• Ending deaths from HIV-related cryptococcal meningitis by 2030

      Shroufi, A; Chiller, T; Jordan, A; Denning, DW; Harrison, TS; Govender, NP; Loyse, A; Baptiste, S; Rajasingham, R; Boulware, DR; et al. (Elsevier, 2021-01-01)
      The UNAIDS target to reduce HIV-related death to fewer than 500 000 deaths per year by 2020 will not be met. 1 This statement might not be headline grabbing as this target was never as prominent as the 90-90-90 targets, 2 the achievement of which is a necessary but not sufficient step towards ending AIDS mortality.
    • Ending the HIV/AIDS Epidemic in Low- and Middle-Income Countries by 2030: Is It Possible?

      Harries, AD; Suthar, A; Takarinda, KC; Tweya, H; Kyaw, NTT; Tayler-Smith, K; Zachariah, R (2016-09)
      The international community has committed to ending the epidemics of HIV/AIDS, tuberculosis, malaria, and neglected tropical infections by 2030, and this bold stance deserves universal support. In this paper, we discuss whether this ambitious goal is achievable for HIV/AIDS and what is needed to further accelerate progress. The joint United Nations Program on HIV/AIDS (UNAIDS) 90-90-90 targets and the related strategy are built upon currently available health technologies that can diagnose HIV infection and suppress viral replication in all people with HIV. Nonetheless, there is much work to be done in ensuring equitable access to these HIV services for key populations and those who remain outside the rims of the traditional health services. Identifying a cure and a preventive vaccine would further help accelerate progress in ending the epidemic. Other disease control programmes could learn from the response to the HIV/AIDS epidemic.
    • The Enduring Burden of Advanced Human Immunodeficiency Virus Disease

      Ford, N; Goemaere, E; Hildebrand, K; Perez-Casas, C (Oxford University Press, 2020-05-05)
    • Ensuring sustainable antiretroviral provision during economic crises.

      Mills, Edward J; Ford, Nathan; Nabiryo, Christine; Cooper, Curtis; Montaner, Julio; University of Ottawa, 451, Smyth Road, Ottawa, ON K1H 8M5, Canada. emills@cfenet.ubc.ca (2010-01-28)
    • The epidemiology of adolescents living with perinatally acquired HIV: A cross-region global cohort analysis

      Slogrove, AL; Schomaker, M; Davies, MA; Williams, P; Balkan, S; Ben-Farhat, J; Calles, N; Chokephaibulkit, K; Duff, C; Eboua, TF; et al. (Public Library of Science, 2018-03-01)
      Globally, the population of adolescents living with perinatally acquired HIV (APHs) continues to expand. In this study, we pooled data from observational pediatric HIV cohorts and cohort networks, allowing comparisons of adolescents with perinatally acquired HIV in "real-life" settings across multiple regions. We describe the geographic and temporal characteristics and mortality outcomes of APHs across multiple regions, including South America and the Caribbean, North America, Europe, sub-Saharan Africa, and South and Southeast Asia.
    • Errors Generated by a Point-Of-Care CD4+ T-Lymphocyte Analyser: a Retrospective Observational Study in Nine Countries

      Fajardo, E; Metcalf, C; Piriou, E; Gueguen, M; Maman, D; Chaillet, P; Cox, V; Rumaney, MB; Tunggal, S; Kosack, C; et al. (World Health Organization, 2015-09-01)
      To estimate the proportion of invalid results generated by a CD4+ T-lymphocyte analyser used by Médecins Sans Frontières (MSF) in field projects and identify factors associated with invalid results.
    • Estimation and Short-Term Prediction of the Course of the HIV Epidemic Using Demographic and Health Survey Methodology-Like Data

      Blaizot, Stéphanie; Riche, Benjamin; Maman, David; Mukui, Irene; Kirubi, Beatrice; Etard, Jean-François; Ecochard, René (Public Library of Science, 2015-06-19)
      Mathematical models have played important roles in the understanding of epidemics and in the study of the impacts of various behavioral or medical measures. However, modeling accurately the future spread of an epidemic requires context-specific parameters that are difficult to estimate because of lack of data. Our objective is to propose a methodology to estimate context-specific parameters using Demographic and Health Survey (DHS)-like data that can be used in mathematical modeling of short-term HIV spreading.
    • Evaluation of a 5-year programme to prevent mother-to-child transmission of HIV infection in Northern Uganda

