• A qualitative assessment of a community antiretroviral therapy group model in Tete, Mozambique

      Rasschaert, Freya; Telfer, Barbara; Lessitala, Faustino; Decroo, Tom; Remartinez, Daniel; Biot, Marc; Candrinho, Baltazar; Mbofana, Francisco; Van Damme, Wim (Public Library of Science, 2014-03-20)
      To improve retention on ART, Médecins Sans Frontières, the Ministry of Health and patients piloted a community-based antiretroviral distribution and adherence monitoring model through Community ART Groups (CAG) in Tete, Mozambique. By December 2012, almost 6000 patients on ART had formed groups of whom 95.7% were retained in care. We conducted a qualitative study to evaluate the relevance, dynamic and impact of the CAG model on patients, their communities and the healthcare system.
    • A qualitative investigation of adherence to nutritional therapy in malnourished adult AIDS patients in Kenya

      Dibari, Filippo; Bahwere, Paluku; Le Gall, Isabelle; Guerrero, Saul; Mwaniki, David; Seal, Andrew; Valid International, Oxford, UK; UCL Centre for International Health and Development, Institute of Child Health, London, UK; MSF-France, Nairobi, Kenya/Paris, France; Centre for Public Health, Kenya Medical Research Institute, KEMRI/CPHR, Nairobi, Kenya; Academy for Educational Development/Regional Office for Eastern and Central Africa, Nairobi, Kenya (Cambridge University Press, 2011-02-04)
      To understand factors affecting the compliance of malnourished, HIV-positive adults with a nutritional protocol using ready-to-use therapeutic food (RUTF; Plumpy'nut®).
    • Rationing antiretroviral therapy in Africa--treating too few, too late.

      Ford, N; Mills, E; Calmy, A; Medical unit, Médecins sans Frontières, and School of Public Health and Family Medicine, University of Cape Town, South Africa. (2009-04-30)
    • Reasons for loss to follow-up among mothers registered in a prevention-of-mother-to-child transmission program in rural Malawi

      Bwirire, L; Fitzgerald, M; Zachariah, R; Chikafa, V; Massaquoi, M; Moens, M; Kamoto, K; Schouten, E (Elsevier, 2008-05-16)
    • Reasons for unsatisfactory acceptance of antiretroviral treatment in the urban Kibera slum, Kenya.

      Unge, C; Johansson, A; Zachariah, R; Some, D; Van Engelgem, I; Ekstrom, A M; Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden. christianunge@gmail.com (Taylor & Francis, 2008-02)
      The aim of this study was to explore why patients in the urban Kibera slum, Nairobi, Kenya, offered free antiretroviral treatment (ART) at the Médecins Sans Frontièrs (MSF) clinic, choose not to be treated despite signs of AIDS. Qualitative semi-structured interviews were conducted with 26 patients, 9 men and 17 women. Six main reasons emerged for not accepting ART: a) fear of taking medication on an empty stomach due to lack of food; b) fear that side-effects associated with ART would make one more ill; c) fear of disclosure and its possible negative repercussions; d) concern for continuity of treatment and care; e) conflicting information from religious leaders and community, and seeking alternative care (e.g. traditional medicine); f) illiteracy making patients unable to understand the information given by health workers.
    • Reflections on a decade of delivering PMTCT in Khayelitsha, South Africa

      Stinson, Kathryn; Giddy, Janet; Cox, Vivian; Burton, Rosie; Ibeto, Maryirene; Cragg, Carol; Van Cutsem, Gilles; Hilderbrand, Katherine; Boulle, Andrew; Coetzee, David; Goemaere, Eric (Health & Medical Publishing Group, 2014-03-25)
    • Reframing HIV Care: Putting People at the Centre of Antiretroviral Delivery

