1
|
Castaño RA, Granados MA, Trujillo N, Bernal JP, Trujillo JF, Trasmondi P, Maestre AF, Cardona JS, Gonzalez R, Larrarte MA, Hernandez DC, Barengo NC, Reynales H. Does performing a Point-Of-Care HbA1c test increase the chances of undertaking an OGTT among individuals at risk of diabetes? A randomized controlled trial. Prim Care Diabetes 2024; 18:624-631. [PMID: 39313407 DOI: 10.1016/j.pcd.2024.09.005] [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] [Received: 01/22/2024] [Revised: 08/20/2024] [Accepted: 09/12/2024] [Indexed: 09/25/2024]
Abstract
AIMS Early detection of type 2 diabetes mellitus is key to reducing micro and macrovascular complications associated with this disease. However, a lab-based process for diagnosis entails the risk of loss-to-follow-up. The objective of this study was to demonstrate if performing a point-of-care test of HbA1c immediately after a screening questionnaire will increase the proportion of individuals showing up for a lab-based confirmatory test as Point-of-care (POC) provides immediate availability, which is expected to reduce loss-to-follow-up. RESEARCH DESIGN AND METHODS This trial was a two-arm, randomized controlled, open-label study. Participants were recruited using the FINDRISC Score in a primary care and community setting. All 902 eligible participants were randomized into the intervention (n=511) and control (n=391) group. The intervention group was given information on healthy lifestyles, and a Point-of-care POC-HbA1c test was performed during the same visit. The control group was only given information on healthy lifestyles. Participants in both groups received a written prescription to have an oral glucose tolerance test (OGTT) performed within the next 30 days. Follow-up phone calls were made at 30 and 90 days to check if participant had undergone the test. The total duration of the intervention was 8 months. The posterior data analysis was made by using the Kolmogorov-Smirnoff test for the quantitative variables, and the descriptive statistics were expressed as means and standard deviation, or median and interquartile range 25 %-75 %, as appropriate. RESULTS At 30 days, 28 % of participants in the intervention group and 26.1 % in the control group undertook the OGTT (RD 1.90 %; 95 % CI -3.94; 7.73). At 90 days, 35.8 % of participants in the intervention group and 37.1 % in the control group undertook the OGTT. There was no statistically significant difference (RD - 3.17 %; 95 % CI -7.04; 0.70) between both groups. CONCLUSIONS The data suggest that performing a POC-HbA1c test after the FINDRISC did not increase the percentage of individuals showing up for the OGTT.
Collapse
Affiliation(s)
- Ramón A Castaño
- [UEB] Universidad El Bosque, Faculty of Medicine, Bogotá. Colombia
| | - Maria A Granados
- [CAIMED] Centro de Atención e Investigación Médica, Chía, Colombia
| | - Natalia Trujillo
- [CAIMED] Centro de Atención e Investigación Médica, Chía, Colombia
| | - Juan P Bernal
- [CAIMED] Centro de Atención e Investigación Médica, Chía, Colombia
| | - Juan F Trujillo
- [CAIMED] Centro de Atención e Investigación Médica, Chía, Colombia
| | | | - Angel F Maestre
- [CAIMED] Centro de Atención e Investigación Médica, Chía, Colombia.
| | - Juan S Cardona
- [CAIMED] Centro de Atención e Investigación Médica, Chía, Colombia
| | | | - María A Larrarte
- [CAIMED] Centro de Atención e Investigación Médica, Chía, Colombia
| | | | - Noël C Barengo
- [HWCM] Department of Medical Education, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA; [UNMdP] Escuela Superior de Medicina, Universidad Nacional de Mar del Plata, Mar del Plata, Argentina
| | | |
Collapse
|
2
|
King JM, Dobbins T, Keen P, Cornelisse VJ, Stoové M, Nigro SJ, Asselin J, Higgins N, Mao L, Aung HL, Petoumenos K, McGregor S. Trends in HIV testing and HIV stage at diagnosis among people newly diagnosed with HIV. AIDS 2024; 38:1774-1782. [PMID: 38905495 PMCID: PMC11356677 DOI: 10.1097/qad.0000000000003961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 06/13/2024] [Accepted: 06/16/2024] [Indexed: 06/23/2024]
Abstract
OBJECTIVE To identify groups more likely to be referred for HIV testing because of symptomatic presentation rather than as part of asymptomatic screening. DESIGN A retrospective analysis of Australian National HIV Registry (NHR) surveillance data including sociodemographic and clinical data, as well as reasons for HIV test. METHODS Using notification records from 2017 to 2022, we summarised reasons for testing leading to an HIV diagnosis. Reasons for testing were combined with clinical status at diagnosis to derive HIV testing categories: testing while symptomatic; asymptomatic HIV screening; seroconversion; and other test reason. We stratified these categories by stage of HIV at diagnosis with late-stage HIV defined as a CD4 + cell count <350 cells/μl at time of diagnosis. RESULTS Among 4134 HIV notifications with at least one reason for testing recorded, STI screening was the predominant reason for test referral (38%), followed by HIV indicative symptoms (31%), and risk behaviour (13%). By testing category, people aged 50 years or older (24%), people with HIV attributed to heterosexual sex (21%), people born in sub-Saharan Africa (19%), and women (17%) had lower levels of asymptomatic screening. More late-stage HIV diagnoses resulted from testing while symptomatic (58%) compared with asymptomatic screening (25%). CONCLUSIONS Older people and heterosexuals may not access HIV focused healthcare where HIV screening is routinely offered. Instead, HIV testing opportunities may arise in other settings. By normalising HIV testing and offering low-cost HIV screening in a range of settings, it may be possible to facilitate earlier HIV diagnoses, better health outcomes, and reduced onward transmission.
Collapse
Affiliation(s)
| | | | | | | | - Mark Stoové
- Disease Elimination Program, Burnet Institute
- School of Public Health and Preventive Medicine, Monash University
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne
| | - Steven J. Nigro
- Epidemiology and Data Systems Branch, Health Protection NSW, NSW Ministry of Health, Sydney
| | | | - Nasra Higgins
- Communicable Disease Epidemiology and Surveillance, Health Protection Branch, Victorian Department of Health, Melbourne
| | - Limin Mao
- Centre for Social Research in Health, UNSW Sydney, Sydney, New South Wales, Australia
| | | | | | | |
Collapse
|
3
|
Sweileh WM. Analysis and mapping of global research publications on point-of-care testing for infectious diseases. J Eval Clin Pract 2024; 30:945-953. [PMID: 38764304 DOI: 10.1111/jep.13996] [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] [Received: 02/07/2024] [Revised: 02/22/2024] [Accepted: 04/07/2024] [Indexed: 05/21/2024]
Abstract
RATIONALE This study presents the first comprehensive analysis and mapping of scientific research on point-of-care testing (POCT) in infectious diseases, filling a gap in understanding the evolving landscape of this field. The identification of research themes and global contributions offers valuable insights. AIMS AND OBJECTIVES This manuscript aims to analyse and map scientific research on POCT in the context of infectious diseases. METHODS The study employed a comprehensive search strategy using terms related to POCT and infectious diseases. The search was conducted on the Scopus database, refining results based on inclusion and exclusion criteria. The dataset of 1719 research articles was then subjected to descriptive analysis and mapping using VOSviewer. RESULTS The research findings indicate an exponential growth in POCT-related publications, with 46.8% published post the COVID-19 pandemic. Plos One journal led in publication frequency, and Biosensors and Bioelectronics received the highest citations per article. North America and Western Europe dominated contributions, with notable participation from China, South Africa, and India. The research landscape revealed the following research themes: detection technologies, human immunodeficiency virus (HIV)/sexually transmitted infection (STI) diagnosis, antibiotic optimisation, and schistosomiasis. Clinical trials focused on antibiotic prescribing, HIV, STIs, and specific infections. The findings suggest a shifting landscape towards POCT, emphasising the need for future planning and investment in healthcare systems. The research identifies areas for future exploration, such as the impact of POCT on antibiotic prescribing and its role in combating infectious diseases in low- and middle-income countries. CONCLUSION Implementation of POCT has the potential to revolutionise infectious disease management, improve patient outcomes, and reduce the global burden of diseases. Better public awareness, healthcare team management, and planning for POCT at entry points are crucial for societal benefit. Results demonstrated the evolving role of POCT in infectious disease management and prevention.
Collapse
Affiliation(s)
- Waleed M Sweileh
- Division of Biomedical Sciences, Department of Physiology and Pharmacology/Toxicology, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| |
Collapse
|
4
|
Violette LR, Thomas KK, Dorward J, Quame-Amaglo J, Garrett N, Drain PK. Early HIV viral suppression associated with subsequent 12-month treatment success among people living with HIV in South Africa. HIV Med 2024; 25:759-765. [PMID: 38488308 PMCID: PMC11405010 DOI: 10.1111/hiv.13633] [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: 11/06/2023] [Accepted: 03/02/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND We analyzed the STREAM (Simplifying HIV TREAtment and Monitoring) study to determine risk factors associated with HIV viraemia and poor retention 18 months after initiation of antiretroviral therapy (ART). METHODS The STREAM study was an open-label randomized controlled trial in Durban, South Africa, that enrolled 390 people living with HIV presenting for their first HIV viral load measurement ~6 months after ART initiation. We used modified Poisson regression with robust standard errors to describe associations between baseline characteristics and three HIV outcomes 18 months after ART initiation: HIV viraemia (>50 copies/mL), poor retention in HIV care, and a composite outcome of poor retention in care and/or HIV viraemia. RESULTS Approximately 18 months after ART initiation, 45 (11.5%) participants were no longer retained in care and 43 (11.8%) had viraemia. People with CD4 counts <200 and those with viraemia 6 months after ART initiation were significantly more likely to have viraemia 18 months after ART initiation (adjusted relative risk [aRR] 4.0; 95% confidence interval [CI] 2.1-7.5 and aRR 5.5; 95% CI 3.3-9.0, respectively). People who did not disclose their HIV status and had viraemia after ART initiation were more likely to not be retained in care 12 months later (aRR 2.6; 95% CI 1.1-6.1 and aRR 2.2; 95% CI 1.0-4.8). People with a CD4 count <200 and those with viraemia were more likely to not achieve the composite outcome 18 months after ART initiation. CONCLUSIONS Viraemia after ART initiation was the strongest predictor of subsequent viraemia and poor care retention. Understanding early indicators can help target our interventions to better engage people who may be more likely to experience persistent viraemia or disengage from HIV care.
Collapse
Affiliation(s)
- Lauren R Violette
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
| | | | - Jienchi Dorward
- Centre for the AIDS Program of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | | | - Nigel Garrett
- Centre for the AIDS Program of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Paul K Drain
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
| |
Collapse
|
5
|
Schroeder LF, Rebman P, Kasaie P, Kenu E, Zelner J, Dowdy D. A Generalizable Decision-Making Framework for Selecting Onsite versus Send-out Clinical Laboratory Testing. Med Decis Making 2024; 44:307-319. [PMID: 38449385 PMCID: PMC10987262 DOI: 10.1177/0272989x241232666] [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] [Indexed: 03/08/2024]
Abstract
BACKGROUND Laboratory networks provide services through onsite testing or through specimen transport to higher-tier laboratories. This decision is based on the interplay of testing characteristics, treatment characteristics, and epidemiological characteristics. OBJECTIVES Our objective was to develop a generalizable model using the threshold approach to medical decision making to inform test placement decisions. METHODS We developed a decision model to compare the incremental utility of onsite versus send-out testing for clinical purposes. We then performed Monte Carlo simulations to identify the settings under which each strategy would be preferred. Tuberculosis was modeled as an exemplar. RESULTS The most important determinants of the decision to test onsite versus send-out were the clinical utility lost due to send-out testing delays and the accuracy decrement with onsite testing. When the sensitivity decrements of onsite testing were minimal, onsite testing tended to be preferred when send-out delays reduced clinical utility by >20%. By contrast, when onsite testing incurred large reductions in sensitivity, onsite testing tended to be preferred when utility lost due to delays was >50%. The relative cost of onsite versus send-out testing affected these thresholds, particularly when testing costs were >10% of treatment costs. CONCLUSIONS Decision makers can select onsite versus send-out testing in an evidence-based fashion using estimates of the percentage of clinical utility lost due to send-out delays and the relative accuracy of onsite versus send-out testing. This model is designed to be generalizable to a wide variety of use cases. HIGHLIGHTS The design of laboratory networks, including the decision to place diagnostic instruments at the point-of-care or at higher tiers as accessed through specimen transport, can be informed using the threshold approach to medical decision making.The most important determinants of the decision to test onsite versus send-out were the clinical utility lost due to send-out testing delays and the accuracy decrement with onsite testing.The threshold approach to medical decision making can be used to compare point-of-care testing accuracy decrements with the lost utility of treatment due to send-out testing delays.The relative cost of onsite versus send-out testing affected these thresholds, particularly when testing costs were >10% of treatment costs.
Collapse
Affiliation(s)
- Lee F. Schroeder
- Department of Pathology, University of Michigan School of Medicine, USA
| | - Paul Rebman
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, USA
| | - Parastu Kasaie
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, USA
| | - Ernest Kenu
- School of Public Health, University of Ghana, Ghana
| | - Jon Zelner
- Department of Epidemiology, University of Michigan School of Public Health, USA
- Center for Social Epidemiology and Population Health, University of Michigan School of Public Health, USA
| | - David Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, USA
| |
Collapse
|
6
|
Wang Y, Wagner AD, Liu S, Kingwara L, Oyaro P, Brown E, Karauki E, Yongo N, Bowen N, Kiiru J, Hassan S, Patel R. Using queueing models as a decision support tool in allocating point-of-care HIV viral load testing machines in Kisumu County, Kenya. Health Policy Plan 2024; 39:44-55. [PMID: 37949109 PMCID: PMC10775219 DOI: 10.1093/heapol/czad111] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 08/18/2023] [Accepted: 11/08/2023] [Indexed: 11/12/2023] Open
Abstract
Point-of-care (POC) technologies-including HIV viral load (VL) monitoring-are expanding globally, including in resource-limited settings. Modelling could allow decision-makers to consider the optimal strategy(ies) to maximize coverage and access, minimize turnaround time (TAT) and minimize cost with limited machines. Informed by formative qualitative focus group discussions with stakeholders focused on model inputs, outputs and format, we created an optimization model incorporating queueing theory and solved it using integer programming methods to reflect HIV VL monitoring in Kisumu County, Kenya. We modelled three scenarios for sample processing: (1) centralized laboratories only, (2) centralized labs with 7 existing POC 'hub' facilities and (3) centralized labs with 7 existing and 1-7 new 'hub' facilities. We calculated total TAT using the existing referral network for scenario 1 and solved for the optimal referral network by minimizing TAT for scenarios 2 and 3. We conducted one-way sensitivity analyses, including distributional fairness in each sub-county. Through two focus groups, stakeholders endorsed the provisionally selected model inputs, outputs and format with modifications incorporated during model-building. In all three scenarios, the largest component of TAT was time spent at a facility awaiting sample batching and transport (scenarios 1-3: 78.7%, 89.9%, 91.8%) and waiting time at the testing site (18.7%, 8.7%, 7.5%); transportation time contributed minimally to overall time (2.6%, 1.3%, 0.7%). In scenario 1, the average TAT was 39.8 h (SD: 2.9), with 1077 h that samples spent cumulatively in the VL processing system. In scenario 2, the average TAT decreased to 33.8 h (SD: 4.8), totalling 430 h. In scenario 3, the average TAT decreased nearly monotonically with each new machine to 31.1 h (SD: 8.4) and 346 total hours. Frequency of sample batching and processing rate most impacted TAT, and inclusion of distributional fairness minimally impacted TAT. In conclusion, a stakeholder-informed resource allocation model identified optimal POC VL hub allocations and referral networks. Using existing-and adding new-POC machines could markedly decrease TAT, as could operational changes.
