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Nabukalu D, Calazans JA, Marston M, Calvert C, Nakawooya H, Nansereko B, Sekubugu R, Nakigozi G, Serwadda D, Sewankambo N, Kigozi G, Gray RH, Nalugoda F, Makumbi F, Lutalo T, Todd J. Estimation of cause-specific mortality in Rakai, Uganda, using verbal autopsy 1999-2019. Glob Health Action 2024; 17:2338635. [PMID: 38717826 PMCID: PMC11080674 DOI: 10.1080/16549716.2024.2338635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 03/31/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND There are scant data on the causes of adult deaths in sub-Saharan Africa. We estimated the level and trends in adult mortality, overall and by different causes, in rural Rakai, Uganda, by age, sex, and HIV status. OBJECTIVES To estimate and analyse adult cause-specific mortality trends in Rakai, Uganda. METHODOLOGY Mortality information by cause, age, sex, and HIV status was recorded in the Rakai Community Cohort study using verbal autopsy interviews, HIV serosurveys, and residency data. We estimated the average number of years lived in adulthood. Using demographic decomposition methods, we estimated the contribution of each cause of death to adult mortality based on the average number of years lived in adulthood. RESULTS Between 1999 and 2019, 63082 adults (15-60 years) were censused, with 1670 deaths registered. Of these, 1656 (99.2%) had completed cause of death data from verbal autopsy. The crude adult death rate was 5.60 (95% confidence interval (CI): 5.33-5.87) per 1000 person-years of observation (pyo). The crude death rate decreased from 11.41 (95% CI: 10.61-12.28) to 3.27 (95% CI: 2.89-3.68) per 1000 pyo between 1999-2004 and 2015-2019. The average number of years lived in adulthood increased in people living with HIV and decreased in HIV-negative individuals between 2000 and 2019. Communicable diseases, primarily HIV and Malaria, had the biggest decreases, which improved the average number of years lived by approximately extra 12 years of life in females and 6 years in males. There were increases in deaths due to non-communicable diseases and external causes, which reduced the average number of years lived in adulthood by 2.0 years and 1.5 years in females and males, respectively. CONCLUSION There has been a significant decline in overall mortality from 1999 to 2019, with the greatest decline seen in people living with HIV since the availability of antiretroviral therapy in 2004. By 2020, the predominant causes of death among females were non-communicable diseases, with external causes of death dominating in males.
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Affiliation(s)
- Dorean Nabukalu
- Data management, Rakai Health Sciences Program, Rakai, Uganda
- Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Júlia Almeida Calazans
- Centre for Demographic Studies (CED), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Milly Marston
- Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Clara Calvert
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | | | - Robert Sekubugu
- Data management, Rakai Health Sciences Program, Rakai, Uganda
| | | | - David Serwadda
- Data management, Rakai Health Sciences Program, Rakai, Uganda
- Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
| | - Nelson Sewankambo
- Data management, Rakai Health Sciences Program, Rakai, Uganda
- College of Health Sciences, Makerere University School of Medicine, Kampala, Uganda
| | - Godfrey Kigozi
- Data management, Rakai Health Sciences Program, Rakai, Uganda
| | - Ronald H Gray
- Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Fred Nalugoda
- Data management, Rakai Health Sciences Program, Rakai, Uganda
| | - Fredrick Makumbi
- Data management, Rakai Health Sciences Program, Rakai, Uganda
- Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
| | - Tom Lutalo
- Data management, Rakai Health Sciences Program, Rakai, Uganda
- Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
| | - Jim Todd
- Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Brizzi A, Kagaayi J, Ssekubugu R, Abeler-Dörner L, Blenkinsop A, Bonsall D, Chang LW, Fraser C, Galiwango RM, Kigozi G, Kyle I, Monod M, Nakigozi G, Nalugoda F, Rosen JG, Laeyendecker O, Quinn TC, Grabowski MK, Reynolds SJ, Ratmann O. Age and gender profiles of HIV infection burden and viraemia: novel metrics for HIV epidemic control in African populations with high antiretroviral therapy coverage. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.21.24306145. [PMID: 38712115 PMCID: PMC11071606 DOI: 10.1101/2024.04.21.24306145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
Introduction To prioritize and tailor interventions for ending AIDS by 2030 in Africa, it is important to characterize the population groups in which HIV viraemia is concentrating. Methods We analysed HIV testing and viral load data collected between 2013-2019 from the open, population-based Rakai Community Cohort Study (RCCS) in Uganda, to estimate HIV seroprevalence and population viral suppression over time by gender, one-year age bands and residence in inland and fishing communities. All estimates were standardized to the underlying source population using census data. We then assessed 95-95-95 targets in their ability to identify the populations in which viraemia concentrates. Results Following the implementation of Universal Test and Treat, the proportion of individuals with viraemia decreased from 4.9% (4.6%-5.3%) in 2013 to 1.9% (1.7%-2.2%) in 2019 in inland communities and from 19.1% (18.0%-20.4%) in 2013 to 4.7% (4.0%-5.5%) in 2019 in fishing communities. Viraemia did not concentrate in the age and gender groups furthest from achieving 95-95-95 targets. Instead, in both inland and fishing communities, women aged 25-29 and men aged 30-34 were the 5-year age groups that contributed most to population-level viraemia in 2019, despite these groups being close to or had already achieved 95-95-95 targets. Conclusions The 95-95-95 targets provide a useful benchmark for monitoring progress towards HIV epidemic control, but do not contextualize underlying population structures and so may direct interventions towards groups that represent a marginal fraction of the population with viraemia.
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Affiliation(s)
- Andrea Brizzi
- Department of Mathematics, Imperial College London, London, United Kingdom
| | | | | | | | | | - David Bonsall
- Big Data Institute, University of Oxford, Oxford, United Kingdom
- Wellcome Centre for Human Genomics, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Larry W. Chang
- Rakai Health Sciences Program, Kalisizo, Uganda
- Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Christophe Fraser
- Big Data Institute, University of Oxford, Oxford, United Kingdom
- Pandemic Sciences Institute, University of Oxford, Oxford, United Kingdom
| | | | | | - Imogen Kyle
- Department of Mathematics, Imperial College London, London, United Kingdom
| | - Mélodie Monod
- Department of Mathematics, Imperial College London, London, United Kingdom
| | | | | | - Joseph G. Rosen
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Oliver Laeyendecker
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Thomas C. Quinn
- Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - M. Kate Grabowski
- Rakai Health Sciences Program, Kalisizo, Uganda
- Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Steven J. Reynolds
- Rakai Health Sciences Program, Kalisizo, Uganda
- Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Oliver Ratmann
- Department of Mathematics, Imperial College London, London, United Kingdom
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Urassa M, Marston M, Mangya C, Materu J, Elsabe D, Safari K, Kagoye S, Todd J, Boerma T. Cohort Profile Update: Magu Health and Demographic Surveillance System, Tanzania. Int J Epidemiol 2024; 53:dyae058. [PMID: 38676640 PMCID: PMC11055399 DOI: 10.1093/ije/dyae058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 04/04/2024] [Indexed: 04/29/2024] Open
Affiliation(s)
- Mark Urassa
- National Institute for Medical Research, Mwanza, Tanzania
| | - Milly Marston
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Charles Mangya
- National Institute for Medical Research, Mwanza, Tanzania
| | | | - Duplessis Elsabe
- Department of Community Health Science, Institute for Global Public Health, University of Manitoba, Winnipeg, MB, Canada
| | | | - Sophia Kagoye
- National Institute for Medical Research, Mwanza, Tanzania
| | - Jim Todd
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Ties Boerma
- Department of Community Health Science, Institute for Global Public Health, University of Manitoba, Winnipeg, MB, Canada
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Houle B, Kabudula C, Mojola SA, Angotti N, Gómez-Olivé FX, Gareta D, Herbst K, Clark SJ, Menken J, Canudas-Romo V. Mortality variability and differentials by age and causes of death in rural South Africa, 1994-2018. BMJ Glob Health 2024; 9:e013539. [PMID: 38589045 PMCID: PMC11015189 DOI: 10.1136/bmjgh-2023-013539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 12/20/2023] [Indexed: 04/10/2024] Open
Abstract
INTRODUCTION Understanding mortality variability by age and cause is critical to identifying intervention and prevention actions to support disadvantaged populations. We assessed mortality changes in two rural South African populations over 25 years covering pre-AIDS and peak AIDS epidemic and subsequent antiretroviral therapy (ART) availability. METHODS Using population surveillance data from the Agincourt Health and Socio-Demographic Surveillance System (AHDSS; 1994-2018) and Africa Health Research Institute (AHRI; 2000-2018) for 5-year periods, we calculated life expectancy from birth to age 85, mortality age distributions and variation, and life-years lost (LYL) decomposed into four cause-of-death groups. RESULTS The AIDS epidemic shifted the age-at-death distribution to younger ages and increased LYL. For AHDSS, between 1994-1998 and 1999-2003 LYL increased for females from 13.6 years (95% CI 12.7 to 14.4) to 22.1 (95% CI 21.2 to 23.0) and for males from 19.9 (95% CI 18.8 to 20.8) to 27.1 (95% CI 26.2 to 28.0). AHRI LYL in 2000-2003 was extremely high (females=40.7 years (95% CI 39.8 to 41.5), males=44.8 years (95% CI 44.1 to 45.5)). Subsequent widespread ART availability reduced LYL (2014-2018) for women (AHDSS=15.7 (95% CI 15.0 to 16.3); AHRI=22.4 (95% CI 21.7 to 23.1)) and men (AHDSS=21.2 (95% CI 20.5 to 22.0); AHRI=27.4 (95% CI 26.7 to 28.2)), primarily due to reduced HIV/AIDS/TB deaths in mid-life and other communicable disease deaths in children. External causes increased as a proportion of LYL for men (2014-2018: AHRI=25%, AHDSS=17%). The share of AHDSS LYL 2014-2018 due to non-communicable diseases exceeded pre-HIV levels: females=43%; males=40%. CONCLUSIONS Our findings highlight shifting burdens in cause-specific LYL and persistent mortality differentials in two populations experiencing complex epidemiological transitions. Results show high contributions of child deaths to LYL at the height of the AIDS epidemic. Reductions in LYL were primarily driven by lowered HIV/AIDS/TB and other communicable disease mortality during the ART periods. LYL differentials persist despite widespread ART availability, highlighting the contributions of other communicable diseases in children, HIV/AIDS/TB and external causes in mid-life and non-communicable diseases in older ages.
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Affiliation(s)
- Brian Houle
- School of Demography, The Australian National University, Acton, Australian Capital Territory, Australia
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Institute of Behavioral Science, University of Colorado Boulder, Boulder, Colorado, USA
| | - Chodziwadziwa Kabudula
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Sanyu A Mojola
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Department of Sociology, School of Public and International Affairs, and Office of Population Research, Princeton University, Princeton, New Jersey, USA
| | - Nicole Angotti
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Institute of Behavioral Science, University of Colorado Boulder, Boulder, Colorado, USA
- Department of Sociology, American University, Washington, DC, USA
| | - Francesc Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Dickman Gareta
- Africa Health Research Institute, Durban, KwaZulu-Natal, South Africa
| | - Kobus Herbst
- Africa Health Research Institute, Durban, KwaZulu-Natal, South Africa
- DSI-MRC South African Population Research Infrastructure Network, Durban, South Africa
| | - Samuel J Clark
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Department of Sociology, The Ohio State University, Columbus, Ohio, USA
| | - Jane Menken
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Institute of Behavioral Science, University of Colorado Boulder, Boulder, Colorado, USA
| | - Vladimir Canudas-Romo
- School of Demography, The Australian National University, Acton, Australian Capital Territory, Australia
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Mwakyandile TM, Shayo GA, Sasi PG, Mugusi FM, Barabona G, Ueno T, Lyamuya EF. Hypertension and traditional risk factors for cardiovascular diseases among treatment naïve HIV- infected adults initiating antiretroviral therapy in Urban Tanzania. BMC Cardiovasc Disord 2023; 23:309. [PMID: 37340390 DOI: 10.1186/s12872-023-03332-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 06/05/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Cardiovascular diseases (CVDs) have become an important cause of ill health and death among people living with HIV and/or AIDS (PLHIV) in the antiretroviral therapy (ART) era. There is scarce data on the burden of hypertension (HTN) and risk factors for CVDs among PLHIV in developing countries, including Tanzania during the ART era. OBJECTIVE(S) To determine the prevalence of HTN and risk factors for CVDs among ART naïve PLHIV initiating ART. METHODS We analysed baseline data of 430 clinical trial participants on the effect of low-dose aspirin on HIV disease progression among HIV-infected individuals initiating ART. HTN was the outcome CVD. Traditional risk factors for CVDs studied were age, alcohol consumption, cigarette smoking, individual and family history of CVDs, diabetes mellitus (DM), obesity/overweight, and dyslipidaemia. A generalized linear model (robust Poisson regression) was used to determine the predictors for HTN. RESULTS The median (IQR) age was 37 (28, 45) years. Females were the majority contributing 64.9% of all participants. The prevalence of HTN was 24.8%. The most prevalent risk factors for CVDs were dyslipidaemia (88.3%), alcohol consumption (49.3%), and overweight or obesity (29.1%). Being overweight or obese predicted the occurrence of HTN, aPR 1.60 (95% CI 1.16-2.21) while WHO HIV clinical stage 3 was protective against HTN, aPR 0.42(95% CI 0.18-0.97). CONCLUSION The prevalence of HTN and traditional risk factors for CVDs in the treatment naïve PLHIV initiating ART are significant. Identifying these risk factors and managing them at the time of ART initiation may lower future CVDs among PLHIV.
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Affiliation(s)
- Tosi M Mwakyandile
- Department of Clinical Pharmacology, School of Biomedical Sciences, Campus College of Medicine, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania.
| | - Grace A Shayo
- Department of Internal Medicine, School of Clinical Medicine, Campus College of Medicine, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Philip G Sasi
- Department of Clinical Pharmacology, School of Biomedical Sciences, Campus College of Medicine, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Ferdinand M Mugusi
- Department of Internal Medicine, School of Clinical Medicine, Campus College of Medicine, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Godfrey Barabona
- Division of Infection and Immunity, Joint Research Centre for Human Retrovirus Infection, Kumamoto University, Kumamoto, Japan
| | - Takamasa Ueno
- Division of Infection and Immunity, Joint Research Centre for Human Retrovirus Infection, Kumamoto University, Kumamoto, Japan
- Department of Microbiology and Immunology, School of Diagnostic Medicine, Campus College of Medicine, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Eligius F Lyamuya
- Collaboration Unit for Infection, Joint Research Centre for Human Retrovirus Infection, Kumamoto University, Kumamoto, Japan
- Department of Microbiology and Immunology, School of Diagnostic Medicine, Campus College of Medicine, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
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Otiende M, Bauni E, Nyaguara A, Amadi D, Nyundo C, Tsory E, Walumbe D, Kinuthia M, Kihuha N, Kahindi M, Nyutu G, Moisi J, Deribew A, Agweyu A, Marsh K, Tsofa B, Bejon P, Bottomley C, Williams TN, Scott JAG. Mortality in rural coastal Kenya measured using the Kilifi Health and Demographic Surveillance System: a 16-year descriptive analysis. Wellcome Open Res 2023; 6:327. [PMID: 37416502 PMCID: PMC10320326 DOI: 10.12688/wellcomeopenres.17307.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2023] [Indexed: 10/30/2023] Open
Abstract
Background: The Kilifi Health and Demographic Surveillance System (KHDSS) was established in 2000 to define the incidence and prevalence of local diseases and evaluate the impact of community-based interventions. KHDSS morbidity data have been reported comprehensively but mortality has not been described. This analysis describes mortality in the KHDSS over 16 years. Methods: We calculated mortality rates from 2003-2018 in four intervals of equal duration and assessed differences in mortality across these intervals by age and sex. We calculated the period survival function and median survival using the Kaplan-Meier method and mean life expectancies using abridged life tables. We estimated trend and seasonality by decomposing a time series of monthly mortality rates. We used choropleth maps and random-effects Poisson regression to investigate geographical heterogeneity. Results: Mortality declined by 36% overall between 2003-2018 and by 59% in children aged <5 years. Most of the decline occurred between 2003 and 2006. Among adults, the greatest decline (49%) was observed in those aged 15-54 years. Life expectancy at birth increased by 12 years. Females outlived males by 6 years. Seasonality was only evident in the 1-4 year age group in the first four years. Geographical variation in mortality was ±10% of the median value and did not change over time. Conclusions: Between 2003 and 2018, mortality among children and young adults has improved substantially. The steep decline in 2003-2006 followed by a much slower reduction thereafter suggests improvements in health and wellbeing have plateaued in the last 12 years. However, there is substantial inequality in mortality experience by geographical location.
