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Dupnik K, Rivera VR, Dorvil N, Akbarnejad H, Gao Y, Liu J, Apollon A, Dumond E, Riviere C, Severe P, Lavoile K, Duran Mendicuti MA, Pierre S, Rouzier V, Walsh KF, Byrne AL, Joseph P, Cremieux PY, Pape JW, Koenig SP. Potential Utility of C-reactive Protein for Tuberculosis Risk Stratification among Patients with Non-Meningitic Symptoms at HIV Diagnosis in Low- and Middle-Income Countries. medRxiv 2023:2023.12.19.23300232. [PMID: 38196598 PMCID: PMC10775334 DOI: 10.1101/2023.12.19.23300232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
Article Summary We assessed the association between C-reactive protein (CRP) and Mycobacterium tuberculosis (TB) diagnosis in symptomatic patients at HIV diagnosis. We found that CRP concentrations can improve tuberculosis risk stratification, facilitating decision making about whether (specific) tuberculosis testing is indicated before antiretroviral therapy initiation. Background The World Health Organization recommends initiating same-day ART while tuberculosis testing is underway for patients with non-meningitic symptoms at HIV diagnosis, though safety data are limited. C-reactive protein (CRP) testing may improve tuberculosis risk stratification in this population. Methods In this baseline analysis of 498 adults (>18 years) with tuberculosis symptoms at HIV diagnosis who were enrolled in a trial of rapid ART initiation in Haiti, we describe test characteristics of varying CRP thresholds in the diagnosis of TB. We also assessed predictors of high CRP (≥3 mg/dL) using generalized linear models. Results Eighty-seven (17.5%) patients were diagnosed with baseline TB. The median CRP was 33.0 mg/L (IQR: 5.1, 85.5) in those with TB, and 2.6 mg/L (IQR: 0.8, 11.7) in those without TB. As the CRP threshold increased from ≥1 mg/L to ≥10 mg/L, the positive predictive value for TB increased from 22.4% to 35.4%, and negative predictive value decreased from 96.9% to 92.3%. With CRP thresholds varying from <1 to <10 mg/L, a range from 25.5% to 64.9% of the cohort would have been eligible for same-day ART, and 0.8% to 5.0% would have untreated TB at ART initiation. Conclusions CRP concentrations can be used to improve TB risk stratification, facilitating same-day decisions about ART initiation. Depending on the CRP threshold, one-quarter to two-thirds of patients could be eligible for same-day ART, with a reduction of 3-fold to 20-fold in the proportion with untreated TB, compared with a strategy of same-day ART while awaiting TB test results.
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Mavian CN, Tagliamonte MS, Alam MT, Sakib SN, Cash MN, Moir M, Jimenez JP, Riva A, Nelson EJ, Cato ET, Ajayakumar J, Louis R, Curtis A, De Rochars VMB, Rouzier V, Pape JW, de Oliveira T, Morris JG, Salemi M, Ali A. Ancestral Origin and Dissemination Dynamics of Reemerging Toxigenic Vibrio cholerae, Haiti. Emerg Infect Dis 2023; 29:2072-2082. [PMID: 37735743 PMCID: PMC10521621 DOI: 10.3201/eid2910.230554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023] Open
Abstract
The 2010 cholera epidemic in Haiti was thought to have ended in 2019, and the Prime Minister of Haiti declared the country cholera-free in February 2022. On September 25, 2022, cholera cases were again identified in Port-au-Prince. We compared genomic data from 42 clinical Vibrio cholerae strains from 2022 with data from 327 other strains from Haiti and 1,824 strains collected worldwide. The 2022 isolates were homogeneous and closely related to clinical and environmental strains circulating in Haiti during 2012-2019. Bayesian hypothesis testing indicated that the 2022 clinical isolates shared their most recent common ancestor with an environmental lineage circulating in Haiti in July 2018. Our findings strongly suggest that toxigenic V. cholerae O1 can persist for years in aquatic environmental reservoirs and ignite new outbreaks. These results highlight the urgent need for improved public health infrastructure and possible periodic vaccination campaigns to maintain population immunity against V. cholerae.
