• Unacceptable attrition among WHO stages 1 and 2 patients in a hospital-based setting in rural Malawi: can we retain such patients within the general health system?

      Tayler-Smith, Katie; Zachariah, Rony; Massaquoi, M; Massaquoi, M; Manzi, Marcel; Pasulani, Olesi; van den Akker, Thomas; Bemelmans, Marielle; Bauernfeind, Ariane; Mwagomba, Beatrice; et al. (2010-05)
      A study conducted among HIV-positive adults in WHO clinical stages 1 and 2 was followed up at Thyolo District Hospital (rural Malawi) to report on: (1) retention and attrition before and while on antiretroviral treatment (ART); and (2) the criteria used for initiating ART. Between June 2008 and January 2009, 1633 adults in WHO stages 1 and 2 were followed up for a total of 282 person-years. Retention in care at 1, 2, 3 and 6 months for those not on ART (n=1078) was 25, 18, 11 and 4% vs. 99, 97, 95 and 90% for patients who started ART (n=555, P=0.001). Attrition rates were 31 times higher among patients not started on ART compared with those started on ART (adjusted hazard ratio, 31.0, 95% CI 22-44). Ninety-two patients in WHO stage 1 or 2 were started on ART without the guidance of a CD4 count, and 11 were incorrectly started on ART with CD4 count > or = 250 cells/mm(3). In a rural district hospital setting in Malawi, attrition of individuals in WHO stages 1 and 2 is unacceptably high, and specific operational strategies need to be considered to retain such patients in the health system.
    • UNITAID can address HCV/HIV co-infection

      von Schoen-Angerer, Tido; Cohn, Jennifer; Swan, Tracy; Piot, Peter (2013-02-23)
    • Universal access in the fight against HIV/AIDS

      Girard, Françoise; Ford, Nathan; Montaner, Julio; Cahn, Pedro; Katabira, Elly; Open Society Institute Public Health Program, New York, NY, USA; Médecins Sans Frontières, Cape Town, South Africa; Division of AIDS, University of British Columbia, Vancouver, BC, Canada; Fundacion Huesped, Buenos Aires, Argentina; Department of Research, Makerere Medical School, Kampala, Uganda. (2010-07-09)
    • Universal access: the benefits and challenges in bringing integrated HIV care to isolated and conflict affected population in the Republic of Congo

      O'Brien, D; Mills, C; Hamel, C; Ford, N; Pottie, K; Medecins Sans Frontieres (BioMedCentral, 2009-01)
    • Uptake of home-based voluntary HIV testing in sub-Saharan Africa: a systematic review and meta-analysis

      Sabapathy, Kalpana; Van den Bergh, Rafael; Fidler, Sarah; Hayes, Richard; Ford, Nathan; London School of Hygiene and Tropical Medicine, London, UK. kalpana.sabapathy@lshtm.ac.uk (2012-12-04)
      Improving access to HIV testing is a key priority in scaling up HIV treatment and prevention services. Home-based voluntary counselling and testing (HBT) as an approach to delivering wide-scale HIV testing is explored here.
    • Using BD Vacutainer CD4 Stabilization Tubes for Absolute Cluster of Differentiation Type 4 Cell Count Measurement on BD FacsCount and Partec Cyflow Cytometers: A Method Comparison Study from Zimbabwe

      Vogt, Florian; Van den Bergh, Rafael; Bernasconi, Andrea; Moyo, Buhlebenkosi; Havazvidi, Liberty; Bastard, Mathieu; Flevaud, Laurence; Taziwa, Fabian; Makondo, Eliphas; Mtapuri-Zinyowera, Sekesai (Public Library of Science, 2015-08-21)
      Blood collected in conventional EDTA tubes requires laboratory analysis within 48 hours to provide valid CD4 cell count results. This restricts access to HIV care for patients from rural areas in resource-constraint settings due to sample transportation problems. Stabilization Tubes with extended storage duration have been developed but not yet evaluated comprehensively.
    • Using BD Vacutainer CD4 Stabilization Tubes for Absolute Cluster of Differentiation Type 4 Cell Count Measurement on BD FacsCount and Partec Cyflow Cytometers: A Method Comparison Study from Zimbabwe.

      Vogt, Florian; Van den Bergh, Rafael; Bernasconi, Andrea; Moyo, Buhlebenkosi; Havazvidi, Liberty; Bastard, Mathieu; Flevaud, Laurence; Taziwa, Fabian; Makondo, Eliphas; Mtapuri-Zinyowera, Sekesai; et al. (2015-08)
      Blood collected in conventional EDTA tubes requires laboratory analysis within 48 hours to provide valid CD4 cell count results. This restricts access to HIV care for patients from rural areas in resource-constraint settings due to sample transportation problems. Stabilization Tubes with extended storage duration have been developed but not yet evaluated comprehensively.
    • Using touchscreen electronic medical record systems to support and monitor national scale-up of antiretroviral therapy in Malawi.

