• Cabergoline for suppression of puerperal lactation in a prevention of mother-to-child HIV-transmission programme in rural Malawi.

      Buhendwa, L; Zachariah, R; Teck, R; Massaquoi, M; Kazima, J; Firmenich, P; Harries, A D; Medecins sans Frontieres, Thyolo District, Malawi. (Royal Society of Medicine, 2008-01)
      This study shows that cabergoline (single oral-dose) is an acceptable, safe and effective drug for suppressing puerperal lactation. It could be of operational benefit not only for artificial feeding, but also for weaning in those that breast-feed within preventive mother-to-child HIV transmission programmes in resource-limited settings.
    • Cascade of HIV Care and Population Biral Suppression in a High-Burden Region of Kenya

      Maman, D; Zeh, C; Mukui, I; Kirubi, B; Masson, S; Opolo, V; Szumilin, E; Riche, B; Etard, JF (Lippincott Williams & Wilkins, 2015-07-31)
      Direct measurement of antiretroviral treatment (ART) program indicators essential for evidence-based planning and evaluation - especially HIV incidence, population viral load, and ART eligibility - is rare in sub-Saharan Africa.
    • Causes and determinants of mortality in HIV-infected adults with tuberculosis: an analysis from the CAMELIA ANRS 1295-CIPRA KH001 randomized trial

      Marcy, Olivier; Laureillard, Didier; Madec, Yoann; Chan, Sarin; Mayaud, Charles; Borand, Laurence; Prak, Narom; Kim, Chindamony; Lak, Kim Khemarin; Hak, Chanroeurn; Dim, Bunnet; Sok, Thim; Delfraissy, Jean-François; Goldfeld, Anne E; Blanc, François-Xavier (Oxford University Press, 2014-08)
      Shortening the interval between antituberculosis treatment onset and initiation of antiretroviral therapy (ART) reduces mortality in severely immunocompromised human immunodeficiency virus (HIV)-infected patients with tuberculosis. A better understanding of causes and determinants of death may lead to new strategies to further enhance survival.
    • Causes of false-positive HIV rapid diagnostic test results

      Klarkowski, Derryck; O'Brien, Daniel P; Shanks, Leslie; Singh, Kasha P (Informa Healthcare, 2014-01)
      HIV rapid diagnostic tests have enabled widespread implementation of HIV programs in resource-limited settings. If the tests used in the diagnostic algorithm are susceptible to the same cause for false positivity, a false-positive diagnosis may result in devastating consequences. In resource-limited settings, the lack of routine confirmatory testing, compounded by incorrect interpretation of weak positive test lines and use of tie-breaker algorithms, can leave a false-positive diagnosis undetected. We propose that heightened CD5+ and early B-lymphocyte response polyclonal cross-reactivity are a major cause of HIV false positivity in certain settings; thus, test performance may vary significantly in different geographical areas and populations. There is an urgent need for policy makers to recognize that HIV rapid diagnostic tests are screening tests and mandate confirmatory testing before reporting an HIV-positive result. In addition, weak positive results should not be recognized as valid except in the screening of blood donors.
    • CD4 count slope and mortality in HIV-infected patients on antiretroviral therapy: multicohort analysis from South Africa

      Hoffmann, Christopher J; Schomaker, Michael; Fox, Matthew P; Mutevedzi, Portia; Giddy, Janet; Prozesky, Hans; Wood, Robin; Garone, Daniela B; Egger, Matthias; Boulle, Andrew; Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA. choffmann@jhmi.edu (Lippincott Williams & Wilkins, 2013-05-01)
      In many resource-limited settings monitoring of combination antiretroviral therapy (cART) is based on the current CD4 count, with limited access to HIV RNA tests or laboratory diagnostics. We examined whether the CD4 count slope over 6 months could provide additional prognostic information.
    • CD4 Testing at Clinics to Assess Eligibility for Antiretroviral Therapy

      Lumala, R; van den Akker, T; Metcalf, CA; Diggle, E; Zamadenga, B; Mbewa, K; Akkeson, A (College of Medicine, University of Malawi, 2012-06-01)
      In 2011, the Ministry of Health raised the CD4 threshold for antiretroviral therapy (ART) eligibility from <250 cells/µl and <350 cells/µl, but at the same time only 8.8% of facilities in Malawi with HIV services provided CD4 testing. We conducted a record review at 10 rural clinics in Thyolo District to assess the impact of introducing CD4 testing on identifying patients eligible for ART.
    • CD4 testing at clinics to assess eligibility for Antiretroviral treatment