      Ahoua, Laurence; Ayikoru, Harriet; Gnauck, Katherine; Odaru, Grace; Odar, Emmanuel; Ondoa-Onama, Christine; Pinoges, Loretxu; Balkan, Suna; Olson, David; Pujades-Rodríguez, Mar; et al. (2010-07-13)
      Prevention of mother-to-child transmission (PMTCT) is essential in HIV/AIDS control. We analysed 2000-05 data from mother-infant pairs in our PMTCT programme in rural Uganda, examining programme utilization and outcomes, HIV transmission rates and predictors of death or loss to follow-up (LFU). Out of 19,017 women, 1,037 (5.5%) attending antenatal care services tested HIV positive. Of these, 517 (50%) enrolled in the PMTCT programme and gave birth to 567 infants. Before tracing, 303 (53%) mother-infant pairs were LFU. Reasons for dropout were infant death and lack of understanding of importance of follow-up. Risk of death or LFU was higher among infants with no or incomplete intrapartum prophylaxis (OR = 1.90, 95% CI 1.07-3.36) and of weaning age <6 months (OR 2.55, 95% CI 1.42-4.58), and lower in infants with diagnosed acute illness (OR 0.30, 95% CI 0.16-0.55). Mother-to-child HIV cumulative transmission rate was 8.3%, and 15.5% when HIV-related deaths were considered. Improved tracking of HIV-exposed infants is needed in PMTCT programmes where access to early infant diagnosis is still limited.
    • The evaluation of a rapid in situ HIV confirmation test in a programme with a high failure rate of the WHO HIV two-test diagnostic algorithm.

      Klarkowski, D; Wazome, J M; Lokuge, K M; Shanks, L; Mills, C; O'Brien, D P; Public Health Department, Médecins Sans Frontières, Amsterdam, The Netherlands. derryck.klarkowski@amsterdam.msf.org (2009-02)
      BACKGROUND: Concerns about false-positive HIV results led to a review of testing procedures used in a Médecins Sans Frontières (MSF) HIV programme in Bukavu, eastern Democratic Republic of Congo. In addition to the WHO HIV rapid diagnostic test algorithm (RDT) (two positive RDTs alone for HIV diagnosis) used in voluntary counselling and testing (VCT) sites we evaluated in situ a practical field-based confirmation test against western blot WB. In addition, we aimed to determine the false-positive rate of the WHO two-test algorithm compared with our adapted protocol including confirmation testing, and whether weakly reactive compared with strongly reactive rapid test results were more likely to be false positives. METHODOLOGY/PRINCIPAL FINDINGS: 2864 clients presenting to MSF VCT centres in Bukavu during January to May 2006 were tested using Determine HIV-1/2 and UniGold HIV rapid tests in parallel by nurse counsellors. Plasma samples on 229 clients confirmed as double RDT positive by laboratory retesting were further tested using both WB and the Orgenics Immunocomb Combfirm HIV confirmation test (OIC-HIV). Of these, 24 samples were negative or indeterminate by WB representing a false-positive rate of the WHO two-test algorithm of 10.5% (95%CI 6.6-15.2). 17 of the 229 samples were weakly positive on rapid testing and all were negative or indeterminate by WB. The false-positive rate fell to 3.3% (95%CI 1.3-6.7) when only strong-positive rapid test results were considered. Agreement between OIC-HIV and WB was 99.1% (95%CI 96.9-99.9%) with no false OIC-HIV positives if stringent criteria for positive OIC-HIV diagnoses were used. CONCLUSIONS: The WHO HIV two-test diagnostic algorithm produced an unacceptably high level of false-positive diagnoses in our setting, especially if results were weakly positive. The most probable causes of the false-positive results were serological cross-reactivity or non-specific immune reactivity. Our findings show that the OIC-HIV confirmation test is practical and effective in field contexts. We propose that all double-positive HIV RDT samples should undergo further testing to confirm HIV seropositivity until the accuracy of the RDT testing algorithm has been established at programme level.
    • Evaluation of a systematic substitution of zidovudine for stavudine-based HAART in a program setting in rural Cambodia

