for the AIDS Programme of Research in South Africa (CAPRISA)University of KwaZulu‐NatalDurbanSouth Africa
| | - Quarraisha Abdool Karim
- Centre for the AIDS Programme of Research in South Africa (CAPRISA)University of KwaZulu‐NatalDurbanSouth Africa
- Department of EpidemiologyColumbia UniversityNew YorkNYUSA
| | - Salim S Abdool Karim
- Centre for the AIDS Programme of Research in South Africa (CAPRISA)University of KwaZulu‐NatalDurbanSouth Africa
- Department of EpidemiologyColumbia UniversityNew YorkNYUSA
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15
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Cohen MS, Council OD, Chen JS. Sexually transmitted infections and HIV in the era of antiretroviral treatment and prevention: the biologic basis for epidemiologic synergy. J Int AIDS Soc 2019; 22 Suppl 6:e25355. [PMID: 31468737 PMCID: PMC6715951 DOI: 10.1002/jia2.25355] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 06/26/2019] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION HIV is a unique sexually transmitted infection (STI) that is greatly affected by other concomitant "classical" bacterial and viral STIs that cause genital ulcers and/or mucosal inflammation. STIs also serve as a marker for risky sexual behaviours. STIs increase infectiousness of people living with HIV by increasing the viral concentration in the genital tract, and by increasing the potential for HIV acquisition in people at risk for HIV. In addition, some STIs can increase blood HIV concentration and promote progression of disease. This review is designed to investigate the complex relationship between HIV and classical STIs. DISCUSSION Treatment of STIs with appropriate antibiotics reduces HIV in blood, semen and female genital secretions. However, community-based trials could not reliably reduce the spread of HIV by mass treatment of STIs. Introduction of antiretroviral agents for the treatment and prevention of HIV has led to renewed interest in the complex relationship between STIs and HIV. Antiretroviral treatment (ART) reduces the infectiousness of HIV and virtually eliminates the transmission of HIV in spite of concomitant or acquired STIs. However, while ART interrupts HIV transmission, it does not stop intermittent shedding of HIV in genital secretions. Such shedding of HIV is increased by STIs, although the viral copies are not likely replication competent or infectious. Pre-exposure prophylaxis (PrEP) of HIV with the combination of tenofovir disoproxil fumarate and emtricitabine (TDF/FTC) prevents HIV acquisition in spite of concomitant STIs. CONCLUSIONS STIs remain pandemic, and the availability of ART may have led to an increase in STIs, as fear of HIV has diminished. Classical STIs present a huge worldwide health burden that cannot be separated from HIV, and they deserve far more attention than they currently receive.
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Affiliation(s)
- Myron S Cohen
- UNC School of MedicineInstitute for Global Health & Infectious DiseasesChapel HillNCUSA
| | | | - Jane S Chen
- Department of EpidemiologyGillings School of Global Public HealthUNCChapel HillNCUSA
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16
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Mayer KH, de Vries HJC. HIV and sexually transmitted infections: reconciling estranged bedfellows in the U = U and PrEP era. J Int AIDS Soc 2019; 22 Suppl 6:e25357. [PMID: 31468731 PMCID: PMC6715941 DOI: 10.1002/jia2.25357] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 06/27/2019] [Indexed: 11/10/2022] Open
Affiliation(s)
- Kenneth H Mayer
- The Fenway InstituteFenway HealthDepartment of MedicineBeth Israel Deaconess Medical CenterMAUSA
- Department of MedicineHarvard Medical SchoolBostonMAUSA
| | - Henry JC de Vries
- Amsterdam UMCDepartment of DermatologyLocation Academic Medical CenterAmsterdam Institute for Infection and Immunology (AI&II)University of AmsterdamAmsterdamNetherlands
- Department of Infectious DiseasesPublic Health Service AmsterdamAmsterdamThe Netherlands
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17
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Phillips AN, Cambiano V, Nakagawa F, Bansi‐Matharu L, Wilson D, Jani I, Apollo T, Sculpher M, Hallett T, Kerr C, van Oosterhout JJ, Eaton JW, Estill J, Williams B, Doi N, Cowan F, Keiser O, Ford D, Hatzold K, Barnabas R, Ayles H, Meyer‐Rath G, Nelson L, Johnson C, Baggaley R, Fakoya A, Jahn A, Revill P. Cost-per-diagnosis as a metric for monitoring cost-effectiveness of HIV testing programmes in low-income settings in southern Africa: health economic and modelling analysis. J Int AIDS Soc 2019; 22:e25325. [PMID: 31287620 PMCID: PMC6615491 DOI: 10.1002/jia2.25325] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 05/22/2019] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION As prevalence of undiagnosed HIV declines, it is unclear whether testing programmes will be cost-effective. To guide their HIV testing programmes, countries require appropriate metrics that can be measured. The cost-per-diagnosis is potentially a useful metric. METHODS We simulated a series of setting-scenarios for adult HIV epidemics and ART programmes typical of settings in southern Africa using an individual-based model and projected forward from 2018 under two policies: (i) a minimum package of "core" testing (i.e. testing in pregnant women, for diagnosis of symptoms, in sex workers, and in men coming forward for circumcision) is conducted, and (ii) core-testing as above plus additional testing beyond this ("additional-testing"), for which we specify different rates of testing and various degrees to which those with HIV are more likely to test than those without HIV. We also considered a plausible range of unit test costs. The aim was to assess the relationship between cost-per-diagnosis and the incremental cost-effectiveness ratio (ICER) of the additional-testing policy. The discount rate used in the base case was 3% per annum (costs in 2018 U.S. dollars). RESULTS There was a strong graded relationship between the cost-per-diagnosis and the ICER. Overall, the ICER was below $500 per-DALY-averted (the cost-effectiveness threshold used in primary analysis) so long as the cost-per-diagnosis was below $315. This threshold cost-per-diagnosis was similar according to epidemic and programmatic features including the prevalence of undiagnosed HIV, the HIV incidence and a measure of HIV programme quality (the proportion of HIV diagnosed people having a viral load <1000 copies/mL). However, restricting to women, additional-testing did not appear cost-effective even at a cost-per-diagnosis of below $50, while restricting to men additional-testing was cost-effective up to a cost-per-diagnosis of $585. The threshold cost per diagnosis for testing in men to be cost-effective fell to $256 when the cost-effectiveness threshold was $300 instead of $500, and to $81 when considering a discount rate of 10% per annum. CONCLUSIONS For testing programmes in low-income settings in southern African there is an extremely strong relationship between the cost-per-diagnosis and the cost-per-DALY averted, indicating that the cost-per-diagnosis can be used to monitor the cost-effectiveness of testing programmes.
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Affiliation(s)
| | | | | | | | | | - Ilesh Jani
- National Institute of HealthMaputoMozambique
| | | | | | - Timothy Hallett
- Department of Infectious Disease EpidemiologyImperial College LondonLondonUK
| | - Cliff Kerr
- Burnet InstituteMelbourneAustralia
- University of SydneySydneyAustralia
| | | | - Jeffrey W Eaton
- Department of Infectious Disease EpidemiologyImperial College LondonLondonUK
| | - Janne Estill
- Institute of Global HealthUniversity of GenevaGenevaSwitzerland
- Institute of Mathematical Statistics and Actuarial ScienceUniversity of BernBernSwitzerland
| | | | - Naoko Doi
- Clinton Health Access Initiative (CHAI)NYUSA
| | - Frances Cowan
- CeSHHARHarareZimbabwe
- Liverpool School of Tropical MedicineLiverpoolUK
| | - Olivia Keiser
- Institute of Global HealthUniversity of GenevaGenevaSwitzerland
| | | | | | | | | | - Gesine Meyer‐Rath
- Health Economics and Epidemiology Research OfficeDepartment of Internal MedicineFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
- Department for Global HealthBoston UniversityBostonMAUSA
| | | | | | | | | | | | - Paul Revill
- Centre for Health EconomicsUniversity of YorkYorkUK
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Gaspar M, Marshall Z, Rodrigues R, Adam BD, Brennan DJ, Hart TA, Grace D. A tale of two epidemics: gay men's mental health and the biomedicalisation of HIV prevention and care in Toronto. Sociol Health Illn 2019; 41:1056-1070. [PMID: 30838679 DOI: 10.1111/1467-9566.12884] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
There is mounting urgency regarding the mental health of gay, bisexual and other men who have sex with men (GBM). We examined how GBM are understanding the relationship between HIV and their mental health given the increasing biomedicalisation of HIV prevention and care. Our Grounded Theory analysis derived from qualitative interviews with 24 GBM living in Toronto, Canada, including both HIV-negative and HIV-positive men. Participants understood biomedical advances, such as undetectable viral load and pre-exposure prophylaxis (PrEP), as providing some relief from HIV-related distress. However, they offered ambivalent perspectives on the biomedicalisation of HIV. Some considered non-HIV-specific stressors (e.g. unemployment, racial discrimination) more significant than HIV-related concerns. These men expressed HIV-related distress as being under control due to biomedical advances or as always negligible when compared to non-HIV-specific stressors. Others emphasised the ongoing mental health implications of HIV (e.g. enduring risk and stigma). We describe a tension between optimistic responses to biomedicine's ability to ease the psychosocial burdens associated with HIV and the inability for biomedicine to address the social and economic determinants driving the dual epidemics of HIV and mental distress amongst GBM. We argue for more socio-material analysis over further sexual behavioural analysis of GBM mental health disparities.
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Affiliation(s)
- Mark Gaspar
- Dalla Lana School of Public Health, University of Toronto, Canada
| | | | | | - Barry D Adam
- Department of Sociology, Anthropology, and Criminology, University of Windsor, Canada
- Ontario HIV Treatment Network, Canada
| | - David J Brennan
- Factor-Inwentash Faculty of Social Work, University of Toronto, Canada
| | - Trevor A Hart
- Dalla Lana School of Public Health, University of Toronto, Canada
- School of Social Work, McGill University, Canada
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Canada
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Ayala G, Bahati M, Balan E, Chang J, Do TD, Fokeerbux NA, Hassan A, Kerboghossian J, Poonkasetwatana M, Saavedra J, Spieldenner A, Thomas RM, Tohme J, Walimba J. Partner Notification: A Community Viewpoint. J Int AIDS Soc 2019; 22 Suppl 3:e25291. [PMID: 31321916 PMCID: PMC6639673 DOI: 10.1002/jia2.25291] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 05/08/2019] [Indexed: 11/25/2022] Open
Affiliation(s)
- George Ayala
- MPact Global Action for Gay Men's Health and RightsOaklandCAUSA
| | - Mahri Bahati
- University of CaliforniaSan FranciscoCAUSA
- Innovative Response Globally to Transgender Women and HIV (IRGT)San FranciscoCAUSA
| | | | - Judy Chang
- International Network of People Who Use Drugs (INPUD)LondonUnited Kingdom
| | - Tri D Do
- University of CaliforniaSan FranciscoCAUSA
| | | | | | | | | | | | - Andrew Spieldenner
- California State UniversitySan MarcosCAUSA
- U.S. People Living with HIV CaucusSan DiegoCaliforniaUSA
| | - Ruth M Thomas
- Global Network of Sex Work ProjectsEdinburghScotland
| | - Johnny Tohme
- MPact Global Action for Gay Men's Health and RightsOaklandCAUSA
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20
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Coetzee L, Bogler L, De Neve J, Bärnighausen T, Geldsetzer P, Vollmer S. HIV, antiretroviral therapy and non-communicable diseases in sub-Saharan Africa: empirical evidence from 44 countries over the period 2000 to 2016. J Int AIDS Soc 2019; 22:e25364. [PMID: 31353831 PMCID: PMC6661400 DOI: 10.1002/jia2.25364] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 07/09/2019] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION The HIV-infected population is growing due to the increased accessibility of antiretroviral therapy (ART) that extends the lifespan of people living with HIV (PLHIV). We aimed to assess whether national HIV prevalence and ART use are associated with an increased prevalence of cardiovascular risk factors. METHODS Using country-level data, we analysed the effect of HIV prevalence and use of ART on cardiovascular risk factors in 44 countries in sub-Saharan Africa between 2000 and 2016. We used fixed-effects estimation to quantify the effect of HIV and ART on the prevalence of diabetes, mean body mass index, the prevalence of overweight, obesity and hypertension, and mean systolic blood pressure. The models were adjusted for calendar time, the age structure of the population, income and education. RESULTS Diabetes prevalence among PLHIV was 5.8 percentage points higher (95% confidence interval (CI) 1.8 pp to 9.8 pp) compared to individuals without HIV. People receiving ART had a 4.6 percentage point higher prevalence (95% CI 2.6 pp to 6.6 pp). The prevalence of obesity was increased by 14.7 percentage points (95% CI 2.5 pp to 26.9 pp) for PLHIV. Receiving ART was associated with an increased obesity prevalence by 14.0 percentage points (95% CI 4.8 pp to 23.2 pp), whereas it had no significant association with the prevalence of overweight. The population aged 40 to 59 had a significantly higher prevalence of diabetes, overweight and obesity. HIV prevalence and ART use had no significant association with the prevalence of hypertension. CONCLUSIONS An ageing HIV-infected population on ART is associated with a significant increase in the prevalence of diabetes and obesity in sub-Saharan Africa. The increasing prevalence of these cardiovascular risk factors emphasizes the need for comprehensive healthcare programmes that screen and treat both HIV and non-communicable diseases to decrease the associated morbidity and mortality rates.
