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Andrianarimanana-Köcher D, Rakotoarivelo RA, Randria MJDD, Raberahona M, Ratefiharimanana A, Andriamasy EH, Vallès X, Benski AC, Emmrich JV, Walsh A, Robinson K, Muller N. Call for action: addressing the alarming surge of HIV in Madagascar. BMJ Glob Health 2024; 9:e015484. [PMID: 38569660 PMCID: PMC11002381 DOI: 10.1136/bmjgh-2024-015484] [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: 02/28/2024] [Accepted: 03/18/2024] [Indexed: 04/05/2024] Open
Affiliation(s)
| | - Rivo Andry Rakotoarivelo
- Faculté de Médecine, Université de Fianarantsoa, Fianarantsoa, Madagascar
- Centre Hospitalier Universitaire Tambohobe, Fianarantsoa, Madagascar
| | - Mamy Jean de Dieu Randria
- Faculté de Médecine, Université d'Antananarivo, Antananarivo, Analamanga, Madagascar
- Centre Hospitalier Universitaire Joseph Raseta Befelatanana, Antananarivo, Madagascar
| | - Mihaja Raberahona
- Faculté de Médecine, Université d'Antananarivo, Antananarivo, Analamanga, Madagascar
- Centre Hospitalier Universitaire Joseph Raseta Befelatanana, Antananarivo, Madagascar
| | - Andosoa Ratefiharimanana
- Institut Supérieur des Technologies Régional d'Alaotra Mangoro, Université de Toamasina, Toamasina, Madagascar
| | | | - Xavier Vallès
- International Health Program from the Catalan Institute for Health, Barcelona, Spain
- Foundation Institute of Research in Health Sciences Germans Trias i Pujol, Badalona, Spain
| | - Anne-Caroline Benski
- Département de la Femme, de l'Enfant et de l'Adolescent, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Julius Valentin Emmrich
- Charité Center for Global Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Andrew Walsh
- Department of Anthropology, University of Western Ontario, London, Ontario, Canada
| | | | - Nadine Muller
- Charité Center for Global Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health at Charité, Berlin, Germany
- Speciality Network: Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Robinson KE, Long JK, Fardine M, Stephano AM, Walsh A, Grewal EP. Patterns of Rising HIV Positivity in Northern Madagascar: Evidence of an Urgent Public Health Concern. Trop Med Infect Dis 2024; 9:19. [PMID: 38251216 PMCID: PMC10820016 DOI: 10.3390/tropicalmed9010019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 01/23/2024] Open
Abstract
Despite over two decades of progress against HIV/AIDS in adjacent sub-Saharan Africa, HIV rates and deaths due to AIDS are exponentially rising in Madagascar. Furthermore, a growing body of evidence suggests that, due to a scarcity of general-population screening data, even the startling increase demonstrated by official models vastly underestimates the true population prevalence of HIV. We aimed to implement a real-world HIV screening and treatment protocol to serve a general population stemming from across northern Madagascar. In collaboration with the Malagasy Ministry of Health, we provided point-of-care HIV screening and confirmatory testing for over 1000 participants from 73 towns, villages, and cities. We recorded an overall HIV prevalence of 2.94%. Notably, we observed a 13.1% HIV prevalence rate among urban populations and showed that proximity to a major route of travel was significantly associated with HIV risk. We also observed a link between HIV risk and various occupations, including those associated with increased mobility (such as mining). Importantly, all HIV-positive individuals were initiated on antiretroviral therapy in concordance with local health authorities. To our knowledge, this study marks the largest primary test data-based HIV study to date among Madagascar's general population, showing a greatly higher HIV prevalence (2.9%) than previously reported modeling-based figures (0.4%). Our rates aligned with the pattern of higher prevalence demonstrated in smaller general-population screening studies occurring more commonly prior to political strife in the mid-2000s. These findings demonstrate evidence of a growing HIV epidemic in northern Madagascar and underscore the need for future investment into more comprehensive HIV screening and control initiatives in Madagascar.
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Affiliation(s)
| | | | | | | | - Andrew Walsh
- Department of Anthropology, University of Western Ontario, London, ON N6A 3K7, Canada
| | - Eric P. Grewal
- Mada Clinics, Maventibao, Madagascar
- Department of Pathology, Massachusetts General Hospital, Boston, MA 02114, USA
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