      Isaakidis, P; Raguenaud, M E; Phe, T; Khim, S; Kuoch, S; Khem, S; Reid, T; Arnould, L; Médecins Sans Frontières OCB, Phnom Penh, Cambodia; Chronic Diseases Clinic, Donkeo Provincial Referral Hospital, Ministry of Health, Takeo, Cambodia; Médecins Sans Frontières OCB, Brussels, Belgium (2008-09-01)
    • Evaluation of Clinical and Immunological Markers for predicting Virological Failure in a HIV/AIDS treatment cohort in Busia, Kenya

      Ferreyra, Cecilia; Yun, Oliver; Eisenberg, Nell; Alonso, Elena; Khamadi, Ashimosi S; Mwau, Matilu; Mugendi, Martha Kihara; Alvarez, Ana; Velilla, Elena; Flevaud, Laurence; et al. (2012-11-21)
      In resource-limited settings where viral load (VL) monitoring is scarce or unavailable, clinicians must use immunological and clinical criteria to define HIV virological treatment failure. This study examined the performance of World Health Organization (WHO) clinical and immunological failure criteria in predicting virological failure in HIV patients receiving antiretroviral therapy (ART).
    • Evaluation of HIV testing algorithms in Ethiopia: the role of the tie-breaker algorithm and weakly reacting test lines in contributing to a high rate of false positive HIV diagnoses

      Shanks, Leslie; Siddiqui, M; Kliescikova, Jarmila; Pearce, Neil; Ariti, Cono; Muluneh, Libsework; Pirou, Erwan; Ritmeijer, Koert; Masiga, Johnson; Abebe, Almaz (BioMed Central (Springer Science), 2015-02-03)
      BackgroundIn Ethiopia a tiebreaker algorithm using 3 rapid diagnostic tests (RDTs) in series is used to diagnose HIV. Discordant results between the first 2 RDTs are resolved by a third `tiebreaker¿ RDT. Médecins Sans Frontières uses an alternate serial algorithm of 2 RDTs followed by a confirmation test for all double positive RDT results. The primary objective was to compare the performance of the tiebreaker algorithm with a serial algorithm, and to evaluate the addition of a confirmation test to both algorithms. A secondary objective looked at the positive predictive value (PPV) of weakly reactive test lines.MethodsThe study was conducted in two HIV testing sites in Ethiopia. Study participants were recruited sequentially until 200 positive samples were reached. Each sample was re-tested in the laboratory on the 3 RDTs and on a simple to use confirmation test, the Orgenics Immunocomb Combfirm® (OIC). The gold standard test was the Western Blot, with indeterminate results resolved by PCR testing.Results2620 subjects were included with a HIV prevalence of 7.7%. Each of the 3 RDTs had an individual specificity of at least 99%. The serial algorithm with 2 RDTs had a single false positive result (1 out of 204) to give a PPV of 99.5% (95% CI 97.3%-100%). The tiebreaker algorithm resulted in 16 false positive results (PPV 92.7%, 95% CI: 88.4%-95.8%). Adding the OIC confirmation test to either algorithm eliminated the false positives. All the false positives had at least one weakly reactive test line in the algorithm. The PPV of weakly reacting RDTs was significantly lower than those with strongly positive test lines.ConclusionThe risk of false positive HIV diagnosis in a tiebreaker algorithm is significant. We recommend abandoning the tie-breaker algorithm in favour of WHO recommended serial or parallel algorithms, interpreting weakly reactive test lines as indeterminate results requiring further testing except in the setting of blood transfusion, and most importantly, adding a confirmation test to the RDT algorithm. It is now time to focus research efforts on how best to translate this knowledge into practice at the field level.Trial registrationClinical Trial registration #: NCT01716299.
    • "Even if she's really sick at home, she will pretend that everything is fine.": Delays in seeking care and treatment for advanced HIV disease in Kinshasa, Democratic Republic of Congo.