      Duncombe, Chris; Rosenblum, Scott; Hellmann, Nicholas; Holmes, Charles; Wilkinson, Lynne; Biot, Marc; Bygrave, Helen; Hoos, David; Garnett, Geoff (Wiley-Blackwell, 2015-01-13)
      The delivery of HIV care in the initial rapid scale-up of HIV care and treatment was based on existing clinic-based models, which are common in highly resourced settings and largely undifferentiated for individual needs. A new framework for treatment based on variable intensities of care tailored to the specific needs of different groups of individuals across the cascade of care is proposed here. Service intensity is characterized by four delivery components: (1) types of services delivered, (2) location of service delivery, (3) provider of health services, and (4) frequency of health services. How these components are developed into a service delivery framework will vary across countries and populations, with the intention being to improve acceptability and care outcomes. The goal of getting more people on treatment before they become ill will necessitate innovative models of delivering both testing and care. As HIV programs expand treatment eligibility, many people entering care will not be "patients" but healthy, active and productive members of society.(1) In order to take the framework to scale, it will be important to: (1) define which individuals can be served by an alternative delivery framework; (2) strengthen health systems that support decentralization, integration and task shifting; (3) make the supply chain more robust; and (4) invest in data systems for patient tracking and for program monitoring and evaluation. This article is protected by copyright. All rights reserved.
    • Registration problems for antiretrovirals in Africa.

      Ford, N; Darder, M; Médecins Sans Frontières, Khayelitsha, 7784 South Africa. Nathan.FORD@london.msf.org (Elsevier, 2006-03-11)
    • Reimagining HIV Service Delivery: The Role Of Differentiated Care From Prevention to Suppression

      Grimsrud, A; Bygrave, H; Doherty, M; Ehrenkranz, P; Ellman, T; Ferris, R; Ford, N; Killingo, B; Mabote, L; Mansell, T; Reinisch, A; Zulu, I; Bekker, LG (International AIDS Society, 2016-12-01)
    • Relationship Between Time to Initiation of Antiretroviral Therapy and Treatment Outcomes: A Cohort Analysis of ART Eligible Adolescents in Zimbabwe

      Vogt, F; Rehman, AM; Kranzer, K; Nyathi, M; Van Griensven, J; Dixon, M; Ndebele, W; Gunguwo, H; Colebunders, R; Ndlovu, M; Apollo, T; Ferrand, RA (Lippincott Williams & Wilkins, 2017-04-01)
      Age-specific retention challenges make antiretroviral therapy (ART) initiation in adolescents difficult, often requiring a lengthy preparation process. This needs to be balanced against the benefits of starting treatment quickly. The optimal time to initiation duration in adolescents is currently unknown.
    • Renal safety of a tenofovir-containing first line regimen: experience from an antiretroviral cohort in rural lesotho.

      Bygrave, Helen; Kranzer, Katharina; Hilderbrand, Katherine; Jouquet, Guillaume; Goemaere, Eric; Vlahakis, Nathalie; Triviño, Laura; Makakole, Lipontso; Ford, Nathan; Médecins Sans Frontières, Morija, Lesotho. (2011-03)
      Current guidelines contraindicate TDF use when creatinine clearance (CrCl) falls below 50 ml/min. We report prevalence of abnormal renal function at baseline and factors associated with abnormal renal function from a community cohort in Lesotho.
    • Resistance profiles after different periods of exposure to a first-line antiretroviral regimen in a Cameroonian cohort of HIV type-1-infected patients.

      Soria, A; Porten, K; Fampou-Toundji, J; Galli, L; Mougnutou, R; Buard, V; Kfutwah, A; Vessière, A; Rousset, D; Teck, R; Calmy, A; Ciaffi, L; Lazzarin, A; Gianotti, N; Department of Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy. a.soria@hsgerardo.org (2009-08)
      BACKGROUND: The lack of HIV type-1 (HIV-1) viral load (VL) monitoring in resource-limited settings might favour the accumulation of resistance mutations and thus hamper second-line treatment efficacy. We investigated the factors associated with resistance after the initiation of antiretroviral therapy (ART) in the absence of virological monitoring. METHODS: Cross-sectional VL sampling of HIV-1-infected patients receiving first-line ART (nevirapine or efavirenz plus stavudine or zidovudine plus lamivudine) was carried out; those with a detectable VL were genotyped. RESULTS: Of the 573 patients undergoing VL sampling, 84 were genotyped. The mean number of nucleoside/nucleotide reverse transcriptase inhibitor (NRTI) mutations increased with the duration of ART exposure (P=0.02). Multivariable analysis showed that patients with a CD4+ T-cell count < or =50 cells/mm(3) at ART initiation (baseline) had a higher mean number of both NRTI and non-NRTI (NNRTI) mutations than those with a baseline CD4+ T-cell count >50 cells/mm(3) (2.10 versus 0.56; P<0.0001; and 1.65 versus 0.76; P=0.005, respectively). A baseline CD4+ T-cell count < or =50 cells/mm(3) predicted > or =1 NRTI mutation (adjusted odds ratio [AOR] 7.49, 95% confidence interval [CI] 2.20-32.14), > or =1 NNRTI mutation (AOR 4.25, 95% CI 1.36-15.48), > or =1 thymidine analogue mutation (AOR 8.45, 95% CI 2.16-40.16) and resistance to didanosine (AOR 6.36, 95% CI 1.49-32.29) and etravirine (AOR 4.72, 95% CI 1.53-15.70). CONCLUSIONS: Without VL monitoring, the risk of drug resistance increases with the duration of ART and is associated with lower CD4+ T-cell counts at ART initiation. These data might help define strategies to preserve second-line treatment options in resource-limited settings.
    • Responding to HIV Infection Associated with Drug Injecting in Eastern Europe.

