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Fotheringham L, Lawson RA, Urasa S, Boshe J, Mukaetova-Ladinska EB, Rogathi J, Howlett W, Dekker MCJ, Gray WK, Evans J, Walker RW, Makupa PC, Paddick SM. Neuropsychological tests associated with symptomatic HIV-associated neurocognitive disorder (HAND) in a cohort of older adults in Tanzania. J Int Neuropsychol Soc 2024; 30:660-670. [PMID: 38766814 DOI: 10.1017/s1355617724000201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
OBJECTIVE Human immunodeficiency virus (HIV)-associated neurocognitive disorder (HAND) prevalence is expected to increase in East Africa as treatment coverage increases, survival improves, and this population ages. This study aimed to better understand the current cognitive phenotype of this newly emergent population of older combination antiretroviral therapy (cART)-treated people living with HIV (PLWH), in which current screening measures lack accuracy. This will facilitate the refinement of HAND cognitive screening tools for this setting. METHOD This is a secondary analysis of 253 PLWH aged ≥50 years receiving standard government HIV clinic follow-up in Kilimanjaro, Tanzania. They were evaluated with a detailed locally normed low-literacy neuropsychological battery annually on three occasions and a consensus panel diagnosis of HAND by Frascati criteria based on clinical evaluation and collateral history. RESULTS Tests of verbal learning and memory, categorical verbal fluency, visual memory, and visuoconstruction had an area under the receiver operating characteristic curve >0.7 for symptomatic HAND (s-HAND) (0.70-0.72; p < 0.001 for all tests). Tests of visual memory, verbal learning with delayed recall and recognition memory, psychomotor speed, language comprehension, and categorical verbal fluency were independently associated with s-HAND in a logistic mixed effects model (p < 0.01 for all). Neuropsychological impairments varied by educational background. CONCLUSIONS A broad range of cognitive domains are affected in older, well-controlled, East African PLWH, including those not captured in widely used screening measures. It is possible that educational background affects the observed cognitive impairments in this setting. Future screening measures for similar populations should consider assessment of visual memory, verbal learning, language comprehension, and executive and motor function.
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Affiliation(s)
- Lachlan Fotheringham
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Cumbria Northumberland Tyne and Wear NHS Foundation Trust, UK
| | - Rachael A Lawson
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Sarah Urasa
- Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
| | - Judith Boshe
- Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
| | | | - Jane Rogathi
- Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
| | - William Howlett
- Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
| | - Marieke C J Dekker
- Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
| | - William K Gray
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK
| | | | - Richard W Walker
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Philip C Makupa
- Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
- Mawenzi Regional Referral Hospital, Kilimanjaro, Tanzania
| | - Stella-Maria Paddick
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Gateshead Health NHS Foundation Trust, Gateshead, UK
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Stockton MA, Gaynes BN, Hosseinipour MC, Pettifor AE, Maselko J, Mphonda SM, Kulisewa K, Udedi M, Pence BW. Association Between Depression and HIV Care Engagement Outcomes Among Patients Newly Initiating ART in Lilongwe, Malawi. AIDS Behav 2021; 25:826-835. [PMID: 32970274 PMCID: PMC7886828 DOI: 10.1007/s10461-020-03041-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2020] [Indexed: 12/13/2022]
Abstract
As in other sub-Saharan countries, the burden of depression is high among people living with HIV in Malawi. However, the association between depression at ART initiation and two critical outcomes-retention in HIV care and viral suppression-is not well understood. Prior to the launch of an integrated depression treatment program, adult patients were screened for depression at ART initiation at two clinics in Lilongwe, Malawi. We compared retention in HIV care and viral suppression at 6 months between patients with and without depression at ART initiation using tabular comparison and regression models. The prevalence of depression among this population of adults newly initiating ART was 27%. Those with depression had similar HIV care outcomes at 6 months to those without depression. Retention metrics were generally poor for those with and without depression. However, among those completing viral load testing, nearly all achieved viral suppression. Depression at ART initiation was not associated with either retention or viral suppression. Further investigation of the relationship between depression and HIV is needed to understand the ways depression impacts the different aspects of HIV care engagement.
