• Antiretroviral treatment uptake and attrition among HIV-positive patients with tuberculosis in Kibera, Kenya

      Tayler-Smith, K.; Zachariah, R.; Manzi, M.; Kizito, W.; Vandenbulcke, A.; Sitienei, J.; Chakaya, J.; Harries, A. D. (2011-11)
    • Are Expert Patients an Untapped Resource for ART Provision in Sub-Saharan Africa?

      Decroo, Tom; Van Damme, Wim; Kegels, Guy; Remartinez, Daniel; Rasschaert, Freya; Médecins Sans Frontières, Avenue Eduardo Mondlane 38, Tete, Mozambique. (2012-04)
      Since the introduction of antiretroviral treatment, HIV/AIDS can be framed as a chronic lifelong condition, requiring lifelong adherence to medication. Reinforcement of self-management through information, acquisition of problem solving skills, motivation, and peer support is expected to allow PLWHA to become involved as expert patients in the care management and to decrease the dependency on scarce skilled medical staff. We developed a conceptual framework to analyse how PLWHA can become expert patients and performed a literature review on involvement of PLWHA as expert patients in ART provision in Sub-Saharan Africa. This paper revealed two published examples: one on trained PLWHA in Kenya and another on self-formed peer groups in Mozambique. Both programs fit the concept of the expert patient and describe how community-embedded ART programs can be effective and improve the accessibility and affordability of ART. Using their day-to-day experience of living with HIV, expert patients are able to provide better fitting solutions to practical and psychosocial barriers to adherence. There is a need for careful design of models in which expert patients are involved in essential care functions, capacitated, and empowered to manage their condition and support fellow peers, as an untapped resource to control HIV/AIDS.
    • ART adherence clubs: a long-term retention strategy for clinically stable patients receiving antiretroviral therapy

      Wilkinson, Lynne Susan; Médecins Sans Frontières Khayelitsha, Cape Town, South Africa (Health and Medical Publishing Group, 2013-05-21)
      The ART-adherence club model described here provides patient-friendly access to antiretroviral therapy (ART) for clinically stable patients. It reduces the burden that stable patients place on healthcare facilities, increasing clinical human resources for new patients, and those clinically unstable and at risk of failing treatment. In the model, 30 patients are allocated to an ART club. The group meets either at a facility or community venue for less than an hour every 2 months. Group meetings are facilitated by a lay club facilitator who provides a quick clinical assessment, referral where necessary, and dispenses pre-packed ART. From January 2011 to December 2012, after adoption for phased rollout by the Western Cape Government, more than 600 ART clubs were established in Cape Town, providing ART care to over 16 000 patients. This extensive, rapid rollout demonstrates active buy-in from patients and facility staff. South Africa should consider a similar model for national rollout.
    • Assessing the outcomes of HIV-infected persons receiving treatment for Kaposi sarcoma in Conakry-Guinea

      Bekolo, CE; Soumah, MM; Tiemtore, OW; Diallo, A; Yuma, JD; Di Stefano, L; Metcalf, C; Cisse, M (BioMed Central, 2017-12-02)
      Médecins Sans Frontières is supporting comprehensive HIV care and treatment for Kaposi Sarcoma (KS) in Guinea, where antiretroviral coverage is low and access to KS treatment is very limited. We aimed to evaluate treatment response and survival outcomes of epidemic KS in this setting.
    • Assessing the quality of data aggregated by antiretroviral treatment clinics in Malawi.

