• Field suitability and diagnostic accuracy of the Biocentric open real-time PCR platform for plasma-based HIV viral load quantification in Swaziland

      Kerschberger, B; Mpala, Q; Uribe, PAD; Maphalala, G; de la Tour, R; Kalombola, S; Bekele, A; Chawinga, T; Mliba, M; Ntshalintshali, N; Phugwayo, N; Kabore, SM; Goiri, J; Dlamini, S; Ciglenecki, I; Fajardo, E (BMC, 2018-11-14)
      Viral load (VL) testing is being scaled up in resource-limited settings. However, not all commercially available VL testing methods have been evaluated under field conditions. This study is one of a few to evaluate the Biocentric platform for VL quantification in routine practice in Sub-Saharan Africa.
    • Mean CD4 cell count changes in patients failing a first-line antiretroviral therapy in resource-limited settings.

      Calmy, Alexandra; Balestre, Eric; Bonnet, Fabrice; Boulle, Andrew; Sprinz, Eduardo; Wood, Robin; Delaporte, Eric; Messou, Eugène; McIntyre, James; El Filali, Kamal Marhoum; Schechter, Mauro; Kumarasamy, N; Bangsberg, David; McPhail, Patrick; Van Der Borght, Stefaan; Zala, Carlos; Egger, Matthias; Thiébaut, Rodolphe; Dabis, François; HIV Unit, Geneva University Hospital, Geneva, Switzerland. acalmy@gmail.com (BMC, 2012-12)
      Changes in CD4 cell counts are poorly documented in individuals with low or moderate-level viremia while on antiretroviral treatment (ART) in resource-limited settings. We assessed the impact of on-going HIV-RNA replication on CD4 cell count slopes in patients treated with a first-line combination ART.
    • Success with antiretroviral treatment for children in Kigali, Rwanda: experience with health center/nurse-based care.

      van Griensven, J; De Naeyer, L; Uwera, J; Asiimwe, A; Gazille, C; Reid, T; Médecins Sans Frontières, Kigali, Rwanda. jvgrie@yahoo.com (BMC, 2008-10)
      BACKGROUND: Although a number of studies have shown good results in treating children with antiretroviral drugs (ARVs) in hospital settings, there is limited published information on results in pediatric programs that are nurse-centered and based in health centers, in particular on the psychosocial aspects of care. METHODS: Program treatment and outcome data were reported from two government-run health centers that were supported by Médecins Sans Frontières (MSF) in Kigali, Rwanda between October 2003 and June 2007. Interviews were held with health center staff and MSF program records were reviewed to describe the organization of the program. Important aspects included adequate training and supervision of nurses to manage ARV treatment. The program also emphasized family-centered care addressing the psychosocial needs of both caregivers and children to encourage early diagnosis, good adherence and follow-up. RESULTS: A total of 315 children (< 15 years) were started on ARVs, at a median age of 7.2 years (range: 0.7-14.9). Sixty percent were in WHO clinical stage I/II, with a median CD4% of 14%. Eighty-nine percent (n = 281) started a stavudine-containing regimen, mainly using the adult fixed-dose combination. The median follow-up time after ARV initiation was 2 years (interquartile range 1.2-2.6). Eighty-four percent (n = 265) of children were still on treatment in the program. Thirty (9.5%) were transferred out, eight (2.6%) died and 12 (3.8%) were lost to follow-up. An important feature of the study was that viral loads were done at a median time period of 18 months after starting ARVs and were available for 87% of the children. Of the 174 samples, VL was < 400 copies/ml in 82.8% (n = 144). Two children were started on second-line ARVs. Treatment was changed due to toxicity for 26 children (8.3%), mainly related to nevirapine. CONCLUSION: This report suggests that providing ARVs to children in a health center/nurse-based program is both feasible and very effective. Adequate numbers and training of nursing staff and an emphasis on the psychosocial needs of caregivers and children have been key elements for the successful scaling-up of ARVs at this level of the health system.