• Treating HIV in Africa: Case Report From Rural Congo.

      Pottie, Kevin; Bamoueni, Sam; Alas, Ahmed; Tu, David; O'Brien, Daniel P; Elisabeth Bruyère Research Institute and Department of Family Medicine, University of Ottawa, Ontario; Medecins Sans Frontieres, Brazzaville; Division of International Health in the Department of Family Practice, University of British Columbia, Vancouver; Medecins Sans Frontieres, Amsterdam (2010-05-01)
    • Treating HIV in the developing world: getting ahead of the drug development curve.

      Ford, N; Calmy, A; von Schoen-Angerer, T (Elsevier, 2007-01)
    • Treating HIV-associated cytomegalovirus retinitis with oral valganciclovir and intra-ocular ganciclovir by primary HIV clinicians in southern Myanmar: a retrospective analysis of routinely collected data

      Murray, J; Hilbig, A; Soe, TT; Ei, WLSS; Soe, KP; Ciglenecki, I (BMC, 2020-11-13)
      Background Cytomegalovirus retinitis (CMVR) is an opportunistic infection in HIV-infected people. Intraocular or intravenous ganciclovir was gold standard for treatment; however, oral valganciclovir replaced this in high-income countries. Low- and middle-income countries (LMIC) frequently use intraocular injection of ganciclovir (IOG) alone because of cost. Methods Retrospective review of all HIV-positive patients with CMVR from February 2013 to April 2017 at a Médecins Sans Frontièrs HIV clinic in Myanmar. Treatment was classified as local (IOG) or systemic (valganciclovir, or valganciclovir and IOG). The primary outcome was change in visual acuity (VA) post-treatment. Mortality was a secondary outcome. Results Fifty-three patients were included. Baseline VA was available for 103 (97%) patient eyes. Active CMVR was present in 72 (68%) eyes. Post-treatment, seven (13%) patients had improvement in VA, 30 (57%) had no change, and three (6%) deteriorated. Among patients receiving systemic therapy, four (12.5%) died, compared with five (24%) receiving local therapy (p = 0.19). Conclusions Our results from the first introduction of valganciclovir for CMVR in LMIC show encouraging effectiveness and safety in patients with advanced HIV. We urge HIV programmes to include valganciclovir as an essential medicine, and to include CMVR screening and treatment in the package of advanced HIV care.
    • Treatment failure and mortality factors in patients receiving second-line HIV therapy in resource-limited countries.