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Affiliation(s)
- Carla N. Mavian
- University of Florida, Gainesville, Florida, USA (C.N. Mavian, M.S. Tagliamonte, M.T. Alam, S.N. Sakib, M.N. Cash, J.P. Jimenez, A. Riva, E.J. Nelson, E.T. Cato, R. Louis, V.M. Beau De Rochars, J.G. Morris Jr., M. Salemi, A. Ali)
- Stellenbosch University, Stellenbosch, South Africa (M. Moir, T. de Oliveira)
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA (J. Ajayakumar, A. Curtis)
- Les Centres GHESKIO, Port-au-Prince, Haiti (V. Rouzier, J.W. Pape)
- Weill Cornell Medical College, New York, New York, USA (V. Rouzier, J.W. Pape)
- University of KwaZulu-Natal, Durban, South Africa (T. de Oliveira)
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa (T. de Oliveira)
- University of Washington, Seattle, Washington, USA (T. de Oliveira)
| | - Massimiliano S. Tagliamonte
- University of Florida, Gainesville, Florida, USA (C.N. Mavian, M.S. Tagliamonte, M.T. Alam, S.N. Sakib, M.N. Cash, J.P. Jimenez, A. Riva, E.J. Nelson, E.T. Cato, R. Louis, V.M. Beau De Rochars, J.G. Morris Jr., M. Salemi, A. Ali)
- Stellenbosch University, Stellenbosch, South Africa (M. Moir, T. de Oliveira)
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA (J. Ajayakumar, A. Curtis)
- Les Centres GHESKIO, Port-au-Prince, Haiti (V. Rouzier, J.W. Pape)
- Weill Cornell Medical College, New York, New York, USA (V. Rouzier, J.W. Pape)
- University of KwaZulu-Natal, Durban, South Africa (T. de Oliveira)
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa (T. de Oliveira)
- University of Washington, Seattle, Washington, USA (T. de Oliveira)
| | - Meer T. Alam
- University of Florida, Gainesville, Florida, USA (C.N. Mavian, M.S. Tagliamonte, M.T. Alam, S.N. Sakib, M.N. Cash, J.P. Jimenez, A. Riva, E.J. Nelson, E.T. Cato, R. Louis, V.M. Beau De Rochars, J.G. Morris Jr., M. Salemi, A. Ali)
- Stellenbosch University, Stellenbosch, South Africa (M. Moir, T. de Oliveira)
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA (J. Ajayakumar, A. Curtis)
- Les Centres GHESKIO, Port-au-Prince, Haiti (V. Rouzier, J.W. Pape)
- Weill Cornell Medical College, New York, New York, USA (V. Rouzier, J.W. Pape)
- University of KwaZulu-Natal, Durban, South Africa (T. de Oliveira)
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa (T. de Oliveira)
- University of Washington, Seattle, Washington, USA (T. de Oliveira)
| | - S. Nazmus Sakib
- University of Florida, Gainesville, Florida, USA (C.N. Mavian, M.S. Tagliamonte, M.T. Alam, S.N. Sakib, M.N. Cash, J.P. Jimenez, A. Riva, E.J. Nelson, E.T. Cato, R. Louis, V.M. Beau De Rochars, J.G. Morris Jr., M. Salemi, A. Ali)
- Stellenbosch University, Stellenbosch, South Africa (M. Moir, T. de Oliveira)
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA (J. Ajayakumar, A. Curtis)
- Les Centres GHESKIO, Port-au-Prince, Haiti (V. Rouzier, J.W. Pape)
- Weill Cornell Medical College, New York, New York, USA (V. Rouzier, J.W. Pape)
- University of KwaZulu-Natal, Durban, South Africa (T. de Oliveira)
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa (T. de Oliveira)
- University of Washington, Seattle, Washington, USA (T. de Oliveira)
| | - Melanie N. Cash
- University of Florida, Gainesville, Florida, USA (C.N. Mavian, M.S. Tagliamonte, M.T. Alam, S.N. Sakib, M.N. Cash, J.P. Jimenez, A. Riva, E.J. Nelson, E.T. Cato, R. Louis, V.M. Beau De Rochars, J.G. Morris Jr., M. Salemi, A. Ali)
- Stellenbosch University, Stellenbosch, South Africa (M. Moir, T. de Oliveira)
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA (J. Ajayakumar, A. Curtis)
- Les Centres GHESKIO, Port-au-Prince, Haiti (V. Rouzier, J.W. Pape)
- Weill Cornell Medical College, New York, New York, USA (V. Rouzier, J.W. Pape)
- University of KwaZulu-Natal, Durban, South Africa (T. de Oliveira)
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa (T. de Oliveira)
- University of Washington, Seattle, Washington, USA (T. de Oliveira)
| | - Monika Moir
- University of Florida, Gainesville, Florida, USA (C.N. Mavian, M.S. Tagliamonte, M.T. Alam, S.N. Sakib, M.N. Cash, J.P. Jimenez, A. Riva, E.J. Nelson, E.T. Cato, R. Louis, V.M. Beau De Rochars, J.G. Morris Jr., M. Salemi, A. Ali)
- Stellenbosch University, Stellenbosch, South Africa (M. Moir, T. de Oliveira)
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA (J. Ajayakumar, A. Curtis)
- Les Centres GHESKIO, Port-au-Prince, Haiti (V. Rouzier, J.W. Pape)
- Weill Cornell Medical College, New York, New York, USA (V. Rouzier, J.W. Pape)
- University of KwaZulu-Natal, Durban, South Africa (T. de Oliveira)
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa (T. de Oliveira)
- University of Washington, Seattle, Washington, USA (T. de Oliveira)
| | - Juan Perez Jimenez
- University of Florida, Gainesville, Florida, USA (C.N. Mavian, M.S. Tagliamonte, M.T. Alam, S.N. Sakib, M.N. Cash, J.P. Jimenez, A. Riva, E.J. Nelson, E.T. Cato, R. Louis, V.M. Beau De Rochars, J.G. Morris Jr., M. Salemi, A. Ali)
