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Chen J, Huang Y, Hui Q, Mathur R, Gwinn M, So-Armah K, Freiberg MS, Justice AC, Xu K, Marconi VC, Sun YV. Epigenetic Associations With Estimated Glomerular Filtration Rate Among Men With Human Immunodeficiency Virus Infection. Clin Infect Dis 2021; 70:667-673. [PMID: 30893429 DOI: 10.1093/cid/ciz240] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 03/19/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND People living with human immunodeficiency virus (HIV) infection have higher risk for chronic kidney disease (CKD), defined by a reduced estimated glomerular filtration rate (eGFR). Previous studies have implicated epigenetic changes related to CKD; however, the mechanism of HIV-related CKD has not been thoroughly investigated. METHODS We conducted an epigenome-wide association study of eGFR among 567 HIV-positive and 117 HIV-negative male participants in the Veterans Aging Cohort Study to identify epigenetic signatures of kidney function. RESULTS By surveying more than 400 000 cytosine guanine dinucleotide (CpG) sites measured from peripheral blood mononuclear cells, we identified 15 sites that were significantly associated with eGFR (false discovery rate Q value < 0.05) among HIV-positive participants. The most significant CpG sites, located at MAD1L1, TSNARE1/BAI1, and LTV1, were all negatively associated with eGFR (cg06329547, P = 5.25 × 10-9; cg23281907, P = 1.37 × 10-8; cg18368637, P = 5.17 × 10-8). We also replicated previously reported eGFR-associated CpG sites including cg17944885 (P = 2.5 × 10-5) located between ZNF788 and ZNF20 on chromosome 19 in the pooled population. CONCLUSIONS In this study we uncovered novel epigenetic associations with kidney function among people living with HIV and suggest potential epigenetic mechanisms linked with HIV-related CKD risk.
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Affiliation(s)
- Junyu Chen
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Yunfeng Huang
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Qin Hui
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Raina Mathur
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Marta Gwinn
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | | | - Matthew S Freiberg
- Cardiovascular Medicine Division, Vanderbilt University School of Medicine and Tennessee Valley Healthcare System, Nashville
| | - Amy C Justice
- Connecticut Veteran Health System, West Haven.,Yale University School of Medicine, New Haven
| | - Ke Xu
- Connecticut Veteran Health System, West Haven.,Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Vincent C Marconi
- Hubert Department of Global Health, Rollins School of Public Health.,Division of Infectious Diseases, Emory University School of Medicine, Atlanta.,Atlanta Veterans Affairs Healthcare System, Decatur
| | - Yan V Sun
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.,Atlanta Veterans Affairs Healthcare System, Decatur.,Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, Georgia
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Stone J, Mukandavire C, Boily M, Fraser H, Mishra S, Schwartz S, Rao A, Looker KJ, Quaife M, Terris‐Prestholt F, Marr A, Lane T, Coetzee J, Gray G, Otwombe K, Milovanovic M, Hausler H, Young K, Mcingana M, Ncedani M, Puren A, Hunt G, Kose Z, Phaswana‐Mafuya N, Baral S, Vickerman P. Estimating the contribution of key populations towards HIV transmission in South Africa. J Int AIDS Soc 2021; 24:e25650. [PMID: 33533115 PMCID: PMC7855076 DOI: 10.1002/jia2.25650] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 10/26/2020] [Accepted: 11/12/2020] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION In generalized epidemic settings, there is insufficient understanding of how the unmet HIV prevention and treatment needs of key populations (KPs), such as female sex workers (FSWs) and men who have sex with men (MSM), contribute to HIV transmission. In such settings, it is typically assumed that HIV transmission is driven by the general population. We estimated the contribution of commercial sex, sex between men, and other heterosexual partnerships to HIV transmission in South Africa (SA). METHODS We developed the "Key-Pop Model"; a dynamic transmission model of HIV among FSWs, their clients, MSM, and the broader population in SA. The model was parameterized and calibrated using demographic, behavioural and epidemiological data from national household surveys and KP surveys. We estimated the contribution of commercial sex, sex between men and sex among heterosexual partnerships of different sub-groups to HIV transmission over 2010 to 2019. We also estimated the efficiency (HIV infections averted per person-year of intervention) and prevented fraction (% IA) over 10-years from scaling-up ART (to 81% coverage) in different sub-populations from 2020. RESULTS Sex between FSWs and their paying clients, and between clients with their non-paying partners contributed 6.9% (95% credibility interval 4.5% to 9.3%) and 41.9% (35.1% to 53.2%) of new HIV infections in SA over 2010 to 2019 respectively. Sex between low-risk groups contributed 59.7% (47.6% to 68.5%), sex between men contributed 5.3% (2.3% to 14.1%) and sex between MSM and their female partners contributed 3.7% (1.6% to 9.8%). Going forward, the largest population-level impact on HIV transmission can be achieved from scaling up ART to clients of FSWs (% IA = 18.2% (14.0% to 24.4%) or low-risk individuals (% IA = 20.6% (14.7 to 27.5) over 2020 to 2030), with ART scale-up among KPs being most efficient. CONCLUSIONS Clients of FSWs play a fundamental role in HIV transmission in SA. Addressing the HIV prevention and treatment needs of KPs in generalized HIV epidemics is central to a comprehensive HIV response.
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Affiliation(s)
- Jack Stone
- Population Health SciencesUniversity of BristolBristolUnited Kingdom
| | - Christinah Mukandavire
- Department of Infectious Disease EpidemiologyLondon School of Hygiene and Tropical MedicineLondonUnited Kingdom
| | - Marie‐Claude Boily
- Department of Infectious Disease EpidemiologyImperial CollegeLondonUnited Kingdom
| | - Hannah Fraser
- Population Health SciencesUniversity of BristolBristolUnited Kingdom
| | | | - Sheree Schwartz
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - Amrita Rao
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | | | - Matthew Quaife
- London School of Hygiene and Tropical MedicineLondonUnited Kingdom
| | | | - Alexander Marr
- University of California San FranciscoSan FranciscoCAUSA
| | - Tim Lane
- Equal InternationalWashingtonDCUSA
| | - Jenny Coetzee
- Perinatal HIV Research UnitFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
- South African Medical Research CouncilCape TownSouth Africa
| | - Glenda Gray
- South African Medical Research CouncilCape TownSouth Africa
| | - Kennedy Otwombe
- Perinatal HIV Research UnitFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Minja Milovanovic
- Perinatal HIV Research UnitFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | | | | | | | | | - Adrian Puren
- National Institute of Communicable DiseasesJohannesburgSouth Africa
| | - Gillian Hunt
- National Institute of Communicable DiseasesJohannesburgSouth Africa
| | - Zamakayise Kose
- Research and Innovation OfficeNorth West UniversityPotchefstroomSouth Africa
| | | | - Stefan Baral
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - Peter Vickerman
- Population Health SciencesUniversity of BristolBristolUnited Kingdom
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Ruiz-Frutos C, Ortega-Moreno M, Allande-Cussó R, Ayuso-Murillo D, Domínguez-Salas S, Gómez-Salgado J. Sense of coherence, engagement, and work environment as precursors of psychological distress among non-health workers during the COVID-19 pandemic in Spain. SAFETY SCIENCE 2021; 133:105033. [PMID: 33046949 PMCID: PMC7539829 DOI: 10.1016/j.ssci.2020.105033] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 10/01/2020] [Indexed: 05/08/2023]
Abstract
BACKGROUND The interrelationship between the sense of coherence, work environment, work engagement, and psychological distress have particular interest in non-health workers who carried out essential activities during the COVID-19 pandemic. OBJECTIVE To assess the effects of the COVID-19 on the physical and mental health of non-health workers. DESIGN Observational descriptive cross-sectional study. DATA SOURCES 1089 questionnaires have been analysed. Engagement (UWES-9), sense of coherence (SOC-13), mental health (Goldberg GHQ-12), demographic data, perception of health and stress and work environment were assessed. RESULTS At low levels of engagement, the percentage of distress is higher (77.9%). Low levels of sense of coherence correspond to the highest percentages of distress (86.3%). The 94.1% believe it necessary for professionals and volunteers involved in COVID-19 to receive psychological support. Low comprehensibility is mediated by the perception of stress; if the perception is low, comprehensibility is modulated by the level of significance; if it is low, it generates 95.9% of distress. CONCLUSION The interrelationship between the sense of coherence, work environment, work engagement, and psychological distress have particular interest in non-health workers who carried out essential activities during the COVID-19 pandemic. Almost all respondents believed that professionals and volunteers involved in COVID-19 should receive psychological support. This may be an indicator of the effect of the COVID-19 pandemic on workers' mental health.
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Affiliation(s)
- Carlos Ruiz-Frutos
- Department of Sociology, Social Work and Public Health, Faculty of Labour Sciences, University of Huelva, 21007 Huelva, Spain
- Safety and Health Postgraduate Programme, Universidad Espíritu Santo, 092301 Guayaquil, Ecuador
| | | | - Regina Allande-Cussó
- Department of Nursing, Faculty of Nursing, Physiotherapy, and Podiatry. University of Seville, Seville 41009, Spain
| | | | - Sara Domínguez-Salas
- Department of Psychology, Universidad Loyola Andalucía, Dos Hermanas, 41704 Sevilla, Spain
| | - Juan Gómez-Salgado
- Department of Sociology, Social Work and Public Health, Faculty of Labour Sciences, University of Huelva, 21007 Huelva, Spain
- Safety and Health Postgraduate Programme, Universidad Espíritu Santo, 092301 Guayaquil, Ecuador
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Shah D, Freas C, Weber IT, Harrison RW. Evolution of drug resistance in HIV protease. BMC Bioinformatics 2020; 21:497. [PMID: 33375936 PMCID: PMC7772915 DOI: 10.1186/s12859-020-03825-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 10/19/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Drug resistance is a critical problem limiting effective antiviral therapy for HIV/AIDS. Computational techniques for predicting drug resistance profiles from genomic data can accelerate the appropriate choice of therapy. These techniques can also be used to identify protease mutants for experimental studies of resistance and thereby assist in the development of next-generation therapies. Few studies, however, have assessed the evolution of resistance from genotype-phenotype data. RESULTS The machine learning produced highly accurate and robust classification of resistance to HIV protease inhibitors. Genotype data were mapped to the enzyme structure and encoded using Delaunay triangulation. Estimates of evolutionary relationships, based on this encoding, and using Minimum Spanning Trees, showed clusters of mutations that closely resemble the wild type. These clusters appear to evolve uniquely to more resistant phenotypes. CONCLUSIONS Using the triangulation metric and spanning trees results in paths that are consistent with evolutionary theory. The majority of the paths show bifurcation, namely they switch once from non-resistant to resistant or from resistant to non-resistant. Paths that lose resistance almost uniformly have far lower levels of resistance than those which either gain resistance or are stable. This strongly suggests that selection for stability in the face of a rapid rate of mutation is as important as selection for resistance in retroviral systems.
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Affiliation(s)
- Dhara Shah
- Department of Computer Science, 25 Park Place, Atlanta, GA 30303 USA
| | - Christopher Freas
- Department of Computer Science, 25 Park Place, Atlanta, GA 30303 USA
| | - Irene T. Weber
- Department of Biology, 100 Piedmont Ave., Atlanta, GA 30303 USA
| | - Robert W. Harrison
- Department of Computer Science, 25 Park Place, Atlanta, GA 30303 USA
- Department of Biology, 100 Piedmont Ave., Atlanta, GA 30303 USA
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105
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Stiller CA, Botta L, Sánchez Perez MJ, Chirlaque López MD, Marcos-Gragera R, Scuderi T, Huws DW, Trama A. Kaposi sarcoma incidence, survival and trends: Data from the information network on rare cancers in Europe (RARECAREnet). Cancer Epidemiol 2020; 70:101877. [PMID: 33385768 DOI: 10.1016/j.canep.2020.101877] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/25/2020] [Accepted: 12/07/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND This study provides updated information on Kaposi sarcoma (KS) in Europe during 1995-2007 from the RARECARENet project. METHODS Data comes from 59 population-based cancer registries in 22 countries. KS was defined as ICD-O-3 morphology code 9140 combined with any topography code. Crude and age-adjusted incidence rates and relative survival for years of diagnosis 2000-2007 and with trends during 1995-2007 were calculated overall, by age and by country. RESULTS The crude annual incidence rate was 0.28 per 100,000 and age-adjusted incidence was 0.23 per 100,000; incidence increased with age, from 0.18/100,000 at age 0-44 to 0.25/100,000 at age 45-64 and 0.69/100,000 at age 65 and over. Age-adjusted incidence in males was more than four times that in females. Portugal, which had the highest incidence of AIDS in Europe, had by far the highest incidence of KS at age 0-44, 1.44/100,000, more than four times the rate in any other country. Incidence among males in Europe aged 0-44 fell significantly between 1995-1998 and 1999-2002, followed by a significant increase in 2003-2007. Younger patients, with predominantly AIDS-related KS, formerly had a worse prognosis, but since 1999-2001 5-year relative survival increased for patients aged under 65, and by 2005-2007 was 83-86 % for all three age groups 0-44, 45-64, and 65 and over. CONCLUSION Survival and quality of life for the increasing number of people in Europe affected by KS should improve further following the development of evidence-based guidelines for its management. Population-based cancer registries will continue to play a vital role in monitoring the burden of KS and improvements in its outcome.
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Affiliation(s)
- Charles A Stiller
- National Cancer Registration and Analysis Service, Public Health England, UK.
| | - Laura Botta
- Research Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - Maria José Sánchez Perez
- Escuela Andaluza de Salud Pública (EASP), Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain.
| | | | - Rafael Marcos-Gragera
- Epidemiology Unit and Girona Cancer Registry, Cancer Plan, Department of Health, Generalitat de Catalunya, Catalan Institute of Oncology, Girona, Spain; Descriptive Epidemiology, Genetics and Cancer Prevention Group, Biomedical Research Institute (IDIBGI), Girona, Spain; University of Girona (UdG), Girona, Spain; Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
| | - Tiziana Scuderi
- UOS Registro Tumori Trapani-Agrigento, Dipartimento di Prevenzione, Asp Trapani, Trapani, Italy.
| | - Dyfed Wyn Huws
- Welsh Cancer Intelligence and Surveillance Unit, Public Health Wales, Cardiff, Wales, UK; Honorary Research Fellow, Swansea University, Swansea, Wales, UK.
| | - Annalisa Trama
- Research Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
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106
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Niu XM, Rao A, Chen D, Sheng B, Weir S, Umar E, Trapence G, Jumbe V, Kamba D, Rucinski K, Viswasam N, Baral S, Bao L. Using factor analyses to estimate the number of female sex workers across Malawi from multiple regional sources. Ann Epidemiol 2020; 55:34-40. [PMID: 33340655 DOI: 10.1016/j.annepidem.2020.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 11/03/2020] [Accepted: 12/02/2020] [Indexed: 01/27/2023]
Abstract
PURPOSE Human immunodeficiency virus (HIV) risks are heterogeneous in nature even in generalized epidemics. However, data are often missing for those at highest risk of HIV, including female sex workers. Statistical models may be used to address data gaps where direct, empiric estimates do not exist. METHODS We proposed a new size estimation method that combines multiple data sources (the Malawi Biological and Behavioral Surveillance Survey, the Priorities for Local AIDS Control Efforts study, and the Malawi Demographic Household Survey). We used factor analysis to extract information from auxiliary variables and constructed a linear mixed effects model for predicting population size for all districts of Malawi. RESULTS On average, the predicted proportion of female sex workers among women of reproductive age across all districts was about 0.58%. The estimated proportions seemed reasonable in comparing with a recent study Priorities for Local AIDS Control Efforts II (PLACE II). Compared with using a single data source, we observed increased precision and better geographic coverage. CONCLUSIONS We illustrate how size estimates from different data sources may be combined for prediction. Applying this approach to other subpopulations in Malawi and to countries where size estimate data are lacking can ultimately inform national modeling processes and estimate the distribution of risks and priorities for HIV prevention and treatment programs.