      Pujades-Rodríguez, Mar; Balkan, Suna; Arnould, Line; Brinkhof, Martin A W; Calmy, Alexandra; Epicentre, Médecins Sans Frontières 42-bis, Bd, 8 rue Saint Sabin, 75011 Paris, France. mar.pujades@epicentre.msf.org (2010-07-21)
      CONTEXT: Long-term antiretroviral therapy (ART) use in resource-limited countries leads to increasing numbers of patients with HIV taking second-line therapy. Limited access to further therapeutic options makes essential the evaluation of second-line regimen efficacy in these settings. OBJECTIVES: To investigate failure rates in patients receiving second-line therapy and factors associated with failure and death. DESIGN, SETTING, AND PARTICIPANTS: Multicohort study of 632 patients > 14 years old receiving second-line therapy for more than 6 months in 27 ART programs in Africa and Asia between January 2001 and October 2008. MAIN OUTCOME MEASURES: Clinical, immunological, virological, and immunovirological failure (first diagnosed episode of immunological or virological failure) rates, and mortality after 6 months of second-line therapy use. Sensitivity analyses were performed using alternative CD4 cell count thresholds for immunological and immunovirological definitions of failure and for cohort attrition instead of death. RESULTS: The 632 patients provided 740.7 person-years of follow-up; 119 (18.8%) met World Health Organization failure criteria after a median 11.9 months following the start of second-line therapy (interquartile range [IQR], 8.7-17.0 months), and 34 (5.4%) died after a median 15.1 months (IQR, 11.9-25.7 months). Failure rates were lower in those who changed 2 nucleoside reverse transcriptase inhibitors (NRTIs) instead of 1 (179.2 vs 251.6 per 1000 person-years; incidence rate ratio [IRR], 0.64; 95% confidence interval [CI], 0.42-0.96), and higher in those with lowest adherence index (383.5 vs 176.0 per 1000 person-years; IRR, 3.14; 95% CI, 1.67-5.90 for < 80% vs > or = 95% [percentage adherent, as represented by percentage of appointments attended with no delay]). Failure rates increased with lower CD4 cell counts when second-line therapy was started, from 156.3 vs 96.2 per 1000 person-years; IRR, 1.59 (95% CI, 0.78-3.25) for 100 to 199/microL to 336.8 per 1000 person-years; IRR, 3.32 (95% CI, 1.81-6.08) for less than 50/microL vs 200/microL or higher; and decreased with time using second-line therapy, from 250.0 vs 123.2 per 1000 person-years; IRR, 1.90 (95% CI, 1.19-3.02) for 6 to 11 months to 212.0 per 1000 person-years; 1.71 (95% CI, 1.01-2.88) for 12 to 17 months vs 18 or more months. Mortality for those taking second-line therapy was lower in women (32.4 vs 68.3 per 1000 person-years; hazard ratio [HR], 0.45; 95% CI, 0.23-0.91); and higher in patients with treatment failure of any type (91.9 vs 28.1 per 1000 person-years; HR, 2.83; 95% CI, 1.38-5.80). Sensitivity analyses showed similar results. CONCLUSIONS: Among patients in Africa and Asia receiving second-line therapy for HIV, treatment failure was associated with low CD4 cell counts at second-line therapy start, use of suboptimal second-line regimens, and poor adherence. Mortality was associated with diagnosed treatment failure.
    • Treatment Initiation, Program Attrition and Patient Treatment Outcomes associated with Scale-up and Decentralization of HIV care in rural Malawi

      McGuire, Megan; Pinoges, Loretxu; Kanapathipillai, Rupa; Munyenyembe, Tamika; Huckabee, Martha; Makombe, Simon; Szumilin, Elisabeth; Heinzelmann, Annette; Pujades-Rodríguez, Mar; Epicentre, Clinical Research Department, Nairobi, Kenya. (2012-10-15)
      To describe patient antiretroviral therapy (cART) outcomes associated with intensive decentralization of services in a rural HIV program in Malawi.
    • Treatment of AIDS in conflict-affected settings: a failure of imagination.

      Ellman, T; Culbert, H; Torres-Feced, V; Médecins Sans Frontières, London WC1R 5DJ, UK. tom.ellman@msf.org (Elsevier, 2008-02-14)
    • Treatment Outcomes for HIV and MDR-TB Co-infected Adults and Children: Systematic Review and Meta-analysis.

      Isaakidis, P; Casas, E C; Das, M; Tseretopoulou, X; Ntzani, E E; Ford, N (International Union Against Tuberculosis and Lung Disease, 2015-08-01)
      The incidence of multidrug-resistant tuberculosis (MDR-TB) is increasing in high human immunodeficiency virus (HIV) prevalence settings, with high associated mortality. Treatment outcomes in HIV-co-infected adults and children are poorly documented.
    • Treatment outcomes from the largest antiretroviral treatment program in Myanmar (Burma): a cohort analysis of retention after scale-up.