- Stellenbosch University, Stellenbosch, South Africa (M. Moir, T. de Oliveira)
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA (J. Ajayakumar, A. Curtis)
- Les Centres GHESKIO, Port-au-Prince, Haiti (V. Rouzier, J.W. Pape)
- Weill Cornell Medical College, New York, New York, USA (V. Rouzier, J.W. Pape)
- University of KwaZulu-Natal, Durban, South Africa (T. de Oliveira)
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa (T. de Oliveira)
- University of Washington, Seattle, Washington, USA (T. de Oliveira)
| | - Alberto Riva
- University of Florida, Gainesville, Florida, USA (C.N. Mavian, M.S. Tagliamonte, M.T. Alam, S.N. Sakib, M.N. Cash, J.P. Jimenez, A. Riva, E.J. Nelson, E.T. Cato, R. Louis, V.M. Beau De Rochars, J.G. Morris Jr., M. Salemi, A. Ali)
- Stellenbosch University, Stellenbosch, South Africa (M. Moir, T. de Oliveira)
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA (J. Ajayakumar, A. Curtis)
- Les Centres GHESKIO, Port-au-Prince, Haiti (V. Rouzier, J.W. Pape)
- Weill Cornell Medical College, New York, New York, USA (V. Rouzier, J.W. Pape)
- University of KwaZulu-Natal, Durban, South Africa (T. de Oliveira)
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa (T. de Oliveira)
- University of Washington, Seattle, Washington, USA (T. de Oliveira)
| | - Eric J. Nelson
- University of Florida, Gainesville, Florida, USA (C.N. Mavian, M.S. Tagliamonte, M.T. Alam, S.N. Sakib, M.N. Cash, J.P. Jimenez, A. Riva, E.J. Nelson, E.T. Cato, R. Louis, V.M. Beau De Rochars, J.G. Morris Jr., M. Salemi, A. Ali)
- Stellenbosch University, Stellenbosch, South Africa (M. Moir, T. de Oliveira)
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA (J. Ajayakumar, A. Curtis)
- Les Centres GHESKIO, Port-au-Prince, Haiti (V. Rouzier, J.W. Pape)
- Weill Cornell Medical College, New York, New York, USA (V. Rouzier, J.W. Pape)
- University of KwaZulu-Natal, Durban, South Africa (T. de Oliveira)
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa (T. de Oliveira)
- University of Washington, Seattle, Washington, USA (T. de Oliveira)
| | - Emilie T. Cato
- University of Florida, Gainesville, Florida, USA (C.N. Mavian, M.S. Tagliamonte, M.T. Alam, S.N. Sakib, M.N. Cash, J.P. Jimenez, A. Riva, E.J. Nelson, E.T. Cato, R. Louis, V.M. Beau De Rochars, J.G. Morris Jr., M. Salemi, A. Ali)
- Stellenbosch University, Stellenbosch, South Africa (M. Moir, T. de Oliveira)
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA (J. Ajayakumar, A. Curtis)
- Les Centres GHESKIO, Port-au-Prince, Haiti (V. Rouzier, J.W. Pape)
- Weill Cornell Medical College, New York, New York, USA (V. Rouzier, J.W. Pape)
- University of KwaZulu-Natal, Durban, South Africa (T. de Oliveira)
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa (T. de Oliveira)
- University of Washington, Seattle, Washington, USA (T. de Oliveira)
| | - Jayakrishnan Ajayakumar
- University of Florida, Gainesville, Florida, USA (C.N. Mavian, M.S. Tagliamonte, M.T. Alam, S.N. Sakib, M.N. Cash, J.P. Jimenez, A. Riva, E.J. Nelson, E.T. Cato, R. Louis, V.M. Beau De Rochars, J.G. Morris Jr., M. Salemi, A. Ali)
- Stellenbosch University, Stellenbosch, South Africa (M. Moir, T. de Oliveira)
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA (J. Ajayakumar, A. Curtis)
- Les Centres GHESKIO, Port-au-Prince, Haiti (V. Rouzier, J.W. Pape)
- Weill Cornell Medical College, New York, New York, USA (V. Rouzier, J.W. Pape)
- University of KwaZulu-Natal, Durban, South Africa (T. de Oliveira)
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa (T. de Oliveira)
- University of Washington, Seattle, Washington, USA (T. de Oliveira)
| | - Rigan Louis
- University of Florida, Gainesville, Florida, USA (C.N. Mavian, M.S. Tagliamonte, M.T. Alam, S.N. Sakib, M.N. Cash, J.P. Jimenez, A. Riva, E.J. Nelson, E.T. Cato, R. Louis, V.M. Beau De Rochars, J.G. Morris Jr., M. Salemi, A. Ali)
- Stellenbosch University, Stellenbosch, South Africa (M. Moir, T. de Oliveira)
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA (J. Ajayakumar, A. Curtis)
- Les Centres GHESKIO, Port-au-Prince, Haiti (V. Rouzier, J.W. Pape)
- Weill Cornell Medical College, New York, New York, USA (V. Rouzier, J.W. Pape)
- University of KwaZulu-Natal, Durban, South Africa (T. de Oliveira)
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa (T. de Oliveira)
- University of Washington, Seattle, Washington, USA (T. de Oliveira)
| | - Andrew Curtis
- University of Florida, Gainesville, Florida, USA (C.N. Mavian, M.S. Tagliamonte, M.T. Alam, S.N. Sakib, M.N. Cash, J.P. Jimenez, A. Riva, E.J. Nelson, E.T. Cato, R. Louis, V.M. Beau De Rochars, J.G. Morris Jr., M. Salemi, A. Ali)
- Stellenbosch University, Stellenbosch, South Africa (M. Moir, T. de Oliveira)
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA (J. Ajayakumar, A. Curtis)
- Les Centres GHESKIO, Port-au-Prince, Haiti (V. Rouzier, J.W. Pape)
- Weill Cornell Medical College, New York, New York, USA (V. Rouzier, J.W. Pape)
- University of KwaZulu-Natal, Durban, South Africa (T. de Oliveira)