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Affiliation(s)
| | - Lisa Bogler
- Department of Economics and Centre for Modern Indian StudiesUniversity of GoettingenGoettingenGermany
| | - Jan‐Walter De Neve
- Heidelberg Institute of Global HealthMedical Faculty and University HospitalHeidelbergGermany
| | - Till Bärnighausen
- Heidelberg Institute of Global HealthMedical Faculty and University HospitalHeidelbergGermany
- Harvard T.H. Chan School of Public HealthBostonMAUSA
| | | | - Sebastian Vollmer
- Department of Economics and Centre for Modern Indian StudiesUniversity of GoettingenGoettingenGermany
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Goh OQ, Colby DJ, Pinyakorn S, Sacdalan C, Kroon E, Chan P, Chomchey N, Kanaprach R, Prueksakaew P, Suttichom D, Trichavaroj R, Spudich S, Robb ML, Phanuphak P, Phanuphak N, Ananworanich J. Switch to dolutegravir is well tolerated in Thais with HIV infection. J Int AIDS Soc 2019; 22:e25324. [PMID: 31294931 PMCID: PMC6621926 DOI: 10.1002/jia2.25324] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 05/22/2019] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Dolutegravir (DTG) is recommended as part of first-line antiretroviral therapy (ART) for people living with HIV(PLHIV). We sought to determine the rate of adverse events (AEs) and discontinuations among Thais treated during acute HIV infection (AHI) and switched to DTG-based regimens. METHODS Thai participants in the SEARCH010/RV254 cohort who initiated ART during AHI and switched to DTG for at least 48 weeks were prospectively observed and included in the analysis. Rates and characteristics of DTG-related AEs and discontinuations were described. RESULTS A total of 313 Thai participants were included in the analysis. The median age was 29 years, 96% were male, 64% had a Bachelor's degree or higher and 16% had a body mass index (BMI) <18.5 kg/m2 . Participants were on ART for a median of 124 weeks before switching to DTG. The median (IQR) body weight increased from 63 (56 to 70) kg before to 65 (58 to 73) kg (p < 0.0001) after 48 weeks of DTG. Forty-nine (16%) developed DTG-related AEs, corresponding to an incidence of 16.6 per 100 person-years. Neuropsychiatric symptoms were most frequently encountered (n = 25, 8%), followed by laboratory abnormalities (n = 16, 5%). Six (2%) discontinued DTG, corresponding to an incidence of 2.4 per 100 person-years. All discontinuations were due to increased liver enzymes in the presence of hepatitis C virus coinfection. In the multivariate analysis, incident hepatitis C virus infection was the only risk factor for discontinuing DTG (hazard ratio 59.4, 95% CI 8.5 to 297.9, p < 0.0001). Neither low BMI nor concurrent abacavir therapy was associated with discontinuation. CONCLUSIONS DTG was well tolerated with few discontinuations in this cohort of young men. Incident hepatitis C virus infection was a driver of liver-related AEs leading to discontinuations. In populations at risk, regular testing for hepatitis C virus during ART is recommended to anticipate possible AEs, guide management and improve safety.
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Affiliation(s)
- Orlanda Q Goh
- SEARCHThe Thai Red Cross AIDS Research CentreBangkokThailand
- Johns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
- Duke‐National University of Singapore Medical SchoolSingaporeSingapore
| | - Donn J Colby
- SEARCHThe Thai Red Cross AIDS Research CentreBangkokThailand
| | - Suteeraporn Pinyakorn
- The Henry M. Jackson Foundation for the Advancement of Military MedicineBethesdaMDUSA
- United States Military HIV Research ProgramWalter Reed Army Institute of ResearchSilver SpringMDUSA
| | - Carlo Sacdalan
- SEARCHThe Thai Red Cross AIDS Research CentreBangkokThailand
| | - Eugène Kroon
- SEARCHThe Thai Red Cross AIDS Research CentreBangkokThailand
| | - Phillip Chan
- SEARCHThe Thai Red Cross AIDS Research CentreBangkokThailand
| | - Nitiya Chomchey
- SEARCHThe Thai Red Cross AIDS Research CentreBangkokThailand
| | | | | | | | - Rapee Trichavaroj
- Department of RetrovirologyArmed Forces Research Institute of Medical SciencesUnited States ComponentBangkokThailand
| | | | - Merlin L Robb
- The Henry M. Jackson Foundation for the Advancement of Military MedicineBethesdaMDUSA
- United States Military HIV Research ProgramWalter Reed Army Institute of ResearchSilver SpringMDUSA
| | | | | | - Jintanat Ananworanich
- SEARCHThe Thai Red Cross AIDS Research CentreBangkokThailand
- The Henry M. Jackson Foundation for the Advancement of Military MedicineBethesdaMDUSA
- United States Military HIV Research ProgramWalter Reed Army Institute of ResearchSilver SpringMDUSA
- Department of Global HealthUniversity of AmsterdamAmsterdamThe Netherlands
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22
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Odoyo JB, Morton JF, Ngure K, O'Malley G, Mugwanya KK, Irungu E, Awuor M, Dolla A, Ongolly F, Bukusi EA, Mugo NR, Baeten JM. Integrating PrEP into HIV care clinics could improve partner testing services and reinforce mutual support among couples: provider views from a PrEP implementation project in Kenya. J Int AIDS Soc 2019; 22 Suppl 3:e25303. [PMID: 31321911 PMCID: PMC6639665 DOI: 10.1002/jia2.25303] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 05/09/2019] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Partner notification services (PNS) increase the HIV status knowledge and linkage to care and treatment. However, it is unclear if PNS can facilitate linkage of HIV-negative partners to prevention services such as pre-exposure prophylaxis (PrEP). Using qualitative methods, we explored provider perspective regarding the interaction of PrEP availability, PNS and antiretroviral treatment (ART) outcomes within a project integrating PrEP services into HIV care clinics in eight counties in western and central Kenya. METHODS From May 2017 to August 2018, data on integrated PrEP service delivery including its interaction with PNS were collected through 71 key informant in-depth interviews with healthcare providers and 24 standardized technical assistance reports summarizing implementation at the participating clinics. Thus, the perspective was from that of providers; analyses focused on emergent themes relating PNS to PrEP and ART services. RESULTS Providers found that PrEP integration provided an additional concrete prevention option for HIV-negative partners and created a motivation to offer PNS to persons living with HIV. PrEP availability also seemed to operate as an incentive for those living with HIV to participate in PNS, which in turn enhanced identification of potential PrEP clients and created an environment for discussing HIV transmission risk. Providers commented that initiating HIV-negative partners on PrEP enhanced mutual monitoring of health outcomes, including improved adherence to ART by partners living with HIV. Clinics noted prioritizing people living with HIV with detectable viral loads for PNS in order to identify HIV-negative partners who would benefit most from PrEP. Providers felt motivated by the apparent synergistic interaction of PNS, PrEP and ART. CONCLUSIONS Providers felt that the integration of PrEP into HIV care clinics stimulated the provision of PNS, and PNS was used to improve the identification of potential PrEP clients. The integrated combination of PNS, PrEP and ART is synergistic and should be promoted in HIV clinics.
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Affiliation(s)
- Josephine B Odoyo
- Kenya Medical Research InstituteCenter for Microbiology ResearchNairobiKenya
| | | | - Kenneth Ngure
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
- Department of Community HealthJomo Kenyatta University of Agriculture and TechnologyNairobiKenya
| | | | | | - Elizabeth Irungu
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
- Kenya Medical Research InstituteCenter for Clinical ResearchNairobiKenya
| | - Merceline Awuor
- Kenya Medical Research InstituteCenter for Microbiology ResearchNairobiKenya
| | - Annabell Dolla
- Kenya Medical Research InstituteCenter for Microbiology ResearchNairobiKenya
| | - Fernandos Ongolly
- Kenya Medical Research InstituteCenter for Clinical ResearchNairobiKenya
| | - Elizabeth A Bukusi
- Kenya Medical Research InstituteCenter for Microbiology ResearchNairobiKenya
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
- Department of Obstetrics and GynecologyUniversity of WashingtonSeattleWAUSA
| | - Nelly R Mugo
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
- Kenya Medical Research InstituteCenter for Clinical ResearchNairobiKenya
| | - Jared M Baeten
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
- Department of MedicineUniversity of WashingtonSeattleWAUSA
- Department of EpidemiologyUniversity of WashingtonSeattleWAUSA
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Brazier E, Maruri F, Duda SN, Tymejczyk O, Wester CW, Somi G, Ross J, Freeman A, Cornell M, Poda A, Musick BS, Zhang F, Althoff KN, Mugglin C, Kimmel AD, Yotebieng M, Nash D. Implementation of "Treat-all" at adult HIV care and treatment sites in the Global IeDEA Consortium: results from the Site Assessment Survey. J Int AIDS Soc 2019; 22:e25331. [PMID: 31623428 PMCID: PMC6625339 DOI: 10.1002/jia2.25331] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [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] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 05/29/2019] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Since 2015, the World Health Organization (WHO) has recommended that all people living with HIV (PLHIV) initiate antiretroviral treatment (ART), irrespective of CD4+ count or clinical stage. National adoption of universal treatment has accelerated since WHO's 2015 "Treat All" recommendation; however, little is known about the translation of this guidance into practice. This study aimed to assess the status of Treat All implementation across regions, countries, and levels of the health care delivery system. METHODS Between June and December 2017, 201/221 (91%) adult HIV treatment sites that participate in the global IeDEA research consortium completed a survey on capacity and practices related to HIV care. Located in 41 countries across seven geographic regions, sites provided information on the status and timing of site-level introduction of Treat All, as well as site-level practices related to ART initiation. RESULTS Almost all sites (93%) reported that they had begun implementing Treat All, and there were no statistically significant differences in site-level Treat All introduction by health facility type, urban/rural location, sector (public/private) or country income level. The median time between national policy adoption and site-level introduction was one month. In countries where Treat All was not yet adopted in national guidelines, 69% of sites reported initiating all patients on ART, regardless of clinical criteria, and these sites had been implementing Treat All for a median period of seven months at the time of the survey. The majority of sites (77%) reported typically initiating patients on ART within 14 days of confirming diagnosis, with 60% to 62% of sites implementing Treat All in East, Southern and West Africa reporting same-day ART initiation for most patients. CONCLUSIONS By mid- to late-2017, the Treat All strategy was the standard of care at almost all IeDEA sites, including rural, primary-level health facilities in low-resource settings. While further assessments of site-level capacity to provide high-quality HIV care under Treat All and to support sustained viral suppression after ART initiation are needed, the widespread introduction of Treat All at the service delivery level is a critical step towards global targets for ending the HIV epidemic as a public health threat.
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Affiliation(s)
- Ellen Brazier
- Institute for Implementation Science in Population HealthCity University of New YorkNew YorkNYUSA
- Graduate School of Public Health and Health Policy (GSPHHP)City University of New YorkNew YorkNYUSA
| | - Fernanda Maruri
- Department of MedicineDivision of Infectious DiseasesVanderbilt University Medical CenterNashvilleTNUSA
| | - Stephany N Duda
- Department of Biomedical InformaticsVanderbilt University School of MedicineNashvilleTNUSA
| | - Olga Tymejczyk
- Institute for Implementation Science in Population HealthCity University of New YorkNew YorkNYUSA
- Graduate School of Public Health and Health Policy (GSPHHP)City University of New YorkNew YorkNYUSA
| | - C William Wester
- Department of MedicineDivision of Infectious DiseasesVanderbilt University Medical CenterNashvilleTNUSA
- Vanderbilt Institute for Global Health (VIGH)NashvilleTNUSA
| | - Geoffrey Somi
- National AIDS Control ProgrammeDar es SalaamTanzania
| | - Jeremy Ross
- TREAT Asia, amfARThe Foundation for AIDS ResearchBangkokThailand
| | - Aimee Freeman
- Bloomberg School of Public HealthJohns Hopkins UniversityBaltimoreMDUSA
| | - Morna Cornell
- School of Public Health and Family MedicineFaculty of Health SciencesUniversity of Cape TownCape TownSouth Africa
| | - Armel Poda
- Hôpital de Jour, Service des Maladies Infectieuses, CHU Souro SanouBobo‐DioulassoBurkina Faso
- Institut Supérieur des Sciences de la Santé (INSSA)Université Nazi BoniBobo‐DioulassoBurkina Faso
| | | | - Fujie Zhang
- Clinical and Research Center of Infectious DiseasesBeijing Ditan HospitalCapital Medical UniversityBeijingChina
| | - Keri N Althoff
- Bloomberg School of Public HealthJohns Hopkins UniversityBaltimoreMDUSA
| | - Catrina Mugglin
- Institute of Social and Preventive MedicineUniversity of BernBernSwitzerland
| | - April D Kimmel
- School of MedicineVirginia Commonwealth UniversityRichmondVAUSA
| | | | - Denis Nash
- Institute for Implementation Science in Population HealthCity University of New YorkNew YorkNYUSA
- Graduate School of Public Health and Health Policy (GSPHHP)City University of New YorkNew YorkNYUSA
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Mahachi N, Muchedzi A, Tafuma TA, Mawora P, Kariuki L, Semo B, Bateganya MH, Nyagura T, Ncube G, Merrigan MB, Chabikuli ON, Mpofu M. Sustained high HIV case-finding through index testing and partner notification services: experiences from three provinces in Zimbabwe. J Int AIDS Soc 2019; 22 Suppl 3:e25321. [PMID: 31321918 PMCID: PMC6639671 DOI: 10.1002/jia2.25321] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 05/16/2019] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Several countries in southern Africa have made significant progress towards reaching the Joint United Nations Programme on HIV/AIDS goal of ensuring that 90% of people living with HIV are aware of their status. In Zimbabwe, progress towards this "first 90" was estimated at 73% in 2016. To reach the remaining people living with HIV who have undiagnosed infection, the Zimbabwe Ministry of Health and Child Care has been promoting index testing and partner notification services (PNS). We describe the implementation of index testing and PNS under the Zimbabwe HIV Care and Treatment (ZHCT) project and the resulting uptake, HIV positivity rate and links to HIV treatment. METHODS The ZHCT project has been implemented since March 2016, covering a total of 12 districts in three provinces. To assess the project's performance on index testing, we extracted data on HIV testing from the district health information system (DHIS 2) from March 2016 to May 2018, validated it using service registers and calculated monthly HIV positivity rates using Microsoft Excel. Data were disaggregated by district, province, sex and service delivery point. We used SPSS to assess for statistical differences in paired monthly HIV positivity rates by sex, testing site, and province. RESULTS The average HIV positivity rate rose from 10% during the first six months of implementation to more than 30% by August 2016 and was sustained above 30% through May 2018. The overall facility HIV positivity rate was 4.1% during the same period. The high HIV positivity rate was achieved for both males and females (mean monthly HIV positivity rate of 31.3% for males and 33.7% for females), with females showing significantly higher positivity compared to males (p < 0.001). The ZHCT mean monthly HIV positivity rate from index testing (32.6%) was significantly higher than that achieved through provider-initiated testing and counselling and other facility HIV testing modalities (4.1%, p < 0.001). CONCLUSIONS The ZHCT project has demonstrated successes in implementing index testing and PNS by attaining a high HIV positivity rate sustained over the study period. As the country moves towards HIV epidemic control, index testing and PNS are critical strategies for targeted HIV case identification.