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Affiliation(s)
- Xiaoyue Maggie Niu
- Department of Statistics, Eberly College of Science, Pennsylvania State University, University Park
| | - Amrita Rao
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - David Chen
- Department of Statistics, Eberly College of Science, Pennsylvania State University, University Park
| | - Ben Sheng
- Department of Statistics, Eberly College of Science, Pennsylvania State University, University Park
| | - Sharon Weir
- Department of Epidemiology, University of North Carolina, Chapel Hill
| | - Eric Umar
- Department of Health Systems and Policy, School of Public Health and Family Medicine, University of Malawi College of Medicine, Blantyre, Malawi
| | | | - Vincent Jumbe
- Department of Health Systems and Policy, School of Public Health and Family Medicine, University of Malawi College of Medicine, Blantyre, Malawi
| | - Dunker Kamba
- Center for Development of People, Blantyre, Malawi
| | - Katherine Rucinski
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Nikita Viswasam
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Stefan Baral
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Le Bao
- Department of Statistics, Eberly College of Science, Pennsylvania State University, University Park.
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107
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Gesesew HA, Ward P, Woldemichael K, Mwanri L. HIV Care continuum Outcomes: Can Ethiopia Meet the UNAIDS 90-90-90 Targets? Ethiop J Health Sci 2020; 30:179-188. [PMID: 32165807 PMCID: PMC7060392 DOI: 10.4314/ejhs.v30i2.5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background Ethiopia has pledged to the UNAIDS 90-90-90 framework. However, the achievements of these UNAIDS targets are not assessed in Southwest Ethiopia. Using HIV care and treatment outcomes as surrogate markers, we assessed all targets. Methods Complex surrogate makers were used to assess the HIV care continuum outcomes using antiretroviral therapy data in Jimma University Teaching Hospital. Early HIV diagnosis was a surrogate marker to measure the first 90. Numbers of people on HIV treatment and who have good adherence were used to measure the second 90. To measure the third 90, we used immunological success that was measured using numbers of CD4 counts, clinical success using WHO clinical stages and treatment success using immunological and clinical successes. Results In total, 8172 patients were enrolled for HIV care from June 2003 to March 2015. For the diagnosis target, the prevalence of early HIV diagnosis among patients on ART was 35% (43% among children and 33.3% among adults). For the treatment target, 5299(65%) received ART of which 1154(22%) patients lost to follow-up or defaulted from ART treatment, and 1015(19%) patients on treatment transferred out to other sites. In addition, 17% had fair or good adherence. Finally, 81% had immunological success, 80% had clinical success and 66% treatment success. Conclusions The study revealed that Southwest Ethiopia achieved 35%, 65% and 66% of the first, second and third UNAIDS targets, a very far performance from achieving the target. These highlight further rigorous interventions to improve outcome of HIV continuum of care.
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Affiliation(s)
- Hailay Abrha Gesesew
- Public Health, Flinders University, Adelaide, Australia.,Epidemiology, Jimma University, Jimma, Ethiopia
| | - Paul Ward
- Public Health, Flinders University, Adelaide, Australia
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Tisdell CA. Economic, social and political issues raised by the COVID-19 pandemic. ECONOMIC ANALYSIS AND POLICY 2020; 68:17-28. [PMID: 32843816 PMCID: PMC7440080 DOI: 10.1016/j.eap.2020.08.002] [Citation(s) in RCA: 107] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 08/19/2020] [Accepted: 08/19/2020] [Indexed: 05/17/2023]
Abstract
This article contributes to the assessment of public policies to control the incidence of COVID-19 in several ways. (1) It contains a brief historical and comparative overview of selected pandemics, particularly in relation to the COVID-19 pandemic; (2) It provides a simple original model which could be used to prioritize the admission of COVID-19 sufferers to hospital (taking into account available hospital capacity) and (3) it specifies a second model to evaluate desired social choices involving the trade-off between the severity of social restrictions (taking into account their impact on the incidence of COVID-19) and the level of economic activity. Bergson-type welfare functions are utilized in the second model. It also critically examines the proposition that the isolation (lockdown) of social groups is a desirable method of limiting the incidence of COVID-19. This leads onto the consideration of the extent to which personal freedom of choice (liberty) ought to be restricted in response to the COVID-19 pandemic. A brief outline follows illustrating the factors that are likely to hinder economic recovery from COVID-19. Particular attention is paid to the moral and ethical questions raised by policies to control COVID-19. These appear to have received little attention in the relevant economic literature.
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Affiliation(s)
- Clement A Tisdell
- School of Economics, The University of Queensland, Brisbane 4072 QLD, Australia
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109
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Advanced HIV disease in the Botswana combination prevention project: prevalence, risk factors, and outcomes. AIDS 2020; 34:2223-2230. [PMID: 32694412 DOI: 10.1097/qad.0000000000002627] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE(S) To determine the proportion of individuals linking to HIV-care with advanced HIV-disease (CD4 cell counts ≤200 cells/μl) in the Botswana Combination Prevention Project, describe the characteristics of these individuals, and examine treatment outcomes. DESIGN A subanalysis of a cluster-randomized HIV-prevention trial. HIV status was assessed in 16-64-year-olds through home and mobile testing. All HIV-positive persons not on antiretroviral therapy were referred to local Ministry of Health and Wellness clinics for treatment. METHODS Analysis was restricted to the 15 intervention clusters. The proportion of individuals with advanced HIV disease was determined; associations between advanced HIV disease and sex and age explored; and rates of viral suppression determined at 1-year. Mortality and retention in care were compared between CD4 strata (CD4 cell counts ≤200 vs. >200 cells/μl). RESULTS Overall, 17.2% [430/2499; 95% confidence interval (CI) 15.7-18.8%] of study participants had advanced HIV disease (CD4 cell counts ≤200 cells/μl) at time of clinic linkage. Men were significantly more likely to present with CD4 cell counts 200 cells/μl or less than women [23.7 vs. 13.4%, adjusted odds ratio 1.9, 95% CI 1.5-2.3]. The risk of advanced HIV disease increased with increasing age (adjusted odds ratio 2.2, 95% CI 1.4-3.2 >35 vs. <25 years). Patients with CD4 cell counts 200 cells/μl or less had significantly higher rates of attrition from care during follow-up (hazards ratio 1.47, 95% CI 1.1-2.1). CONCLUSION Advanced HIV disease due to late presentation to or disengagement from antiretroviral therapy care remains common in the Treat All era in Botswana, calling for innovative testing, linkage, and treatment strategies to engage and retain harder-to-reach populations in care.
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Abstract
This paper reviews the current epidemics of human immunodeficiency virus (HIV) infection in China, particularly the globally available prevention strategies developed and implemented. This review focuses on HIV prevention measures in general, such as education, testing, and counseling and in specific responses to transmission modes, such as blood safety, harm reduction for people who inject drugs, and condom promotion to reduce sexual transmission. We also assess newly developed prevention measures, such as prevention treatment, pre-exposure prophylaxis, post-exposure prophylaxis, male circumcision, and promising potential future preventions, including microbicides and vaccines. Based on this assessment, we provide recommendations for their implementation in China. We conclude that there is no magic bullet for HIV prevention, particularly sexual transmission of the disease, but only a combination of these prevention strategies can control the HIV epidemic.
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111
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Pour M, James L, Singh K, Mampunza S, Baer F, Scott J, Berg MG, Rodgers MA, Cloherty GA, Hackett Jr J, McArthur CP. Increased HIV in Greater Kinshasa Urban Health Zones: Democratic Republic of Congo (2017-2018). AIDS Res Ther 2020; 17:67. [PMID: 33225968 PMCID: PMC7682026 DOI: 10.1186/s12981-020-00322-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 10/23/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Diagnosis of people living with HIV (PLHIV) is the first step toward achieving the new Fast Track Strategy to end AIDS by 2030: 95-95-95. However, reaching PLHIV is especially difficult in resource-limited settings such as the Democratic Republic of Congo (DRC), where reliable prevalence data is lacking. This study evaluated the prevalence of HIV in patients in the urban Kinshasa area. METHODS Individuals seeking healthcare were tested for HIV between February 2017 and July 2018 at existing Kinshasa urban clinics. The study was conducted in two phases. Case finding was optimized in a pilot study phase using a modified cell phone-based Open\Data Kit (ODK) collection system. HIV prevalence was then determined from data obtained between March-July of 2018 from 8320 individuals over the age of 18 years receiving care at one of 47 clinics in Kinshasa. RESULTS The prevalence of HIV in our study was 11.0% (95% CI 10.3-11.6%) overall and 8.14% in the subset of N = 1240 participants who were healthy mothers seeking prenatal care. These results are in sharp contrast to President's Emergency Plan for AIDS Relief (PEPFAR) estimates of 2.86%, but are consistent with data from surrounding countries. CONCLUSION While this data is sub-national and reflects an urban healthcare setting, given the large population of Kinshasa and rapidly changing age demographics, the results suggest that HIV prevalence in the DRC is substantially higher than previously reported.
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112
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Chatha ZF, Rashid U, Olsen S, Din FU, Khan A, Nawaz K, Gan SH, Khan GM. Pharmacist-led counselling intervention to improve antiretroviral drug adherence in Pakistan: a randomized controlled trial. BMC Infect Dis 2020; 20:874. [PMID: 33228562 PMCID: PMC7684945 DOI: 10.1186/s12879-020-05571-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 10/31/2020] [Indexed: 12/31/2022] Open
Abstract
Background Pakistan is facing a growing population of people living with human immunodeficiency (HIV). In this randomized controlled trial, we investigate if a pharmacist-led intervention can increase adherence to antiretroviral therapy (ART) for people living with HIV (PLWH). Methods Adults with HIV, who have been taking ART for more than 3 months were randomly assigned to receive either a pharmacist-led intervention or their usual care. Measures of adherence were collected at 1) baseline 2) just prior to delivery of intervention and 3) 8 weeks later. The primary outcomes were CD4 cell count and self-reported adherence measured with the AIDS Clinical Trial Group (ACTG) questionnaire. Results Post-intervention, the intervention group showed a statistically significant increase in CD4 cell counts as compared to the usual care group (p = 0.0054). In addition, adherence improved in the intervention group, with participants being 5.96 times more likely to report having not missed their medication for longer periods of time (p = 0.0086) while participants in the intervention group were 7.74 times more likely to report missing their ART less frequently (p < 0.0001). Conclusions The findings support the improvement in ART adherence and HIV management. Trial registration The trial is registered with Australian New Zealand Clinical Trials Registry (ACTRN12618001882213). Registered 20 November 2018. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-020-05571-w.
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Affiliation(s)
| | - Usman Rashid
- Health and Rehabilitation Research Institute, Auckland University of Technology (AUT), Auckland, New Zealand
| | - Sharon Olsen
- Health and Rehabilitation Research Institute, Auckland University of Technology (AUT), Auckland, New Zealand
| | - Fakhar Ud Din
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan.
| | - Amjad Khan
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan.
| | - Komal Nawaz
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
| | - Siew Hua Gan
- School of Pharmacy, Monash University Malaysia, 47500, Bandar Sunway, Selangor Darul Ehsan, Malaysia
| | - Gul Majid Khan
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan.
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Alene KA, Jegnie A, Adane AA. Multidrug-resistant tuberculosis during pregnancy and adverse birth outcomes: a systematic review and meta-analysis. BJOG 2020; 128:1125-1133. [PMID: 33068306 DOI: 10.1111/1471-0528.16573] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 10/01/2020] [Accepted: 10/14/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Multidrug-resistant tuberculosis (MDR-TB) is a major global public health concern. However, there is a dearth of literature on whether MDR-TB and its medications impact maternal and perinatal outcomes, and when such evidence exists the findings are conflicting. OBJECTIVES This systematic review and meta-analysis aimed to examine the impact of MDR-TB and its medications during pregnancy on maternal and perinatal outcomes. SEARCH STRATEGY PubMed, Scopus and Web of Science databases were searched from earliest to February 2020. SELECTION CRITERIA Records were screened based on pre-defined selection criteria and assessed for quality by two independent reviewers. DATA COLLECTION AND ANALYSIS A meta-analysis was performed using the random effects model to calculate pooled prevalence for each outcome. MAIN RESULTS Of the 72 records identified, 12 were included in the systematic review and meta-analysis, consisting of 174 pregnant women with MDR-TB and 110 adverse outcomes. Maternal death, pregnancy loss, preterm birth and low birthweight were the most common maternal and perinatal adverse outcomes reported in the studies. The overall pooled prevalence was 7.5% (95% CI 3.2-12.8) for maternal death, 10.6% (95% CI 6.0-16.3) for pregnancy loss, 12.9% (95% CI 0.0-38.0) for preterm birth and 23.7% (95% CI 17.0-31.0) for low birthweight. CONCLUSIONS The findings suggest that MDR-TB is associated with a high risk of adverse maternal and perinatal outcomes, but these should be interpreted cautiously because the evidence is largely preliminary. Adequately powered prospective cohort studies are urgently required to corroborate these findings. TWEETABLE ABSTRACT Multidrug-resistant tuberculosis may increase the risk of adverse maternal and perinatal outcomes.
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Affiliation(s)
- K A Alene
- Faculty of Health Sciences, Curtin University, Bentley, WA, Australia.,Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, WA, Australia.,Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - A Jegnie
- UWA School of Agriculture and Environment, The University of Western Australia, Crawley, WA, Australia
| | - A A Adane
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.,Telethon Kids Institute, The University of Western Australia, Nedlands, WA, Australia
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Challenges in estimating HIV prevalence trends and geographical variation in HIV prevalence using antenatal data: Insights from mathematical modelling. PLoS One 2020; 15:e0242595. [PMID: 33216793 PMCID: PMC7679018 DOI: 10.1371/journal.pone.0242595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 11/05/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND HIV prevalence data among pregnant women have been critical to estimating HIV trends and geographical patterns of HIV in many African countries. Although antenatal HIV prevalence data are known to be biased representations of HIV prevalence in the general population, mathematical models have made various adjustments to control for known sources of bias, including the effect of HIV on fertility, the age profile of pregnant women and sexual experience. METHODS AND FINDINGS We assessed whether assumptions about antenatal bias affect conclusions about trends and geographical variation in HIV prevalence, using simulated datasets generated by an agent-based model of HIV and fertility in South Africa. Results suggest that even when controlling for age and other previously-considered sources of bias, antenatal bias in South Africa has not been constant over time, and trends in bias differ substantially by age. Differences in the average duration of infection explain much of this variation. We propose an HIV duration-adjusted measure of antenatal bias that is more stable, which yields higher estimates of HIV incidence in recent years and at older ages. Simpler measures of antenatal bias, which are not age-adjusted, yield estimates of HIV prevalence and incidence that are too high in the early stages of the HIV epidemic, and that are less precise. Antenatal bias in South Africa is substantially greater in urban areas than in rural areas. CONCLUSIONS Age-standardized approaches to defining antenatal bias are likely to improve precision in model-based estimates, and further recency adjustments increase estimates of HIV incidence in recent years and at older ages. Incompletely adjusting for changing antenatal bias may explain why previous model estimates overstated the early HIV burden in South Africa. New assays to estimate the fraction of HIV-positive pregnant women who are recently infected could play an important role in better estimating antenatal bias.