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa (T. de Oliveira)
- University of Washington, Seattle, Washington, USA (T. de Oliveira)
| | - V. Madsen Beau De Rochars
- University of Florida, Gainesville, Florida, USA (C.N. Mavian, M.S. Tagliamonte, M.T. Alam, S.N. Sakib, M.N. Cash, J.P. Jimenez, A. Riva, E.J. Nelson, E.T. Cato, R. Louis, V.M. Beau De Rochars, J.G. Morris Jr., M. Salemi, A. Ali)
- Stellenbosch University, Stellenbosch, South Africa (M. Moir, T. de Oliveira)
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA (J. Ajayakumar, A. Curtis)
- Les Centres GHESKIO, Port-au-Prince, Haiti (V. Rouzier, J.W. Pape)
- Weill Cornell Medical College, New York, New York, USA (V. Rouzier, J.W. Pape)
- University of KwaZulu-Natal, Durban, South Africa (T. de Oliveira)
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa (T. de Oliveira)
- University of Washington, Seattle, Washington, USA (T. de Oliveira)
| | - Vanessa Rouzier
- University of Florida, Gainesville, Florida, USA (C.N. Mavian, M.S. Tagliamonte, M.T. Alam, S.N. Sakib, M.N. Cash, J.P. Jimenez, A. Riva, E.J. Nelson, E.T. Cato, R. Louis, V.M. Beau De Rochars, J.G. Morris Jr., M. Salemi, A. Ali)
- Stellenbosch University, Stellenbosch, South Africa (M. Moir, T. de Oliveira)
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA (J. Ajayakumar, A. Curtis)
- Les Centres GHESKIO, Port-au-Prince, Haiti (V. Rouzier, J.W. Pape)
- Weill Cornell Medical College, New York, New York, USA (V. Rouzier, J.W. Pape)
- University of KwaZulu-Natal, Durban, South Africa (T. de Oliveira)
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa (T. de Oliveira)
- University of Washington, Seattle, Washington, USA (T. de Oliveira)
| | - Jean William Pape
- University of Florida, Gainesville, Florida, USA (C.N. Mavian, M.S. Tagliamonte, M.T. Alam, S.N. Sakib, M.N. Cash, J.P. Jimenez, A. Riva, E.J. Nelson, E.T. Cato, R. Louis, V.M. Beau De Rochars, J.G. Morris Jr., M. Salemi, A. Ali)
- Stellenbosch University, Stellenbosch, South Africa (M. Moir, T. de Oliveira)
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA (J. Ajayakumar, A. Curtis)
- Les Centres GHESKIO, Port-au-Prince, Haiti (V. Rouzier, J.W. Pape)
- Weill Cornell Medical College, New York, New York, USA (V. Rouzier, J.W. Pape)
- University of KwaZulu-Natal, Durban, South Africa (T. de Oliveira)
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa (T. de Oliveira)
- University of Washington, Seattle, Washington, USA (T. de Oliveira)
| | - Tulio de Oliveira
- University of Florida, Gainesville, Florida, USA (C.N. Mavian, M.S. Tagliamonte, M.T. Alam, S.N. Sakib, M.N. Cash, J.P. Jimenez, A. Riva, E.J. Nelson, E.T. Cato, R. Louis, V.M. Beau De Rochars, J.G. Morris Jr., M. Salemi, A. Ali)
- Stellenbosch University, Stellenbosch, South Africa (M. Moir, T. de Oliveira)
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA (J. Ajayakumar, A. Curtis)
- Les Centres GHESKIO, Port-au-Prince, Haiti (V. Rouzier, J.W. Pape)
- Weill Cornell Medical College, New York, New York, USA (V. Rouzier, J.W. Pape)
- University of KwaZulu-Natal, Durban, South Africa (T. de Oliveira)
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa (T. de Oliveira)
- University of Washington, Seattle, Washington, USA (T. de Oliveira)
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Vilbrun SC, Souroutzidis A, Walsh KF, Ellis J, Guiteau C, Delva S, Joissaint G, Joseph P, Pape JW, Koenig SP. Successful outcomes for patients with drug-resistant tuberculosis despite civil unrest and COVID-19 in Haiti. PLOS Glob Public Health 2023; 3:e0002356. [PMID: 37698996 PMCID: PMC10497149 DOI: 10.1371/journal.pgph.0002356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 08/12/2023] [Indexed: 09/14/2023]
Abstract
Globally, treatment outcomes for people with multi-drug/rifampin-resistant tuberculosis (MDR/RR-TB) are sub-optimal, with MDR/RR-TB programs further weakened due to the COVID-19 pandemic, and in Haiti, by severe civil unrest. We assessed the impact of these disruptions on treatment outcomes at GHESKIO, in Port-au-Prince, Haiti. We conducted a retrospective analysis including all adults (age ≥18 years) who initiated MDR/RR-TB treatment at GHESKIO from 2010 to 2020. We assessed predictors of poor treatment outcome using multivariable logistic regression, adjusting for baseline characteristics and year of treatment. 453 patients initiated treatment for MDR/RR-TB at GHESKIO. Median age was 31 (IQR: 25, 40), 233 (51.4%) were male, and 100 (22.1%) were living with HIV. Three hundred sixty-nine patients (81.5%) achieved cure, 42 (9.3%) died, 40 (8.8%) were lost to follow-up and 2 (<1%) failed treatment. HIV status was associated with poor treatment outcome (aRR: 1.65 (95% CI: 1.09, 2.48)) but there was no difference by year of treatment initiation. Outcomes for patients with MDR/RR-TB remained outstanding, even during the COVID-19 pandemic and severe civil unrest in Haiti. We attribute this resilience in care to the adaptability of program staff and provision of economic and psychosocial support.