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Affiliation(s)
- Mark Otiende
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
| | - Evasius Bauni
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
| | - Amek Nyaguara
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
| | - David Amadi
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
| | - Christopher Nyundo
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
| | - Emmanuel Tsory
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
| | - David Walumbe
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
| | - Michael Kinuthia
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
| | - Norbert Kihuha
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
| | - Michael Kahindi
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
| | - Gideon Nyutu
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
| | - Jennifer Moisi
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
| | - Amare Deribew
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
| | - Ambrose Agweyu
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
| | - Kevin Marsh
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Benjamin Tsofa
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
| | - Philip Bejon
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Christian Bottomley
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Thomas N. Williams
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
| | - J. Anthony G. Scott
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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Bourgi K, Ofner S, Musick B, Griffith B, Diero L, Wools-Kaloustian K, Yiannoutsos CT, Gupta SK. Weight Gain Among Treatment-Naïve Persons With HIV Receiving Dolutegravir in Kenya. J Acquir Immune Defic Syndr 2022; 91:490-496. [PMID: 36126175 PMCID: PMC9814314 DOI: 10.1097/qai.0000000000003087] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/16/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Several recent studies have linked integrase strand transfer inhibitors (INSTI) with increased weight gain. SETTING The effects of sex on weight gain with dolutegravir (DTG)-based antiretroviral therapy (ART) among treatment-naïve participants in a lower-income, sub-Saharan population with high rates of pre-ART underweight and tuberculosis (TB) coinfection are unknown. METHODS Our analysis included treatment-naïve participants in Kenya and starting their first treatment regimen between January 1, 2015, and September 30, 2018. Participants were grouped into 2 cohorts based on the initial treatment regimen [DTG vs. nonnucleoside reverse transcriptase inhibitors (NNRTI)]. We modelled weight changes over time using a multivariable nonlinear mixed-effect model, with participant as a random effect. Logistic regression models were constructed to evaluate the association between different variables with extreme increase in body mass index (≥10% increase). RESULTS Seventeen thousand forty-four participants met our inclusion criteria. Sixty-two percent of participants were women, 6% were receiving active TB therapy, and 97% were on NNRTI-based regimens. Participants starting DTG-based regimens were more likely to gain weight when compared with participants starting NNRTI-based regimens. Female participants starting DTG-based regimens experienced the highest weight gain compared with other participants (mean gain of 6.1 kgs at 18 months). Female participants receiving DTG-based regimens, along with participants with lower CD4 cell counts, underweight at baseline, and those receiving active TB therapy were also at higher risk for extreme body mass index increase. CONCLUSIONS Our study in a lower-income sub-Saharan African population confirms higher weight gain with DTG-based regimens compared with traditional ART for treatment-naïve patients.
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Affiliation(s)
- Kassem Bourgi
- Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Susan Ofner
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Beverly Musick
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Bradley Griffith
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Lameck Diero
- College of Health Sciences, Moi University School of Medicine, Eldoret, Kenya
| | - Kara Wools-Kaloustian
- Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Constantin T Yiannoutsos
- Department of Biostatistics and Health Data Science, Indiana University R.M. Fairbanks School of Public Health, Indianapolis, Indiana, USA
| | - Samir K. Gupta
- Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Syndemics of intimate partner violence among women in HIV endemic South Africa: geospatial analysis of nationally representative data. Sci Rep 2022; 12:18083. [PMID: 36302814 PMCID: PMC9613977 DOI: 10.1038/s41598-022-20230-7] [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] [Received: 08/31/2021] [Accepted: 09/09/2022] [Indexed: 12/30/2022] Open
Abstract
Despite some improvement in lowering HIV incidence, HIV-related challenges, such as intimate partner violence (IPV), remain unacceptably high among women in South Africa. For decades, researchers and activists have pointed to the complex and intertwined reality of the substance abuse, violence and AIDS (SAVA) syndemic that endangers women. However, more recent systematic review/meta-analysis evidence points to inconclusive association between IPV and alcohol use. Furthermore, much of the evidence is often non-population-based that focuses on the co-occurrence rather than synergistic SAVA interaction. In this study, using the latest data from the South Africa Demographic and Health Survey (SA-DHS), we identified geographic synergistic clustering of IPV associated with HIV and substance abuse in South Africa as a measure of population-level interactions among these factors. The SA-DHS is a nationally representative sample that includes wide-ranging data on health, social challenges and household geo-locations of 5,874 women who participated in the domestic violence module. First, geographical IPV, harmful alcohol use (as the substance abuse measure available in SA-DHS) and HIV clusters were identified using the Kulldorff spatial scan statistic in SaTScan. Second, synergistic interactions related to recent IPV (i.e. recent physical, sexual, emotional violence during the last 12 months) with harmful alcohol use and HIV challenge were measured using RERI [Relative excess risk due to interaction], AP [attributable proportion] and S [Synergy index]. In our results, we spatially identified geographical physical IPV syndemic interactions in parts of the Eastern Cape/Free State Provinces (RERI = 4.42 [95% CI: 2.34-6.51], AP = 0.56 [95% CI: 0.44-0.68], S = 2.77 [95% CI: 2.01-3.84], but not in other forms of IPV. Although IPV, based on decade old concept of SAVA syndemic, was less common/widespread than expected from the national scale population-based data, we identified population-level physical violence syndemic occurring in South Africa. Our study highlights the need to prioritize public health response targeting vulnerable populations residing in these high-risk areas of syndemic mechanisms linking these synergistic epidemics that women face in South Africa.
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9
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Lyons CE, Stokes-Cawley OJ, Simkin A, Bowring AL, Mfochive Njindam I, Njoya O, Bissek AZK, Tamoufe U, Georges S, Kakanou FZ, Turpin G, Levitt D, Billong SC, Mishra S, Baral S. Modeling the potential impact of pre-exposure prophylaxis for HIV among men who have sex with men in Cameroon. BMC Infect Dis 2022; 22:751. [PMID: 36163000 PMCID: PMC9513877 DOI: 10.1186/s12879-022-07738-z] [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] [Received: 04/14/2022] [Accepted: 09/14/2022] [Indexed: 11/26/2022] Open
Abstract
Background Men who have sex with men (MSM) are consistently burdened by HIV at higher levels than other adults. While HIV prevention programs for MSM are growing in coverage and quality, HIV incidence remains high. In response, pre-exposure prophylaxis (PrEP) was introduced in 2019 to support HIV risk reduction among MSM in Cameroon. Understanding how PrEP initiation programs will change the HIV prevalence among MSM in Cameroon is important to developing effective programs. Methods This study uses a mathematical model to simulate population-level HIV transmission among MSM in the cities of Yaoundé and Douala, Cameroon. PrEP is incorporated into the model at rates that equal 25%, 50%, or 75% coverage after twenty years to assess the potential effects on HIV prevalence among MSM, requiring annual initiation rates of 2.5%, 6.8%, and 17.2% for Yaoundé and 2.2%, 5.6%, and 13.4% for Douala, respectively. The data utilized for this model are from a cross sectional study which recruited MSM through respondent-driven sampling of MSM in two major cities in Cameroon: Yaoundé and Douala. Results The model estimated an HIV prevalence of 43.2% among MSM, annual HIV diagnoses of 300 per 10,000 MSM and antiretroviral therapy (ART) coverage of 53.9% in Yaoundé. In Douala, estimated prevalence is 26.5% among MSM, 167 per 10,000 MSM annual diagnoses and ART coverage of 72.0%. Standalone PrEP interventions aimed at 50% coverage at the end of a 20-year program would reduce the prevalence from 43.2% to 35.4% in Yaoundé and from 26.5 to 20.1% in Douala. Combining PrEP with a 10% increase in HIV testing would decrease the number of MSM living with HIV and unaware of their status from 9.8 to 6.0% in Yaoundé and from 8.7 to 4.6% in Douala. Conclusions PrEP would be beneficial in reducing prevalence even at varying initiation and coverage levels. Combination of PrEP and increased HIV testing further decreased the number of undiagnosed MSM. This study supports the utility of implementing PrEP as part of comprehensive HIV prevention programming among MSM in Cameroon. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07738-z.
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Affiliation(s)
- Carrie E Lyons
- Department of Epidemiology, Johns Hopkins School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA.
| | - Owen J Stokes-Cawley
- Department of Epidemiology, Johns Hopkins School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Anna Simkin
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Anna L Bowring
- Department of Epidemiology, Johns Hopkins School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Iliassou Mfochive Njindam
- Department of Epidemiology, Johns Hopkins School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Oudou Njoya
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Anne Zoung-Kanyi Bissek
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.,Division of Operations Research, Ministry of Health, Yaoundé, Cameroon
| | - Ubald Tamoufe
- Metabiota, Yaounde, Cameroon.,Johns Hopkins Cameroon Program, Yaounde, Cameroon
| | | | - Florence Zeh Kakanou
- Directorate of Epidemic, Pandemic and Disease Control, Ministry of Public Health, Yaoundé, Cameroon
| | - Gnilane Turpin
- Department of Epidemiology, Johns Hopkins School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | | | - Serge Clotaire Billong
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.,Central Technical Group, National AIDS Control Committee, Yaoundé, Cameroon
| | - Sharmistha Mishra
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
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10
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Baisley K, Orne-Gliemann J, Larmarange J, Plazy M, Collier D, Dreyer J, Mngomezulu T, Herbst K, Hanekom W, Dabis F, Siedner MJ, Iwuji C. Early HIV treatment and survival over six years of observation in the ANRS 12249 Treatment as Prevention Trial. HIV Med 2022; 23:922-928. [PMID: 35218300 PMCID: PMC9545558 DOI: 10.1111/hiv.13263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 01/09/2022] [Accepted: 01/18/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Population-based universal test and treat (UTT) trials have shown an impact on population-level virological suppression. We followed the ANRS 12249 TasP trial population for 6 years to determine whether the intervention had longer-term survival benefits. METHODS The TasP trial was a cluster-randomized trial in South Africa from 2012 to 2016. All households were offered 6-monthly home-based HIV testing. Immediate antiretroviral therapy (ART) was offered through trial clinics to all people living with HIV (PLHIV) in intervention clusters and according to national guidelines in control clusters. After the trial, individuals attending the trial clinics were transferred to the public ART programme. Deaths were ascertained through annual demographic surveillance. Random-effects Poisson regression was used to estimate the effect of trial arm on mortality among (i) all PLHIV; (ii) PLHIV aware of their status and not on ART at trial entry; and (iii) PHLIV who started ART during the trial. RESULTS Mortality rates among PLHIV were 9.3/1000 and 10.4/1000 person-years in the control and intervention arms, respectively. There was no evidence that the intervention decreased mortality among all PLHIV [adjusted rate ratio (aRR) = 1.10, 95% confidence interval (CI) = 0.85-1.43, p = 0.46] or among PLHIV who were aware of their status but not on ART. Among individuals who initiated ART, the intervention decreased mortality during the trial (aRR = 0.49, 95% CI = 0.28-0.85, p = 0.01), but not after the trial ended. CONCLUSIONS The 'treat all' strategy reduced mortality among individuals who started ART but not among all PLHIV. To achieve maximum benefit of immediate ART, barriers to ART uptake and retention in care need to be addressed.
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Affiliation(s)
- Kathy Baisley
- Africa Health Research Institute, Durban, South Africa.,Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Joanna Orne-Gliemann
- University of Bordeaux, Inserm, Institut de Recherche pour le Développement (IRD), UMR 1219, Bordeaux, France
| | - Joseph Larmarange
- Centre Population et Développement (Ceped), Institut de Recherche pour le Développement (IRD), Université de Paris, Inserm, Paris, France
| | - Melanie Plazy
- University of Bordeaux, Inserm, Institut de Recherche pour le Développement (IRD), UMR 1219, Bordeaux, France
| | - Dami Collier
- Division of Infection and Immunity, University College London, London, UK.,Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID), Cambridge, UK
| | - Jaco Dreyer
- Africa Health Research Institute, Durban, South Africa
| | | | - Kobus Herbst
- Africa Health Research Institute, Durban, South Africa.,DSI-MRC South African Population Research Infrastructure Network, Durban, South Africa
| | - Willem Hanekom
- Africa Health Research Institute, Durban, South Africa.,Division of Infection and Immunity, University College London, London, UK
| | - Francois Dabis
- University of Bordeaux, Inserm, Institut de Recherche pour le Développement (IRD), UMR 1219, Bordeaux, France
| | - Mark J Siedner
- Africa Health Research Institute, Durban, South Africa.,Harvard Medical School, Boston, Massachusetts, USA
| | - Collins Iwuji
- Africa Health Research Institute, Durban, South Africa.,Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
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11
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Wekesa P, McLigeyo A, Owuor K, Mwangi J, Ngugi E. Survival probability and factors associated with time to loss to follow-up and mortality among patients on antiretroviral treatment in central Kenya. BMC Infect Dis 2022; 22:522. [PMID: 35668350 PMCID: PMC9171980 DOI: 10.1186/s12879-022-07505-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 05/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Retention of patients who are receiving antiretroviral therapy (ART) remains a challenge especially in the setting of rapid expansion of HIV services. Retention in care remains vital to the HIV care continuum, and has been associated with viral suppression and improved survival. This study aimed to ascertain survival rates, time to loss to follow-up (LTFU) or mortality events and factors associated with time to LTFU or mortality among patients enrolled on antiretroviral therapy at health facilities in central Kenya. METHODS This was a retrospective cohort study among patients initiated on ART between 2004 and 2012 in central Kenya. Demographic characteristics, clinical characteristics and outcomes data were analyzed using Stata version 15.1. Competing risks regression analysis and cummulative incidence functions were used to estimate survival. RESULTS A total of 31,346 patients were included, of whom 65.6% were female, 76.0% were aged between 20 and 50 years old, and 38.9% were diagnosed at WHO stage III. At 36 months, overall retention was 68.8%, LTFU was 27.1%, and mortality was 4.1%. The total person-years of follow up was 74,986. The incidence rate of LTFU was 9.99 per 100 person years for a total of 9383.25 person-years of follow up. The mortality rate was 1.25 per 100 person years for a total of 875.5 person-years among those who died. The median time to LTFU was 11 months (IQR 3-22) while median time to death was 3 months (IQR 0-13). Men, unmarried patients, patients presenting with advanced HIV, not on TB treatment, and enrolled into the HIV program in later cohorts, had a shorter time to mortality and LTFU. CONCLUSION Our study demonstrated evidence of scale-up of HIV treatment programs in central Kenya. While most patients were enrolled at an advanced WHO clinical stage, overall 36-month mortality remained low, but occurred earlier during follow-up. Cohort LTFU at 36-months reduced in later years with the losses occurring within the 1st year of follow-up. Predictors of early mortality and LTFU included being male, single, separated or divorced, advanced WHO clinical stage, and among patients not on TB treatment.
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Affiliation(s)
- P Wekesa
- Centre for Health Solutions - Kenya, Nairobi, Kenya.
| | - A McLigeyo
- Centre for Health Solutions - Kenya, Nairobi, Kenya
| | - K Owuor
- Centre for Health Solutions - Kenya, Nairobi, Kenya
| | - J Mwangi
- Division of Global HIV & TB, Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - E Ngugi
- Division of Global HIV & TB, Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
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12
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Kanyama C, Chagomerana MB, Chawinga C, Ngoma J, Shumba I, Kumwenda W, Armando B, Kumwenda T, Kumwenda E, Hosseinipour MC. Implementation of tuberculosis and cryptococcal meningitis rapid diagnostic tests amongst patients with advanced HIV at Kamuzu Central Hospital, Malawi, 2016–2017. BMC Infect Dis 2022; 22:224. [PMID: 35247971 PMCID: PMC8897937 DOI: 10.1186/s12879-022-07224-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 02/28/2022] [Indexed: 11/10/2022] Open
Abstract
Background Cryptococcal meningitis (CM) and tuberculosis (TB) remain leading causes of hospitalization and death amongst people living with HIV, particularly those with advanced HIV disease. In hospitalized patients, prompt diagnosis of these diseases may improve patient outcomes. The advanced HIV rapid diagnostic tests such as determine TB urine lipoarabinomannan lateral flow assay (urine LAM), urine X-pert MTB/RIF assay (urine X-pert), and serum/blood cryptococcal antigen test (serum CrAg) are recommended but frequently not available in many resource-limited settings. We describe our experience providing these tests in a routine hospital setting. Method From 1 August 2016 to 31 January 2017, a prospective cohort study to diagnose TB and Cryptococcal meningitis using point of care tests was conducted in the medical wards at Kamuzu Central Hospital, in Lilongwe, Malawi. The tests offered were PIMA CD4 cell count, serum CrAg, urine LAM, and urine X-pert. The testing was integrated into an existing HIV/TB treatment room on the wards and performed close to admission time. Patients were followed until discharge or death in the ward. Results We included 438 HIV-positive patients; 76% had a previously known HIV diagnosis (87% already on ART). We measured CD4 count in 365/438 (83%), serum CrAg in 301/438 (69%), urine LAM in 363/438 (83%), and urine X-pert in 292/438 (67%). The median CD4 count was 144 cells/ml (IQR 46–307). Serum CrAg positivity rate was 23 /301 (8%) and CM was confirmed by CSF Crag in 13/23 (56%). The majority of CM patients 9/13 (69%) started antifungal therapy within two days of diagnosis. Urine LAM and urine X-pert positivity rates were 81/363(22%) and (14/292 (5%) respectively. The positivity rate of urine LAM was higher in patients with low CD4 cell counts (< 100 cells/ml) and low BMI (< 18.5). Most patients with positive urine LAM started TB treatment on the same day. Despite the early diagnosis and treatment of TB and CM, the inpatient mortality was high; 30% and 25% respectively. Conclusion Although advanced HIV rapid diagnostic tests are recommended, one key challenge in implementation is the limited trained personnel administering the tests. Despite the effective use of the point of care tests in the clinical care of hospitalized TB and CM patients, mortality among these patients remained unacceptably high. Henceforth we need to train other cadres apart from nurses, clinicians, and laboratory technicians to conduct the tests. There is an urgent need to identify and modify other risks of death from TB and CM. Trial registration: Malawi National Health Science Research committee: Protocol # 1144. Registered 2 July 2014 and University Of North Carolina IRB #: UNCPM 21412, approved 13th October 2014.