Collapse
Affiliation(s)
| | - Anjuli D Wagner
- Department of Global Health, University of Washington, Seattle, Washington 98195, USA
- Department of Industrial and Systems Engineering, University of Washington, Seattle, Washington 98195, USA
| | - Shan Liu
- Department of Industrial and Systems Engineering, University of Washington, Seattle, Washington 98195, USA
| | | | | | | | | | | | - Nancy Bowen
- National Public Health Laboratory, Nairobi 00100, Kenya
| | - John Kiiru
- National Public Health Laboratory, Nairobi 00100, Kenya
| | - Shukri Hassan
- Department of Global Health, University of Washington, Seattle, Washington 98195, USA
| | - Rena Patel
- Department of Global Health, University of Washington, Seattle, Washington 98195, USA
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle 98195, USA
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama 35294, USA
| |
Collapse
|
7
|
Ditondo P, Luemba A, Chuy RI, Mucinya G, Ade S. Contribution des diagnostics au points de service dans l’identification de la maladie à VIH avancée. Public Health Action 2023; 13:7-12. [PMID: 37529556 PMCID: PMC10380412 DOI: 10.5588/pha.23.0005] [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: 02/11/2023] [Accepted: 04/14/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Médecins Sans Frontières Belgium installed point-of-care (POC) diagnostics for the early detection of advanced HIV disease (AHD), and in its presence, TB and cryptococcosis, in six health centres (Kasai, St Ambroise, St Joseph, Libondi, Lisanga and Kimia) in Kinshasa, Democratic Republic of the Congo (DRC). OBJECTIVE To document their contribution to the diagnosis of these conditions. METHOD This is a retrospective cross-sectional study of HIV-positive adolescents and adults admitted with suspected AHD. A comparison 2 years before and 2 years after installation of POC was performed. RESULTS A total of 745 and 887 patients were included before and after POC, respectively. The mean age was 39.7 years (standard deviation [SD] 12.04); 66% (n = 1,077) were women. Patients with CD4 counts increased from 40.3% (n = 300) to 64.4% (n = 573) (P < 0.001). After the installation of POC, they ranged from 47.8% (Lisanga) to 97.1% (Kasai). The proportion of AHD was comparable (n = 158, 52.7% vs. n = 288, 50.3%; P = 0.779). Among patients with AHD, TB was detected in 28.5% (n = 82), of which 41.5% (n = 34) were confirmed; cryptococcosis was detected in 24.7% (n = 71), of which 9.9% (n = 7) were confirmed. Disparities between centres were observed. CONCLUSION The POCs have increased patient access to CD4 testing and diagnosis of AHD in the six centres in DRC. However, actions are required to improve this performance, including screening for TB and cryptococcosis.
Collapse
Affiliation(s)
- P Ditondo
- Médecins Sans Frontières Belgique, Kinshasa, RDC
| | - A Luemba
- Médecins Sans Frontières Belgique, Kinshasa, RDC
| | - R Ingwe Chuy
- Programme National de Lutte Contre le VIH/SIDA, Kinshasa, RDC
| | - G Mucinya
- Médecins Sans Frontières Belgique, Kinshasa, RDC
| | - S Ade
- Faculté de Médecine, Université de Parakou, Parakou, Bénin
| |
Collapse
|
8
|
Lazarus JV, Villota-Rivas M, Ryan P, Buti M, Grau-López L, Cuevas G, Espada JL, Morón W, Palma-Álvarez RF, Feld JJ, Valencia J. Combined COVID-19 vaccination and hepatitis C virus screening intervention in marginalised populations in Spain. COMMUNICATIONS MEDICINE 2023; 3:66. [PMID: 37173456 PMCID: PMC10180614 DOI: 10.1038/s43856-023-00292-y] [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: 11/03/2022] [Accepted: 04/19/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND COVID-19 has hindered hepatitis C virus (HCV) and HIV screening, particularly in marginalised groups, who have some of the highest rates of these conditions and lowest rates of COVID-19 vaccination. We assessed the acceptability of combining HCV testing with COVID-19 vaccination in a centre for addiction services (CAS) in Barcelona and a mobile testing unit (MTU) in Madrid, Spain. METHODS From 28/09/2021 to 30/06/2022, 187 adults from marginalised populations were offered HCV antibody (Ab) testing along with COVID-19 vaccination. If HCV Ab+, they were tested for HCV-RNA. MTU participants were also screened for HIV. HCV-RNA+ and HIV+ participants were offered treatment. Data were analysed descriptively. RESULTS Findings show how of the 86 CAS participants: 80 (93%) had been previously vaccinated for COVID-19, of whom 72 (90%) had the full first round schedule; none had a COVID-19 vaccine booster and all received a COVID-19 vaccine; 54 (62.8%) were tested for HCV Ab, of whom 17 (31.5%) were positive, of whom all were tested for HCV-RNA and none were positive. Of the 101 MTU participants: none had been vaccinated for COVID-19 and all received a COVID-19 vaccine; all were tested for HCV Ab and HIV and 15 (14.9%) and 9 (8.9%) were positive, respectively; of those HCV Ab+, 9 (60%) were HCV-RNA+, of whom 8 (88.9%) have started treatment; 5 (55.6%) of those HIV+ had abandoned antiretroviral therapy, of whom 3 (60%) have re-started it. CONCLUSIONS The intervention was accepted by 54 (62.8%) CAS participants and all MTU participants and can be used in marginalised communities.
Collapse
Affiliation(s)
- Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain.
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.
- CUNY Graduate School of Public Health and Health Policy, New York, NY, USA.
| | - Marcela Villota-Rivas
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Pablo Ryan
- Department of Internal Medicine, Hospital Universitario Infanta Leonor, Madrid, Spain
- Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | - Maria Buti
- Liver Unit, Hospital Universitario Vall d'Hebron, Barcelona, Spain
- CIBERhd, Instituto de Salud Carlos III, Madrid, Spain
| | - Lara Grau-López
- Department of Psychiatry, Addiction and Dual Diagnosis Section, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Psychiatry Group, Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
- Biomedical Network Research Centre on Mental Health (CIBERSAM), Madrid, Spain
- Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Guillermo Cuevas
- Department of Internal Medicine, Hospital Universitario Infanta Leonor, Madrid, Spain
| | | | | | - Raul Felipe Palma-Álvarez
- Department of Psychiatry, Addiction and Dual Diagnosis Section, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Psychiatry Group, Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
- Biomedical Network Research Centre on Mental Health (CIBERSAM), Madrid, Spain
- Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Jordan J Feld
- Toronto Centre for Liver Disease, University Health Network, Toronto, Canada
| | - Jorge Valencia
- Department of Internal Medicine, Hospital Universitario Infanta Leonor, Madrid, Spain
- Harm reduction Unit "SMASD", Madrid, Spain
- Mobile testing unit, Madrid, Spain
| |
Collapse
|
9
|
Bayisa L, Bayisa D, Turi E, Mulisa D, Tolossa T, Akuma AO, Bokora MC, Rundasa DT. Same-Day ART Initiation and Associated Factors Among People Living with HIV on Lifelong Therapy at Nekemte Specialized Hospital, Western Ethiopia. HIV AIDS (Auckl) 2023; 15:11-22. [PMID: 36718213 PMCID: PMC9884049 DOI: 10.2147/hiv.s395238] [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: 11/02/2022] [Accepted: 01/13/2023] [Indexed: 01/26/2023] Open
Abstract
Background The test-and-treat approach recommends early ART initiation (same day). Early ART start has double the benefits as treatment and as prevention. However, there is limited information regarding same-day ART initiation in Ethiopia. Hence, this study aimed to assess the magnitude and factors of same-day ART initiation among people living with HIV (PLHIV) on ART at Nekemte specialized hospital, in Western Ethiopia. Methods A cross-sectional study was conducted among 483 PLHIV from January 10 to February 15, 2021. Data were collected using an investigator-administered questionnaire. Epi Data 3.1 and STATA 14.0 were used for data entry and analysis, respectively. Variables with P-value <0.25 from bivariable analysis were included in the multivariable analysis. AOR with 95% CI and P-value <0.05 were used to declare statistical significance. Results A total of 483 study subjects participated and gave a 100% response rate. Two thirds (65%) of them started ART on the same day with a 95% CI [60.2-68.8]. Urban dwellers (AOR = 3.93 (95% 1.96-7.87)), with no OIs (AOR = 4.02 (95% CI: 1.54-10.47)), not screened for TB (AOR = 6.02 (95% CI: 1.71-21.15)), tested via VCT (AOR = 2.32 (95% CI: 1.37-3.26)), who have not used CPT (AOR = 1.88 (95% CI: 1.10-3.23)), who have not used IPT (AOR = 2.36 (95% CI: 1.0-5.57)), who were tested in 2019/20 (AOR = 2.37 (95% CI: 1.08-5.518)), and with BMI ≥25 kg/m2 (AOR = 2.18 (95% CI: 1.05-4.52)) were significantly associated with same-day ART initiation. Conclusion Two thirds of study subjects initiated ART on the same day as HIV diagnosis. Voluntary testing and immediate referral to HIV care, advocating test-and-treat, and intensive counseling should be strengthened and reinforced for newly diagnosed HIV-positive people. Given that, high attention should be paid to individuals from urban residence, not screened for TB, who have not used CPT and IPT prophylaxis.
Collapse
Affiliation(s)
- Lami Bayisa
- Department of Nursing, School of Nursing and Midwifery, Wollega University, Nekemte, Ethiopia,Correspondence: Lami Bayisa, Department of Nursing, School of Nursing and Midwifery, Wollega University, P.O.Box: 395, Nekemte, Ethiopia, Tel +251 924318135, Email
| | - Diriba Bayisa
- Department of Midwifery, School of Nursing and Midwifery, Wollega University, Nekemte, Ethiopia
| | - Ebisa Turi
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Diriba Mulisa
- Department of Nursing, School of Nursing and Midwifery, Wollega University, Nekemte, Ethiopia
| | - Tadesse Tolossa
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Adugna Olani Akuma
- Department of Nursing, School of Nursing and Midwifery, Wollega University, Nekemte, Ethiopia
| | - Merga Chala Bokora
- Department of Midwifery, School of Nursing and Midwifery, Wollega University, Nekemte, Ethiopia
| | - Dawit Tesfaye Rundasa
- Department of Nursing, School of Nursing and Midwifery, Wollega University, Nekemte, Ethiopia
| |
Collapse
|
10
|
Pugh LE, Roberts JS, Viswasam N, Hahn E, Ryan S, Turpin G, Lyons CE, Baral S, Hansoti B. Systematic review of interventions aimed at improving HIV adherence to care in low- and middle-income countries in Sub-Saharan Africa. J Infect Public Health 2022; 15:1053-1060. [PMID: 36063721 PMCID: PMC10117278 DOI: 10.1016/j.jiph.2022.08.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 08/12/2022] [Accepted: 08/23/2022] [Indexed: 11/15/2022] Open
Abstract
Long-term adherence to antiretroviral medication continues to present as a challenge along the continuum of the HIV care cascade. HIV interventions and support programs are significantly threatened in resource-limited settings by challenges in maintaining long-term follow-up for ART adherence. We sought to complete a systematic review to comprehensively examine ART adherence and retention in care interventions in Sub-Saharan Africa and to report on the implementation of interventions in real-world settings to inform future health investments in HIV care. Interventions were grouped according to their impact on individual, community, and health-systems levels. While a vast majority of studies evaluated a combination of interventions, those studies that incorporated the community as a resource were most successful. In addition, providing education and behavior reminders proved effective and should be accompanied by community and peer efforts for best results. Multi-level interventions, such as combining individual and community-level interventions showed promising results for long term ART adherence.
Collapse
Affiliation(s)
- Laura E Pugh
- School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jacob S Roberts
- School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Nikita Viswasam
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Elizabeth Hahn
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sophia Ryan
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ghilane Turpin
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Carrie E Lyons
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Stefan Baral
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Bhakti Hansoti
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of International Health, Bloomberg School of Public Health, Baltimore, Maryland, USA.
| |
Collapse
|
11
|
Spooner E, Reddy T, Mchunu N, Reddy S, Daniels B, Ngomane N, Luthuli N, Kiepiela P, Coutsoudis A. Point-of-care CD4 testing: Differentiated care for the most vulnerable. J Glob Health 2022; 12:04004. [PMID: 35136596 PMCID: PMC8818294 DOI: 10.7189/jogh.12.04004] [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] [Indexed: 11/25/2022] Open
Abstract
Background South Africa, with the highest burden of HIV infection globally, has made huge strides in its HIV/ART programme, but AIDS deaths have not decreased proportionally to ART uptake. Advanced HIV disease (CD4 < 200 cells/mm3) persists, and CD4 count testing is being overlooked since universal test-and-treat was implemented. Point-of-care CD4 testing could address this gap and assure differentiated care to these vulnerable patients with low CD4 counts. Methods A time randomised implementation trial was conducted, enrolling 603 HIV positive non-ART, not pregnant patients at a primary health care clinic in Durban, South Africa. Weeks were randomised to either point-of-care CD4 testing (n = 305 patients) or standard-of-care central laboratory CD4 testing (n = 298 patients) to assess the proportion initiating ART at 3 months. Cox regression, with robust standard errors adjusting for clustering by week, were used to assess the relationship between treatment initiation and arm. Results Among the 578 (299 point-of-care and 279 standard-of-care) patients eligible for analysis, there was no significant difference in the number of eligible patients initiating ART within 3 months in the point-of-care (73%) and the standard-of-care (68%) groups (P = 0.112). The time-to-treat analysis was not significantly different in patients with CD4 counts of 201-500 cells/mm3 which could have been due to appointment scheduling to cope with the large burden of cases. However, in patients with advanced HIV disease (CD4 < 200cells/mm3) 65% more patients started ART earlier in the point-of-care group (HR 1.65 (95% confidence interval (CI) = 0.99-2.75; P = 0.052) compared to the standard-of-care group. Conclusions Point-of-care testing decreased time-to-treatment in those with advanced HIV disease. With universal test and treat for HIV, rollout of simple point-of-care CD4 testing would ensure early diagnosis of advanced HIV disease and facilitate differentiated care for these vulnerable patients as per the World Health Organisation 2020 target product profile for point-of-care CD4 testing. Trial registration ISRCTN14220457.