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Affiliation(s)
- Stalz Charles Vilbrun
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | | | - Kathleen F. Walsh
- Center for Global Health, Weill Cornell Medicine, New York, NY, United States of America
- Division of General Internal Medicine, Weill Cornell Medicine, New York, NY, United States of America
| | - Joshua Ellis
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Colette Guiteau
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Sobieskye Delva
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Guy Joissaint
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Patrice Joseph
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Jean William Pape
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
- Center for Global Health, Weill Cornell Medicine, New York, NY, United States of America
| | - Serena P. Koenig
- Division of Infectious Diseases and Division of Global Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
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Dorvil N, Rivera VR, Riviere C, Berman R, Severe P, Bang H, Lavoile K, Devieux JG, Faustin M, Saintyl G, Mendicuti MD, Pierre S, Apollon A, Dumond E, Forestal GPL, Rouzier V, Marcelin A, McNairy ML, Walsh KF, Dupnik K, Reif LK, Byrne AL, Bousleiman S, Orvis E, Joseph P, Cremieux PY, Pape JW, Koenig SP. Same-day testing with initiation of antiretroviral therapy or tuberculosis treatment versus standard care for persons presenting with tuberculosis symptoms at HIV diagnosis: A randomized open-label trial from Haiti. PLoS Med 2023; 20:e1004246. [PMID: 37294843 PMCID: PMC10292694 DOI: 10.1371/journal.pmed.1004246] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 06/26/2023] [Accepted: 05/25/2023] [Indexed: 06/11/2023] Open
Abstract
BACKGROUND Same-day HIV testing and antiretroviral therapy (ART) initiation is being widely implemented. However, the optimal timing of ART among patients with tuberculosis (TB) symptoms is unknown. We hypothesized that same-day treatment (TB treatment for those diagnosed with TB; ART for those not diagnosed with TB) would be superior to standard care in this population. METHODS AND FINDINGS We conducted an open-label trial among adults with TB symptoms at initial HIV diagnosis at GHESKIO in Haiti; participants were recruited and randomized on the same day. Participants were randomized in a 1:1 ratio to same-day treatment (same-day TB testing with same-day TB treatment if TB diagnosed; same-day ART if TB not diagnosed) versus standard care (initiating TB treatment within 7 days and delaying ART to day 7 if TB not diagnosed). In both groups, ART was initiated 2 weeks after TB treatment. The primary outcome was retention in care with 48-week HIV-1 RNA <200 copies/mL, with intention to treat (ITT) analysis. From November 6, 2017 to January 16, 2020, 500 participants were randomized (250/group); the final study visit occurred on March 1, 2021. Baseline TB was diagnosed in 40 (16.0%) in the standard and 48 (19.2%) in the same-day group; all initiated TB treatment. In the standard group, 245 (98.0%) initiated ART at median of 9 days; 6 (2.4%) died, 15 (6.0%) missed the 48-week visit, and 229 (91.6%) attended the 48-week visit. Among all who were randomized, 220 (88.0%) received 48-week HIV-1 RNA testing; 168 had <200 copies/mL (among randomized: 67.2%; among tested: 76.4%). In the same-day group, 249 (99.6%) initiated ART at median of 0 days; 9 (3.6%) died, 23 (9.2%) missed the 48-week visit, and 218 (87.2%) attended the 48-week visit. Among all who were randomized, 211 (84.4%) received 48-week HIV-1 RNA; 152 had <200 copies/mL (among randomized: 60.8%; among tested: 72.0%). There was no difference between groups in the primary outcome (60.8% versus 67.2%; risk difference: -0.06; 95% CI [-0.15, 0.02]; p = 0.14). Two new grade 3 or 4 events were reported per group; none were judged to be related to the intervention. The main limitation of this study is that it was conducted at a single urban clinic, and the generalizability to other settings is uncertain. CONCLUSIONS In patients with TB symptoms at HIV diagnosis, we found that same-day treatment was not associated with superior retention and viral suppression. In this study, a short delay in ART initiation did not appear to compromise outcomes. TRIAL REGISTRATION This study is registered with ClinicalTrials.gov NCT03154320.