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13
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Houle B, Kabudula CW, Tilstra AM, Mojola SA, Schatz E, Clark SJ, Angotti N, Gómez-Olivé FX, Menken J. Twin epidemics: the effects of HIV and systolic blood pressure on mortality risk in rural South Africa, 2010-2019. BMC Public Health 2022; 22:387. [PMID: 35209881 PMCID: PMC8866551 DOI: 10.1186/s12889-022-12791-z] [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] [Received: 10/25/2021] [Accepted: 02/14/2022] [Indexed: 11/19/2022] Open
Abstract
Background Sub-Saharan African settings are experiencing dual epidemics of HIV and hypertension. We investigate effects of each condition on mortality and examine whether HIV and hypertension interact in determining mortality. Methods Data come from the 2010 Ha Nakekela population-based survey of individuals ages 40 and older (1,802 women; 1,107 men) nested in the Agincourt Health and socio-Demographic Surveillance System in rural South Africa, which provides mortality follow-up from population surveillance until mid-2019. Using discrete-time event history models stratified by sex, we assessed differential mortality risks according to baseline measures of HIV infection, HIV-1 RNA viral load, and systolic blood pressure. Results During the 8-year follow-up period, mortality was high (477 deaths). Survey weighted estimates are that 37% of men (mortality rate 987.53/100,000, 95% CI: 986.26 to 988.79) and 25% of women (mortality rate 937.28/100,000, 95% CI: 899.7 to 974.88) died. Over a quarter of participants were living with HIV (PLWH) at baseline, over 50% of whom had unsuppressed viral loads. The share of the population with a systolic blood pressure of 140mm Hg or higher increased from 24% at ages 40-59 to 50% at ages 75-plus and was generally higher for those not living with HIV compared to PLWH. Men and women with unsuppressed viral load had elevated mortality risks (men: adjusted odds ratio (aOR) 3.23, 95% CI: 2.21 to 4.71, women: aOR 2.05, 95% CI: 1.27 to 3.30). There was a weak, non-linear relationship between systolic blood pressure and higher mortality risk. We found no significant interaction between systolic blood pressure and HIV status for either men or women (p>0.05). Conclusions Our results indicate that HIV and elevated blood pressure are acting as separate, non-interacting epidemics affecting high proportions of the older adult population. PLWH with unsuppressed viral load were at higher mortality risk compared to those uninfected. Systolic blood pressure was a mortality risk factor independent of HIV status. As antiretroviral therapy becomes more widespread, further longitudinal follow-up is needed to understand how the dynamics of increased longevity and multimorbidity among people living with both HIV and high blood pressure, as well as the emergence of COVID-19, may alter these patterns. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-12791-z.
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Affiliation(s)
- Brian Houle
- School of Demography, The Australian National University, Canberra, Australia. .,MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
| | - Chodziwadziwa W Kabudula
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Andrea M Tilstra
- Nuffield College, University of Oxford, Oxford, UK.,Institute of Behavioral Science and Department of Sociology, University of Colorado Boulder, Boulder, USA.,Leverhulme Centre for Demographic Science, Department of Sociology, University of Oxford, Oxford, UK
| | - Sanyu A Mojola
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.,Department of Sociology, School of Public and International Affairs, and Office of Population Research, Princeton University, Princeton, USA
| | - Enid Schatz
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.,Department of Public Health, University of Missouri, Columbia, USA
| | - Samuel J Clark
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.,Department of Sociology, The Ohio State University, Columbus, USA
| | - Nicole Angotti
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.,Department of Sociology, American University, Washington, USA
| | - F Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Jane Menken
- Institute of Behavioral Science and Department of Sociology, University of Colorado Boulder, Boulder, USA
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14
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Jani C, Al Omari O, Singh H, Walker A, Patel K, Mouchati C, Radwan A, Pandit Z, Hanbury G, Crowley C, Marshall DC, Goodall R, Shalhoub J, Salciccioli JD, Tapan U. Trends of HIV-Related Cancer Mortality between 2001 and 2018: An Observational Analysis. Trop Med Infect Dis 2021; 6:tropicalmed6040213. [PMID: 34941669 PMCID: PMC8707967 DOI: 10.3390/tropicalmed6040213] [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: 10/18/2021] [Revised: 12/06/2021] [Accepted: 12/17/2021] [Indexed: 12/16/2022] Open
Abstract
The burden of AIDS-defining cancers has remained relatively steady for the past two decades, whilst the burden of non-AIDS-defining cancer has increased. Here, we conduct a study to describe mortality trends attributed to HIV-associated cancers in 31 countries. We extracted HIV-related cancer mortality data from 2001 to 2018 from the World Health Organization Mortality Database. We computed age-standardized death rates (ASDRs) per 100,000 population using the World Standard Population. Data were visualized using Locally Weighted Scatterplot Smoothing (LOWESS). Data for females were available for 25 countries. Overall, there has been a decrease in mortality attributed to HIV-associated cancers among most of the countries. In total, 18 out of 31 countries (58.0%) and 14 out of 25 countries (56.0%) showed decreases in male and female mortality, respectively. An increasing mortality trend was observed in many developing countries, such as Malaysia and Thailand, and some developed countries, such as the United Kingdom. Malaysia had the greatest increase in male mortality (+495.0%), and Canada had the greatest decrease (−88.5%). Thailand had the greatest increase in female mortality (+540.0%), and Germany had the greatest decrease (−86.0%). At the endpoint year, South Africa had the highest ASDRs for both males (16.8/100,000) and females (19.2/100,000). The lowest was in Japan for males (0.07/100,000) and Egypt for females (0.028/100,000).
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Affiliation(s)
- Chinmay Jani
- Department of Medicine, Mount Auburn Hospital/Beth Israel Lahey Health, Cambridge, MA 02138, USA; (O.A.O.); (A.W.); (Z.P.)
- Harvard Medical School, Boston, MA 02115, USA;
- MDR Collaboration, London W2 1NY, UK; (H.S.); (K.P.); (C.M.); (G.H.); (C.C.); (D.C.M.); (R.G.); (J.S.)
- Correspondence: ; Tel.: +1-857-284-3042
| | - Omar Al Omari
- Department of Medicine, Mount Auburn Hospital/Beth Israel Lahey Health, Cambridge, MA 02138, USA; (O.A.O.); (A.W.); (Z.P.)
- Harvard Medical School, Boston, MA 02115, USA;
- MDR Collaboration, London W2 1NY, UK; (H.S.); (K.P.); (C.M.); (G.H.); (C.C.); (D.C.M.); (R.G.); (J.S.)
| | - Harpreet Singh
- MDR Collaboration, London W2 1NY, UK; (H.S.); (K.P.); (C.M.); (G.H.); (C.C.); (D.C.M.); (R.G.); (J.S.)
- Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Alexander Walker
- Department of Medicine, Mount Auburn Hospital/Beth Israel Lahey Health, Cambridge, MA 02138, USA; (O.A.O.); (A.W.); (Z.P.)
- Harvard Medical School, Boston, MA 02115, USA;
| | - Kripa Patel
- MDR Collaboration, London W2 1NY, UK; (H.S.); (K.P.); (C.M.); (G.H.); (C.C.); (D.C.M.); (R.G.); (J.S.)
- Smt NHL Municipal Medical College, Ahmedabad 380006, Gujarat, India
| | - Christian Mouchati
- MDR Collaboration, London W2 1NY, UK; (H.S.); (K.P.); (C.M.); (G.H.); (C.C.); (D.C.M.); (R.G.); (J.S.)
- Department of Pediatrics, Case Western Reserve University, Cleveland, OH 44106, USA
- Department of Pediatrics, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
| | - Amr Radwan
- Department of Internal Medicine, Section of Hematology and Oncology, Boston Medical Center, Boston, MA 02118, USA; (A.R.); (U.T.)
- Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA
| | - Zuha Pandit
- Department of Medicine, Mount Auburn Hospital/Beth Israel Lahey Health, Cambridge, MA 02138, USA; (O.A.O.); (A.W.); (Z.P.)
- Harvard Medical School, Boston, MA 02115, USA;
| | - Georgina Hanbury
- MDR Collaboration, London W2 1NY, UK; (H.S.); (K.P.); (C.M.); (G.H.); (C.C.); (D.C.M.); (R.G.); (J.S.)
- Imperial College Healthcare NHS Trust, London W2 1NY, UK
| | - Conor Crowley
- MDR Collaboration, London W2 1NY, UK; (H.S.); (K.P.); (C.M.); (G.H.); (C.C.); (D.C.M.); (R.G.); (J.S.)
- Division of Pulmonary and Critical Care, Lahey Hospital, Burlington, MA 01805, USA
| | - Dominic C. Marshall
- MDR Collaboration, London W2 1NY, UK; (H.S.); (K.P.); (C.M.); (G.H.); (C.C.); (D.C.M.); (R.G.); (J.S.)
- National Heart and Lung Institute, Imperial College London, London SW3 6LY, UK
| | - Richard Goodall
- MDR Collaboration, London W2 1NY, UK; (H.S.); (K.P.); (C.M.); (G.H.); (C.C.); (D.C.M.); (R.G.); (J.S.)
- Department of Surgery and Cancer, Imperial College London, London SW7 2AZ, UK
| | - Joseph Shalhoub
- MDR Collaboration, London W2 1NY, UK; (H.S.); (K.P.); (C.M.); (G.H.); (C.C.); (D.C.M.); (R.G.); (J.S.)
- Department of Surgery and Cancer, Imperial College London, London SW7 2AZ, UK
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London W12 0HS, UK
| | - Justin D. Salciccioli
- Harvard Medical School, Boston, MA 02115, USA;
- MDR Collaboration, London W2 1NY, UK; (H.S.); (K.P.); (C.M.); (G.H.); (C.C.); (D.C.M.); (R.G.); (J.S.)
- Department of Pulmonary and Critical Care, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Umit Tapan
- Department of Internal Medicine, Section of Hematology and Oncology, Boston Medical Center, Boston, MA 02118, USA; (A.R.); (U.T.)
- Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA
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Kibuuka H, Musingye E, Mwesigwa B, Semwogerere M, Iroezindu M, Bahemana E, Maswai J, Owuoth J, Esber A, Dear N, Crowell TA, Polyak CS, Ake JA. Predictors of All-Cause Mortality among People with HIV in a Prospective Cohort Study in East Africa and Nigeria. Clin Infect Dis 2021; 75:657-664. [PMID: 34864933 PMCID: PMC9464064 DOI: 10.1093/cid/ciab995] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Indexed: 11/21/2022] Open
Abstract
Background Introduction of antiretroviral therapy (ART) has been associated with a decline in human immunodeficiency virus (HIV)-related mortality, although HIV remains a leading cause of death in sub-Saharan Africa. We describe all-cause mortality and its predictors in people living with HIV (PLWH) in the African Cohort Study (AFRICOS). Methods AFRICOS enrolls participants with or without HIV at 12 sites in Kenya, Uganda, Tanzania, and Nigeria. Evaluations every 6 months include sociobehavioral questionnaires, medical history, physical examination, and laboratory tests. Mortality data are collected from medical records and survivor interviews. Multivariable Cox proportional hazards models were used to calculate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for factors associated with mortality. Results From 2013 through 2020, 2724 PLWH completed at least 1 follow-up visit or experienced death. Of these 58.4% were females, 25.8% were aged ≥ 50 years, and 98.3% were ART-experienced. We observed 11.42 deaths per 1000 person-years (95% CI: 9.53–13.68) with causes ascertained in 54% of participants. Deaths were caused by malignancy (28.1%), infections (29.7%), and other non-HIV related conditions. Predictors of mortality included CD4 ≤ 350 cells/µL (aHR 2.01 [95% CI: 1.31–3.08]), a log10copies/mL increase of viral load (aHR 1.36 [95% CI: 1.22–1.51]), recent fever (aHR 1.85[95% CI: 1.22–2.81]), body mass index < 18.5 kg/m2 (aHR 2.20 [95% CI: 1.44–3.38]), clinical depression (aHR 2.42 [95% CI: 1.40–4.18]), World Health Organization (WHO) stage III (aHR 2.18 [95% CI: 1.31–3.61]), a g/dL increase in hemoglobin (aHR 0.79 [95% CI: .72–.85]), and every year on ART (aHR 0.67 [95% CI: .56–.81]). Conclusions The mortality rate was low in this cohort of mostly virally suppressed PLWH. Patterns of deaths and identified predictors suggest multiple targets for interventions to reduce mortality.
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Affiliation(s)
- Hannah Kibuuka
- Makerere University Walter Reed Project, Kampala, Uganda
| | - Ezra Musingye
- Makerere University Walter Reed Project, Kampala, Uganda
| | - Betty Mwesigwa
- Makerere University Walter Reed Project, Kampala, Uganda
| | | | - Michael Iroezindu
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,HJF Medical Research International, Abuja, Nigeria
| | - Emmanuel Bahemana
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,HJF Medical Research International, Mbeya, Tanzania
| | - Jonah Maswai
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,HJF Medical Research International, Kericho, Kenya
| | - John Owuoth
- U.S. Army Medical Research Directorate - Africa, Kisumu, Kenya.,HJF Medical Research International, Kisumu, Kenya
| | - Allahna Esber
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Nicole Dear
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Trevor A Crowell
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Christina S Polyak
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Julie A Ake
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
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16
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Otiende M, Bauni E, Nyaguara A, Amadi D, Nyundo C, Tsory E, Walumbe D, Kinuthia M, Kihuha N, Kahindi M, Nyutu G, Moisi J, Deribew A, Agweyu A, Marsh K, Tsofa B, Bejon P, Bottomley C, Williams TN, Scott JAG. Mortality in rural coastal Kenya measured using the Kilifi Health and Demographic Surveillance System: a 16-year descriptive analysis. Wellcome Open Res 2021. [DOI: 10.12688/wellcomeopenres.17307.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background: The Kilifi Health and Demographic Surveillance System (KHDSS) was established in 2000 to define the incidence and prevalence of local diseases and evaluate the impact of community-based interventions. KHDSS morbidity data have been reported comprehensively but mortality has not been described. This analysis describes mortality in the KHDSS over 16 years. Methods: We calculated mortality rates from 2003–2018 in four intervals of equal duration and assessed differences in mortality across these intervals by age and sex. We calculated the period survival function and median survival using the Kaplan–Meier method and mean life expectancies using abridged life tables. We estimated trend and seasonality by decomposing a time series of monthly mortality rates. We used choropleth maps and random-effects Poisson regression to investigate geographical heterogeneity. Results: Mortality declined by 36% overall between 2003–2018 and by 59% in children aged <5 years. Most of the decline occurred between 2003 and 2006. Among adults, the greatest decline (49%) was observed in those aged 15–54 years. Life expectancy at birth increased by 12 years. Females outlived males by 6 years. Seasonality was only evident in the 1–4 year age group in the first four years. Geographical variation in mortality was ±10% of the median value and did not change over time. Conclusions: Between 2003 and 2018, mortality among children and young adults has improved substantially. The steep decline in 2003–2006 followed by a much slower reduction thereafter suggests improvements in health and wellbeing have plateaued in the last 12 years. However, there is substantial inequality in mortality experience by geographical location.