      Venables, E; Casteels, I; Manziasi Sumbi, E; Goemaere, E (Public Library of Science, 2019-02-13)
      HIV prevalence in the Democratic Republic of Congo (DRC) is estimated to be 1.2%, and access to HIV testing and treatment remains low across the country. Despite advances in treatment, HIV continues to be one of the main reasons for hospitalisation and death in low- and middle-income countries, including DRC, but the reasons why people delay seeking health-care when they are extremely sick remain little understood. People in Kinshasa, DRC, continue to present to health-care facilities in an advanced stage of HIV when they are close to death and needing intensive treatment.
    • Excellent outcomes among HIV+ children on ART, but unacceptably high pre-ART mortality and losses to follow-up: a cohort study from Cambodia.

      Raguenaud, M-E; Isaakidis, P; Zachariah, R; Te, V; Soeung, S; Akao, K; Kumar, V; Médecins Sans Frontières, 72, Street 592, Phnom Penh, Cambodia. eve_raguenaud@hotmail.com (2009-08-20)
      BACKGROUND: Although HIV program evaluations focusing on mortality on ART provide important evidence on treatment effectiveness, they do not asses overall HIV program performance because they exclude patients who are eligible but not started on ART for whatever reason. The objective of this study was to measure mortality that occurs both pre-ART and during ART among HIV-positive children enrolled in two HIV-programs in Cambodia. METHODS: Retrospective cohort study on 1168 HIV-positive children <15 years old registered in two HIV-programs over a four-year period. Mortality rates were calculated for both children on treatment and children not started on ART. RESULTS: Over half (53%) of children were 5 years or above and only 69(6%) were <18 months. Overall, 9% (105/1168) of children died since the set-up of the programs. By the end of the observation period, 66(14.5%) patients not on ART had died compared to 39(5.5%) of those under treatment, and 100(22%) who did not start ART were lost-to-follow-up compared to 13(2%) on ART. 66/105 (62.8%) of all in-program deaths occurred before starting ART, of which 56% (37/66) and 79% (52/66) occurred within 3 and 6 months of enrollment respectively. Mortality rate ratio between children not on ART and children on ART was 4.1 (95%CI: 2.7-6.2) (P < 0.001). The most common contributing cause of death in first 3 months of treatment and in first 3 months of program enrollment was tuberculosis. 41/52 (79%) children who died within 6 months of enrollment had met the ART eligibility criteria before death. CONCLUSION: HIV-positive children experienced a high mortality and loss-to-follow-up rates before starting ART. These program outcomes may be improved by a more timely ART initiation. Measuring overall in-program mortality as opposed to only mortality on ART is recommended in order to more accurately evaluate pediatric HIV-programs performance.
    • Expanding Access to HIV Viral Load Testing: A Systematic Review of RNA Stability in EDTA Tubes and PPT beyond Current Time and Temperature Thresholds

      Bonner, Kimberly; Siemieniuk, Reed A; Boozary, Andrew; Roberts, Teri; Fajardo, Emmanuel; Cohn, Jennifer (Public Library of Science, 2014-12-01)
      HIV viral load (VL) testing is the gold standard for antiretroviral treatment monitoring, but many barriers exist to VL testing in resource-limited settings, including storage and transport limitations for whole blood and plasma. Data from various studies indicate that HIV RNA is stable beyond current recommendations. We conducted a systematic review to assess stability data of HIV RNA in whole blood and plasma across times and temperatures.
    • Expanding HIV care in Africa: making men matter.