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Affiliation(s)
- Nancy Dorvil
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Vanessa R. Rivera
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Cynthia Riviere
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Richard Berman
- The Analysis Group, Boston, Massachusetts, United States of America
| | - Patrice Severe
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Heejung Bang
- University of California, Davis School of Medicine, Davis, California, United States of America
| | - Kerlyne Lavoile
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Jessy G. Devieux
- Florida International University, Miami, Florida, United States of America
| | - Mikerlyne Faustin
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Giovanni Saintyl
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Maria Duran Mendicuti
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Samuel Pierre
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Alexandra Apollon
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Emelyne Dumond
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | | | - Vanessa Rouzier
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
- Weill Cornell Medicine, New York, New York, United States of America
| | - Adias Marcelin
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | | | - Kathleen F. Walsh
- Weill Cornell Medicine, New York, New York, United States of America
| | - Kathryn Dupnik
- Weill Cornell Medicine, New York, New York, United States of America
| | - Lindsey K. Reif
- Weill Cornell Medicine, New York, New York, United States of America
| | - Anthony L. Byrne
- St. Vincent’s Hospital, Darlinghurst, New South Wales, Australia
| | | | - Eli Orvis
- The Analysis Group, Boston, Massachusetts, United States of America
| | - Patrice Joseph
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | | | - Jean William Pape
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
- Weill Cornell Medicine, New York, New York, United States of America
| | - Serena P. Koenig
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
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Reif LK, Sabwa S, Rouzier V, Mourra MN, Yan LD, Sufra R, Pape JW, Fitzgerald D, Safford MM, Mcnairy M. Abstract P130: CVD Risk Factors Among Young People in Haiti: Implications for Low-Income Countries. Circulation 2023. [DOI: 10.1161/circ.147.suppl_1.p130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
Introduction:
Over 80% of the global cardiovascular disease (CVD) burden is in low-income countries, including Haiti. Emerging data from these settings indicate CVD risk factors occur earlier in the life-course, but our knowledge of the age of onset and associated factors is limited. This study provides the first population-based estimates of CVD risk factors among young people ages 18-30 years in Haiti.
Hypothesis:
We hypothesized that elevated blood pressure (pre-hypertension (SBP/DBP >120-140/80-89) or hypertension (SBP/DBP >140/90 or on treatment) is the most common CVD risk factor among young people ages 18-30 years with an estimated prevalence >15%.
Methods:
This is a cross-sectional analysis within the Haiti CVD Cohort Study, a population-based longitudinal study of adults ≥18 years in Port au Prince. Participants were enrolled between March 2019-April 2021 using multistage random sampling. At enrollment, sociodemographic and health behaviors were assessed coupled with a physical exam and laboratory measures. CVD risk factors included: elevated BP, dyslipidemia (LDL-C ≥100mg/dL), kidney disease (urine albumin creatinine ratio (ACR) or estimated glomerular filtration rate (eGFR)), obesity (BMI > 30kg/m
2
), and smoking, alcohol use, and physical activity using the WHO STEPS survey.
Results:
Among 957 participants ages 18-30 years, median age was 24 years (IQR 21-27) and 52% were female. Prevalence of elevated BP was 23% (20% pre-hypertension, 3% hypertension), 34% dyslipidemia, 5% ACR ≥30mg/g, 0.21% eGFR < 60 mL/min/1.73, and 7% obese. Other CVD risk factors include: 4% were current smokers, 6% reported any lifetime tobacco use, 19% reported one or more alcoholic drinks per day, and 47% reported low physical activity.
Compared to participants ages 18-24 years, those ages 25-30 years had higher odds of pre-hypertension/hypertension (aOR=1.56, 95% CI: 1.13-2.15), but lower odds of dyslipidemia (aOR=0.55, 95% CI: 0.41-0.74). Females had lower odds of pre-hypertension/hypertension (aOR= 0.24, 95% CI: 0.17-0.35) and dyslipidemia (aOR=0.47, 95% CI: 0.35-0.64). Being obese was associated with a higher odds of pre-hypertension/hypertension (aOR=2.21, 95% CI: 1.14-4.16) but lower odds of dyslipidemia (aOR= 0.35, 95%CI: 0.20-0.61) compared to normal weight.
Conclusion:
These data provide previously unknown population-based estimates of CVD risk factors among young people in a low-income country. Rates of elevated BP and dyslipidemia are alarmingly high and occur prematurely in the life-course in this cohort and are associated with risk of future CVD events and mortality. Despite low prevalence of smoking and drinking alcohol, smoking tobacco was still associated with an increased odds of dyslipidemia. Additional drivers of early-onset CVD risk factors must be identified to guide targeted interventions for primordial and primary prevention as well as treatment.