      Douglas, Gerald P; Gadabu, Oliver J; Joukes, Sabine; Mumba, Soyapi; McKay, Michael V; Ben-Smith, Anne; Jahn, Andreas; Schouten, Erik J; Landis Lewis, Zach; van Oosterhout, Joep J; et al. (2010-09)
    • Variability of Growth in Children Starting Antiretroviral Treatment in Southern Africa

      Gsponer, Thomas; Weigel, Ralf; Davies, Mary-Ann; Bolton, Carolyn; Moultrie, Harry; Vaz, Paula; Rabie, Helena; Technau, Karl; Ndirangu, James; Eley, Brian; et al. (American Academy of Pediatrics, 2012-10)
      Poor growth is an indication for antiretroviral therapy (ART) and a criterion for treatment failure. We examined variability in growth response to ART in 12 programs in Malawi, Zambia, Zimbabwe, Mozambique, and South Africa.
    • Variation in Specificity of HIV Rapid Diagnostic Tests over Place and Time: An Analysis of Discordancy Data Using a Bayesian Approach

      Klarkowski, Derryck; Glass, Kathryn; O'Brien, Daniel; Lokuge, Kamalini; Piriou, Erwan; Shanks, Leslie; Médecins sans Frontières, Operational Centre Amsterdam, Amsterdam, The Netherlands (Public Library of Science, 2013-11)
      Recent trends to earlier access to anti-retroviral treatment underline the importance of accurate HIV diagnosis. The WHO HIV testing strategy recommends the use of two or three rapid diagnostic tests (RDTs) combined in an algorithm and assume a population is serologically stable over time. Yet RDTs are prone to cross reactivity which can lead to false positive or discordant results. This paper uses discordancy data from Médecins Sans Frontières (MSF) programmes to test the hypothesis that the specificity of RDTs change over place and time.
    • Very early anthropometric changes after antiretroviral therapy predict subsequent survival, in karonga, Malawi.

      Maman, David; Glynn, Judith R; Crampin, Amelia C; Kranzer, Katharina; Saul, Jacqueline; Jahn, Andreas; Mwinuka, Venance; Ngwira, Msenga Hc; Mvula, Hazzie; Munthali, Fipson; et al. (2012-06)
      Antiretroviral (ART) scale-up in Malawi has been achieved on a large scale based mainly on clinical criteria. Simple markers of prognosis are useful, and we investigated the value of very early anthropometric changes in predicting mortality.
    • Very early mortality in patients starting antiretroviral treatment at primary health centres in rural Malawi.

      Zachariah, Rony; Harries, Katie; Moses, Massaquoi; Manzi, Marcel; Line, Arnould; Mwagomba, Beatrice; Harries, Anthony D; Medecins Sans Frontieres, Medical Department, Brussels, Belgium. zachariah@internet.lu (2009-07-15)
      OBJECTIVES: To report on the cumulative proportion of deaths occurring within 3 months of starting antiretroviral treatment (ART) and to identify factors associated with such deaths, among adults at primary health centres in a rural district of Malawi. METHODS: Retrospective cohort study: from June 2006 to April 2008, deaths occurring over a 3-month period were determined and risk factors examined. RESULTS: A total of 2316 adults (706 men and 1610 women; median age 35 years) were included in the analysis and followed up for a total of 1588 person-years (PY); 277 (12%) people died, of whom 206 (74%) people died within 3 months of initiating ART (cumulative incidence: 13.0; 95% confidence interval: 11.3-14.8 per 100 PY of follow-up). Significant risk factors associated with early deaths included male sex, WHO stage 4 disease, oesophageal or persistent oral candidiasis and unexplained presumed or measured weight loss >10%. One in every 3 patients who either died or was lost to follow up had unexplained weight loss >10%, and survival in this group was significantly different from patients without this condition. CONCLUSIONS: Seven in 10 individuals initiating ART at primary health centres die early. Specific groups of patients are at higher risk of such mortality and should receive priority attention, care and support.
    • Viewpoint: Why do we need a point-of-care CD4 test for low-income countries?

      Zachariah, R; Reid, S D; Chaillet, P; Massaquoi, M; Schouten, E J; Harries, A D; Médecins sans Frontières, Operational Centre Brussels; CD4 Initiative, Institute for Global Health, UK; Clinton Health Access Initiative, Liberia; Department of HIV/AIDS, Ministry of Health, Malawi; Management Sciences for Health, Malawi; International Union against Tuberculosis and Lung Disease, France; London School of Hygiene and Tropical Medicine, UK (2010-11-02)
      In this paper, we discuss the reasons why we urgently need a point-of-care (POC) CD4 test, elaborate the problems we have experienced with the current technology which hampers CD4-count coverage and highlight the ideal characteristics of a universal CD4 POC test. It is high-time that CD4 technology is simplified and adapted for wider use in low-income countries to change the current paradigm of restricted access once and for all.
    • Village-based AIDS prevention in a rural district in Uganda.