      Makombe, S D; Hochgesang, M; Jahn, A; Tweya, H; Hedt, B; Chuka, S; Yu, J K L; Aberle-Grasse, J; Pasulani, O; Bailey, C; Kamoto, K; Schouten, E J; Harries, A D; Clinical HIV Unit, Ministry of Health, Lilongwe, Malawi. (2008-04)
      PROBLEM: As national antiretroviral treatment (ART) programmes scale-up, it is essential that information is complete, timely and accurate for site monitoring and national planning. The accuracy and completeness of reports independently compiled by ART facilities, however, is often not known. APPROACH: This study assessed the quality of quarterly aggregate summary data for April to June 2006 compiled and reported by ART facilities ("site report") as compared to the "gold standard" facility summary data compiled independently by the Ministry of Health supervision team ("supervision report"). Completeness and accuracy of key case registration and outcome variables were compared. Data were considered inaccurate if variables from the site reports were missing or differed by more than 5% from the supervision reports. Additionally, we compared the national summaries obtained from the two data sources. LOCAL SETTING: Monitoring and evaluation of Malawi's national ART programme is based on WHO's recommended tools for ART monitoring. It includes one master card for each ART patient and one patient register at each ART facility. Each quarter, sites complete cumulative cohort analyses and teams from the Ministry of Health conduct supervisory visits to all public sector ART sites to ensure the quality of reported data. RELEVANT CHANGES: Most sites had complete case registration and outcome data; however many sites did not report accurate data for several critical data fields, including reason for starting, outcome and regimen. The national summary using the site reports resulted in a 12% undercount in the national total number of persons on first-line treatment. Several facility-level characteristics were associated with data quality. LESSONS LEARNED: While many sites are able to generate complete data summaries, the accuracy of facility reports is not yet adequate for national monitoring. The Ministry of Health and its partners should continue to identify and support interventions such as supportive supervision to build sites' capacity to maintain and compile quality data to ensure that accurate information is available for site monitoring and national planning.
    • 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.
    • AZT impairs immunological recovery on first-line ART: collaborative analysis of cohort studies in Southern Africa

      Wandeler, Gilles; Gsponer, Thomas; Mulenga, Lloyd; Garone, Daniela; Wood, Robin; Maskew, Mhairi; Prozesky, Hans; Hoffmann, Christopher; Ehmer, Jochen; Dickinson, Diana; Davies, Mary-Ann; Egger, Matthias; Keiser, Olivia; a.Division of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland b.Department of Infectious Diseases, University Hospital Bern, Bern, Switzerland c.Centre for Infectious Disease Research in Zambia, Lusaka, Zambia d.Khayelitsha ART Programme, Médecins Sans Frontières, Cape Town, South Africa e.The Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa f.Themba Lethu, Johannesburg, South Africa g.Division of Infectious Diseases, Department of Medicine, University of Stellenbosch and Tygerberg Academic Hospital, Cape Town, South Africa h.Aurum Institute for Health Research, Johannesburg, South Africa i.SolidarMed Lesotho, Lucerne, Switzerland j.HIV private practice, Gaborone, Botswana k.School of Public Health and Family Medicine, University of Cape Town, South Africa (Wolters Kluwer Health | Lippincott Williams & Wilkins, 2013-05-08)
      OBJECTIVES
    • Barriers to pilot mobile teleophthalmology in a rural hospital in Southern Malawi

      Pérez, Guillermo Martínez; Swart, Wayne; Munyenyembe, Jimmy Kondwani; Saranchuk, Peter (African Field Epidemiology Network, 2014-09-10)
    • Baseline characteristics, response to and outcome of antiretroviral therapy among patients with HIV-1, HIV-2 and dual infection in Burkina Faso.

      Harries, Katie; Zachariah, Rony; Manzi, Marcel; Firmenich, Peter; Mathela, Richard; Drabo, Joseph; Onadja, G; Arnould, Line; Harries, A D; Médecins Sans Frontières, Medical Department (Operational Research), Brussels Operational Center, 68 Rue de Gasperich, L-1617, Luxembourg. (2009-09-22)
      In an urban district hospital in Burkina Faso we investigated the relative proportions of HIV-1, HIV-2 and HIV-1/2 among those tested, the baseline sociodemographic and clinical characteristics, and the response to and outcome of antiretroviral therapy (ART). A total of 7368 individuals (male=32%; median age=34 years) were included in the analysis over a 6 year period (2002-2008). The proportions of HIV-1, HIV-2 and dual infection were 94%, 2.5% and 3.6%, respectively. HIV-1-infected individuals were younger, whereas HIV-2-infected individuals were more likely to be male, have higher CD4 counts and be asymptomatic on presentation. ART was started in 4255 adult patients who were followed up for a total of 8679 person-years, during which time 469 deaths occurred. Mortality differences by serotype were not statistically significant, but were generally worse for HIV-2 and HIV-1/2 after controlling for age, CD4 count and WHO stage. Among severely immune-deficient patients, mortality was higher for HIV-2 than HIV-1. CD4 count recovery was poorest for HIV-2. HIV-2 and dually infected patients appeared to do less well on ART than HIV-1 patients. Reasons may include differences in age at baseline, lower intrinsic immune recovery in HIV-2, use of ineffective ART regimens (inappropriate prescribing) by clinicians, and poor drug adherence.
    • Benefit of viral load testing for confirmation of immunological failure in HIV patients treated in rural Malawi.