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6
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Zainabadi K, Saito K, Mishra S, Walsh KF, Mathurin LD, Vilbrun SC, Ocheretina O, Pape JW, Fitzgerald DW, Nathan CF, Lee MH. Transcriptional Biomarkers of Differentially Detectable Mycobacterium tuberculosis in Patient Sputum. mBio 2022; 13:e0270122. [PMID: 36326252 PMCID: PMC9765512 DOI: 10.1128/mbio.02701-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 10/06/2022] [Indexed: 11/05/2022] Open
Abstract
Certain populations of Mycobacterium tuberculosis go undetected by standard diagnostics but can be enumerated using limiting dilution assays. These differentially detectable M. tuberculosis (DD M. tuberculosis) populations may have relevance for persistence due to their drug tolerance. It is unclear how well DD M. tuberculosis from patients is modeled by a recently developed in vitro model in which M. tuberculosis starved in phosphate-buffered saline is incubated with rifampin to produce DD M. tuberculosis (the PBS-RIF model). This study attempted to answer this question. We selected 14 genes that displayed differential expression in the PBS-RIF model and evaluated their expression in patient sputa containing various proportions of DD M. tuberculosis. The expression of 12/14 genes correlated with the relative abundance of DD M. tuberculosis in patient sputa. Culture filtrate (CF), which promotes recovery of DD M. tuberculosis from certain patient sputa, improved these correlations in most cases. The gene whose reduced expression relative to M. tuberculosis 16S rRNA showed the greatest association with the presence and relative abundance of DD M. tuberculosis in patient sputa, icl1, was recently shown to play a functional role in restraining DD M. tuberculosis formation in the PBS-RIF model. Expression of icl1, combined with two additional DD M. tuberculosis-related genes, showed strong performance for predicting the presence or absence of DD M. tuberculosis in patient sputa (receiver operating characteristic [ROC] area under the curve [AUC] = 0.88). Thus, the in vitro DD M. tuberculosis model developed by Saito et al. (K. Saito, T. Warrier, S. Somersan-Karakaya, L. Kaminski, et al., Proc Natl Acad Sci U S A 114:E4832-E4840, 2017, https://doi.org/10.1073/pnas.1705385114) bears a resemblance to DD M. tuberculosis found in tuberculosis (TB) patients, and DD M. tuberculosis transcriptional profiles may be useful for monitoring DD M. tuberculosis populations in patient sputum. IMPORTANCE Differentially detectable M. tuberculosis (DD M. tuberculosis), which is detectable by limiting dilution assays but not by CFU, is present and enriched for in TB patient sputum after initiation of first-line therapy. These cryptic cells may play a role in disease persistence due to their phenotypic tolerance to anti-TB drugs. A recently developed in vitro model of DD M. tuberculosis (the PBS-RIF model) has expanded our understanding of these cells, though how well it translates to DD M. tuberculosis in patients is currently unknown. To answer this question, we selected 14 genes that displayed differential expression in the PBS-RIF model and evaluated their expression in TB patient sputa. We found that 12/14 of these genes showed a similar expression profile in patient sputa that correlated with the relative abundance of DD M. tuberculosis. Further, the expression of three of these genes showed strong performance for predicting the presence or absence of DD M. tuberculosis in patient sputa. The use of DD M. tuberculosis transcriptional profiles may allow for easier monitoring of DD M. tuberculosis populations in patient sputum in comparison to limiting dilution assays.
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Affiliation(s)
- Kayvan Zainabadi
- Center for Global Health, Weill Cornell Medicine, New York, New York, USA
| | - Kohta Saito
- Department of Medicine, Division of Infectious Diseases, Weill Cornell Medicine, New York, New York, USA
| | - Saurabh Mishra
- Department of Microbiology & Immunology, Weill Cornell Medicine, New York, New York, USA
| | - Kathleen Frances Walsh
- Center for Global Health, Weill Cornell Medicine, New York, New York, USA
- Department of Medicine, Division of General Internal Medicine, Weill Cornell Medicine, New York, New York, USA
| | | | | | - Oksana Ocheretina
- Center for Global Health, Weill Cornell Medicine, New York, New York, USA
| | - Jean William Pape
- Center for Global Health, Weill Cornell Medicine, New York, New York, USA
- Les Centres GHESKIO, Port-au-Prince, Haiti
| | | | - Carl F. Nathan
- Department of Microbiology & Immunology, Weill Cornell Medicine, New York, New York, USA
| | - Myung Hee Lee
- Center for Global Health, Weill Cornell Medicine, New York, New York, USA
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7
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Zainabadi K, Lee MH, Walsh KF, Vilbrun SC, Mathurin LD, Ocheretina O, Pape JW, Fitzgerald DW. An optimized method for purifying, detecting and quantifying Mycobacterium tuberculosis RNA from sputum for monitoring treatment response in TB patients. Sci Rep 2022; 12:17382. [PMID: 36253384 PMCID: PMC9574834 DOI: 10.1038/s41598-022-19985-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 09/07/2022] [Indexed: 02/05/2023] Open
Abstract
Diagnostics that more accurately detect and quantify viable Mycobacterium tuberculosis (Mtb) in the sputum of patients undergoing therapy are needed. Current culture- and molecular-based tests have shown limited efficacy for monitoring treatment response in TB patients, either due to the presence of viable sub-populations of Mtb which fail to grow under standard culture conditions (termed differentially detectable/culturable Mtb, DD Mtb) or the prolonged half-life of Mtb DNA in sputum. Here, we report an optimized RNA-based method for detecting and quantifying viable Mtb from patient sputum during the course of therapy. We first empirically derived a novel RNA extraction protocol from sputum that improves recovery of Mtb RNA while almost completely eliminating contamination from Mtb DNA and host nucleic acids. Next, we identified five Mtb 16S rRNA primer sets with varying limits of detection that were capable of distinguishing between live versus dead H37Rv Mtb. This combined protocol was then tested on sputa from a longitudinal cohort of patients receiving therapy for drug sensitive (DS) or drug resistant (DR) TB with first-line or second-line regimens, respectively. Results were compared with that of culture, including CFU, BACTEC MGIT, and a limiting dilution assay capable of detecting DD Mtb. The five 16S rRNA primer sets positively identified nearly all (range 94-100%) culture positive sputa, and a portion (19-37%) of culture negative sputa. In comparison, ten highly expressed Mtb mRNAs showed positivity in 72-86% of culture positive sputa, and in 0-13% of culture negative sputa. Two of the five 16S rRNA primer sets were able to positively identify 100% of culture positive sputa, and when tested on culture negative sputa from the DS cohort at 2 months post-initiation of therapy, identified 40% of samples as positive; a percentage that is in line with expected treatment failure rates when first-line therapy is discontinued early. These two primer sets also detected 16S rRNA in 13-20% of sputa at 6 months post-initiation of therapy in the DR cohort. Cycle threshold values for 16S rRNA showed a strong correlation with Mtb numbers as determined by culture (R > 0.87), including as Mtb numbers declined during the course of treatment with first-line and second-line regimens. The optimized molecular assay outlined here may have utility for monitoring treatment response in TB patients.