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Benamor Teixeira MDL, Fuller TL, Fragoso Da Silveira Gouvêa MI, Santos Cruz ML, Ceci L, Pinheiro Lattanzi F, Sidi LC, Mendes-Silva W, Nielsen-Saines K, Joao EC. Efficacy of Three Antiretroviral Regimens Initiated during Pregnancy: Clinical Experience in Rio de Janeiro. Antimicrob Agents Chemother 2020; 64:AAC.01068-20. [PMID: 33020151 PMCID: PMC7674033 DOI: 10.1128/aac.01068-20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 09/24/2020] [Indexed: 11/20/2022] Open
Abstract
Few studies have compared the clinical efficacy and adverse events of combined antiretroviral therapy (cART) regimens in pregnant women seeking obstetrical care. The objective of this study was to compare the efficacy (virus load response), adverse events, and obstetrical and neonatal outcomes of three different regimens of cART in HIV-infected pregnant women initiating treatment in Rio de Janeiro, Brazil. This was a retrospective cohort study of cART-naive pregnant women who initiated either ritonavir-boosted protease inhibitors (atazanavir or lopinavir), efavirenz, or raltegravir plus a backbone regimen. From 2014 to 2018, 390 pregnant women were followed over time. At baseline, the median viral load (VL) for HIV was 4.1 log copies/ml. Among participants who received cART for 2 to 7 weeks, the VL decline was greater for raltegravir (2.24 log copies/ml) than for efavirenz or protease inhibitors (P < 0.001). Virologic suppression was achieved in 87% of women on raltegravir near delivery versus 73% on efavirenz and 70% on protease inhibitors (P = 0.011). Patients on raltegravir achieved virologic suppression faster than those on other regimens (P = 0.019). Overall, the HIV perinatal infection rate was 1.5%. This clinical study compared three potent and well-tolerated cART regimens and demonstrated that a higher proportion of participants on raltegravir achieved an undetectable HIV VL near delivery (P = 0.011) compared to the other arms. These findings suggest that raltegravir-containing regimens are optimal regimens for women with HIV initiating treatment late in pregnancy.
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Affiliation(s)
- Maria de Lourdes Benamor Teixeira
- Infectious Diseases Department, Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Trevon L Fuller
- Infectious Diseases Department, Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil
| | - Maria Isabel Fragoso Da Silveira Gouvêa
- Infectious Diseases Department, Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | - Loredana Ceci
- Infectious Diseases Department, Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil
| | | | - Leon Claude Sidi
- Infectious Diseases Department, Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil
| | - Wallace Mendes-Silva
- Maternity-Fetal Department and Infectious Diseases Department, Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil
| | - Karin Nielsen-Saines
- Department of Pediatric Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Esau Custodio Joao
- Infectious Diseases Department, Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil
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Melis T, Fikadu Y, Lemma L. Perceived Stigma and Associated Factors Among HIV Positive Adult Patients Attending Antiretroviral Therapy Clinics at Public Facilities of Butajira Town, Southern Ethiopia, 2020. HIV AIDS (Auckl) 2020; 12:717-724. [PMID: 33204172 PMCID: PMC7665444 DOI: 10.2147/hiv.s280501] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 10/14/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Stigma refers to attitudes and beliefs that lead people to reject, avoid, or fear those they perceive as being different. It identifies people as criminals, slaves, or traitors to be shunned. Globally 30-80% of people living with HIV experience stigma during their lifetime. There is a paucity of research in identifying determinants of stigma on HIV positive patients in Ethiopia. The aim of this study is to assess magnitude and factors associated with stigma among HIV positive adults attending antiretroviral therapy (ART) clinics at public health facilities of Butajira town. METHODS Institution-based cross-sectional study was conducted at public health facilities of Butajira town. A total of 403 study participants were selected by systematic random sampling technique. Data were collected by using pre-tested interviewer-administered semi-structured questionnaire. The collected data were entered into EpiData3.1 and exported to SPSS version 23. Bivariate and multivariable logistic regression analysis were used to identify factors associated with stigma. The strength of association was assessed by crude odds ratio and adjusted odds ratio for bivariate and multivariable logistic regression analysis, respectively. Statistical significance was declared at p-value <0.05 and 95% CI. RESULTS The magnitude of stigma among HIV positive patient was 28.9%. Discussing about safer sex (AOR: 2; 95% CI: (1.14,3.18), disclosing HIV positive status (AOR: 6;95% CI: (2.3,14.9), being a female (AOR: 2.5; 95% CI: (1.41,4.12) and age >34 years (AOR: 4; 95% CI: (1.46,12.9) were the independent factors associated with stigma in HIV positive patients. CONCLUSION The magnitude of stigma in ART patient is still unresolved problem. Discussing about safer sex, disclosing HIV positive status, being a female and age were the independent factors associated with stigma in HIV positive patients.
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Affiliation(s)
- Tamirat Melis
- Wachamo University, College of Medicine & Health Sciences, Department of Public Health, Hosanna, Ethiopia
| | - Yohannes Fikadu
- Wolkite University, College of Medicine & Health Sciences, Department of Public Health, Wolkite, Ethiopia
| | - Lire Lemma
- Wachamo University, College of Medicine & Health Sciences, Department of Public Health, Hosanna, Ethiopia
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Kafeero HM, Ndagire D, Ocama P, Walusansa A, Sendagire H. Sero-prevalence of human immunodeficiency virus-hepatitis B virus (HIV-HBV) co-infection among pregnant women attending antenatal care (ANC) in sub-Saharan Africa (SSA) and the associated risk factors: a systematic review and meta-analysis. Virol J 2020; 17:170. [PMID: 33160386 PMCID: PMC7648981 DOI: 10.1186/s12985-020-01443-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 10/27/2020] [Indexed: 12/14/2022] Open
Abstract
Background There is plenitude of information on HIV infection among pregnant mothers attending antenatal care (ANC) in sub-Saharan Africa. However, the epidemiology of HBV–HIV co-infections in the same cohort is not clear despite the common route of transmission of both viruses. The aim of our study was to synthesize data on the prevalence of HBV–HIV co-infection among pregnant women attending ANC in Sub-Saharan Africa to assist in the design of public health interventions to mitigate the challenge.
Methods The study was done in tandem with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) standards and the Cochran’s Q test, I2 statistics for heterogeneity and the prevalence were calculated using commercially available software called MedCalcs (https://www.medcalc.org). A random effect model was used to pool the prevalence since all the heterogeneities were high (≥ 78%) and Phet < 0.05 indicated significant heterogeneities. The risk factors and risk differences for HBV–HIV co-infection were analyzed. Any likely sources of heterogeneity were analyzed through sensitivity analysis, meta-regression and sub-group analysis. All analyses were done at 95% level of significance and a P < 0.05 was considered significant. Results The overall pooled prevalence of HBV–HIV co-infection among pregnant mothers in sub-Saharan Africa was low 3.302% (95%CI = 2.285 to 4.4498%) with heterogeneities (I2) of 97.59% (P > 0.0001). Within regional sub group meta-analyses, West Africa had significantly higher prevalence of 5.155% (95% = 2.671 to 8.392%) with heterogeneity (I2) of 92.25% (P < 0.0001) than any other region (P < 0.001). Articles published from 2004–2010 had significantly higher prevalence of 6.356% (95% = 3.611 to 9.811%) with heterogeneity (I2) 91.15% (P < 0.0001) compared to those published from 2011 to 2019 (P < 0.001). The HIV positive cohort had significantly higher prevalence of HBV–HIV co-infection of 8.312% (95% CI = 5.806 to 11.22%) with heterogeneity (I2)94.90% (P < 0.0001) than the mothers sampled from the general population with a prevalence of 2.152% (95% CI = 1.358 to 3.125%) (P < 0.001). The overall and sub group analyses had high heterogeneities (I2 > 89%, P < 0.0001) but was reduced for South Africa (I2) = 78.4% (P = 0.0314). Age, marital status and employment were independent factors significantly associated with risk of HBV–HIV co-infection (P < 0.001) but not extent of gravidity and education level (P > 0.05). After meta-regression for year of publication and sample size for HBsAg positivity, the results were not significantly associated with HBV pooled prevalence for sample size (P = 0.146) and year of publication (P = 0.560). Following sensitivity analysis, the HBsAg pooled prevalence slightly increased to 3.429% (95% CI = 2.459 to 4.554%) with heterogeneity I2 = 96.59% (95% CI = 95.93 to 97.14%), P < 0.0001 Conclusion There is an urgent need for routine HBV screening among HIV positive pregnant mothers attending antenatal care in sub-Saharan Africa to establish the extent of HBV–HIV co-infection in this cohort. Future studies need to investigate the putative risk factors for HBV–HIV co-infection and prioritize plausible control strategies.
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Affiliation(s)
- Hussein Mukasa Kafeero
- Department of Medical Microbiology, College of Health Sciences, Makerere University, P.O Box 7062, Kampala, Uganda. .,Department of Medical Microbiology, Habib Medical School, Faculty of Health Sciences, Islamic University in Uganda, P.O Box 7689, Kampala, Uganda.
| | - Dorothy Ndagire
- Department of Plant Sciences, Microbiology and Biotechnology, College of Natural Sciences, Makerere University, P.O Box 7062, Kampala, Uganda
| | - Ponsiano Ocama
- Department of Medicine, College of Health Sciences, Makerere University, P.O Box 7062, Kampala, Uganda
| | - Abdul Walusansa
- Department of Medical Microbiology, Habib Medical School, Faculty of Health Sciences, Islamic University in Uganda, P.O Box 7689, Kampala, Uganda
| | - Hakim Sendagire
- Department of Medical Microbiology, College of Health Sciences, Makerere University, P.O Box 7062, Kampala, Uganda.,Department of Medical Microbiology, Habib Medical School, Faculty of Health Sciences, Islamic University in Uganda, P.O Box 7689, Kampala, Uganda
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Avanceña ALV, Hutton DW. Optimization Models for HIV/AIDS Resource Allocation: A Systematic Review. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:1509-1521. [PMID: 33127022 DOI: 10.1016/j.jval.2020.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 07/23/2020] [Accepted: 08/07/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE This study reviews optimization models for human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) resource allocation. METHODS We searched 2 databases for peer-reviewed articles published from January 1985 through August 2019 that describe optimization models for resource allocation in HIV/AIDS. We included models that consider 2 or more competing HIV/AIDS interventions. We extracted data on selected characteristics and identified similarities and differences across models. We also assessed the quality of mathematical disease transmission models based on the best practices identified by a 2010 task force. RESULTS The final qualitative synthesis included 23 articles that used 14 unique optimization models. The articles shared several characteristics, including the use of dynamic transmission modeling to estimate health benefits and the inclusion of specific high-risk groups in the study population. The models explored similar HIV/AIDS interventions that span primary and secondary prevention and antiretroviral treatment. Most articles were focused on sub-Saharan African countries (57%) and the United States (39%). There was notable variation in the types of optimization objectives across the articles; the most common was minimizing HIV incidence or maximizing infections averted (87%). Articles that utilized mathematical modeling of HIV disease and transmission displayed variable quality. CONCLUSIONS This systematic review of the literature identified examples of optimization models that have been applied in different settings, many of which displayed similar features. There were similarities in objective functions across optimization models, but they did not align with global HIV/AIDS goals or targets. Future work should be applied in countries facing the largest declines in HIV/AIDS funding.
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Affiliation(s)
- Anton L V Avanceña
- Department of Health Management and Policy, University of Michigan, Ann Arbor, MI, USA.
| | - David W Hutton
- Department of Health Management and Policy and Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, MI, USA
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Abstract
Human immunodeficiency virus (HIV) is one of the most serious pediatric infectious diseases, affecting around 3 million children and adolescents worldwide. Lifelong antiretroviral treatment (ART) provides multiple benefits including sustained virologic suppression, restoration and preservation of immune function, decreased morbidity and mortality, and improved quality of life. However, access to ART, particularly among neonates and young infants, continues to be challenging due to limited number of suitable formulations and limited access to pediatric ARV drug. Moreover, children and adolescents living with HIV may experience long-term HIV- and ART-associated comorbidities including cardiovascular, renal, neurological, and metabolic complications. We provide an overview of currently available formulations, dosing, and safety considerations for pediatric antiretroviral drugs by drug classes and according to the three age groups including neonates, children, and adolescents.
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Affiliation(s)
- Sahera Dirajlal-Fargo
- Pediatric Infectious Diseases, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
| | - Wei Li A Koay
- Department of Pediatrics, School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA.,Division of Infectious Diseases, Children's National Medical Center, Washington, DC, USA
| | - Natella Rakhmanina
- Department of Pediatrics, School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA.,Division of Infectious Diseases, Children's National Medical Center, Washington, DC, USA.,Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, USA
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120
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Gorgens M, Longosz AF, Ketende S, Nkambule M, Dlamini T, Mabuza M, Sikwibele K, Tsododo V, Dlamini M, Dennis-Langa F, Heard W, Low A, Harimurti P, Wilson D, Mabuza K, de Walque D. Evaluating the effectiveness of incentives to improve HIV prevention outcomes for young females in Eswatini: Sitakhela Likusasa impact evaluation protocol and baseline results. BMC Public Health 2020; 20:1591. [PMID: 33092558 PMCID: PMC7579927 DOI: 10.1186/s12889-020-09680-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 10/12/2020] [Indexed: 10/13/2023] Open
Abstract
Background Eswatini continues to have the highest prevalence of HIV in the world, and one of the highest HIV incidences among adult populations (aged 15–49). This analysis reports on both key elements of study design/protocol and baseline results from an impact evaluation of an intervention incentivizing (i) initiation, enrolment, attendance or completion of some form of education, and (ii) lower risk sexual behaviour. Methods The impact evaluation employs a two by two factorial design in which participants are enrolled in either the incentive for education arm (‘education treatment arm’ providing a conditional cash incentive) or the control arm (‘education control arm’). In each of these arms, 50% of participants were randomized to also be eligible for selection – three times a year – to participate in a conditional raffle conditional on testing negative for curable STIs (syphilis and Trichomonas vaginalis). Results Baseline recruitment and screening occurred in 2016 when a total of 6055 individuals were screened of which 4863 participated in the baseline survey, and 4819 individuals were randomized into one of the study arms. The baseline prevalence of HIV, Trichomonas vaginalis, and syphilis among adolescent girls and young women 8.20% (397/4840), 3.31% (150/4533) and 0.17% (8/4830) respectively. Conclusions An educational cash incentive and raffle incentive impact evaluation that addresses adolescent girls and young women who are in-education and out-of-education has the potential to reduce HIV risk in adolescent girls and young women in Eswatini. Trial registration Name of the registry: Pan African Clinical Trials Registry. Trial registration number: PACTR201811609257043. Date of registration: May 11, 2018 ‘Retrospectively registered’. URL of trial registry record: https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=4685
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Affiliation(s)
| | - Andrew F Longosz
- The World Bank Group, 1776 G Street, Washington, DC, 20006, USA.
