• Adults receiving HIV care before the start of antiretroviral therapy in sub-Saharan Africa: patient outcomes and associated risk factors

      Bastard, Mathieu; Nicolay, Nathalie; Szumilin, Elisabeth; Balkan, Suna; Poulet, Elisabeth; Pujades-Rodriguez, Mar (Lippincott Williams & Wilkins, 2013-12-15)
      Gaining understanding of the period before antiretroviral therapy (ART) is needed to improve treatment outcomes and to reduce HIV transmission. This study describes the cascade of enrollment in HIV care, pre-ART follow-up, and predictors of mortality and lost to follow-up (LTFU) before ART initiation.
    • Association between older age and adverse outcomes on antiretroviral therapy: a cohort analysis of programme data from nine countries.

      Greig, Jane; Casas, Esther C; O'Brien, Daniel P; Mills, Edward J; Ford, Nathan; Médecins Sans Frontières, London, UK. jane.greig@london.msf.org (2012-07-31)
      Recent studies have highlighted the increased risk of adverse outcomes among older patients on antiretroviral therapy (ART). We report on the associations between older age and adverse outcomes in HIV/AIDS antiretroviral programmes across 17 programmes in sub-Saharan Africa.
    • Correcting mortality for loss to follow-up: a nomogram applied to antiretroviral treatment programmes in sub-Saharan Africa.

      Egger, Matthias; Spycher, Ben D; Sidle, John; Weigel, Ralf; Geng, Elvin H; Fox, Matthew P; MacPhail, Patrick; van Cutsem, Gilles; Messou, Eugène; Wood, Robin; Nash, Denis; Pascoe, Margaret; Dickinson, Diana; Etard, Jean-François; McIntyre, James A; Brinkhof, Martin W G; Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland; Moi University School of Medicine, Eldoret, Kenya; Lighthouse Trust, Kamuzu Hospital, Lilongew, Malawi; Divison of HIV/AIDS, Department of Medicine, University of California, San Franciso, California, USA; Center for Global Health and Development, Boston University, Boston, Massachusetts, USA; Right to Care, Thema Leftu Clinic, Joseph Hospital, Johannesburg, South Africa; Khayelitsha Medecins sans Frontieres programme, University of Cape Town, Cape Town, South Africa; Centre de Prise en Charge, de Recherche et de Formation sur le VH/SIDA, Abidjan, Cote d'Ivoire; Desmond Tutu Hiv Centre, Cape Town, South Africa, Mailman School, Columbia University, NY, NY, USA; Newlands Clinic, Harare, Zimbabwe; Independent Surgery, Gaborone, Botswana; Institut de Recherece pour le Developpement/UMR 145, Montpeller, France; Perinatal Hiv Research Unit, Soweto, South Africa. (2011-01)
      The World Health Organization estimates that in sub-Saharan Africa about 4 million HIV-infected patients had started antiretroviral therapy (ART) by the end of 2008. Loss of patients to follow-up and care is an important problem for treatment programmes in this region. As mortality is high in these patients compared to patients remaining in care, ART programmes with high rates of loss to follow-up may substantially underestimate mortality of all patients starting ART.
    • Cotrimoxazole prophylaxis for HIV-positive TB patients in developing countries.

      Zachariah, R; Massaquoi, M; Medecins sans Frontieres, Operational Research HIV-TB, Medical department, Brussels Operational Center, 68 Rue de Gaspench, L-1617 Luxemburg. zachariah@internet.lu (2006-04)
      Despite provisional recommendations from the World Health Organization and UNAIDS that cotrimoxazole (CTX) prophylaxis be offered to all individuals living with AIDS, including HIV-positive patients with TB, its routine use in developing countries particularly Africa has been minimal. Concerns were expressed regarding its effectiveness in areas of high bacterial resistance, that its widespread use might substantially increase bacterial cross-resistance in the community and that this intervention might promote resistance of malaria parasites to sulphadoxine-pyrimethamine. We review the current evidence on the above concerns and highlight the main operational considerations related to implementing CTX prophylaxis as a basic component of care for HIV-positive TB patients in developing countries.
    • Cytomegalovirus retinitis: the neglected disease of the AIDS pandemic.

      Heiden, D; Ford, N; Wilson, D; Rodriguez, W; Margolis, T; Janssens, B; Bedelu, M; Tun, N; Goemaere, E; Saranchuk, P; Sabapathy, K; Smithuis, F; Luyirika, E; Drew, W L; Department of Ophthalmology and Pacific Vision Foundation, California Pacific Medical Center, San Francisco, California, United States of America. dheidenpea@yahoo.com (PLoS, 2007-12)
    • Diagnosis and management of antiretroviral-therapy failure in resource-limited settings in sub-Saharan Africa: challenges and perspectives.