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17
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Jani C, Patel K, Walker A, Singh H, Al Omari O, Crowley C, Marshall DC, Goodall R, Rupal A, Salciccioli JD, Shalhoub J. Trends of HIV Mortality between 2001 and 2018: An Observational Analysis. Trop Med Infect Dis 2021; 6:173. [PMID: 34698297 PMCID: PMC8544718 DOI: 10.3390/tropicalmed6040173] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/12/2021] [Accepted: 09/14/2021] [Indexed: 01/05/2023] Open
Abstract
Since the beginning of the epidemic in the early 1980s, HIV-related illnesses have led to the deaths of over 32.7 million individuals. The objective of this study was to describe current mortality rates for HIV through an observational analysis of HIV mortality data from 2001 to 2018 from the World Health Organization (WHO) Mortality Database. We computed age-standardized death rates (ASDRs) per 100,000 people using the World Standard Population. We plotted trends using locally weighted scatterplot smoothing (LOWESS). Data for females were available for 42 countries. In total, 31/48 (64.60%) and 25/42 (59.52%) countries showed decreases in mortality in males and females, respectively. South Africa had the highest ASDRs for both males (467.7/100,000) and females (391.1/100,000). The lowest mortalities were noted in Egypt for males (0.2/100,000) and in Japan for females (0.01/100,000). Kyrgyzstan had the greatest increase in mortality for males (+6998.6%). Estonia had the greatest increase in mortality for females (+5877.56%). The disparity between Egypt (the lowest) and South Africa (the highest) was 3042-fold for males. Between Japan and South Africa, the disparity was 43,454-fold for females. Although there was a decrease in mortality attributed to HIV among most of the countries studied, a rising trend remained in a number of developing countries.
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Affiliation(s)
- Chinmay Jani
- Department of Medicine, Mount Auburn Hospital/Beth Israel Lahey Health, Cambridge, MA 02138, USA; (A.W.); (O.A.O.); (A.R.)
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA;
- Medical Data Research Collaborative, London W2 1NY, UK; (H.S.); (C.C.); (D.C.M.); (R.G.); (J.S.)
| | - Kripa Patel
- Smt NHL Municipal Medical College, Ahmedabad 380006, Gujarat, India;
| | - Alexander Walker
- Department of Medicine, Mount Auburn Hospital/Beth Israel Lahey Health, Cambridge, MA 02138, USA; (A.W.); (O.A.O.); (A.R.)
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA;
- Medical Data Research Collaborative, London W2 1NY, UK; (H.S.); (C.C.); (D.C.M.); (R.G.); (J.S.)
| | - Harpreet Singh
- Medical Data Research Collaborative, London W2 1NY, UK; (H.S.); (C.C.); (D.C.M.); (R.G.); (J.S.)
- Division of Pulmonary and Critical Care, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Omar Al Omari
- Department of Medicine, Mount Auburn Hospital/Beth Israel Lahey Health, Cambridge, MA 02138, USA; (A.W.); (O.A.O.); (A.R.)
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA;
- Medical Data Research Collaborative, London W2 1NY, UK; (H.S.); (C.C.); (D.C.M.); (R.G.); (J.S.)
| | - Conor Crowley
- Medical Data Research Collaborative, London W2 1NY, UK; (H.S.); (C.C.); (D.C.M.); (R.G.); (J.S.)
- Division of Pulmonary and Critical Care, Lahey Hospital, Burlington, MA 01805, USA
| | - Dominic C. Marshall
- Medical Data Research Collaborative, London W2 1NY, UK; (H.S.); (C.C.); (D.C.M.); (R.G.); (J.S.)
- National Heart and Lung Institute, Imperial College London, London SW3 6LY, UK
| | - Richard Goodall
- Medical Data Research Collaborative, London W2 1NY, UK; (H.S.); (C.C.); (D.C.M.); (R.G.); (J.S.)
- Department of Surgery and Cancer, Imperial College London, London SW7 5NH, UK
| | - Arashdeep Rupal
- Department of Medicine, Mount Auburn Hospital/Beth Israel Lahey Health, Cambridge, MA 02138, USA; (A.W.); (O.A.O.); (A.R.)
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA;
- Medical Data Research Collaborative, London W2 1NY, UK; (H.S.); (C.C.); (D.C.M.); (R.G.); (J.S.)
| | - Justin D. Salciccioli
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA;
- Medical Data Research Collaborative, London W2 1NY, UK; (H.S.); (C.C.); (D.C.M.); (R.G.); (J.S.)
- Division of Pulmonary and Critical Care, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Joseph Shalhoub
- Medical Data Research Collaborative, London W2 1NY, UK; (H.S.); (C.C.); (D.C.M.); (R.G.); (J.S.)
- Department of Surgery and Cancer, Imperial College London, London SW7 5NH, UK
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London W2 1NY, UK
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18
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Silhol R, Coupland H, Baggaley RF, Miller L, Staadegaard L, Gottlieb SL, Stannah J, Turner KME, Vickerman P, Hayes R, Mayaud P, Looker KJ, Boily MC. What Is the Burden of Heterosexually Acquired HIV Due to HSV-2? Global and Regional Model-Based Estimates of the Proportion and Number of HIV Infections Attributable to HSV-2 Infection. J Acquir Immune Defic Syndr 2021; 88:19-30. [PMID: 34117163 PMCID: PMC8397258 DOI: 10.1097/qai.0000000000002743] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 05/20/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Biological and epidemiological evidence suggest that herpes simplex virus type 2 (HSV-2) elevates HIV acquisition and transmission risks. We improved previous estimates of the contribution of HSV-2 to HIV infections by using a dynamic transmission model. SETTING World Health Organization regions. METHODS We developed a mathematical model of HSV-2/HIV transmission among 15- to 49-year-old heterosexual, non-drug-injecting populations, calibrated using region-specific demographic and HSV-2/HIV epidemiological data. We derived global and regional estimates of the contribution of HSV-2 to HIV infection over 10 years [the transmission population-attributable fraction (tPAF)] under 3 additive scenarios, assuming: (1) HSV-2 increases only HIV acquisition risk (conservative); (2) HSV-2 also increases HIV transmission risk (liberal); and (3) HIV or antiretroviral therapy (ART) also modifies HSV-2 transmission risk, and HSV-2 decreases ART effect on HIV transmission risk (fully liberal). RESULTS Under the conservative scenario, the predicted tPAF was 37.3% (95% uncertainty interval: 33.4%-43.2%), and an estimated 5.6 (4.5-7.0) million incident heterosexual HIV infections were due to HSV-2 globally over 2009-2018. The contribution of HSV-2 to HIV infections was largest for the African region [tPAF = 42.6% (38.0%-51.2%)] and lowest for the European region [tPAF = 11.2% (7.9%-13.8%)]. The tPAF was higher among female sex workers, their clients, and older populations, reflecting their higher HSV-2 prevalence. The tPAF was approximately 50% and 1.3- to 2.4-fold higher for the liberal or fully liberal scenario than the conservative scenario across regions. CONCLUSION HSV-2 may have contributed to at least 37% of incident HIV infections in the past decade worldwide, and even more in Africa, and may continue to do so despite increased ART access unless future improved HSV-2 control measures, such as vaccines, become available.
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Affiliation(s)
- Romain Silhol
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London
| | - Helen Coupland
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London
| | - Rebecca F. Baggaley
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London
- Department of Respiratory Sciences, University of Leicester
| | - Lori Miller
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Lisa Staadegaard
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London
| | - Sami L. Gottlieb
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - James Stannah
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal (QC), Canada
| | | | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Richard Hayes
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Philippe Mayaud
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Katharine J. Looker
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Marie-Claude Boily
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London
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19
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Wong EB, Olivier S, Gunda R, Koole O, Surujdeen A, Gareta D, Munatsi D, Modise TH, Dreyer J, Nxumalo S, Smit TK, Ording-Jespersen G, Mpofana IB, Khan K, Sikhosana ZEL, Moodley S, Shen YJ, Khoza T, Mhlongo N, Bucibo S, Nyamande K, Baisley KJ, Cuadros D, Tanser F, Grant AD, Herbst K, Seeley J, Hanekom WA, Ndung'u T, Siedner MJ, Pillay D. Convergence of infectious and non-communicable disease epidemics in rural South Africa: a cross-sectional, population-based multimorbidity study. Lancet Glob Health 2021; 9:e967-e976. [PMID: 34143995 PMCID: PMC8220132 DOI: 10.1016/s2214-109x(21)00176-5] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND There has been remarkable progress in the treatment of HIV throughout sub-Saharan Africa, but there are few data on the prevalence and overlap of other significant causes of disease in HIV endemic populations. Our aim was to identify the prevalence and overlap of infectious and non-communicable diseases in such a population in rural South Africa. METHODS We did a cross-sectional study of eligible adolescents and adults from the Africa Health Research Institute demographic surveillance area in the uMkhanyakude district of KwaZulu-Natal, South Africa. The participants, who were 15 years or older, were invited to participate at a mobile health camp. Medical history for HIV, tuberculosis, hypertension, and diabetes was established through a questionnaire. Blood pressure measurements, chest x-rays, and tests of blood and sputum were taken to estimate the population prevalence and geospatial distribution of HIV, active and lifetime tuberculosis, elevated blood glucose, elevated blood pressure, and combinations of these. FINDINGS 17 118 adolescents and adults were recruited from May 25, 2018, to Nov 28, 2019, and assessed. Overall, 52·1% (95% CI 51·3-52·9) had at least one active disease. 34·2% (33·5-34·9) had HIV, 1·4% (1·2-1·6) had active tuberculosis, 21·8% (21·2-22·4) had lifetime tuberculosis, 8·5% (8·1-8·9) had elevated blood glucose, and 23·0% (22·4-23·6) had elevated blood pressure. Appropriate treatment and optimal disease control was highest for HIV (78·1%), and lower for elevated blood pressure (42·5%), active tuberculosis (29·6%), and elevated blood glucose (7·1%). Disease prevalence differed notably by sex, across age groups, and geospatially: men had a higher prevalence of active and lifetime tuberculosis, whereas women had a substantially high prevalence of HIV at 30-49 years and an increasing prevalence of multiple and poorly controlled non-communicable diseases when older than 50 years. INTERPRETATION We found a convergence of infectious and non-communicable disease epidemics in a rural South African population, with HIV well treated relative to all other diseases, but tuberculosis, elevated blood glucose, and elevated blood pressure poorly diagnosed and treated. A public health response that expands the successes of the HIV testing and treatment programme to provide multidisease care targeted to specific populations is required to optimise health in such settings in sub-Saharan Africa. FUNDING Wellcome Trust, Bill & Melinda Gates Foundation, the South African Department of Science and Innovation, South African Medical Research Council, and South African Population Research Infrastructure Network. TRANSLATION For the isiZulu translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Emily B Wong
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa; Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA; Division of Infectious Diseases, University of Alabama Birmingham, Birmingham, AL, USA; Division of Infection and Immunity, University College London, London, UK.
| | - Stephen Olivier
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa
| | - Resign Gunda
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa; School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Olivier Koole
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa; London School of Hygiene & Tropical Medicine, London, UK
| | - Ashmika Surujdeen
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa
| | - Dickman Gareta
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa
| | - Day Munatsi
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa
| | | | - Jaco Dreyer
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa
| | - Siyabonga Nxumalo
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa
| | - Theresa K Smit
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa
| | | | | | - Khadija Khan
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa
| | | | - Sashen Moodley
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa
| | - Yen-Ju Shen
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa
| | - Thandeka Khoza
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa
| | - Ngcebo Mhlongo
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa
| | - Sanah Bucibo
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa
| | - Kennedy Nyamande
- Department of Pulmonology and Critical Care, Inkosi Albert Luthuli Hospital, Durban, South Africa; Department of Respiratory Medicine, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Kathy J Baisley
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa; London School of Hygiene & Tropical Medicine, London, UK
| | - Diego Cuadros
- Department of Geography, University of Cincinnati, USA
| | - Frank Tanser
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa; School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa; Lincoln International Institute for Rural Health, University of Lincoln, UK; Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Durban, South Africa
| | - Alison D Grant
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa; School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa; London School of Hygiene & Tropical Medicine, London, UK; School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Kobus Herbst
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa; Department of Science and Innovation, Medical Research Council, South African Population Research Infrastructure, Durban, South Africa
| | - Janet Seeley
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa; London School of Hygiene & Tropical Medicine, London, UK
| | - Willem A Hanekom
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa; Division of Infection and Immunity, University College London, London, UK
| | - Thumbi Ndung'u
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa; Division of Infection and Immunity, University College London, London, UK; HIV Pathogenesis Programme, Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa; The Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology and Harvard Medical School, Cambridge, MA, USA; Max Planck Institute for Infection Biology, Berlin, Germany
| | - Mark J Siedner
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa; Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA; School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Deenan Pillay
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa; Division of Infection and Immunity, University College London, London, UK
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20
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Silhol R, Baral S, Bowring AL, Mukandavire C, Njindam IM, Rao A, Schwartz S, Tamoufe U, Billong SC, Njoya O, Zoung-Kanyi Bissek AC, Calleja JMG, Vickerman P, Mishra S, Boily MC. Quantifying the Evolving Contribution of HIV Interventions and Key Populations to the HIV Epidemic in Yaoundé, Cameroon. J Acquir Immune Defic Syndr 2021; 86:396-405. [PMID: 33234807 DOI: 10.1097/qai.0000000000002580] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 11/04/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Key populations (KP) including men who have sex with men (MSM), female sex workers (FSW), and their clients are disproportionately affected by HIV in Sub-Saharan Africa. We estimated the evolving impact of past interventions and contribution of unmet HIV prevention/treatment needs of key populations and lower-risk groups to HIV transmission. SETTING Yaoundé, Cameroon. METHODS We parametrized and fitted a deterministic HIV transmission model to Yaoundé-specific demographic, behavioral, HIV, and intervention coverage data in a Bayesian framework. We estimated the fraction of incident HIV infections averted by condoms and antiretroviral therapy (ART) and the fraction of all infections over 10-year periods directly and indirectly attributable to sex within and between each risk group. RESULTS Condom use and ART together may have averted 43% (95% uncertainty interval: 31-54) of incident infections over 1980-2018 and 72% (66-79) over 2009-2018. Most onward transmissions over 2009-2018 stemmed from sex between lower-risk individuals [47% (32-61)], clients [37% (23-51)], and MSM [35% (20-54)] with all their partners. The contribution of commercial sex decreased from 25% (8-49) over 1989-1998 to 8% (3-22) over 2009-2018, due to higher intervention coverage among FSW. CONCLUSION Condom use and recent ART scale-up mitigated the HIV epidemic in Yaoundé and changed the contribution of different partnerships to onward transmission over time. Findings highlight the importance of prioritizing HIV prevention and treatment for MSM and clients of FSW whose unmet needs now contribute most to onward transmission, while maintaining services that successfully reduced transmissions in the context of commercial sex.
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Affiliation(s)
- Romain Silhol
- Department of Infectious Disease Epidemiology, Imperial College London, HPTN Modelling Centre, London, United Kingdom
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Anna L Bowring
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
- Burnet Institute, Melbourne, Australia
| | - Christinah Mukandavire
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
| | - Iliassou M Njindam
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Amrita Rao
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Sheree Schwartz
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Ubald Tamoufe
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
- Metabiota, Yaoundé, Cameroon
| | - Serge C Billong
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
- National AIDS Control Committee (NACC/CNLS), Yaoundé, Cameroon
| | - Oudou Njoya
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Anne-Cecile Zoung-Kanyi Bissek
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
- Division of Operations Research, Ministry of Health, Yaoundé, Cameroon
| | | | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Sharmistha Mishra
- St. Michael's Hospital, Li Ka Shing Knowledge Institute, University of Toronto, Toronto, Canada; and
- Division of Infectious Disease, Department of Medicine, University of Toronto, Toronto, Canada
| | - Marie-Claude Boily
- Department of Infectious Disease Epidemiology, Imperial College London, HPTN Modelling Centre, London, United Kingdom
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
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21
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Birhanu H, Alle A, Birhanu MY. Rate and Predictors of Mortality Among Adults on Antiretroviral Therapy at Debre Markos Referral Hospital, North West Ethiopia. HIV AIDS (Auckl) 2021; 13:251-259. [PMID: 33688265 PMCID: PMC7936681 DOI: 10.2147/hiv.s294111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 02/17/2021] [Indexed: 11/23/2022] Open
Abstract
Background Human immunodeficiency virus/Acquired immunodeficiency syndrome is a chronic communicable disease with devastating global socio-economic, and political impacts commonly affecting the young and early adult populations. Ethiopia is doing well in controlling HIV/AIDS epidemic infection among African countries. This study set out to determine the mortality rate and its predictors among adults on antiretroviral therapy at Debre Markos Referral Hospital, northwest Ethiopia. Methods A hospital-based retrospective follow-up study was conducted from February to March 2018. A computer-generated simple random sample selected 480 cards of patients on antiretroviral therapy who were enrolled between February 2010 to January 2018. Epi-data Version 4.2 software was used for data entry and SPSS Version 25 for management and analysis. An adjusted hazard rate with a 95% confidence interval was used to identify significant predictors of mortality. Results The mortality rate was about 3.9 per 100 person-years. Cotrimoxazole prophylactic therapy (AHR: 2.99; 95% CI: 1.58, 5.70), being single (AHR: 2.37: 95% CI: 1.15, 4.87), non-disclosed status (AHR: 7.77; 95% CI: 3.76, 16.06), anemia (AHR: 2.16; 95% CI: 1.14, 4.09), bedridden (AHR: 6.11; 95% CI: 2.42, 15.41) or ambulatory (AHR: 2.16; 95%: 1.04, 4.51), presence of opportunistic infections (OIs) (AHR: 5.02; 95% CI: 1.70, 14.83) and tuberculosis (TB) co-infection (AHR: 5.57; 95% CI: 2.23, 13.88) were the significant predictors. Conclusion and Recommendation This study had a high mortality rate. Being single, bedridden, TB coinfection, anemia, and cotrimoxazole prophylaxis were the predictors of mortality. Therefore, psychological support and close follow-up for single, non-disclosed, non-adherent patients and early detection and treatment of anemia, tuberculosis, and OIs to reduce mortality is recommended.