| | | | | | | | - Mbuso Mabuza
- National Emergency Response for HIV/AIDS, Mbabane, Eswatini
| | | | | | | | | | - Wendy Heard
- The World Bank Group, 1776 G Street, Washington, DC, 20006, USA
| | | | - Pandu Harimurti
- The World Bank Group, 1776 G Street, Washington, DC, 20006, USA
| | - David Wilson
- The World Bank Group, 1776 G Street, Washington, DC, 20006, USA
| | - Khanya Mabuza
- National Emergency Response for HIV/AIDS, Mbabane, Eswatini
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Hailu BA, Tadese F, Bogale GG, Molla A, Miheretu BA, Beyene J. Spatial patterns and associated factors of HIV Seropositivity among adults in Ethiopia from EDHS 2016: a spatial and multilevel analysis. BMC Infect Dis 2020; 20:751. [PMID: 33054788 PMCID: PMC7557038 DOI: 10.1186/s12879-020-05456-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 09/27/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND HIV is a major public health issue, especially in developing countries. It is important to track and design successful intervention programs to explore the spatial pattern, distribution, and associated factors of HIV Seropositivity. This study therefore showed the spatial variation of HIV Seropositivity and related factors in Ethiopia. METHODS A total sample of 25,774 individual data collected from the 2016 EDHS data were primarily HIV biomarkers, IR, MR, and GPS. Spatial heterogeneity analysis was used with methods such as Morans I, Interpolation, and Kulldorff 's scan statistic. Spatial analysis was conducted using open source tools (QGIS, GeoDa, SaTScan). Multilevel logistic regression analysis was performed using Stata14 to identify HIV-associated factors. Finally, the AOR with a 95% confidence interval was used to report the mixed-effect logistic regression result in the full model. RESULT The prevalence of HIV / AIDS at national level was 0.93%. The highest prevalence regions were Gambela, Addis Abeba, Harari and Diredawa, accounting for 4.79, 3.36, 2.65 and 2.6%, respectively. Higher HIV seropositive spatial clusters have been established in the Gambela and Addis Ababa regions. Multilevel analysis at the individual level being married [AOR = 2.19 95% CI: (1.11-4.31)] and previously married [AOR = 6.45, 95% CI: (3.06-13.59)], female [AOR = 1.8, 95% CI: (1.19-2.72)], first-sex at age ≤15 [AOR = 4.39, 95% CI: (1.70-11.34)], 18-19 [AOR = 2.67 95% CI: (1.05-6.8)], middle age group (25-34) [AOR = 6.53, 95% CI: (3.67-11.75)], older age group (>34) [AOR = 2.67 95% CI: (1.05-6.8)], primary school [AOR = 3.03, 95% CI: (1.92-4.79)], secondary school [AOR = 3.37, 95% CI: (1.92-5.92) were significantly associated with serropositivity. Regarding household level, place of residence [urban: AOR = 6.13 CI: (3.12, 12.06)], female-headed households (AOR = 2.24 95% CI: (1.57-3.73), media exposure [low exposure (AOR = 0.53 95% CI: (0.33-0.86), no exposure AOR = 0.39 95% CI: (0.23-0.65)] and increased household size [AOR = 0.72 95% CI: (0.65-0.8)] were associated with HIV Seropositivity. CONCLUSION High cluster HIV cases were found in Gambela, Addis Abeba, Harari, and Diredawa. Having a history of married, start sex at a younger age, female-headed household, urban residence, and lower household size is more affected by HIV/AIDS. So any concerned body work around this risk group and area can be effective in the reduction of transmission.
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Affiliation(s)
- Bayuh Asmamaw Hailu
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences Wollo University, Dessie, Ethiopia.
| | - Fentaw Tadese
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences Wollo University, Dessie, Ethiopia
| | - Getahun Gebre Bogale
- Department of Health Informatics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Asressie Molla
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences Wollo University, Dessie, Ethiopia
| | | | - Joseph Beyene
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
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Alexander Ishungisa M, Moen K, Leyna G, Makyao N, Ramadhan A, Lange T, Meyrowitsch DW, Mizinduko M, Likindikoki S, Leshabari M, Mmbaga EJ. HIV prevalence among men who have sex with men following the implementation of the HIV preventive guideline in Tanzania: respondent-driven sampling survey. BMJ Open 2020; 10:e036460. [PMID: 33020084 PMCID: PMC7537429 DOI: 10.1136/bmjopen-2019-036460] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES To estimate HIV prevalence and associated risk factors among men who have sex with men (MSM) in Dar es Salaam, Tanzania following the implementation of the national comprehensive package of HIV interventions for key population (CHIP). DESIGN A cross-sectional survey using respondent-driven sampling. SETTING Dar es Salaam, Tanzania's largest city. PARTICIPANTS Men who occasionally or regularly have sex with another man, aged 18 years and above and living in Dar es Salaam city at least 6 months preceding the study. PRIMARY OUTCOME MEASURE HIV prevalence was the primary outcome. Independent risk factors for HIV infection were examined using weighted logistics regression modelling. RESULTS A total of 777 MSM with a mean age of 26 years took part in the study. The weighted HIV prevalence was 8.3% (95% CI: 6.3%-10.9%) as compared with 22.3% (95% CI: 18.7%-26.4%) observed in a similar survey in 2014. Half of the participants had had sex with more than two partners in the month preceding the survey. Among those who had engaged in transactional sex, 80% had used a condom during last anal sex with a paying partner. Participants aged 25 and above had four times higher odds of being infected than those aged 15-19 years. HIV infection was associated with multiple sexual partnerships (adjusted OR/AOR, 3.0; 95% CI: 1.8-12.0), not having used condom during last sex with non-paying partner (AOR, 4.1; 95% CI: 1.4-7.8) and ever having engaged in group sex (AOR, 3.4; 95% CI: 1.7-3.6). CONCLUSION HIV prevalence among MSM in Dar es Salaam has decreased by more than a half over the past 5 years, coinciding with implementation of the CHIP. It is nonetheless two times as high as that of men in the general population. To achieve the 2030 goal, behavioural change interventions and roll out of new intervention measures such as pre-exposure prophylaxis are urgently needed.
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Affiliation(s)
- Mwijage Alexander Ishungisa
- Behavioral Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
- Medical Botany, Plant Breeding and Agronomy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Kare Moen
- Department of Community Medicine and Global Health, University of Oslo, Oslo, Norway
| | - Germana Leyna
- Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Neema Makyao
- National AIDS Control Programme, Ministry of Health, Tanzania National AIDS Control Program, Dar es Salaam, United Republic of Tanzania
| | - Angela Ramadhan
- National AIDS Control Programme, Ministry of Health, Kilimanjaro Christian Medical University College, Moshi, United Republic of Tanzania
| | - Theis Lange
- Section of Biostatistics, University of Copenhagen, Kobenhavns, Denmark
| | | | - Mucho Mizinduko
- Epidemiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Samuel Likindikoki
- Department of Sychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Melkzedeck Leshabari
- Department of Behavioral Sciences, Muhimbili University College of Health Sciences, Dar es Salaam, United Republic of Tanzania
| | - Elia John Mmbaga
- Epidemiology and Biostatistics, Muhimbili University Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
- Community Medicine and Global Health, Universitetet i Oslo Avdeling for samfunnsmedisin, Oslo, Norway
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Machado DB, Pescarini JM, Ramos D, Teixeira R, Lozano R, Pereira VODM, Azeredo C, Paes-Sousa R, Malta DC, Barreto ML. Monitoring the progress of health-related sustainable development goals (SDGs) in Brazilian states using the Global Burden of Disease indicators. Popul Health Metr 2020; 18:7. [PMID: 32993666 PMCID: PMC7526114 DOI: 10.1186/s12963-020-00207-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 06/19/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Measuring the Global Burden of Disease (GBD) has been the key to verifying the evolution of health indicators worldwide. We analyse subnational GBD data for Brazil in order to monitor the performance of the Brazilian states in the last 28 years on their progress towards meeting the health-related SDGs. METHODS As part of the GBD study, we assessed the 41 health-related indicators from the SDGs in Brazil at the subnational level for all the 26 Brazilian states and the Federal District from 1990 to 2017. The GBD group has rescaled all worldwide indicators from 0 to 100, assuming that for each one of them, the worst value among all countries and overtime is 0, and the best is 100. They also estimate the overall health-related SDG index as a function of all previously estimated health indicators and the SDI index (Socio-Demographic Index) as a function of per capita income, average schooling in the population aged 15 years or over, and total fertility rate under the age of 25 (TFU25). RESULTS From 1990 to 2017, most subnational health-related SDGs, the SDG and SDI indexes improved considerable in most Brazilian states. The observed differences in SDG indicators within Brazilian states, including HIV incidence and health worker density, increased over time. In 2017, health-related indicators that achieved good results globally included the prevalence of child wasting, NTD, household air pollution, conflict mortality, skilled birth attendance, use of modern contraceptive methods, vaccine coverage, and health worker density, but poor results were observed for child overweight and homicide rates. The high rates of overweight, alcohol consumption, and smoking prevalence found in the historically richest regions (i.e., the South and Southeast), contrast with the high rates of tuberculosis, maternal, neonatal, and under-5 mortality and WASH-related mortality found in the poorer regions (i.e., the North and Northeast). CONCLUSIONS The majority of Brazil's health-related SDG indicators have substantially improved over the past 28 years. However, inequalities in health among the Brazilian states and regions remain noticeable negatively affecting the Brazilian population, which can contribute to Brazil not achieving the SDG 2030 targets.
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Affiliation(s)
- Daiane Borges Machado
- Center of Data and Knowledge Integration for Health (Cidacs), Oswaldo Cruz Foundation, Salvador, Brazil.,Centre for Global Mental Health, London School of Hygiene & Tropical Medicine (LSHTM), London, UK
| | - Júlia Moreira Pescarini
- Center of Data and Knowledge Integration for Health (Cidacs), Oswaldo Cruz Foundation, Salvador, Brazil.
| | - Dandara Ramos
- Center of Data and Knowledge Integration for Health (Cidacs), Oswaldo Cruz Foundation, Salvador, Brazil.,Institute of Collective Health (ISC), Federal University of Bahia (UFBA), Salvador, Brazil
| | - Renato Teixeira
- Public Health Graduate Program, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Rafael Lozano
- School of Medicine, Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | | | - Cimar Azeredo
- Brazilian Institute of Geography and Statistics (IBGE), Rio de Janeiro, Brazil
| | | | - Deborah Carvalho Malta
- Escola de Enfermagem, Departamento Materno Infantil e Saúde Pública, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Mauricio L Barreto
- Center of Data and Knowledge Integration for Health (Cidacs), Oswaldo Cruz Foundation, Salvador, Brazil.,Institute of Collective Health (ISC), Federal University of Bahia (UFBA), Salvador, Brazil
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González-Alcaide G, Menchi-Elanzi M, Nacarapa E, Ramos-Rincón JM. HIV/AIDS research in Africa and the Middle East: participation and equity in North-South collaborations and relationships. Global Health 2020; 16:83. [PMID: 32943058 PMCID: PMC7499968 DOI: 10.1186/s12992-020-00609-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 08/11/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND HIV/AIDS has attracted considerable research attention since the 1980s. In the current context of globalization and the predominance of cooperative work, it is crucial to analyze the participation of the countries and regions where the infection is most prevalent. This study assesses the participation of African countries in publications on the topic, as well as the degree of equity or influence existing in North-South relations. METHODS We identified all articles and reviews of HIV/AIDS indexed in the Web of Science Core Collection. We analyzed the scientific production, collaboration, and contributions from African and Middle Eastern countries to scientific activity in the region. The concept of leadership, measured through the participation as the first author of documents in collaboration was used to determine the equity in research produced through international collaboration. RESULTS A total of 68,808 documents published from 2010 to 2017 were analyzed. Researchers from North America and Europe participated in 82.14% of the global scientific production on HIV/AIDS, compared to just 21.61% from Africa and the Middle East. Furthermore, the publications that did come out of these regions was concentrated in a small number of countries, led by South Africa (41% of the documents). Other features associated with HIV/AIDS publications from Africa include the importance of international collaboration from the USA, the UK, and other European countries (75-93% of the documents) and the limited participation as first authors that is evident (30 to 36% of the documents). Finally, the publications to which African countries contributed had a notably different disciplinary orientation, with a predominance of research on public health, epidemiology, and drug therapy. CONCLUSIONS It is essential to foster more balance in research output, avoid the concentration of resources that reproduces the global North-South model on the African continent, and focus the research agenda on local priorities. To accomplish this, the global North should strengthen the transfer of research skills and seek equity in cooperative ties, favoring the empowerment of African countries. These efforts should be concentrated in countries with low scientific activity and high incidence and prevalence of the disease. It is also essential to foster intraregional collaborations between African countries.
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Affiliation(s)
| | - Marouane Menchi-Elanzi
- Department of Internal Medicine, General University Hospital of Alicante, Alicante, Spain
| | - Edy Nacarapa
- Infectious Disease Division, Carmelo Hospital of Chókwè - Daughters of Charity, Saint Vincent of Paul, Chókwè, Gaza Province, Mozambique
- Tinpswalo Association, Research Unit, Vincentian Association to Fight AIDS and TB, Chókwè, Gaza Province, Mozambique
| | - José-Manuel Ramos-Rincón
- Department of Internal Medicine, General University Hospital of Alicante, Alicante, Spain.
- Department of Clinical Medicine, Miguel Hernandez University of Elche, Alicante, Spain.
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Moving to Another World: Understanding the Impact of Clinical Trial Closure on Research Participants Living With HIV in Uganda. J Assoc Nurses AIDS Care 2020; 30:e96-e108. [PMID: 30664024 DOI: 10.1097/jnc.0000000000000057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Despite an increasing need for clinical trials involving people living with HIV (PLWH), little is known about how PLWH experience trial closure, particularly in low-income countries, where the majority of trials take place. We sought to explore the impact of trial closure on PLWH in Uganda. This was an interpretive, grounded theory study using in-depth interviews, conducted between October 2014 and August 2015. Adult participants (N = 23) from 3 trials were included. The findings indicated that trial closure was represented as "moving to another world" and was an emotional transition, linked to a loss of quality care in the research environment, the need to find alternative health facilities, fear of experiencing unwanted side effects, a desire to receive trial feedback, and difficulties linking to posttrial care. We concluded that PLWH leaving trials in a resource-limited setting required holistic care to facilitate their transition back to "usual care."
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126
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Abioye AI, Andersen CT, Sudfeld CR, Fawzi WW. Anemia, Iron Status, and HIV: A Systematic Review of the Evidence. Adv Nutr 2020; 11:1334-1363. [PMID: 32383731 PMCID: PMC7490171 DOI: 10.1093/advances/nmaa037] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 10/29/2019] [Indexed: 12/12/2022] Open
Abstract
People living with HIV (PLWHIV) are at high risk of anemia due to inadequate iron intake, HIV and opportunistic infections, and inflammation, and as a side effect of antiretroviral therapy. Though iron supplementation can reduce iron deficiency anemia (IDA) in the general population, its role in anemia and in the health of PLWHIV is unclear due to concerns that iron supplementation may increase HIV replication and risk of opportunistic infections. We systematically reviewed the evidence on indicators of iron status, iron intake, and clinical outcomes among adults and children with HIV. The evidence suggests that anemia is associated with an increased risk of all-cause mortality and incident tuberculosis among HIV-infected individuals, regardless of anemia type, and the magnitude of the risk is greater with more severe anemia. High serum ferritin is associated with adverse clinical outcomes, although it is unclear if this is due to high iron or inflammation from disease progression. One large observational study found an increased risk of all-cause mortality among HIV-infected adults if they received iron supplementation. Published randomized controlled trials of iron supplementation among PLWHIV tend to have small sample sizes and have been inconclusive in terms of effectiveness and safety. Large randomized trials exploring approaches to safely and effectively provide iron supplementation to PLWHIV are warranted.