Collapse
Affiliation(s)
- Elizabeth Spooner
- Department of Paediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa
- South African Medical Research Council, HIV Prevention Research Unit, Durban, South Africa
| | - Tarylee Reddy
- South African Medical Research Council, Biostatistics Unit, Durban, South Africa
| | - Nobuhle Mchunu
- South African Medical Research Council, Biostatistics Unit, Durban, South Africa
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | | | - Brodie Daniels
- South African Medical Research Council, HIV Prevention Research Unit, Durban, South Africa
| | | | | | | | - Anna Coutsoudis
- Department of Paediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa
| |
Collapse
|
12
|
Challenges to improved animal rabies surveillance: Experiences from pilot implementation of decentralized diagnostic units in Chad. Acta Trop 2021; 221:105984. [PMID: 34058158 DOI: 10.1016/j.actatropica.2021.105984] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 05/14/2021] [Accepted: 05/17/2021] [Indexed: 12/31/2022]
Abstract
Better surveillance is desperately needed to guide rabies prevention and control to achieve the goal of zero dog-mediated human rabies by 2030, defined by the World Health Organization (WHO) and partners in 2015. With the help of funding from the Vaccine Alliance (GAVI) learning agenda, we implemented animal rabies surveillance based on One Health communication, improved accessibility of diagnostic testing and facilitated sample transport to increase case detection in three regions of Chad. Through the project, rabies surveillance, previously only available in N'Djaména, was extended to selected provincial rural and urban areas. Nine decentralized diagnostic units (DDU) were established, hosted by veterinary district agencies (VDA) in four different administrative regions. Four additional VDAs in the study area were reinforced with facilitation of sample collection and transport. Staff from all these 13 veterinary facilities were trained in sample collection and diagnostics. DDUs performed Rapid Immunodiagnostic Tests (RIDT) providing a preliminary result before samples were sent to the central laboratory in N'Djamena for confirmation with the standard Florescent Antibody Test (FAT). Within the project period from June 2016 to March 2018, 115 samples were reported by veterinary facilities in the study areas compared to 63 samples received from outside the study area, the vast majority of them originating from the capital city N'Djaména (N=61). Eighty nine percent of all 178 samples reported to IRED during the project period tested positive. Most of the samples originated from dogs (92%). Other confirmed rabies positive animals observed were cats, a donkey and a pig. Although surveillance of animal rabies was the focus, four human saliva samples were also submitted for diagnosis. We observed high differences in reporting rates between the four study regions. This could be attributable to differences in rabies epidemiology but are also influenced by the distance to the central laboratory in N'Djaména, the cultural background and the level of public awareness. The possibility for local testing through RIDT was very welcomed by local veterinary staff and preliminary insights suggest a positive influence on One Health communication and PEP initiation. However, these aspects as well as the relative impact of local testing on sample collection in comparison to reinforcement of sample collection and transport alone, need to be further investigated. Challenges encountered related to poor infrastructure (buildings, appliances, materials) and low logistic capacity (lacking means and material for transport and communication) of veterinary services in Chad. In addition, veterinary personnel lack experience in data management. Together with staff turnover, this leads to a need for repeated training. Major shortcoming of the approach was the high cost per sample and limited sustainability beyond the project timeframe.
Collapse
|
13
|
Uzoaru F, Nwaozuru U, Ong JJ, Obi F, Obiezu-Umeh C, Tucker JD, Shato T, Mason SL, Carter V, Manu S, BeLue R, Ezechi O, Iwelunmor J. Costs of implementing community-based intervention for HIV testing in sub-Saharan Africa: a systematic review. Implement Sci Commun 2021; 2:73. [PMID: 34225820 PMCID: PMC8259076 DOI: 10.1186/s43058-021-00177-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 06/22/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Community-based interventions (CBIs) are interventions aimed at improving the well-being of people in a community. CBIs for HIV testing seek to increase the availability of testing services to populations that have been identified as at high risk by reaching them in homes, schools, or community centers. However, evidence for a detailed cost analysis of these community-based interventions in sub-Saharan Africa (SSA) is limited. We conducted a systematic review of the cost analysis of HIV testing interventions in SSA. METHODS Keyword search was conducted on SCOPUS, CINAHL, MEDLINE, PsycINFO, Web of Science, and Global Health databases. Three categories of key terms used were cost (implementation cost OR cost-effectiveness OR cost analysis OR cost-benefit OR marginal cost), intervention (HIV testing), and region (sub-Saharan Africa OR sub-Saharan Africa OR SSA). CBI studies were included if they primarily focused on HIV testing, was implemented in SSA, and used micro-costing or ingredients approach. RESULTS We identified 1533 citations. After screening, ten studies were included in the review: five from East Africa and five from Southern Africa. Two studies conducted cost-effectiveness analysis, and one study was a cost-utility analysis. The remainder seven studies were cost analyses. Four intervention types were identified: HIV self-testing (HIVST), home-based, mobile, and Provider Initiated Testing and Counseling. Commonly costed resources included personnel (n = 9), materials and equipment (n = 6), and training (n = 5). Cost outcomes reported included total intervention cost (n = 9), cost per HIV test (n = 9), cost per diagnosis (n = 5), and cost per linkage to care (n = 3). Overall, interventions were implemented at a higher cost than controls, with the largest cost difference with HIVST compared to facility-based testing. CONCLUSION To better inform policy, there is an urgent need to evaluate the costs associated with implementing CBIs in SSA. It is important for cost reports to be detailed, uniform, and informed by economic evaluation guidelines. This approach minimizes biases that may lead decision-makers to underestimate the resources required to scale up, sustain, or reproduce successful interventions in other settings. In an evolving field of implementation research, this review contributes to current resources on implementation cost studies.
Collapse
Affiliation(s)
- Florida Uzoaru
- College of Public Health and Social Justice, Saint Louis University, St Louis, MO, USA.
| | - Ucheoma Nwaozuru
- College of Public Health and Social Justice, Saint Louis University, St Louis, MO, USA
| | - Jason J Ong
- Department of Clinical Research and Development, London School of Hygiene and Tropical Medicine, United Kingdom Central Clinical School, Monash University, Melbourne, Australia
| | - Felix Obi
- Health Policy Research Group, University of Nigeria, Nsukka, Nigeria
| | - Chisom Obiezu-Umeh
- College of Public Health and Social Justice, Saint Louis University, St Louis, MO, USA
| | - Joseph D Tucker
- Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Thembekile Shato
- College of Public Health and Social Justice, Saint Louis University, St Louis, MO, USA
| | - Stacey L Mason
- College of Public Health and Social Justice, Saint Louis University, St Louis, MO, USA
| | - Victoria Carter
- College of Public Health and Social Justice, Saint Louis University, St Louis, MO, USA
| | - Sunita Manu
- College of Public Health and Social Justice, Saint Louis University, St Louis, MO, USA
| | - Rhonda BeLue
- College of Public Health and Social Justice, Saint Louis University, St Louis, MO, USA
| | - Oliver Ezechi
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Juliet Iwelunmor
- College of Public Health and Social Justice, Saint Louis University, St Louis, MO, USA
| |
Collapse
|
14
|
Vidhyavathi V, Iqbal HS, Kanthamani K, Solomon SS, Nandagopal P, Luchters S, Pham MD, Forbes J, Crowe SM, McMurran C, Anderson DA, Balakrishnan P. Performance characteristics of an instrument-free point-of-care CD4 test (VISITECT®CD4) for use in resource-limited settings. J Int Med Res 2021; 48:300060520955028. [PMID: 32985310 PMCID: PMC7536493 DOI: 10.1177/0300060520955028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective CD4+ T lymphocyte count remains the most common biomarker of immune status
and disease progression in human immunodeficiency virus (HIV)-positive
individuals. VISITECT®CD4 is an instrument-free, low-cost point-of-care CD4
test with a cut-off of 350 CD4 cells/μL. This study aimed to evaluate
VISITECT®CD4 test's diagnostic accuracy. Methods Two hundred HIV-positive patients attending a tertiary HIV centre in South
India were recruited. Patients provided venous blood for reference and
VISITECT®CD4 tests. An additional finger-prick blood sample was obtained for
VISITECT®CD4. VISITECT®CD4's diagnostic performance in identifying
individuals with CD4 counts ≤350 cells/μL was assessed by calculating
sensitivity, specificity, positive predictive value (PPV) and negative
predictive value (NPV) taking flow cytometry as the reference. Results The overall agreement between VISITECT®CD4 and flow cytometry was 89.5% using
venous blood and 81.5% using finger-prick blood. VISITECT®CD4 showed better
performance using venous blood [sensitivity: 96.6% (95% confidence interval:
92.1%–98.9%), specificity: 70.9% (57.1%–82.4%), PPV: 89.7% (83.9%–94.0%) and
NPV: 88.6% (75.4%–96.2%)] than using finger-prick blood [sensitivity: 84.8%
(77.9%–90.2%), specificity: 72.7% (59.0%–83.9%), PPV: 89.1% (82.7%–93.8%)
and NPV: 64.5% (51.3%–76.3%)]. Conclusion VISITECT®CD4 performed well using venous blood, demonstrating its potential
utility in decentralization of CD4 testing services in resource-constrained
settings.
Collapse
Affiliation(s)
| | - Hussain Syed Iqbal
- YRG Centre for AIDS Research and Education, Voluntary Health
Services, Chennai, India
| | - Kannaiyan Kanthamani
- YRG Centre for AIDS Research and Education, Voluntary Health
Services, Chennai, India
| | - Sunil Suhas Solomon
- YRG Centre for AIDS Research and Education, Voluntary Health
Services, Chennai, India
- Johns Hopkins University School of Medicine, Baltimore,
USA
| | | | - Stanley Luchters
- Department of Population Health, Aga Khan University, Nairobi,
Kenya
- Burnet Institute, Melbourne, Australia
- Department of Epidemiology and Preventive Medicine, Monash
University, Melbourne, Australia
- Department of Public Health and Primary Care, Ghent University,
Ghent, Belgium
| | - Minh D. Pham
- Burnet Institute, Melbourne, Australia
- Department of Epidemiology and Preventive Medicine, Monash
University, Melbourne, Australia
| | | | - Suzanne M. Crowe
- Burnet Institute, Melbourne, Australia
- Department of Epidemiology and Preventive Medicine, Monash
University, Melbourne, Australia
| | | | | | - Pachamuthu Balakrishnan
- YRG Centre for AIDS Research and Education, Voluntary Health
Services, Chennai, India
- Pachamuthu Balakrishnan, YRG Centre for AIDS
Research and Education, Voluntary Health Services Hospital Campus, Taramani,
Chennai – 600113, India.
| |
Collapse
|
15
|
Gill MJ, Powell M, Vu Q, Krentz HB. Economic impact on direct healthcare costs of missing opportunities for diagnosing HIV within healthcare settings. HIV Med 2021; 22:723-731. [PMID: 33979022 DOI: 10.1111/hiv.13121] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 04/03/2021] [Accepted: 04/12/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND The economic consequences of a missed opportunity for HIV testing at an earlier stage of infection within a healthcare setting are poorly described. METHODS For all newly diagnosed HIV patients followed at the Southern Alberta HIV/AIDS Clinic (SAC), Calgary, Canada, between 1 April 2011 and 1 April 2016, all clinical encounters occurring < 3 years prior to diagnosis within the region were obtained. The direct costs of HIV care after diagnosis to 31 March 2019 were determined from a payers' perspective and reported as mean cost per patient per month (PPPM) in 2019 Canadian dollars (CDN$). Patients with no encounters for 3 years prior to diagnosis were compared with patients with encounters, with special attention to patients with HIV clinical indicator conditions (HCICs). RESULTS Of 388 patients, 60% had one or more prior encounter without HIV testing; 14% had been treated for an HCIC. Females, older patients and heterosexuals were more likely to have prior encounters. At diagnosis, patients with previous encounters presented with lower CD4 counts and higher rates of AIDS. The mean PPPM costs for patients with any prior encounter or for an HCIC-based encounter were 16% and 33% higher, respectively, than for patients with no prior encounters. While mean PPPM costs for antiretroviral drugs and outpatient visits were slightly higher, in-patient costs were 10 times higher for people with HIV who had a previous HCIC encounter vs. those with no encounters (CDN$316 vs. $31, respectively). CONCLUSIONS Any healthcare visit, especially for an HCIC, represents relatively easy opportunities for HIV testing. Not testing can result in poorer health and higher costs. Targeted clinical testing and novel interventions to correct overlooked testing opportunities within healthcare settings may be an easy way to implement cost savings.
Collapse
Affiliation(s)
- M J Gill
- Southern Alberta Clinic, Calgary, AB, Canada.,Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - M Powell
- Southern Alberta Clinic, Calgary, AB, Canada.,Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Q Vu
- Southern Alberta Clinic, Calgary, AB, Canada
| | - H B Krentz
- Southern Alberta Clinic, Calgary, AB, Canada.,Department of Medicine, University of Calgary, Calgary, AB, Canada
| |
Collapse
|
16
|
Msimango L, Gibbs A, Shozi H, Ngobese H, Humphries H, Drain PK, Garrett N, Dorward J. Acceptability of point-of-care viral load testing to facilitate differentiated care: a qualitative assessment of people living with HIV and nurses in South Africa. BMC Health Serv Res 2020; 20:1081. [PMID: 33239012 PMCID: PMC7690121 DOI: 10.1186/s12913-020-05940-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 11/18/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Providing viral load (VL) results to people living with HIV (PLHIV) on antiretroviral therapy (ART) remains a challenge in low and middle-income countries. Point-of-care (POC) VL testing could improve ART monitoring and the quality and efficiency of differentiated models of HIV care. We assessed the acceptability of POC VL testing within a differentiated care model that involved task-shifting from professional nurses to less highly-trained enrolled nurses, and an option of collecting treatment from a community-based ART delivery programme. METHODS We undertook a qualitative sub-study amongst clients on ART and nurses within the STREAM study, a randomized controlled trial of POC VL testing and task-shifting in Durban, South Africa. Between March and August 2018, we conducted 33 semi-structured interviews with clients, professional and enrolled nurses and 4 focus group discussions with clients. Interviews and focus groups were audio recorded, transcribed, translated and thematically analysed. RESULTS Amongst 55 clients on ART (median age 31, 56% women) and 8 nurses (median age 39, 75% women), POC VL testing and task-shifting to enrolled nurses was acceptable. Both clients and providers reported that POC VL testing yielded practical benefits for PLHIV by reducing the number of clinic visits, saving time, travel costs and days off work. Receiving same-day POC VL results encouraged adherence amongst clients, by enabling them to see immediately if they were 'good' or 'bad' adherers and enabled quick referrals to a community-based ART delivery programme for those with viral suppression. However, there was some concern regarding the impact of POC VL testing on clinic flows when implemented in busy public-sector clinics. Regarding task-shifting, nurses felt that, with extra training, enrolled nurses could help decongest healthcare facilities by quickly issuing ART to stable clients. Clients could not easily distinguish enrolled nurses from professional nurses, instead they highlighted the importance of friendliness, respect and good communication between clients and nurses. CONCLUSIONS POC VL testing combined with task-shifting was acceptable to clients and healthcare providers. Implementation of POC VL testing and task shifting within differentiated care models may help achieve international treatment targets. TRIAL REGISTRATION NCT03066128 , registered 22/02/2017.
Collapse
Affiliation(s)
- Lindani Msimango
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
| | - Andrew Gibbs
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Hlengiwe Shozi
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
| | - Hope Ngobese
- Ethekwini Municipal Health Department, Durban, South Africa
| | - Hilton Humphries
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
| | - Paul K Drain
- Department of Global Health, Schools of Medicine and Public Health, University of Washington, Seattle, USA
- Department of Medicine, School of Medicine, University of Washington, Seattle, USA
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, USA
| | - Nigel Garrett
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Jienchi Dorward
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa.
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
| |
Collapse
|
17
|
Mbuagbaw L, Hajizadeh A, Wang A, Mertz D, Lawson DO, Smieja M, Benoit AC, Alvarez E, Puchalski Ritchie L, Rachlis B, Logie C, Husbands W, Margolese S, Zani B, Thabane L. Overview of systematic reviews on strategies to improve treatment initiation, adherence to antiretroviral therapy and retention in care for people living with HIV: part 1. BMJ Open 2020; 10:e034793. [PMID: 32967868 PMCID: PMC7513605 DOI: 10.1136/bmjopen-2019-034793] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 07/01/2020] [Accepted: 08/07/2020] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES We sought to map the evidence and identify interventions that increase initiation of antiretroviral therapy, adherence to antiretroviral therapy and retention in care for people living with HIV at high risk for poor engagement in care. METHODS We conducted an overview of systematic reviews and sought for evidence on vulnerable populations (men who have sex with men (MSM), African, Caribbean and Black (ACB) people, sex workers (SWs), people who inject drugs (PWID) and indigenous people). We searched PubMed, Excerpta Medica dataBASE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Web of Science and the Cochrane Library in November 2018. We screened, extracted data and assessed methodological quality in duplicate and present a narrative synthesis. RESULTS We identified 2420 records of which only 98 systematic reviews were eligible. Overall, 65/98 (66.3%) were at low risk of bias. Systematic reviews focused on ACB (66/98; 67.3%), MSM (32/98; 32.7%), PWID (6/98; 6.1%), SWs and prisoners (both 4/98; 4.1%). Interventions were: mixed (37/98; 37.8%), digital (22/98; 22.4%), behavioural or educational (9/98; 9.2%), peer or community based (8/98; 8.2%), health system (7/98; 7.1%), medication modification (6/98; 6.1%), economic (4/98; 4.1%), pharmacy based (3/98; 3.1%) or task-shifting (2/98; 2.0%). Most of the reviews concluded that the interventions effective (69/98; 70.4%), 17.3% (17/98) were neutral or were indeterminate 12.2% (12/98). Knowledge gaps were the types of participants included in primary studies (vulnerable populations not included), poor research quality of primary studies and poorly tailored interventions (not designed for vulnerable populations). Digital, mixed and peer/community-based interventions were reported to be effective across the continuum of care. CONCLUSIONS Interventions along the care cascade are mostly focused on adherence and do not sufficiently address all vulnerable populations.