      Sabapathy, Kalpana; Ford, Nathan; Chan, Khin Nyein; Kyaw, Moe Kyaw; Elema, Riekje; Smithuis, Frank; Floyd, Sian; Imperial College London, London, United Kingdom; Medecins Sans Frontieres, Amsterdam, The Netherlands, Medecins Sans Frontieres, Geneva, Switzerland; Medecisn Sans Frontieres, Yangon, Myanmar; Medical Action Myanmar, Yangon, Myanmar; London School of Hygiene and Tropical Medicine, London, United Kingdom. (2012-06-01)
      Antiretroviral treatment (ART) coverage in Myanmar is well below average. This study describes retention and baseline predictors of prognosis from the largest ART program in the country.
    • Treatment outcomes of patients on Second-line Antiretroviral Therapy in resource-limited settings: A Systematic Review and Meta-Analysis

      Ajose, Olawale; Mookerjee, Siddharth; Mills, Edward J; Boulle, Andrew; Ford, Nathan; Clinton Health Access Initiative, Dar es Salaam, Tanzania. (2012-05-15)
      A growing proportion of patients on antiretroviral therapy in resource-limited settings have switched to second-line regimens. We carried out a systematic review in order to summarize reported rates and reasons for virological failure among people on second-line therapy in resource-limited settings.
    • Treatment Outcomes of Treatment-Naïve Hepatitis C Patients co-infected with HIV: a systematic review and meta-analysis of observational cohorts

      Davies, Anna; Singh, Kasha P; Shubber, Zara; Ducros, Philipp; Mills, Edward J; Cooke, Graham; Ford, Nathan; Department of Infectious Diseases, Faculty of Medicine, Imperial College, London, United Kingdom. (2013-02-05)
      Co-infection with Hepatitis C (HCV) and HIV is common and HIV accelerates hepatic disease progression due to HCV. However, access to HCV treatment is limited and success rates are generally poor.
    • Treatment Outcomes Stratified by Baseline Immunological Status Among Young Children Receiving Nonnucleoside Reverse-Transcriptase Inhibitor-Based Antiretroviral Therapy in Resource-Limited Settings.

      O'Brien, D P; Sauvageot, D; Olson, D; Schaeffer, M; Humblet, P; Pudjades, M; Ellman, T; Zachariah, R; Szumilin, E; Arnould, L; et al. (Published by: Infectious Diseases Society of America, 2007-05-01)
      A study of 568 children aged <5 years who commenced nonnucleoside reverse-transcriptase inhibitor-based antiretroviral therapy in resource-limited settings revealed good early outcomes. After 12 months of antiretroviral therapy, survival probability was 0.89 (95% confidence interval, 0.86-0.92), with no significant difference among children stratified on the basis of baseline immunological levels; 62% attained a CD4 cell percentage >25%, and 7% continued to have a CD4 cell percentage <15%.
    • Treatment Response and Mortality among Patients Starting Antiretroviral Therapy with and without Kaposi Sarcoma: A Cohort Study

      Maskew, Mhairi; Fox, Matthew P; van Cutsem, Gilles; Chu, Kathryn; Macphail, Patrick; Boulle, Andrew; Egger, Matthias; for IeDEA Southern Africa; Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. mmaskew@heroza.org (2013-06)
      Improved survival among HIV-infected individuals on antiretroviral therapy (ART) has focused attention on AIDS-related cancers including Kaposi sarcoma (KS). However, the effect of KS on response to ART is not well-described in Southern Africa. We assessed the effect of KS on survival and immunologic and virologic treatment responses at 6- and 12-months after initiation of ART.
    • Trends in loss to follow-up among migrant workers on antiretroviral therapy in a community cohort in Lesotho.