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Affiliation(s)
- Ajibola I Abioye
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
| | | | - Christopher R Sudfeld
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Wafaie W Fawzi
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
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Cardona Arias JA, Palacios Mena VO, Dizu Calambas KF, Flórez Duque J, Higuita Gutiérrez LF. SEROPREVALENCIA DE VIH Y FACTORES ASOCIADOS EN DONANTES DE UN BANCO DE SANGRE DE LA CIUDAD DE MEDELLÍN - COLOMBIA, 2005 – 2018. ACTA BIOLÓGICA COLOMBIANA 2020. [DOI: 10.15446/abc.v25n3.79489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
El objetivo de esta investigación fue estimar la seropositividad de VIH y factores asociados en donantes de un banco de sangre de la ciudad de Medellín - Colombia, 2005 - 2018. Se realizó un estudio transversal en 166 603 donantes del banco de Sangre de la Escuela de Microbiología de la Universidad de Antioquia. Las estimaciones se basaron en proporciones y razones de odds con sus intervalos de confianza del 95 %. La mayoría de donantes fueron del Valle de Aburrá, 50,2 % hombres, 65,4 % altruistas, 59,3 % de primera vez y 81,2 % captados fuera de las instalaciones del Banco. La seropositividad general de VIH fue 0,275 % (IC 95 %=0,25-0,30), en las frecuencias específicas fue del 0,324 % en hombres y 0,224 % en mujeres; 0,299 % en donantes con edad entre 18 - 40 años, 0,212% en los de 41 - 65 años, y del 0,333 % en los de primera vez; 0,213 % en lo no repetitivos y 0,149 % en los donantes repetitivos. Se concluye que la seropositividad de la infección fue similar en comparación con investigaciones previas, con un descenso importante desde el 2013. El riesgo de infección fue estadísticamente mayor en los hombres, los menores de 40 años y donantes de primera vez. Esto es importante para conocer la línea base y evaluar acciones de prevención en la población de estudio, orientar estudios etiológicos y mejorar políticas de hemovigilancia.
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Wilson TE, Massiah C, Radigan R, DeHovitz J, Govindarajulu US, Holman S, Melendez M, Yusuff J, Taylor T. The positive affect, promoting Positive Engagement, and Adherence for Life (APPEAL) feasibility trial: Design and rationale. Health Psychol 2020; 39:767-775. [PMID: 32833478 DOI: 10.1037/hea0000880] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To describe development of the Positive Affect, Promoting Positive Engagement, and Adherence for Life (APPEAL) program. METHOD APPEAL is intended to increase HIV medication adherence through promotion of positive affect, and was developed through an iterative process involving 6 focus groups (N = 34) that elicited feedback on intervention content, followed by an individually administered prepilot of the entire intervention (N = 7). RESULTS Participants provided feedback on important potential moderator variables, including depression, on mode of intervention administration, and on anticipated barriers and benefits to participation. Insights gained were used to finalize study procedures in preparation for a feasibility trial. For the feasibility trial, a total of 80 participants who, in the past 6 months have had at least one plasma HIV RNA >200 copies/mL, will be randomized to receive APPEAL or standard of care (N = 40 per group). Intervention group participants will receive 3 monthly, individually administered sessions, and all participants will have their medication adherence monitored and complete structured interviews at baseline and at 3 and 6 months. CONCLUSION The APPEAL program is innovative in that it focuses on promoting self-regulation of positive emotions, an understudied approach to promoting chronic disease self-management behaviors such as HIV medication adherence. Findings from the feasibility trial will gauge suitability of the APPEAL intervention and evaluation methods for subsequent testing in a confirmatory trial and will examine changes in positive affect, the primary mechanism of change targeted in the intervention. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Tracey E Wilson
- Department of Community Health Sciences and Medicine, State University of New York, Downstate Health Sciences University
| | - Chanée Massiah
- Department of Epidemiology and Biostatistics, State University of New York, Downstate Health Sciences University
| | - Rachel Radigan
- Department of Epidemiology and Biostatistics, State University of New York, Downstate Health Sciences University
| | - Jack DeHovitz
- Department of Medicine, State University of New York, Downstate Health Sciences University
| | - Usha S Govindarajulu
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai
| | - Susan Holman
- Department of Medicine, State University of New York, Downstate Health Sciences University
| | - Michelle Melendez
- Department of Medicine, State University of New York, Downstate Health Sciences University
| | - Jameela Yusuff
- Department of Medicine, State University of New York, Downstate Health Sciences University
| | - Tonya Taylor
- Department of Medicine, State University of New York, Downstate Health Sciences University
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Sagnia B, Mbakop Ghomsi F, Gutierrez A, Sosso S, Kamgaing R, Nanfack AJ, Nji N, Ambada G, Lissom A, Tchouangueu TF, Ngu Ndengkoh L, Domkam I, Nchinda G, Ndjolo A. Performance of the BD FACSPresto near to patient analyzer in comparison with representative conventional CD4 instruments in Cameroon. AIDS Res Ther 2020; 17:53. [PMID: 32799909 PMCID: PMC7429678 DOI: 10.1186/s12981-020-00309-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 08/07/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND In the context of scaling the viral load in resource limited settings, following HIV infected patient's adults and children with CD4+ T-lymphocyte count still very important in settings where the decentralization of treatment still has some challenges. Effective HIV monitoring in these resource-constrained settings needs affordable and reliable CD4+ T lymphocytes enumeration methods. We investigated the validity of a BD FACSPresto POC which is a dedicated system for enumeration that uses immunofluorescent technologies. In this study, we have assessed the sensitivity, specificity and correlation between most representative flow cytometry instruments present in Cameroon with more than 5000 CD4 T cells tests per year including FACSCalibur, FACSCount, and PIMA POC from Becton-Dickinson and ALERE respectively. METHODS 268 patients aged from 1 to 72 years old were enrolled and included in the study after inform consent. The BD FACSPresto POC CD4+ T cell technology was placed at CIRCB and operated by technician staff. HIV infected patients were from Chantal BIYA international reference Center (CIRCB), Centre de Sante Catholique de NKOLODOM, Centre de Sante Catholique de BIKOP and CASS de Nkolndongo-Yaounde We compared the accuracy of the BD FACSPresto and three existing reference technologies with more than 5000 tests per year like FACSCalibur, FACSCount and PIMA according to the number of CD4 test done per year and their repartition in the country. Bland-Altman method and correlation analysis were used to estimate mean bias and 95% limits of agreement and to compare the methods, including analysis by subgroup of participant gestational age. In addition sensitivity and specificity were determined. Statistical significance was set at P-value < 0.05. RESULTS The BD FACSPresto POC system has excellent precision, accuracy and linearity for CD4+ T lymphocytes enumeration. Good correlations were obtained between the BD FACSPresto poc system and other single platform methods. Bland-Altman plots showed interchangeability between two machines mean bias BD-FACSPresto vs PIMA = - 126,522(- 161,221 to - 91,822) BD-FACSPresto vs FACSCount = - 38,708 (- 58,935 to - 18,482) and FACSPresto vs FACSCALIBUR = 0.791(- 11,908 to 13,491). Mean difference with Absolute CD4+ T-lymphocyte values obtained from the BD FACSPresto system correlated well with PIMA, FACSCount, and FACSCalibur method with R2 equal to 0.88, 0.92 and 0.968 respectively with P < 0.001 for all. The mean comparison between values obtained from BD FACSPresto with PIMA, FACSCount, and FACSCalibur using paired T test give P = 0.17, P = 0.5 and P = 0.6 respectively meaning that there is no significant differences between values obtained with BD FACSPresto and PIMA, FACSCount or FACSCalibur CD4 enumeration machines. Further analysis revealed close agreement between all the three instruments with no significant difference between the forth methods (P = 0.91). CONCLUSION This BD-FACSPresto POC system is a simple, robust and reliable system for enumeration of absolute and percentage of CD4+ T-lymphocytes especially suitable for remote areas with limited resources. Having one BD-FACSPresto POC system easy to use, should reduce the cost and thus increase and improved access to CD4 testing for HIV infected patients in resource-constrained countries. BD-FACSPresto POC CD4 will enable reduction in patient time and improve the overall quality of ART service count and may improve test access in remote areas. This technology can allow for greater decentralization and wider access to CD4 testing and ART.
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Mansoor E, Azam N, Niazi SK, Sheikh N, Baig MA, Azim MT, Klair N. Rising HIV seroconversion rates & associated risks among employees of organization 'X': A case control study, Pakistan, 2017. Pak J Med Sci 2020; 36:1349-1354. [PMID: 32968407 PMCID: PMC7501025 DOI: 10.12669/pjms.36.6.1735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background and Objectives: In 2004 Pakistan escalated from ‘low-prevalence’ to ‘concentrated’ phase of HIV epidemic. Despite global decline in HIV incidence since 1997, rate of HIV infections in Pakistan is persistently rising since 1990. Available literature focusses on key populations or localized outbreaks limited by short study duration and regional applicability of results. We studied HIV seroconversion trends over a period of 8 years in a geographically diverse population and evaluated associated risk factors. Methods: A desk review of HIV surveillance data from 2010 to 2017 was carried out at Armed Forces Institute of Pathology. A case was defined as any adult employed in organization ‘X’, initially screened for HIV but later seroconverted on ELISA and western blot. Case-control study was conducted on cases diagnosed in 2017. Age and sex matched controls were identified from same population sub-group. Structured telephonic interviews were conducted and statistical analysis done at 5% margin of error. Results: The annual HIV diagnosis rate remained relatively stable till 2015 (< 40 /100,000/yr) after which it rose sharply to 60/100,000/yr in 2016 .Upward trend continued in 2017 to reach 125/100,000/yr (>200% increase from baseline). Acquisition of HIV was significantly associated with commercial sex activities (OR=9; 95% CI: 1.25-395). Conclusion: HIV seroconversion rates among employees of organization X have increased significantly in the past two years. Unlike HIV outbreaks previously reported from Pakistan, sexual route seems to be the predominant mode of transmission. Focus is mandated on prevention of sexual transmission of HIV at national level as well for all vulnerable populations.
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Affiliation(s)
- Eisha Mansoor
- Eisha Mansoor, MBBS. Armed Forces Post Graduate Medical Institute, Rawalpindi, Pakistan
| | - Naila Azam
- Naila Azam, FCPS (Community Medicine), MCPS (Family Medicine). Armed Forces Post Graduate Medical Institute, Rawalpindi, Pakistan
| | - Saifullah Khan Niazi
- Saifullah Khan Niazi, FCPS (Virology). Armed Forces Institute of Pathology, Rawalpindi, Pakistan
| | - Naveen Sheikh
- Naveen Sheikh, Medical Student, Army Medical College, Rawalpindi, Pakistan
| | - Mirza Amir Baig
- Mirza Amir Baig, MPH, MHM. National Institute of Health, Islamabad - Pakistan
| | - Mansoor Tariq Azim
- Mansoor Tariq Azim, MBBS, FCPS (General Surgery). Military Hospital, Rawalpindi, Pakistan
| | - Nimra Klair
- Nimra Klair, Medical Student, Medical Student, Army Medical College, Rawalpindi, Pakistan
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Rech-Medeiros AF, Marcon PDS, Tovo CDV, de Mattos AA. Evaluation of response to hepatitis B virus vaccine in adults with human immunodeficiency virus. Ann Hepatol 2020; 18:725-729. [PMID: 31176604 DOI: 10.1016/j.aohep.2019.03.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 01/26/2019] [Accepted: 02/10/2019] [Indexed: 02/04/2023]
Abstract
INTRODUCTION AND AIM Viral hepatitis is a serious public health problem. The risk of progression to chronic hepatitis in hepatitis B virus (HBV) infection occurs in 5-10% of adults and is a leading cause of cirrhosis and hepatocellular carcinoma worldwide. Individuals infected with human immunodeficiency virus (HIV) may have coinfection with HBV. The existence of unvaccinated groups represents a significant risk not only individually but also at the community level. The aim of this study was to evaluate HBV vaccine response in adults with HIV infection. MATERIALS AND METHODS A retrospective, descriptive study of the cross-sectional type was carried out in an outpatient HIV referral center in southern Brazil. All medical records of adult HIV patients seen during January 2006 to December 2015 were selected. In statistical analysis, a significance level of 5% was used. RESULTS Of the 201 patients evaluated with a complete vaccination scheme, 55.72% were males, with a mean age of 43.86±12.68 years. Vaccine response occurred in 80.10% (161/201) of the patients, and it did not correlate with age, CD4+ cell count or viral load. CONCLUSION HBV vaccine response in a HIV population was satisfactory, highlighting the importance of vaccination for prevention, cost reduction and better prognosis in preventing HBV/HIV coinfection.
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Affiliation(s)
- Arlete F Rech-Medeiros
- Hepatology Post-Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Patrícia Dos S Marcon
- Hepatology Post-Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil; Department of Gastroenterology, Hospital Mãe de Deus, Porto Alegre, RS, Brazil.
| | - Cristiane do V Tovo
- Hepatology Post-Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Angelo A de Mattos
- Hepatology Post-Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
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Sweileh WM. Bibliometric analysis of scientific publications on "sustainable development goals" with emphasis on "good health and well-being" goal (2015-2019). Global Health 2020; 16:68. [PMID: 32723366 PMCID: PMC7385333 DOI: 10.1186/s12992-020-00602-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 07/23/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Global progress in the United Nations' Sustainable Development Goals (SDGs) requires significant national and international research efforts and collaboration. The current study aimed to provide policymakers, academics, and researchers with a snapshot of global SDGs-related research activity. METHOD This was a cross-sectional descriptive bibliometric study. SciVerse Scopus was used to retrieve SDGs-related research publications for the period from 2015 to 2019. RESULTS In total, 18,696 documents were found. The Sustainability journal ranked first (n = 1008; 5.4%) in the number of SDGs-related publications. The World Health Organization was the most active institution in publishing SDGs-related documents (n = 581; 1.3%). Most of the retrieved documents belonged to SDG 17 (partnership) followed by SDG 13 (climate action), and SDG 12 (responsible consumption and production), while SDG 7 (affordable and clean energy) had the least number of publications. The European region (n = 9756; 52.2%) had the highest research contribution while the Eastern Mediterranean region (n = 1052; 5.6%) had the least contribution. After exclusion of SDG 17, the SDG 3 (good health and well-being) was the top researched SDG for the African region, the Eastern Mediterranean regions, and the South-Eastern Asian region. For the region of the Americas, European region, and the Western Pacific region, the SDG 13 (climate action) was the most researched. The SDG 7 (affordable and clean energy) was the least researched in the African region, the region of the Americas, the European region, and the South-East Asian region. In the Eastern Mediterranean region, SDG 10 (reduced inequality) was the least researched while in the Western Pacific region, SDG 5 (gender inequality) was the least researched. The most researched targets of SDG 3 were targets 7 (sexual and reproductive health services) and 8 (universal health coverage) while the least researched targets were 5 (substance use disorders) and 9 (death from hazardous materials). International research collaboration within SDG 3 between high- and low-income countries was inadequate. CONCLUSION The analysis presented in the current study are useful for researchers, institutes, governments, funding agencies, and policy-makers. Countries in Africa, the Middle East, and South-East Asia need to increase their funding and research collaboration in the field of SDGs.
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Affiliation(s)
- Waleed M Sweileh
- Department of Physiology, Pharmacology/Toxicology, Division of Biomedical Sciences, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.
