• Burden, characteristics, management and outcomes of HIV-infected patients with Kaposi's sarcoma in Zomba, Malawi

      Mwinjiwa, E.; Isaakidis, P.; Van den Bergh, R.; Harries, A. D.; Bezanson, K. D.; Beyene, T.; Thompson, C.; Joshua, M.; Akello, H.; van Lettow, M. (Public Health Action, 2013-06-21)
    • Did the 2014 Ebola Outbreak in Liberia Affect HIV Testing, Linkage to Care and ART Initiation?

      Jacobs, G; Bhat, P; Owiti, P; Edwards, J; Tweya, H; Najjemba, R (International Union Against Tuberculosis and Lung Disease, 2017-06-21)
      Setting: Health facilities providing human immunodeficiency virus (HIV) testing, care and treatment in Liberia. Objective: To evaluate individuals aged ⩾15 years who were tested, diagnosed and enrolled into HIV care before (2013), during (2014) and after the Ebola outbreak (2015). Design: A cross-sectional descriptive study. Results: A median of 6930 individuals aged ⩾15 years per county were tested for HIV before the Ebola outbreak; this number declined by 35% (2444/6930) during the outbreak. HIV positivity remained similar before (7028/207 314, 3.4%) and during the outbreak (4146/121 592, 3.5%). During Ebola, HIV testing declined more in highly affected counties (68 035/127 468, 47%) than in counties that were less affected (16 444/23 955, 31%, P < 0.001). Compared to the pre-Ebola period, HIV testing in less-affected counties recovered more quickly during the post-outbreak period, with a 19% increase in testing, while medium and highly affected counties remained at respectively 38% and 48% below pre-outbreak levels. Enrolment for HIV care increased during and after the outbreak compared to the pre-Ebola period. Conclusion: HIV testing and diagnosis were significantly limited during the Ebola outbreak, with the most severe effects occurring in highly affected counties. However, enrolment for HIV care and treatment were resilient throughout the outbreak. Pro-active measures are needed to sustain HIV testing rates in future epidemics.
    • HIV Testing and Retention in Care of Infants Born to HIV- Infected Women Enrolled in 'Option B+', Thyolo, Malawi

      Martínez Pérez, G; Metcalf, C; Garone, D; Coulborn, R; Harries, A D; Hedt-Gauthier, B; Murowa, M; Mwenelupembe, GS; Van den Bergh, R; Triviño Durán, L (International Union Against Tuberculosis and Lung Disease, 2014-06-21)
      Prevention of mother-to-child transmission 'Option B+' originated in Malawi in 2011 to prevent new infections in infants exposed to the human immunodeficiency virus (HIV). We assessed 12-month programme retention and HIV testing uptake among infants born to HIV-infected mothers from September 2011 to June 2012 in Thyolo District Hospital. Of 513 infants, 368 (71.7%) remained in care at 12 months. Altogether, 412 (80.3%) underwent HIV DNA polymerase chain reaction testing, with 267 (52.0%) tested at 6-12 weeks, and 255 (49.7%) underwent rapid HIV testing, with 144 (28.1%) tested at 12 months. Eighty-eight (17.2%) infants had both tests as scheduled. Measures are needed to improve adherence to national testing protocols.
    • HIV testing and retention in care of infants born to HIV-infected women enrolled in 'Option B+', Thyolo, Malawi

      Perez, G. Martinez; Metcalf, C.; Garone, D.; Coulborn, R.; Harries, A. D.; Hedt-Gauthier, B.; Murowa, M.; Mwenelupembe, G. S.; Van den Bergh, R.; Duran, L. Triviño (The Union, 2014-06-21)
    • IPT during HIV treatment in Myanmar: high rates of coverage, completion and drug adherence