      Lumala, R; Van den Akker, T; Metcalf, C; Diggle, E; Zamagenga, B; Mbewa, K; Akkeson, A; MSF (2012-06)
    • CD4+ cell count at antiretroviral therapy initiation and economic restoration in rural Uganda

      Venkataramani, Atheendar S; Thirumurthy, Harsha; Haberer, Jessica E; Boum, Yap; Siedner, Mark J; Kembabazi, Annet; Hunt, Peter W; Martin, Jeffrey N; Bangsberg, David R; Tsai, Alexander C (Lippincott Williams & Wilkins, 2014-01-08)
      To determine whether earlier initiation of antiretroviral therapy (ART) is associated with better economic outcomes.
    • Challenge and co-operation: civil society activism for access to HIV treatment in Thailand.

      Ford, N; Wilson, D; Cawthorne, P; Kumphitak, A; Kasi-Sedapan, S; Kaetkaew, S; Teemanka, S; Donmon, B; Preuanbuapan, C; Médecins Sans Frontières, Bangkok, Thailand. david.wilson.thai@gmail.com (Published by Wiley-Blackwell, 2009-03)
      Civil society has been a driving force behind efforts to increase access to treatment in Thailand. A focus on HIV medicines brought civil society and non-governmental and government actors together to fight for a single cause, creating a platform for joint action on practical issues to improve care for people with HIV/AIDS (PHA) within the public health system. The Thai Network of People with HIV/AIDS, in partnership with other actors, has provided concrete support for patients and for the health system as a whole; its efforts have contributed significantly to the availability of affordable generic medicines, early treatment for opportunistic infections, and an informed and responsible approach towards antiretroviral treatment that is critical to good adherence and treatment success. This change in perception of PHA from 'passive receiver' to 'co-provider' of health care has led to improved acceptance and support within the healthcare system. Today, most PHA in Thailand can access treatment, and efforts have shifted to supporting care for excluded populations.
    • Challenges associated with providing diabetes care in humanitarian settings

      Boulle, P; Kehlenbrink, S; Smith, J; Beran, D; Jobanputra, K (Elsevier, 2019-03-13)
      The humanitarian health landscape is gradually changing, partly as a result of the shift in global epidemiological trends and the rise of non-communicable diseases, including diabetes. Humanitarian actors are progressively incorporating care for diabetes into emergency medical response, but challenges abound. This Series paper discusses contemporary practical challenges associated with diabetes care in humanitarian contexts in low-income and middle-income countries, using the six building blocks of health systems described by WHO (information and research, service delivery, health workforce, medical products and technologies, governance, and financing) as a framework. Challenges include the scarcity of evidence on the management of diabetes and clinical guidelines adapted to humanitarian contexts; unavailability of core indicators for surveillance and monitoring systems; and restricted access to the medicines and diagnostics necessary for adequate clinical care. Policy and system frameworks do not routinely include diabetes and little funding is allocated for diabetes care in humanitarian crises. Humanitarian organisations are increasingly gaining experience delivering diabetes care, and interagency collaboration to coordinate, improve data collection, and analyse available programmes is in progress. However, the needs around all six WHO health system building blocks are immense, and much work needs to be done to improve diabetes care for crisis-affected populations.
    • Challenges in the management of disseminated progressive histoplasmosis in human immunodeficiency virus-infected patients in resource-limited settings

      Murphy, Richard A; Gounder, Lilishia; Manzini, Thandekile C; Ramdial, Pratistadevi K; Castilla, Carmen; Moosa, Mahomed-Yunus S (Oxford University Press, 2015-03-30)
      The diagnosis of histoplasmosis in patients with human immunodeficiency virus in southern Africa is complicated by the nonspecific presentation of the disease in this patient group and the unavailability of sensitive diagnostics including antigen assays. Treatment options are also limited due to the unavailability of liposomal amphotericin and itraconazole, and the inability to perform therapeutic drug monitoring further confounds management. We present 3 clinical cases to illustrate the limits of diagnosis and management in the southern African context, and we highlight the need for additional diagnostic tools and treatment options in resource-limited settings.
    • Changes in Estimated Glomerular Filtration Rate Over Time in South African HIV-1-Infected Patients Receiving Tenofovir: a Retrospective Cohort Study