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Tombini LHT, Kupek E. Size of the Adult HIV-Infected Population Adjusted for the Unreported AIDS Mortality in the Santa Catarina State, Brazil, 2008-2017. Curr HIV Res 2020; 17:277-289. [PMID: 31556859 DOI: 10.2174/1570162x17666190926164117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 09/10/2019] [Accepted: 09/20/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To estimate the number of 15-79-year-old individuals infected with HIV in the Santa Catarina state, Brazil, during the period 2008-2017. METHODS Three official registers of the HIV-infected individuals were compiled: SINAN for the HIV/AIDS epidemiological surveillance, SIM for mortality and SISCEL for the HIV viral load and CD4/CD8 cell count. Their records were linked by a unique personal identifier. Capture-recapture estimates were obtained by log-linear modelling with both the main effects and interaction between the registers, adjusted for age, sex and period. An adjustment for underreporting of AIDS-related deaths used published data on ill-defined causes of death and AIDS mortality. RESULTS After data sorting, 67340 HIV/AIDS records were identified: 29734 (44.2%) by SINAN, 5540 (8.2%) by SIM and 32066 (47.6%) by SISCEL. After record linkage, the HIV population size was estimated at 45707, whereas the capture-recapture method added 44 individuals. The number of new HIV/AIDS notifications per year increased significantly in 2014-2017 compared to the period 2011-2013 among 15-34-year-old men and less so for older men and women. Including 1512 unreported AIDS-related deaths gave an estimated 47263 HIV-infected individuals with 95% confidence interval (CI) of 47245-47282 and corresponding incidence of 93 (95% CI 91-96) p/100000. Case ascertainment of 62.9%, 78.5% and 67.8% was estimated for SINAN, SIM and SISCEL, respectively. CONCLUSION Three major HIV/AIDS registers in Brazil showed significant under-notification of the HIV/AIDS epidemiological surveillance amenable to significant improvement by routine record linkage.
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Affiliation(s)
- Larissa Hermes Thomas Tombini
- Program of Post-Graduation in Collective Health, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
| | - Emil Kupek
- Program of Post-Graduation in Collective Health, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
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Frailty transitions, inflammation, and mortality among persons aging with HIV infection and injection drug use. AIDS 2020; 34:1217-1225. [PMID: 32287069 DOI: 10.1097/qad.0000000000002527] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Frailty is a critical aging-related syndrome marked by diminished physiologic reserve and heightened vulnerability to stress, predictive of major adverse clinical outcomes in HIV-infected and uninfected adults. Frailty is a dynamic state, yet little data exist on predictors and consequences of frailty transitions. DESIGN/METHODS Frailty was assessed semiannually among HIV-infected and uninfected persons with prior injection drug use using the five Fried phenotype domains. An inflammatory index score was constructed from IL-6 and soluble TNF-α receptor-1 data. Markov transition models assessed determinants of frailty transitions. Cox proportional hazards models estimated mortality risk. RESULTS Among 1353 AIDS Linked to the IntraVenous Experience participants with 9559 frailty transition assessments, 33% were HIV-infected. Younger age, higher education, employment, reduced comorbidity, HIV virologic suppression, elevated CD4 nadir (>500 cells/μl) and absence of a prior AIDS diagnosis were significantly associated with both reduced frailty progression and greater frailty recovery. Each SD decrease in inflammatory index score was associated with decreased frailty progression [odds ratio 0.78; 95% confidence interval (CI), 0.65, 0.92] and increased frailty recovery (odds ratio 1.29; 95% CI, 1.08, 1.53). Being frail at one of two consecutive visits was associated with increased mortality, compared with maintenance of a nonfrail state. Being frail at both of two consecutive visits demonstrated the highest mortality risk (hazard ratio 3.23; 95% CI, 2.1, 4.96). CONCLUSION Sustained, and to a lesser degree, intermittent frail states are associated with increased mortality. HIV virologic suppression with earlier antiretroviral therapy, reduced comorbidity, and reduced inflammation may prevent frailty progression and promote frailty recovery, consequently improving survival for persons aging with HIV and persons with prior injection drug use.
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Abstract
The novel coronavirus 2019 illness (COVID-19) has completely transformed and uprooted lives across the globe. While different diseases, there are critical observations and lessons to be learned from the ongoing HIV epidemic to inform our response to COVID-19. We reflect on how this relates to (1) testing, including contact tracing; (2) health system redesign; (3) telehealth; (4) health disparities; (5) political denial, with inadequate and uncoordinated governmental response; (6) occupational exposure; and (7) complex reactions among healthcare providers. Decades of experiences with HIV provide an important framework for moving forward as we combat COVID-19.
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Kim TI, Hessel K, Orion KC. Patient Characteristics, Patterns, and Repair of Aneurysms in Human Immunodeficiency Virus-Positive Patients. Ann Vasc Surg 2020; 70:393-400. [PMID: 32599105 DOI: 10.1016/j.avsg.2020.06.042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/15/2020] [Accepted: 06/17/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Human immunodeficiency virus (HIV) is a multisystem disease and is associated with vascular complications including aneurysm formation. HIV-associated aneurysms are well documented and may present in unusual locations with concerning features. However, the literature regarding aneurysms in HIV-positive patients is limited to case series with limited data regarding aneurysm patterns. Furthermore, several small series have documented poor outcomes with surgical repair. Thus, our aim was to investigate the characteristics, patterns, and repair of aneurysms in HIV-positive patients in a multicenter study. METHODS All patients with a diagnosis of aneurysms and HIV were retrospectively identified from 2013 to 2018 across 2 institutions. Comorbidities, HIV-related characteristics, aneurysm characteristics, and repair were reviewed. RESULTS There were a total of 104 HIV-positive patients with 129 aneurysms. The mean age at the time of diagnosis was 57.7 ± 10.3 years, 80.8% of patients were male, and 32.0% had a history of acquired immunodeficiency syndrome. The average time from HIV diagnosis to aneurysm diagnosis was 14.1 ± 10.1 years. There were 53 (41.1%) ascending aortic, 25 (19.4%) abdominal aortic, 14 (10.9%) cerebral artery aneurysms, 13 (10.1%) descending thoracic, 9 (7.0%) iliac, 6 (4.7%) femoropopliteal, 4 (3.1%) visceral, 3 (2.9%) axillosubclavian, 1 (0.8%) carotid, and 1 (0.8%) coronary artery aneurysms. There were 23 (22.1%) patients with aneurysms in multiple vascular beds, 10 (9.6%) saccular aneurysms, and 1 (0.8%) inflammatory aneurysm. There were 7 ruptures (cerebral, descending thoracic, and iliac), 3 type A dissections (ascending aorta), and 1 thrombosis (popliteal). There were 26 (25.0%) patients who underwent surgical repair. This included 8 endovascular aneurysm repairs for abdominal aortic aneurysms, 6 endovascular coiling, clipping, and stent procedures for cerebral aneurysms, 4 open ascending aorta repairs, 2 bypasses for popliteal artery aneurysms, 2 endovascular stents for axillosubclavian artery aneurysms, 1 open descending aortic aneurysm repair, 1 endovascular aneurysm repair for an iliac aneurysm, 1 endovascular coiling for a renal artery aneurysm, and 1 open repair of a femoral artery aneurysm. Perioperative complications were common at 46.2%, although mortality was low at 3.8%. CONCLUSIONS Although aneurysms were widespread, most HIV-positive patients had large vessel aneurysms in this study. There was a high prevalence of saccular and multiple aneurysms, and repair was associated with low rates of mortality despite high rates of complications. Additional studies are necessary to characterize this rare entity.
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Affiliation(s)
- Tanner I Kim
- Division of Vascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Kara Hessel
- Division of Vascular Diseases and Surgery, Department of Surgery, Ohio State University Wexner Medical Center, Columbus, OH
| | - Kristine C Orion
- Division of Vascular Diseases and Surgery, Department of Surgery, Ohio State University Wexner Medical Center, Columbus, OH.
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Abstract
Traumatic injuries account for 10% of all mortalities in the United States. Globally, it is estimated that by the year 2030, 2.2 billion people will be overweight (BMI ≥ 25) and 1.1 billion people will be obese (BMI ≥ 30). Obesity is a known risk factor for suboptimal outcomes in trauma; however, the extent of this impact after blunt trauma remains to be determined. The incidence, prevalence, and mortality rates from blunt trauma by age, gender, cause, BMI, year, and geography were abstracted using datasets from 1) the Global Burden of Disease group 2) the United States Nationwide Inpatient Sample databank 3) two regional Level II trauma centers. Statistical analyses, correlations, and comparisons were made on a global, national, and state level using these databases to determine the impact of BMI on blunt trauma. The incidence of blunt trauma secondary to falls increased at global, national, and state levels during our study period from 1990 to 2015, with a corresponding increase in BMI at all levels ( P < 0.05). Mortality due to fall injuries was higher in obese patients at all levels ( P < 0.05). Analysis from Nationwide Inpatient Sample database demonstrated higher mortality rates for obese patients nationally, both after motor vehicle collisions and mechanical falls ( P < 0.05). In obese and nonobese patients, regional data demonstrated a higher blunt trauma mortality rate of 2.4% versus 1.2%, respectively ( P < 0.05) and a longer hospital length of stay of 4.13 versus 3.26 days, respectively ( P = 0.018). The obesity rate and incidence of blunt trauma secondary to falls are increasing, with a higher mortality rate and longer length of stay in obese blunt trauma patients.
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Shallo SA, Tassew M. HIV Positive Status Disclosure and Its Associated Factors Among Children on Antiretroviral Therapy in West Shoa Zone, Western Ethiopia, 2019: A Mixed Method Cross-Sectional Study. J Multidiscip Healthc 2020; 13:507-517. [PMID: 32606722 PMCID: PMC7305934 DOI: 10.2147/jmdh.s258851] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 06/05/2020] [Indexed: 01/18/2023] Open
Abstract
Background Evidence from previous studies supports the idea that informing children about their HIV status has long-term positive implications in HIV disease management, children's quality of life, and ART drug adherence. However, in sub-Saharan African Countries, the HIV status disclosure among children ranges from 0% to 69.2%. So it is important to investigate the up to date evidence that will help in designing contextualized approaches for disclosure. Therefore, this study aimed to assess the HIV status disclosure and its associated factors among children on ART in West Shoa Zone, Ethiopia. Materials and Methods Institutional-based observational study was conducted from February to April 2019. Quantitative data were collected from a randomly selected sample of 247 HIV positive children on ART for the last six months, and the qualitative data were collected from caregivers and health care professionals. Results The mean age of the children was 11.11±SD2.8, and 43.6%, (95% CI: 37, 50.9) of the children were fully disclosed. The average age at disclosure was 11±SD2.12. The main reasons for the disclosure were for drug adherence and better self-care while being underage was the commonest reason for non-disclosure. Compared to the age 10-15 years, the child in the age 6-9 was 97% [AOR: 0.027, 95% CI: 0.003, 0.22, P<0.001] less likely to be disclosed. Female children were 2.7 times more likely to be disclosed compared with male children [AOR: 2.73, 95% CI: 1.24, 6, P<0.013]. Conclusion This finding reveals that HIV status disclosure is generally low, and the decision to disclose or not is affected by factors like child-related, caregivers, and health institution-related factors. This may affect the child's drug adherence, treatment outcome, and disease transmission. Updating health care providers' knowledge and skills and working on caregivers' attitude are needed to manage disclosure and challenges following it.
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Affiliation(s)
- Seifadin Ahmed Shallo
- Department of Public Health, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Mesfin Tassew
- Department of Pediatrics and Child Health, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
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Lara BMDC, Pádua CMD, Mendicino CCP, Rocha GM. Osteopenia and osteoporosis among treatment-experienced people living with HIV. Braz J Infect Dis 2020; 24:288-295. [PMID: 32553468 PMCID: PMC9392122 DOI: 10.1016/j.bjid.2020.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 05/14/2020] [Accepted: 05/28/2020] [Indexed: 11/29/2022] Open
Abstract
Introduction Life expectancy of people living with human immunodeficiency (PLHIV) has increased mainly due to the accessibility and effectiveness of antiretroviral therapy (ART). However, adverse effects from long-term use of antiretrovirals, and the physiological changes associated with aging, may compromise the quality of life of PLHIV, in addition to causing new demands on the healthcare system. Objectives Estimate the frequency of osteoporosis and osteopenia in patients on prolonged ART and to verify their associated factors. Methods A cross-sectional study was conducted in Belo Horizonte, Minas Gerais, Brazil, from August 2017 to June 2018, in a sample of PLHIV (age ≥ 18 years) who started ART between 2001 and 2005. Data were collected through face-to-face interviews, physical evaluation, laboratory tests, and Dual-Energy X-Ray Absorptiometry Screening (DEXA). The outcome of interest was presence of bone alteration, defined as presence of osteopenia or osteoporosis in DEXA. The association between the explanatory variables and the event was assessed through odds ratio (OR) estimate, with 95% confidence interval (CI). Multiple logistic regression was performed to evaluate factors independently associated with bone alteration. Results Among 92 participants, 47.8% presented bone alteration (19.6% osteoporosis and 28.2% osteopenia). The variables that remained in the final logistic regression model were age ≥ 50 years (OR: 12.53; 95% CI: 4.37–35.90) and current alcohol use (OR: 2.63; 95% CI: 0.94–7.37). Conclusions This study showed a high frequency of bone changes, especially in PLHIV older than 50 years. This information is useful to stimulate the screening and timely intervention of this comorbidity of PLHIV on prolonged use of ART in order to prevent or minimize complications and new demands on the healthcare system.
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Rumisha SF, George J, Bwana VM, Mboera LEG. Years of potential life lost and productivity costs due to premature mortality from six priority diseases in Tanzania, 2006-2015. PLoS One 2020; 15:e0234300. [PMID: 32516340 PMCID: PMC7282655 DOI: 10.1371/journal.pone.0234300] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 05/22/2020] [Indexed: 01/14/2023] Open
Abstract
Background Mortality statistics are traditionally used to quantify the burden of disease and to determine the relative importance of the various causes of death. Some of the most frequently used indices to quantify the burden of disease are the years of potential life lost (YPLL) and years of potential productive life lost (YPPLL). These two measures reflect the mortality trends in younger age groups and they provide a more accurate picture of premature mortality. This study was carried out to determine YPLL, YPPLL and cost of productivity lost (CPL) due to premature mortality caused by selected causes of deaths in Tanzania. Methods and findings Malaria, respiratory diseases, HIV/AIDS, tuberculosis, cancers and injuries were selected for this analysis. The number of deaths by sex and age groups were obtained from hospital death registers and ICD-10 reporting forms in 39 public hospitals in Tanzania, covering a period of 2006–2015. The life expectancy method and human capital approach were used to estimate the YPLL, YPPLL and CPL due to premature mortality. During 2006–2015, malaria, HIV/AIDS, tuberculosis, respiratory diseases, HIV+tuberculosis, cancer and injury were responsible for a total of 96,834 hospital deaths, of which 46.4% (n = 57,508) were among individuals in the productive age groups (15–64 years). The reported deaths contributed to 2,850,928 YPLL (female = 1,326,724; male = 1,524,205) with an average of 29 years per death. The average YPLL among females (32) was higher than among males (28). Malaria (YPLL = 38 per death) accounted for over one-third (35%) of the total YPLL. There was a significant increase in YPLL due to the selected underlying causes of death over the 10-year period. Deaths from the selected causes resulted into 1,207,499 YPPLL (average = 21 per death). Overall, HIV/AIDS contributed to the highest YPPLL (323,704), followed by malaria (243,490) and injuries (196,505). While there was a general decrease in YPPLL due to malaria, there was an increase of YPPLL due to HIV/AIDS, respiratory diseases, cancer and injuries during the 10-year period. The total CPL due to the six diseases was US$ 148,430,009 for 10 years. The overall CPL was higher among males than females by 29.1%. Over half (58%) of the losses were due to deaths among males. HIV/AIDS accounted for the largest (29.2%) CPL followed by malaria (17.8%) and respiratory diseases (14.6%). The CPL increased from US$11.4 million in 2006 to US$17.9 million in 2016. Conclusions The YPLL, YPPLL and CPL due to premature death associated with the six diseases in Tanzania are substantially high. While malaria accounted for highest YPLL, HIV/AIDS accounted for highest YPPLL and CPL. The overall CPL was higher among males than among females. Setting resource allocation priorities to malaria, HIV/AIDS and respiratory diseases that are responsible for the majority of premature deaths could potentially reduce the costs of productivity loss in Tanzania.
