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Dakum P, Avong YK, Okuma J, Sorungbe T, Jatau B, Nedmbi N, Odutola MK, Abimiku A, Mensah CO, Kayode GA. Prevalence and risk factors for obesity among elderly patients living with HIV/AIDS in a low-resource setting. Medicine (Baltimore) 2021; 100:e25399. [PMID: 33847636 PMCID: PMC8052014 DOI: 10.1097/md.0000000000025399] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 03/14/2021] [Indexed: 01/04/2023] Open
Abstract
Obesity is associated with detrimental changes in cardiovascular and metabolic parameters, including blood pressure, dyslipidemia, markers of systemic inflammation, and insulin resistance. In the elderly living with the human immunodeficiency virus (EPLHIV), and being treated with antiretroviral medications, the obesity complications escalate and expose the elderly to the risk of noncommunicable diseases. Given that over 3 million EPLHIV in sub-Sahara Africa, we assessed the prevalence of obesity and its associated factors among EPLHIV in a low-resource setting.This was a cross sectional study of EPLHIV aged 50 years and older, being treated with antiretroviral medications from 2004 to 2018. HIV treatment data collected from multiple treatment sites were analyzed. Baseline characteristics of the participants were described, and multivariable relative risk model was applied to assess the associations between obesity (body mass index [BMI] ≥30 kg/m2) and the prespecified potential risk factors.Of the 134,652 in HIV cohort, 19,566 (14.5%) were EPLHIV: 12,967 (66.3%) were normal weight (18.5 ≤ BMI < 25), 4548 (23.2%) were overweight (25 ≤ BMI < 30), while 2,051 (10.5%) were obese (BMI ≥30). The average age the normal weight (57.1; standard deviation 6.6) and the obese (56.5; standard deviation 5.5) was similar. We observed that being an employed (relative risk [RR] 1.71; 95% confidence interval [CI] 1.48-2.00; P < .001), educated (RR 1.93; 95% CI 1.54-2.41; P < .001), and presence of hypertension (RR 1.78; 95% CI 1.44-2.20; P < .001), increased the risk of obesity. Also, being male (RR 0.38; 95% CI 0.33-0.44; P < .001), stages III/IV of the World Health Organization clinical stages of HIV (RR 0.58; 95% CI 0.50-0.68; P < .001), tenofovir-based regimen (RR 0.84; 95% CI 0.73-0.96, P < .001), and low CD4 count (RR 0.56; 95% CI 0.44-0.71; P < .001) were inversely associated with obesity.This study demonstrates that multiple factors are driving obesity prevalence in EPLHIV. The study provides vital information for policy-makers and HIV program implementers in implementing targeted-interventions to address obesity in EPLHIV. Its findings would assist in the implementation of a one-stop-shop model for the management of HIV and other comorbid medical conditions in EPLHIV.