      Bygrave, Helen; Kranzer, Katharina; Hilderbrand, Katherine; Whittall, Jonathan; Jouquet, Guillaume; Goemaere, Eric; Vlahakis, Nathalie; Triviño, Laura; Makakole, Lipontso; Ford, Nathan; et al. (2010-10-08)
      BACKGROUND: The provision of antiretroviral therapy (ART) to migrant populations raises particular challenges with respect to ensuring adequate treatment support, adherence, and retention in care. We assessed rates of loss to follow-up for migrant workers compared with non-migrant workers in a routine treatment programme in Morjia, Lesotho. DESIGN: All adult patients (≥18 years) initiating ART between January 1, 2008, and December 31, 2008, and followed up until the end of 2009, were included in the study. We described rates of loss to follow-up according to migrant status by Kaplan-Meier estimates, and used Poisson regression to model associations between migrant status and loss to follow-up controlling for potential confounders identified a priori. RESULTS: Our cohort comprised 1185 people, among whom 12% (148) were migrant workers. Among the migrant workers, median age was 36.1 (29.6-45.9) and the majority (55%) were male. We found no statistically significant differences between baseline characteristics and migrant status. Rates of lost to follow up were similar between migrants and non-migrants in the first 3 months but differences increased thereafter. Between 3 and 6 months after initiating antiretroviral therapy, migrants had a 2.78-fold increased rate of defaulting (95%CI 1.15-6.73); between 6 and 12 months the rate was 2.36 times greater (95%CI 1.18-4.73), whereas after 1 year the rate was 6.69 times greater (95%CI 3.18-14.09). CONCLUSIONS: Our study highlights the need for programme implementers to take into account the specific challenges that may influence continuity of antiretroviral treatment and care for migrant populations.
    • Tuberculosis and the risk of opportunistic infections and cancers in HIV-infected patients starting ART in Southern Africa.

      Fenner, Lukas; Reid, Stewart E; Fox, Matthew P; Garone, Daniela; Wellington, Maureen; Prozesky, Hans; Zwahlen, Marcel; Schomaker, Michael; Wandeler, Gilles; Kancheya, Nzali; et al. (2013-02)
      To investigate the incidence of selected opportunistic infections (OIs) and cancers and the role of a history of tuberculosis (TB) as a risk factor for developing these conditions in HIV-infected patients starting antiretroviral treatment (ART) in Southern Africa.
    • Twenty‐four‐month outcomes from a cluster‐randomized controlled trial of extending antiretroviral therapy refills in ART adherence clubs

      Cassidy, T; Grimsrud, A; Keene, C; Lebelo, K; Hayes, H; Orrell, C; Zokufa, N; Mutsetekwa, T; Voget, J; Gerstenhaber, R; et al. (Wiley Open Access, 2020-12-19)
      Introduction The antiretroviral therapy (ART) adherence club (AC) model has supported clinically stable HIV patients’ retention with group ART refills and psychosocial support. Reducing visit frequency by increasing ART refills to six months could further benefit patients and unburden health systems. We conducted a pragmatic non‐inferiority cluster randomized trial comparing standard of care (SoC) ACs and six‐month refill intervention ACs in a primary care facility in Khayelitsha, South Africa. Methods Existing community‐based and facility‐based ACs were randomized to either SoC or intervention ACs. SoC ACs met five times annually, receiving two‐month refills with a four‐month refill over year‐end. Blood was drawn at one AC visit with a clinical assessment at the next. Intervention ACs met twice annually receiving six‐month refills, with an individual blood collection visit before the annual clinical assessment AC visit. The first study visits were in October and November 2017 and participants followed for 27 months. We report retention in care, viral load completion and viral suppression (<400 copies/mL) 24 months after enrolment and calculated intention‐to‐treat risk differences for the primary outcomes using generalized estimating equations specifying for clustering by AC. Results Of 2150 participants included in the trial, 977 were assigned to the intervention arm (40 ACs) and 1173 to the SoC (48 ACs). Patient characteristics at enrolment were similar across groups. Retention in care at 24 months was similarly high in both arms: 93.6% (1098/1173) in SoC and 92.6% (905/977) in the intervention arm, with a risk difference of −1.0% (95% CI: −3.2 to 1.3). The intervention arm had higher viral load completion (90.8% (999/1173) versus 85.1% (887/977)) and suppression (87.3% (969 /1173) versus 82.6% (853/977)) at 24 months, with a risk difference for completion of 5.5% (95% CI: 1.5 to 9.5) and suppression of 4.6% (95% CI: 0.2 to 9.0). Conclusions Intervention AC patients receiving six‐month ART refills showed non‐inferior retention in care, viral load completion and viral load suppression to those in SoC ACs, adding to a growing literature showing good outcomes with extended ART dispensing intervals.
    • 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.