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Lippman SA, El Ayadi AM, Grignon JS, Puren A, Liegler T, Venter WDF, Ratlhagana MJ, Morris JL, Naidoo E, Agnew E, Barnhart S, Shade SB. Improvements in the South African HIV care cascade: findings on 90-90-90 targets from successive population-representative surveys in North West Province. J Int AIDS Soc 2019; 22:e25295. [PMID: 31190460 PMCID: PMC6562149 DOI: 10.1002/jia2.25295] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 04/30/2019] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION To achieve epidemic control of HIV by 2030, countries aim to meet 90-90-90 targets to increase knowledge of HIV-positive status, initiation of antiretroviral therapy (ART) and viral suppression by 2020. We assessed the progress towards these targets from 2014 to 2016 in South Africa as expanded treatment policies were introduced using population-representative surveys. METHODS Data were collected in January to March 2014 and August to November 2016 in Dr. Ruth Segomotsi Mompati District, North West Province. Each multi-stage cluster sample included 46 enumeration areas (EA), a target of 36 dwelling units (DU) per EA, and a single resident aged 18 to 49 per DU. Data collection included behavioural surveys, rapid HIV antibody testing and dried blood spot collection. We used weighted general linear regression to evaluate differences in the HIV care continuum over time. RESULTS Overall, 1044 and 971 participants enrolled in 2014 and 2016 respectively with approximately 77% undergoing HIV testing. Despite increases in reported testing, known status among people living with HIV (PLHIV) remained similar at 68.7% (95% Confidence Interval (CI) = 60.9-75.6) in 2014 and 72.8% (95% CI = 63.6-80.4) in 2016. Men were consistently less likely than women to know their status. Among those with known status, PLHIV on ART increased significantly from 80.9% (95% CI = 71.9-87.4) to 91.5% (95% CI = 84.4-95.5). Viral suppression (<5000 copies/mL using DBS) among those on ART increased significantly from 55.0% (95% CI = 39.6-70.4) in 2014 to 81.4% (95% CI = 72.0-90.8) in 2016. Among all PLHIV an estimated 72.0% (95% CI = 63.8-80.1) of women and 45.8% (95% CI = 27.0-64.7) of men achieved viral suppression by 2016. CONCLUSIONS Over a period during which fixed-dose combination was introduced, ART eligibility expanded, and efforts to streamline treatment were implemented, major improvements in the second and third 90-90-90 targets were achieved. Achieving the first 90 target will require targeted and improved testing models for men.
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Affiliation(s)
- Sheri A Lippman
- Center for AIDS Prevention StudiesDepartment of MedicineUniversity of CaliforniaSan FranciscoCAUSA
| | - Alison M El Ayadi
- Bixby Center for Global Reproductive HealthDepartment of Obstetrics, Gynecology and Reproductive SciencesUniversity of CaliforniaSan FranciscoCAUSA
| | - Jessica S Grignon
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
- International Training and Education Center for Health (I‐TECH) South AfricaPretoriaRepublic of South Africa
| | - Adrian Puren
- Centre for HIV and STIsNational Institute for Communicable Diseases/NHLSDivision of VirologySchool of PathologyUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Teri Liegler
- HIV/AIDS DivisionDepartment of MedicineHIV, Infectious Diseases and Global Health DivisionUniversity of CaliforniaSan FranciscoCAUSA
| | - W D Francois Venter
- Wits Reproductive Health and HIV Institute (WRHI)Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Mary J Ratlhagana
- International Training and Education Center for Health (I‐TECH) South AfricaPretoriaRepublic of South Africa
| | - Jessica L Morris
- Center for AIDS Prevention StudiesDepartment of MedicineUniversity of CaliforniaSan FranciscoCAUSA
| | - Evasen Naidoo
- International Training and Education Center for Health (I‐TECH) South AfricaPretoriaRepublic of South Africa
| | - Emily Agnew
- Center for AIDS Prevention StudiesDepartment of MedicineUniversity of CaliforniaSan FranciscoCAUSA
| | - Scott Barnhart
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
| | - Starley B Shade
- Center for AIDS Prevention StudiesDepartment of MedicineUniversity of CaliforniaSan FranciscoCAUSA
- Institute for Global Health ScienceDepartment of Epidemiology and BiostatisticsUniversity of CaliforniaSan FranciscoCAUSA
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Tulloch KJ, Dodin P, Tremblay‐Racine F, Elwood C, Money D, Boucoiran I. Cabergoline: a review of its use in the inhibition of lactation for women living with HIV. J Int AIDS Soc 2019; 22:e25322. [PMID: 31183987 PMCID: PMC6558502 DOI: 10.1002/jia2.25322] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 05/22/2019] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION In developed countries, breastfeeding is not recommended for women living with human immunodeficiency virus (WLWH). However, lactation symptoms can be distressing for women who choose not to breastfeed. There is currently no universal guideline on the most appropriate options for prevention or reduction of lactation symptoms amongst WLWH. This review describes the evidence base for using cabergoline, a dopaminergic agonist, for the post-partum inhibition of lactation for WLWH. METHODS A scoping review of post-partum pharmaceutical lactation inhibition specific for WLWH was conducted using searches in PubMed, Medline Ovid, EBM Reviews Ovid, Embase, Web of Science and Scopus until 2019. A narrative review of cabergoline pharmacologic properties, therapeutic efficacy, tolerability data and drug interaction data relevant to lactation inhibition was then conducted. RESULTS AND DISCUSSION Among 1366 articles, the scoping review identified 13 relevant publications. Eight guidelines providing guidance regarding lactation inhibition for WLWH and two surveys of medical practice on this topic in UK have been published. Three studies have evaluated the use of pharmaceutical agents in WLWH. Two of these studies evaluated cabergoline and reported it to be an effective method of lactation inhibition in this population. The third study evaluated ethinyl estradiol and bromocriptine use and showed poor efficacy. Cabergoline is a long-acting dopamine D2 agonist and ergot derivative that inhibits prolactin secretion and suppresses physiologic lactation when given as a single oral dose of 1 mg after delivery. Cabergoline is at least as effective as bromocriptine for lactation inhibition with success rates between 78% and 100%. Transient, mild to moderate adverse events to cabergoline are described in clinical trials. Few drug interactions exist as cabergoline is neither a substrate nor an inducer/inhibitor of hepatic cytochrome P450 isoenzymes. There are no reported clinically significant drug-drug interactions between cabergoline and any antiretroviral medications including protease inhibitors. CONCLUSIONS Cabergoline is a safe and effective pharmacologic option for the prevention of physiological lactation and associated physical symptoms in non-breastfeeding women. Future studies should focus on its safety, efficacy and acceptability among WLWH.
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Affiliation(s)
- Karen J Tulloch
- Department of PharmacyBC Women's Hospital and Health CentreVancouverBCCanada
- Women's Health Research InstituteVancouverBCCanada
| | | | | | - Chelsea Elwood
- Women's Health Research InstituteVancouverBCCanada
- Department of Obstetrics and GynaecologyUniversity of British ColumbiaVancouverBCCanada
| | - Deborah Money
- Women's Health Research InstituteVancouverBCCanada
- Department of Obstetrics and GynaecologyUniversity of British ColumbiaVancouverBCCanada
| | - Isabelle Boucoiran
- Department of Obstetrics and GynecologyCHU Sainte‐JustineUniversité de MontréalMontrealQCCanada
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Msukwa MT, Keiser O, Jahn A, Van Oosterhout JJ, Edmonds A, Phiri N, Manjomo R, Davies MA, Estill J. Timing of combination antiretroviral therapy (cART) initiation is not associated with stillbirth among HIV-infected pregnant women in Malawi. Trop Med Int Health 2019; 24:727-735. [PMID: 30891866 PMCID: PMC7137352 DOI: 10.1111/tmi.13233] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 01/08/2023]
Abstract
OBJECTIVE To assess the association between timing of maternal combination ART (cART) initiation and stillbirth among HIV-infected pregnant women in Malawi's Option B+ programme. METHODS Cohort study of HIV-infected pregnant women delivering singleton live or stillborn babies at ≥28 weeks of gestation using routine data from maternity registers between 1 January 2012 and 30 June 2015. We defined stillbirth as death of a foetus at ≥28 weeks of gestation. We report proportions of stillbirth according to timing of maternal cART initiation (before pregnancy, 1st or 2nd trimester, or 3rd trimester or labour). We used logistic regression, with robust standard errors to account for clustering of women within health facilities, to investigate the association between timing of cART initiation and stillbirth. RESULTS Of 10 558 mother-infant pairs abstracted from registers, 8380 (79.4%) met inclusion criteria. The overall rate of stillbirth was 25 per 1000 deliveries (95% confidence interval 22-29). We found no significant association between timing of maternal cART initiation and stillbirth. In multivariable models, older maternal age, male sex of the infant, breech vaginal delivery, delivery at < 34 weeks of gestation and experience of any maternal obstetric complication were associated with higher odds of stillbirth. Deliveries managed by a mission hospital or health centre were associated with lower odds of stillbirth. CONCLUSION Pregnant women's exposure to cART, regardless of time of its initiation, was not associated with increased odds of stillbirth.
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Affiliation(s)
- Malango T. Msukwa
- Institute of Global Health, University of Geneva, Geneva, Switzerland
- Baobab Health Trust, Lilongwe, Malawi
| | - Olivia Keiser
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Andreas Jahn
- Department of HIV and AIDS, Ministry of Health, Lilongwe, Malawi
| | - Joep J. Van Oosterhout
- Dignitas International, Zomba, Malawi
- Department of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Andrew Edmonds
- The University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Nozgechi Phiri
- Institute of Global Health, University of Geneva, Geneva, Switzerland
- Baobab Health Trust, Lilongwe, Malawi
| | | | - Mary-Ann Davies
- Centre of Infectious Disease Epidemiology and Research, University of Cape Town, South Africa
| | - Janne Estill
- Institute of Global Health, University of Geneva, Geneva, Switzerland
- Institute of Mathematical Statistics and Actuarial Science, University of Bern, Switzerland
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Pittala S, Bagley K, Schwartz JA, Brown EP, Weiner JA, Prado IJ, Zhang W, Xu R, Ota-Setlik A, Pal R, Shen X, Beck C, Ferrari G, Lewis GK, LaBranche CC, Montefiori DC, Tomaras GD, Alter G, Roederer M, Fouts TR, Ackerman ME, Bailey-Kellogg C. Antibody Fab-Fc properties outperform titer in predictive models of SIV vaccine-induced protection. Mol Syst Biol 2019; 15:e8747. [PMID: 31048360 PMCID: PMC6497031 DOI: 10.15252/msb.20188747] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 04/01/2019] [Accepted: 04/04/2019] [Indexed: 01/13/2023] Open
Abstract
Characterizing the antigen-binding and innate immune-recruiting properties of the humoral response offers the chance to obtain deeper insights into mechanisms of protection than revealed by measuring only overall antibody titer. Here, a high-throughput, multiplexed Fab-Fc Array was employed to profile rhesus macaques vaccinated with a gp120-CD4 fusion protein in combination with different genetically encoded adjuvants, and subsequently subjected to multiple heterologous simian immunodeficiency virus (SIV) challenges. Systems analyses modeling protection and adjuvant differences using Fab-Fc Array measurements revealed a set of correlates yielding strong and robust predictive performance, while models based on measurements of response magnitude alone exhibited significantly inferior performance. At the same time, rendering Fab-Fc measurements mathematically independent of titer had relatively little impact on predictive performance. Similar analyses for a distinct SIV vaccine study also showed that Fab-Fc measurements performed significantly better than titer. These results suggest that predictive modeling with measurements of antibody properties can provide detailed correlates with robust predictive power, suggest directions for vaccine improvement, and potentially enable discovery of mechanistic associations.
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Affiliation(s)
| | | | | | - Eric P Brown
- Thayer School of Engineering, Dartmouth, Hanover, NH, USA
| | | | | | | | - Rong Xu
- Profectus BioSciences, Inc., Baltimore, MD, USA
| | | | - Ranajit Pal
- Advanced Bioscience Laboratories, Inc., Rockville, MD, USA
| | | | - Charles Beck
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Guido Ferrari
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - George K Lewis
- Institute for Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Celia C LaBranche
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | | | | | - Galit Alter
- Harvard Medical School, Boston, MA, USA
- Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology and Harvard University, Boston, MA, USA
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Schroeder SE, Higgs P, Winter R, Brown G, Pedrana A, Hellard M, Doyle J, Stoové M. Hepatitis C risk perceptions and attitudes towards reinfection among HIV-diagnosed gay and bisexual men in Melbourne, Australia. J Int AIDS Soc 2019; 22:e25288. [PMID: 31111671 PMCID: PMC6528066 DOI: 10.1002/jia2.25288] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 04/30/2019] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Gay and bisexual men (GBM) are at increased risk of hepatitis C/HIV co-infection. In Australia, the availability of subsidized direct-acting antiviral treatment for hepatitis C has rendered eliminating co-infection possible. High reinfection rates in subgroups with continued exposure may compromise elimination efforts. To inform the development of hepatitis C risk reduction support in GBM, we explored reinfection risk perceptions and attitudes among GBM living with HIV recently cured from hepatitis C. METHODS Between April and August 2017, 15 GBM living with diagnosed HIV were recruited from high caseload HIV primary care services in Melbourne following successful hepatitis C treatment. In-depth interviews were conducted exploring understandings of hepatitis C risks, experiences of co-infection and attitudes towards reinfection. Constructivist grounded theory guided data aggregation. RESULTS Participants' understandings of their hepatitis C infection and reinfection trajectories were captured in three categories. Hepatitis C and HIV disease dichotomies: Hepatitis C diagnosis was a shock to most participants and contrasted with feelings of inevitability associated with HIV seroconversion. While HIV was normalized, hepatitis C was experienced as highly stigmatizing. Despite injecting drug use, interviewees did not identify with populations typically at risk of hepatitis C. Risk environments and avoiding reinfection: Interviewees identified their social and sexual networks as risk-perpetuating environments where drug use was ubiquitous and higher risk sex was common. Avoiding these risk environments to avoid reinfection resulted in community disengagement, leaving many feeling socially isolated. Hepatitis C care as a catalyst for change: Engagement in hepatitis C care contributed to a better understanding of hepatitis C risks. Interviewees were committed to applying their improved competencies around transmission risk reduction to avoid reinfection. Interviewees also considered hepatitis C care as a catalyst to reduce their drug use. CONCLUSIONS Hepatitis C/HIV co-infection among GBM cannot be understood in isolation from co-occurring drug use and sex, nor as separate from their HIV infection. Hepatitis C prevention must address subcultural heterogeneity and the intersectionality between multiple stigmatized social identities. Hepatitis C care presents an opportunity to provide support beyond cure. Peer support networks could mitigate social capital loss following a commitment to behaviour change and reduce hepatitis C reinfection risks.
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Affiliation(s)
| | - Peter Higgs
- Disease Elimination ProgramBurnet InstituteMelbourneAustralia
- Department of Public HealthLa Trobe UniversityMelbourneAustralia
| | - Rebecca Winter
- Disease Elimination ProgramBurnet InstituteMelbourneAustralia
- Department of Gastroenterology and HepatologySt Vincent's HospitalMelbourneAustralia
| | - Graham Brown
- Department of Public HealthLa Trobe UniversityMelbourneAustralia
| | - Alisa Pedrana
- Disease Elimination ProgramBurnet InstituteMelbourneAustralia
- School of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia
| | - Margaret Hellard
- Disease Elimination ProgramBurnet InstituteMelbourneAustralia
- School of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia
- Department of Infectious DiseasesThe Alfred HospitalMelbourneAustralia
| | - Joseph Doyle
- Disease Elimination ProgramBurnet InstituteMelbourneAustralia
- School of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia
- Department of Infectious DiseasesThe Alfred HospitalMelbourneAustralia
| | - Mark Stoové
- Disease Elimination ProgramBurnet InstituteMelbourneAustralia
- Department of Infectious DiseasesThe Alfred HospitalMelbourneAustralia
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Ross J, Sinayobye JD, Yotebieng M, Hoover DR, Shi Q, Ribakare M, Remera E, Bachhuber MA, Murenzi G, Sugira V, Nash D, Anastos K. Early outcomes after implementation of treat all in Rwanda: an interrupted time series study. J Int AIDS Soc 2019; 22:e25279. [PMID: 30993854 PMCID: PMC6468264 DOI: 10.1002/jia2.25279] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 03/29/2019] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Nearly all countries in sub-Saharan Africa have adopted policies to provide antiretroviral therapy (ART) to all persons living with HIV (Treat All), though HIV care outcomes of these programmes are not well-described. We estimated changes in ART initiation and retention in care following Treat All implementation in Rwanda in July 2016. METHODS We conducted an interrupted time series analysis of adults enrolling in HIV care at ten Rwandan health centres from July 2014 to September 2017. Using segmented linear regression, we assessed changes in levels and trends of 30-day ART initiation and six-month retention in care before and after Treat All implementation. We compared modelled outcomes with counterfactual estimates calculated by extrapolating baseline trends. Modified Poisson regression models identified predictors of outcomes among patients enrolling after Treat All implementation. RESULTS Among 2885 patients, 1803 (62.5%) enrolled in care before and 1082 (37.5%) after Treat All implementation. Immediately after Treat All implementation, there was a 31.3 percentage point increase in the predicted probability of 30-day ART initiation (95% CI 15.5, 47.2), with a subsequent increase of 1.1 percentage points per month (95% CI 0.1, 2.1). At the end of the study period, 30-day ART initiation was 47.8 percentage points (95% CI 8.1, 87.8) above what would have been expected under the pre-Treat All trend. For six-month retention, neither the immediate change nor monthly trend after Treat All were statistically significant. While 30-day ART initiation and six-month retention were less likely among patients 15 to 24 versus >24 years, the predicted probability of both outcomes increased significantly for younger patients in each month after Treat All implementation. CONCLUSIONS Implementation of Treat All in Rwanda was associated with a substantial increase in timely ART initiation without negatively impacting care retention. These early findings support Treat All as a strategy to help achieve global HIV targets.
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Affiliation(s)
- Jonathan Ross
- Department of MedicineMontefiore Medical Center/Albert Einstein College of MedicineBronxNYUSA
| | | | - Marcel Yotebieng
- Division of EpidemiologyCollege of Public HealthOhio State UniversityColumbusOHUSA
| | - Donald R Hoover
- Department of Statistics and Biostatistics and Institute for HealthHealth Care Policy and Aging ResearchRutgers the State University of New JerseyPiscatawayNJUSA
| | - Qiuhu Shi
- Department of Epidemiology and Community HealthNew York Medical CollegeValhallaNYUSA
| | | | | | - Marcus A Bachhuber
- Department of MedicineMontefiore Medical Center/Albert Einstein College of MedicineBronxNYUSA
| | - Gad Murenzi
- Research DivisionRwanda Military HospitalKigaliRwanda
| | | | - Denis Nash
- Institute for Implementation Science in Population HealthCity University of New YorkNew YorkNYUSA
| | - Kathryn Anastos
- Department of MedicineMontefiore Medical Center/Albert Einstein College of MedicineBronxNYUSA
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Mayer CM, Owaraganise A, Kabami J, Kwarisiima D, Koss CA, Charlebois ED, Kamya MR, Petersen ML, Havlir DV, Jewell BL. Distance to clinic is a barrier to PrEP uptake and visit attendance in a community in rural Uganda. J Int AIDS Soc 2019; 22:e25276. [PMID: 31037845 PMCID: PMC6488759 DOI: 10.1002/jia2.25276] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 03/14/2019] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Geographic and transportation barriers are associated with poorer HIV-related health outcomes in sub-Saharan Africa, but data on the impact of these barriers on prevention interventions are limited. We estimated the association between distance to clinic and other transportation-related barriers on pre-exposure prophylaxis (PrEP) uptake and initial clinic visit attendance in a rural community in southwestern Uganda enrolled in the ongoing SEARCH study (NCT01864603). METHODS Community-wide HIV testing was conducted and offered to adult (≥15 years) participants in Ruhoko. Participants were eligible for PrEP based on an empiric risk score, having an HIV-discordant partner, or self-referral at either the community health campaign or during home-based testing from March to April 2017. We collected data from PrEP-eligible households on GPS-measured distance to clinic, walking time to clinic and road difficulty. A sample of participants was also asked to identify their primary barriers to PrEP use with a semi-quantitative questionnaire. We used multivariable logistic regression to evaluate the association between transportation barriers and (1) PrEP uptake among PrEP-eligible individuals and (2) four-week clinic visit attendance among PrEP initiators. RESULTS Of the 701 PrEP-eligible participants, 272 (39%) started PrEP within four weeks; of these, 45 (17%) were retained at four weeks. Participants with a distance to clinic of ≥2 km were less likely to start PrEP (aOR 0.34; 95% CI 0.15 to 0.79, p = 0.012) and less likely to be retained on PrEP once initiated (aOR 0.29; 95% CI 0.10 to 0.84; p = 0.024). Participants who were deemed eligible during home-based testing and did not have the option of same-day PrEP start were also substantially less likely to initiate PrEP (aOR 0.16, 95% CI 0.07 to 0.37, p < 0.001). Of participants asked to name barriers to PrEP use (N = 98), the most frequently cited were "needing to take PrEP every day" (N = 18) and "low/no risk of getting HIV" (N = 18). Transportation-related barriers, including "clinic is too far away" (N = 6) and "travel away from home" (N = 4) were also reported. CONCLUSIONS Distance to clinic is a significant predictor of PrEP uptake and four-week follow-up visit attendance in a community in rural Uganda. Interventions that address geographic and transportation barriers may improve PrEP uptake and retention in sub-Saharan Africa.
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Affiliation(s)
| | | | - Jane Kabami
- Infectious Diseases Research CollaborationKampalaUganda
| | | | | | | | | | | | - Diane V Havlir
- University of California San FranciscoSan FranciscoCAUSA
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McHenry MS, Balogun KA, McDonald BC, Vreeman RC, Whipple EC, Serghides L. In utero exposure to HIV and/or antiretroviral therapy: a systematic review of preclinical and clinical evidence of cognitive outcomes. J Int AIDS Soc 2019; 22:e25275. [PMID: 30983111 PMCID: PMC6462810 DOI: 10.1002/jia2.25275] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 03/15/2019] [Indexed: 01/29/2023] Open
Abstract
INTRODUCION With the increasing number of children exposed to HIV or antiretroviral therapy in utero, there are concerns that this population may have worse neurodevelopmental outcomes compared to those who are unexposed. The objective of this study was to systematically review the clinical and preclinical literature on the effects of in utero exposure to HIV and/or antiretroviral therapy (ART) on neurodevelopment. METHODS We systematically searched OVID Medline, PsycINFO and Embase, as well as the Cochrane Collaborative Database, Google Scholar and bibliographies of pertinent articles. Titles, abstracts, and full texts were assessed independently by two reviewers. Data from included studies were extracted. Results are summarized qualitatively. RESULTS The search yielded 3027 unique titles. Of the 255 critically reviewed full-text articles, 25 met inclusion criteria for the systematic review. Five articles studied human subjects and looked at brain structure and function. The remaining 20 articles were preclinical studies that mostly focused on behavioural assessments in animal models. The few clinical studies had mixed results. Some clinical studies found no difference in white matter while others noted higher fractional anisotropy and lower mean diffusivity in the brains of HIV-exposed uninfected children compared to HIV-unexposed uninfected children, correlating with abnormal neurobehavioral scores. Preclinical studies focused primarily on neurobehavioral changes resulting from monotherapy with either zidovudine or lamivudine. Various developmental and behavioural changes were noted in preclinical studies with ART exposure, including decreased grooming, decreased attention, memory deficits and fewer behaviours associated with appropriate social interaction. CONCLUSIONS While the existing literature suggests that there may be some neurobehavioral differences associated with HIV and ART exposure, limited data are available to substantially support these claims. More research is needed comparing neurobiological factors between HIV-exposed uninfected and HIV-unexposed uninfected children and using exposures consistent with current clinical care.
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Affiliation(s)
- Megan S McHenry
- Department of PediatricsIndiana University School of MedicineIndianapolisIndianaUSA
- Academic Model Providing Access to Healthcare (AMPATH)EldoretKenya
| | - Kayode A Balogun
- Toronto General Hospital Research InstituteUniversity Health NetworkTorontoCanada
| | - Brenna C McDonald
- Department of Radiology and Imaging SciencesIndiana University School of MedicineIndianapolisIndianaUSA
| | - Rachel C Vreeman
- Department of PediatricsIndiana University School of MedicineIndianapolisIndianaUSA
- Academic Model Providing Access to Healthcare (AMPATH)EldoretKenya
| | - Elizabeth C Whipple
- Ruth Lilly Medical LibraryIndiana University School of MedicineIndianapolisIndianaUSA
| | - Lena Serghides
- Toronto General Hospital Research InstituteUniversity Health NetworkTorontoCanada
- Department of ImmunologyInstitute of Medical SciencesTorontoCanada
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Baguso GN, Turner CM, Santos G, Raymond HF, Dawson‐Rose C, Lin J, Wilson EC. Successes and final challenges along the HIV care continuum with transwomen in San Francisco. J Int AIDS Soc 2019; 22:e25270. [PMID: 31037858 PMCID: PMC6488760 DOI: 10.1002/jia2.25270] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 03/07/2019] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION To examine the HIV care continuum for transwomen living in San Francisco and to determine factors associated with poor HIV-related health outcomes. METHODS Data were collected from 2016 to 2017 with transwomen in San Francisco. Respondent-driven sampling (RDS) was used to recruit a population-based sample. Bivariate associations were assessed, and RDS-weighted multivariable logistic regression was used to identify associations between exposures and outcomes along the HIV care continuum. RESULTS Of the 123 self-identified transwomen in this analysis, ages ranged from 23 to 71 years with a majority identifying as Latina (40.8%) and African American (29.2%). An estimate of 14.3% of participants were not engaged in care, 13% were not currently on antiretroviral therapy (ART), 22.2% had a self-reported detectable viral load and 13.5% had unknown viral load. Those using hormones had lower odds of not being on ART compared to those who did not use hormones. Those with unstable housing had a higher relative risk ratio of having a detectable viral load. Those who experienced both anti-trans discrimination and racism had higher odds of not being in HIV care. CONCLUSIONS San Francisco has made substantial progress engaging transwomen in the HIV care continuum, but the final push to ensure viral suppression will require addressing social determinants. Future interventions to increase HIV care engagement, ART use and viral suppression among transwomen must address housing needs and risks related to the overlapping effect of both anti-trans discrimination and racism.
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Affiliation(s)
- Glenda N Baguso
- Department of Community Health SystemsUniversity of California San FranciscoSan FranciscoCAUSA
| | - Caitlin M Turner
- San Francisco Department of Public HealthCenter for Public Health ResearchSan FranciscoUSA
| | - Glenn‐Milo Santos
- San Francisco Department of Public HealthCenter for Public Health ResearchSan FranciscoUSA
| | - H Fisher Raymond
- San Francisco Department of Public HealthCenter for Public Health ResearchSan FranciscoUSA
| | - Carol Dawson‐Rose
- Department of Community Health SystemsUniversity of California San FranciscoSan FranciscoCAUSA
| | - Jess Lin
- San Francisco Department of Public HealthCenter for Public Health ResearchSan FranciscoUSA
| | - Erin C Wilson
- San Francisco Department of Public HealthCenter for Public Health ResearchSan FranciscoUSA
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Dang VPL, Pham VH, Dinh TT, Le TH, Nguyen VL, Vu TP. Growth in children infected with HIV receiving anti-retroviral therapy in Vietnam. Pediatr Int 2019; 61:369-374. [PMID: 30742346 DOI: 10.1111/ped.13800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 12/10/2018] [Accepted: 02/07/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND There are currently two markers used to monitor treatment response to anti-retroviral therapy (ART) in HIV-infected children: CD4 T-cell count and HIV viral load; but analysis of these could be challenging in resource-poor countries. The aim of this study was therefore to determine whether change in growth parameters such as weight-for-age Z score (WAZ), height-for-age Z score (HAZ) and body mass index-for-age Z score (BMIZ) is associated with treatment response in HIV-infected children. METHODS This was a nested case-control study, in which the data were collected at enrolment and then periodically every 6 months for a total 36 month follow up of 107 HIV-infected children enrolled and treated at National Hospital of Pediatrics, Vietnam. RESULTS At treatment initiation, WAZ, HAZ and BMIZ were not significantly higher in the treatment success (TS) group compared with the treatment failure (TF) group. After ART initiation, WAZ and HAZ increased, and this was significant in the TS group (from -1.5 to -0.54, P < 0.01 and from -2.06 to -0.84, P < 0.01, respectively). Low HAZ was significantly associated with TF (HR, 0.71; 95% CI: 0.54-0.92). CONCLUSION Height-for-age Z score was the most sensitive growth parameter in prediction of the treatment response. In order to use growth parameters, particularly HAZ as a prognosis marker for TF in clinical practice, further research should be conducted to evaluate the role of growth parameters and their effects on treatment response.
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Hyle EP, Bekker L, Martey EB, Huang M, Xu A, Parker RA, Walensky RP, Middelkoop K. Cardiovascular risk factors among ART-experienced people with HIV in South Africa. J Int AIDS Soc 2019; 22:e25274. [PMID: 30990252 PMCID: PMC6466898 DOI: 10.1002/jia2.25274] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 03/12/2019] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION People with HIV (PWH) are at increased risk for atherosclerotic cardiovascular disease (CVD). Screening for CVD risk factors is recommended but not routine in South African HIV clinics. We sought to describe the prevalence of CVD risk factors among antiretroviral treatment (ART)-experienced patients in South Africa. METHODS We performed a prospective, observational cross-sectional study of PWH (>21 years, excluding pregnant women) on ART in South Africa. We interviewed patients regarding CVD risk factors, and obtained two blood pressure (BP) measurements and random/fasting glucose via a point-of-care glucometer. Standardized chart reviews provided individuals' HIV-specific data. We defined hypertension as: self-reported use of antihypertensives or mean systolic BP (SBP) ≥140 mmHg or diastolic BP (DBP) ≥90 mmHg (Stage 1) or SBP ≥160 mmHg or DBP ≥100 mmHg (Stage 2). We defined diabetes as self-reported use of insulin/oral hypoglycaemics or fasting (random) glucose ≥7.0 (≥11.1) mmol. We obtained risk ratios (RR) for hypertension from a multivariable log-binomial regression model, adjusting for age, sex and diabetes. RESULTS From March 2015 to February 2016, 458 participants enrolled with median age 38 years (interquartile range (IQR) 33 to 44 years) and median CD4 466/μL (IQR 317 to 638/μL); 78% were women. Participants were on ART for a median of four years, with 33% on ART ≥6 years. Almost a quarter (106/458) met the study definition for hypertension, of whom 45/106 (42%) were previously diagnosed, 23/45 (51%) were on medication and 4/23 (17%) were controlled. Eight participants had asymptomatic hypertensive urgency (BP≥180/110 mmHg). Of the 458 participants, 26 (6%) met the study definition for diabetes, half of whom (13/26) were already diagnosed; 11/13 (85%) were on treatment, of whom 4/11 (36%) had normal glucose. Age was the only significant predictor of hypertension (RR, 1.04; 95% CI, 1.03 to 1.06, p < 0.0001) in the multivariable model. CONCLUSIONS Hypertension and diabetes were prevalent among PWH prescribed ART in South Africa with less than half diagnosed, and still fewer treated and controlled. Hypertension was independently associated with age but not with HIV-specific factors. Screening for and treatment of CVD risk factors could decrease future morbidity and mortality, especially as this population ages.