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Avong YK, Jatau B, Gurumnaan R, Danat N, Okuma J, Usman I, Mordi D, Ukpabi B, Kayode GA, Dutt S, El-Tayeb O, Afolabi B, Ambrose I, Agbaji O, Osakwe A, Ibrahim A, Ogar C, Nosiri H, Avong EB, Adekanmbi V, Uthman O, Abimiku A, Oni YO, Mensah CO, Dakum P, Mberu KE, Ogundahunsi OAT. Addressing the under-reporting of adverse drug reactions in public health programs controlling HIV/AIDS, Tuberculosis and Malaria: A prospective cohort study. PLoS One 2018; 13:e0200810. [PMID: 30133453 PMCID: PMC6104922 DOI: 10.1371/journal.pone.0200810] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 07/03/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Adverse Drug Reactions (ADRs) are a major clinical and public health problem world-wide. The prompt reporting of suspected ADRs to regulatory authorities to activate drug safety surveillance and regulation appears to be the most pragmatic measure for addressing the problem. This paper evaluated a pharmacovigilance (PV) training model that was designed to improve the reporting of ADRs in public health programs treating the Human Immunodeficiency Virus (HIV), Tuberculosis (TB) and Malaria. METHODS A Structured Pharmacovigilance and Training Initiative (SPHAR-TI) model based on the World Health Organization accredited Structured Operational Research and Training Initiative (SOR-IT) model was designed and implemented over a period of 12 months. A prospective cohort design was deployed to evaluate the outcomes of the model. The primary outcomes were knowledge gained and Individual Case Safety Reports (ICSR) (completed adverse drug reactions monitoring forms) submitted, while the secondary outcomes were facility based Pharmacovigilance Committees activated and health facility healthcare workers trained by the participants. RESULTS Fifty-five (98%) participants were trained and followed up for 12 months. More than three quarter of the participants have never received training on pharmacovigilance prior to the course. Yet, a significant gain in knowledge was observed after the participants completed a comprehensive training for six days. In only seven months, 3000 ICSRs (with 100% completeness) were submitted, 2,937 facility based healthcare workers trained and 46 Pharmacovigilance Committees activated by the participants. Overall, a 273% increase in ICSRs submission to the National Agency for Food and Drug Administration and Control (NAFDAC) was observed. CONCLUSION Participants gained knowledge, which tended to increase the reporting of ADRs. The SPHAR-TI model could be an option for strengthening the continuous reporting of ADRs in public health programs in resource limited settings.
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Affiliation(s)
- Yohanna Kambai Avong
- Institute of Human Virology, Nigeria, Maina Court, Central Business District, Abuja, Nigeria
| | - Bolajoko Jatau
- Institute of Human Virology, Nigeria, Maina Court, Central Business District, Abuja, Nigeria
| | - Ritmwa Gurumnaan
- Institute of Human Virology, Nigeria, Maina Court, Central Business District, Abuja, Nigeria
| | - Nanfwang Danat
- Institute of Human Virology, Nigeria, Maina Court, Central Business District, Abuja, Nigeria
| | - James Okuma
- Institute of Human Virology, Nigeria, Maina Court, Central Business District, Abuja, Nigeria
| | - Istifanus Usman
- Institute of Human Virology, Nigeria, Maina Court, Central Business District, Abuja, Nigeria
| | - Dennis Mordi
- Institute of Human Virology, Nigeria, Maina Court, Central Business District, Abuja, Nigeria
| | - Blessing Ukpabi
- Institute of Human Virology, Nigeria, Maina Court, Central Business District, Abuja, Nigeria
| | - Gbenga Ayodele Kayode
- Institute of Human Virology, Nigeria, Maina Court, Central Business District, Abuja, Nigeria
| | - Saswata Dutt
- Institute of Human Virology, Nigeria, Maina Court, Central Business District, Abuja, Nigeria
| | - Osman El-Tayeb
- Demian Foundation of Belgium, Ibadan, Oyo State, Nigeria
| | - Bamgboye Afolabi
- Health, Environment and Development Foundation, Lagos State, Lagos, Nigeria
| | - Isah Ambrose
- Faculty of Pharmaceutical Sciences, University of Benin, Benin City, Edo State, Benin, Nigeria
| | - Oche Agbaji
- Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | | | - Ali Ibrahim
- National Agency for Food and Drug Administration and Control, Federal Capital Territory, Abuja, Nigeria
| | - Comfort Ogar
- National Agency for Food and Drug Administration and Control, Federal Capital Territory, Abuja, Nigeria
| | - Helga Nosiri