      De Waal, R; Cohen, K; Fox, MP; Stinson, K; Maartens, G; Boulle, A; Igumbor, EU; Davies, MA (International AIDS Society, 2017-04-10)
      Tenofovir has been associated with decline in kidney function, but in patients with low baseline kidney function, improvements over time have been reported. Additionally, the magnitude and trajectory of estimated glomerular filtration rate (eGFR) changes may differ according to how eGFR is calculated. We described changes in eGFR over time, and the incidence of, and risk factors for, kidney toxicity, in a South African cohort.
    • Characteristics, Immunological Response & Treatment Outcomes of HIV-2 Compared with HIV-1 & Dual Infections (HIV 1/2) in Mumbai

      Chiara, Montaldo; Rony, Zachariah; Homa, Mansoor; Bhanumati, Varghese; Ladomirska, Joanna; Manzi, M; Wilson, N; Alaka, Deshpande; Harries, A D; Medecins sans Frontieres, India; Operational Centre Brussels, Belgium; Medecins Sans Frontieres, Luxembourg; ART Centre, JJ Hospital, India; International Union against Tuberculosis & Lung Disease, India; International Union against Tuberculosis & Lung Disease, France; London School of Hygiene & Tropical Medicine, United Kingdom (2010-12-01)
      Information available on HIV-2 and dual infection (HIV-1/2) is limited. This study was carried out among HIV positive individuals in an urban referral clinic in Khar, Mumbai, India, to report on relative proportions of HIV-1, HIV-2 and HIV-1/2 and baseline characteristics, response to and outcomes on antiretroviral treatment (ART).
    • 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.
    • Clinical mentorship of nurse initiated antiretroviral therapy in Khayelitsha, South Africa: a quality of care assessment.

      Green, Ann; de Azevedo, Virginia; Patten, Gabriela; Davies, Mary-Ann; Ibeto, Mary; Cox, Vivian (Public Library of Science, 2014-06)
      To combat the AIDS epidemic and increase HIV treatment access, the South African government implemented a nurse-based, doctor-supported model of care that decentralizes administration of antiretroviral treatment (ART) for HIV positive patients through nurse initiated and managed ART. Médecins Sans Frontières (MSF) implemented a mentorship programme to ensure successful task-shifting, subsequently assessing the quality of clinical care provided by nurses.
    • Clinical screening for HIV in a health centre setting in urban Kenya: an entry point for voluntary counselling, HIV testing and early diagnosis of HIV infection?

      Arendt, V; Mossong, J; Zachariah, R; Inwani, C; Farah, B; Robert, I; Waelbrouck, A; Fonck, K; Médecins Sans Frontières, Mission Kenya, Brussels Operational Centre, Brussels, Belgium. (2007-01)
      A study was conducted among patients attending a public health centre in Nairobi, Kenya in order to (a) verify the prevalence of HIV, (b) identify clinical risk factors associated with HIV and (c) determine clinical markers for clinical screening of HIV infection at the health centre level. Of 304 individuals involved in the study,107(35%) were HIV positive. A clinical screening algorithm based on four clinical markers, namely oral thrush, past or present TB, past or present herpes zoster and prurigo would pick out 61 (57%) of the 107 HIV-positive individuals. In a resource-poor setting, introducing a clinical screening algorithm for HIV at the health centre level could provide an opportunity for targeting voluntary counselling and HIV testing, and early access to a range of prevention and care interventions.
    • Clinical Update on AIDS

      Harries AD; Zachariah R (2009-01)
    • Closer to 90-90-90. The Cascade of Care After 10 Years of ART Scale-Up in Rural Malawi: a Population Study

      Maman, D; Chilima, B; Masiku, C; Ayouba, A; Masson, S; Szumilin, E; Peeters, M; Ford, N; Heinzelmann, A; Riche, B; Etard, JF (International AIDS Society, 2016-02-15)
      The antiretroviral therapy (ART) programme supported by Médecins Sans Frontières in the rural Malawian district of Chiradzulu was one of the first in sub-Saharan Africa to scale up ART delivery in 2002. After more than a decade of continuous involvement, we conducted a population survey to evaluate the cascade of care, including population viral load, in the district.
    • Closing the gaps: Steps towards elimination of mother-to-child transmission of HIV

      Ibeto, Mary; Giddy, Janet; Cox, Vivian (Health & Medical Publishing, 2014-09-01)