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Affiliation(s)
- Melissa A Stockton
- Epidemiology Department, University of North Carolina at Chapel Hill Gillings School of Global Public Health, 135 Dauer Dr, Chapel Hill, NC, 27599, USA.
| | - Bradley N Gaynes
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, 333 S Columbia St, Chapel Hill, NC, 27516, USA
| | - Mina C Hosseinipour
- University of North Carolina Project-Malawi, Tidziwe Centre, Private Bag A-104, Lilongwe, Malawi
- Division of Infectious Disease, University of North Carolina at Chapel Hill School of Medicine, 333 S Columbia St, Chapel Hill, NC, 27516, USA
| | - Audrey E Pettifor
- Epidemiology Department, University of North Carolina at Chapel Hill Gillings School of Global Public Health, 135 Dauer Dr, Chapel Hill, NC, 27599, USA
| | - Joanna Maselko
- Epidemiology Department, University of North Carolina at Chapel Hill Gillings School of Global Public Health, 135 Dauer Dr, Chapel Hill, NC, 27599, USA
| | - Steven M Mphonda
- University of North Carolina Project-Malawi, Tidziwe Centre, Private Bag A-104, Lilongwe, Malawi
| | - Kazione Kulisewa
- College of Medicine, Department of Mental Health, University of Malawi, P/Bag 360, Chichiri, Blantyre 3, Malawi
| | - Michael Udedi
- NCDs & Mental Health Unit, Ministry of Health, P. O. Box 30377, Capital City, Lilongwe 3, Malawi
- College of Medicine, Department of Mental Health, University of Malawi, P/Bag 360, Chichiri, Blantyre 3, Malawi
| | - Brian W Pence
- Epidemiology Department, University of North Carolina at Chapel Hill Gillings School of Global Public Health, 135 Dauer Dr, Chapel Hill, NC, 27599, USA
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Brault MA, Spiegelman D, Abdool Karim SS, Vermund SH. Integrating and Interpreting Findings from the Latest Treatment as Prevention Trials. Curr HIV/AIDS Rep 2020; 17:249-258. [PMID: 32297219 DOI: 10.1007/s11904-020-00492-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE OF REVIEW In 2018-2019, studies were published assessing the effectiveness of reducing HIV incidence by expanding HIV testing, linkage to HIV treatment, and assistance to persons living with HIV to adhere to their medications (the "90-90-90" strategy). These tests of "treatment as prevention" (TasP) had complex results. RECENT FINDINGS The TasP/ANRS 12249 study in South Africa, the SEARCH study in Kenya and Uganda, and one comparison (arms A to C) of the HPTN 071 (PopART) study in South Africa and Zambia did not demonstrate a community impact on HIV incidence. In contrast, the Botswana Ya Tsie study and the second comparison (arms B to C) of PopART indicated significant ≈ 30% reductions in HIV incidence in the intervention communities where TasP was expanded. We discuss the results of these trials and outline future research and challenges. These include the efficient expansion of widespread HIV testing, better linkage to care, and viral suppression among all persons living with HIV. A top implementation science priority for the next decade is to determine what strategies to use in specific local contexts.
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Affiliation(s)
- Marie A Brault
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA.