      Kanapathipillai, Rupa; McGuire, Megan; Mogha, Robert; Szumilin, Elisabeth; Heinzelmann, Annette; Pujades-Rodriguez, Mar; Médecins Sans Frontières, Chiradzulu, Malawi  Monash Medical Centre, Clayton, Vic., Australia  Epicentre, Paris, France  Médecins Sans Frontières, Paris, France. (2011-09-01)
      Objective  Viral load testing is used in the HIV programme of Chiradzulu, Malawi, to confirm the diagnosis of immunological failure to prevent unnecessary switching to second-line therapy. Our objective was to quantify the benefit of this strategy for management of treatment failure in a large decentralized HIV programme in Africa. Methods  Retrospective analysis of monitoring data from adults treated with first-line antiretroviral regimens for >1 year and meeting the WHO immunological failure criteria in an HIV programme in rural Malawi. The positive predictive value of using immunological failure criteria to diagnose virological failure (viral load >5000 copies/ml) was estimated. Results  Of the 227 patients with immunological failure (185 confirmed with a repeat CD4 measurement), 155 (68.2%) had confirmatory viral load testing. Forty-four (28.4%) had viral load >5000 copies/ml and 57 (36.8%) >1000 copies/ml. Positive predictive value was 28.4% (95% CI 21.4-36.2%). Repeat CD4 count testing showed that 41% of patients initially diagnosed with immunological failure did no longer meet failure criteria. Conclusions  Our results support the need for confirming all cases of immunological failure with viral load testing before switching to second-line ART to optimize the use of resources in developing countries.
    • A biregional survey and review of first-line treatment failure and second-line paediatric antiretroviral access and use in Asia and southern Africa

      Van Cutsem, G; Saphonn, V; Saramony, S; Vibol, U; Zhang, FJ; Han, N; Saghayam, S; Kurniati, N; Muktiarti, D; Fong, SM; Thien, M; Nik Yusoff, NK; Hai, LC; Razali, K; TREAT Asia/amfAR - The Foundation for AIDS Research, Bangkok, Thailand. annette.sohn@treatasia.org (BioMed Central, 2011-04-08)
      To better understand the need for paediatric second-line antiretroviral therapy (ART), an ART management survey and a cross-sectional analysis of second-line ART use were conducted in the TREAT Asia Paediatric HIV Observational Database and the IeDEA Southern Africa (International Epidemiologic Databases to Evaluate AIDS) regional cohorts.
    • Brief Report: Decentralizing ART Supply for Stable HIV Patients to Community-Based Distribution Centers: Program Outcomes From an Urban Context in Kinshasa, DRC

      Vogt, F; Kalenga, L; Lukela, J; Salumu, F; Diallo, I; Nico, E; Lampart, E; Van den Bergh, R; Shah, S; Ogundahunsi, O; Zachariah, R; Van Griensven, J (Lippincott Williams & Wilkins, 2017-02-14)
    • Burden and outcome of HIV infection and other morbidities in health care workers attending an Occupational Health Program at the Provincial Hospital of Tete, Mozambique.