      Ousley, J; Soe, KP; Kyaw, NTT; Anicete, R; Mon, PE; Lwin, H; Win, T; Cristofani, S; Telnov, A; Fernandez, M; et al. (International Union Against Tuberculosis and Lung Disease, 2018-03-21)
      Setting: A southern Myanmar district providing isoniazid preventive therapy (IPT) in one of the last countries to formally recommend it as part of human immunodeficiency virus (HIV) care.Objective:To assess coverage and adherence and the feasibility of IPT scale-up in a routine care setting in Myanmar.Design:A retrospective analysis of people living with HIV (PLHIV) screened for tuberculosis (TB) and enrolled in IPT over a 3-year period (July 2011-June 2014) using clinical databases.Results:Among 3377 patients under HIV care and screened for TB, 2740 (81.1%) initiated IPT, with 2651 (96.8%) completing a 6- or 9-month course of IPT; 83 (3.1%) interrupted treatment for different reasons, including loss to follow-up (n= 41), side effects (n= 15) or drug adherence issues (n= 9); 6 (0.2%) died. Among the IPT patients, 33 (1.2%) were diagnosed with TB, including 9 (0.3%) while on IPT and 24 (0.9%) within 1 year of completion of therapy. Among the PLHIV who completed IPT, one case of isoniazid resistance was detected.Conclusion:Scaling up IPT in Myanmar HIV settings is feasible with high rates of drug adherence and completion, and a low rate of discontinuation due to side effects. IPT scale-up should be prioritised in HIV clinical settings in Myanmar.
    • Retention and sustained viral suppression in HIV patients transferred to community refill centres in Kinshasa, DRC

      Moudachirou, R; van Cutsem, G; Chuy, RI; Tweya, H; Senkoro, M; Mabhala, M; Zolfo, M (International Union Against Tuberculosis and Lung Disease, 2020-03-21)
      Setting: In 2010, Médecins Sans Frontières set up decentralised community antiretroviral therapy (ART) refill centres ("poste de distribution communautaire", PODI) for the follow-up of stable human immunodeficiency virus (HIV) patients. Objective: To assess retention in care and sustained viral suppression after transfer to three main PODI in Kinshasa, Democratic Republic of Congo (DRC) (PODI Barumbu/Central, PODI Binza Ozone/West and PODI Masina I/East). Design: Retrospective cohort study using routine programme data for adult HIV patients transferred from Kabinda Hospital to PODIs between January 2015 and June 2017. Results: A total of 337 patients were transferred to PODIs: 306 (91%) were on ART for at least 12 months; 118 (39%) had a routine "12-month" viral load (VL) done, 93% (n = 110) of whom had a suppressed VL <1000 copies/ml. Median time from enrolment into PODI to 12-month routine VL was 14.6 months (IQR 12.2-20.8). Kaplan-Meier estimates of retention in care at 6, 12 and 18 months after enrolment into PODIs were respectively 96%, 92% and 88%. Conclusion: Retention in care and viral suppression among patients in PODI with VL results were better than patients in clinic care and national outcomes.
    • Scaling up HIV viral load monitoring in Manicaland, Zimbabwe: challenges and opportunities from the field

      Nyagadza, B; Kudya, N; Mbofana, E; Masaka, S; Garone, D; Chen, CY; Mulingwa, A; Uzande, C; Isaakidis, P; Ndlovu, Z (International Union Against Tuberculosis and Lung Disease, 2019-12-21)
      Background: Demand for viral load (VL) monitoring is expected to increase; however, implementation of the multifaceted VL testing poses numerous challenges. We report experiences from Médecins Sans Frontiéres (MSF) and partners in the scale-up of HIV VL in collaboration with the Ministry of Health and Child Care (MoHCC) of Zimbabwe. Methods: A retrospective data review of routine reports from MSF-supported health facilities in Manicaland Province (Zimbabwe) was conducted. These secondary aggregate data were triangulated, and emerging themes of lessons learnt from VL monitoring were shared. Results: A VL testing coverage of 63% (5966/9456) was achieved among the 40 health facilities, together with a switch rate to second-line antiretroviral therapy (ART) of 46.4% (108/233). The key enablers to scaling-up the VL monitoring were well-equipped and supported VL laboratories, the operationalisation of the on-the-job clinical mentoring and systematic weaning off of better performing health facilities. Concerted efforts from different implementing partners and funders in the HIV programme, and close collaboration with MoHCC were pivotal. Conclusion: Our experience indicates that clinical mentoring is effective, and resulted in high VL testing coverage and up-skilling primary health care workers in VL monitoring. Attention must be focused on innovations for improving VL result utilisation, especially the identification and management of patients who fail ART.
    • Southern African HIV Clinicians Society guidelines for antiretroviral therapy in adults: 2020 update

      Nel, J; Dlamini, S; Meintjes, G; Burton, R; Black, JM; Davies, NECG; Hefer, E; Maartens, G; Mangena, PM; Mathe, MT; et al. (International Union Against Tuberculosis and Lung Disease, 2020-09-16)