| | - Donna Spiegelman
- Department of Biostatistics; Center for Methods in Implementation and Prevention Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Salim S Abdool Karim
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Sten H Vermund
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
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Wang G, Lu C, Qin S, Wei W, Lai J, Jiang J, Liang B, Zhou O, Han J, Yang Y, Ye L, Liang H, Ning C. 90-90-90 cascade analysis on reported CLHIV infected by mother-to-child transmission in Guangxi, China: a modeling study. Sci Rep 2020; 10:5295. [PMID: 32210333 PMCID: PMC7093517 DOI: 10.1038/s41598-020-62281-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 03/11/2020] [Indexed: 11/21/2022] Open
Abstract
The prevalence of HIV in Guangxi was very high, and there were many children living with HIV (CLHIV) because of larger baseline of pregnant women infected by HIV. It is necessary for children to explore the status of antiretroviral therapy (ART) on different initial CD4 counts in children with HIV infected by mother-to-child transmission (MTCT) in Guangxi and to evaluate the progress towards the 90-90-90 targets proposed by UNAIDS/WHO. Based on a retrospective observational cohort of children with HIV infected from the Guangxi Center for Disease Prevention and Control (CDC), the variables of all patients included viral loads, CD4 counts, laboratory results and WHO clinical staging of HIV/AIDS were collected. Several indicators were defined before analyzed: (1) diagnosis of MTCT: infants born to HIV-positive mothers who tested positive for HIV twice before 18 months; (2) ART initiation: the children who were enrolled in the treatment cohort and were still having HIV monitoring as of 6 months before date censored and (3) viral suppression: a recently viral load measurement that was less than 1000 copies per milliliter. The number of CLHIV in Guangxi was projected by using the estimates of the national HIV/AIDS prevalence from China CDC. An Autoregressive Integrated Moving Average (ARIMA) model and the Holt Exponential Smoothing (ES) model were used to predict the number of CLHIV, the diagnosed CLHIV, the diagnosed CLHIV receiving ART and the number of them achieving viral suppression, in 2019 and 2021, respectively. In this 14-year HIV/AIDS treatment cohort, 807 children who were HIV infected by MTCT were enrolled. The ARIMA and Holt ES models showed that by the end of 2019, 82.71% of all CLHIV in Guangxi knew their HIV status, 84.50% of those diagnosed had initiated ART, and 85.68% of those on ART had durable viral suppression. By the end of 2021, 93.51% of all CLHIV in Guangxi will know their HIV status, 84.28% of those diagnosed will have initiated antiretroviral therapy, and 85.83% of those on ART will have durable viral suppression. Therefore, in 2021, Guangxi fails to achieve the WHO/UNAIDS 90-90-90 targets for CLHIV, and there is still a wide time interval between the first HIV-positive diagnosis and ART initiation. National free antiretroviral treatment program (NFATP) requires strong enforcement to reduce the prevalence of later chronic diseases and complications.
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Affiliation(s)
- Gang Wang
- Guangxi Collaborative Innovation Center for Biomedicine, Guangxi Medical University, Nanning, 530021, Guangxi, China
- Guangxi Key Laboratory of AIDS Prevention and Treatment, Guangxi Medical University, Nanning, 530021, Guangxi, China
- Life Science Institute, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Chunyan Lu
- Guangxi Center for Disease Prevention and Control, Nanning, 530021, Guangxi, China
| | - Shanfang Qin
- Longtan Hospital of Guangxi Zhuang Autonomous Region, Liuzhou, 545005, Guangxi, China
| | - Wudi Wei
- Guangxi Key Laboratory of AIDS Prevention and Treatment, Guangxi Medical University, Nanning, 530021, Guangxi, China
- Nursing College, Guangxi Medical University, Nanning, 530021, Guangxi, China
- School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Jingzhen Lai
- Guangxi Key Laboratory of AIDS Prevention and Treatment, Guangxi Medical University, Nanning, 530021, Guangxi, China
- Life Science Institute, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Junjun Jiang
- Guangxi Collaborative Innovation Center for Biomedicine, Guangxi Medical University, Nanning, 530021, Guangxi, China
- Guangxi Key Laboratory of AIDS Prevention and Treatment, Guangxi Medical University, Nanning, 530021, Guangxi, China
- School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Bingyu Liang
- Guangxi Key Laboratory of AIDS Prevention and Treatment, Guangxi Medical University, Nanning, 530021, Guangxi, China
- School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Oulu Zhou
- Guangxi Collaborative Innovation Center for Biomedicine, Guangxi Medical University, Nanning, 530021, Guangxi, China
- Guangxi Key Laboratory of AIDS Prevention and Treatment, Guangxi Medical University, Nanning, 530021, Guangxi, China
- School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Jing Han
- Guangxi Collaborative Innovation Center for Biomedicine, Guangxi Medical University, Nanning, 530021, Guangxi, China
- Guangxi Key Laboratory of AIDS Prevention and Treatment, Guangxi Medical University, Nanning, 530021, Guangxi, China
- Life Science Institute, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Yao Yang
- Guangxi Key Laboratory of AIDS Prevention and Treatment, Guangxi Medical University, Nanning, 530021, Guangxi, China
- School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Li Ye
- Guangxi Collaborative Innovation Center for Biomedicine, Guangxi Medical University, Nanning, 530021, Guangxi, China
- Guangxi Key Laboratory of AIDS Prevention and Treatment, Guangxi Medical University, Nanning, 530021, Guangxi, China
- Life Science Institute, Guangxi Medical University, Nanning, 530021, Guangxi, China
- School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Hao Liang
- Guangxi Collaborative Innovation Center for Biomedicine, Guangxi Medical University, Nanning, 530021, Guangxi, China.