      Mills, E; Ford, N; Mugyenyi, P; Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada V5Z4B4. emills@cfenet.ubc.ca (2009-07-25)
    • Exploring HIV infection and susceptibility to measles among older children and adults in Malawi: a facility-based study

      Polonsky, Jonathan A; Singh, Beverley; Masiku, Charlie; Langendorf, Céline; Kagoli, Matthew; Hurtado, Northan; Berthelot, Mathilde; Heinzelmann, Annette; Puren, Adrian; Grais, RFebecca F (Elsevier, 2014-12-11)
      Background HIV infection increases measles susceptibility in infants, but little is known about this relationship among older children and adults. We conducted a facility-based study to explore whether HIV status and/or CD4 count were associated with either measles seroprotection and/or measles antibody concentration. Methods We conveniently sampled HIV-infected patients presenting for follow-up care, and HIV-uninfected individuals presenting for HIV testing at Chiradzulu District Hospital, Malawi, from January to September 2012. We recorded age, sex and reported measles vaccination and infection history. Blood samples were taken to determine CD4 count and measles antibody concentration. Results 1935 (1434 HIV-infected; 501 HIV-uninfected) participants were recruited. The majority of adults, and approximately half the children, were measles seroprotected, with lower odds among HIV-infected children (adjusted OR=0.27, 95% CI: 0.10-0.69, p=0.006), but not adults. Among HIV-infected participants, neither CD4 count (p=0.16) nor time on antiretroviral therapy (p=0.25) were associated with measles antibody concentration, while older age (p<0.001) and female sex (p<0.001) were independently associated with this measure. Conclusions We found no evidence that HIV infection contributes to the risk for measles infection among adults, but HIV-infected children (including at ages older than previously reported), were less likely to be seroprotected in this sample.
    • Exploring HIV risk perception and behaviour in the context of antiretroviral treatment: results from a township household survey.

      Boulle, A; Hilderbrand, K; Menten, J; Coetzee, D; Ford, N; Matthys, F; Boelaert, M; Van der Stuyft, P; School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa. andrew.boulle@uct.ac.za (Taylor & Francis, 2008-08)
      The objective of this cross-sectional household survey was to assess factors influencing HIV risk perception, behaviour and intervention uptake in a community characterised by high HIV prevalence and availability of antiretroviral therapy (ART). The survey was conducted in Khayelitsha, South Africa and involved two-stage sampling with self-weighting clusters and random selection of households within clusters. One man and woman between 14 and 49 years old was interviewed in each household; 696 men and 879 women were interviewed for a response rate of 84% and 92% respectively. Ninety-three percent and 94% were sexually active with median age of sexual debut 15.3 and 16.5 years. Eighty-three percent and 82% reported a partner at the time of interview and 29% and 8% had additional partner(s). Forty-one percent and 33% reported condom use during the last sexual encounter. Thirty-seven percent of men not using condoms did not as they believed their partner to be faithful, whilst 27% of women did not as their partner refused. Twenty-eight percent and 53% had been tested for HIV. Having undergone HIV testing was not associated with condom usage, whilst current relationship status was the strongest association with condom usage for both men and women. In spite of a relatively high uptake of condoms and testing as well as ART availability, the HIV epidemic has continued unabated in Khayelitsha. Even greater coverage of preventive interventions is required, together with a national social and political environment that builds on the availability of both preventive and treatment services.
    • Extremely Low Hepatitis C prevalence among HIV co-infected individuals in 4 countries in sub-Saharan Africa

      Loarec, A; Carnimeo, V; Molfino, L; Kizito, W; Muyindike, W; Andrieux-Meyer, I; Balkan, S; Nzomukunda, Y; Mwanga-Amumpaire, J; Ousley, J; et al. (Lippincott, Williams & Wilkins, 2018-11-16)
      : A multicentric, retrospective case-series analysis (facility-based) in five sites across Kenya, Malawi, Mozambique, and Uganda screened HIV-positive adults for hepatitis C virus (HCV) antibodies using Oraquick rapid testing and viral confirmation (in three sites). Results found substantially lower prevalence than previously reported for these countries compared with previous reports, suggesting that targeted integration of HCV screening in African HIV programs may be more impactful than routine screening.This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0.
    • Eye exam with indirect ophthalmoscopy for diagnosis of disseminated tuberculosis in patients with HIV/AIDS

      Heiden, David; Margolis, Todd P; Lowinger, Alan; Saranchuk, Peter (BMJ Publishing Group, 2013-05-01)