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Affiliation(s)
- Emily P Hyle
- Medical Practice Evaluation CenterMassachusetts General HospitalBostonMAUSA
- Division of Infectious DiseasesMassachusetts General HospitalBostonMAUSA
- Harvard University Center for AIDS Research (CFAR)BostonMAUSA
- Harvard Medical SchoolBostonMAUSA
| | - Linda‐Gail Bekker
- Desmond Tutu HIV CentreInstitute of Infectious Disease & Molecular Medicine and Department of Medicine Faculty of Health SciencesUniversity of Cape TownCape TownSouth Africa
| | - Emily B Martey
- Medical Practice Evaluation CenterMassachusetts General HospitalBostonMAUSA
| | - Mingshu Huang
- Medical Practice Evaluation CenterMassachusetts General HospitalBostonMAUSA
- Biostatistics CenterMassachusetts General HospitalBostonMAUSA
| | - Ai Xu
- Biostatistics CenterMassachusetts General HospitalBostonMAUSA
| | - Robert A Parker
- Medical Practice Evaluation CenterMassachusetts General HospitalBostonMAUSA
- Harvard University Center for AIDS Research (CFAR)BostonMAUSA
- Harvard Medical SchoolBostonMAUSA
- Biostatistics CenterMassachusetts General HospitalBostonMAUSA
| | - Rochelle P Walensky
- Medical Practice Evaluation CenterMassachusetts General HospitalBostonMAUSA
- Division of Infectious DiseasesMassachusetts General HospitalBostonMAUSA
- Harvard University Center for AIDS Research (CFAR)BostonMAUSA
- Harvard Medical SchoolBostonMAUSA
- Division of Infectious DiseasesBrigham and Women's HospitalBostonMAUSA
- Division of General Internal MedicineMassachusetts General HospitalBostonMAUSA
| | - Keren Middelkoop
- Desmond Tutu HIV CentreInstitute of Infectious Disease & Molecular Medicine and Department of Medicine Faculty of Health SciencesUniversity of Cape TownCape TownSouth Africa
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Drake AL, Thomson KA, Quinn C, Newman Owiredu M, Nuwagira IB, Chitembo L, Essajee S, Baggaley R, Johnson CC. Retest and treat: a review of national HIV retesting guidelines to inform elimination of mother-to-child HIV transmission (EMTCT) efforts. J Int AIDS Soc 2019; 22:e25271. [PMID: 30958644 PMCID: PMC6452920 DOI: 10.1002/jia2.25271] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 03/07/2019] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION High maternal HIV incidence contributes substantially to mother-to-child HIV transmission (MTCT) in some settings. Since 2006, HIV retesting during the third trimester and breastfeeding has been recommended by the World Health Organization in higher prevalence (≥5%) settings to reduce MTCT. However, many countries lack clarity on when and how often to retest pregnant and postpartum women to optimize resources and service delivery. We reviewed and characterized national guidelines on maternal retesting based on timing and frequency. METHODS We identified 52 countries to represent variations in HIV prevalence, geography, and MTCT priority and searched available national MTCT, HIV testing and HIV treatment policies published between 2007 and 2017 for recommendations on retesting during pregnancy, labour/delivery and postpartum. Recommended retesting frequency and timing was extracted. Country HIV prevalence was classified as: very low (<1%), low (1% to 5%), intermediate (>5 to <15%) and high (≥15%). Women with unknown HIV status at delivery/postpartum were included in retesting guidelines. RESULTS AND DISCUSSION Overall, policies from 49 countries were identified; 51% from 2015 or later and most (n = 25) were from Africa. Four countries were high HIV prevalence, seven intermediate, sixteen low and twenty-two very low. Most (n = 31) had guidance on universal voluntary opt-out HIV testing at the first antenatal care (ANC) visit. Beyond the first ANC visit, the majority (78%, n = 38) had guidance on retesting; 22 recommended retesting all women with unknown/negative status, five only if unknown HIV status, three in pregnancy based on risk and eight combining these approaches. Retesting was universally recommended during pregnancy, labour/delivery, and postpartum for all high prevalence settings and four of seven intermediate prevalence settings. Five UNAIDS priority countries for EMTCT with low/very low HIV prevalence, but high/intermediate MTCT, had no guidance on retesting. CONCLUSIONS Retesting guidelines for pregnant and postpartum women were ubiquitous in high prevalence countries and defined in some intermediate prevalence countries, but absent in some low HIV prevalence countries with high MTCT. Countries may require additional guidance on how to optimize maternal HIV testing and whether to prioritize retesting efforts or discontinue universal retesting based on HIV incidence. Research is needed to assess country-level guideline implementation and impact.
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Affiliation(s)
- Alison L Drake
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
| | - Kerry A Thomson
- Department of EpidemiologyUniversity of WashingtonSeattleWAUSA
| | - Caitlin Quinn
- HIV DepartmentWorld Health OrganizationGenevaSwitzerland
| | | | - Innocent B Nuwagira
- Family and Reproductive Health ClusterWorld Health Organization, Regional Office for AfricaOuagadougouBurkina Faso
| | - Lastone Chitembo
- HIV/Tuberculosis/Hepatitis ProgrammeWorld Health Organization, Regional Office for AfricaLusakaZambia
| | | | | | - Cheryl C Johnson
- HIV DepartmentWorld Health OrganizationGenevaSwitzerland
- Clinical Research DepartmentLondon School of Hygiene and Tropical MedicineLondonUnited Kingdom
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Ku SW, Jiamsakul A, Joshi K, Pasayan MKU, Widhani A, Chaiwarith R, Kiertiburanakul S, Avihingsanon A, Ly PS, Kumarasamy N, Do CD, Merati TP, Nguyen KV, Kamarulzaman A, Zhang F, Lee MP, Choi JY, Tanuma J, Khusuwan S, Sim BLH, Ng OT, Ratanasuwan W, Ross J, Wong W. Cotrimoxazole prophylaxis decreases tuberculosis risk among Asian patients with HIV. J Int AIDS Soc 2019; 22:e25264. [PMID: 30924281 PMCID: PMC6439318 DOI: 10.1002/jia2.25264] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 02/20/2019] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION Cotrimoxazole (CTX) is recommended as prophylaxis against Pneumocystis jiroveci pneumonia, malaria and other serious bacterial infections in HIV-infected patients. Despite its in vitro activity against Mycobacterium tuberculosis, the effects of CTX preventive therapy on tuberculosis (TB) remain unclear. METHODS Adults living with HIV enrolled in a regional observational cohort in Asia who had initiated combination antiretroviral therapy (cART) were included in the analysis. Factors associated with new TB diagnoses after cohort entry and survival after cART initiation were analysed using Cox regression, stratified by site. RESULTS A total of 7355 patients from 12 countries enrolled into the cohort between 2003 and 2016 were included in the study. There were 368 reported cases of TB after cohort entry with an incidence rate of 0.99 per 100 person-years (/100 pys). Multivariate analyses adjusted for viral load (VL), CD4 count, body mass index (BMI) and cART duration showed that CTX reduced the hazard for new TB infection by 28% (HR 0.72, 95% CI l 0.56, 0.93). Mortality after cART initiation was 0.85/100 pys, with a median follow-up time of 4.63 years. Predictors of survival included age, female sex, hepatitis C co-infection, TB diagnosis, HIV VL, CD4 count and BMI. CONCLUSIONS CTX was associated with a reduction in the hazard for new TB infection but did not impact survival in our Asian cohort. The potential preventive effect of CTX against TB during periods of severe immunosuppression should be further explored.
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Affiliation(s)
- Stephane Wen‐Wei Ku
- Division of Infectious DiseasesDepartment of MedicineTaipei Veterans General HospitalTaipeiTaiwan
- Division of Infectious DiseasesDepartment of MedicineTaipei City Hospital Renai BranchTaipeiTaiwan
| | | | | | | | - Alvina Widhani
- Working Group on AIDSFaculty of MedicineUniversity of Indonesia/Cipto Mangunkusumo HospitalJakartaIndonesia
| | - Romanee Chaiwarith
- Research Institute for Health SciencesChiang Mai UniversityChiang MaiThailand
| | | | - Anchalee Avihingsanon
- Faculty of MedicineChulalongkorn University and HIV‐NAT/Thai Red Cross AIDS Research CentreBangkokThailand
| | - Penh Sun Ly
- National Center for HIV/AIDSDermatology & STDs, and University of Health SciencesPhnom PenhCambodia
| | - Nagalingeswaran Kumarasamy
- Chennai Antiviral Research and Treatment Clinical Research Site (CART CRS)YRGCARE Medical CentreVHSChennaiIndia
| | | | - Tuti P Merati
- Faculty of MedicineUdayana University & Sanglah HospitalBaliIndonesia
| | | | | | - Fujie Zhang
- Beijing Ditan HospitalCapital Medical UniversityBeijingChina
| | - Man Po Lee
- Queen Elizabeth HospitalHong Kong SARChina
| | - Jun Yong Choi
- Department of Internal MedicineYonsei University College of MedicineSeoulSouth Korea
- AIDS Research InstituteYonsei University College of MedicineSeoulSouth Korea
| | - Junko Tanuma
- National Center for Global Health and MedicineTokyoJapan
| | | | | | - Oon Tek Ng
- Tan Tock Seng HospitalTan Tock SengSingapore
| | - Winai Ratanasuwan
- Faculty of MedicineSiriraj HospitalMahidol UniversityBangkokThailand
| | - Jeremy Ross
- TREAT AsiaamfAR – The Foundation for AIDS ResearchBangkokThailand
| | - Wing‐Wai Wong
- Division of Infectious DiseasesDepartment of MedicineTaipei Veterans General HospitalTaipeiTaiwan
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Cambiano V, Johnson CC, Hatzold K, Terris‐Prestholt F, Maheswaran H, Thirumurthy H, Figueroa C, Cowan FM, Sibanda EL, Ncube G, Revill P, Baggaley RC, Corbett EL, Phillips A. The impact and cost-effectiveness of community-based HIV self-testing in sub-Saharan Africa: a health economic and modelling analysis. J Int AIDS Soc 2019; 22 Suppl 1:e25243. [PMID: 30907498 PMCID: PMC6432108 DOI: 10.1002/jia2.25243] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 01/18/2019] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION The prevalence of undiagnosed HIV is declining in Africa, and various HIV testing approaches are finding lower positivity rates. In this context, the epidemiological impact and cost-effectiveness of community-based HIV self-testing (CB-HIVST) is unclear. We aimed to assess this in different sub-populations and across scenarios characterized by different adult HIV prevalence and antiretroviral treatment programmes in sub-Saharan Africa. METHODS The synthesis model was used to address this aim. Three sub-populations were considered for CB-HIVST: (i) women having transactional sex (WTS); (ii) young people (15 to 24 years); and (iii) adult men (25 to 49 years). We assumed uptake of CB-HIVST similar to that reported in epidemiological studies (base case), or assumed people use CB-HIVST only if exposed to risk (condomless sex) since last HIV test. We also considered a five-year time-limited CB-HIVST programme. Cost-effectiveness was defined by an incremental cost-effectiveness ratio (ICER; cost-per-disability-adjusted life-year (DALY) averted) below US$500 over a time horizon of 50 years. The efficiency of targeted CB-HIVST was evaluated using the number of additional tests per infection or death averted. RESULTS In the base case, targeting adult men with CB-HIVST offered the greatest impact, averting 1500 HIV infections and 520 deaths per year in the context of a simulated country with nine million adults, and impact could be enhanced by linkage to voluntary medical male circumcision (VMMC). However, the approach was only cost-effective if the programme was limited to five years or the undiagnosed prevalence was above 3%. CB-HIVST to WTS was the most cost-effective. The main drivers of cost-effectiveness were the cost of CB-HIVST and the prevalence of undiagnosed HIV. All other CB-HIVST scenarios had an ICER above US$500 per DALY averted. CONCLUSIONS CB-HIVST showed an important epidemiological impact. To maximize population health within a fixed budget, CB-HIVST needs to be targeted on the basis of the prevalence of undiagnosed HIV, sub-population and the overall costs of delivering this testing modality. Linkage to VMMC enhances its cost-effectiveness.