Collapse
Affiliation(s)
- Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, Ontario, Canada
- Centre for the Develoment of Best Practices in Health, Yaounde Central Hospital, Yaounde, Cameroon
| | - Anisa Hajizadeh
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Annie Wang
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Dominik Mertz
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Daeria O Lawson
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Division of Rheumatology, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Marek Smieja
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Anita C Benoit
- Women's College Research Institute, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth Alvarez
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Ontario, Canada
| | - Lisa Puchalski Ritchie
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Emergency Medicine, University Health Network, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - Beth Rachlis
- Division of Clinical Public Health, Dalla Lana School of Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Carmen Logie
- Women's College Research Institute, Toronto, Ontario, Canada
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | | | - Shari Margolese
- Canadian HIV Trials Network Community Advisory Committee, Vancouver, British Columbia, Canada
| | - Babalwa Zani
- Knowledge Translation Unit, University of Cape Town Lung Institute, Rondebosch, Western Cape, South Africa
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, Ontario, Canada
- Pediatrics and Anesthesia, McMaster University, Hamilton, Ontario, Canada
- Centre for Evaluation of Medicine, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada
| |
Collapse
|
18
|
Cassedy A, Mullins E, O'Kennedy R. Sowing seeds for the future: The need for on-site plant diagnostics. Biotechnol Adv 2020; 39:107358. [DOI: 10.1016/j.biotechadv.2019.02.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 01/28/2019] [Accepted: 02/21/2019] [Indexed: 01/09/2023]
|
19
|
Ford JS, Marianelli LG, Frassone N, Debes JD. Hepatitis B screening in an argentine ED: Increasing vaccination in a resource-limited setting. Am J Emerg Med 2020; 38:296-299. [PMID: 31353159 PMCID: PMC6980425 DOI: 10.1016/j.ajem.2019.158354] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 07/16/2019] [Accepted: 07/16/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND There is limited data regarding the use of emergency departments (EDs) for infectious disease screening and vaccination in resource-limited regions. In these settings, EDs are often the only contact that patients have with the healthcare system, turning an ED visit into an opportune time to deliver preventative health services. METHODS In this pilot study, patients that met inclusion criteria were prospectively tested for hepatitis B surface antigen test (HBsAg). Previously unvaccinated patients who tested negative for HBsAg were offered HBV vaccination. The study setting was a public infectious disease hospital in Cordoba, Argentina. The primary outcomes were new HBV diagnoses, as well as vaccination completion between screening modalities (Point-of-Care-Testing-POCT vs. laboratory testing) and same vs. different day vaccination. RESULTS We screened 100 patients for HBV (75 POCT & 25 laboratory). The median age of participants was 35 years (IQR 24-52) and 55% were male. No patients tested positive for HBsAg. All patients who completed first dose vaccination were initially screened with the POCT. No patients screened with laboratory testing returned for vaccination. Patients who were scheduled for vaccination the same day were more likely to complete vaccination compared to those scheduled for another day (75% vs. 14%, p < .001). CONCLUSION Our study supports the use of HBV POCTs in the ED in conjunction with vaccination of HBV-negative individuals. In regions with low HBV endemicity, direct vaccination without HBsAg testing may be more cost effective. We believe that this acute-care screening model is applicable to other resource-limited settings.
Collapse
Affiliation(s)
- James S Ford
- Department of Emergency Medicine, University of California Davis School of Medicine, Sacramento, CA, USA
| | | | - Natalia Frassone
- Department of Infectious Diseases, Hospital Rawson, Cordoba, Cordoba, Argentina
| | - Jose D Debes
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
| |
Collapse
|
20
|
Reddy S, Gibbs A, Spooner E, Ngomane N, Reddy T, |Luthuli N, Ramjee G, Coutsoudis A, Kiepiela P. Assessment of the Impact of Rapid Point-of-Care CD4 Testing in Primary Healthcare Clinic Settings: A Survey Study of Client and Provider Perspectives. Diagnostics (Basel) 2020; 10:E81. [PMID: 32024166 PMCID: PMC7168920 DOI: 10.3390/diagnostics10020081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 12/05/2019] [Accepted: 12/07/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The high burden of disease in South Africa presents challenges to public health services. Point-of-care (POC) technologies have the potential to address these gaps and improve healthcare systems. This study ascertained the acceptability and impact of POC CD4 testing on patients' health and clinical management. METHODS We conducted a qualitative survey study with patients (n = 642) and healthcare providers (n = 13) at the Lancers Road (experienced POC) and Chesterville (non-experienced POC) primary healthcare (PHC) clinics from September 2015 to June 2016. RESULTS Patients (99%) at Lancers and Chesterville PHCs were positive about POC CD4 testing, identifying benefits: No loss/delay of test results (6.4%), cost/time saving (19.5%), and no anxiety (5.1%), and 58.2% were ready to initiate treatment. Significantly more patients at Chesterville than Lancers Road PHC felt POC would provide rapid clinical decision making (64.7% vs. 48.1%; p < 0.0001) and better clinic accessibility (40.4% vs. 24.7%; p < 0.0001) respectively. Healthcare providers thought same-day CD4 results would impact: Clinical management (46.2%), patient readiness (46.2%), and adherence (23.0%), and would reduce follow-up visits (7.7%), while 38.5% were concerned that further tests and training (15.4%) were required before antiretroviral therapy (ART) initiation. CONCLUSION The high acceptability of POC CD4 testing and the immediate health, structural, and clinical management benefits necessitates POC implementation studies.
Collapse
Affiliation(s)
- Shabashini Reddy
- South African Medical Research Council, Durban 4000, South Africa;
- Wits Health Consortium, Parktown, Johannesburg 2091, South Africa
| | - Andrew Gibbs
- South African Medical Research Council, Gender and Health Research Unit, Durban Centre for Rural Health, University of KwaZulu Natal, Durban 4000, South Africa;
| | - Elizabeth Spooner
- South African Medical Research Council, HIV Prevention Research Unit, Durban 3600, South Africa; (E.S.); (G.R.)
| | | | - Tarylee Reddy
- South African Medical Research Council, Biostatistics Unit, Durban 4000, South Africa;
| | | | - Gita Ramjee
- South African Medical Research Council, HIV Prevention Research Unit, Durban 3600, South Africa; (E.S.); (G.R.)
| | - Anna Coutsoudis
- School of Clinical Medicine, University of KwaZulu Natal, Durban 4000, South Africa;
| | - Photini Kiepiela
- South African Medical Research Council, Durban 4000, South Africa;
- Wits Health Consortium, Parktown, Johannesburg 2091, South Africa
| |
Collapse
|
21
|
Zwakala Ndoda: a cluster and individually randomized trial aimed at improving testing, linkage, and adherence to treatment for hard-to reach men in KwaZulu-Natal, South Africa. Trials 2019; 20:798. [PMID: 31888701 PMCID: PMC6937627 DOI: 10.1186/s13063-019-3908-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 11/15/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Men in sub-Saharan Africa are less likely than women to get tested for HIV, less likely to present for treatment, less likely to be maintained in treatment, more likely to have detectable viral load, more likely to transmit HIV with unprotected intercourse, and more likely to progress to AIDS and die sooner from HIV. The ultimate objective of this research is to provide evidence-based strategies to improve HIV testing and treatment of HIV-infected men. METHODS This study is being conducted in the Greater Edendale Area and Vulindlela region in KwaZulu-Natal, South Africa. It is a two-stage design of a cluster-randomized trial and an individual randomized trial to test how structural and individual-level interventions address the demand-side factors that affect HIV testing and treatment for hard-to reach, high-risk men. It combines male-focused mobilization, community-based mobile HIV testing services, and a small incentive to determine if the strategies singly and in combination can result in more men diagnosed with HIV, and more men linked to and maintained in care with undetectable viral load. DISCUSSION A priority for sub-Sahara Africa is developing and evaluating novel and cost-effective strategies for identifying hard-to-reach groups such as men, linking them to HIV testing and care services, and maintaining them in care to the point of viral suppression. We propose a combination prevention intervention that addresses men's individual, interpersonal, and structural barriers to testing and care. This includes male-led mobilization to encourage uptake of testing and treatment, male-focused testing venues, male-only counselors, developing counseling models that are flexible and responsive to men, and strategies for adhering to clinic visits without missing work and navigating the healthcare system. By thoughtfully combining male-focused mobilization, and testing and addressing some of the barriers to male engagement with health facilities, this study hopes to add to the growing evidence base about how to reach, test, link, and maintain a hard-to-reach group such as men in HIV treatment and care services. TRIAL REGISTRATION ClinicalTrials.gov, NCT03794245. Registered on 4 January 2019.
Collapse
|
22
|
Zang X, Krebs E, Wang L, Marshall BDL, Granich R, Schackman BR, Montaner JSG, Nosyk B. Structural Design and Data Requirements for Simulation Modelling in HIV/AIDS: A Narrative Review. PHARMACOECONOMICS 2019; 37:1219-1239. [PMID: 31222521 PMCID: PMC6711792 DOI: 10.1007/s40273-019-00817-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Born out of a necessity for fiscal sustainability, simulation modeling is playing an increasingly prominent role in setting priorities for combination implementation strategies for HIV treatment and prevention globally. The design of a model and the data inputted into it are central factors in ensuring credible inferences. We executed a narrative review of a set of dynamic HIV transmission models to comprehensively synthesize and compare the structural design and the quality of evidence used to support each model. We included 19 models representing both generalized and concentrated epidemics, classified as compartmental, agent-based, individual-based microsimulation or hybrid in our review. We focused on four structural components (population construction; model entry, exit and HIV care engagement; HIV disease progression; and the force of HIV infection), and two analytical components (model calibration/validation; and health economic evaluation, including uncertainty analysis). While the models we reviewed focused on a variety of individual interventions and their combinations, their structural designs were relatively homogenous across three of the four focal components, with key structural elements influenced by model type and epidemiological context. In contrast, model entry, exit and HIV care engagement tended to differ most across models, with some health system interactions-particularly HIV testing-not modeled explicitly in many contexts. The quality of data used in the models and the transparency with which the data was presented differed substantially across model components. Representative and high-quality data on health service delivery were most commonly not accessed or were unavailable. The structure of an HIV model should ideally fit its epidemiological context and be able to capture all efficacious treatment and prevention services relevant to a robust combination implementation strategy. Developing standardized guidelines on evidence syntheses for health economic evaluation would improve transparency and help prioritize data collection to reduce decision uncertainty.
Collapse
Affiliation(s)
- Xiao Zang
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 613-1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Emanuel Krebs
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 613-1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
| | - Linwei Wang
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 613-1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
| | | | - Reuben Granich
- Independent Public Health Consultant, Washington, DC, USA
| | | | - Julio S G Montaner
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 613-1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Bohdan Nosyk
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 613-1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada.
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
| |
Collapse
|
23
|
Tran MV, Susumu K, Medintz IL, Algar WR. Supraparticle Assemblies of Magnetic Nanoparticles and Quantum Dots for Selective Cell Isolation and Counting on a Smartphone-Based Imaging Platform. Anal Chem 2019; 91:11963-11971. [DOI: 10.1021/acs.analchem.9b02853] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Michael V. Tran
- Department of Chemistry, University of British Columbia, 2036 Main Mall, Vancouver, British Columbia V6T 1Z1, Canada
| | - Kimihiro Susumu
- KeyW Corporation, Hanover, Maryland 21076, United States
- Optical Sciences Division, Code 5600, U.S. Naval Research Laboratory, Washington, D.C. 20375, United States
| | - Igor L. Medintz
- Center for Bio/Molecular Science and Engineering, Code 6900, U.S. Naval Research Laboratory, Washington, D.C. 20375, United States
| | - W. Russ Algar
- Department of Chemistry, University of British Columbia, 2036 Main Mall, Vancouver, British Columbia V6T 1Z1, Canada
| |
Collapse
|
24
|
Mateo-Urdiales A, Johnson S, Smith R, Nachega JB, Eshun-Wilson I. Rapid initiation of antiretroviral therapy for people living with HIV. Cochrane Database Syst Rev 2019; 6:CD012962. [PMID: 31206168 PMCID: PMC6575156 DOI: 10.1002/14651858.cd012962.pub2] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Despite antiretroviral therapy (ART) being widely available, HIV continues to cause substantial illness and premature death in low-and-middle-income countries. High rates of loss to follow-up after HIV diagnosis can delay people starting ART. Starting ART within seven days of HIV diagnosis (rapid ART initiation) could reduce loss to follow-up, improve virological suppression rates, and reduce mortality. OBJECTIVES To assess the effects of interventions for rapid initiation of ART (defined as offering ART within seven days of HIV diagnosis) on treatment outcomes and mortality in people living with HIV. We also aimed to describe the characteristics of rapid ART interventions used in the included studies. SEARCH METHODS We searched CENTRAL, the Cochrane Database of Systematic Reviews, MEDLINE, Embase, and four other databases up to 14 August 2018. There was no restriction on date, language, or publication status. We also searched ClinicalTrials.gov and the World Health Organization (WHO) International Clinical Trials Registry Platform, and websites for unpublished literature, including conference abstracts. SELECTION CRITERIA We included randomized controlled trials (RCTs) that compared rapid ART versus standard care in people living with HIV. Children, adults, and adolescents from any setting were eligible for inclusion. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the eligibility of the studies identified in the search, assessed the risk of bias and extracted data. The primary outcomes were mortality and virological suppression at 12 months. We have presented all outcomes using risk ratios (RR), with 95% confidence intervals (CIs). Where appropriate, we pooled the results in meta-analysis. We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS We included seven studies with 18,011 participants in the review. All studies were carried out in low- and middle-income countries in adults aged 18 years old or older. Only one study included pregnant women.In all the studies, the rapid ART intervention was offered as part of a package that included several cointerventions targeting individuals, health workers and health system processes delivered alongside rapid ART that aimed to facilitate uptake and adherence to ART.Comparing rapid ART with standard initiation probably results in greater viral suppression at 12 months (RR 1.18, 95% CI 1.10 to 1.27; 2719 participants, 4 studies; moderate-certainty evidence) and better ART uptake at 12 months (RR 1.09, 95% CI 1.06 to 1.12; 3713 participants, 4 studies; moderate-certainty evidence), and may improve retention in care at 12 months (RR 1.22, 95% CI 1.11 to 1.35; 5001 participants, 6 studies; low-certainty evidence). Rapid ART initiation was associated with a lower mortality estimate, however the CIs included no effect when compared to standard of care (RR 0.72, 95% CI 0.51 to 1.01; 5451 participants, 7 studies; very low-certainty evidence). It is uncertain whether rapid ART has an effect on modification of ART treatment regimens as data are lacking (RR 7.89, 95% CI 0.76 to 81.74; 977 participants, 2 studies; very low-certainty evidence). There was insufficient evidence to draw conclusions on the occurrence of adverse events. AUTHORS' CONCLUSIONS RCTs that include initiation of ART within one week of diagnosis appear to improve outcomes across the HIV treatment cascade in low- and middle-income settings. The studies demonstrating these effects delivered rapid ART combined with several setting-specific cointerventions. This highlights the need for pragmatic research to identify feasible packages that assure the effects seen in the trials when delivered through complex health systems.
