• Adapting a community-based ART delivery model to the patients' needs: a mixed methods research in Tete, Mozambique

      Rasschaert, Freya; Decroo, Tom; Remartinez, Daniel; Telfer, Barbara; Lessitala, Faustino; Biot, Marc; Candrinho, Baltazar; Van Damme, Wim (BioMed Central, 2014-04)
      To improve retention in antiretroviral therapy (ART), lessons learned from chronic disease care were applied to HIV care, providing more responsibilities to patients in the care of their chronic disease. In Tete--Mozambique, patients stable on ART participate in the ART provision and peer support through Community ART Groups (CAG). This article analyses the evolution of the CAG-model during its implementation process.
    • Assessing the outcomes of HIV-infected persons receiving treatment for Kaposi sarcoma in Conakry-Guinea

      Bekolo, CE; Soumah, MM; Tiemtore, OW; Diallo, A; Yuma, JD; Di Stefano, L; Metcalf, C; Cisse, M (BioMed Central, 2017-12-02)
      Médecins Sans Frontières is supporting comprehensive HIV care and treatment for Kaposi Sarcoma (KS) in Guinea, where antiretroviral coverage is low and access to KS treatment is very limited. We aimed to evaluate treatment response and survival outcomes of epidemic KS in this setting.
    • A biregional survey and review of first-line treatment failure and second-line paediatric antiretroviral access and use in Asia and southern Africa

      Van Cutsem, G; Saphonn, V; Saramony, S; Vibol, U; Zhang, FJ; Han, N; Saghayam, S; Kurniati, N; Muktiarti, D; Fong, SM; Thien, M; Nik Yusoff, NK; Hai, LC; Razali, K; TREAT Asia/amfAR - The Foundation for AIDS Research, Bangkok, Thailand. annette.sohn@treatasia.org (BioMed Central, 2011-04-08)
      To better understand the need for paediatric second-line antiretroviral therapy (ART), an ART management survey and a cross-sectional analysis of second-line ART use were conducted in the TREAT Asia Paediatric HIV Observational Database and the IeDEA Southern Africa (International Epidemiologic Databases to Evaluate AIDS) regional cohorts.
    • Challenges and successes in the implementation of option B+ to prevent mother-to-child transmission of HIV in southern Swaziland.

      Etoori, D; Kerschberger, B; Staderini, N; Ndlangamandla, M; Nhlabatsi, B; Jobanputra, K; Mthethwa-Hleza, S; Parker, LA; Sibanda, S; Mabhena, E; Pasipamire, M; Kabore, SM; Rusch, B; Jamet, C; Ciglenecki, I; Teck, R (BioMed Central, 2018-03-20)
      Background Universal antiretroviral therapy (ART) for all pregnant/ breastfeeding women living with Human Immunodeficiency Virus (HIV), known as Prevention of mother-to child transmission of HIV (PMTCT) Option B+ (PMTCTB+), is being scaled up in most countries in Sub-Saharan Africa. In the transition to PMTCTB+, many countries face challenges with proper implementation of the HIV care cascade. We aimed to describe the feasibility of a PMTCTB+ approach in the public health sector in Swaziland. Methods Lifelong ART was offered to a cohort of HIV+ pregnant women aged ≥16 years at the first antenatal care (ANC1) visit in 9 public sector facilities, between 01/2013 and 06/2014. The study enrolment period was divided into 3 phases (early: 01–06/2013, mid: 07–12/2013 and late: 01–06/2014) to account for temporal trends. Kaplan-Meier estimates and Cox proportional-hazards regression models were applied for ART initiation and attrition analyses. Results Of 665 HIV+ pregnant women, 496 (74.6%) initiated ART. ART initiation increased in later study enrolment phases (mid: aHR: 1.41; later: aHR: 2.36), and decreased at CD4 ≥ 500 (aHR: 0.69). 52.9% were retained in care at 24 months. Attrition was associated with ANC1 in the third trimester (aHR: 2.37), attending a secondary care facility (aHR: 1.98) and ART initiation during later enrolment phases (mid aHR: 1.48; late aHR: 1.67). Of 373 women eligible, 67.3% received a first VL. 223/251 (88.8%) were virologically suppressed (< 1000 copies/mL). Of 670 infants, 53.6% received an EID test, 320/359 had a test result recorded and of whom 7 (2.2%) were HIV+. Conclusions PMTCTB+ was found to be feasible in this setting, with high rates of maternal viral suppression and low transmission to the infant. High treatment attrition, poor follow-up of mother-baby pairs and under-utilisation of VL and EID testing are important programmatic challenges.
    • Clinical features and management of a severe paradoxical reaction associated with combined treatment of Buruli ulcer and HIV co-infection