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Affiliation(s)
| | - Atsede Alle
- Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Molla Yigzaw Birhanu
- Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
- Correspondence: Molla Yigzaw Birhanu P. O. Box 269 Email
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Lopez-Varela E, Augusto O, Fuente-Soro L, Sacoor C, Nhacolo A, Casavant I, Karajeanes E, Vaz P, Naniche D. Quantifying the gender gap in the HIV care cascade in southern Mozambique: We are missing the men. PLoS One 2021; 16:e0245461. [PMID: 33577559 PMCID: PMC7880488 DOI: 10.1371/journal.pone.0245461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 01/04/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND HIV-infected men have higher rates of delayed diagnosis, reduced antiretroviral treatment (ART) retention and mortality than women. We aimed to assess, by gender, the first two UNAIDS 90 targets in rural southern Mozambique. METHODS This analysis was embedded in a larger prospective cohort enrolling individuals with new HIV diagnosis between May 2014-June 2015 from clinic and home-based testing (HBT). We assessed gender differences between steps of the HIV-cascade. Adjusted HIV-community prevalence was estimated using multiple imputation (MI). RESULTS Among 11,773 adults randomized in HBT (7084 female and 4689 male), the response rate before HIV testing was 48.7% among eligible men and 62.0% among women (p<0.001). MI did not significantly modify all-age HIV-prevalence for men but did decrease prevalence estimates in women from 36.4%to 33.0%. Estimated proportion of HIV-infected individuals aware of their status was 75.9% for men and 88.9% for women. In individuals <25 years, we observed up to 22.2% disparity in awareness of serostatus between genders. Among individuals eligible for ART, similar proportions of men and women initiated treatment (81.2% and 85.9%, respectively). Fourfold more men than womenwere in WHO stage III/IV AIDS at first clinical visit. Once on ART, men had a twofold higher 18-month loss to follow-up rate than women. CONCLUSION The contribution of missing HIV-serostatus data differentially impacted indicators of HIV prevalence and of achievement of UNAIDS targets by age and gender and men were missing long before the second 90. Increased efforts to characterize missing men and their needs will and their needs will allow us to urgently address the barriers to men accessing care and ensure men are not left behind in the UNAIDS 90-90-90 targets achievement.
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Affiliation(s)
- Elisa Lopez-Varela
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- ISGlobal, Instituto de Salud Global de Barcelona, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
| | - Orvalho Augusto
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Facultade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Laura Fuente-Soro
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- ISGlobal, Instituto de Salud Global de Barcelona, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
| | - Charfudin Sacoor
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Ariel Nhacolo
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | | | | | - Paula Vaz
- Fundação Ariel Glaser Contra o SIDA Pediátrico, Maputo, Mozambique
| | - Denise Naniche
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- ISGlobal, Instituto de Salud Global de Barcelona, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
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Gregson S, Nyamukapa C. Did sexual behaviour differences between HIV infection and treatment groups offset the preventative biological effects of ART roll-out in Zimbabwe? Population Studies 2021; 75:457-476. [PMID: 33559537 DOI: 10.1080/00324728.2021.1874043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Declines in HIV incidence have been slower than expected during the roll-out of antiretroviral treatment (ART) services in sub-Saharan African populations suffering generalized epidemics. Using data from a population-based, open cohort HIV sero-survey (2004-13), we found evidence for initial reductions in sexual activity and multiple sexual partnerships, followed by increases during the period of ART scale-up in areas of high HIV prevalence in Manicaland, east Zimbabwe. Recent population-level increases in condom use were also recorded, but largely reflected high use by the rapidly growing proportion of HIV-infected individuals on treatment. Sexual risk behaviour increased in susceptible uninfected individuals and in untreated (and therefore more infectious) HIV-infected men, which may have slowed the decline in HIV incidence in this area. Intensified primary HIV prevention programmes, together with strengthened risk screening, referral, and support services following HIV testing, could help to maximize the impact of 'test-and-treat' programmes in reducing new infections.
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Affiliation(s)
- Simon Gregson
- Imperial College London.,Biomedical Research and Training Institute
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24
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Murugavel KG, Thakar M, Mehendale S. Recent HIV infection testing algorithms. Indian J Med Res 2020; 152:181-183. [PMID: 33107480 PMCID: PMC7881816 DOI: 10.4103/ijmr.ijmr_2576_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- K G Murugavel
- Division of Immunology, YRG CARE, Chennai 600 113, Tamil Nadu, India
| | - Madhuri Thakar
- Department of Immunology & Serology, ICMR-National AIDS Research Institute, Pune 411 026, Maharashtra, India
| | - Sanjay Mehendale
- Director Research, P.D. Hinduja National Hospital & Medical Research Center, Mumbai, 400 016, Maharashtra, India
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Zeng YQ, Xiao J, Li CL, Wang Y, Zhang L, Pang XL, Wang D, Du J, Zhao HX. Prevalence and risk factors for bone mineral density changes in antiretroviral therapy-naive human immunodeficiency virus-infected adults: a Chinese cohort study. Chin Med J (Engl) 2020; 133:2940-2946. [PMID: 33278100 PMCID: PMC7752695 DOI: 10.1097/cm9.0000000000001317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background Studies have reported that low bone mineral density (BMD) is prevalent in human immunodeficiency virus (HIV)-infected patients; however, the factors that contribute to HIV-related BMD changes are yet to be fully understood. Due to the application of dual X-ray absorptiometry (DXA) among a select group of hospitals only, the prevalence and risk factors of low BMD in HIV-infected populations have not been intensively investigated in China. Thus, the aim of our study was to investigate the prevalence of and risk factors associated with BMD changes among antiretroviral therapy (ART)-naive HIV-positive patients in China. Methods The assessment of the prevalence of and risk factors associated with BMD changes was conducted among 156 ART-naive HIV-infected patients. Demographic and clinical data, as well as results of fasting blood tests were obtained from patients. Further, all patients underwent DXA scans to determine BMD, which was then used to classify patients with osteopenia/osteoporosis. The risk factors of reduced BMD were then evaluated using binary logistic regression. Results Among the 156 ART-naive HIV-infected participants, osteopenia and osteoporosis were diagnosed in 48.7% (76/156) and 4.5% (7/156) of patients, respectively. The lumbar spine was most likely to have reduced BMD (49.4% [77/156]), and the proportion of osteopenia in the left hip (32.7% [51/156]) was higher than in the right hip (24.4% [38/156]). In the lumbar spine, bone loss rate in the L1 section (60.9% [95/156]) was the most significant (L2, 53.2% [83/156]; L3, 45.5% [71/156]; L4, 52.6% [82/156]). Further analysis showed that, compared with the neck (26.9% [42/156] in the left, 18.6% [29/156] in the right) and the interior (15.4% [24/156] in the left, 13.5% [21/156] in the right), the trochanter had the greatest probability of reduced BMD (46.2% [72/156] in the left, 28.8% [45/156] in the right). In the risk factor analysis, low body mass index (BMI: <18.5 kg/m2) was positively associated with reduced BMD (Exp (B) = 39.743, 95% confidence interval: 3.234–488.399, P = 0.004), and was specifically positively correlated with BMD values at three sites (r = 0.335 at right hip, r = 0.327 at left hip, r = 0.311 at lumbar spine). Conclusion Reduced BMD was found in the majority of ART-naive HIV-infected patients and BMI was identified as an additional risk factor for reduced BMD. Our results show that BMD reduction was simultaneously present in the left hip, right hip, and lumbar spine among nearly one fifth of patients. Our work highlights the importance of closely monitoring BMD in ART-naive patients and provides a foundation for the clinical intervention of bone demineralization in them.
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Affiliation(s)
- Yong-Qin Zeng
- Department of Infection, Beijing Ditan Hospital, Peking University, Beijing 100015, China
| | - Jiang Xiao
- Clinical and Research Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Cui-Lin Li
- Department of Infection, Beijing Ditan Hospital, Peking University, Beijing 100015, China
| | - Yu Wang
- Clinical and Research Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Ling Zhang
- Clinical and Research Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Xiao-Li Pang
- Clinical and Research Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Di Wang
- Clinical and Research Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Juan Du
- Clinical and Research Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Hong-Xin Zhao
- Department of Infection, Beijing Ditan Hospital, Peking University, Beijing 100015, China.,Clinical and Research Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
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26
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Androutsakos T, Schina M, Pouliakis A, Kontos A, Sipsas N, Hatzis G. Liver Fibrosis Assessment in a Cohort of Greek HIV Mono-Infected Patients by Non-Invasive Biomarkers. Curr HIV Res 2020; 17:173-182. [PMID: 31549590 DOI: 10.2174/1570162x17666190809153245] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 07/26/2019] [Accepted: 08/03/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Non-alcoholic Fatty Liver Disease (NAFLD) is common in HIV-infected individuals. Liver biopsy remains the gold-standard procedure for the diagnosis of liver fibrosis, but both Transient Elastography (TE) and Non-invasive Biomarkers (NIBMs) have emerged as alternatives. OBJECTIVES Our study's aim was to validate commonly used NIBMs for the assessment of liver fibrosis in a cohort of Greek HIV-mono-infected patients. METHODS Inclusion criteria were confirmed HIV-infection and age>18 years and exclusion criteria HBV or HCV seropositivity, liver disease other than NAFLD, alcohol abuse, ascites, transaminases levels>4xULN(upper limit of normal) and Body-Mass index(BMI)>40. Liver stiffness (LS) measurement with TE and thorough laboratory work up and medical history were acquired at study entry. FIB-4, APRI, NFS, BARD, Forns and Lok scores were calculated for each patient. RESULTS A total of 157 patients were eligible for this study. Significant liver fibrosis, compatible with Metavir score of F3-F4, was found in only 11(7%) patients. These findings were in accordance with those of the NIBMs; the BARD score constituting the only exception, allocating 102(65%) patients as having significant liver fibrosis. In order to obtain a balance between sensitivity and specificity new cut-offs for each NIBM were calculated; FIB-4 score yielded the best results, since by changing the cut-off to 1.49 a sensitivity and specificity balanced for both close to 85% was achieved. CONCLUSION Our findings suggest that NIBMs can be used for the evaluation of liver fibrosis in HIV mono-infected patients. New cut-offs for NIBMs should probably be calculated, to help distinguishing patients with significant from those with mild/no fibrosis.
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Affiliation(s)
- Theodoros Androutsakos
- Department of Pathophysiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Schina
- Liver unit, Euroclinic of Athens, Athens, Greece
| | - Abraham Pouliakis
- Second Department of Pathology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Nikolaos Sipsas
- Department of Pathophysiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Infectious Diseases Unit, Laiko General Hospital, Athens, Greece
| | - Gregorios Hatzis
- Department of Pathophysiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Fearon E, Tenza S, Mokoena C, Moodley K, Smith AD, Bourne A, Weatherburn P, Palanee-Phillips T. HIV testing, care and viral suppression among men who have sex with men and transgender individuals in Johannesburg, South Africa. PLoS One 2020; 15:e0234384. [PMID: 32555703 PMCID: PMC7299351 DOI: 10.1371/journal.pone.0234384] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 05/26/2020] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Men who have sex with men and transgender individuals (MSM/TG) carry a disproportionately high burden of HIV, including in South Africa. However, there are few empirical population-representative estimates of viral suppression and the HIV care cascade including HIV testing among this population, nor of factors associated with these outcomes. METHODS We conducted a respondent driven sampling (RDS) survey among 301 MSM/TG in Johannesburg in 2017. Participants gave blood samples for HIV testing and viral load. Participants self-completed a survey including sociodemographics, HIV testing history, and engagement in care. We calculated RDS-II weighted estimates of the percentage of HIV-negative MSM/TG reporting HIV testing in the previous 6 months, their testing experience and preferences. Among those HIV-positive, we estimated the percentage status-aware, on ART, and virally suppressed (<50 viral copies/ml plasma). We conducted RDS-weighted robust Poisson regression to obtain weighted prevalence ratios of factors associated with 1) HIV testing among those HIV-negative; and 2) viral suppression among those HIV-positive. RESULTS There were 118/300 HIV-positive MSM/TG, (37.5%). Of the HIV-negative MSM/TG, 61.5% reported that they had tested for HIV in the previous 6 months, which was associated with selling sex to men (Prevalence Ratio = 1.67, 95% CI 1.36-2.05). There were 76/118 HIV-positive MSM/TG (56.5%) who reported having previously tested positive for HIV and 39/118 (30.0%) who reported current ART. There were 58/118 HIV-positive MSM/TG with viral loads <50 copies/ml plasma (46.9%). Viral suppression was associated with older age (adjusted PR = 1.03, 95% CI 1.00-1.06 for each year), neighbourhood, and having bought sex from men (adjusted PR = 1.53, 95% CI 1.12-2.08). CONCLUSIONS HIV prevalence was very high. Viral suppression among those HIV-positive was similar to the general male population in South Africa, but remains far short of national and international targets. A majority of HIV-negative MSM/TG had HIV tested in the previous 6 months, though there is room for improvement.
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Affiliation(s)
- Elizabeth Fearon
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Siyanda Tenza
- Wits Reproductive Health and HIV Institute, Johannesburg, South Africa
| | - Cecilia Mokoena
- Wits Reproductive Health and HIV Institute, Johannesburg, South Africa
| | - Kerushini Moodley
- Wits Reproductive Health and HIV Institute, Johannesburg, South Africa
| | - Adrian D. Smith
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Adam Bourne
- Australian Research Centre in Sex, Health and Society, LaTrobe University, Melbourne, Australia
| | - Peter Weatherburn
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, United Kingdom
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HIV-Related Deaths in Nairobi, Kenya: Results From a HIV Mortuary Surveillance Study, 2015. J Acquir Immune Defic Syndr 2019; 81:18-23. [PMID: 30964803 DOI: 10.1097/qai.0000000000001975] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Death is an important but often unmeasured endpoint in public health HIV surveillance. We sought to describe HIV among deaths using a novel mortuary-based approach in Nairobi, Kenya. METHODS Cadavers aged 15 years and older at death at Kenyatta National Hospital (KNH) and City Mortuaries were screened consecutively from January 29 to March 3, 2015. Cause of death was abstracted from medical files and death notification forms. Cardiac blood was drawn and tested for HIV infection using the national HIV testing algorithm followed by viral load testing of HIV-positive samples. RESULTS Of 807 eligible cadavers, 610 (75.6%) had an HIV test result available. Cadavers from KNH had significantly higher HIV positivity at 23.2% (95% CI: 19.3 to 27.7) compared with City Mortuary at 12.6% (95% CI: 8.8 to 17.8), P < 0.001. HIV prevalence was significantly higher among women than men at both City (33.3% vs. 9.2%, P = 0.008) and KNH Mortuary (28.8% vs. 19.0%, P = 0.025). Half (53.3%) of HIV-infected cadavers had no diagnosis before death, and an additional 22.2% were only diagnosed during hospitalization leading to death. Although not statistically significant, 61.9% of males had no previous diagnosis compared with 45.8% of females (P = 0.144). Half (52.3%) of 44 cadavers at KNH with HIV diagnosis before death were on treatment, and 1 in 5 (22.7%) with a previous diagnosis had achieved viral suppression. CONCLUSIONS HIV prevalence was high among deaths in Nairobi, especially among women, and previous diagnosis among cadavers was low. Establishing routine mortuary surveillance can contribute to monitoring HIV-associated deaths among cadavers sent to mortuaries.