      Burrows, D; Rhodes, T; Trautmann, F; Bijl, M; Stimson, G; Sarankov, Y; Ball, A; Fitch, C; Harm Reduction Training Programme, Russian Federation, Médecins Sans Frontières, Moscow, Russian Federation. (1998-12)
    • Response to Comment on "Alert, but not Alarmed" - A Comment on "Towards More Accurate HIV Testing in Sub-Saharan Africa: A Multi-Site Evaluation of HIV RDTs and Risk Factors for False Positives (Kosack et al. 2017)"

      Kosack, C; Page, A; Beelaert, G; Benson, T; Savane, A; Ng'ang'a, A; Andre, B; Zahinda, J; Shanks, L; Fransen, K (International AIDS Society, 2017-06-19)
    • Response to highly active antiretroviral therapy among severely immuno-compromised HIV-infected patients in Cambodia.

      Madec, Y; Laureillard, D; Pinoges, L; Fernandez, M; Prak, N; Ngeth, C; Moeung, S; Song, S; Balkan, S; Ferradini, L; Quillet, C; Fontanet, A; Unité d'Epidémiologie des Maladies Emergentes, Institut Pasteur, 25-28 rue du Docteur Roux, 75015 Paris, France. (2007-01-30)
      BACKGROUND: HAART efficacy was evaluated in a real-life setting in Phnom Penh (Médecins Sans Frontières programme) among severely immuno-compromised patients. METHODS: Factors associated with mortality and immune reconstitution were identified using Cox proportional hazards and logistic regression models, respectively. RESULTS: From July 2001 to April 2005, 1735 patients initiated HAART, with median CD4 cell count of 20 (inter-quartile range, 6-78) cells/microl. Mortality at 2 years increased as the CD4 cell count at HAART initiation decreased, (4.4, 4.5, 7.5 and 24.7% in patients with CD4 cell count > 100, 51-100, 21-50 and < or = 20 cells/microl, respectively; P < 10). Cotrimoxazole and fluconazole prophylaxis were protective against mortality as long as CD4 cell counts remained < or = 200 and < or = 100 cells/microl, respectively. The proportion of patients with successful immune reconstitution (CD4 cell gain > 100 cells/microl at 6 months) was 46.3%; it was lower in patients with previous ART exposure [odds ratio (OR), 0.16; 95% confidence interval (CI), 0.05-0.45] and patients developing a new opportunistic infection/immune reconstitution infection syndromes (OR, 0.71; 95% CI, 0.52-0.98). Similar efficacy was found between the stavudine-lamivudine-nevirapine fixed dose combination and the combination stavudine-lamivudine-efavirenz in terms of mortality and successful immune reconstitution. No surrogate markers for CD4 cell change could be identified among total lymphocyte count, haemoglobin, weight and body mass index. CONCLUSION: Although CD4 cell count-stratified mortality rates were similar to those observed in industrialized countries for patients with CD4 cell count > 50 cells/microl, patients with CD4 cell count < or = 20 cells/microl posed a real challenge to clinicians. Widespread voluntary HIV testing and counselling should be encouraged to allow HAART initiation before the development of severe immuno-suppression.
    • Retention and attrition during the preparation phase and after start of antiretroviral treatment in Thyolo, Malawi, and Kibera, Kenya: implications for programmes?