Collapse
Affiliation(s)
- Alberto Mateo-Urdiales
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK, L3 5QA
| | | | | | | | | |
Collapse
|
25
|
Katz IT, Bogart LM, Dietrich JJ, Leslie HH, Iyer HS, Leone D, Magidson JF, Earnshaw VA, Courtney I, Tshabalala G, Fitzmaurice GM, Orrell C, Gray G, Bangsberg DR. Understanding the role of resilience resources, antiretroviral therapy initiation, and HIV-1 RNA suppression among people living with HIV in South Africa: a prospective cohort study. AIDS 2019; 33 Suppl 1:S71-S79. [PMID: 31397725 PMCID: PMC6712569 DOI: 10.1097/qad.0000000000002175] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Failure to initiate antiretroviral therapy (ART) and achieve virologic suppression are significant barriers to the United Nations 90-90-90 goals. Identifying resilience resources, or modifiable strength-based factors, among people living with HIV is critical for successful HIV treatment and prevention. DESIGN Prospective cohort study. METHODS From July 2014 to July 2015, 500 adults presenting for voluntary counseling and HIV testing who were diagnosed with HIV and were ART-eligible in South Africa (Soweto and Gugulethu) were enrolled and surveyed. Logistic regression models assessed resilience-related predictors of ART initiation within 6 months of voluntary counseling and HIV testing for HIV, and HIV-1 plasma RNA suppression within 9 months, adjusting for sociodemographic factors. RESULTS Within 6 months, 62% initiated ART, and within 9 months, 25% had evidence of an undetectable HIV-1 plasma RNA (<50 copies/ml). Participants who initiated ART relied less on social support from friends [adjusted odds ratio (aOR) 0.94, 95% confidence interval (CI): 0.89-0.99], coped using self-distraction (aOR 1.05, 95% CI: 1.00-1.10) and avoided coping through substance use (aOR 0.79, 95% CI: 0.65-0.97), as compared with participants who did not initiate ART. Those who achieved plasma RNA suppression relied more on social support from a significant other/partner (aOR 1.04, 95% CI: 1.02-1.07), used positive religious coping (aOR 1.03, 95% CI: 1.00-1.07), and were less likely to engage in denial coping (aOR 0.84, 95% CI: 0.77-0.92), compared with those who initiated ART but did not achieve plasma RNA suppression. CONCLUSION Interventions optimizing resilience resources and decreasing maladaptive coping strategies (e.g., substance use, denial) may present a feasible approach to maximizing ART-based HIV treatment strategies among South African people living with HIV.
Collapse
Affiliation(s)
- Ingrid T. Katz
- Department of Medicine, Brigham and Women’s Hospital
- Harvard Medical School
- Massachusetts General Hospital Center for Global Health, Boston
- Harvard Global Health Institute, Cambridge, Massachusetts
| | | | - Janan J. Dietrich
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Dominick Leone
- Department of Medicine, Brigham and Women’s Hospital
- Brigham and Women’s Hospital, Channing Division of Network Medicine, Boston, Massachusetts
| | | | - Valerie A. Earnshaw
- Department of Human Development and Family Sciences, University of Delaware, Newark, Delaware, USA
| | - Ingrid Courtney
- Desmond Tutu HIV Foundation, University of Cape Town Medical School, Cape Town, South Africa
| | - Gugu Tshabalala
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Garrett M. Fitzmaurice
- Department of Medicine, Brigham and Women’s Hospital
- Harvard Medical School
- Department of Biostatistics, Harvard School of Public Health, Boston
- Laboratory for Psychiatric Biostatistics, McLean Hospital, Belmont, Massachusetts, USA
| | - Catherine Orrell
- Desmond Tutu HIV Foundation, University of Cape Town Medical School, Cape Town, South Africa
| | - Glenda Gray
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Office of the President, South African Medical Research Council, Western Cape, South Africa
| | - David R. Bangsberg
- Oregon Health & Science University-Portland State University School of Public Health, Portland, Oregon, USA
| |
Collapse
|
26
|
Point-of-Care HIV Viral Load Testing: an Essential Tool for a Sustainable Global HIV/AIDS Response. Clin Microbiol Rev 2019; 32:32/3/e00097-18. [PMID: 31092508 DOI: 10.1128/cmr.00097-18] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The global public health community has set ambitious treatment targets to end the HIV/AIDS pandemic. With the notable absence of a cure, the goal of HIV treatment is to achieve sustained suppression of an HIV viral load, which allows for immunological recovery and reduces the risk of onward HIV transmission. Monitoring HIV viral load in people living with HIV is therefore central to maintaining effective individual antiretroviral therapy as well as monitoring progress toward achieving population targets for viral suppression. The capacity for laboratory-based HIV viral load testing has increased rapidly in low- and middle-income countries, but implementation of universal viral load monitoring is still hindered by several barriers and delays. New devices for point-of-care HIV viral load testing may be used near patients to improve HIV management by reducing the turnaround time for clinical test results. The implementation of near-patient testing using these new and emerging technologies may be an essential tool for ensuring a sustainable response that will ultimately enable an end to the HIV/AIDS pandemic. In this report, we review the current and emerging technology, the evidence for decentralized viral load monitoring by non-laboratory health care workers, and the additional considerations for expanding point-of-care HIV viral load testing.
Collapse
|
27
|
Toward Improving Accessibility of Point-of-Care Diagnostic Services for Maternal and Child Health in Low- and Middle-Income Countries. POINT OF CARE 2019; 18:17-25. [PMID: 30886544 PMCID: PMC6407818 DOI: 10.1097/poc.0000000000000180] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Point-of-care (POC) testing can improve health care provision in settings with limited access to health care services. Access to POC diagnostic services has shown potential to alleviate some diagnostic challenges and delays associated with laboratory-based methods in low- and middle-income countries. Improving accessibility to POC testing (POCT) services during antenatal and perinatal care is among the global health priorities to improve maternal and child health. This review provides insights on the availability of POC testing designed for diagnosing HIV, syphilis, and malaria in pregnancy to improve maternal and child health. In addition, factors such as accessibility of POC testing, training of health work force, and the efficiency of POC testing services delivery in low- and middle-income countries are discussed. A framework to help increase access to POC diagnostic services and improve maternal and child health outcomes in low- and middle-income countries is proposed.
Collapse
|
28
|
Chibawara T, Mbuagbaw L, Kitenge M, Nyasulu P. Effects of antiretroviral therapy in HIV-positive adults on new HIV infections among young women: a systematic review protocol. Syst Rev 2019; 8:68. [PMID: 30837002 PMCID: PMC6402083 DOI: 10.1186/s13643-019-0982-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 02/25/2019] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The HIV/AIDS pandemic has struck regions, countries, and populations in different ways. With the introduction of antiretroviral drugs, people living with HIV (PLHIV) have a much better prognosis, even though there are still many new infections in young women. The role of widespread antiretroviral therapy (ART) on the incidence of HIV in young women is unknown. METHODS We will conduct a comprehensive search of MEDLINE (PubMed), Excerpta Medica database (EMBASE), Scopus, Google Scholar, Cochrane Central Register of Controlled Trials (CENTRAL), World Health Organization's (WHO's) library database, Latin American and Caribbean Health Sciences Literature (LILACS), conference abstracts, and gray literature sources to identify any relevant literature. We will include randomized and non-randomized clinical trials and cohort studies in which ART was offered to adults aged 18 and above reporting outcomes in females aged 15 to 24 years. The outcomes of interest are HIV incidence, ART initiation, adherence, retention, and viral load suppression. We will screen titles, abstracts, and the full texts of relevant articles in duplicate. Disagreements will be resolved by consensus. We will extract data on the risk of HIV infection in younger females after the use of ART in the adult population. DISCUSSION To our knowledge, this is the first systematic review to look at the impact of ART use among adults on HIV incidence in young women. The results of this review will be used in a modeling study to simulate the effects of using ART as an effective tool to prevent sexual transmission of HIV to young women. Our findings will inform the treatment-as-prevention (TasP) strategy to reduce new HIV infections among young women. SYSTEMATIC REVIEW REGISTRATION The systematic review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO), registration number CRD42018099174 .
Collapse
Affiliation(s)
- Trust Chibawara
- Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.,Biostatistics Unit, Father Sean O'Sullivan Research Centre, St. Joseph's Healthcare, Hamilton, ON, Canada.,Centre for Development of Best Practices in Health (CDBPH), Yaoundé Central Hospital, Yaoundé, Cameroon
| | - Marcel Kitenge
- Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,Médecins Sans Frontières, Doctors Without Borders-Rustenburg, Rustenburg, North West, South Africa
| | - Peter Nyasulu
- Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa. .,Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| |
Collapse
|
29
|
Scorgie F, Mohamed Y, Anderson D, Crowe SM, Luchters S, Chersich MF. Qualitative assessment of South African healthcare worker perspectives on an instrument-free rapid CD4 test. BMC Health Serv Res 2019; 19:123. [PMID: 30764808 PMCID: PMC6376755 DOI: 10.1186/s12913-019-3948-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 02/04/2019] [Indexed: 01/02/2023] Open
Abstract
Background Accurate measurement of CD4 cell counts remains an important tenet of clinical care for people living with HIV. We assessed an instrument-free point-of-care CD4 test (VISITECT® CD4) based on a lateral flow principle, which gives visual results after 40 min. The test involves five steps and categorises CD4 counts as above or below 350 cells/μL. As one component of a performance evaluation of the test, this qualitative study explored the views of healthcare workers in a large women and children’s hospital on the acceptability and feasibility of the test. Methods Perspectives on the VISITECT® CD4 test were elicited through in-depth interviews with eight healthcare workers involved in the performance evaluation at an antenatal care facility in Johannesburg, South Africa. Audio recordings were transcribed in full and analysed thematically. Results Healthcare providers recognised the on-going relevance of CD4 testing. All eight perceived the VISITECT® CD4 test to be predominantly user-friendly, although some felt that the need for precision and optimal concentration in performing test procedures made it more challenging to use. The greatest strength of the test was perceived to be its quick turn-around of results. There were mixed views on the semi-quantitative nature of the test results and how best to integrate this test into existing health services. Participants believed that patients in this setting would likely accept the test, given their general familiarity with other point-of-care tests. Conclusions Overall, the VISITECT® CD4 test was acceptable to healthcare workers and those interviewed were supportive of scale-up and implementation in other antenatal care settings. Both health workers and patients will need to be oriented to the semi-quantitative nature of the test and how to interpret the results of tests. Electronic supplementary material The online version of this article (10.1186/s12913-019-3948-x) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Fiona Scorgie
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Yasmin Mohamed
- Burnet Institute, Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | | | | | - Stanley Luchters
- Burnet Institute, Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia.,Department of Population Health, Aga Khan University, Nairobi, Kenya.,International Centre for Reproductive Health, Department of Public Health and Primary Care, Ghent University, Gent, Belgium
| | - Matthew F Chersich
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,International Centre for Reproductive Health, Department of Public Health and Primary Care, Ghent University, Gent, Belgium
| |
Collapse
|
30
|
Luchters S, Technau K, Mohamed Y, Chersich MF, Agius PA, Pham MD, Garcia ML, Forbes J, Shepherd A, Coovadia A, Crowe SM, Anderson DA. Field Performance and Diagnostic Accuracy of a Low-Cost Instrument-Free Point-of-Care CD4 Test (Visitect CD4) Performed by Different Health Worker Cadres among Pregnant Women. J Clin Microbiol 2019; 57:e01277-18. [PMID: 30463898 PMCID: PMC6355532 DOI: 10.1128/jcm.01277-18] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 11/12/2018] [Indexed: 12/27/2022] Open
Abstract
Measuring CD4 counts remains an important component of HIV care. The Visitect CD4 is the first instrument-free low-cost point-of-care CD4 test with results interpreted visually after 40 min, providing a result of ≥350 CD4 cells/mm3 The field performance and diagnostic accuracy of the test was assessed among HIV-infected pregnant women in South Africa. A nurse performed testing at the point-of-care using both venous and finger-prick blood, and a counselor and laboratory staff tested venous blood in the clinic laboratory (four Visitect CD4 tests/participant). Performance was compared to the mean CD4 count from duplicate flow cytometry tests on venous blood (FACSCalibur Trucount). In 2017, 156 patients were enrolled, providing a total of 624 Visitect CD4 tests (468 venous and 156 finger-prick samples). Of 624 tests, 28 (4.5%) were inconclusive. Generalized linear mixed modeling showed better performance of the test on venous blood (sensitivity = 81.7%; 95% confidence interval [CI] = 72.3 to 91.1]; specificity = 82.6%, 95% CI = 77.1 to 88.1) than on finger-prick specimens (sensitivity = 60.7%; 95% CI = 45.0 to 76.3; specificity = 89.5%, 95% CI = 83.2 to 95.8; P = 0.001). No difference in performance was detected by cadre of health worker (P = 0.113) or between point-of-care versus laboratory-based testing (P = 0.108). Adequate performance of Visitect CD4 with different operators and at the point of care, with no need of electricity or instrument, shows the potential utility of this device, especially for facilitating decentralization of CD4 testing services in rural areas.
Collapse
Affiliation(s)
- Stanley Luchters
- Burnet Institute, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- International Centre for Reproductive Health, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Karl Technau
- Empilweni Services and Research Unit, Department of Paediatrics & Child Health, Rahima Moosa Mother and Child Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Yasmin Mohamed
- Burnet Institute, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Matthew F Chersich
- International Centre for Reproductive Health, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Paul A Agius
- Burnet Institute, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Minh D Pham
- Burnet Institute, Melbourne, Victoria, Australia
| | | | - James Forbes
- Omega Diagnostics, Ltd., Omega House, Alva, Scotland
| | | | - Ashraf Coovadia
- Empilweni Services and Research Unit, Department of Paediatrics & Child Health, Rahima Moosa Mother and Child Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Suzanne M Crowe
- Burnet Institute, Melbourne, Victoria, Australia
- The Alfred Hospital and Department of Infectious Diseases, Monash University, Melbourne, Victoria, Australia
| | | |
Collapse
|
31
|
Linkage to care of HIV positive clients in a community based HIV counselling and testing programme: A success story of non-governmental organisations in a South African district. PLoS One 2019; 14:e0210826. [PMID: 30668598 PMCID: PMC6342293 DOI: 10.1371/journal.pone.0210826] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 01/02/2019] [Indexed: 12/02/2022] Open
Abstract
Introduction Although current data projects South Africa potentially meeting the UN target to test 90% of all people living with HIV by 2020, linking them to HIV care remains a big challenge. In an effort to increase linkage to care (LTC) of HIV positive clients an innovative collaborative intervention between two non-governmental organisations was developed and implemented between 2016 and 2017. This paper investigated the outcome of this collaborative intervention. Methods We used a mixed methods approach to assess the outcome of the innovative relationship. This was done by analysing routine programmatic quantitative data on LTC between 2015 and 2017 and qualitatively interviewing five programme managers, four programme implementers and five HIV positive clients on their perceived success/failure factors. Qualitative data were analysed using thematic content analysis while LTC rates were descriptively analysed. Two consultative meetings presented draft findings to programme managers (n = 7) and implementers (n = 10) for feedback, results verification and confirmation. Results In 2015 cumulative LTC rate was 27% and it rose to 85% two years post-intervention in 2017. Six themes emerged as success factors at the health system and structural levels and these include: provision of client escort services, health facility human resource capacity strengthening, inter and intra-organisational teamwork, onsite LTC, facilitated and expedited jumping of queues and shifting administrative tasks to non-clinical staff to protect nurses’ time on ART initiation. These measures in turn ensured increased, affordable and swift ART initiation of clients while strengthening client support. Conclusions We concluded that multi-faceted interventions that target both health system challenges including staff shortages, efficiencies, and extended facility opening times, and structural inadequacies, including client time and resource limitations due to poverty or nature of jobs, can help to increase LTC.