- National Agency for Food and Drug Administration and Control, Federal Capital Territory, Abuja, Nigeria
| | | | - Victor Adekanmbi
- Division of Population Medicine, Cardiff University, Cardiff, United Kingdom
| | - Olalekan Uthman
- Warwick Medical School, University of Warwick, Coventry United Kingdom
| | - Alash’le Abimiku
- Institute of Human Virology, Nigeria, Maina Court, Central Business District, Abuja, Nigeria
| | - Yetunde O. Oni
- National Agency for Food and Drug Administration and Control, Federal Capital Territory, Abuja, Nigeria
| | - Charles Olalekan Mensah
- Institute of Human Virology, Nigeria, Maina Court, Central Business District, Abuja, Nigeria
| | - Patrick Dakum
- Institute of Human Virology, Nigeria, Maina Court, Central Business District, Abuja, Nigeria
| | - Kamau Edward Mberu
- Special Program for Research in Tropical Diseases, World Health Organization (TDR), Geneva, Switzerland
| | - Olumide A. T. Ogundahunsi
- Special Program for Research in Tropical Diseases, World Health Organization (TDR), Geneva, Switzerland
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Avong YK, Isaakidis P, Hinderaker SG, Van den Bergh R, Ali E, Obembe BO, Ekong E, Adebamowo C, Ndembi N, Okuma J, Osakwe A, Oladimeji O, Akang G, Obasanya JO, Eltayeb O, Agbaje AV, Abimiku A, Mensah CO, Dakum PS. Doing no harm? Adverse events in a nation-wide cohort of patients with multidrug-resistant tuberculosis in Nigeria. PLoS One 2015; 10:e0120161. [PMID: 25781958 PMCID: PMC4364363 DOI: 10.1371/journal.pone.0120161] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 02/03/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Adverse events (AEs) of second line anti-tuberculosis drugs (SLDs) are relatively well documented. However, the actual burden has rarely been described in detail in programmatic settings. We investigated the occurrence of these events in the national cohort of multidrug-resistant tuberculosis (MDR-TB) patients in Nigeria. METHOD This was a retrospective, observational cohort study, using pharmacovigilance data systematically collected at all MDR-TB treatment centers in Nigeria. Characteristics of AEs during the intensive phase treatment were documented, and risk factors for development of AEs were assessed. RESULTS Four hundred and sixty patients were included in the analysis: 62% were male; median age was 33 years [Interquartile Range (IQR):28-42] and median weight was 51 kg (IQR: 45-59). Two hundred and three (44%) patients experienced AEs; four died of conditions associated with SLD AEs. Gastro-intestinal (n = 100), neurological (n = 75), ototoxic (n = 72) and psychiatric (n = 60) AEs were the most commonly reported, whereas ototoxic and psychiatric AEs were the most debilitating. Majority of AEs developed after 1-2 months of therapy, and resolved in less than a month after treatment. Some treatment centers were twice as likely to report AEs compared with others, highlighting significant inconsistencies in reporting at different treatment centers. Patients with a higher body weight had an increased risk of experiencing AEs. No differences were observed in risk of AEs between HIV-infected and uninfected patients. Similarly, age was not significantly associated with AEs. CONCLUSION Patients in the Nigerian MDR-TB cohort experienced a wide range of AEs, some of which were disabling and fatal. Early identification and prompt management as well as standardized reporting of AEs at all levels of healthcare, including the community is urgently needed. Safer regimens for drug-resistant TB with the shortest duration are advocated.
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Affiliation(s)
| | - Petros Isaakidis
- Médecins Sans Frontières, Operational Research Unit, Luxembourg City, Luxembourg
| | | | - Rafael Van den Bergh
- Médecins Sans Frontières, Operational Research Unit, Luxembourg City, Luxembourg
| | - Engy Ali
- Médecins Sans Frontières, Operational Research Unit, Luxembourg City, Luxembourg
| | | | | | - Clement Adebamowo
- Institute of Human Virology, Abuja, Nigeria
- University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | | | | | - Adeline Osakwe
- National Agency for Food and Drug Administration Control, Abuja, Nigeria
| | - Olanrewaju Oladimeji
- Zankli Medical Centre, Abuja, Nigeria
- Liverpool School of Tropical Medicines, Pembroke Place, Liverpool, United Kingdom
| | - Gabriel Akang
- National Tuberculosis and Leprosy Control Program, Abuja, Nigeria
| | | | - Osman Eltayeb
- Damien Foundation Belgium, Nigeria Project, Ibadan, Nigeria
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