- Guangxi Key Laboratory of AIDS Prevention and Treatment, Guangxi Medical University, Nanning, 530021, Guangxi, China.
- Life Science Institute, Guangxi Medical University, Nanning, 530021, Guangxi, China.
- School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China.
| | - Chuanyi Ning
- Guangxi Key Laboratory of AIDS Prevention and Treatment, Guangxi Medical University, Nanning, 530021, Guangxi, China.
- Life Science Institute, Guangxi Medical University, Nanning, 530021, Guangxi, China.
- Nursing College, Guangxi Medical University, Nanning, 530021, Guangxi, China.
- School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China.
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Baranczuk Z, Estill J, Blough S, Meier S, Merzouki A, Maathuis MH, Keiser O. Socio-behavioural characteristics and HIV: findings from a graphical modelling analysis of 29 sub-Saharan African countries. J Int AIDS Soc 2019; 22:e25437. [PMID: 31854506 PMCID: PMC6921084 DOI: 10.1002/jia2.25437] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 11/20/2019] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Socio-behavioural factors may contribute to the wide variance in HIV prevalence between and within sub-Saharan African (SSA) countries. We studied the associations between socio-behavioural variables potentially related to the risk of acquiring HIV. METHODS We used Bayesian network models to study associations between socio-behavioural variables that may be related to HIV. A Bayesian network consists of nodes representing variables, and edges representing the conditional dependencies between variables. We analysed data from Demographic and Health Surveys conducted in 29 SSA countries between 2010 and 2016. We predefined and dichotomized 12 variables, including factors related to age, literacy, HIV knowledge, HIV testing, domestic violence, sexual activity and women's empowerment. We analysed data on men and women for each country separately and then summarized the results across the countries. We conducted a second analysis including also the individual HIV status in a subset of 23 countries where this information was available. We presented summary graphs showing associations that were present in at least six countries (five in the analysis with HIV status). RESULTS We analysed data from 190,273 men (range across countries 2295 to 17,359) and 420,198 women (6621 to 38,948). The two variables with the highest total number of edges in the summary graphs were literacy and rural/urban location. Literacy was negatively associated with false beliefs about AIDS and, for women, early sexual initiation, in most countries. Literacy was also positively associated with ever being tested for HIV and the belief that women have the right to ask their husband to use condoms if he has a sexually transmitted infection. Rural location was positively associated with false beliefs about HIV and the belief that beating one's wife is justified, and negatively associated with having been tested for HIV. In the analysis including HIV status, being HIV positive was associated with female-headed household, older age and rural location among women, and with no variables among men. CONCLUSIONS Literacy and urbanity were strongly associated with several factors that are important for HIV acquisition. Since literacy is one of the few variables that can be improved by interventions, this makes it a promising intervention target.
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Affiliation(s)
- Zofia Baranczuk
- Institute of Global HealthUniversity of GenevaGenevaSwitzerland
- Department of PsychologyUniversity of ZurichZurichSwitzerland
- Institute of MathematicsUniversity of ZurichZurichSwitzerland
| | - Janne Estill
- Institute of Global HealthUniversity of GenevaGenevaSwitzerland
- Institute of Mathematical Statistics and Actuarial ScienceUniversity of BernBernSwitzerland
| | - Sara Blough
- Institute of Global HealthUniversity of GenevaGenevaSwitzerland
- Rollins School of Public HealthEmory UniversityAtlantaGAUSA
| | - Sonja Meier
- Seminar for StatisticsETH ZürichZurichSwitzerland
| | - Aziza Merzouki
- Institute of Global HealthUniversity of GenevaGenevaSwitzerland
| | | | - Olivia Keiser
- Institute of Global HealthUniversity of GenevaGenevaSwitzerland
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