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Affiliation(s)
- Susan F. Rumisha
- National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Janeth George
- SACIDS Foundation for One Health, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Veneranda M. Bwana
- National Institute for Medical Research, Amani Research Centre, Muheza, Tanzania
| | - Leonard E. G. Mboera
- National Institute for Medical Research, Dar es Salaam, Tanzania
- SACIDS Foundation for One Health, Sokoine University of Agriculture, Morogoro, Tanzania
- * E-mail:
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Incidences and factors associated with viral suppression or rebound among HIV patients on combination antiretroviral therapy from three counties in Kenya. Int J Infect Dis 2020; 97:151-158. [PMID: 32497804 DOI: 10.1016/j.ijid.2020.05.097] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/18/2020] [Accepted: 05/24/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Limited data are available on the incidence and factors associated with viral rebound following viral suppression among HIV-infected individuals taking antiretroviral therapy (ART) in Kenya. Furthermore, the durability of viral suppression among HIV individuals taking ART is unknown. Information on incidence rates and factors associated with HIV viral load rebound and the durability of viral suppression (undetectable HIV copies in plasma) among HIV-infected individuals taking ART, will help improve the long-term management of HIV-infected individuals and explore approaches to long-term HIV remission or complete cure. OBJECTIVES The objectives of this study were to investigate the incidence rates of viral rebound following viral suppression, factors associated with viral rebound, and the durability of viral suppression among HIV-infected individuals on ART from Kilifi, Meru, and Nakuru counties in Kenya. METHODS This was a retrospective study involving 600 HIV-infected individuals taking combination ART (cART) and enrolled in comprehensive care centers (CCCs) at Malindi Sub-county Hospital, Nakuru Level 5 Hospital, and Meru Level 5 Hospital in Kenya. The medical files were inspected and medical history records abstracted for the selected participants. Participant laboratory data including HIV viral loads, types and history of ART, and treatment history of any opportunistic infections were abstracted using an abstraction checklist. Participants were grouped into those who achieved HIV viral suppression, with viral loads lower than the detection limit (LDL) (viral suppression), and those who experienced one or more detectable viral load measurements >40 copies/ml following the initial LDL (viral rebound). Durable viral suppression was defined as all viral load values at LDL over the 2-year period (2017-2019). Univariate and multivariate Poisson regression analyses were performed to assess the rates of viral rebound, as well as to investigate factors associated with it. RESULTS Out of 549 HIV-positive patients, 324/549 (59%) achieved HIV viral suppression (Meru 159/194 (82%), Nakuru 21/178 (12%), and Malindi 144/177 (81%)). The overall viral rebound rate was 41%, with site-specific viral rebound of 88.2%, 18.6%, and 18.0% in Nakuru, Malindi, and Meru, respectively. There was an overall rate of first viral rebound of 3.9 (95% confidence interval (CI) 6.9-14.4), 0.7 (95% CI 0.5-1.0), and 0.89 (95% CI 0.64-1.24) per 100 person-months in Nakuru, Malindi, and Meru, respectively. Good ART adherence (p = 0.0002), widow status (p = 0.0062), and World Health Organization (WHO) stage I (p = 0.0002) were associated with viral suppression, while poor ART adherence (p < 0.0001), WHO stage II (p = 0.0024), and duration on ART of 36 months (p = 0.0350) were associated with viral rebound. CONCLUSIONS The rate of viral suppression in patients on cART in the CCCs fell short of the WHO target. However, the study provides proof of evidence of undetectable viral load levels for more than 2 years, a sign that the United Nation's 2030 objective of controlling the risk of HIV transmission could be achieved.
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Jesus TS, Landry MD, Brooks D, Hoenig H. Physical Rehabilitation Needs Per Condition Type: Results From the Global Burden of Disease Study 2017. Arch Phys Med Rehabil 2020; 101:960-968. [DOI: 10.1016/j.apmr.2019.12.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 12/11/2019] [Accepted: 12/29/2019] [Indexed: 12/12/2022]
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Wirth KE, Gaolathe T, Pretorius Holme M, Mmalane M, Kadima E, Chakalisa U, Manyake K, Matildah Mbikiwa A, Simon SV, Letlhogile R, Mukokomani K, van Widenfelt E, Moyo S, Bennett K, Leidner J, Powis KM, Lebelonyane R, Alwano MG, Jarvis J, Dryden-Peterson SL, Kgathi C, Moore J, Bachanas P, Raizes E, Abrams W, Block L, Sento B, Novitsky V, El-Halabi S, Marukutira T, Mills LA, Sexton C, Pals S, Shapiro RL, Wang R, Lei Q, DeGruttola V, Makhema J, Essex M, Lockman S, Tchetgen Tchetgen EJ. Population uptake of HIV testing, treatment, viral suppression, and male circumcision following a community-based intervention in Botswana (Ya Tsie/BCPP): a cluster-randomised trial. Lancet HIV 2020; 7:e422-e433. [PMID: 32504575 PMCID: PMC7864245 DOI: 10.1016/s2352-3018(20)30103-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 03/20/2020] [Accepted: 03/20/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND In settings with high HIV prevalence and treatment coverage, such as Botswana, it is unknown whether uptake of HIV prevention and treatment interventions can be increased further. We sought to determine whether a community-based intervention to identify and rapidly treat people living with HIV, and support male circumcision could increase population levels of HIV diagnosis, treatment, viral suppression, and male circumcision in Botswana. METHODS The Ya Tsie Botswana Combination Prevention Project study was a pair-matched cluster-randomised trial done in 30 communities across Botswana done from Oct 30, 2013, to June 30, 2018. 15 communities were randomly assigned to receive HIV prevention and treatment interventions, including enhanced HIV testing, earlier antiretroviral therapy (ART), and strengthened male circumcision services, and 15 received standard of care. The first primary endpoint of HIV incidence has already been reported. In this Article, we report findings for the second primary endpoint of population uptake of HIV prevention services, as measured by proportion of people known to be HIV-positive or tested HIV-negative in the preceding 12 months; proportion of people living with HIV diagnosed and on ART; proportion of people living with HIV on ART with viral suppression; and proportion of HIV-negative men circumcised. A longitudinal cohort of residents aged 16-64 years from a random, approximately 20% sample of households across the 15 communities was enrolled to assess baseline uptake of study outcomes; we also administered an end-of-study survey to all residents not previously enrolled in the longitudinal cohort to provide study end coverage estimates. Differences in intervention uptake over time by randomisation group were tested via paired Student's t test. The study has been completed and is registered with ClinicalTrials.gov (NCT01965470). FINDINGS In the six communities participating in the end-of-study survey, 2625 residents (n=1304 from standard-of-care communities, n=1321 from intervention communities) were enrolled into the 20% longitudinal cohort at baseline from Oct 30, 2013, to Nov 24, 2015. In the same communities, 10 791 (86%) of 12 489 eligible enumerated residents not previously enrolled in the longitudinal cohort participated in the end-of-study survey from March 30, 2017, to Feb 25, 2018 (5896 in intervention and 4895 in standard-of-care communities). At study end, in intervention communities, 1228 people living with HIV (91% of 1353) were on ART; 1166 people living with HIV (88% of 1321 with available viral load) were virally suppressed, and 673 HIV-negative men (40% of 1673) were circumcised in intervention communities. After accounting for baseline differences, at study end the proportion of people living with HIV who were diagnosed was significantly higher in intervention communities (absolute increase of 9% to 93%) compared with standard-of-care communities (absolute increase of 2% to 88%; prevalence ratio [PR] 1·08 [95% CI 1·02-1·14], p=0·032). Population levels of ART, viral suppression, and male circumcision increased from baseline in both groups, with greater increases in intervention communities (ART PR 1·12 [95% CI 1·07-1·17], p=0·018; viral suppression 1·13 [1·09-1·17], p=0·017; male circumcision 1·26 [1·17-1·35], p=0·029). INTERPRETATION It is possible to achieve very high population levels of HIV testing and treatment in a high-prevalence setting. Maintaining these coverage levels over the next decade could substantially reduce HIV transmission and potentially eliminate the epidemic in these areas. FUNDING US President's Emergency Plan for AIDS Relief through the Centers for Disease Control and Prevention.
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Affiliation(s)
- Kathleen E Wirth
- Department of Biostatistics, Harvard T H Chan School of Public Health, Boston, MA, USA.
| | | | - Molly Pretorius Holme
- Department of Immunology and Infectious Diseases, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Mompati Mmalane
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Etienne Kadima
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Unoda Chakalisa
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Kutlo Manyake
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | | | | | - Rona Letlhogile
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | | | | | - Sikhulile Moyo
- Department of Immunology and Infectious Diseases, Harvard T H Chan School of Public Health, Boston, MA, USA; Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Kara Bennett
- Bennett Statistical Consulting, Ballston Lake, NY, USA
| | - Jean Leidner
- Goodtables Data Consulting, Norman, Oklahoma, USA
| | - Kathleen M Powis
- Department of Immunology and Infectious Diseases, Harvard T H Chan School of Public Health, Boston, MA, USA; Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana; Department of Medicine, Massachusetts General Hospital, Boston, MA, USA; Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
| | | | - Mary Grace Alwano
- Centers for Disease Control and Prevention-Botswana, Gaborone, Botswana
| | - Joseph Jarvis
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana; Centers for Disease Control and Prevention-Botswana, Gaborone, Botswana
| | - Scott L Dryden-Peterson
- Department of Immunology and Infectious Diseases, Harvard T H Chan School of Public Health, Boston, MA, USA; Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana; Division of Infectious Diseases, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Coulson Kgathi
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Janet Moore
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Pam Bachanas
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Elliot Raizes
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - William Abrams
- Centers for Disease Control and Prevention-Botswana, Gaborone, Botswana
| | - Lisa Block
- Centers for Disease Control and Prevention, Atlanta, GA, USA; Intellectual Concepts, Atlanta, GA, USA
| | - Baraedi Sento
- Tebelopele Voluntary Counseling and Testing Center, Gaborone, Botswana
| | - Vlad Novitsky
- Department of Immunology and Infectious Diseases, Harvard T H Chan School of Public Health, Boston, MA, USA
| | | | | | - Lisa A Mills
- Centers for Disease Control and Prevention-Botswana, Gaborone, Botswana
| | - Connie Sexton
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sherri Pals
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Roger L Shapiro
- Department of Immunology and Infectious Diseases, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Rui Wang
- Department of Biostatistics, Harvard T H Chan School of Public Health, Boston, MA, USA; Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Quanhong Lei
- Department of Biostatistics, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Victor DeGruttola
- Department of Biostatistics, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Joseph Makhema
- Department of Immunology and Infectious Diseases, Harvard T H Chan School of Public Health, Boston, MA, USA; Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Myron Essex
- Department of Immunology and Infectious Diseases, Harvard T H Chan School of Public Health, Boston, MA, USA; Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Shahin Lockman
- Department of Immunology and Infectious Diseases, Harvard T H Chan School of Public Health, Boston, MA, USA; Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana; Division of Infectious Diseases, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Eric J Tchetgen Tchetgen
- Department of Biostatistics, Harvard T H Chan School of Public Health, Boston, MA, USA; Department of Statistics, The Wharton School at the University of Pennsylvania, Philadelphia, PA, USA
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144
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Chao A, Spiegelman D, Khan S, Walsh F, Mazibuko S, Pasipamire M, Chai B, Reis R, Mlambo K, Delva W, Khumalo G, Zwane M, Fleming Y, Mafara E, Hettema A, Lejeune C, Bärnighausen T, Okello V. Mortality under early access to antiretroviral therapy vs. Eswatini's national standard of care: the MaxART clustered randomized stepped-wedge trial. HIV Med 2020; 21:429-440. [PMID: 32458567 DOI: 10.1111/hiv.12876] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 03/18/2020] [Accepted: 04/13/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Current WHO guidelines recommend the treatment of all HIV-infected individuals with antiretroviral therapy (ART) to improve survival and quality of life, and decrease infection of others. MaxART is the first implementation trial of this strategy embedded within a government-managed health system, and assesses mortality as a secondary outcome. Because primary findings strongly supported scale-up of the 'treat all' strategy (hereafter Treat All), this analysis examines mortality as an additional indicator of its impact. METHODS MaxART was conducted in 14 Eswatinian health clinics through a clinic-based stepped-wedge design, by transitioning clinics from then-national standard of care (SoC) to the Treat All intervention. All-cause, disease-related, and HIV-related mortality were analysed using the Cox proportional hazards model, censoring SoC participants at clinic transition. Median follow-up time among study participants was 292 days. There were 36/2034 deaths in SoC (1.77%) and 49/1371 deaths in Treat All (3.57%). RESULTS Between September 2014 and August 2017, 3405 participants were enrolled. In SoC and Treat All interventions, respectively, the multivariable-adjusted 12-month all-cause mortality rates were 1.42% [95% confidence interval (CI): 0.66-2.17] and 1.60% (95% CI: 0.78-2.40), disease-related mortality rates were 1.02% (95% CI: 0.40-1.64) and 1.10% (95% CI: 0.46-1.73), and HIV-related mortality rates were 1.03% (95% CI: 0.40-1.65) and 0.99% (95% CI: 0.40-1.58). Treat All had no impact on all-cause [hazard ratio (HR) = 1.12, 95% CI: 0.58-2.18, P = 0.73], disease-related (HR = 1.04, 95% CI: 0.52-2.11, P = 0.90), or HIV-related mortality (HR = 0.93, 95% CI: 0.46-1.87, P = 0.83). CONCLUSION There was no immediate benefit of the Treat All strategy on mortality, nor evidence of harm. Longer follow-up of participants is needed to establish long-term consequences.