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Affiliation(s)
- Valentina Cambiano
- Institute for Global HealthUniversity College LondonLondonUnited Kingdom
| | | | | | - Fern Terris‐Prestholt
- Department of Global Health and DevelopmentLondon School of Hygiene and Tropical MedicineLondonUnited Kingdom
| | - Hendy Maheswaran
- Institute of Psychology, Health and SocietyUniversity of LiverpoolLiverpoolUnited Kingdom
| | - Harsha Thirumurthy
- Department of Medical Ethics and Health PolicyPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | | | - Frances M Cowan
- Centre for Sexual Health and HIV AIDS Research (CeSHHAR)HarareZimbabwe
- Liverpool School of Tropical MedicineLiverpoolUnited Kingdom
| | - Euphemia L Sibanda
- Centre for Sexual Health and HIV AIDS Research (CeSHHAR)HarareZimbabwe
- Liverpool School of Tropical MedicineLiverpoolUnited Kingdom
| | - Getrude Ncube
- Zimbabwe Ministry of Health and Child CareHarareZimbabwe
| | - Paul Revill
- Centre for Health EconomicsUniversity of YorkYorkUnited Kingdom
| | | | - Elizabeth L Corbett
- Malawi–Liverpool–Wellcome Trust Clinical Research ProgrammeBlantyreMalawi
- Department of Clinical ResearchLondon School of Hygiene& Tropical MedicineLondonUnited Kingdom
| | - Andrew Phillips
- Institute for Global HealthUniversity College LondonLondonUnited Kingdom
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Sibanda EL, d'Elbée M, Maringwa G, Ruhode N, Tumushime M, Madanhire C, Ong JJ, Indravudh P, Watadzaushe C, Johnson CC, Hatzold K, Taegtmeyer M, Hargreaves JR, Corbett EL, Cowan FM, Terris‐Prestholt F. Applying user preferences to optimize the contribution of HIV self-testing to reaching the "first 90" target of UNAIDS Fast-track strategy: results from discrete choice experiments in Zimbabwe. J Int AIDS Soc 2019; 22 Suppl 1:e25245. [PMID: 30907515 PMCID: PMC6432101 DOI: 10.1002/jia2.25245] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 01/18/2019] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION New HIV testing strategies are needed to reach the United Nations' 90-90-90 target. HIV self-testing (HIVST) can increase uptake, but users' perspectives on optimal models of distribution and post-test services are uncertain. We used discrete choice experiments (DCEs) to explore the impact of service characteristics on uptake along the testing cascade. METHODS DCEs are a quantitative survey method that present respondents with repeated choices between packages of service characteristics, and estimate relative strengths of preferences for service characteristics. From June to October 2016, we embedded DCEs within a population-based survey following door-to-door HIVST distribution by community volunteers in two rural Zimbabwean districts: one DCE addressed HIVST distribution preferences; and the other preferences for linkage to confirmatory testing (LCT) following self-testing. Using preference coefficients/utilities, we identified key drivers of uptake for each service and simulated the effect of changes of outreach and static/public clinics' characteristics on LCT. RESULTS Distribution and LCT DCEs surveyed 296/329 (90.0%) and 496/594 (83.5%) participants; 81.8% and 84.9% had ever-tested, respectively. The strongest distribution preferences were for: (1) free kits - a $1 increase in the kit price was associated with a disutility (U) of -2.017; (2) door-to-door kit delivery (U = +1.029) relative to collection from public/outreach clinic; (3) telephone helpline for pretest support relative to in-person or no support (U = +0.415); (4) distributors from own/local village (U = +0.145) versus those from external communities. Participants who had never HIV tested valued phone helplines more than those previously tested. The strongest LCT preferences were: (1) immediate antiretroviral therapy (ART) availability: U = +0.614 and U = +1.052 for public and outreach clinics, respectively; (2) free services: a $1 user fee increase decreased utility at public (U = -0.381) and outreach clinics (U = -0.761); (3) proximity of clinic (U = -0.38 per hour walking). Participants reported willingness to link to either location; but never-testers were more averse to LCT. Simulations showed the importance of availability of ART: ART unavailability at public clinics would reduce LCT by 24%. CONCLUSIONS Free HIVST distribution by local volunteers and immediately available ART were the strongest relative preferences identified. Accommodating LCT preferences, notably ensuring efficient provision of ART, could facilitate "resistant testers" to test while maximizing uptake of post-test services.
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Affiliation(s)
- Euphemia L Sibanda
- Centre for Sexual Health & HIV AIDS Research (CeSHHAR) ZimbabweHarareZimbabwe
- Department of International Public HealthLiverpool School of Tropical MedicineLiverpoolUnited Kingdom
| | - Marc d'Elbée
- Faculty of Public Health and PolicyLondon School of Hygiene and Tropical MedicineLondonUnited Kingdom
| | - Galven Maringwa
- Centre for Sexual Health & HIV AIDS Research (CeSHHAR) ZimbabweHarareZimbabwe
| | - Nancy Ruhode
- Centre for Sexual Health & HIV AIDS Research (CeSHHAR) ZimbabweHarareZimbabwe
| | - Mary Tumushime
- Centre for Sexual Health & HIV AIDS Research (CeSHHAR) ZimbabweHarareZimbabwe
| | - Claudius Madanhire
- Centre for Sexual Health & HIV AIDS Research (CeSHHAR) ZimbabweHarareZimbabwe
| | - Jason J Ong
- Faculty of Public Health and PolicyLondon School of Hygiene and Tropical MedicineLondonUnited Kingdom
- Faculty of Infectious and Tropical DiseasesLondon School of Hygiene and Tropical MedicineLondonUnited Kingdom
| | - Pitchaya Indravudh
- Malawi‐Liverpool Wellcome Trust Clinical Research ProgrammeBlantyreMalawi
| | | | - Cheryl C Johnson
- Faculty of Infectious and Tropical DiseasesLondon School of Hygiene and Tropical MedicineLondonUnited Kingdom
- Department of HIV/AIDSWorld Health OrganizationGenevaSwitzerland
| | - Karin Hatzold
- Population Services InternationalJohannesburgSouth Africa
| | - Miriam Taegtmeyer
- Department of International Public HealthLiverpool School of Tropical MedicineLiverpoolUnited Kingdom
| | - James R Hargreaves
- Faculty of Public Health and PolicyLondon School of Hygiene and Tropical MedicineLondonUnited Kingdom
| | - Elizabeth L Corbett
- Faculty of Infectious and Tropical DiseasesLondon School of Hygiene and Tropical MedicineLondonUnited Kingdom
- Malawi‐Liverpool Wellcome Trust Clinical Research ProgrammeBlantyreMalawi
| | - Frances M Cowan
- Centre for Sexual Health & HIV AIDS Research (CeSHHAR) ZimbabweHarareZimbabwe
- Department of International Public HealthLiverpool School of Tropical MedicineLiverpoolUnited Kingdom
| | - Fern Terris‐Prestholt
- Faculty of Public Health and PolicyLondon School of Hygiene and Tropical MedicineLondonUnited Kingdom
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Eaton JW, Terris‐Prestholt F, Cambiano V, Sands A, Baggaley RC, Hatzold K, Corbett EL, Kalua T, Jahn A, Johnson CC. Optimizing HIV testing services in sub-Saharan Africa: cost and performance of verification testing with HIV self-tests and tests for triage. J Int AIDS Soc 2019; 22 Suppl 1:e25237. [PMID: 30907507 PMCID: PMC6545556 DOI: 10.1002/jia2.25237] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 01/02/2019] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Strategies employing a single rapid diagnostic test (RDT) such as HIV self-testing (HIVST) or "test for triage" (T4T) are proposed to increase HIV testing programme impact. Current guidelines recommend serial testing with two or three RDTs for HIV diagnosis, followed by retesting with the same algorithm to verify HIV-positive status before anti-retroviral therapy (ART) initiation. We investigated whether clients presenting to HIV testing services (HTS) following a single reactive RDT must undergo the diagnostic algorithm twice to diagnose and verify HIV-positive status, or whether a diagnosis with the setting-specific algorithm is adequate for ART initiation. METHODS We calculated (1) expected number of false-positive (FP) misclassifications per 10,000 HIV negative persons tested, (2) positive predictive value (PPV) of the overall HIV testing strategy compared to the WHO recommended PPV ≥99%, and (3) expected cost per FP misclassified person identified by additional verification testing in a typical low-/middle-income setting, compared to the expected lifetime ART cost of $3000. Scenarios considered were as follows: 10% prevalence using two serial RDTs for diagnosis, 1% prevalence using three serial RDTs, and calibration using programmatic data from Malawi in 2017 where the proportion of people testing HIV positive in facilities was 4%. RESULTS In the 10% HIV prevalence setting with a triage test, the expected number of FP misclassifications was 0.86 per 10,000 tested without verification testing and the PPV was 99.9%. In the 1% prevalence setting, expected FP misclassifications were 0.19 with 99.8% PPV, and in the Malawi 2017 calibrated setting the expected misclassifications were 0.08 with 99.98% PPV. The cost per FP identified by verification testing was $5879, $3770, and $24,259 respectively. Results were sensitive to assumptions about accuracy of self-reported reactive results and whether reactive triage test results influenced biased interpretation of subsequent RDT results by the HTS provider. CONCLUSIONS Diagnosis with the full algorithm following presentation with a reactive triage test is expected to achieve PPV above the 99% threshold. Continuing verification testing prior to ART initiation remains recommended, but HIV testing strategies involving HIVST and T4T may provide opportunities to maintain quality while increasing efficiency as part of broader restructuring of HIV testing service delivery.
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Affiliation(s)
- Jeffrey W Eaton
- Department of Infectious Disease EpidemiologyImperial College LondonLondonUnited Kingdom
| | - Fern Terris‐Prestholt
- Department of Global Health and DevelopmentLondon School of Hygiene and Tropical MedicineLondonUnited Kingdom
| | - Valentina Cambiano
- Institute for Global HealthUniversity College LondonLondonUnited Kingdom
| | - Anita Sands
- Essential Medicines and Health Products DepartmentWorld Health OrganizationGenevaSwitzerland
| | - Rachel C Baggaley
- Global HIV and Hepatitis DepartmentWorld Health OrganizationGenevaSwitzerland
| | - Karin Hatzold
- Population Services InternationalJohannesburgSouth Africa
| | - Elizabeth L Corbett
- Clinical Research DepartmentLondon School of Hygiene and Tropical MedicineLondonUnited Kingdom
- Malawi Liverpool Wellcome Trust Clinical Research ProgrammeBlantyreMalawi
| | - Thoko Kalua
- Department of HIV/AIDSMinistry of HealthLilongweMalawi
| | - Andreas Jahn
- Department of HIV/AIDSMinistry of HealthLilongweMalawi
- International Training and Education Center for Health (I‐TECH)LilongweMalawi
| | - Cheryl C Johnson
- Global HIV and Hepatitis DepartmentWorld Health OrganizationGenevaSwitzerland
- Clinical Research DepartmentLondon School of Hygiene and Tropical MedicineLondonUnited Kingdom
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Stonbraker S, Richards S, Halpern M, Bakken S, Schnall R. Priority Topics for Health Education to Support HIV Self-Management in Limited-Resource Settings. J Nurs Scholarsh 2019; 51:168-177. [PMID: 30450740 PMCID: PMC6414238 DOI: 10.1111/jnu.12448] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2018] [Indexed: 01/30/2023]
Abstract
PURPOSE The purpose of this study was to identify and prioritize the information that persons living with HIV (PLWH) in a limited-resource setting need to effectively manage their health. DESIGN AND METHODS A data sources triangulation method was used to compare data from three separate sources: (a) 107 interviews with Spanish-speaking PLWH being seen at a healthcare clinic in the Dominican Republic (DR); (b) 40 interviews with Spanish-speaking healthcare providers from the same clinic in the DR; and (c) an integrative literature review of English- and Spanish-language articles that assessed the health information needs of PLWH in Latin America and the Caribbean. We compared information needs across sources and developed a prioritized list of the topics important to provide PLWH in a clinical setting. FINDINGS Triangulation identified the most important topics for HIV-related health education for PLWH as medication and adherence, followed by transmission, including risks and prevention strategies, mental health management, and knowledge of HIV in general. CONCLUSIONS The identification of evidence-based health education priorities establishes a guide that healthcare providers may use to help PLWH effectively manage their health and creates a foundation from which further studies on improving clinical interactions may be generated. CLINICAL RELEVANCE Using the priorities identified, nurses and other health educators can improve patient education, and consequently self-management, by making evidence-based choices about what information to provide to their patients.
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Affiliation(s)
- Samantha Stonbraker
- Alpha Zeta, Postdoctoral Fellow, Columbia University School of Nursing, New York, NY, USA, and Director of Research, Clínica de Familia La Romana, Dominican Republic
| | - Sheyla Richards
- MD/MS Global Health focus student, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Mina Halpern
- Executive Director, Clínica de Familia La Romana, Dominican Republic
| | - Suzanne Bakken
- Alpha Zeta, Alumni Professor of Nursing, and Professor of Biomedical Informatics, Columbia University, New York, NY, USA
| | - Rebecca Schnall
- Alpha Zeta, Mary Dickey Lindsay Assistant Professor of Disease Prevention and Health Promotion, Columbia University School of Nursing, New York, NY USA
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Stockdale L, Nash S, Nalwoga A, Gibson L, Painter H, Raynes J, Asiki G, Newton R, Fletcher H. HIV, HCMV and mycobacterial antibody levels: a cross-sectional study in a rural Ugandan cohort. Trop Med Int Health 2019; 24:247-257. [PMID: 30506614 PMCID: PMC6378403 DOI: 10.1111/tmi.13188] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES A growing evidence base implicates human cytomegalovirus (HCMV) as a risk factor for TB disease. We investigated total IgG and mycobacteria-specific antibodies in a cross-sectional study nested within a rural Ugandan General Population Cohort (GPC), in relation to HIV infection and the magnitude of HCMV IgG response. METHODS Sera from 2189 individuals (including 27 sputum-positive TB cases) were analysed for antibodies against mycobacteria (Ag85A, PPD, LAM, ESAT6/CFP10) and HCMV, tetanus toxoid (TT) and total IgG. RESULTS Anti-mycobacterial antibodies increased with age until approximately 20 years, when they plateaued. Higher HCMV exposure (measured by IgG) was associated with lower levels of some anti-mycobacterial antibodies, but no increase in total IgG. HIV infection was associated with a decrease in all anti-mycobacterial antibodies measured and with an increase in total IgG. CONCLUSIONS The increase in anti-mycobacterial antibodies with age suggests increasing exposure to non-tuberculous mycobacteria (NTM), and to M.tb itself. HIV infection is associated with decreased levels of all mycobacterial antibodies studied here, and high levels of HCMV IgG are associated with decreased levels of some mycobacterial antibodies. These findings point towards the importance of humoral immune responses in HIV/TB co-infection and highlight a possible role of HCMV as a risk factor for TB disease.
