• Extremely Low Hepatitis C prevalence among HIV co-infected individuals in 4 countries in sub-Saharan Africa

      Loarec, A; Carnimeo, V; Molfino, L; Kizito, W; Muyindike, W; Andrieux-Meyer, I; Balkan, S; Nzomukunda, Y; Mwanga-Amumpaire, J; Ousley, J; Bygrave, H; Maman, D (Lippincott, Williams & Wilkins, 2018-11-16)
      : A multicentric, retrospective case-series analysis (facility-based) in five sites across Kenya, Malawi, Mozambique, and Uganda screened HIV-positive adults for hepatitis C virus (HCV) antibodies using Oraquick rapid testing and viral confirmation (in three sites). Results found substantially lower prevalence than previously reported for these countries compared with previous reports, suggesting that targeted integration of HCV screening in African HIV programs may be more impactful than routine screening.This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0.
    • The impact of lay counselors on HIV testing rates: Quasi-experimental evidence from lay counselor redeployment in KwaZulu-Natal, South Africa

      Hu, J; Geldsetzer, P; Steele, SJ; Matthews, P; Ortblad, K; Solomon, T; Shroufi, A; van Cutsem, G; Tanser, F; Wyke, S; Vollmer, S; Pillay, D; Mcconnell, M; Bärnighausen, T (Lippincott Williams & Wilkins, 2018-06-14)
      This study aimed to determine the causal effect of the number of lay counselors employed at a primary care clinic in rural South Africa on the number of clinic-based HIV tests performed.
    • Is it safe to drop CD4+ monitoring among virologically suppressed patients: a cohort evaluation from Khayelitsha, South Africa

      Ford, Nathan; Stinson, Kathryn; Davies, Mary-Ann; Cox, Vivian; Patten, Gabriela; Cragg, Carol; Van Cutsem, Gilles; Boulle, Andrew (Lippincott Williams & Wilkins, 2014-09-10)
    • Outcomes After Virologic Failure of First-Line ART in South Africa

      Murphy, Richard A; Sunpath, Henry; Lu, Zhigang; Chelin, Neville; Losina, Elena; Gordon, Michelle; Ross, Douglas; Ewusi, Aba D; Matthews, Lynn T; Kuritzkes, Daniel R; Marconi, Vincent C; Operational Support Unit, Doctors Without Borders, New York, New York; McCord Hospital, Durban, South Africa; Massachusetts General Hospital, Boston, Massachusetts, USA; Nelson Mandela School of Medicine, Durban; St. Mary’s Hospital, Mariannhill, South Africa; Harvard Medical School; Division of Infectious Diseases, Beth Israel Deaconess Medical Center; Section of Retroviral Therapeutics, Brigham and Women’s Hospital, Boston, Massachusetts; Infectious Disease Service, San Antonio Military Medical Center, Fort Sam Houston, Texas; Emory University School of Medicine, Atlanta, Georgia, USA (2010-04-24)
      To determine initial 24-week outcomes among prospectively enrolled patients with failure of initial antiretroviral therapy (ART).
    • Simplifying switch to second line ART: Predicted effect of defining failure of first-line efavirenz-based regimens in sub-Saharan Africa by a single viral load > 1000 copies/ml.

      Shroufi, A; Van Custem, G; Cambiano, V; Bansi-Matharu, L; Duncan, K; Murphy, RA; Maman, D; Phillips, A (Wolters Kluwer Health, 2019-04-16)
      BACKGROUND: Many individuals failing first-line antiretroviral therapy (ART) in sub-Saharan Africa never initiate second-line antiretroviral treatment (ART) or do so after significant delay. For people on ART with a viral load (VL) > 1000 copies/ml, the World Health Organization (WHO) recommends a second VL measurement 3 months after the first VL and enhanced adherence support. Switch to a second-line regimen is contingent upon a persistently elevated VL > 1000 copies/ml. Delayed second-line switch places patients at increased risk for opportunistic infections and mortality. METHODS: To assess the potential benefits of a simplified second-line ART switch strategy, we use an individual-based model of HIV transmission, progression and the effect of ART which incorporates consideration of adherence and drug resistance to compare predicted outcomes of 2 policies, defining 1st-line regimen failure for patients on efavirenz based ART as either (i) two consecutive VL values > 1000 copies/ml, with the second after an enhanced adherence intervention (implemented as per current WHO guidelines) or (ii) a single VL value > 1000 copies/ml. We simulated a range of setting-scenarios reflecting the breadth of the sub-Saharan African HIV epidemic, taking into account potential delays in defining failure and switch to second line ART. FINDINGS: The use of a single VL > 1000 copies/ml to define ART failure would lead to a higher proportion of persons with NNRTI resistance switched to second-line ART (65% vs 48%; difference 17% [90% range 14% - 20%]), resulting in a median 18% reduction in the rate of AIDS-related death over setting scenarios (90% range 6% - 30%; from a median of 3·1 to 2·5 per 100 person years) over 3 years. The simplified strategy also is predicted to reduce the rate of AIDS conditions by a median of 31% (90% Range 8% - 49%) among people on 1st line ART with a viral load > 1000 copies/ml in the past 6 months. For a country of 10 million adults (and a median of 880,000 people with HIV), we estimate that this approach would lead to a median of 1,322 (90% range 67 to 3,513) AIDS deaths averted per year over three years. For South Africa this would represent around 10,215 deaths averted annually. INTERPRETATION: As a step towards reducing unnecessary mortality associated with delayed second line ART switch, defining failure of first-line efavirenz-based regimens as a single VL>1000 copies/ml should be considered. FUNDING: No specific funding was obtained for the analysis or writing of this manuscript.