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Affiliation(s)
- A Chao
- Department of Biostatistics, Yale School of Public Health, Center for Methods in Implementation and Prevention Science (CMIPS), New Haven, CT, USA
| | - D Spiegelman
- Department of Biostatistics, Yale School of Public Health, Center for Methods in Implementation and Prevention Science (CMIPS), New Haven, CT, USA
| | - S Khan
- Clinton Health Access Initiative (CHAI), Mbabane, Eswatini
| | - F Walsh
- Clinton Health Access Initiative (CHAI), Boston, MA, USA
| | - S Mazibuko
- Eswatini National ART program (SNAP), Ministry of Health, Mbabane, Eswatini
| | - M Pasipamire
- Eswatini National ART program (SNAP), Ministry of Health, Mbabane, Eswatini
| | - B Chai
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - R Reis
- Leiden University Medical Center, Leiden University, Leiden, Netherlands.,Amsterdam Institute for Social Science, University of Amsterdam, Amsterdam, Netherlands.,Children's Institute, University of Cape Town, Cape Town, South Africa
| | - K Mlambo
- Clinton Health Access Initiative (CHAI), Mbabane, Eswatini
| | - W Delva
- The South African Department of Science and Technology - National Research Foundation (DST-NRF) Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa.,Center for Statistics, Hasselt University, Diepenbeek, Belgium.,International Centre for Reproductive Health, Ghent University, Gent, Belgium.,Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | - G Khumalo
- Eswatini National Network of People Living with HIV (SWANNEPHA), Mbabane, Eswatini
| | | | | | - E Mafara
- Clinton Health Access Initiative (CHAI), Mbabane, Eswatini
| | - A Hettema
- Clinton Health Access Initiative (CHAI), Mbabane, Eswatini
| | - C Lejeune
- Clinton Health Access Initiative (CHAI), Mbabane, Eswatini
| | - T Bärnighausen
- Heidelberg Institute of Public Health, University of Heidelberg, Heidelberg, Germany
| | - V Okello
- Directorate Office, Ministry of Health, Mbabane, Eswatini
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145
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Jonnalagadda S, Yuengling K, Abrams E, Stupp P, Voetsch A, Patel M, Minisi Z, Eliya M, Hamunime N, Rwebembera A, Kirungi W, Mulenga L, Mushavi A, Ryan C, Ts'oeu M, Kim E, Dziuban EJ, Hageman K, Galbraith J, Mweebo K, Mwila A, Gonese E, Patel H, Modi S, Saito S. Survival and HIV-Free Survival Among Children Aged ≤3 Years - Eight Sub-Saharan African Countries, 2015-2017. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2020; 69:582-586. [PMID: 32407305 PMCID: PMC7238953 DOI: 10.15585/mmwr.mm6919a3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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146
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Nguyen PT, Gilmour S, Le PM, Nguyen TT, Tanuma J, Nguyen HV. Factors associated with high-risk behaviors of people newly diagnosed with HIV/AIDS: results from a cross-sectional study in Vietnam. AIDS Care 2020; 33:607-615. [PMID: 32397740 DOI: 10.1080/09540121.2020.1761519] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Towards the elimination of this global epidemic, understanding the high-risk behaviors of people newly diagnosed with HIV/AIDS (PNDWH) is essential. This study aimed to describe the general characteristics and high-risk behaviors of PNDWH and identify associated factors for adopting high-risk behaviors. A cross-sectional survey was conducted in Vietnam to explore the high-risk behaviors of 506 PNDWH. Associated factors were identified using multivariable logistic regressions. 83.2% of participants had sex without using a condom, and 27.9% had more than two sex partners. Among injected drug users, 44% had shared needles with an average number of 2.1 shared partners. Male, Kinh ethnicity (Vietnamese), high income, and high educational level were risk factors for high-risk behaviors. Our findings revealed the first time a comprehensive picture of PNDWH and emphasized the high prevalence of STIs, including untreated STIs and the long delay since the early HIV diagnosis. Also, our model found much higher risk behaviors among participants who were non-adherent to ART and those currently enrolled in ART. By better managing newly-diagnosed cases, better integrating STI management services and prevention consultants, as well as improving ART adherence programs, Vietnam can make better progress towards the complete control of HIV for its most vulnerable populations.
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Affiliation(s)
- Phuong The Nguyen
- Graduate School of Public Health, St. Luke's International University, Tokyo, Japan
| | - Stuart Gilmour
- Division of Biostatistics and Bioinformatics, Graduate School of Public Health, St. Luke's International University, Tokyo, Japan
| | - Phuong Mai Le
- Graduate School of Public Health, St. Luke's International University, Tokyo, Japan
| | - Trung Tri Nguyen
- Monitoring and Evaluation Department, Center for Community Health Research and Development, Hanoi, Vietnam
| | - Junko Tanuma
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Huy Van Nguyen
- Division of Biostatistics and Bioinformatics, Graduate School of Public Health, St. Luke's International University, Tokyo, Japan
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147
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Saxton PJW, Azariah S, Franklin RA, Forster RF, Werder SF, Jenkins R, Myers JM, Rich JG, Te Wake WP, Fisher MD. Baseline characteristics of gay and bisexual men in a HIV pre-exposure prophylaxis demonstration project with equity quotas in Auckland, New Zealand. Sex Health 2020; 16:47-55. [PMID: 30274568 DOI: 10.1071/sh18056] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 08/08/2018] [Indexed: 11/23/2022]
Abstract
Background In New Zealand, pre-exposure prophylaxis (PrEP) should target gay and bisexual men (GBM), and equity is an important principle. Baseline characteristics of GBM offered PrEP in a demonstration project with an enrolment quota of 50% non-Europeans are described. METHODS An open-label, single-arm treatment evaluation study design ('NZPrEP') was used. The settings were four publicly funded sexual health clinics in Auckland in 2017. The study population was 150 GBM recruited from clinics, community sources and social media. Participants self-completed an online questionnaire about PrEP awareness, attitudes and sexual risk behaviour in the last 3 months. Baseline characteristics are described and examined to determine whether these were associated with PrEP initiation status (self-referral vs doctor/nurse recommendation). RESULTS In total, 150 GBM of whom half (52%) were non-European, including 21.3% Maori, 19.3% Asian and 8.7% Pacific, were enrolled into the study. Two-thirds (65.3%) self-referred for PrEP and one-third (34.7%) were recommended PrEP by the doctor/nurse. Participants reported a high number of male condomless receptive anal intercourse partners (MenAICLR) (median 3, range 0-50), with 10% reporting 10 or more MenAICLR and 45.3% reporting group sex. In the previous year, 65.3% had a sexually transmissible infection (STI); 18% had rectal chlamydia or gonorrhoea at enrolment. Almost half (47.7%) had recently used drugs with sex, including 8.1% who used methamphetamine. Participants recommended PrEP had lower education, lived less centrally and had a higher STI prevalence than PrEP self-referrers, but their risk behaviour was similar. CONCLUSIONS Early PrEP adopters in New Zealand have high HIV risk. Demonstration projects should consider equity mechanisms so that minorities can participate meaningfully.
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Affiliation(s)
- Peter J W Saxton
- Gay Men's Sexual Health research group, Department of Social and Community Health, School of Population Health, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - Sunita Azariah
- Auckland Regional Sexual Health Service, Auckland District Health Board, Private Bag 92024, Auckland, New Zealand
| | - Richard A Franklin
- Auckland Regional Sexual Health Service, Auckland District Health Board, Private Bag 92024, Auckland, New Zealand
| | - Rose F Forster
- Auckland Regional Sexual Health Service, Auckland District Health Board, Private Bag 92024, Auckland, New Zealand
| | - Suzanne F Werder
- Auckland Regional Sexual Health Service, Auckland District Health Board, Private Bag 92024, Auckland, New Zealand
| | - Renee Jenkins
- Auckland Regional Sexual Health Service, Auckland District Health Board, Private Bag 92024, Auckland, New Zealand
| | - Jason M Myers
- New Zealand AIDS Foundation, PO Box 6663, Wellesley St, Auckland 1141, New Zealand
| | - Joseph G Rich
- New Zealand AIDS Foundation, PO Box 6663, Wellesley St, Auckland 1141, New Zealand
| | - Whatitiri P Te Wake
- New Zealand AIDS Foundation, PO Box 6663, Wellesley St, Auckland 1141, New Zealand
| | - Mark D Fisher
- Body Positive, PO Box 68-766, Wellesley St, Auckland 1141, New Zealand
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148
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Li L, Yuan T, Wang J, Fitzpatrick T, Li Q, Li P, Tang X, Xu G, Chen D, Liang B, Cai W, Zou H. Sex differences in HIV treatment outcomes and adherence by exposure groups among adults in Guangdong, China: A retrospective observational cohort study. EClinicalMedicine 2020; 22:100351. [PMID: 32510049 PMCID: PMC7264977 DOI: 10.1016/j.eclinm.2020.100351] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION We aimed to assess sex differences in treatment outcomes and adherence comparing men who have sex with women (MSW), men who have sex with men (MSM), and women who have sex with men (WSM), as well as men and women who inject drugs living with HIV on combination antiretroviral therapy (ART) in Guangdong, China. METHODS We performed a retrospective observational cohort study with data from the National Free Antiretroviral Treatment Program database. We included ART-naive patients aged 18 to 80 years who had contracted HIV through sex or injecting drugs, initiated first-line ART between January 2004 and December 2016, and had at least 60 days of follow-up. Participants were followed for five years. Kaplan-Meier analysis and Cox proportional hazard models were used to evaluate all-cause mortality. Cumulative incidence function and Cox proportional hazards models accounting for competing risks were used to evaluate disease progression to AIDS. Modified Poisson regression models were used to evaluate immunological and virological responses and loss to follow-up. Repeated measures analysis was used to evaluate regular CD4+ cell count, HIV viral load monitoring, ART adherence, side effects, and interruption of ART. FINDINGS We included 26,409 persons living with HIV. 21,779 (82·5%) people acquired HIV through sex (5118 WSM [23·5%], 8506 MSW [39·0%], 8175 MSM [37·5%]), and 4610 people (17·5%) through injection drug use (249 women [5·4%], 4361 men [94·6%]). Among those infected through sex, MSW had increased risks of all-cause mortality (adjusted hazard ratio [aHR] 1·48, 95% CI 1·20-1·83), progression to AIDS (1·27, 1·09-1·47), virological failure (adjusted incidence rates ratio [aIRR] 1·27, 95% CI 1·09-1·48), and loss to follow-up (1·22, 1·10-1·35) compared to WSM. In contrast, MSM had lower risk of all-cause mortality (aHR 0·49, 95%CI 0·32-0·76), disease progression to AIDS (0·83, 0·68-1·00), and virological failure (aIRR 0·78, 95%CI 0·65-0·94), were more likely to receive regular CD4+ cell count (1·08, 1·07-1·10) and HIV viral load monitoring (1·13, 1·12-1·15), were less likely to report missing ART doses (0·54, 0·49-0·61), interrupt ART (0·34, 0·26-0·44), or be lost to follow-up (0·56, 0·49-0·65) compared to WSM. Men who inject drugs were almost twice as likely as women who inject drugs to die (aHR 1·72, 95%CI 1·03-2·85), experience disease progression to AIDS (2·05, 1·18-3·57), virological failure (aIRR 1·81, 95%CI 1·19-2·76), report ART side effects (1·78, 1·43-2·22), and interruptions in ART (2·29, 1·50-3·50). INTERPRETATION Our findings highlight the importance of identifying potentially at-risk MSW and promoting HIV education and testing among them. Particular attention is warranted among men who inject drugs to improve timely HIV diagnosis, drug interaction management, and retention in treatment. Additional research from rural settings is needed to assess the long-term treatment outcomes and adherence in MSM with HIV.
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Affiliation(s)
- Linghua Li
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Tanwei Yuan
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Junfeng Wang
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Thomas Fitzpatrick
- School of Medicine, University of Washington, Seattle, WA, United States
| | - Quanming Li
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Peiyang Li
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Xiaoping Tang
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Guohong Xu
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Dahui Chen
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Bowen Liang
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Weiping Cai
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Huachun Zou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
- Kirby Institute, the University of New South Wales, Sydney, Australia
- Corresponding author at: School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
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149
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Degeling C, Carter SM, van Oijen AM, McAnulty J, Sintchenko V, Braunack-Mayer A, Yarwood T, Johnson J, Gilbert GL. Community perspectives on the benefits and risks of technologically enhanced communicable disease surveillance systems: a report on four community juries. BMC Med Ethics 2020; 21:31. [PMID: 32334597 PMCID: PMC7183724 DOI: 10.1186/s12910-020-00474-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 04/17/2020] [Indexed: 12/18/2022] Open
Abstract
Background Outbreaks of infectious disease cause serious and costly health and social problems. Two new technologies – pathogen whole genome sequencing (WGS) and Big Data analytics – promise to improve our capacity to detect and control outbreaks earlier, saving lives and resources. However, routinely using these technologies to capture more detailed and specific personal information could be perceived as intrusive and a threat to privacy. Method Four community juries were convened in two demographically different Sydney municipalities and two regional cities in New South Wales, Australia (western Sydney, Wollongong, Tamworth, eastern Sydney) to elicit the views of well-informed community members on the acceptability and legitimacy of:
making pathogen WGS and linked administrative data available for public health research using this information in concert with data linkage and machine learning to enhance communicable disease surveillance systems
Fifty participants of diverse backgrounds, mixed genders and ages were recruited by random-digit-dialling and topic-blinded social-media advertising. Each jury was presented with balanced factual evidence supporting different expert perspectives on the potential benefits and costs of technologically enhanced public health research and communicable disease surveillance and given the opportunity to question experts. Results Almost all jurors supported data linkage and WGS on routinely collected patient isolates for the purposes of public health research, provided standard de-identification practices were applied. However, allowing this information to be operationalised as a syndromic surveillance system was highly contentious with three juries voting in favour, and one against by narrow margins. For those in favour, support depended on several conditions related to system oversight and security being met. Those against were concerned about loss of privacy and did not trust Australian governments to run secure and effective systems. Conclusions Participants across all four events strongly supported the introduction of data linkage and pathogenomics to public health research under current research governance structures. Combining pathogen WGS with event-based data surveillance systems, however, is likely to be controversial because of a lack of public trust, even when the potential public health benefits are clear. Any suggestion of private sector involvement or commercialisation of WGS or surveillance data was unanimously rejected.
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Affiliation(s)
- Chris Degeling
- Australian Centre for Health Engagement, Evidence and Values, University of Wollongong, Wollongong, Australia. .,School of Health and Society, University of Wollongong, Wollongong, Australia.
| | - Stacy M Carter
- Australian Centre for Health Engagement, Evidence and Values, University of Wollongong, Wollongong, Australia.,School of Health and Society, University of Wollongong, Wollongong, Australia
| | - Antoine M van Oijen
- Molecular Horizons and the Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | | | - Vitali Sintchenko
- The Centre for Infectious Diseases and Microbiology - Public Health, Westmead, Sydney, Australia.,Marie Bashir Institute for Infectious Disease and Biosecurity, The University of Sydney, Sydney, Australia
| | - Annette Braunack-Mayer
- Australian Centre for Health Engagement, Evidence and Values, University of Wollongong, Wollongong, Australia.,School of Health and Society, University of Wollongong, Wollongong, Australia
| | - Trent Yarwood
- Cairns and Hinterland Hospital and Health Service, Cairns, Australia.,Cairns Clinical School, James Cook University, Cairns, Australia.,Rural Clinical School, University of Queensland, Brisbane, Australia
| | - Jane Johnson
- The Centre for Infectious Diseases and Microbiology - Public Health, Westmead, Sydney, Australia.,Sydney Health Ethics, School of Public Health, The University of Sydney, Sydney, Australia
| | - Gwendolyn L Gilbert
- The Centre for Infectious Diseases and Microbiology - Public Health, Westmead, Sydney, Australia.,Marie Bashir Institute for Infectious Disease and Biosecurity, The University of Sydney, Sydney, Australia.,Sydney Health Ethics, School of Public Health, The University of Sydney, Sydney, Australia
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150
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Relationship of HIV Status and Fatigue, Cardiorespiratory Fitness, Myokines, and Physical Activity. J Assoc Nurses AIDS Care 2020; 30:392-404. [PMID: 31241504 DOI: 10.1097/jnc.0000000000000022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
People living with HIV (PLWH) experience high rates of fatigue, which can be improved with physical activity. We examined relationships between HIV infection, fatigue, cardiorespiratory fitness, physical activity, and myokines. Twenty PLWH and 20 HIV-uninfected adults completed a fatigue assessment, a maximal cardiometabolic exercise test, serum measures of myokines, and wore an accelerometer for 7 days. Measures were completed at baseline, 3 months, and 6 months. At baseline, PLWH had more fatigue (4.7 ± 2.6 vs. 2.8 ± 2.5, p = .01) and higher peak ventilatory efficiency (VE/VCO2; 33 ± 5.5 vs. 30.2 ± 2.5; p = .06). Half of PLWH engaged in at least one 10-minute bout of physical activity in the previous week, compared with control subjects (65%). Over time, HIV infection and fibroblast growth factor 21 were associated with fatigue (p < .05). People living with HIV have more fatigue and a higher ventilatory efficiency; expression of fibroblast growth factor 21 may underpin this relationship.
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