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Affiliation(s)
- Lisa Stockdale
- Faculty of Infectious and Tropical DiseasesLondon School of Hygiene and Tropical MedicineLondonUK
| | - Stephen Nash
- Faculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineLondonUK
| | - Angela Nalwoga
- Faculty of Infectious and Tropical DiseasesLondon School of Hygiene and Tropical MedicineLondonUK
- Medical Research Council/Uganda Virus Research InstituteEntebbeUganda
| | - Lorna Gibson
- Faculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineLondonUK
| | - Hannah Painter
- Faculty of Infectious and Tropical DiseasesLondon School of Hygiene and Tropical MedicineLondonUK
| | - John Raynes
- Faculty of Infectious and Tropical DiseasesLondon School of Hygiene and Tropical MedicineLondonUK
| | - Gershim Asiki
- African Population and Health Research CenterNairobiKenya
- Department of Women's and Children's HealthKarolinska InstitutetStockholmSweden
| | - Robert Newton
- Medical Research Council/Uganda Virus Research InstituteEntebbeUganda
- Department of Health SciencesUniversity of YorkYorkUK
- International Agency for Research on CancerLyonFrance
| | - Helen Fletcher
- Faculty of Infectious and Tropical DiseasesLondon School of Hygiene and Tropical MedicineLondonUK
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Alhaj M, Amberbir A, Singogo E, Banda V, van Lettow M, Matengeni A, Kawalazira G, Theu J, Jagriti MR, Chan AK, van Oosterhout JJ. Retention on antiretroviral therapy during Universal Test and Treat implementation in Zomba district, Malawi: a retrospective cohort study. J Int AIDS Soc 2019; 22:e25239. [PMID: 30734510 PMCID: PMC6367572 DOI: 10.1002/jia2.25239] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 12/19/2018] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Since June 2016, the national HIV programme in Malawi has adopted Universal Test and Treat (UTT) guidelines requiring that all persons who test HIV positive will be referred to start antiretroviral therapy (ART). Although there is strong evidence from clinical trials that early initiation of ART leads to reduced morbidity and mortality, the impact of UTT on retention on ART in real-life programmatic settings in Africa is not yet known. METHODS We conducted a retrospective cohort study in Zomba district, Malawi to compare ART outcomes of patients who initiated ART under 2016 UTT guidelines and those who started ART prior to rollout of UTT (pre-UTT). We analysed data from 32 rural and urban health facilities of various sizes. Cox proportional hazards modelling was used to determine the independent risk factors of attrition from ART at 12 months. All analyses were adjusted for clustering by health facility using a robust standard errors approach. RESULTS Among 1492 patients (mean age 34.4 years, 933 (63%) female) who initiated ART during the study period, 501 were enrolled in the pre-UTT cohort and 911 during UTT. At 12 months, retention on ART in the UTT cohort was higher than in the pre-UTT cohort 83.0% (95% confidence interval (CI): 81.0% to 85.0%) versus 76.2% (95% CI 73.9% to 78.5%). Adolescents, aged 10 to 19 years (adjusted hazard ratio (aHR) 1.53; 95% CI 1.01 to 2.32), and women who were pregnant or breastfeeding at ART initiation (aHR 1.87; 95% CI 1.30 to 2.38) were at higher risk of attrition in the combined pre-UTT and UTT cohort. CONCLUSIONS Retention on ART was nearly 6% higher after UTT introduction. Young adults and women who were pregnant or breastfeeding at the start of ART were at increased risk of attrition, emphasizing the need for targeted interventions for these groups to achieve the 90-90-90 UNAIDS targets in the UTT era.
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Affiliation(s)
- Mohammad Alhaj
- Dalla Lana School of Public HealthUniversity of TorontoTorontoCanada
- Dignitas InternationalZombaMalawi
| | - Alemayehu Amberbir
- Dalla Lana School of Public HealthUniversity of TorontoTorontoCanada
- Dignitas InternationalZombaMalawi
| | | | | | - Monique van Lettow
- Dalla Lana School of Public HealthUniversity of TorontoTorontoCanada
- Dignitas InternationalZombaMalawi
| | | | - Gift Kawalazira
- Zomba District Health OfficeMalawi Ministry of HealthZombaMalawi
| | - Joe Theu
- Dignitas InternationalZombaMalawi
| | | | - Adrienne K Chan
- Dalla Lana School of Public HealthUniversity of TorontoTorontoCanada
- Dignitas InternationalZombaMalawi
- Division of Infectious DiseasesSunnybrook Health Sciences CentreUniversity of TorontoTorontoCanada
| | - Joep J van Oosterhout
- Dignitas InternationalZombaMalawi
- Department of MedicineCollege of MedicineUniversity of MalawiBlantyreMalawi
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Castilho JL, Escuder MM, Veloso V, Gomes JO, Jayathilake K, Ribeiro S, Souza RA, Ikeda ML, de Alencastro PR, Tupinanbas U, Brites C, McGowan CC, Grangeiro A, Grinsztejn B. Trends and predictors of non-communicable disease multimorbidity among adults living with HIV and receiving antiretroviral therapy in Brazil. J Int AIDS Soc 2019; 22:e25233. [PMID: 30697950 PMCID: PMC6351749 DOI: 10.1002/jia2.25233] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 12/19/2018] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION People living with HIV (PLHIV) on antiretroviral therapy (ART) experience high rates of non-communicable diseases (NCDs). These co-morbidities often accumulate and older adults may suffer from multimorbidity. Multimorbidity has been associated with loss of quality of life, polypharmacy, and increased risk of frailty and mortality. Little is known of the trends or predictors NCD multimorbidity in PLHIV in low- and middle-income countries. METHODS We examined NCD multimorbidity in adult PLHIV initiating ART between 2003 and 2014 using a multi-site, observational cohort in Brazil. NCDs included cardiovascular artery disease, hyperlipidemia (HLD), diabetes, chronic kidney disease, cirrhosis, osteoporosis, osteonecrosis, venous thromboembolism and non-AIDS-defining cancers. Multimorbidity was defined as the incident accumulation of two or more unique NCDs. We used Poisson regression to examine trends and Cox proportional hazard models to examine predictors of multimorbidity. RESULTS Of the 6206 adults, 332 (5%) developed multimorbidity during the study period. Parallel to the ageing of the cohort, the prevalence of multimorbidity rose from 3% to 11% during the study period. Older age, female sex (adjusted hazard ratio (aHR) = 1.30 (95% confidence interval (CI) 1.03 to 1.65)) and low CD4 nadir (<100 vs. ≥200 cells/mm3 aHR = 1.52 (95% CI: 1.15 to 2.01)) at cohort entry were significantly associated with increased risk of multimorbidity. Among patients with incident multimorbidity, the most common NCDs were HLD and diabetes; however, osteoporosis was also frequent in women (16 vs. 35% of men and women with multimorbidity respectively). CONCLUSIONS Among adult PLHIV in Brazil, NCD multimorbidity increased from 2003 to 2014. Females and adults with low CD4 nadir were at increased risk in adjusted analyses. Further studies examining prevention, screening and management of NCDs in PLHIV in low- and middle-income countries are needed.
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Affiliation(s)
- Jessica L Castilho
- Division of Infectious DiseasesVanderbilt University Medical CenterNashvilleTNUSA
| | - Maria M Escuder
- São Paulo State Department of HealthInstitute of HealthSão PauloBrazil
| | - Valdiléa Veloso
- National Institute of Infectology – Evandro ChagasOswaldo Cruz FoundationRio de JaneiroBrazil
| | - Jackeline O Gomes
- São Paulo State Department of HealthInstitute of HealthSão PauloBrazil
| | - Karu Jayathilake
- Division of Infectious DiseasesVanderbilt University Medical CenterNashvilleTNUSA
| | - Sayonara Ribeiro
- National Institute of Infectology – Evandro ChagasOswaldo Cruz FoundationRio de JaneiroBrazil
| | - Rosa A Souza
- São Paulo State Department of HealthAIDS Reference and Training CenterSão PauloBrazil
| | - Maria L Ikeda
- School of HealthUniversity do Vale do Rio dos SinosPorto AlegreBrazil
| | - Paulo R de Alencastro
- Care and Treatment Clinic of the Partenon SanatoriumRio Grande do Sul State Department of HealthPorto AlegreBrazil
| | - Unai Tupinanbas
- Medical SchoolFederal University of Minas GeraisBelo HorizonteBrazil
| | - Carlos Brites
- Edgar Santos University Hospital ComplexFederal University of BahiaSalvadorBrazil
| | - Catherine C McGowan
- Division of Infectious DiseasesVanderbilt University Medical CenterNashvilleTNUSA
| | - Alexandre Grangeiro
- Department of Preventive MedicineUniversity of São Paulo School of MedicineSão PauloBrazil
| | - Beatriz Grinsztejn
- National Institute of Infectology – Evandro ChagasOswaldo Cruz FoundationRio de JaneiroBrazil
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Macías J, Téllez F, Rivero-Juárez A, Palacios R, Morano LE, Merino D, Collado A, García-Fraile L, Omar M, Pineda JA. Early emergence of opportunistic infections after starting direct-acting antiviral drugs in HIV/HCV-coinfected patients. J Viral Hepat 2019; 26:48-54. [PMID: 30199593 DOI: 10.1111/jvh.13003] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 07/19/2018] [Accepted: 08/15/2018] [Indexed: 12/14/2022]
Abstract
Varicella-zoster virus and hepatitis B virus reactivations have been reported after starting interferon-free direct-acting antiviral agent (DAA) combinations. HIV/HCV-coinfected patients could be a high-risk group for the reactivation of latent infections. Because of these, we report the occurrence of severe infections after starting DAA regimens in HIV/HCV-coinfected patients. Individuals included in the HEPAVIR-DAA (NCT02057003) cohort were selected if they had received all-oral DAA combinations. A retrospective review of clinical events registered between the start of DAAs and 12 months after SVR12 was carried out. Overall, 38 (4.5%) of 848 patients presented infections. The incidence (95% confidence interval) of infections was 4.6 (3.3-6.3) cases per 100 person-years. The median (Q1-Q3) time to the infection since baseline was 23 (7.3-33) weeks. Five (13%) of the patients with infections died; four of them had cirrhosis. The frequency of previous AIDS was 21 (54%) for patients with infections and 324 (40%) for those without infections (P = 0.084). The median (Q1-Q3) nadir CD4 cell count of individuals with and without infections was 75 (53-178) and 144 (67-255) cells/μL, respectively (P = 0.047). Immunodepression-associated infections were observed in 9 (1.1%) patients. All of them had suppressed HIV replication with antiretroviral therapy. In conclusion, severe infections are relatively common among HIV/HCV-coinfected patients receiving all-oral DAA combinations. Some unusual reactivations of latent infections in patients with suppressed HIV replication seem to be temporally linked with DAA use.
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Affiliation(s)
- Juan Macías
- Infectious Diseases and Microbiology Unit, Hospital Universitario de Valme, Seville, Spain
| | - Francisco Téllez
- Infectious Diseases and Microbiology Unit, Hospital Universitario de Puerto Real, Instituto de Investigación e Innovación en Ciencias Biomédicas de la Provincia de Cádiz (INiBICA), Cadiz, Spain
| | - Antonio Rivero-Juárez
- Instituto Maimonides de Investigación Biomedica de Córdoba (IMIBIC), Hospital Universitario Reina Sofia, Cordoba, Spain
| | - Rosario Palacios
- Infectious Diseases, Microbiology and Preventive Medicine Unit, Hospital Universitario Virgen de la Victoria, Malaga, Spain
| | - Luis E Morano
- Infectious Diseases Unit, Hospital Universitario Alvaro Cunqueiro, Vigo, Spain
| | - Dolores Merino
- Infectious Diseases Unit, Hospital Juan Ramón Jiménez, Huelva, Spain
| | - Antonio Collado
- Infectious Diseases Unit, Hospital Torrecárdenas, Almeria, Spain
| | - Lucio García-Fraile
- Infectious Diseases-Internal Medicine Service, Hospital Universitario de la Princesa, Madrid, Spain
| | - Mohamed Omar
- Infectious Diseases Unit, Hospital de Jaen, Jaen, Spain
| | - Juan A Pineda
- Infectious Diseases and Microbiology Unit, Hospital Universitario de Valme, Seville, Spain
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Kiros YK, Elinav H, Gebreyesus A, Gebremeskel H, Azar J, Chemtob D, Abreha H, Elbirt D, Shahar E, Chowers M, Turner D, Grossman Z, Haile A, Sutton RE, Maayan SL, Wolday D. Identification and characterization of HIV positive Ethiopian elite controllers in both Africa and Israel. HIV Med 2019; 20:33-37. [PMID: 30318718 PMCID: PMC6510948 DOI: 10.1111/hiv.12680] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES HIV elite controllers (ECs) are a unique subgroup of HIV-positive patients who are long-term virologically suppressed in the absence of antiretroviral treatment (ART). The prevalence of this subgroup is estimated to be < 1%. Various cohorts of ECs have been described in developed countries, most of which have been demographically heterogeneous. The aim of this study was to identify ECs in two large African cohorts and to estimate their prevalence in a relatively genetically homogenous population. METHODS We screened two cohorts of HIV-positive Ethiopian patients. The first cohort resided in Mekelle, Ethiopia. The second was comprised of HIV-positive Ethiopian immigrants in Israel. In the Mekelle cohort, ART-naïve subjects with stable CD4 counts were prospectively screened using two measurements of viral load 6 months apart. Subjects were defined as ECs when both measurements were undetectable. In the Israeli cohort, subjects with consistently undetectable viral loads (mean of 17 viral load measurements/patient) and stable CD4 count > 500 cells/μL were defined as ECs. RESULTS In the Mekelle cohort, 16 of 9515 patients (0.16%) fitted the definition of EC, whereas seven of 1160 (0.6%) in the Israeli cohort were identified as ECs (P = 0.011). CONCLUSIONS This is the first large-scale screening for HIV-positive ECs to be performed in entirely African cohorts. The overall prevalence of ECs is within the range of that previously described in developing countries. The significant difference in prevalence between the two cohorts of similar genetic background is probably a consequence of selection bias but warrants further investigation into possible environmental factors which may underlie the EC state.
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Affiliation(s)
- Y K Kiros
- Mekelle University College of Health Sciences, Mekelle, Tigray, Ethiopia
| | - H Elinav
- Clinical Microbiology and Infectious Diseases Department, Hadassah University Medical Center, Jerusalem, Israel
| | - A Gebreyesus
- Mekelle University College of Health Sciences, Mekelle, Tigray, Ethiopia
| | - H Gebremeskel
- Mekelle University College of Health Sciences, Mekelle, Tigray, Ethiopia
| | - J Azar
- Internal Medicine Division, Hadassah University Medical Center, Jerusalem, Israel
| | - D Chemtob
- Department of Tuberculosis and AIDS, Ministry of Health, Jerusalem, Israel
| | - H Abreha
- Mekelle University College of Health Sciences, Mekelle, Tigray, Ethiopia
| | - D Elbirt
- The Allergy, Clinical Immunology and AIDS Unit, Kaplan Medical Center, Rehovot, Israel
| | - E Shahar
- Institute of Allergy, Immunology and AIDS Rambam Medical Center, Haifa, Israel
| | - M Chowers
- Infectious Diseases Unit, Meir Medical Center, Kfar Saba, Israel
| | - D Turner
- Crusaid Kobler AIDS Center, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Z Grossman
- Clinical Microbiology and Infectious Diseases Department, Hadassah University Medical Center, Jerusalem, Israel
| | - A Haile
- Mekelle University College of Health Sciences, Mekelle, Tigray, Ethiopia
| | - R E Sutton
- Division of Infectious Diseases, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - S L Maayan
- Division of Infectious Diseases, Barzilai Medical Center, Ashkelon, Israel
| | - D Wolday
- Mekelle University College of Health Sciences, Mekelle, Tigray, Ethiopia
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Tuthill EL, Tomori C, Van Natta M, Coleman JS. "In the United States, we say, 'No breastfeeding,' but that is no longer realistic": provider perspectives towards infant feeding among women living with HIV in the United States. J Int AIDS Soc 2019; 22:e25224. [PMID: 30657639 PMCID: PMC6338297 DOI: 10.1002/jia2.25224] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 12/05/2018] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Currently, the United States (U.S.) recommends that infants born to women living with HIV (WLHIV) be fed formula, whereas many low-resource settings follow the World Health Organization's recommendation to exclusively breastfeed with ongoing antiretroviral therapy. Evidence on infant feeding among WLHIV in high-resource countries suggest that these contrasting recommendations create challenges for providers and patients. Our study used multiple methods to understand providers' infant feeding perspectives on caring for their pregnant and post-partum WLHIV in the U.S. METHODS We sent a survey (n = 93) to providers across the U.S. who have cared for WLHIV. A subset of survey participants opted into a follow-up qualitative interview (n = 21). These methods allowed us to capture a broad understanding of provider attitudes via the survey and more nuanced qualitative interviews. The study was completed prior to an updated breastfeeding section of the U.S. Perinatal Guidelines. RESULTS The majority of providers (66.7%) discussed infant feeding intent with their patients using open-ended questions. Many also discussed alternative feeding methods (37.6%) and disclosure avoidance strategies (34.4%). Over 75% (95% confidence interval (CI): 65.1 to 84.2) of participants reported that a WLHIV asked if she could breastfeed her child, and 29% (95% CI 20 to 40.3) reported caring for a patient who breastfed despite recommendations against breastfeeding. Providers reported that their patients' primary concern was stigma associated with not breastfeeding (58%), while providers were primarily concerned about medication adherence during breastfeeding (70%). Through qualitative analysis, four overarching categories emerged that reflect providers' sentiments, including (1) U.S. guidelines inadequately addressing WLHIV's desire to breastfeed; (2) negotiating patient autonomy amidst complex feeding situations; (3) harm reduction approaches to supporting WLHIV in breastfeeding; and (4) providers anticipating multilayered patient stigmatization. CONCLUSIONS The majority of provider respondents cared for a WLHIV who desired to breastfeed, and a third had WLHIV who breastfed despite recommendations against it. Providers found that the status of U.S. guidelines and their incongruity with WHO guidelines left them without adequate resources to support WLHIV's infant feeding decisions. Our findings provide important insight to inform professional associations' discussions about public health policy as they consider future directions for infant feeding guidelines among WLHIV.
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Affiliation(s)
- Emily L Tuthill
- Department of Community Health SystemsSchool of Nursing University of CaliforniaSan FranciscoCAUSA
| | - Cecilia Tomori
- Department of AnthropologyDurham UniversityDurhamUK
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - Meredith Van Natta
- Department of Social and Behavioral SciencesUniversity of CaliforniaSan FranciscoCAUSA
| | - Jenell S Coleman
- Department of Gynecology/ObstetricsJohns Hopkins University School of MedicineBaltimoreMDUSA
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Ong JJ, Walker S, Grulich A, Hoy J, Read TRH, Bradshaw C, Chen M, Garland SM, Hillman R, Templeton DJ, Hocking J, Eu B, Tee BK, Chow EPF, Fairley CK. Incorporating digital anorectal examinations for anal cancer screening into routine HIV care for men who have sex with men living with HIV: a prospective cohort study. J Int AIDS Soc 2018; 21:e25192. [PMID: 30516346 PMCID: PMC6280647 DOI: 10.1002/jia2.25192] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 09/11/2018] [Accepted: 09/18/2018] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Men who have sex with men (MSM) living with HIV have a high risk of anal cancer, which is often detected at late stages, when morbidity and mortality are high. The objective of this study was to describe the feasibility and challenges to incorporating regular digital anorectal examination (DARE) into routine HIV care for MSM living with HIV, from the perspective of patients, physicians and the health service. METHODS In 2014, we recruited 327 MSM living with HIV, aged 35 and above from one major sexual health centre (n = 187), two high HIV caseload general practices (n = 118) and one tertiary hospital (n = 22) in Melbourne, Australia. Men were followed up for two years and DARE was recommended at baseline, year 1 and year 2. Data were collected regarding patient and physician experience, and health service use. An ordered logit model was used to assess the relationship between sociodemographic factors and the number of DAREs performed. RESULTS Mean age of men was 51 (SD ± 9) years, 69% were Australian born, 32% current smokers, and mean CD4 was 630 (SD ± 265) cells per mm3 , with no significant differences between clinical sites. Overall, 232 (71%) men received all three DAREs, 71 (22%) received two DAREs, and 24 (7%) had one DARE. Adverse outcomes were rarely reported: anal pain (1.2% of total DAREs), bleeding (0.8%) and not feeling in control of their body during the examination (1.6%). Of 862 DAREs performed, 33 (3.8%) examinations resulted in a referral to a colorectal surgeon. One Stage 1 anal cancer was detected. CONCLUSION Incorporation of an early anal cancer detection programme into routine HIV clinical care for MSM living with HIV showed high patient acceptability, uncommon adverse outcomes and specialist referral patterns similar to other cancer screening programmes.
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Affiliation(s)
- Jason J Ong
- Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
- London School of Hygiene and Tropical MedicineLondonUK
- Melbourne Sexual Health CentreAlfred HealthCarltonVictoriaAustralia
| | - Sandra Walker
- Melbourne Sexual Health CentreAlfred HealthCarltonVictoriaAustralia
| | - Andrew Grulich
- Kirby InstituteUniversity of New South WalesSydneyNew South WalesAustralia
| | - Jennifer Hoy
- Department of Infectious DiseasesAlfred Hospital and Monash UniversityMelbourneVictoriaAustralia
| | - Tim RH Read
- Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
- Melbourne Sexual Health CentreAlfred HealthCarltonVictoriaAustralia
| | - Catriona Bradshaw
- Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
- Melbourne Sexual Health CentreAlfred HealthCarltonVictoriaAustralia
| | - Marcus Chen
- Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
- Melbourne Sexual Health CentreAlfred HealthCarltonVictoriaAustralia
| | - Suzanne M Garland
- Department of Obstetrics and GynaecologyDepartment of Microbiology in Infectious DiseasesUniversity of MelbourneRoyal Women's HospitalMurdoch Children's Research InstituteParkvilleVictoriaAustralia
| | - Richard Hillman
- HIV, Immunology and Infectious DiseaseSt Vincent's HospitalDarlinghurstNew South WalesAustralia
| | - David J Templeton
- Kirby InstituteUniversity of New South WalesSydneyNew South WalesAustralia
- RPA Sexual HealthSydney Local Health DistrictSydney Medical SchoolThe University of SydneySydneyNew South WalesAustralia
| | - Jane Hocking
- Melbourne School of Population and Global HealthUniversity of MelbourneParkvilleVictoriaAustralia
| | - Beng Eu
- Prahran Market ClinicPrahranVictoriaAustralia
| | - Bian Kiem Tee
- The Centre ClinicVictorian AIDS CouncilSt KildaVictoriaAustralia
| | - Eric P F Chow
- Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
- Melbourne Sexual Health CentreAlfred HealthCarltonVictoriaAustralia
| | - Christopher K Fairley
- Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
- Melbourne Sexual Health CentreAlfred HealthCarltonVictoriaAustralia
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Nouaman MN, Vinikoor M, Seydi M, Ekouevi DK, Coffie PA, Mulenga L, Tanon A, Egger M, Dabis F, Jaquet A, Wandeler G. High prevalence of binge drinking among people living with HIV in four African countries. J Int AIDS Soc 2018; 21:e25202. [PMID: 30549445 PMCID: PMC6294116 DOI: 10.1002/jia2.25202] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 10/08/2018] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Excessive alcohol consumption leads to unfavourable outcomes in people living with HIV (PLHIV), including reduced adherence to antiretroviral therapy (ART) and engagement into care. However, there is limited information on alcohol consumption patterns among PLHIV in sub-Saharan Africa. METHODS Using a cross-sectional approach, the Alcohol Use Disorders Identification Test (AUDIT-C) was administered to PLHIV attending HIV clinics in Côte d'Ivoire, Togo, Senegal and Zambia (2013 to 2015). Hazardous drinking was defined as an AUDIT-C score ≥4 for men or ≥3 for women, and binge drinking as ≥6 drinks at least once per month. The prevalence of binge drinking was compared to estimates from the general population using data from the World Health Organization. Factors associated with binge drinking among persons declaring any alcohol use in the past year were assessed using a logistic regression model to estimate odds ratio (OR) and their corresponding 95% confidence intervals (CI). RESULTS Among 1824 PLHIV (median age 39 years, 62.8% female), the prevalence of hazardous alcohol use ranged from 0.9% in Senegal to 38.4% in Zambia. The prevalence of binge drinking ranged from 14.3% among drinkers in Senegal to 81.8% in Zambia, with higher estimates among PLHIV than in the general population. Male sex (OR 2.4, 95% CI 1.6 to 3.7), tobacco use (OR 1.7, 95% CI 1.0 to 2.9) and living in Zambia were associated with binge drinking. CONCLUSIONS Alcohol consumption patterns varied widely across settings and binge drinking was more frequent in HIV-positive individuals compared to the general population. Interventions to reduce excessive alcohol use are urgently needed to optimize adherence in the era of universal ART.
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Affiliation(s)
| | - Michael Vinikoor
- Department of MedicineUniversity of Alabama at BirminghamBirminghamALUSA
- Centre for Infectious Disease Research in Zambia (CIDRZ)LusakaZambia
| | - Moussa Seydi
- Service de maladies infectieuses et tropicalesCRCF, CHU de FannDakarSénégal
| | - Didier K Ekouevi
- Programme PACCICHU de TreichvilleAbidjanCôte d'Ivoire
- INSERM U1219 Bordeaux Population Health ResearchISPEDUniversité de BordeauxBordeauxFrance
- Département de santé publiqueFaculté des Sciences de la santéUniversité de LoméLoméTogo
| | - Patrick A Coffie
- Programme PACCICHU de TreichvilleAbidjanCôte d'Ivoire
- CHU de TreichvilleService de maladies infectieuses et tropicalesAbidjanCôte d'Ivoire
| | - Lloyd Mulenga
- University Teaching HospitalLusakaZambia
- Zambia Ministry of HealthLusakaZambia
| | - Aristophane Tanon
- CHU de TreichvilleService de maladies infectieuses et tropicalesAbidjanCôte d'Ivoire
| | - Matthias Egger
- Institute of Social and Preventive MedicineUniversity of BernBernSwitzerland
- Centre for Infectious Diseases Epidemiology and ResearchUniversity of Cape TownCape TownSouth Africa
| | - François Dabis
- INSERM U1219 Bordeaux Population Health ResearchISPEDUniversité de BordeauxBordeauxFrance
| | - Antoine Jaquet
- INSERM U1219 Bordeaux Population Health ResearchISPEDUniversité de BordeauxBordeauxFrance
| | - Gilles Wandeler
- Service de maladies infectieuses et tropicalesCRCF, CHU de FannDakarSénégal
- Institute of Social and Preventive MedicineUniversity of BernBernSwitzerland
- Department of Infectious DiseasesBern University HospitalUniversity of BernBernSwitzerland
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50
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Kariminia A, Law M, Davies M, Vinikoor M, Wools‐Kaloustian K, Leroy V, Edmonds A, McGowan C, Vreeman R, Fairlie L, Ayaya S, Yotebieng M, Takassi E, Pinto J, Adedimeji A, Malateste K, Machado DM, Penazzato M, Hazra R, Sohn AH. Mortality and losses to follow-up among adolescents living with HIV in the IeDEA global cohort collaboration. J Int AIDS Soc 2018; 21:e25215. [PMID: 30548817 PMCID: PMC6291755 DOI: 10.1002/jia2.25215] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 11/15/2018] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION We assessed mortality and losses to follow-up (LTFU) during adolescence in routine care settings in the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium. METHODS Cohorts in the Asia-Pacific, the Caribbean, Central, and South America, and sub-Saharan Africa (Central, East, Southern, West) contributed data, and included adolescents living with HIV (ALHIV) enrolled from January 2003 and aged 10 to 19 years (period of adolescence) while under care up to database closure (June 2016). Follow-up started at age 10 years or the first clinic visit, whichever was later. Entering care at <15 years was a proxy for perinatal infection, while entering care ≥15 years represented infection acquired during adolescence. Competing risk regression was used to assess associations with death and LTFU among those ever receiving triple-drug antiretroviral therapy (triple-ART). RESULTS Of the 61,242 ALHIV from 270 clinics in 34 countries included in the analysis, 69% (n = 42,138) entered care <15 years of age (53% female), and 31% (n = 19,104) entered care ≥15 years (81% female). During adolescence, 3.9% died, 30% were LTFU and 8.1% were transferred. For those with infection acquired perinatally versus during adolescence, the four-year cumulative incidences of mortality were 3.9% versus 5.4% and of LTFU were 26% versus 69% respectively (both p < 0.001). Overall, there were higher hazards of death for females (adjusted sub-hazard ratio (asHR) 1.19, 95% confidence interval (CI) 1.07 to 1.33), and those starting treatment at ≥5 years of age (highest asHR for age ≥15: 8.72, 95% CI 5.85 to 13.02), and in care in mostly urban (asHR 1.40, 95% CI 1.13 to 1.75) and mostly rural settings (asHR 1.39, 95% CI 1.03 to 1.87) compared to urban settings. Overall, higher hazards of LTFU were observed among females (asHR 1.12, 95% CI 1.07 to 1.17), and those starting treatment at age ≥5 years (highest asHR for age ≥15: 11.11, 95% CI 9.86 to 12.53), in care at district hospitals (asHR 1.27, 95% CI 1.18 to 1.37) or in rural settings (asHR 1.21, 95% CI 1.13 to 1.29), and starting triple-ART after 2006 (highest asHR for 2011 to 2016 1.84, 95% CI 1.71 to 1.99). CONCLUSIONS Both mortality and LTFU were worse among those entering care at ≥15 years. ALHIV should be evaluated apart from younger children and adults to identify population-specific reasons for death and LTFU.
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Affiliation(s)
| | - Matthew Law
- The Kirby InstituteUNSW SydneySydneyAustralia
| | - Mary‐Ann Davies
- Centre for Infectious Disease Epidemiology and ResearchUniversity of Cape TownCape TownSouth Africa
| | | | | | | | - Andrew Edmonds
- The University of North Carolina at Chapel HillChapel HillNCUSA
| | | | | | - Lee Fairlie
- Wits Reproductive Health and HIV InstituteJohannesburgSouth Africa
| | - Samuel Ayaya
- Moi University College of Health SciencesEldoretKenya
| | | | | | - Jorge Pinto
- Federal University of Minas GeraisBelo HorizoneBrazil
| | | | | | | | | | - Rohan Hazra
- Eunice Kennedy Shriver National Institute of Child Health and Human DevelopmentBethesdaMDUSA
| | - Annette H Sohn
- TREAT Asia/amfARThe Foundation for AIDS ResearchBangkokThailand
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