Collapse
|
32
|
Opollo VS, Nikuze A, Ben-Farhat J, Anyango E, Humwa F, Oyaro B, Wanjala S, Omwoyo W, Majiwa M, Akelo V, Zeh C, Maman D. Field evaluation of near point of care Cepheid GeneXpert HIV-1 Qual for early infant diagnosis. PLoS One 2018; 13:e0209778. [PMID: 30589900 PMCID: PMC6307732 DOI: 10.1371/journal.pone.0209778] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 12/11/2018] [Indexed: 11/18/2022] Open
Abstract
Background Access to point-of-care HIV testing shortens turn-around times, time to diagnosis and reduces loss to follow-up hence minimizing barriers to early linkage to care and treatment among HIV infected infants. Currently samples for early infant HIV diagnosis are sent to centralized testing facilities which are few and located only at specific regions in Kenya. However, there are Point of Care (POC) early infant diagnosis [EID] technologies elsewhere such as SAMBA and ALERE-Q that are yet to be evaluated in Kenya despite the urgent need for data to inform policy formulation regarding EID. The Cepheid GeneXpert HIV-1 Qual (GeneXpert) technology for POC EID offers a great opportunity to minimize HIV associated morbidity, mortality and loss to follow-up through decentralization of early infant HIV testing to the clinics. This technology also allows for same-day results thus facilitating prompt linkage to care. Methods We evaluated the GeneXpert HIV Qual EID POC in Homabay County against the standard of care platform, Roche CAP/CTM HIV-1 qualitative PCR, using dried blood spots (DBS). Between February—July 2016, DBS samples were collected from HIV exposed children <18 months of age enrolled in a cross-sectional study. Samples were collected by qualified nurse counselors, and were tested by trained technicians using field based GeneXpert and conventional laboratory based Roche CAP/CTM HIV-1 qualitative PCR. Sensitivity and specificity were determined. Results Overall, 3,814 mother/infant pairs were included in the study, out of which 921 infants were HIV exposed as per the mothers’ HIV status and based on the infant’s HIV rapid test. A total of 969 PCR tests were performed, out of which 30 (3.3%) infants were concordantly positive using both platforms. GeneXpert HIV-1 Qual yielded a sensitivity of 94.1% and specificity of 99.8% with an overall error rate of 0.7%. Conclusion Our findings show that GeneXpert HIV-1 Qual performs well compared to CAP/CTM using DBS samples, suggesting that this technology may be adopted in decentralized laboratories as a near POC device. It may contribute to prompt diagnosis of HIV exposed infants hence enabling early linkage to care, thus advancing further gains in EID.
Collapse
Affiliation(s)
- Valarie Sarah Opollo
- Kenya Medical Research Institute/Centre for Global Health Research, Kisumu, Kenya
- * E-mail:
| | | | | | - Emily Anyango
- Kenya Medical Research Institute/Centre for Global Health Research, Kisumu, Kenya
| | - Felix Humwa
- Kenya Medical Research Institute/Centre for Global Health Research, Kisumu, Kenya
| | - Boaz Oyaro
- Kenya Medical Research Institute/Centre for Global Health Research, Kisumu, Kenya
| | | | | | - Maxwel Majiwa
- Kenya Medical Research Institute/Centre for Global Health Research, Kisumu, Kenya
| | - Victor Akelo
- Kenya Medical Research Institute/Centre for Global Health Research, Kisumu, Kenya
| | - Clement Zeh
- U.S. Centers for Disease Control and Prevention, Clinical Research Center, Kisumu, Kenya
| | | |
Collapse
|
33
|
MacKellar D, Maruyama H, Rwabiyago OE, Steiner C, Cham H, Msumi O, Weber R, Kundi G, Suraratdecha C, Mengistu T, Byrd J, Pals S, Churi E, Madevu-Matson C, Kazaura K, Morales F, Rutachunzibwa T, Justman J, Rwebembera A. Implementing the package of CDC and WHO recommended linkage services: Methods, outcomes, and costs of the Bukoba Tanzania Combination Prevention Evaluation peer-delivered, linkage case management program, 2014-2017. PLoS One 2018; 13:e0208919. [PMID: 30543693 PMCID: PMC6292635 DOI: 10.1371/journal.pone.0208919] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 11/26/2018] [Indexed: 12/23/2022] Open
Abstract
Although several studies have evaluated one or more linkage services to improve early enrollment in HIV care in Tanzania, none have evaluated the package of linkage services recommended by the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO). We describe the uptake of each component of the CDC/WHO recommended package of linkage services, and early enrollment in HIV care and antiretroviral therapy (ART) initiation among persons with HIV who participated in a peer-delivered, linkage case management (LCM) program implemented in Bukoba, Tanzania, October 2014 –May 2017. Of 4206 participants (88% newly HIV diagnosed), most received recommended services including counseling on the importance of early enrollment in care and ART (100%); escort by foot or car to an HIV care and treatment clinic (CTC) (83%); treatment navigation at a CTC (94%); telephone support and appointment reminders (77% among clients with cellphones); and counseling on HIV-status disclosure and partner/family testing (77%), and on barriers to care (69%). During three periods with different ART-eligibility thresholds [CD4<350 (Oct 2014 –Dec 2015, n = 2233), CD4≤500 (Jan 2016 –Sept 2016, n = 1221), and Test & Start (Oct 2016 –May 2017, n = 752)], 90%, 96%, and 97% of clients enrolled in HIV care, and 47%, 67%, and 86% of clients initiated ART, respectively, within three months of diagnosis. Of 463 LCM clients who participated in the last three months of the rollout of Test & Start, 91% initiated ART. Estimated per-client cost was $44 United States dollars (USD) for delivering LCM services in communities and facilities overall, and $18 USD for a facility-only model with task shifting. Well accepted by persons with HIV, peer-delivered LCM services recommended by CDC and WHO can achieve near universal early ART initiation in the Test & Start era at modest cost and should be considered for implementation in facilities and communities experiencing <90% early enrollment in ART care.
Collapse
Affiliation(s)
- Duncan MacKellar
- Division of Global HIV and TB, National Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
| | | | | | | | - Haddi Cham
- Division of Global HIV and TB, National Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Omari Msumi
- ICAP at Columbia University, Dar es Salaam, Tanzania
| | - Rachel Weber
- CTS Global, Inc., assigned to Centers for Disease Control and Prevention, Dar es Salaam, Tanzania
| | - Gerald Kundi
- ICAP at Columbia University, Dar es Salaam, Tanzania
| | - Chutima Suraratdecha
- Division of Global HIV and TB, National Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Tewodaj Mengistu
- Division of Global HIV and TB, National Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | - Sherri Pals
- Division of Global HIV and TB, National Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Eliufoo Churi
- ICAP at Columbia University, Dar es Salaam, Tanzania
| | | | | | | | | | - Jessica Justman
- ICAP at Columbia University, New York, New York, United States of America
| | - Anath Rwebembera
- National AIDS Control Program, MoHCDGEC, Dar es Salaam, Tanzania
| |
Collapse
|
34
|
Abstract
HIV diagnostics have played a central role in the remarkable progress in identifying, staging, initiating, and monitoring infected individuals on life-saving antiretroviral therapy. They are also useful in surveillance and outbreak responses, allowing for assessment of disease burden and identification of vulnerable populations and transmission "hot spots," thus enabling planning, appropriate interventions, and allocation of appropriate funding. HIV diagnostics are critical in achieving epidemic control and require a hybrid of conventional laboratory-based diagnostic tests and new technologies, including point-of-care (POC) testing, to expand coverage, increase access, and positively impact patient management. In this review, we provide (i) a historical perspective on the evolution of HIV diagnostics (serologic and molecular) and their interplay with WHO normative guidelines, (ii) a description of the role of conventional and POC testing within the tiered laboratory diagnostic network, (iii) information on the evaluations and selection of appropriate diagnostics, (iv) a description of the quality management systems needed to ensure reliability of testing, and (v) strategies to increase access while reducing the time to return results to patients. Maintaining the central role of HIV diagnostics in programs requires periodic monitoring and optimization with quality assurance in order to inform adjustments or alignment to achieve epidemic control.
Collapse
|
35
|
Kohatsu L, Bolu O, Schmitz ME, Chang K, Lemwayi R, Arnett N, Mwasekaga M, Nkengasong J, Mosha F, Westerman LE. Evaluation of Specimen Types for Pima CD4 Point-of-Care Testing: Advantages of Fingerstick Blood Collection into an EDTA Microtube. PLoS One 2018; 13:e0202018. [PMID: 30138398 PMCID: PMC6107158 DOI: 10.1371/journal.pone.0202018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 07/26/2018] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Effective point-of-care testing (POCT) is reliant on optimal specimen collection, quality assured testing, and expedited return of results. Many of the POCT are designed to be used with fingerstick capillary blood to simplify the blood collection burden. However, fingerstick blood collection has inherent errors in sampling. An evaluation of the use of capillary and venous blood with CD4 POCT was conducted. METHODS Three different specimen collection methods were evaluated for compatibility using the Alere Pima CD4 assay at 5 HIV/AIDS healthcare sites in Dar es Salaam, Tanzania. At each site, whole blood specimens were collected from enrolled patients by venipuncture and fingerstick. Pima CD4 testing was performed at site of collection on venipuncture specimens (Venous) and fingerstick blood directly applied to a Pima CD4 cartridge (Capillary-Direct) and collected into an EDTA microtube (Capillary-Microtube). Venous blood was also tested at the laboratory by the reference CD4 method and Pima for comparison analysis. RESULTS All three specimen collection methods were successfully collected by healthcare workers for use with the Pima CD4 assay. When compared to the reference CD4 method, Pima CD4 testing with the Capillary-Microtube method performed similarly to Venous, while Pima CD4 counts with the Capillary-Direct method were slightly more biased (-20 cells/μL) and variable (-229 to +189 cells/μL limit of agreement). Even though all three collection methods had similar invalid Pima testing rates (10.5%, 9.8%, and 8.3% for Capillary-Direct, Capillary-Microtube, and Venous respectively), the ability to perform repeat testing with Capillary-Microtube and Venous specimens increased the likelihood of acquiring a valid CD4 result with the Pima assay. CONCLUSIONS Capillary blood, either directly applied to Pima CD4 cartridges or collected in an EDTA microtube, and venous blood are suitable specimens for Pima CD4 testing. The advantages of capillary blood collection in an EDTA microtube are that it uses fingerstick collection which mimics venous blood and allows extra testing without additional blood collection.
Collapse
Affiliation(s)
- Luciana Kohatsu
- United States Centers for Disease Control & Prevention, Center for Global Health, Division of Global HIV/AIDS, Atlanta, Georgia, United States of America
| | - Omotayo Bolu
- United States Centers for Disease Control & Prevention, Center for Global Health, Division of Global HIV/AIDS, Atlanta, Georgia, United States of America
| | - Mary E. Schmitz
- United States Centers for Disease Control & Prevention, Dar es Salaam, Tanzania
- Allan Rosenfield Global Health Fellowship, Association of Schools and Programs of Public Health, Washington DC, United States of America
| | - Karen Chang
- United States Centers for Disease Control & Prevention, Dar es Salaam, Tanzania
- Allan Rosenfield Global Health Fellowship, Association of Schools and Programs of Public Health, Washington DC, United States of America
| | - Ruth Lemwayi
- African Field Epidemiology Network, Dar es Salaam, Tanzania
| | - Nichole Arnett
- United States Centers for Disease Control & Prevention, Center for Global Health, Division of Global HIV/AIDS, Atlanta, Georgia, United States of America
| | - Michael Mwasekaga
- United States Centers for Disease Control & Prevention, Dar es Salaam, Tanzania
| | - John Nkengasong
- United States Centers for Disease Control & Prevention, Center for Global Health, Division of Global HIV/AIDS, Atlanta, Georgia, United States of America
| | - Fausta Mosha
- African Field Epidemiology Network, Dar es Salaam, Tanzania
- Ministry of Health Community Development Gender Elderly and Children, Government of Tanzania, Dar es Salaam, Tanzania
| | - Larry E. Westerman
- United States Centers for Disease Control & Prevention, Center for Global Health, Division of Global HIV/AIDS, Atlanta, Georgia, United States of America
| |
Collapse
|
36
|
Langwenya N, Phillips TK, Brittain K, Zerbe A, Abrams EJ, Myer L. Same-day antiretroviral therapy (ART) initiation in pregnancy is not associated with viral suppression or engagement in care: A cohort study. J Int AIDS Soc 2018; 21:e25133. [PMID: 29939483 PMCID: PMC6016637 DOI: 10.1002/jia2.25133] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 05/04/2018] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Many prevention of mother-to-child HIV transmission programmes across Africa initiate HIV-infected (HIV positive) pregnant women on lifelong antiretroviral therapy (ART) on the first day of antenatal care ("same-day" initiation). However, there are concerns that same-day initiation may limit patient preparation before starting ART and contribute to subsequent non-adherence, disengagement from care and raised viral load. We examined if same-day initiation was associated with viral suppression and engagement in care during pregnancy. METHODS Consecutive ART-eligible pregnant women making their first antenatal care (ANC) visit at a primary care facility in Cape Town, South Africa were enrolled into a prospective cohort between March 2013 and June 2014. Before July 2013, ART eligibility was based on CD4 cell count ≤350 cells/μL ("Option A"), with a 1 to 2 week delay from the first ANC visit to ART initiation for patient preparation; thereafter all women were eligible regardless of CD4 cell count ("Option B+") and offered ART on the same day as first ANC visit. Women were followed with viral load testing conducted separately from routine ART services, and engagement in ART services was measured using routinely collected clinic, pharmacy and laboratory records through 12 months postpartum. RESULTS Among 628 HIV-positive women (median age, 28 years; median gestation at ART start, 21 weeks; 55% newly diagnosed with HIV), 73% initiated ART same-day; this proportion was higher under Option B+ versus Option A (85% vs. 20%). Levels of viral suppression (viral load <50 copies/mL) at delivery (74% vs. 82%) and 12 months postpartum (74% vs. 71%) were similar under same-day versus delayed initiation respectively. Findings were consistent when viral suppression was defined at <1000 copies/mL, after adjustment for demographic/clinical measures and across subgroups of age, CD4 and timing of HIV diagnosis. Time to first viral rebound following initial suppression did not differ by timing of ART initiation nor did engagement in care through 12 months postpartum (same-day = 73%, delayed = 73%, p = 0.910). CONCLUSIONS These data suggest that same-day ART initiation during pregnancy is not associated with lower levels of engagement in care or viral suppression through 12 months post-delivery in this setting, providing reassurance to ART programmes implementing Option B+.
Collapse
Affiliation(s)
- Nontokozo Langwenya
- Division of Epidemiology and BiostatisticsSchool of Public Health and Family MedicineUniversity of Cape TownCape TownSouth Africa
- Centre for Infectious Diseases Epidemiology & ResearchUniversity of Cape TownCape TownSouth Africa
| | - Tamsin K Phillips
- Division of Epidemiology and BiostatisticsSchool of Public Health and Family MedicineUniversity of Cape TownCape TownSouth Africa
- Centre for Infectious Diseases Epidemiology & ResearchUniversity of Cape TownCape TownSouth Africa
| | - Kirsty Brittain
- Division of Epidemiology and BiostatisticsSchool of Public Health and Family MedicineUniversity of Cape TownCape TownSouth Africa
- Centre for Infectious Diseases Epidemiology & ResearchUniversity of Cape TownCape TownSouth Africa
| | - Allison Zerbe
- ICAP at Columbia UniversityMailman School of Public HealthNew YorkNew York
| | - Elaine J Abrams
- ICAP at Columbia UniversityMailman School of Public HealthNew YorkNew York
- Columbia UniversityCollege of Physicians & SurgeonsNew YorkNew York
| | - Landon Myer
- Division of Epidemiology and BiostatisticsSchool of Public Health and Family MedicineUniversity of Cape TownCape TownSouth Africa
- Centre for Infectious Diseases Epidemiology & ResearchUniversity of Cape TownCape TownSouth Africa
| |
Collapse
|
37
|
Page-Shipp L, Lewis JJ, Velen K, Senoge S, Zishiri E, Popane F, Chihota VN, Clark D, Churchyard GJ, Charalambous S. Household point of care CD4 testing and isoniazid preventive therapy initiation in a household TB contact tracing programme in two districts of South Africa. PLoS One 2018; 13:e0192089. [PMID: 29499060 PMCID: PMC5834159 DOI: 10.1371/journal.pone.0192089] [Citation(s) in RCA: 5] [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: 10/24/2017] [Accepted: 01/16/2018] [Indexed: 01/03/2023] Open
Abstract
Background In South Africa, TB household contact tracing provides an opportunity for increased TB and HIV case finding. We aimed to determine the effect of two new potential interventions for TB contact tracing programmes: Point of Care CD4 (PoC CD4) on HIV linkage to care and household Isoniazid Preventive Therapy (IPT) provision on uptake and retention of IPT. Methods A pragmatic, three-arm, cluster-randomized trial was undertaken. TB Household contacts were randomised to 3 arms: 1) Standard of Care TB and HIV testing (SOC); 2) SOC with POC CD4 for those testing HIV positive; 3) SOC with POC CD4 and IPT for eligible household members. Linkage to care within 90 days was assessed either through patient visits (at 10 weeks and 6 months) or via telephonic contact. Results 2,243 index TB patients and 3,012 contacts (64,3% female, median age 30 years) were enrolled. On self-report, 26(1.2%) were currently receiving TB treatment and 1816 (60.3%) reported a prior HIV test. HIV testing uptake was 34.7% in the SoC arm, 40.2% in the PoC CD4 arm (RR1.16, CI 0.99–1.36, p-value = 0.060) and 39.9% in the PoC CD4 + HH-IPT arm (RR = 1.15, CI 0.99–1.35, p-value = 0.075). Linkage to care within 3 months was 30.8% in the SoC arm and 42.1% in the POC CD4 arms (RR 1.37; CI: 0.68–2.76, p-value = 0.382). 20/21 contacts (95.2%) initiated IPT in the PoC CD4 + HH-IPT arm, compared to 3/20 (15.0%) in the PoC CD4 arm (p = 0.004; p-value from Fisher’s exact test < 0.001). Among 3,008 contacts screened for tuberculosis, 15 (3.4%) had bacteriologically confirmed TB with an overall yield of TB of 0.5% (95% CI: 0.3%, 0.8%). Conclusions Household PoC CD4 testing and IPT initiation is feasible. There was only weak evidence that PoCCD4 led to a small increase in HCT uptake and no evidence for an increase in linkage-to-care. IPT initiation and completion was increased by the household intervention. Although feasible, these interventions had low impact due to the low uptake of HIV testing in households.
Collapse
Affiliation(s)
| | - James J. Lewis
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Kavindhran Velen
- The Aurum Institute, Johannesburg, South Africa
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | | | | | - Dave Clark
- The Aurum Institute, Johannesburg, South Africa
| | - Gavin J. Churchyard
- The Aurum Institute, Johannesburg, South Africa
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- The School of Public Health, University of Witwatersrand, Johannesburg, South Africa
- Advancing Care and Treatment for TB and HIV, Medical Research Council Collaborating Centre of Excellence, Johannesburg, South Africa
| | - Salome Charalambous
- The Aurum Institute, Johannesburg, South Africa
- The School of Public Health, University of Witwatersrand, Johannesburg, South Africa
- Advancing Care and Treatment for TB and HIV, Medical Research Council Collaborating Centre of Excellence, Johannesburg, South Africa
| |
Collapse
|
38
|
Mateo-Urdiales A, Johnson S, Nachega JB, Eshun-Wilson I. Rapid initiation of antiretroviral therapy for people living with HIV. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2018. [DOI: 10.1002/14651858.cd012962] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Alberto Mateo-Urdiales
- Liverpool School of Tropical Medicine; Department of Clinical Sciences; Liverpool UK L3 5QA
| | - Samuel Johnson
- Liverpool School of Tropical Medicine; Department of Clinical Sciences; Liverpool UK L3 5QA
| | - Jean B Nachega
- University of Pittsburgh; Department of Epidemiology, Infectious Diseases and Microbiology; Pittsburgh Pennsylvania USA
- Johns Hopkins Bloomberg School of Public Health; Department of Epidemiology and International Health; Baltimore Maryland USA
- Stellenbosch University; Centre for Infectious Diseases; Cape Town South Africa
| | - Ingrid Eshun-Wilson
- Stellenbosch University; Centre for Evidence Based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences; Francie van Zyl Drive, Tygerberg, 7505, Parow Cape Town Western Cape South Africa 7505
| |
Collapse
|
39
|
Dunning L, Kroon M, Hsiao NY, Myer L. Field evaluation of HIV point-of-care testing for early infant diagnosis in Cape Town, South Africa. PLoS One 2017; 12:e0189226. [PMID: 29261707 PMCID: PMC5738050 DOI: 10.1371/journal.pone.0189226] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 11/21/2017] [Indexed: 12/21/2022] Open
Abstract
Background Early infant HIV diagnosis (EID) coverage and uptake remains challenging. Point-of-care (POC) testing may improve access and turn-around-times, but, while several POC technologies are in development there are few data on their implementation in the field. Methods We conducted an implementation study of the Alere q Detect POC system for EID at two public sector health facilities in Cape Town. HIV-exposed neonates undergoing routine EID testing at a large maternity hospital and a primary care clinic received both laboratory-based HIV PCR testing per local protocols and a POC test. We analysed the performance of POC versus laboratory testing, and conducted semi-structured interviews with providers to assess acceptability and implementation issues. Results Overall 478 specimens were taken: 311 tests were performed at the obstetric hospital (median child age, 1 days) and 167 six-week tests in primary care (median child age, 42 days). 9.0% of all tests resulted in an error with no differences by site; most errors resolved with retesting. POC was more sensitive (100%; lower 95% CI, 39.8%) and specific (100%, lower 95% CI, 98%) among older children tested in primary care compared with birth testing in hospital (90.0%, 95% CI, 55.5–99.8% and 100.0%, lower 95% CI, 98.4%, respectively). Negative predictive value was high (>99%) at both sites. In interviews, providers felt the device was simple to use and facilitated decision-making in the management of infants. However, many wanted clarity on the cause of errors on the POC device to help guide repeat testing. Conclusions POC EID testing performs well in field implementation in health care facilities and appears highly acceptable to health care providers.
Collapse
Affiliation(s)
- Lorna Dunning
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Centre for Infectious Diseases Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- * E-mail:
| | - Max Kroon
- Department of Neonatal Medicine, University of Cape Town, Cape Town, South Africa
| | - Nei-yuan Hsiao
- Division of Medical Virology, University of Cape Town, Cape Town, South Africa
| | - Landon Myer
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Centre for Infectious Diseases Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
40
|
Factors Associated With Poor Linkage to HIV Care in South Africa: Secondary Analysis of Data From the Thol'impilo Trial. J Acquir Immune Defic Syndr 2017; 76:453-460. [PMID: 28961678 DOI: 10.1097/qai.0000000000001550] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Poor linkage to HIV care is impeding achievement of the Joint United Nations Programme on HIV and AIDS (UNAIDS) 90-90-90 targets. This study aims to identify risk factors for poor linkage-to-care after HIV counseling and testing, thereby informing strategies to achieve 90-90-90. SETTING The Thol'impilo trial was a large randomized controlled trial performed between 2012 and 2015 in South Africa, comparing different strategies to improve linkage-to-care among adults aged ≥18 years who tested HIV-positive at mobile clinic HIV counseling and testing. METHODS In this secondary analysis, sociodemographic factors associated with time to linkage-to-care were identified using Cox regression. RESULTS Of 2398 participants, 61% were female, with median age 33 years (interquartile range: 27-41) and median CD4 count 427 cells/mm (interquartile range: 287-595). One thousand one hundred one participants (46%) had clinic verified linkage-to-care within 365 days of testing HIV-positive. In adjusted analysis, younger age [≤30 vs >40 years: adjusted hazard ratio (aHR): 0.58, 95% CI: 0.50 to 0.68; 31-40 vs >40 years: aHR: 0.81, 95% CI: 0.70 to 0.94, test for trend P < 0.001], being male (aHR: 0.86, 95% CI: 0.76 to 0.98, P = 0.028), not being South African (aHR: 0.79, 95% CI: 0.66 to 0.96, P = 0.014), urban district (aHR: 0.82, 95% CI: 0.73 to 0.93, P = 0.002), being employed (aHR: 0.81, 95% CI: 0.72 to 0.92, P = 0.001), nondisclosure of HIV (aHR: 0.63, 95% CI: 0.56 to 0.72, P < 0.001), and having higher CD4 counts (test for trend P < 0.001) were all associated with decreased hazard of linkage-to-care. CONCLUSION Linkage-to-care was low in this relatively large cohort. Increasing linkage-to-care requires innovative, evidence-based interventions particularly targeting individuals who are younger, male, immigrant, urban, employed, and reluctant to disclose their HIV status.
Collapse
|
41
|
Multidisciplinary Point-of-Care Testing in South African Primary Health Care Clinics Accelerates HIV ART Initiation but Does Not Alter Retention in Care. J Acquir Immune Defic Syndr 2017; 76:65-73. [PMID: 28542080 DOI: 10.1097/qai.0000000000001456] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Lack of accessible laboratory infrastructure limits HIV antiretroviral therapy (ART) initiation, monitoring, and retention in many resource-limited settings. Point-of-care testing (POCT) is advocated as a mechanism to overcome these limitations. We executed a pragmatic, prospective, randomized, controlled trial comparing the impact of POCT vs. standard of care (SOC) on treatment initiation and retention in care. METHODS Selected POC technologies were embedded at 3 primary health clinics in South Africa. Confirmed HIV-positive participants were randomized to either SOC or POC: SOC participants were venesected and specimens referred to the laboratory with patient follow-up as per algorithm (∼3 visits); POC participants had phlebotomy and POCT immediately on-site using Pima CD4 to assess ART eligibility followed by hematology, chemistry, and tuberculosis screening with the goal of receiving same-day adherence counseling and treatment initiation. Participant outcomes measured at recruitment 6 and 12 months after initiation. RESULTS Four hundred thirty-two of 717 treatment eligible participants enrolled between May 2012 and September 2013: 198 (56.7%) SOC; 234 (63.6%) POC. Mean age was 37.4 years; 60.5% were female. Significantly more participants were initiated using POC [adjusted prevalence ratio (aPR) 0.83; 95% confidence interval (CI): 0.74 to 0.93; P < 0.0001], the median time to initiation was 1 day for POC and 26.5 days for SOC. The proportion of patients in care and on ART was similar for both arms at 6 months (47 vs. 50%) (aPR 0.96; 95% CI: 0.79 to 1.16) and 12 months (32 vs. 32%) (aPR 1.05; 95% CI: 0.80 to 1.38), with similar mortality rates. Loss to follow-up at 12 months was higher for POC (36% vs. 51%) (aPR 0.82; 95% CI: 0.65 to 1.04). CONCLUSIONS Adoption of POCT accelerated ART initiation but once on treatment, there was unexpectedly higher loss to follow-up on POC and no improvement in outcomes at 12 months over SOC.
Collapse
|
42
|
Strategies to Accelerate HIV Care and Antiretroviral Therapy Initiation After HIV Diagnosis: A Randomized Trial. J Acquir Immune Defic Syndr 2017; 75:540-547. [PMID: 28471840 DOI: 10.1097/qai.0000000000001428] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Determine the effectiveness of strategies to increase linkage to care after testing HIV positive at mobile HIV testing in South Africa. DESIGN Unmasked randomized controlled trial. METHODS Recruitment of adults testing HIV positive and not currently in HIV care occurred at 7 mobile HIV counseling and testing units in urban, periurban, and rural South Africa with those consenting randomized 1:1:1:1 into 1 of 4 arms. Three strategies were compared with standard of care (SOC): point-of-care CD4 count testing (POC CD4), POC CD4 plus longitudinal strengths-based counseling (care facilitation; CF), and POC CD4 plus transport reimbursement (transport). Participants were followed up telephonically and through clinic records and analyzed with an intention-to-treat analysis. RESULTS From March 2013 to October 2014, 2558 participants were enrolled, of whom 160 were excluded postrandomization. Compared with the SOC arm where 298 (50%) reported having entered care, linkage to care was 319 (52%) for POC CD4, hazard ratio (HR) 1.0 [95% confidence interval (CI): 0.89 to 1.2, P = 0.6]; 331 (55%) for CF, HR: 1.1 (95% CI: 0.84 to 1.3, P = 0.2); and 291 (49%) for transport, HR 0.97 (95% CI: 0.83 to 1.1, P = 0.7). Linkage to care verified with clinical records that occurred for 172 (29%) in the SOC arm; 187 (31%) in the POC CD4 arm, HR: 1.0 (95% CI: 0.86 to 1.3, P = 0.6); 225 (38%) in the CF arm, HR: 1.4 (95% CI: 1.1 to 1.7, P = 0.001); and 180 (31%) in the transport arm, HR: 1.1 (95% CI: 0.88 to 1.3, P = 0.5). CONCLUSIONS CF improved verified linkage to care from 29% to 38%.
Collapse
|
43
|
Kaindjee-Tjituka F, Sawadogo S, Mutandi G, Maher AD, Salomo N, Mbapaha C, Neo M, Beukes A, Gweshe J, Muadinohamba A, Lowrance DW. Task-shifting point-of-care CD4+ testing to lay health workers in HIV care and treatment services in Namibia. Afr J Lab Med 2017; 6:643. [PMID: 29159139 PMCID: PMC5684646 DOI: 10.4102/ajlm.v6i1.643] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 07/02/2017] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Access to CD4+ testing remains a common barrier to early initiation of antiretroviral therapy among persons living with HIV/AIDS in low- and middle-income countries. The feasibility of task-shifting of point-of-care (POC) CD4+ testing to lay health workers in Namibia has not been evaluated. METHODS From July to August 2011, Pima CD4+ analysers were used to improve access to CD4+ testing at 10 selected public health facilities in Namibia. POC Pima CD4+ testing was performed by nurses or lay health workers. Venous blood samples were collected from 10% of patients and sent to centralised laboratories for CD4+ testing with standard methods. Outcomes for POC Pima CD4+ testing and patient receipt of results were compared between nurses and lay health workers and between the POC method and standard laboratory CD4+ testing methods. RESULTS Overall, 1429 patients received a Pima CD4+ test; 500 (35.0%) tests were performed by nurses and 929 (65.0%) were performed by lay health workers. When Pima CD4+ testing was performed by a nurse or a lay health worker, 93.2% and 95.2% of results were valid (p = 0.1); 95.6% and 98.1% of results were received by the patient (p = 0.007); 96.2% and 94.0% of results were received by the patient on the same day (p = 0.08). Overall, 97.2% of Pima CD4+ results were received by patients, compared to 55.4% of standard laboratory CD4+ results (p < 0.001). CONCLUSIONS POC CD4+ testing was feasible and effective when task-shifted to lay health workers. Rollout of POC CD4+ testing via task-shifting can improve access to CD4+ testing and retention in care between HIV diagnosis and antiretroviral therapy initiation in low- and middle-income countries.
Collapse
Affiliation(s)
| | | | - Graham Mutandi
- US Centers for Disease Control and Prevention, Windhoek, Namibia
| | - Andrew D. Maher
- US Centers for Disease Control and Prevention, Windhoek, Namibia
| | - Natanael Salomo
- US Centers for Disease Control and Prevention, Windhoek, Namibia
| | - Claudia Mbapaha
- US Centers for Disease Control and Prevention, Windhoek, Namibia
| | - Marytha Neo
- US Centers for Disease Control and Prevention, Windhoek, Namibia
| | - Anita Beukes
- US Centers for Disease Control and Prevention, Windhoek, Namibia
| | - Justice Gweshe
- Directorate of Special Programs, Ministry of Health and Social Services, Windhoek, Namibia
| | - Alexinah Muadinohamba
- Directorate of Special Programs, Ministry of Health and Social Services, Windhoek, Namibia
| | - David W. Lowrance
- Directorate of Special Programs, Ministry of Health and Social Services, Windhoek, Namibia
| |
Collapse
|
44
|
Joseph J, Gotora T, Erlwanger AS, Mushavi A, Zizhou S, Masuka N, Boeke CE, Mangwiro AZ. Impact of Point-of-Care CD4 Testing on Retention in Care Among HIV-Positive Pregnant and Breastfeeding Women in the Context of Option B+ in Zimbabwe: A Cluster Randomized Controlled Trial. J Acquir Immune Defic Syndr 2017; 75 Suppl 2:S190-S197. [PMID: 28498189 DOI: 10.1097/qai.0000000000001341] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Scale-up of Option B+ in Zimbabwe has increased antiretroviral therapy (ART) coverage but patient loss-to-follow-up remains high; thus, effective strategies to improve retention in care are needed. Evidence for Elimination, a cluster randomized controlled trial, evaluated the impact of point-of-care (POC) CD4 testing with CD4 count-specific adherence counseling on rates of retention among 1150 HIV-positive pregnant women initiating ART in Zimbabwe. METHODS Thirty-two primary care health facilities were randomized to offer either standard-of-care (SOC) or POC CD4 testing plus CD4-specific counseling to clients (POC Plus). The primary outcome was the proportion of HIV-positive pregnant women retained on ART after 12 months, calculated by cluster-adjusted proportions, unadjusted and adjusted relative risks (RR and aRR, respectively). RESULTS Retention in care 12 months after initiation was 50.7% and 54.5% in the POC Plus and SOC arms, respectively (RR 0.93, 95% confidence interval [CI]: 0.78 to 1.11; aRR 0.91, 95% CI: 0.77 to 1.07). Although considered not retained, 9.7% transferred to another facility and 0.2% died. Most women, 95.3% in POC Plus and 92.9% in SOC, initiated ART within 1 month of antenatal booking (RR 1.03, 95% CI: 0.97 to 1.08). DISCUSSION Although patient retention was similar in both arms, women in the POC Plus arm were more likely to have received a CD4 test at booking and a repeat CD4 test later in care. CD4 is no longer required for treatment initiation but is still recommended in national guidelines and is of value in clinical management. Further work is needed to identify effective strategies to increase patient retention in ART care.
Collapse
Affiliation(s)
- Jessica Joseph
- *Clinton Health Access Initiative, Boston, MA; †Clinton Health Access Initiative, Harare, Zimbabwe; and ‡Ministry of Health and Child Care, Harare, Zimbabwe
| | | | | | | | | | | | | | | |
Collapse
|
45
|
Implementation and Operational Research: Cost and Efficiency of a Hybrid Mobile Multidisease Testing Approach With High HIV Testing Coverage in East Africa. J Acquir Immune Defic Syndr 2017; 73:e39-e45. [PMID: 27741031 DOI: 10.1097/qai.0000000000001141] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In 2013-2014, we achieved 89% adult HIV testing coverage using a hybrid testing approach in 32 communities in Uganda and Kenya (SEARCH: NCT01864603). To inform scalability, we sought to determine: (1) overall cost and efficiency of this approach; and (2) costs associated with point-of-care (POC) CD4 testing, multidisease services, and community mobilization. METHODS We applied microcosting methods to estimate costs of population-wide HIV testing in 12 SEARCH trial communities. Main intervention components of the hybrid approach are census, multidisease community health campaigns (CHC), and home-based testing for CHC nonattendees. POC CD4 tests were provided for all HIV-infected participants. Data were extracted from expenditure records, activity registers, staff interviews, and time and motion logs. RESULTS The mean cost per adult tested for HIV was $20.5 (range: $17.1-$32.1) (2014 US$), including a POC CD4 test at $16 per HIV+ person identified. Cost per adult tested for HIV was $13.8 at CHC vs. $31.7 by home-based testing. The cost per HIV+ adult identified was $231 ($87-$1245), with variability due mainly to HIV prevalence among persons tested (ie, HIV positivity rate). The marginal costs of multidisease testing at CHCs were $1.16/person for hypertension and diabetes, and $0.90 for malaria. Community mobilization constituted 15.3% of total costs. CONCLUSIONS The hybrid testing approach achieved very high HIV testing coverage, with POC CD4, at costs similar to previously reported mobile, home-based, or venue-based HIV testing approaches in sub-Saharan Africa. By leveraging HIV infrastructure, multidisease services were offered at low marginal costs.
Collapse
|
46
|
Keane J, Pharr JR, Buttner MP, Ezeanolue EE. Interventions to Reduce Loss to Follow-up During All Stages of the HIV Care Continuum in Sub-Saharan Africa: A Systematic Review. AIDS Behav 2017; 21:1745-1754. [PMID: 27578001 DOI: 10.1007/s10461-016-1532-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The continuum of care for successful HIV treatment includes HIV testing, linkage, engagement in care, and retention on antiretroviral therapy (ART). Loss to follow-up (LTFU) is a significant disruption to this pathway and a common outcome in sub-Saharan Africa. This review of literature identified interventions that have reduced LTFU in the HIV care continuum. A search was conducted utilizing terms that combined the disease state, stages of the HIV care continuum, interventions, and LTFU in sub-Saharan Africa and articles published between January 2010 and July 2015. Thirteen articles were included in the final review. Use of point of care CD4 testing and community-supported programs improved linkage, engagement, and retention in care. There are few interventions directed at LTFU and none that span across the entire continuum of HIV care. Further research could focus on devising programs that include a series of interventions that will be effective through the entire continuum.
Collapse
|
47
|
Effect of Point-of-Care Diagnostics on Maternal Outcomes in Human Immunodeficiency Virus–Infected Women. POINT OF CARE 2017. [DOI: 10.1097/poc.0000000000000135] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
48
|
Mashamba-Thompson TP, Morgan RL, Sartorius B, Dennis B, Drain PK, Thabane L. Effect of Point-of-Care Diagnostics on Maternal Outcomes in Human Immunodeficiency Virus-Infected Women: Systematic Review and Meta-analysis. POINT OF CARE 2017; 16:67-77. [PMID: 29242711 PMCID: PMC5726275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION The World Health Organization advocates for increased accessibility of HIV-related point-of-care (POC) diagnostics in settings that lack laboratory infrastructure. The aim of this study is to assess the impact of POC diagnostics on maternal health outcomes in HIV-infected women. METHODS A systematic literature review used multiple data sources as follows: Cochrane Infectious Disease Group Specialized Register; Cochrane Central Register of Control Trials, published in The Cochrane Library; PubMed; EBSCOhost and LILACS from January 2000 to October 2015. References of included studies were hand searched. Randomized controlled trials (RCTs) and observational studies examining health outcomes of HIV-infected women were eligible for inclusion in this review. The Cochrane Risk of Bias tool was used for bias assessment of the included studies. PRISMA guidelines were used for reporting. RESULTS Of the 695 studies identified, six retrievable studies (five cross-sectional studies and one case control study) met the inclusion criteria and were included in this study. These studies examined a total of 167 HIV-infected women in different study settings. No studies reported evidence of CD4 count, viral load and TB, and the syphilis POC test impact on HIV-infected women was not found by this study. Included studies reported the impact of various HIV rapid tests across the following five maternal outcomes: timely receipt of results with pooled effect size (ES) = 1.00 (95% confidence interval [CI]: (0.98; 1.02); enabling partner testing, ES = 0.95 (0.85; 1.04); prevention of mother-to-child transmission of HIV, ES = 0.86 (0.79; 0.93); linkage to antiretroviral treatment (ART), ES = 0.76 (0.69; 0.84); and linkage to HIV care, ES = 0.50 (0.18; 0.82). No studies reported evidence of the impact of POC testing on maternal mortality or maternal and child morbidity of HIV-infected women. CONCLUSIONS The review provides an international overview of the impact of HIV POC diagnostics on maternal outcomes in HIV-infected women, showing the evidence that the HIV POC test is significantly associated with decreased mother-to-child transmission of HIV and increased linkage to ART and HIV care for HIV-infected women. It also revealed a gap in the literature aimed at assessing the impact of POC diagnostics on maternal morbidity and mortality in HIV-infected women.
Collapse
Affiliation(s)
- Tivani P Mashamba-Thompson
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Rebecca L Morgan
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Benn Sartorius
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Brittany Dennis
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Paul K Drain
- International Clinical Research Center, Department of Global Health, University of Washington, Seattle, USA
- Division of Infectious Diseases, Department of Medicine, University of Washington, Seattle, USA
- Department of Epidemiology, University of Washington, Seattle, USA
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Lehana Thabane
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Biostatistics Unit/FSORC, St Joseph's Healthcare, Hamilton, Ontario, Canada
| |
Collapse
|
49
|
Zeh C, Rose CE, Inzaule S, Desai MA, Otieno F, Humwa F, Akoth B, Omolo P, Chen RT, Kebede Y, Samandari T. Laboratory-based performance evaluation of PIMA CD4+ T-lymphocyte count point-of-care by lay-counselors in Kenya. J Immunol Methods 2017; 448:44-50. [PMID: 28529048 DOI: 10.1016/j.jim.2017.05.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 02/24/2017] [Accepted: 05/17/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND CD4+ T-lymphocyte count testing at the point-of-care (POC) may improve linkage to care of persons diagnosed with HIV-1 infection, but the accuracy of POC devices when operated by lay-counselors in the era of task-shifting is unknown. We examined the accuracy of Alere's Pima™ POC device on both capillary and venous blood when performed by lay-counselors and laboratory technicians. METHODS In Phase I, we compared the perfomance of POC against FACSCalibur™ for 280 venous specimens by laboratory technicians. In Phase II we compared POC performance by lay-counselors versus laboratory technicians using 147 paired capillary and venous specimens, and compared these to FACSCalibur™. Statistical analyses included Bland-Altman analyses, concordance correlation coefficient, sensitivity, and specificity at treatment eligibility thresholds of 200, 350, and 500cells/μl. RESULTS Phase I: POC sensitivity and specificity were 93.0% and 84.1% at 500cells/μl, respectively. Phase II: Good agreement was observed for venous POC results from both lay-counselors (concordance correlation coefficient (CCC)=0.873, bias -86.4cells/μl) and laboratory technicians (CCC=0.920, bias -65.7cells/μl). Capillary POC had good correlation: lay-counselors (CCC=0.902, bias -71.2cells/μl), laboratory technicians (CCC=0.918, bias -63.0cells/μl). Misclassification at the 500 cells/μl threshold for venous blood was 13.6% and 10.2% for lay-counselors and laboratory technicians and 12.2% for capillary blood in both groups. POC tended to under-classify the CD4 values with increasingly negative bias at higher CD4 values. CONCLUSIONS Pima™ results were comparable to FACSCalibur™ for both venous and capillary specimens when operated by lay-counselors. POC CD4 testing has the potential to improve linkage to HIV care without burdening laboratory technicians in resource-limited settings.
Collapse
Affiliation(s)
- Clement Zeh
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Charles E Rose
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Seth Inzaule
- Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Mitesh A Desai
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | | | - Felix Humwa
- Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Benta Akoth
- Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Paul Omolo
- Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Robert T Chen
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States.
| | - Yenew Kebede
- Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Taraz Samandari
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| |
Collapse
|
50
|
Gebremicael G, Belay Y, Girma F, Abreha Y, Gebreegziabxier A, Tesfaye S, Messele Z, Assefa Y, Bellete B, Kassa D, Vojnov L. The performance of BD FACSPresto™ for CD4 T-cell count, CD4% and hemoglobin concentration test in Ethiopia. PLoS One 2017; 12:e0176323. [PMID: 28448581 PMCID: PMC5407647 DOI: 10.1371/journal.pone.0176323] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 04/07/2017] [Indexed: 11/19/2022] Open
Abstract
Introduction In Ethiopia, CD4+ T-cell counting is still required for all patients at baseline before antiretroviral therapy (ART) and to determine eligibility and follow-up of opportunistic infection prophylaxis. However, access to CD4+ T cell count in rural health facilities remains a major challenge in Ethiopia like other resource-limited settings. Methodology Both capillary and venous blood was drawn from each of 325 study participant recruited in Addis Ababa and surroundings. The CD4+ T-cell count, CD4%, and hemoglobin (Hgb) were tested at one of the four study health facilities using capillary blood and BD FACSPresto™ device. These tests were also done at the national HIV reference laboratory, using venous blood with BD FACSCalibur™, Sysmex XT-1800i™, and BD FACSPresto™. Results BD FACSPresto™ had an absolute mean bias of -13.3 cells/ul (-2.99%) and 28.3 cells/μl (6.4%) using venous and capillary blood, respectively, compared with BD FACSCalibur™. The absolute CD4 assay on the BD FACSPresto™ had a regression coefficient (R2) of 0.87 and 0.92 using capillary blood and venous blood samples, respectively, compared with BD FACSCalibur™. The percentage similarity of the BD FACSPresto™ using capillary and venous blood was 105.2% and 99.3%, respectively. The sensitivity of the FACSPresto™ using threshold of 500 cells/μl for ART eligibility using capillary and venous blood was 87.9 and 94.3%, while the specificity was 91.4 and 83.8%, respectively. Furthermore, the BD FACSPresto™ had an absolute mean bias of -0.2 dl/μl (0.0%) (95% LOA: -1.7, 1.3) and -0.59 dl/μl (0.1%) (95% LOA: -1.49, 0.31) for Hgb using capillary and venous blood compared with the Sysmex XT-1800i™, respectively. Conclusion Our results showed acceptable agreement between the BD FACSPresto™ and BD FACSCalibur™ for CD4+ T-cell counting and CD4%; and between the BD FACSPresto™ and Sysmex XT-1800i™for measuring Hgb concentration.
Collapse
Affiliation(s)
- Gebremedhin Gebremicael
- HIV and TB diseases research directorate, Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
- * E-mail:
| | - Yohanes Belay
- HIV and TB diseases research directorate, Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
| | - Fitsum Girma
- HIV and TB diseases research directorate, Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
| | - Yemane Abreha
- HIV and TB diseases research directorate, Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
| | - Atsbeha Gebreegziabxier
- HIV and TB diseases research directorate, Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
| | - Simret Tesfaye
- HIV and TB diseases research directorate, Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
| | - Zelalem Messele
- Clinton Health Access Initiative, Inc. (CHAI), Addis Ababa, Ethiopia
| | - Yibeltal Assefa
- HIV and TB diseases research directorate, Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
| | - Bahrie Bellete
- Clinton Health Access Initiative, Inc. (CHAI), Addis Ababa, Ethiopia
| | - Desta Kassa
- HIV and TB diseases research directorate, Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
| | - Lara Vojnov
- Clinton Health Access Initiative, Boston, Massachusetts, United States of America
| |
Collapse
|