      Wanda, Franck; Nkemenang, Patrick; Ehounou, Genevieve; Tchaton, Marie; Comte, Eric; Toutous Trellu, Laurence; Masouyé, Isabelle; Christinet, Vanessa; O' Brien, Daniel P (BioMed Central, 2014-07-30)
      In West and Central Africa Buruli ulcer (BU) and HIV co-infection is increasingly recognised and management of these two diseases combined is an emerging challenge for which there is little published information. In this case we present a severe paradoxical reaction occurring after commencing antibiotic treatment for BU combined with antiretroviral therapy for HIV, and describe its clinical features and management. This includes to our knowledge the first reported use of prednisolone in Africa to manage a severe paradoxical reaction related to BU treatment.
    • Combined Interventions to Reduce HIV Incidence in KwaZulu-Natal: A Modelling Study

      Blaizot, S; Huerga, H; Riche, B; Ellman, T; Shroufi, A; Etard, J; Ecochard, R (BioMed Central, 2017-07-26)
      Combined prevention interventions, including early antiretroviral therapy initiation, may substantially reduce HIV incidence in hyperendemic settings. Our aim was to assess the potential short-term impact of combined interventions on HIV spreading in the adult population of Mbongolwane and Eshowe (KwaZulu-Natal, South Africa) using sex- and age-specific scenarios, and age-targeted interventions.
    • A Comparison of Self-report and Antiretroviral Detection to inform estimates of Antiretroviral Therapy Coverage, Viral Load Suppression and HIV incidence in Kwazulu-Natal, South Africa

      Huerga, H; Shiferie, F; Grebe, E; Giuliani, R; Farhat, JB; Van-Cutsem, G; Cohen, K (BioMed Central, 2017-09-29)
      Accurately identifying individuals who are on antiretroviral therapy (ART) is important to determine ART coverage and proportion on ART who are virally suppressed. ART is also included in recent infection testing algorithms used to estimate incidence. We compared estimates of ART coverage, viral load suppression rates and HIV incidence using ART self-report and detection of antiretroviral (ARV) drugs and we identified factors associated with discordance between the methods.
    • Dilution Testing Using Rapid Diagnostic Tests in a HIV Diagnostic Algorithm: a Novel Alternative for Confirmation Testing in Resource Limited Settings

      Shanks, L; Siddiqui, MR; Abebe, A; Piriou, E; Pearce, N; Ariti, C; Masiga, J; Muluneh, L; Wazome, J; Ritmeijer, K; Klarkowski, D (BioMed Central, 2015-05-14)
      Current WHO testing guidelines for resource limited settings diagnose HIV on the basis of screening tests without a confirmation test due to cost constraints. This leads to a potential risk of false positive HIV diagnosis. In this paper, we evaluate the dilution test, a novel method for confirmation testing, which is simple, rapid, and low cost. The principle of the dilution test is to alter the sensitivity of a rapid diagnostic test (RDT) by dilution of the sample, in order to screen out the cross reacting antibodies responsible for falsely positive RDT results.
    • Driving a decade of change: HIV/AIDS, patents and access to medicines for all