      Schopper, D; Doussantousse, S; Ayiga, N; Ezatirale, G; Idro, W J; Homsy, J; Médecins Sans Frontières, Geneva, Switzerland. (Oxford Journals, 1995-06)
      OBJECTIVE: To design, implement and evaluate a village-based AIDS prevention programme in a rural district in north-western Uganda. A baseline KAP survey of the general population was carried out to design a district-wide information campaign and condom promotion programme. Eighteen months later the impact achieved was measured through a second KAP survey, using the same methodology. METHODS: Anonymous structured interviews were conducted in March 1991 and October 1992 with 1486 and 1744 randomly selected individuals age 15-49, respectively. RESULTS: At 18 months, 60% of respondents had participated in an information session in the past year (47% women, 71% men) and 42% had received a pamphlet about AIDS (26% women, 58% men). Knowledge about AIDS, high initially (94%), reached 98%. More respondents knew that the incubation period is longer than one year (from 29% to 40%), and were willing to take care of a PWA (from 60% to 77%). Knowledge about condoms increased from 26 to 63% in women and 57 to 91% in men. Ever use of condoms among persons having engaged in casual sex in the past year increased from 6 to 33% in women, and 27 to 48% in men. Fifty per cent of condom users criticized lack of regular access to condoms. CONCLUSIONS: This is the first documented example of the impact a village-based AIDS prevention programme can achieve in a rural African community. Critical areas to be improved were identified, such as: women must be given better access to information, more attention must be paid to explain the asymptomatic state of HIV infection in appropriate terms, and condom social marketing must be developed.
    • Viraemia and HIV-1 drug resistance mutations among patients receiving antiretroviral treatment in Mozambique.

      Maldonado, F; Biot, M; Roman, F; Masquelier, C; Anapenge, M; Bastos, R; Chuquela, H C; Arendt, V; Schmit, J; Zachariah, R; et al. (2008-09-17)
      This study was conducted among individuals taking first-line antiretroviral treatment (ART) for at least 12 months under programme conditions in Maputo, Mozambique in order to report on the level of detectable viraemia and the proportion and types of drug resistance mutations among those with detectable viral loads. HIV-1 RNA viral load levels (lower detection limit <50 copies/ml) were measured, and resistance mutations were sequenced. One hundred and forty-nine consecutive patients (69% females, median age 36 years) were included after a mean follow-up time of 23 months. One hundred and seven (72%; 95% CI 64-79) had undetectable viral load, while in 42 (28%, 95% CI 21-36) viral load was detectable (range 50-58884 copies/ml). From 15 patients with viral load >1000 copies/ml, 12 viruses were sequenced: eight were C subtypes and four were circulating recombinant forms (CRF08). Eight (5%; 95% CI 2-9) patients with detectable viral load had one or more major resistance mutations. Nucleoside reverse transcriptase inhibitor (NRTI) and non-NRTI mutations were observed. There were no major mutations for resistance to protease inhibitors. In Maputo, the level of detectable viraemia is reassuringly low. While embarking on ART scale-up, wider surveillance is warranted to monitor programme quality and limit the development of drug resistance, which remains a major potential challenge for the future of ART in Africa.
    • Viral load for HIV treatment failure management: a report of eight drug-resistant tuberculosis cases co-infected with HIV requiring second-line antiretroviral treatment in Mumbai, India

      Andries, Aristomo; Das, Mrinalini; Isaakidis, Petros; Saranchuk, Peter (American Society of Tropical Medicine and Hygiene, 2013-12)
    • Viral Load Monitoring as a Tool to Reinforce Adherence: A Systematic Review

      Bonner, Kimberly; Mezochow, Alyssa; Roberts, Teri; Ford, Nathan; Cohn, Jennifer; Access Campaign, Médecins Sans Frontières, Geneva, Switzerland. Kimberly.bonner@geneva.msf.org (Lippincott Williams & Wilkins, 2013-09-01)
      Viral load monitoring has been proposed as a tool to reinforce adherence, but outcomes have never been systematically assessed.
    • Viral load monitoring in resource-limited settings: a medical and public health priority.

      Ford, Nathan; Roberts, Teri; Calmy, Alexandra; Medecins Sans Frontieres, Geneva, Switzerland; Centre for Infectious Disease Epidemiology and Research, University of Cape Town; HIV/AIDS Unit, Infectious Disease Service, Geneva University Hospital, Geneva, Switzerland. (2012-08-24)
    • Viral Load Monitoring of Antiretroviral Therapy, cohort viral load and HIV transmission in Southern Africa: A Mathematical Modelling Analysis

      Estill, Janne; Aubrière, Cindy; Egger, Matthias; Johnson, Leigh; Wood, Robin; Garone, Daniela; Gsponer, Thomas; Wandeler, Gilles; Boulle, Andrew; Davies, Mary-Ann; et al. (2012-03-20)
      In low-income settings, treatment failure is often identified using CD4 cell count monitoring. Consequently, patients remain on a failing regimen, resulting in a higher risk of transmission. We investigated the benefit of routine viral load monitoring for reducing HIV transmission.
    • Viral load testing in a resource-limited setting: quality control is critical.

      Greig, Jane; du Cros, Philipp; Klarkowski, Derryck; Mills, Clair; Jørgensen, Steffen; Harrigan, P Richard; O'Brien, Daniel P; Manson Unit, Médecins Sans Frontières, London, UK. jane.greig@london.msf.org. (2011-05)
      ABSTRACT: