• Management of BU-HIV co-infection

      O'Brien, D P; Ford, N; Vitoria, M; Christinet, V; Comte, E; Calmy, A; Stienstra, Y; Eholie, S; Asiedu, K (2014-06-20)
      Buruli Ulcer (BU)-HIV co-infection is an important emerging management challenge for BU disease. Limited by paucity of scientific studies, guidance for management of this co-infection has been lacking.
    • [Management of HIV/AIDS patients in Kompong Cham, Cambodia]

      Allemand-Sourrieu, J; Gazin, P; Moreau, J; Programme MSF-France de traitement du sida au Cambodge. allemandjulie@yahoo.fr (2007-02)
      In 2003 the NGO Médecins sans Frontières started an anti-viral drug treatment program for HIV/AIDS patients in the regional hospital of Kompong Cham, Cambodia. In 2005 a total of 1100 adults and 149 children were on the active list. Sixty percent of new patients were at WHO stages 3 or 4. Compliance with HAART was high after 24 months. Access to second-line regimens is discussed.
    • The marriage of science and optimized HIV care in resource-limited settings

      Calmy, A; Pizzocolo, C; Pizarro, L; Brücker, G; Murphy, R; Katlama, C; Strategies in Resource-Limited Settings Working Group; Campaign for Access to Essential Medicines, Médecins Sans Frontières, Geneva; Geneva University, Geneva, Switzerland; Solidarité Théapeutique et Initiatives contre le Sida, Paris; Université Paris 11, Faculté de Médicine Paris-Sud, Le Kremlin-Bicêtre, Paris; Université Pierre et Marie Curie, Paris, France (2008-11-12)
    • Mean CD4 cell count changes in patients failing a first-line antiretroviral therapy in resource-limited settings.

      Calmy, Alexandra; Balestre, Eric; Bonnet, Fabrice; Boulle, Andrew; Sprinz, Eduardo; Wood, Robin; Delaporte, Eric; Messou, Eugène; McIntyre, James; El Filali, Kamal Marhoum; Schechter, Mauro; Kumarasamy, N; Bangsberg, David; McPhail, Patrick; Van Der Borght, Stefaan; Zala, Carlos; Egger, Matthias; Thiébaut, Rodolphe; Dabis, François; HIV Unit, Geneva University Hospital, Geneva, Switzerland. acalmy@gmail.com (BMC, 2012-12)
      Changes in CD4 cell counts are poorly documented in individuals with low or moderate-level viremia while on antiretroviral treatment (ART) in resource-limited settings. We assessed the impact of on-going HIV-RNA replication on CD4 cell count slopes in patients treated with a first-line combination ART.
    • Monitoring HIV Viral Load in Resource Limited Settings: Still a Matter of Debate?

      Arnedo, M; Alonso, E; Eisenberg, N; Ibáñez, L; Ferreyra, C; Jaén, A; Flevaud, L; Khamadi, S; Roddy, P; Gatell, JM; Dalmau, D (Public Library of Science, 2012-12-06)
      Consequences of lack of viral monitoring in predicting the effects of development of HIV drug resistance mutations during HAART in resource-limited settings (RLS) is still a matter of debate.
    • Monitoring of antiretroviral therapy and mortality in HIV programmes in Malawi, South Africa and Zambia: mathematical modelling study

      Estill, Janne; Egger, Matthias; Johnson, Leigh F; Gsponer, Thomas; Wandeler, Gilles; Davies, Mary-Ann; Boulle, Andrew; Wood, Robin; Garone, Daniela; Stringer, Jeffrey S A; Hallett, Timothy B; Keiser, Olivia; Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland. jestill@ispm.unibe.ch (Public Library of Science, 2013-02-28)
      Mortality in patients starting antiretroviral therapy (ART) is higher in Malawi and Zambia than in South Africa. We examined whether different monitoring of ART (viral load [VL] in South Africa and CD4 count in Malawi and Zambia) could explain this mortality difference.
    • Monitoring the response to antiretroviral therapy in resource-poor settings: the Malawi model.

      Harries, A D; Gomani, P; Teck, R; de Teck, O; Bakali, E; Zachariah, R; Libamba, E; Mwansambo, A; Salaniponi, F; Mpazanje, R; National Tuberculosis Control Programme, Ministry of Health and Population, P.O. Box 30377, Lilongwe, Malawi. adharries@malawi.net (2004-12)
      With assistance from the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), Malawi is scaling-up the delivery of antiretroviral (ARV) therapy to HIV-positive eligible patients. The country has developed National ARV Treatment Guidelines, which emphasize a structured and standardized approach for all aspects of ARV delivery, including monitoring and evaluation. Using the successful DOTS model adapted by National TB Control Programmes throughout the world, Malawi has developed a system of quarterly ARV cohort and cumulative ARV quarterly analyses. Thyolo district, in the southern region of Malawi, has been using this system since April 2003. This paper describes the standardized ARV treatment regimens and the treatment outcomes used in Thyolo to assess the impact of treatment, the registration and monitoring systems and how the cohort analyses are carried out. Data are presented for case registration and treatment outcome for the first quarterly cohort (April to June) and the combined cohorts (April to June and July to September). Such quarterly analyses may be useful for districts and Ministries of Health in assessing ARV delivery, although the burden of work involved in calculating the numbers may become large once ARV delivery systems have been established for several years.
    • Monitoring the South African National Antiretroviral Treatment Programme, 2003-2007: the IeDEA Southern Africa collaboration.

      Cornell, Morna; Technau, Karl; Fairall, Lara; Wood, Robin; Moultrie, Harry; van Cutsem, Gilles; Giddy, Janet; Mohapi, Lerato; Eley, Brian; MacPhail, Patrick; Prozesky, Hans; Rabie, Helena; Davies, Mary-Ann; Maxwell, Nicola; Boulle, Andrew; Infectious Disease Epidemiology Unit, School of Public Health and Family Medicine, University of Cape Town. morna@global.co.za (2009-09)
      OBJECTIVES: To introduce the combined South African cohorts of the International epidemiologic Databases to Evaluate AIDS Southern Africa (IeDEA-SA) collaboration as reflecting the South African national antiretroviral treatment (ART) programme; to characterise patients accessing these services; and to describe changes in services and patients from 2003 to 2007. DESIGN AND SETTING: Multi-cohort study of 11 ART programmes in Gauteng, Western Cape, Free State and KwaZulu-Natal. SUBJECTS: Adults and children (<16 years old) who initiated ART with > or =3 antiretroviral drugs before 2008. RESULTS: Most sites were offering free treatment to adults and children in the public sector, ranging from 264 to 17,835 patients per site. Among 45,383 adults and 6,198 children combined, median age (interquartile range) was 35.0 years (29.8-41.4) and 42.5 months (14.7-82.5), respectively. Of adults, 68% were female. The median CD4 cell count was 102 cells/microl (44-164) and was lower among males than females (86, 34-150 v. 110, 50-169, p<0.001). Median CD4% among children was 12% (7-17.7). Between 2003 and 2007, enrolment increased 11-fold in adults and 3-fold in children. Median CD4 count at enrolment increased for all adults (67-111 cells/microl, p<0.001) and for those in stage IV (39-89 cells/microl, p<0.001). Among children <5 years, baseline CD4% increased over time (11.5-16.0%, p<0.001). CONCLUSIONS: IeDEA-SA provides a unique opportunity to report on the national ART programme. The study describes dramatically increased enrolment over time. Late diagnosis and ART initiation, especially of men and children, need attention. Investment in sentinel sites will ensure good individual-level data while freeing most sites to continue with simplified reporting.
    • Mortality and Clinical Outcomes in Children Treated With Antiretroviral Therapy in Four African Vertical Programs During The First Decade of Paediatric HIV Care, 2001-2010

      Ben-Farhat, J; Schramm, B; Nicolay, N; Wanjala, S; Szumilin, E; Balkan, S; Pujades-Rodríguez, M (Wiley-Blackwell, 2016-12-19)
      To assess mortality and clinical outcomes in children treated with antiretroviral therapy in four African vertical programs between 2001 and 2010.
    • Mortality by baseline CD4 cell count among HIV patients initiating antiretroviral therapy: evidence from a large cohort in Uganda

      Mills, Edward J; Bakanda, Celestin; Birungi, Josephine; Mwesigwa, Robert; Chan, Keith; Ford, Nathan; Hogg, Robert S; Cooper, Curtis; Faculty of Health Sciences, University of Ottawa, Ottawa, Canada; The AIDS Support Organization (TASO), Headquarters, Kampala, Uganda; British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada; Médecins Sans Frontiers (MSF), Geneva, Switzerland; Division of Infectious Diseases, The Ottawa Hospital, Ottawa, Canada (Lippincott Williams & Wilkins, 2011-03-27)
      Evaluations of CD4 cell count and other prognostic factors on the survival of HIV patients in sub-Saharan Africa are extremely limited. Funders have been reticent to recommend earlier initiation of treatment. We aimed to examine the effect of baseline CD4 cell count on mortality using data from HIV patients receiving combination antiretroviral therapy (cART) in Uganda.
    • Mortality in Patients with HIV-1 Infection Starting Antiretroviral Therapy in South Africa, Europe, or North America: A Collaborative Analysis of Prospective Studies

      Boulle, Andrew; Schomaker, Michael; May, Margaret T; Hogg, Robert S; Shepherd, Bryan E; Monge, Susana; Keiser, Olivia; Lampe, Fiona C; Giddy, Janet; Ndirangu, James; Garone, Daniela; Fox, Matthew; Ingle, Suzanne M; Reiss, Peter; Dabis, Francois; Costagliola, Dominique; Castagna, Antonella; Ehren, Kathrin; Campbell, Colin; Gill, M John; Saag, Michael; Justice, Amy C; Guest, Jodie; Crane, Heidi M; Egger, Matthias; Sterne, Jonathan A C (2014-09-09)
      High early mortality in patients with HIV-1 starting antiretroviral therapy (ART) in sub-Saharan Africa, compared to Europe and North America, is well documented. Longer-term comparisons between settings have been limited by poor ascertainment of mortality in high burden African settings. This study aimed to compare mortality up to four years on ART between South Africa, Europe, and North America.
    • Mortality in the first six months among HIV-positive and HIV-negative patients empirically treated for tuberculosis.

      Huerga, H; Ferlazzo, G; Wanjala, S; Bastard, M; Bevilacqua, P; Ardizzoni, E; Sitienei, J; Bonnet, M (BioMed Central, 2019-02-11)
      Empirical treatment of tuberculosis (TB) may be necessary in patients with negative or no Xpert MTB/RIF results. In a context with access to Xpert, we assessed mortality in the 6 months after the initial TB consultation among HIV-positive and HIV-negative patients who received empirical TB treatment or TB treatment based on bacteriological confirmation and we compared it with the mortality among those who did not receive TB treatment.
    • Mortality of patients lost to follow-up in antiretroviral treatment programmes in resource-limited settings: systematic review and meta-analysis

      Brinkhof, M; Pujades-Rodriguez, M; Egger, M; Division of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland; Epicentre, Médecins Sans Frontières, Paris, France; Department of Social Medicine, University of Bristol, Bristol, United Kingdom (2009-06-04)
      BACKGROUND: The retention of patients in antiretroviral therapy (ART) programmes is an important issue in resource-limited settings. Loss to follow up can be substantial, but it is unclear what the outcomes are in patients who are lost to programmes. METHODS AND FINDINGS: We searched the PubMed, EMBASE, Latin American and Caribbean Health Sciences Literature (LILACS), Indian Medlars Centre (IndMed) and African Index Medicus (AIM) databases and the abstracts of three conferences for studies that traced patients lost to follow up to ascertain their vital status. Main outcomes were the proportion of patients traced, the proportion found to be alive and the proportion that had died. Where available, we also examined the reasons why some patients could not be traced, why patients found to be alive did not return to the clinic, and the causes of death. We combined mortality data from several studies using random-effects meta-analysis. Seventeen studies were eligible. All were from sub-Saharan Africa, except one study from India, and none were conducted in children. A total of 6420 patients (range 44 to 1343 patients) were included. Patients were traced using telephone calls, home visits and through social networks. Overall the vital status of 4021 patients could be ascertained (63%, range across studies: 45% to 86%); 1602 patients had died. The combined mortality was 40% (95% confidence interval 33%-48%), with substantial heterogeneity between studies (P<0.0001). Mortality in African programmes ranged from 12% to 87% of patients lost to follow-up. Mortality was inversely associated with the rate of loss to follow up in the programme: it declined from around 60% to 20% as the percentage of patients lost to the programme increased from 5% to 50%. Among patients not found, telephone numbers and addresses were frequently incorrect or missing. Common reasons for not returning to the clinic were transfer to another programme, financial problems and improving or deteriorating health. Causes of death were available for 47 deaths: 29 (62%) died of an AIDS defining illness. CONCLUSIONS: In ART programmes in resource-limited settings a substantial minority of adults lost to follow up cannot be traced, and among those traced 20% to 60% had died. Our findings have implications both for patient care and the monitoring and evaluation of programmes.
    • Mortality reduction associated with HIV/AIDS care and antiretroviral treatment in rural Malawi: evidence from registers, coffin sales and funerals.

      Mwagomba, Beatrice; Zachariah, Rony; Massaquoi, Moses; Misindi, Dalitso; Manzi, Marcel; Mandere, Bester C; Bemelmans, Marielle; Philips, Mit; Kamoto, Kelita; Schouten, Eric J; Harries, A D; Thyolo District Health Services, Ministry of Health and Population, Thyolo, Malawi. (2010-05)
      BACKGROUND: To report on the trend in all-cause mortality in a rural district of Malawi that has successfully scaled-up HIV/AIDS care including antiretroviral treatment (ART) to its population, through corroborative evidence from a) registered deaths at traditional authorities (TAs), b) coffin sales and c) church funerals. METHODS AND FINDINGS: Retrospective study in 5 of 12 TAs (covering approximately 50% of the population) during the period 2000-2007. A total of 210 villages, 24 coffin workshops and 23 churches were included. There were a total of 18,473 registered deaths at TAs, 15781 coffins sold, and 2762 church funerals. Between 2000 and 2007, there was a highly significant linear downward trend in death rates, sale of coffins and church funerals (X(2) for linear trend: 338.4 P<0.0001, 989 P<0.0001 and 197, P<0.0001 respectively). Using data from TAs as the most reliable source of data on deaths, overall death rate reduction was 37% (95% CI:33-40) for the period. The mean annual incremental death rate reduction was 0.52/1000/year. Death rates decreased over time as the percentage of people living with HIV/AIDS enrolled into care and ART increased. Extrapolating these data to the entire district population, an estimated 10,156 (95% CI: 9786-10259) deaths would have been averted during the 8-year period. CONCLUSIONS: Registered deaths at traditional authorities, the sale of coffins and church funerals showed a significant downward trend over a 8-year period which we believe was associated with the scaling up HIV/AIDS care and ART.
    • Mortality, AIDS-morbidity, and loss to follow-up by current CD4 cell count among HIV-1-infected adults receiving antiretroviral therapy in Africa and Asia: data from the ANRS 12222 collaboration

      Gabillard, Delphine; Lewden, Charlotte; Ndoye, Ibra; Moh, Raoul; Segeral, Olivier; Tonwe-Gold, Besigin; Etard, Jean-François; Pagnaroat, Men; Fournier-Nicolle, Isabelle; Eholié, Serge; Konate, Issouf; Minga, Albert; Mpoudi-Ngole, Eitel; Koulla-Shiro, Sinata; Zannou, Djimon Marcel; Anglaret, Xavier; Laurent, Christian (Lippincott Williams and Wilkins, 2013-04-15)
      In resource-limited countries, estimating CD4-specific incidence rates of mortality and morbidity among patients receiving antiretroviral therapy (ART) may help assess the effectiveness of care and treatment programmes, identify program weaknesses, and inform decisions.
    • Mother to Mother (M2M) peer support for women in prevention of mother to child transmission (PMTCT) programmes: a qualitative study

      Shroufi, Amir; Mafara, Emma; Saint-Sauveur, Jean François; Taziwa, Fabian; Viñoles, Mari Carmen; Médecins Sans Frontières, Operational Centre Barcelona-Athens, Belgravia, Harare, Zimbabwe (Public Library of Science, 2013-06-05)
      Introduction Mother-to-Mother (M2M) or “Mentor Mother” programmes utilise HIV positive mothers to provide support and advice to HIV positive pregnant women and mothers of HIV exposed babies. Médecins Sans Frontières (MSF) supported a Mentor Mother programme in Bulawayo, Zimbabwe from 2009 to 2012; with programme beneficiaries observed to have far higher retention at 6–8 weeks (99% vs 50%, p<0.0005) and to have higher adherence to Prevention of Mother to Child Transmission (PMTCT) guidelines, compared to those not opting in. In this study we explore how the M2M progamme may have contributed to these findings. Methods In this qualitative study we used thematic analysis of in-depth interviews (n = 79). This study was conducted in 2 urban districts of Bulawayo, Zimbabwe’s second largest city. Results Interviews were completed by 14 mentor mothers, 10 mentor mother family members, 30 beneficiaries (women enrolled both in PMTCT and M2M), 10 beneficiary family members, 5 women enrolled in PMTCT but who had declined to take part in the M2M programme and 10 health care staff members. All beneficiaries and health care staff reported that the programme had improved retention and provided rich information on how this was achieved. Additionally respondents described how the programme had helped bring about beneficial behaviour change. Conclusions M2M programmes offer great potential to empower communities affected by HIV to catalyse positive behaviour change. Our results illustrate how M2M involvement may increase retention in PMTCT programmes. Non-disclosure to one’s partner, as well as some cultural practices prevalent in Zimbabwe appear to be major barriers to participation in M2M programmes.
    • Motives, sexual behaviour, and risk factors associated with HIV in individuals seeking voluntary counselling and testing in a rural district of Malawi.

      Zachariah, R; Spielmann M P; Harries, A D; Buhendwa, L; Chingi, C; Medecins sans Frontieres, Thyolo, Malawi. zachariah@internet.lu (2003-04)
      A study was conducted among individuals seeking voluntary HIV counselling and testing (VCT) in order to (a) describe their motives and source(s) of information, (b) describe their sexual behaviour; and (c) identify risk factors associated with HIV infection. Of 723 individuals who sought VCT, the most common reason (50%) was recent knowledge of HIV/AIDS and a desire to know their HIV status. The majority (77%) underwent VCT after being encouraged by others who knew their status. Ninety five per cent reported sexual encounters, with 337 (49%) engaging in unprotected sex. HIV prevalence was 31% and an HIV-positive status was associated with being female, being over 25 years of age and/or being a farmer. There is a demand for VCT, and the service provides an opportunity for intensive education about HIV/AIDS prevention on a one-to-one basis. It could also be an entry point to prevention and care for those who are infected.
    • Moxifloxacin for Buruli ulcer/HIV coinfected patients: kill two birds with one stone?

      O'Brien, Daniel P; Comte, Eric; Ford, Nathan; Christinet, Vanessa; du Cros, Philipp; aManson Unit, Médecins Sans Frontières, London, UK bDepartment of Infectious Diseases, Geelong Hospital, Geelong cDepartment of Medicine and Infectious Diseases, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia dMedical Unit, Médecins Sans Frontières, Geneva, Switzerland eCenter for Infectious Diseases Epidemiology Research, University of Cape Town, Cape Town, South Africa fDepartment of HIV, University Hospitals of Geneva, Geneva, Switzerland. (2013-09-10)
    • Multi-Country Validation of SAMBA - A Novel Molecular Point-of- Care Test for HIV-1 Detection in Resource-Limited Setting

      Ondiek, J; Namukaya, Z; Mtapuri-Zinyowera, S; Balkan, S; Elbireer, A; Ushiro Lumb, I; Kiyaga, C; Goel, N; Ritchie, A; Ncube, P; Omuomu, K; Ndiege, K; Kekitiinwa, A; Mangwanya, D; Fowler, Mary G; Nadala, L; Lee, H (Lippincott Williams & Wilkins, 2017-06-09)
      Early diagnosis of HIV-1 infection and the prompt initiation of antiretroviral therapy are critical to achieving a reduction in the morbidity and mortality of infected infants. The SAMBA HIV-1 Qual Whole Blood Test was developed specifically for early infant diagnosis and prevention of mother-to-child transmission programs implemented at the point-of-care in resource-limited settings.
    • Mutational Correlates of Virological Failure in Individuals Receiving a WHO-Recommended Tenofovir-Containing First-Line Regimen: An International Collaboration

      Rhee, SY; Varghese, V; Holmes, SP; Van Zyl, GU; Steegen, K; Boyd, MA; Cooper, DA; Nsanzimana, S; Saravanan, S; Charpentier, C; de Oliveira, T; Etiebet, MA; Garcia, F; Goedhals, D; Gomes, P; Günthard, HF; Hamers, RL; Hoffmann, CJ; Hunt, G; Jiamsakul, A; Kaleebu, P; Kanki, P; Kantor, R; Kerschberger, B; Marconi, VC; D'amour Ndahimana, J; Ndembi, N; Ngo-Giang-Huong, N; Rokx, C; Santoro, MM; Schapiro, JM; Schmidt, D; Seu, L; Sigaloff, KCE; Sirivichayakul, S; Skhosana, L; Sunpath, H; Tang, M; Yang, C; Carmona, S; Gupta, RK; Shafer, RW (Elsevier, 2017-03-19)
      Tenofovir disoproxil fumarate (TDF) genotypic resistance defined by K65R/N and/or K70E/Q/G occurs in 20% to 60% of individuals with virological failure (VF) on a WHO-recommended TDF-containing first-line regimen. However, the full spectrum of reverse transcriptase (RT) mutations selected in individuals with VF on such a regimen is not known. To identify TDF regimen-associated mutations (TRAMs), we compared the proportion of each RT mutation in 2873 individuals with VF on a WHO-recommended first-line TDF-containing regimen to its proportion in a cohort of 50,803 antiretroviral-naïve individuals. To identify TRAMs specifically associated with TDF-selection pressure, we compared the proportion of each TRAM to its proportion in a cohort of 5805 individuals with VF on a first-line thymidine analog-containing regimen. We identified 83 TRAMs including 33 NRTI-associated, 40 NNRTI-associated, and 10 uncommon mutations of uncertain provenance. Of the 33 NRTI-associated TRAMs, 12 - A62V, K65R/N, S68G/N/D, K70E/Q/T, L74I, V75L, and Y115F - were more common among individuals receiving a first-line TDF-containing compared to a first-line thymidine analog-containing regimen. These 12 TDF-selected TRAMs will be important for monitoring TDF-associated transmitted drug-resistance and for determining the extent of reduced TDF susceptibility in individuals with VF on a TDF-containing regimen.