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Global variations in mortality in adults after initiating antiretroviral treatment: an updated analysis of the International epidemiology Databases to Evaluate AIDS cohort collaboration. AIDS 2019; 33 Suppl 3:S283-S294. [PMID: 31800405 PMCID: PMC6919233 DOI: 10.1097/qad.0000000000002358] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND UNAIDS models use data from the International epidemiology Databases to Evaluate AIDS (IeDEA) collaboration in setting assumptions about mortality rates after antiretroviral treatment (ART) initiation. This study aims to update these assumptions with new data, to quantify the extent of regional variation in ART mortality and to assess trends in ART mortality. METHODS Adult ART patients from Africa, Asia and the Americas were included if they had a known date of ART initiation during 2001-2017 and a baseline CD4 cell count. In cohorts that relied only on passive follow-up (no patient tracing or linkage to vital registration systems), mortality outcomes were imputed in patients lost to follow-up based on a meta-analysis of tracing study data. Poisson regression models were fitted to the mortality data. RESULTS 464 048 ART patients were included. In multivariable analysis, mortality rates were lowest in Asia and highest in Africa, with no significant differences between African regions. Adjusted mortality rates varied significantly between programmes within regions. Mortality rates in the first 12 months after ART initiation were significantly higher during 2001-2006 than during 2010-2014, although the difference was more substantial in Asia and the Americas [adjusted incidence rate ratio (aIRR) 1.43, 95% CI: 1.22-1.66] than in Africa (aIRR 1.07, 95% CI: 1.04-1.11). CONCLUSION There is substantial variation in ART mortality between and within regions, even after controlling for differences in mortality by age, sex, baseline CD4 category and calendar period. ART mortality rates have declined substantially over time, although declines have been slower in Africa.
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Abstract
OBJECTIVE HIV-associated mortality rates in Africa decreased by 10-20% annually in 2003-2011, after the introduction of antiretroviral therapy (ART). We sought to document HIV-associated mortality rates in the general population in Kenya after 2011 in an era of expanded access to ART. DESIGN We obtained data on mortality rates and migration from a health and demographic surveillance system (HDSS) in Gem, western Kenya, and data for HDSS residents aged 15-64 years from home-based HIV counseling and testing (HBCT) rounds in 2011, 2012, 2013, and 2016. METHODS Mortality trends were determined among a closed cohort of residents who participated in at least the 2011 round of HBCT. RESULTS Of 32 467 eligible HDSS residents, 22 688 (70%) participated in the 2011 round and comprised the study cohort. All-cause mortality rates declined from 10.0 [95% confidence interval (CI) 8.4-11.7] per 1000 in 2011 to 7.4 (95% CI 5·7-9·0) in 2016, whereas the mortality rate was stable among HIV-uninfected residents, at 5.7 per 1000 person-years. Among HIV-infected residents, mortality rates declined from 30.5 per 1000 in 2011 to 15.9 per 1000 in 2016 (average decline 6% per year). The HIV-infected group receiving ART had higher mortality rates than the HIV-uninfected group [adjusted rate ratio (aRR) 2.8, 95% CI 2.2-3.4], as did the HIV-infected group who did not receive ART (aRR 5.3, 95% CI 4.5-6.2). CONCLUSIONS Mortality rates among HIV-infected individuals declined substantially during ART expansion between 2011 and 2016, though less than during early ART introduction. Mortality trends among HIV-infected populations are critical to understanding epidemic dynamics.
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Olakunde BO, Adeyinka DA, Olawepo JO, Pharr JR. HIV testing among men in Nigeria: a comparative analysis between young people and adults. AIDS Care 2019; 32:155-162. [PMID: 31137949 DOI: 10.1080/09540121.2019.1622642] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
HIV testing among men is critical to ending the HIV epidemic in sub-Saharan Africa. Using the Multiple Indicator Cluster Survey, 2016/2017, we examined the uptake and determinants of HIV testing among sexually active men in Nigeria. A total of 1254 young people (15-24 years) and 7866 adults (25-49 years) were included in the analysis. We conducted binary logistic regression analyses to estimate the odds ratio (OR) and adjusted OR for testing for HIV in the last 12 months preceding the survey. Approximately 18.7% of men had tested for HIV (young people [17%] vs. adult [19%], p=0.125). The overall adjusted model showed that the likelihood of HIV testing was significantly higher among those with at least primary education, currently married, who used condom at last sexual intercourse, who drank alcohol one month preceding the survey, with no discriminatory attitudes towards people living with HIV (PLHIV), exposed to media, in the rich and richest quintiles, and in the North Central Zone. Education, geopolitical zone, and discriminatory attitudes towards PLHIV were the significant factors common to both age groups. Our results suggest that HIV testing among sexually active men in Nigeria is low, and the determinants vary between young people and adults.
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Affiliation(s)
- Babayemi O Olakunde
- School of Public Health, University of Nevada, Las Vegas, NV, USA.,National Agency for the Control of AIDS, Abuja, Nigeria
| | - Daniel A Adeyinka
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Canada.,National AIDS & STIs Control Programme, Federal Ministry of Health, Abuja, Nigeria
| | - John O Olawepo
- School of Public Health, University of Nevada, Las Vegas, NV, USA.,Caritas Nigeria, Abuja, Nigeria
| | - Jennifer R Pharr
- School of Public Health, University of Nevada, Las Vegas, NV, USA
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Raberahona M, Lidamahasolo Z, Andriamamonjisoa J, Andriananja V, Andrianasolo RL, Rakotoarivelo RA, Randria MJDD. Knowledge, attitudes, perception and practices regarding antiretroviral therapy among HIV-infected adults in Antananarivo, Madagascar: a cross-sectional survey. BMC Health Serv Res 2019; 19:341. [PMID: 31138303 PMCID: PMC6537363 DOI: 10.1186/s12913-019-4173-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 05/20/2019] [Indexed: 01/05/2023] Open
Abstract
Background Adherence to antiretroviral therapy (ART) may be influenced by knowledge, perception and perception regarding ART. The purpose of this study was to assess knowledge, attitude/perception and practice regarding ART among people living with HIV/AIDS (PLHIV). Methods We conducted a cross-sectional survey to assess knowledge, attitudes, perception and practices ART in PLHIV. The survey was suggested to all PLHIV of at least 18 years old and who were on ART for at least 1 month. PLHIV who were unable to answer questions correctly and those who did not complete the survey for any reason were excluded. Results During the study period, 234 PLHIV were included. Participants were mostly men (75.2%). The median age was 33 years (IQR: 27–41). The median time since HIV diagnosis was 25 months (IQR: 9–56) and the median duration of ART was 18 months (IQR: 8–48). 87.6% had an overall good knowledge of ART. However, only 3.2% knew the name of their ART, 31.2% were aware that ART should be taken at a fixed time and 17.1% knew how to take ART in relation to food intake. 75.6% of participants had an overall positive attitude/perception of ART. However, 10.7% were convinced that other methods were more effective than ART for treating HIV and 42.7% thought that taking ART was shameful. The assessment of practices showed that in case of missed dose, 48.3% of participants routinely skipped this dose instead of trying to take it as soon as possible. In multivariate analysis, good knowledge of ART was independently associated with high level of education (aOR: 4.7, IC95%: 1.6–13.7, p = 0.004) and disclosure of HIV status (aOR: 2.7, IC95%: 1.1–6.6, p = 0.029). Conclusions This study showed an overall good knowledge and a predominantly positive attitude/perception of ART. However, accurate knowledge of ART intake was insufficient and the stigma associated with taking ART remained very present. Furthermore, very heterogeneous practices may reflect lack of instruction given by the physician regarding ART intake. Electronic supplementary material The online version of this article (10.1186/s12913-019-4173-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mihaja Raberahona
- Infectious Diseases Department, University Hospital Joseph Raseta Befelatanana, Antananarivo, Madagascar.
| | - Zinara Lidamahasolo
- Department of Pharmacy, Faculty of Medicine, University of Antananarivo, Antananarivo, Madagascar
| | | | - Volatiana Andriananja
- Infectious Diseases Department, University Hospital Joseph Raseta Befelatanana, Antananarivo, Madagascar
| | | | | | - Mamy Jean de Dieu Randria
- Infectious Diseases Department, University Hospital Joseph Raseta Befelatanana, Antananarivo, Madagascar.,Faculty of Medicine, University of Antananarivo, Antananarivo, Madagascar
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Dwyer-Lindgren L, Cork MA, Sligar A, Steuben KM, Wilson KF, Provost NR, Mayala BK, VanderHeide JD, Collison ML, Hall JB, Biehl MH, Carter A, Frank T, Douwes-Schultz D, Burstein R, Casey DC, Deshpande A, Earl L, El Bcheraoui C, Farag TH, Henry NJ, Kinyoki D, Marczak LB, Nixon MR, Osgood-Zimmerman A, Pigott D, Reiner RC, Ross JM, Schaeffer LE, Smith DL, Davis Weaver N, Wiens KE, Eaton JW, Justman JE, Opio A, Sartorius B, Tanser F, Wabiri N, Piot P, Murray CJL, Hay SI. Mapping HIV prevalence in sub-Saharan Africa between 2000 and 2017. Nature 2019; 570:189-193. [PMID: 31092927 PMCID: PMC6601349 DOI: 10.1038/s41586-019-1200-9] [Citation(s) in RCA: 258] [Impact Index Per Article: 51.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 04/10/2019] [Indexed: 12/16/2022]
Abstract
HIV/AIDS is a leading cause of disease burden in sub-Saharan Africa. Existing evidence has demonstrated that there is substantial local variation in the prevalence of HIV; however, subnational variation has not been investigated at a high spatial resolution across the continent. Here we explore within-country variation at a 5 × 5-km resolution in sub-Saharan Africa by estimating the prevalence of HIV among adults (aged 15–49 years) and the corresponding number of people living with HIV from 2000 to 2017. Our analysis reveals substantial within-country variation in the prevalence of HIV throughout sub-Saharan Africa and local differences in both the direction and rate of change in HIV prevalence between 2000 and 2017, highlighting the degree to which important local differences are masked when examining trends at the country level. These fine-scale estimates of HIV prevalence across space and time provide an important tool for precisely targeting the interventions that are necessary to bringing HIV infections under control in sub-Saharan Africa. Fine-scale estimates of the prevalence of HIV in adults across sub-Saharan Africa reveal substantial within-country variation and local differences in both the direction and rate of change in the prevalence of HIV between 2000 and 2017.
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Affiliation(s)
- Laura Dwyer-Lindgren
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Michael A Cork
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Amber Sligar
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Krista M Steuben
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Kate F Wilson
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Naomi R Provost
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | - John D VanderHeide
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Michael L Collison
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Jason B Hall
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Molly H Biehl
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Austin Carter
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Tahvi Frank
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Dirk Douwes-Schultz
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Roy Burstein
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Daniel C Casey
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Aniruddha Deshpande
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Lucas Earl
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Charbel El Bcheraoui
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Tamer H Farag
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Nathaniel J Henry
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Damaris Kinyoki
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Laurie B Marczak
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Molly R Nixon
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | - David Pigott
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Robert C Reiner
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Jennifer M Ross
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.,Department of Global Health, University of Washington, Seattle, WA, USA.,Department of Medicine, University of Washington, Seattle, WA, USA
| | - Lauren E Schaeffer
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - David L Smith
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Nicole Davis Weaver
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Kirsten E Wiens
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Jeffrey W Eaton
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.,Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Jessica E Justman
- ICAP, Mailman School of Public Health, Columbia University, New York, NY, USA.,Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Alex Opio
- Medireal Investment Uganda, Entebbe, Uganda
| | - Benn Sartorius
- Public Health Medicine, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Frank Tanser
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.,Africa Health Research Institute, KwaZulu-Natal, South Africa.,Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa.,Research Department of Infection & Population Health, University College London, London, UK
| | - Njeri Wabiri
- HIV/AIDS, STIs & TB Research Programme, Human Sciences Research Council, Pretoria, South Africa
| | - Peter Piot
- London School of Hygiene & Tropical Medicine, London, UK
| | | | - Simon I Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
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Luma HN, Mboringong F, Doualla MS, Nji M, Donfack OT, Kamdem F, Ngouadjeu E, Lepka FK, Mapoure YN, Mbatchou HB. Mortality in Hospitalised HIV/AIDS Patients in a Tertiary Centre in Sub-Saharan Africa: Trends Between 2007 and 2015, Causes and Associated Factors. Open AIDS J 2018. [DOI: 10.2174/1874613601812010162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
With easy accessibility to combination Antiretroviral Therapy (cART), mortality amongst hospitalized HIV/AIDS patients needs to be described.
Objective:
We aimed at determining the trends, causes and factors associated with in-hospital mortality amongst HIV/AIDS patients in the Douala General Hospital.
Methods:
We retrospectively reviewed hospitalisation records of HIV/AIDS patients hospitalized in the medical wards of the DGH from 2007 to 2015. Four cause-of-death categories were defined: 1. Communicable conditions and AIDS-defining malignancies, 2. Chronic non-communicable conditions and non-AIDS defining malignancies’, 3. Other non-communicable conditions and 4. Unknown conditions. Logistic regression was used to determine factors associated mortality.
Results:
We analyzed 891 eligible files. The mean age was 43 (standard deviation (SD): 10) years and median length of hospital stay was 9 (interquatile range (IQR)4 - 15) days. The overall all-cause mortality was 23.5% (95% CI: 20.8% - 26.4%). The category - communicable conditions and AIDS defining malignancies represented 79.9%, of deaths and this remained constant for each year during the study period. Tuberculosis was the most common specific cause of death (23.9%). Patients who had two (OR=2.35, 95%CI: 1.35 - 4.06) and more than two (OR=4.23, 95%CI: 1.62 – 11.12) opportunistic infections, a haemoglobin level less than 10g/l (OR=2.38, 95%CI: 1.58 - 3.59) had increased odds of dying.
Conclusion:
In-hospital mortality is high amongst HIV/AIDS patients at the Douala general hospital. The category - communicable conditions and AIDS defining malignancies - is still the main underlying cause of death. We hope that our findings will help to develop interventions aimed at reducing in-hospital mortality.
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Rich KM, Huamaní JV, Kiani SN, Cabello R, Elish P, Arce JF, Pizzicato LN, Soria J, Wickersham JA, Sanchez J, Altice FL. Correlates of viral suppression among HIV-infected men who have sex with men and transgender women in Lima, Peru. AIDS Care 2018; 30:1341-1350. [PMID: 29843518 PMCID: PMC8236114 DOI: 10.1080/09540121.2018.1476657] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
In Peru, HIV is concentrated among men who have sex with men (MSM) and transgender women (TGW). Between June 2015 and August 2016, 591 HIV-positive MSM and TGW were recruited at five clinical care sites in Lima, Peru. We found that 82.4% of the participants had achieved viral suppression (VS; VL < 200) and 73.6% had achieved maximal viral suppression (MVS; VL < 50). Multivariable modeling indicated that patients reporting transportation as a barrier to HIV care were less likely to achieve VS (aOR = 0.47; 95% CI = 0.30-0.75) and MVS (aOR = 0.56; 95% CI = 0.37-0.84). Alcohol use disorders were negatively associated with MVS (aOR = 0.62; 95% CI = 0.30-0.75) and age was positively associated with achieving MVS (aOR = 1.29; 95% CI = 1.04-1.59). These findings underscore the need for more accessible HIV care with integrated behavioral health services in Lima, Peru.