      Casas, Esther Carrillo; Decroo, Tom; Mahoudo, Jules Aimé Bonou; Baltazar, Jesus Maria; Dores, Carla Das; Cumba, Luisa; De Weggheleire, Anja; Huyst, Veerle; Bottieau, Emmanuel; Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium  Médecins Sans Frontières, Tete, Mozambique  Provincial Hospital of Tete, Tete, Mozambique  Provincial Health Directorate of Tete, Tete, Mozambique. (2011-08-18)
      Objectives  To investigate the burden and outcome of HIV infection and other morbidities amongst a Mozambican hospital staff. Methods  Within an occupational health service set up in April 2008 in the provincial hospital of Tete, Mozambique, we offered to all staff members an initial clinical, laboratory and radiological screening and followed them up prospectively until April 2010. Results  A total of 47.5% of 423 health workers attended the program. The cohort (female-to-male ratio: 2.2; mean age: 39 years) consisted mostly of auxiliary staff (43%) and nurses (29.8%). At initial screening, 71% were asymptomatic. HIV infection (28.4%) and tuberculosis (TB) (21%) were the main reported antecedent illnesses. Laboratory screening revealed anaemia (haemoglobin level <10 mg/dl) in 9% participants, abnormal liver enzymes in 23.9% and a reactive non-treponemal syphilis test in 5%. Of 145 performed chest X-rays, 13% showed abnormalities. All 113 health workers not recently tested for HIV were screened, and 31 were newly diagnosed with HIV infection (resulting in an overall HIV prevalence of 43.8%). Nine cases of TB were diagnosed at screening/during follow-up. In April 2010, all but one of the participants were alive. All HIV-infected health workers under antiretroviral therapy were actively followed-up. Conclusion  Serious conditions were frequently diagnosed in health workers, in particular HIV infection. Mid-term outcome was favourable within this program. Creation of screening and care services dedicated to caregivers should be of highest priority in similar African settings.
    • Burden of HIV-Related Cytomegalovirus Retinitis in Resource-Limited Settings: A Systematic Review

      Ford, Nathan; Shubber, Zara; Saranchuk, Peter; Pathai, Sophia; Durier, Nicolas; O'Brien, Daniel P; Mills, Edward J; Pascual, Fernando; Hoen, Ellen 't; Holland, Gary N; Heiden, David; Department of HIV/AIDS, World Health Organization, Geneva, Switzerland. (Oxford University Press, 2013-09-02)
      Background. Cytomegalovirus (CMV) is a late-stage opportunistic infection in people living with human immunodeficiency virus (HIV)/AIDS. Lack of ophthalmological diagnostic skills, lack of convenient CMV treatment, and increasing access to antiretroviral therapy have all contributed to an assumption that CMV retinitis is no longer a concern in low- and middle-income settings. Methods. We conducted a systematic review and meta-analysis of published and unpublished studies reporting prevalence of CMV retinitis in low- and middle-income countries. Eligible studies assessed the occurrence of CMV retinitis by funduscopic examination within a cohort of at least 10 HIV-positive adult patients. Results. We identified 65 studies from 24 countries, mainly in Asia (39 studies, 12 931 patients) and Africa (18 studies, 4325 patients). By region, the highest prevalence was observed in Asia with a pooled prevalence of 14.0% (11.8%-16.2%). Almost a third (31.6%, 95% confidence interval [CI], 27.6%-35.8%) had vision loss in 1 or both eyes. Few studies reported immune status, but where reported CD4 count at diagnosis of CMV retinitis was <50 cells/µL in 73.4% of cases. There was no clear pattern of prevalence over time, which was similar for the period 1993-2002 (11.8%; 95% CI, 8%-15.7%) and 2009-2013 (17.6%; 95% CI, 12.6%-22.7%). Conclusions. Prevalence of CMV retinitis in resource low- and middle-income countries, notably Asian countries, remains high, and routine retinal screening of late presenting HIV-positive patients should be considered. HIV programs must ensure capacity to manage the needs of patients who present late for care.
    • Burden, characteristics, management and outcomes of HIV-infected patients with Kaposi's sarcoma in Zomba, Malawi

      Mwinjiwa, E.; Isaakidis, P.; Van den Bergh, R.; Harries, A. D.; Bezanson, K. D.; Beyene, T.; Thompson, C.; Joshua, M.; Akello, H.; van Lettow, M. (Public Health Action, 2013-06-21)
    • 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.