      Hoen, Ellen 't; Berger, Jonathan; Calmy, Alexandra; Moon, Suerie; Medicines Patent Pool Initiative, UNITAID Secretariat, Geneva, Switzerland; SECTION27, Braamfontein, Johannesburg, South Africa; HIV Unit, Division of Infectious Disease, Geneva University Hospital, Geneva, Switzerland; Médecins Sans Frontières Campaign for Access to Essential Medicines, Geneva, Switzerland; Sustainability Science Program, Center for International Development, Kennedy School of Government, Harvard University, Cambridge, MA, USA (BioMed Central, 2011-03-27)
      Since 2000, access to antiretroviral drugs to treat HIV infection has dramatically increased to reach more than five million people in developing countries. Essential to this achievement was the dramatic reduction in antiretroviral prices, a result of global political mobilization that cleared the way for competitive production of generic versions of widely patented medicines.Global trade rules agreed upon in 1994 required many developing countries to begin offering patents on medicines for the first time. Government and civil society reaction to expected increases in drug prices precipitated a series of events challenging these rules, culminating in the 2001 World Trade Organization's Doha Declaration on the Agreement on Trade-Related Aspects of Intellectual Property Rights and Public Health. The Declaration affirmed that patent rules should be interpreted and implemented to protect public health and to promote access to medicines for all. Since Doha, more than 60 low- and middle-income countries have procured generic versions of patented medicines on a large scale.Despite these changes, however, a "treatment timebomb" awaits. First, increasing numbers of people need access to newer antiretrovirals, but treatment costs are rising since new ARVs are likely to be more widely patented in developing countries. Second, policy space to produce or import generic versions of patented medicines is shrinking in some developing countries. Third, funding for medicines is falling far short of needs. Expanded use of the existing flexibilities in patent law and new models to address the second wave of the access to medicines crisis are required.One promising new mechanism is the UNITAID-supported Medicines Patent Pool, which seeks to facilitate access to patents to enable competitive generic medicines production and the development of improved products. Such innovative approaches are possible today due to the previous decade of AIDS activism. However, the Pool is just one of a broad set of policies needed to ensure access to medicines for all; other key measures include sufficient and reliable financing, research and development of new products targeted for use in resource-poor settings, and use of patent law flexibilities. Governments must live up to their obligations to protect access to medicines as a fundamental component of the human right to health.
    • HIV-associated Kaposi's sarcoma in Maputo, Mozambique: outcomes in a specialized treatment center, 2010-2015

      Fardhdiani, V; Molfino, L; Zamudio, AG; Manuel, R; Luciano, G; Ciglenecki, I; Rusch, B; Toutous Trellu, L; Coldiron, ME (BioMed Central, 2018-01-19)
      Kaposi's sarcoma (KS) is a common HIV-associated malignancy associated with disability, pain and poor outcomes. The cornerstone of its treatment is antiretroviral therapy, but advanced disease necessitates the addition of chemotherapy. In high-income settings, this often consists of liposomal anthracyclines, but in Mozambique, the first line includes conventional doxorubicin, bleomycin and vincristine, which is poorly-tolerated. Médecins Sans Frontières supports the Ministry of Health (MOH) in a specialized HIV and KS treatment center at the Centro de Referencia de Alto Maé in Maputo.
    • How labour intensive is a doctor-based delivery model for antiretroviral treatment (ART)? Evidence from an observational study in Siem Reap, Cambodia

      Van Damme, W; Kheang, S; Janssens, B; Kober, K; Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium. Médecins Sans Frontières–Belgium, Phnom Penh, Cambodia. (BioMed Central, 2007-05-01)
      BACKGROUND: Funding for scaling-up antiretroviral treatment (ART) in low-income countries has increased substantially, but the lack of human resources for health (HRH) is increasingly being identified as an important constraint for scaling-up ART. METHODS: In a clinic run by Médecins Sans Frontières in Siem Reap, Cambodia, we documented the use of doctor-time for ART in September 2004 and in August 2005, for different phases in ART (pre-ART, ART initiation, ART follow-up Year 1, & ART follow-up Year 2). Based on these observations and using a variety of assumptions for survival of patients on ART (between 90 and 95% annually) and for further reductions in doctor-time per patient (between 0 and 10% annually), we estimated the need for doctors for the period 2004 till 2013 in the Siem Reap clinic, and in a hypothetical district in sub-Saharan Africa. RESULTS: In the Siem Reap clinic, we found that from 2004 to 2005 the doctor-time needed per patient was reduced by between 14% and 33%, thanks to a reduction in number of visits per patient and shorter consultation times. In 2004, 2.06 full-time equivalent (FTE) doctors were needed for 522 patients on ART, and in 2005 this was slightly reduced to 1.97 FTE doctors for 911 patients on ART. By 2013, Siem Reap clinic will need between 2 and 5 FTE doctors for ART. In a district in sub-Saharan Africa with 200,000 inhabitants and 20% adult HIV prevalence, using a similar doctor-based ART delivery model, between 4 and 11 FTE doctors would be needed to cover 50% of ART needs. CONCLUSION: ART is labour intensive. Important reductions in doctor-time per patient can be realized during scaling-up. The doctor-based ART delivery model analysed seems adequate for Cambodia. However, for many districts in sub-Saharan Africa a doctor-based ART delivery model may be incompatible with their HRH constraints.
    • Immunovirological response to combined antiretroviral therapy and drug resistance patterns in children: 1- and 2-year outcomes in rural Uganda.

      Ahoua, Laurence; Guenther, Gunar; Rouzioux, Christine; Pinoges, Loretxu; Anguzu, Paul; Taburet, Anne-Marie; Balkan, Suna; Olson, David M; Olaro, Charles; Pujades-Rodríguez, Mar; Clinical Research Department, Epicentre, Paris, France; Laboratory of Virology, Necker Hospital, Paris, France; Department of Operations, Médecins Sans Frontières, Arua, Uganda; Laboratory of Clinical Pharmacology, Bicêtre Hospital, Kremlin Bicêtre, France; Medical Department, Médecins Sans Frontières, Paris, France; Medical Department, Médecins Sans Frontières, New York, USA; Medical and Administrative Hospital Direction, Arua Regional Referral Hospital, Arua, Uganda (BioMed Central, 2011-07-26)
      Children living with HIV continue to be in urgent need of combined antiretroviral therapy (ART). Strategies to scale up and improve pediatric HIV care in resource-poor regions, especially in sub-Saharan Africa, require further research from these settings. We describe treatment outcomes in children treated in rural Uganda after 1 and 2 years of ART start.
    • Mortality in the first six months among HIV-positive and HIV-negative patients empirically treated for tuberculosis.

      Huerga, H; Ferlazzo, G; Wanjala, S; Bastard, M; Bevilacqua, P; Ardizzoni, E; Sitienei, J; Bonnet, M (BioMed Central, 2019-02-11)
      Empirical treatment of tuberculosis (TB) may be necessary in patients with negative or no Xpert MTB/RIF results. In a context with access to Xpert, we assessed mortality in the 6 months after the initial TB consultation among HIV-positive and HIV-negative patients who received empirical TB treatment or TB treatment based on bacteriological confirmation and we compared it with the mortality among those who did not receive TB treatment.
    • Opportunities to improve storage and transportation of blood specimens for CD4 testing in a rural district in Zimbabwe using BD vacutainer CD4 stabilization tubes: a stability and diagnostic accuracy study