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Affiliation(s)
| | - Javier Valencia Huamaní
- Asociación Civil Impacta Salud y Educación, Av. Almte. Miguel Grau 1010, Distrito de Barranco 15063, Peru
| | - Sara N. Kiani
- Yale AIDS Program, 135 College Street, New Haven, CT
| | - Robinson Cabello
- Associación Vía Libre, Paraguay 478, Distrito de Lima LIMA 01, Peru
| | - Paul Elish
- Yale AIDS Program, 135 College Street, New Haven, CT
| | - Jorge Florez Arce
- Hospital Nacional Arzobispo Loayza, Av. Alfonso Ugarte 848, Distrito de Lima, 15082 Peru
| | | | - Jaime Soria
- Hospital Nacional Dos de Mayo, Av. Miguel Grau 13, Distrito de Lima, 15003, Lima
| | - Jeffrey A. Wickersham
- Yale AIDS Program, 135 College Street, New Haven, CT
- Yale School of Medicine, Section of Infectious Diseases, New Haven, CT
- University of Malaya, Centre of Excellence on Research in AIDS (CERIA), Kuala Lumpar, Malaysia
| | - Jorge Sanchez
- Asociación Civil Impacta Salud y Educación, Av. Almte. Miguel Grau 1010, Distrito de Barranco 15063, Peru
- Centro de Investigaciones Biomédicas, Tecnológicas y Medioambientales, Calle Jose Santos Chocano 199, Bellavista, Callao, Peru
| | - Frederick L. Altice
- Yale AIDS Program, 135 College Street, New Haven, CT
- Yale School of Medicine, Section of Infectious Diseases, New Haven, CT
- University of Malaya, Centre of Excellence on Research in AIDS (CERIA), Kuala Lumpar, Malaysia
- Yale School of Public Health, Division of Epidemiology, New Haven, CT
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Dwomoh D, Tambaa C, Ayisi Addo S, Wiah E, Abdulai M, Bosomprah S. Effect of antiretroviral therapy on all-cause mortality among people living with HIV/AIDS in Ghana using Mahalanobis distant metric matching within propensity score caliper analysis: A retrospective cohort study. PLoS One 2018; 13:e0203461. [PMID: 30192892 PMCID: PMC6128569 DOI: 10.1371/journal.pone.0203461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 08/21/2018] [Indexed: 11/18/2022] Open
Abstract
Several health interventions have been put in place to improve health outcomes of people living with HIV/AIDS (PLHIV) in Ghana. We evaluated the impact of Antiretroviral Therapy (ART) on all-cause mortality in Ghana using matching procedures. This was a retrospective cohort study of 12,881 HIV/AIDS patients initiated on ART at 40 sentinel sites and 199 treatment centers between 2013 and 2016 countrywide. Patients were included if they had date of ART initiation and if they had mortality outcome recorded. Mahalanobis distant metric matching within propensity score caliper and other matching procedures were used to evaluate the effectiveness of ART in reducing the risk of all-cause mortality among PLHIV in Ghana. We performed sensitivity analysis using different matching procedures including Kernel weighting adjustment and Mahalanobis distance metric matching with nearest neighbour to ascertain the robustness of our results in the presence of unmeasured covariates. The proportion of patients on ART was 60.3% (95% CI: 59.5-61.1). The total number of mortalities reported was only 734 representing 4.6% (95% CI: 4.2-4.9) of the studied population. The risk of all-cause mortality has reduced by 11.6 percentage point among HIV/AIDS patients who were on ART compared to those who were not on ART (95% CI: 9.6-13.4). ART was associated with a decreased risk of all-cause mortality. Effort being made by Government and non-Governmental organizations in support of ART treatment in Ghana should continue unabated to help reduce mortality rate and improve health outcomes among HIV/AIDS. To reduce bias to the barest minimum between treatment and intervention group when evaluating the effectiveness of health interventions, it is recommended to use matching procedures especially when the study design is not a randomized control trial.
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Affiliation(s)
- Duah Dwomoh
- Department of Biostatistics, School of Public Health, University of Ghana, Accra, Ghana
| | | | | | - Ekow Wiah
- National AIDS/STI Control Programme, Accra, Ghana
| | | | - Samuel Bosomprah
- Department of Biostatistics, School of Public Health, University of Ghana, Accra, Ghana
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Horner MJ, Gopal S. Opportunities to Understand Unique Cancer Risks in Global HIV-Infected Populations. J Natl Cancer Inst 2018. [PMID: 29529221 DOI: 10.1093/jnci/djy030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Marie-Josèphe Horner
- Epidemiology, Gillings School of Global Public Health.,UNC Project-Malawi, Lilongwe, Malawi
| | - Satish Gopal
- Epidemiology, Gillings School of Global Public Health.,Lineberger Comprehensive Cancer Center.,UNC Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC.,UNC Project-Malawi, Lilongwe, Malawi.,Malawi Cancer Consortium and Regional Center of Research Excellence for Non-Communicable Diseases, Lilongwe, Malawi.,Department of Medicine, University of Malawi College of Medicine, Blantyre, Malawi
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38
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Effect of age at initiation of antiretroviral therapy on treatment outcomes; A retrospective cohort study at a large HIV clinic in southwestern Uganda. PLoS One 2018; 13:e0201898. [PMID: 30110364 PMCID: PMC6093656 DOI: 10.1371/journal.pone.0201898] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 07/24/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The prevalence of HIV infection among older persons is increasing yet older age at initiation of antiretroviral therapy (ART) may be associated with poorer treatment outcomes including mortality. However, majority of these studies have been done in the western world and there is limited data in resource limited settings. Our study used routinely collected health facility data to assess trends in age at initiation of ART, the effect of age at ART initiation on mortality and immunological response at a large urban hospital in south western Uganda. METHODS We conducted a retrospective records review of patients attending the HIV clinic at Mbarara Regional Referral Hospital in western Uganda. We retrieved records for 8,533 patients who started ART between January 2006 and December 2012. Their data had been collected and stored as part of the larger International Epidemiological Database for the Evaluation of AIDS (IeDEA). Age was stratified into three categories namely; 18-34 (young adults), 35-49 (mid-age) and 50 years or older (older adults). Survival analysis procedures with Kaplan-Meier's plots were used to calculate the survival probability with mortality as the endpoint and Poisson regression analysis used to determine the adjusted relative risks (RR) of mortality. RESULTS The proportion of young adults and patients at WHO stage I initiating ART increased steadily over the 7-year period. Older age at ART initiation (> = 50 years) was associated with a higher risk of mortality with adjusted relative risk (RR) at 1.63, (95% CI 1.26-2.11) compared to younger age. Male gender, WHO stages III and IV, lower CD4 count and lower body mass index were also all independently and significantly associated with higher risk for mortality. Older adults also had a poorer immunological response RR = 1.79 (95% CI 0.89-3.58) but was not statistically significant. CONCLUSIONS Following ART initiation, older adults compared to the young, have a higher risk of mortality. This age group should be targeted first for 'screen and treat' approach. Optimization of ART treatment regimens for this age group is also required to reduce mortality and improve immunological response.
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Skovdal M, Maswera R, Kadzura N, Nyamukapa C, Rhead R, Wringe A, Gregson S. Parental obligations, care and HIV treatment: How care for others motivates self-care in Zimbabwe. J Health Psychol 2018; 25:2178-2187. [PMID: 30027764 PMCID: PMC7583436 DOI: 10.1177/1359105318788692] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This article examines how parental obligations of care intersect with HIV treatment-seeking behaviours and retention. It draws on qualitative data from eastern Zimbabwe, produced from 65 interviews. Drawing on theories of practice and care ethics, our analysis revealed that norms of parental obligation and care acted as key motivators for ongoing engagement with HIV services and treatment. Parents' attentiveness to the future needs of their children (caring about), and sense of obligation (taking care of) and improved ability to care (caregiving) following treatment initiation, emerged as central to understanding their drive for self-care and engagement with HIV services.
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Affiliation(s)
| | | | - Noah Kadzura
- Biomedical Research and Training Institute, Zimbabwe
| | - Constance Nyamukapa
- Biomedical Research and Training Institute, Zimbabwe.,Imperial College London, UK
| | | | | | - Simon Gregson
- Biomedical Research and Training Institute, Zimbabwe.,Imperial College London, UK
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40
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Precarious transition: a mortality study of South African ex-miners. BMC Public Health 2018; 18:862. [PMID: 29996801 PMCID: PMC6042385 DOI: 10.1186/s12889-018-5749-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 06/25/2018] [Indexed: 12/04/2022] Open
Abstract
Background Despite their burden of a triple epidemic of silicosis, tuberculosis and HIV infection, little is known about the mortality experience of miners from the South African mining industry once they leave employment. Such information is important because of the size and dispersion of this population across a number of countries and the progressive nature of these diseases. Methods This study included 306,297 South African miners who left the industry during 2001–2013. The study aimed to calculate crude and standardised mortality rates, identify secular trends in mortality and model demographic and occupational risk factors for mortality. Results Crude mortality rates peaked in the first year after exit (32.8/1000 person-years), decreasing with each year from exit. Overall mortality was 20% higher than in the general population. Adjusted annual mortality halved over the 12 year period. Mortality predictors were being a black miner [adjusted hazard ratio (aHR) 3.30; 95% confidence interval (CI) 3.15–3.46]; underground work (aHR 1.33; 95% CI 1.28–1.39); and gold aHR 1.15 (95% CI 1.12–1.19) or multiple commodity employment (aHR 1.15; 95% CI 1.11–1.19). Conclusions This is the first long-term mortality assessment in the large ex-miner population from the South African mining industry. Mortality patterns follow that of the national HIV-tuberculosis epidemic and antiretroviral treatment availability. However, ex-miners have further elevated mortality and a very high mortality risk in the year after leaving the workforce. Coordinated action between the mining industry, governments and non-governmental organisations is needed to reduce the impact of this precarious transition. Electronic supplementary material The online version of this article (10.1186/s12889-018-5749-2) contains supplementary material, which is available to authorized users.
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Gunda DW, Maganga SC, Nkandala I, Kilonzo SB, Mpondo BC, Shao ER, Kalluvya SE. Prevalence and Risk Factors of Active TB among Adult HIV Patients Receiving ART in Northwestern Tanzania: A Retrospective Cohort Study. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2018; 2018:1346104. [PMID: 30073038 PMCID: PMC6057398 DOI: 10.1155/2018/1346104] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 06/19/2018] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Although ART has improved the outcome of people living with HIV/AIDS, still some patients develop TB while receiving ART. The literature on the magnitude of this problem is still scarce in our setting especially northwestern Tanzania. This study was designed to determine the prevalence of active TB among HIV patients on ART and assess its potential risk factors. METHODS A retrospective cohort study was done among adult HIV-positive patients initiated on ART at Bugando Medical Centre. Patients who were TB positive before ART initiation were excluded. Data regarding demographic, clinical, and laboratory information, TB status on receipt of ART, and time on ART were collected and analyzed using STATA 11 to determine the prevalence of TB and its associated factors. RESULTS In total, 391 patients were enrolled in this study. The median age was 39 (32-46) years, and a total of 129 (32.99%) participants had CD4 counts <200 cells/µl and 179 (45.78%) had WHO stage 3 and 4 illnesses. A total of 43 (11.0%) participants developed TB while receiving ART which was independently associated with male gender (OR = 2.9; p=0.007), WHO clinical stage 3 and 4 (OR = 1.4; p=0.029), baseline CD4 count <200 cells/µl (OR = 9.1; p < 0.001), and having not used IPT (OR = 3.1; p=0.05). CONCLUSIONS Active TB is prevalent among HIV patients while receiving ART in northwestern Tanzania which is independently associated with male gender, advanced HIV disease, and nonuse of IPT. Universal HIV testing could reduce late HIV diagnosis and hence reduce the risk of developing TB while receiving ART in our setting. Also IPT should be widely used for those who are negative for TB on screening.
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Affiliation(s)
- Daniel W. Gunda
- Department of Medicine, Weill Bugando School of Medicine, 1464 Mwanza, Tanzania
| | - Simon C. Maganga
- Department of Medicine, Weill Bugando School of Medicine, 1464 Mwanza, Tanzania
| | - Igembe Nkandala
- Department of Medicine, Weill Bugando School of Medicine, 1464 Mwanza, Tanzania
| | - Semvua B. Kilonzo
- Department of Medicine, Weill Bugando School of Medicine, 1464 Mwanza, Tanzania
| | - Bonaventura C. Mpondo
- Department of Medicine, College of Health Sciences, University of Dodoma, 395 Dodoma, Tanzania
| | - Elichilia R. Shao
- Department of Infectious Disease, Kilimanjaro Christian Medical College, Moshi, Tanzania
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Weldegebreal T, Ahmed I, Muhiye A, Belete S, Bekele A, Kaba M. Magnitude of opportunistic diseases and their predictors among adult people living with HIV enrolled in care: national level cross sectional study, Ethiopia. BMC Public Health 2018; 18:820. [PMID: 29970047 PMCID: PMC6029130 DOI: 10.1186/s12889-018-5733-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 06/21/2018] [Indexed: 11/13/2022] Open
Abstract
Background Opportunistic diseases cause morbidity and mortality among human immunodeficiency virus (HIV) infected persons. There is dearth of evidence on the magnitude and predictors of opportunistic diseases among PLHIV in Ethiopia. This study was conducted to determine the magnitude and predictors of opportunistic diseases among adults enrolled in the national HIV/AIDS care and treatment services and generate information for program planning and medicine quantification in the country. Methods A health facility-based cross-sectional study was conducted. Probability proportional to size and random sampling methods were employed to select health facilities and medical records of adult HIV-infected patients respectively. A total of 7826 medical records were reviewed from 60 health facilities nationwide. Socio-demographic and clinical data including diagnosis of opportunistic diseases were collected from the medical records. Period prevalence of opportunistic diseases over one year period was determined. Bivariate and multivariate logistic regression was used to measure associations between independent variables and the dependent variable, occurrence of opportunistic diseases. Results Of the total of 7826 study participants, 3748 (47.9%) were from hospitals and 4078 were from health centers. The majority (61.8%) were female. The median age was 32 years with interquartile range (IQR) of 27–40. The median duration of stay in HIV care was 56 (IQR = 28–80) months; 7429 (94.9%) were on antiretroviral treatment. A total of 1665 cases of opportunistic diseases were recorded with an overall prevalence estimated at 21.3% (95% confidence interval (CI): 20.36, 22.18%). Skin diseases (4.1%), diarrhea (4.1%), bacterial pneumonia (3.6%), recurrent upper respiratory tract infections (3.1%) and tuberculosis (2.7%) were the leading opportunistic diseases. Isoniazid preventive therapy coverage among eligible patients was 24.8%. Persons with a CD4 count < 200 cells/mm3 [adjusted odds ratio (AOR) 1.80, 95% CI: 1.45, 2.23]; and who were bed ridden or ambulatory functional status [AOR (95% CI) = 3.19 (2.32, 4.39)] were independent predictors of diagnosis of opportunistic diseases. Conclusion Opportunistic diseases were found to be pervasive among HIV infected adults in Ethiopia. Proactive identification and management, and prevention of opportunistic diseases should be strengthened especially among females, ambulatory or bed-ridden, and patients with low CD4 cell count.
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Affiliation(s)
- Teklu Weldegebreal
- U.S. Centers for Disease Control and Prevention- Ethiopia, Addis Ababa, Ethiopia
| | - Ismael Ahmed
- U.S. Centers for Disease Control and Prevention- Ethiopia, Addis Ababa, Ethiopia.
| | - Abiyou Muhiye
- Ethiopian Public Health Association, Addis Ababa, Ethiopia
| | | | | | - Mirgissa Kaba
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
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Karat AS, Maraba N, Tlali M, Charalambous S, Chihota VN, Churchyard GJ, Fielding KL, Hanifa Y, Johnson S, McCarthy KM, Kahn K, Chandramohan D, Grant AD. Performance of verbal autopsy methods in estimating HIV-associated mortality among adults in South Africa. BMJ Glob Health 2018; 3:e000833. [PMID: 29997907 PMCID: PMC6035502 DOI: 10.1136/bmjgh-2018-000833] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 06/02/2018] [Accepted: 06/04/2018] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Verbal autopsy (VA) can be integrated into civil registration and vital statistics systems, but its accuracy in determining HIV-associated causes of death (CoD) is uncertain. We assessed the sensitivity and specificity of VA questions in determining HIV status and antiretroviral therapy (ART) initiation and compared HIV-associated mortality fractions assigned by different VA interpretation methods. METHODS Using the WHO 2012 instrument with added ART questions, VA was conducted for deaths among adults with known HIV status (356 HIV positive and 103 HIV negative) in South Africa. CoD were assigned using physician-certified VA (PCVA) and computer-coded VA (CCVA) methods and compared with documented HIV status. RESULTS The sensitivity of VA questions in detecting HIV status and ART initiation was 84.3% (95% CI 80 to 88) and 91.0% (95% CI 86 to 95); 283/356 (79.5%) HIV-positive individuals were assigned HIV-associated CoD by PCVA, 166 (46.6%) by InterVA-4.03, 201 (56.5%) by InterVA-5, and 80 (22.5%) and 289 (81.2%) by SmartVA-Analyze V.1.1.1 and V.1.2.1. Agreement between PCVA and older CCVA methods was poor (chance-corrected concordance [CCC] <0; cause-specific mortality fraction [CSMF] accuracy ≤56%) but better between PCVA and updated methods (CCC 0.21-0.75; CSMF accuracy 65%-98%). All methods were specific (specificity 87% to 96%) in assigning HIV-associated CoD. CONCLUSION All CCVA interpretation methods underestimated the HIV-associated mortality fraction compared with PCVA; InterVA-5 and SmartVA-Analyze V.1.2.1 performed better than earlier versions. Changes to VA methods and classification systems are needed to track progress towards targets for reducing HIV-associated mortality.