      Zachariah, R; Tayler-Smith, K; Manzi, M; Massaquoi, M; Mwagomba, B; van Griensven, J; van Engelgem, I; Arnould, L; Schouten, E J; Chimbwandira, F M; Harries, A D; Médecins sans Frontières, Medical Department (Operational Research), Brussels Operational Center, 68 Rue de Gasperich, L-1617, Luxembourg, Luxembourg. zachariah@internet.lu (2011-08)
      Among adults eligible for antiretroviral therapy (ART) in Thyolo (rural Malawi) and Kibera (Nairobi, Kenya), this study (a) reports on retention and attrition during the preparation phase and after starting ART and (b) identifies risk factors associated with attrition. 'Retention' implies being alive and on follow-up, whilst 'attrition' implies loss to follow-up, death or stopping treatment (if on ART). There were 11,309 ART-eligible patients from Malawi and 3633 from Kenya, of whom 8421 (74%) and 2792 (77%), respectively, went through the preparation phase and started ART. In Malawi, 2649 patients (23%) were lost to attrition in the preparation phase and 2189 (26%) after starting ART. Similarly, in Kenya 546 patients (15%) were lost to attrition in the ART preparation phase and 647 (23%) while on ART. Overall programme attrition was 43% (4838/11,309) for Malawi and 33% (1193/3633) for Kenya. Restricting cohort evaluation to 'on ART' (as is usually done) underestimates overall programme attrition by 38% in Malawi and 36% in Kenya. Risk factors associated with attrition in the preparation phase included male sex, age <35 years, advanced HIV/AIDS disease and increasing malnutrition. Considerable attrition occurs during the preparation phase of ART, and programme evaluations confined to on-treatment analysis significantly underestimate attrition. This has important operational implications, which are discussed here.
    • Retention and Risk Factors for Attrition in a Large Public Health ART Program in Myanmar: A Retrospective Cohort Analysis.

      Thida, Aye; Tun, Sai Thein Than; Zaw, Sai Ko Ko; Lover, Andrew A; Cavailler, Philippe; Chunn, Jennifer; Aye, Mar Mar; Par, Par; Naing, Kyaw Win; Zan, Kaung Nyunt; Shwe, Myint; Kyaw, Thar Tun; Waing, Zaw Htoon; Clevenbergh, Philippe (Public Library of Science, 2014-09-30)
      The outcomes from an antiretroviral treatment (ART) program within the public sector in Myanmar have not been reported. This study documents retention and the risk factors for attrition in a large ART public health program in Myanmar.
    • Retention in care among clinically stable antiretroviral therapy patients following a six-monthly clinical consultation schedule: findings from a cohort study in rural Malawi

      Wringe, A; Cawley, C; Szumilin, E; Salumu, L; Amoros Quiles, I; Pasquier, E; Masiku, C; Nicholas, S (Wiley Open Access, 2018-11)
      Longer intervals between clinic consultations for clinically stable antiretroviral therapy (ART) patients may improve retention in care and reduce facility workload. We assessed long-term retention among clinically stable ART patients attending six-monthly clinical consultations (SMCC) with three-monthly fast-track drug refills, and estimated the number of consultations "saved" by this model of ART delivery in rural Malawi.
    • Retention on ART and predictors of disengagement from care in several alternative community-centred ART refill models in rural Swaziland

      Pasipamire, L; Nesbitt, RC; Ndlovu, S; Sibanda, G; Mamba, S; Lukhele, N; Pasipamire, M; Kabore, SM; Rusch, B; Ciglenecki, I; Kerschberger, B (Wiley, 2018-09-21)
      A broad range of community-centred care models for patients stable on anti-retroviral therapy (ART) have been proposed by the World Health Organization to better respond to patient needs and alleviate pressure on health systems caused by rapidly growing patient numbers. Where available, often a single alternative care model is offered in addition to routine clinical care. We operationalized several community-centred ART delivery care models in one public sector setting. Here, we compare retention in care and on ART and identify predictors of disengagement with care.
    • A Retrospective Survey of HIV Drug Resistance Among Patients 1 Year After Initiation of Antiretroviral Therapy at 4 Clinics in Malawi

      Wadonda-Kabondo, N.; Hedt, B. L.; van Oosterhout, J. J.; Moyo, K.; Limbambala, E.; Bello, G.; Chilima, B.; Schouten, E.; Harries, A.; Massaquoi, M.; Porter, C.; Weigel, R.; Hosseinipour, M.; Aberle-Grasse, J.; Jordan, M. R.; Kabuluzi, S.; Bennett, D. E. (2012-05)