      Fajardo, Emmanuel; Metcalf, Carol; Mbofana, Elton; van Vyve, Charlotte; Munyaradzi, Dhodho; Simons, Sandra; Kuhudzayi, Misheck; Bygrave, Helen (BioMed Central, 2014-10-22)
      BackgroundCD4+ T-cell testing of blood specimens collected in standard EDTA Vacutainer tubes and transported at ambient temperature, must be completed within 48 hours with the BD FACSCount¿ flow cytometer, restricting specimen collection in remote clinics with no on-site testing and limited specimen transport services. We conducted a study in Buhera District, Zimbabwe, to assess the stability and accuracy of CD4+ T-cell results of samples collected in Stabilization Tubes (ST) and stored at ambient temperature for varying time periods.MethodsPaired EDTA and ST samples were collected from 51 HIV-positive patients aged 18 years and older. CD4+ T-cell testing was done on arrival in the laboratory (Day 0). ST samples were retested on Days 3, 5, and 7. Nineteen ST samples were stored for an additional week and retested on Day 14.ResultsThere was a strong correlation between absolute CD4+ T-cell counts measured in the EDTA Day 0 reference sample and Day 7 ST sample (Spearman¿s rho: 0.9778; mean difference: ¿4.9 cells/¿L and limits of agreement (LOA): 98.5 and 88.7 cells/¿L); and the reference sample and Day 14 ST sample (Spearman¿s rho: 0.9632; mean difference 5.1 cells/¿L and LOA: ¿99.6 and 109.8 cells/¿L. Using a 350 cells/¿L threshold, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were all 100% on Day 7, and 83.3%, 100%, 100% and 92.9% on Day 14. Using a 500 cells/¿L threshold, the sensitivity, specificity, PPV and NVP were 100%, 88.5%, 88.5% and 100% on Day 7 and 88.9%, 80.0%, 80.0% and 88.9% on Day 14.ConclusionsCD4 ST can be used and stored up to 7 days as a reliable alternative to standard EDTA tubes in settings where CD4+ T-cell testing within 48 hours is not feasible. Despite the small sample size, results suggest that ST may be stored up to 14 days at room temperature for CD4 testing, without compromising accuracy. However, further studies with larger sample sizes are needed to confirm this preliminary finding.
    • Potential Impact of Multiple Interventions on HIV Incidence in a Hyperendemic Region in Western Kenya: a Modelling Study

      Blaizot, S; Maman, D; Riche, B; Mukui, I; Kirubi, B; Ecochard, R; Etard, JF (BioMed Central, 2016-04-29)
      Multiple prevention interventions, including early antiretroviral therapy initiation, may reduce HIV incidence in hyperendemic settings. Our aim was to predict the short-term impact of various single and combined interventions on HIV spreading in the adult population of Ndhiwa subcounty (Nyanza Province, Kenya).
    • Progress towards the UNAIDS 90-90-90 goals by age and gender in a rural area of KwaZulu-Natal, South Africa: a household-based community cross-sectional survey

      Huerga, H; Van Cutsem, G; Ben Farhat, J; Puren, A; Bouhenia, M; Wiesner, L; Dlamini, L; Maman, D; Ellman, T; Etard, JF (BioMed Central, 2018-03-02)
      The Joint United Nations Programme on HIV/AIDS (UNAIDS) has developed an ambitious strategy to end the AIDS epidemic. After eight years of antiretroviral therapy (ART) program we assessed progress towards the UNAIDS 90-90-90 targets in Mbongolwane and Eshowe, KwaZulu-Natal, South Africa.
    • Risk Factors for Unstructured Treatment Interruptions and Association with Survival in Low to Middle Income Countries

      McMahon, JH; Spelman, T; Ford, N; Greig, J; Mesic, A; Ssonko, C; Casas, EC; O'Brien, DP (BioMed Central, 2016-07-11)
      Antiretroviral therapy (ART) treatment interruptions lead to poor clinical outcomes with unplanned or unstructured TIs (uTIs) likely to be underreported. This study describes; uTIs, their risk factors and association with survival.
    • Six-monthly appointment spacing for clinical visits as a model for retention in HIV Care in Conakry-Guinea: a cohort study

      Bekolo, CE; Diallo, A; Philips, M; Yuma, JD; Di Stefano, L; Drèze, S; Mouton, J; Koita, Y; Tiomtore, OW (BioMed Central, 2017-12-13)
      The outbreak of the Ebola virus disease (EVD) in 2014 led to massive dropouts in HIV care in Guinea. Meanwhile, Médecins Sans Frontières (MSF) was implementing a six-monthly appointment spacing approach adapted locally as Rendez-vous de Six Mois (R6M) with an objective to improve retention in care. We sought to evaluate this innovative model of ART delivery in circumstances where access to healthcare is restricted.