      Harries, Anthony D; Zachariah, Rony; van Oosterhout, Joep J; Reid, Steven D; Hosseinipour, Mina C; Arendt, Vic; Chirwa, Zengani; Jahn, Andreas; Schouten, Erik J; Kamoto, Kelita; International Union against Tuberculosis and Lung Disease, Paris, France. adharries@theunion.org (2010-01)
      Despite the enormous progress made in scaling up antiretroviral therapy (ART) in sub-Saharan Africa, many challenges remain, not least of which are the identification and management of patients who have failed first-line therapy. Less than 3% of patients are receiving second-line treatment at present, whereas 15-25% of patients have detectable viral loads 12 months or more into treatment, of whom a substantial proportion might have virological failure. We discuss the reasons why virological ART failure is likely to be under-diagnosed in the routine health system, and address the current difficulties with standard recommended second-line ART regimens. The development of new diagnostic tools for ART failure, in particular a point-of-care HIV viral-load test, combined with simple and inexpensive second-line therapy, such as boosted protease-inhibitor monotherapy, could revolutionise the management of ART failure in resource-limited settings.
    • Editorial: The AIDS crisis, cost-effectiveness and academic activism.

      Boelaert, M; Van Damme, W; Meessen, B; Van der Stuyft, P (2002-12)
    • Involving Traditional Healers in AIDS Education and Counselling in Sub-Saharan Africa: A Review

      King, R; Homsy, J; Médecins Sans Frontières-Switzerland in Kampala, Uganda. (1997)
    • Mortality, AIDS-morbidity, and loss to follow-up by current CD4 cell count among HIV-1-infected adults receiving antiretroviral therapy in Africa and Asia: data from the ANRS 12222 collaboration

      Gabillard, Delphine; Lewden, Charlotte; Ndoye, Ibra; Moh, Raoul; Segeral, Olivier; Tonwe-Gold, Besigin; Etard, Jean-François; Pagnaroat, Men; Fournier-Nicolle, Isabelle; Eholié, Serge; Konate, Issouf; Minga, Albert; Mpoudi-Ngole, Eitel; Koulla-Shiro, Sinata; Zannou, Djimon Marcel; Anglaret, Xavier; Laurent, Christian (Lippincott Williams and Wilkins, 2013-04-15)
      In resource-limited countries, estimating CD4-specific incidence rates of mortality and morbidity among patients receiving antiretroviral therapy (ART) may help assess the effectiveness of care and treatment programmes, identify program weaknesses, and inform decisions.
    • Promoting long term adherence to Antiretroviral Treatment

      Mills, Edward J; Lester, Richard; Ford, Nathan (2012-06-28)
    • Providing antiretroviral care in conflict settings.

      Mills, Edward J; Ford, Nathan; Singh, Sonal; Eyawo, Oghenowede; BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada. emills@cfenet.ubc.ca (2009-11)
      There has been an historic expectation that delivering combination antiretroviral therapy (cART) to populations affected by violent conflict is untenable due to population movement and separation of drug supplies. There is now emerging evidence that cART provision can be successful in these populations. Using examples from Médecins Sans Frontières experience in a variety of African settings and also local nongovernmental organizations' experiences in northern Uganda, we examine novel approaches that have ensured retention in programs and adequate adherence. Emerging guidelines from United Nations bodies now support the expansion of cART in settings of conflict.
    • Similar mortality and reduced loss to follow-up in integrated compared with vertical programs providing antiretroviral treatment in sub-saharan Africa.

      Greig, Jane; O'Brien, Daniel P; Ford, Nathan; Spelman, Tim; Sabapathy, Kalpana; Shanks, Leslie; Manson Unit, Médecins sans Frontières, Saffron Hill, London, UK. jane.greig@london.msf.org (2012-04-15)
      Vertical HIV programs have achieved good results but may not be feasible or appropriate in many resource-limited settings. Médecins sans Frontières has treated HIV in vertical programs since 2000 and over time integrated HIV treatment into general health care services using simplified protocols. We analyzed the survival probability among patients receiving antiretroviral therapy (ART) from 2003 to 2010 in integrated versus vertical programs in 9 countries in sub-Saharan Africa.
    • Tenofovir in second-line ART in Zambia and South Africa: collaborative analysis of cohort studies.

      Wandeler, Gilles; Keiser, Olivia; Mulenga, Lloyd; Hoffmann, Christopher J; Wood, Robin; Chaweza, Thom; Brennan, Alana; Prozesky, Hans; Garone, Daniela; Giddy, Janet; Chimbetete, Cleophas; Boulle, Andrew; Egger, Matthias; Division of International and Environmental Health, Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, CH-3012 Bern, Switzerland. gwandeler@ispm.unibe.ch (2012-09-01)
      Tenofovir (TDF) is increasingly used in second-line antiretroviral treatment (ART) in sub-Saharan Africa. We compared outcomes of second-line ART containing and not containing TDF in cohort studies from Zambia and the Republic of South Africa (RSA).