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Affiliation(s)
- Aaron S Karat
- TB Centre, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Mpho Tlali
- The Aurum Institute, Johannesburg, South Africa
| | - Salome Charalambous
- The Aurum Institute, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Violet N Chihota
- The Aurum Institute, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Gavin J Churchyard
- TB Centre, London School of Hygiene & Tropical Medicine, London, UK
- The Aurum Institute, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Katherine L Fielding
- TB Centre, London School of Hygiene & Tropical Medicine, London, UK
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Yasmeen Hanifa
- TB Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Suzanne Johnson
- Foundation for Professional Development, Pretoria, South Africa
| | - Kerrigan M McCarthy
- The Aurum Institute, Johannesburg, South Africa
- Division of Public Health, Surveillance and Response, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
- Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeâ University, Umeâ, Sweden
| | - Daniel Chandramohan
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | - Alison D Grant
- TB Centre, London School of Hygiene & Tropical Medicine, London, UK
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Africa Health Research Institute, Somkhele, South Africa
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
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44
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Olney JJ, Eaton JW, Braitstein P, Hogan JW, Hallett TB. Optimal timing of HIV home-based counselling and testing rounds in Western Kenya. J Int AIDS Soc 2018; 21:e25142. [PMID: 29883052 PMCID: PMC5993164 DOI: 10.1002/jia2.25142] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 05/22/2018] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Weaknesses in care programmes providing anti-retroviral therapy (ART) persist and are often instigated by late HIV diagnosis and poor linkage to care. We investigated the potential for a home-based counselling and testing (HBCT) campaign to be improved through the optimal timing and enhancement of testing rounds to generate greater health outcomes at minimum cost. METHODS Using a mathematical model of HIV care calibrated to longitudinal data from The Academic Model Providing Access To Healthcare (AMPATH) in Kenya, we simulated HBCT campaigns between 2016 and 2036, assessing the impact and total cost of care for each, for a further 20 years. RESULTS We find that simulating five equally spaced rounds averts 1.53 million disability-adjusted life-years (DALYs) at a cost of $1617 million. By altering the timing of HBCT rounds, a four-round campaign can produce greater impact for lower cost. With "front-loaded" rounds, the cost per DALY averted is reduced by 12% as fewer rounds are required ($937 vs. $1060). Furthermore, improvements to HBCT coverage and linkage to care avert over two million DALYs at a cost per DALY averted of $621 (41% less than the reference scenario). CONCLUSIONS Countries implementing HBCT can reduce costs by optimally timing rounds and generate greater health outcomes through improving linkage, coverage, and retention. Tailoring HBCT campaigns to individual settings can enhance patient outcomes for minimal cost.
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Affiliation(s)
- Jack J Olney
- Centre for Health Economics & Policy Innovation, Imperial College Business School, London, United Kingdom
| | - Jeffrey W Eaton
- Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| | - Paula Braitstein
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Medicine, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Joseph W Hogan
- Department of Biostatistics and Center for Statistical Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Timothy B Hallett
- Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
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45
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Sherr L, Cluver LD, Toska E, He E. Differing psychological vulnerabilities among behaviourally and perinatally HIV infected adolescents in South Africa - implications for targeted health service provision. AIDS Care 2018; 30:92-101. [PMID: 29848010 DOI: 10.1080/09540121.2018.1476664] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
HIV infections are growing the fastest amongst adolescents, especially in sub Saharan Africa. On reaching adolescence, perinatally-infected youth may have different needs to those who acquired infection behaviourally. Yet both have sub-optimal adherence with implications for their own health as well as onward transmission. This study uses the world's largest community-based study of HIV-positive adolescents from the Eastern Cape, South Africa. Clinic records at N = 53 district health facilities generated a log of all ART-initiated adolescents who were then interviewed in the community: N = 1058 (90%) were tracked and participated. Ethical approval, informed consent and data collector training preceded data gathering. Inventories comprised validated measures of mental health (depression, anxiety, suicidality and internalised stigma), substance use, ART adherence, and clinic attendance. Analyses were conducted using SPSS25 and STATA15. Perinatally-infected adolescents (n = 792, 77.3%) were significantly more likely to be ART adherent (OR = 1.54 95%CI: 1.14-2.07 p = 0.005), retained in healthcare (OR = 1.59 95%CI1.18-2.14 p = 0.002), and treated well by clinic staff (OR = 2.12 95%CI1.59-3.07 p ≤ 0.001). Behaviourally-infected adolescents were more likely to be depressed (B = 0.81 p ≤ 0.001), anxious (B = 1.36 p ≤ 0.001), report internalised stigma (B = 0.91 p ≤ 0.001), express suicidal ideation (OR = 3.65 95%CI: 1.96-6.82 p ≤ 0.001) and report excessive substance use in the past year (OR = 9.37 95%CI5.73-15.35 p ≤ 0.001). Being older explained most of these differences, with female adolescents living with HIV more likely to report suicidal ideation. However, behaviourally-infected adolescents were more likely to report substance use (OR = 2.69 95%CI: 1.48-4.91 p = 0.001), depression (B = 0.406, p = 0.022), anxiety (B = 1.359, p ≤ 0.001), and internalised stigma (B = 0.403, p = 0.007) in multivariate regression analyses, controlling for covariates. Moderation analyses (adjusting for multiple testing) suggest that behaviourally-infected HIV-positive adolescents who are also maternal orphans are more likely to report higher rates of depression (B = 1.075, p < 0.001). These notable differences by mode of infection suggest that studies which conflate HIV-positive adolescents may blur the clinical and psychological experiences of these two different sub-populations. Drivers of non-adherence, poor retention in care, and mental health problems may differ by mode of infection, requiring tailored interventions. Health and social service provision, if it is to be effective, needs to address these different youth profiles to ensure optimal adherence, development and wellbeing throughout the life course.
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Affiliation(s)
- L Sherr
- a UCL , London , United Kingdom
| | - L D Cluver
- b Dept of Social Policy and Intervention , University of Oxford , Oxford , United Kingdom.,c Dept of Psychiatry and Mental Health , University of Cape Town , Cape Town , South Africa
| | - E Toska
- b Dept of Social Policy and Intervention , University of Oxford , Oxford , United Kingdom.,d AIDS and Society Research Unit , University of Cape Town , Cape Town , South Africa
| | - E He
- e Washington University in St. Louis , St Louis , MO , USA
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46
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Cawley C, McRobie E, Oti S, Njamwea B, Nyaguara A, Odhiambo F, Otieno F, Njage M, Shoham T, Church K, Mee P, Todd J, Zaba B, Reniers G, Wringe A. Identifying gaps in HIV policy and practice along the HIV care continuum: evidence from a national policy review and health facility surveys in urban and rural Kenya. Health Policy Plan 2018; 32:1316-1326. [PMID: 28981667 PMCID: PMC5886069 DOI: 10.1093/heapol/czx091] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2017] [Indexed: 11/14/2022] Open
Abstract
The last decade has seen rapid evolution in guidance from the WHO concerning the provision of HIV services along the diagnosis-to-treatment continuum, but the extent to which these recommendations are adopted as national policies in Kenya, and subsequently implemented in health facilities, is not well understood. Identifying gaps in policy coverage and implementation is important for highlighting areas for improving service delivery, leading to better health outcomes. We compared WHO guidance with national policies for HIV testing and counselling, prevention of mother-to-child transmission, HIV treatment and retention in care. We then investigated implementation of these national policies in health facilities in one rural (Kisumu) and one urban (Nairobi) sites in Kenya. Implementation was documented using structured questionnaires that were administered to in-charge staff at 10 health facilities in Nairobi and 34 in Kisumu. Policies were defined as widely implemented if they were reported to occur in > 70% facilities, partially implemented if reported to occur in 30–70% facilities, and having limited implementation if reported to occur in < 30% facilities. Overall, Kenyan national HIV care and treatment policies were well aligned with WHO guidance. Policies promoting access to treatment and retention in care were widely implemented, but there was partial or limited implementation of several policies promoting access to HIV testing, and the more recent policy of Option B+ for HIV-positive pregnant women. Efforts are needed to improve implementation of policies designed to increase rates of diagnosis, thus facilitating entry into HIV care, if morbidity and mortality burdens are to be further reduced in Kenya, and as the country moves towards universal access to antiretroviral therapy.
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Affiliation(s)
- Caoimhe Cawley
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Ellen McRobie
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Samuel Oti
- African Population and Health Research Centre, P.O. Box 10787-00100, Nairobi, Kenya
| | - Brian Njamwea
- African Population and Health Research Centre, P.O. Box 10787-00100, Nairobi, Kenya
| | - Amek Nyaguara
- KEMRI/CDC Center for Global Health Research (CGHR), P.O. Box 1578, Kisumu, Kenya
| | - Frank Odhiambo
- KEMRI/CDC Center for Global Health Research (CGHR), P.O. Box 1578, Kisumu, Kenya
| | - Fredrick Otieno
- KEMRI/CDC Center for Global Health Research (CGHR), P.O. Box 1578, Kisumu, Kenya
| | | | - Tara Shoham
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Kathryn Church
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Paul Mee
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Jim Todd
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Basia Zaba
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Georges Reniers
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Alison Wringe
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
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47
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Price AJ, Glynn J, Chihana M, Kayuni N, Floyd S, Slaymaker E, Reniers G, Zaba B, McLean E, Kalobekamo F, Koole O, Nyirenda M, Crampin AC. Sustained 10-year gain in adult life expectancy following antiretroviral therapy roll-out in rural Malawi: July 2005 to June 2014. Int J Epidemiol 2018; 46:479-491. [PMID: 28338707 PMCID: PMC5813794 DOI: 10.1093/ije/dyw208] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2016] [Indexed: 01/06/2023] Open
Abstract
Background: Improved life expectancy in high HIV prevalence populations has been observed since antiretroviral therapy (ART) scale-up. However, it is unclear if the benefits are sustained, and the mortality among HIV-positive individuals not (yet) on ART is not well described. We assessed temporal change in mortality over 9 years in rural Malawi. Methods: Within a demographic surveillance site in northern rural Malawi, we combined demographic, HIV and ART uptake data. We calculated life expectancy using Kaplan-Meier estimates, and compared mortality rates and rate ratios using Poisson regression, by period of ART availability (July 2005–June 2008, July 2008–June 2011 and July 2011–June 2014). Results: Among 32 664 individuals there were 1424 deaths; 1930 individuals were known HIV-positive, of whom 1382 started ART. Overall, life expectancy at age 15 years increased by 10 years within 5 years of ART introduction, and plateaued. Age-standardized adult mortality rates declined from 11.3/1000 to 7.5/1000 person-years between the first and last time period. In July 2011-June 2014 compared with July 2005–June 2008, mortality declined in HIV-positive individuals on ART (rate ratio adjusted (aRR) for age, sex, location and education, 0.3; 95% confidence interval (CI) 0.2–0.5) and in those not (yet) on ART (aRR 0.3; 95%CI 0.1–0.5) but not in HIV-negative individuals (aRR 1.1; 95%CI 0.7–1.9). Conclusions: Total population adult life expectancy increased toward that of HIV-negative individuals by 2011 and remained raised. The reduction in all-cause and HIV-related mortality in HIV-positive individuals not (yet) on ART suggests ART uptake is occurring at an earlier disease stage, particularly in women.
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Affiliation(s)
- Alison J Price
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Judith Glynn
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Sian Floyd
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Emma Slaymaker
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine and
| | - Georges Reniers
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine and
| | - Basia Zaba
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine and
| | - Estelle McLean
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Olivier Koole
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Moffat Nyirenda
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Amelia C Crampin
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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48
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Wringe A, Renju J, Seeley J, Moshabela M, Skovdal M. Bottlenecks to HIV care and treatment in sub-Saharan Africa: a multi-country qualitative study. Sex Transm Infect 2018; 93:sextrans-2017-053172. [PMID: 28736397 PMCID: PMC5739850 DOI: 10.1136/sextrans-2017-053172] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 05/20/2017] [Indexed: 11/30/2022] Open
Affiliation(s)
- Alison Wringe
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Jenny Renju
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Janet Seeley
- Medical Research Council/Uganda Virus Research Institute Research Unit on AIDS, Entebbe, Uganda.,Department of Global Health, London School of Hygiene and Tropical Medicine, London, UK.,Africa Health Research Institute, KwaZulu Natal, South Africa
| | - Mosa Moshabela
- Africa Health Research Institute, KwaZulu Natal, South Africa.,University of KwaZulu Natal, Durban, South Africa
| | - Morten Skovdal
- University of Copenhagen, Copenhagen, Denmark.,Biomedical Research and Training Institute, Harare, Zimbabwe
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49
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Sharrow DJ, Godwin J, He Y, Clark SJ, Raftery AE. Probabilistic population projections for countries with generalized HIV/AIDS epidemics. POPULATION STUDIES 2018; 72:1-15. [PMID: 29256327 PMCID: PMC5921864 DOI: 10.1080/00324728.2017.1401654] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In 2015, the United Nations (UN) issued probabilistic population projections for all countries up to 2100, by simulating future levels of total fertility and life expectancy and combining the results using a standard cohort component projection method. For the 40 countries with generalized HIV/AIDS epidemics, the mortality projections used the Spectrum/Estimation and Projection Package (EPP) model, a complex, multistate model designed for short-term projections of policy-relevant quantities for the epidemic. We propose a simpler approach that is more compatible with existing UN projection methods for other countries. Changes in life expectancy are projected probabilistically using a simple time series regression and then converted to age- and sex-specific mortality rates using model life tables designed for countries with HIV/AIDS epidemics. These are then input to the cohort component method, as for other countries. The method performed well in an out-of-sample cross-validation experiment. It gives similar short-run projections to Spectrum/EPP, while being simpler and avoiding multistate modelling.
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Affiliation(s)
- David J. Sharrow
- Center for Statistics and the Social Sciences, University of Washington
| | | | - Yanjun He
- Department of Statistics, University of Washington
| | - Samuel J. Clark
- Department of Sociology, University of Washington
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand
| | - Adrian E. Raftery
- Department of Statistics, University of Washington
- Department of Sociology, University of Washington
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50
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Bebell LM, Ngonzi J, Siedner MJ, Muyindike WR, Bwana BM, Riley LE, Boum Y, Bangsberg DR, Bassett IV. HIV Infection and risk of postpartum infection, complications and mortality in rural Uganda. AIDS Care 2018; 30:943-953. [PMID: 29451005 DOI: 10.1080/09540121.2018.1434119] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
HIV infection may increase risk of postpartum infection and infection-related mortality. We hypothesized that postpartum infection incidence and attributable mortality in Mbarara, Uganda would be higher in HIV-infected than HIV-uninfected women. We performed a prospective cohort study of 4231 women presenting to a regional referral hospital in 2015 for delivery or postpartum care. All febrile or hypothermic women, and a subset of randomly selected normothermic women were followed during hospitalization and with 6-week postpartum phone interviews. The primary outcome was in-hospital postpartum infection. Secondary outcomes included in-hospital complications (mortality, re-operation, intensive care unit transfer, need for imaging or blood transfusion) and 6-week mortality. We performed multivariable regression analyses to estimate adjusted differences in each outcome by HIV serostatus. Mean age was 25.2 years and 481 participants (11%) were HIV-infected. Median CD4+ count was 487 (IQR 325, 696) cells/mm3, and 90% of HIV-infected women (193/215 selected for in-depth survey) were on antiretroviral therapy. Overall, 5% (205/4231) of women developed fever or hypothermia. Cumulative in-hospital postpartum infection incidence was 2.0% and did not differ by HIV status (aOR 1.4, 95% CI 0.6-3.3, P = 0.49). However, more HIV-infected women developed postpartum complications (4.4% vs. 1.2%, P = 0.001). In-hospital mortality was rare (2/1768, 0.1%), and remained so at 6 weeks (4/1526, 0.3%), without differences by HIV serostatus (P = 1.0 and 0.31, respectively). For women in rural Uganda with high rates of antiretroviral therapy coverage, HIV infection did not predict postpartum infection or mortality, but was associated with increased risk of postpartum complications.
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Affiliation(s)
- Lisa M Bebell
- a Division of Infectious Diseases , Massachusetts General Hospital , Boston , MA , USA.,b Massachusetts General Hospital Center for Global Health , Boston , MA , USA
| | - Joseph Ngonzi
- c Faculty of Medicine , Mbarara University of Science and Technology , Mbarara , Uganda
| | - Mark J Siedner
- a Division of Infectious Diseases , Massachusetts General Hospital , Boston , MA , USA.,b Massachusetts General Hospital Center for Global Health , Boston , MA , USA.,c Faculty of Medicine , Mbarara University of Science and Technology , Mbarara , Uganda
| | - Winnie R Muyindike
- d Department of Medicine , Mbarara Regional Referral Hospital , Mbarara , Uganda
| | - Bosco M Bwana
- c Faculty of Medicine , Mbarara University of Science and Technology , Mbarara , Uganda
| | - Laura E Riley
- e Division of Obstetrics and Gynecology , Massachusetts General Hospital , Boston , MA , USA
| | - Yap Boum
- c Faculty of Medicine , Mbarara University of Science and Technology , Mbarara , Uganda.,f Epicentre Mbarara Research Centre , Mbarara , Uganda
| | - David R Bangsberg
- a Division of Infectious Diseases , Massachusetts General Hospital , Boston , MA , USA.,b Massachusetts General Hospital Center for Global Health , Boston , MA , USA
| | - Ingrid V Bassett
- a Division of Infectious Diseases , Massachusetts General Hospital , Boston , MA , USA
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