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Affiliation(s)
- Kayvan Zainabadi
- Center for Global Health, Weill Cornell Medicine, New York, NY, USA.
| | - Myung Hee Lee
- Center for Global Health, Weill Cornell Medicine, New York, NY, USA
| | - Kathleen Frances Walsh
- Center for Global Health, Weill Cornell Medicine, New York, NY, USA
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | | | | | | | - Jean William Pape
- Center for Global Health, Weill Cornell Medicine, New York, NY, USA
- Les Centres GHESKIO, Port-au-Prince, Haiti
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8
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Dade E, Metz M, Pierre JL, Rouzier V, Sufra R, Fox E, Preval F, St-Preux S, Zephir JR, Ariste W, Rasul R, Sabwa S, Roberts N, Deschamps MM, Severe P, Fitzgerald D, Pape JW, Yan LD, McNairy ML. High prevalence of obesity among women in urban Haiti: Findings from a population-based cohort. Front Public Health 2022; 10:976909. [PMID: 36276356 PMCID: PMC9581236 DOI: 10.3389/fpubh.2022.976909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/23/2022] [Indexed: 01/25/2023] Open
Abstract
Introduction Obesity is associated with increased risk of non-communicable diseases and death and is increasing rapidly in low- and middle-income countries, including Haiti. There is limited population-based data on body mass index (BMI) and waist circumference (WC) and associated risk factors in Haiti. This study describes BMI and WC, and factors associated with obesity using a population-based cohort from Port-au-Prince. Methods Baseline sociodemographic and clinical data were collected from participants in the Haiti CVD Cohort Study between March 2019 and August 2021. Weight was categorized by BMI (kg/m2) with obesity defined as ≥30 kg/m2. Abdominal obesity was defined using WC cutoffs of ≥80 cm for women and ≥94 cm for men based on WHO guidelines. Sociodemographic and behavioral risk factors, including age, sex, educational attainment, income, smoking status, physical activity, fat/oil use, daily fruit/vegetable consumption, and frequency of fried food intake were assessed for their association with obesity using a Poisson multivariable regression. Results Among 2,966 participants, median age was 41 years (IQR: 28-55) and 57.6% were women. Median BMI was 24.0 kg/m2 (IQR: 20.9-28.1) and 508 (17.1%) participants were obese. Women represented 89.2% of the population with BMI ≥30 kg/m2. A total of 1,167 (68.3%) women had WC ≥80 cm and 144 (11.4%) men had WC ≥94 cm. BMI ≥30 kg/m2 was significantly more prevalent among women than men [PR 5.7; 95% CI: (4.3-7.6)], those 40-49 years compared to 18-29 years [PR 3.3; 95% CI: (2.4-4.6)], and those with income >10 USD per day compared to ≤1 USD [PR 1.3; 95% CI: (1.0-1.6)]. There were no significant associations with other health and behavioral risk factors. Discussion In Haiti, women have an alarming 6-fold higher obesity prevalence compared to men (26.5 vs. 4.3%) and 89.2% of participants with obesity were women. Abdominal obesity was high, at 44.3%. Haiti faces a paradox of an ongoing national food insecurity crises and a burgeoning obesity epidemic. Individual, social, and environmental drivers of obesity, especially among women, need to be identified.
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Affiliation(s)
- Eliezer Dade
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Miranda Metz
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Jean Lookens Pierre
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Vanessa Rouzier
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Rodney Sufra
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Elizabeth Fox
- Department of Public and Ecosystem Health, Cornell University, Ithaca, NY, United States
| | - Fabyola Preval
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Stephano St-Preux
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Jean Ronald Zephir
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Wilson Ariste
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Rehana Rasul
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, United States
| | - Shalom Sabwa
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Nicholas Roberts
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Marie Marcelle Deschamps
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Patrice Severe
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Daniel Fitzgerald
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, NY, United States
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Jean William Pape
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Lily Du Yan
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, NY, United States
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Margaret L. McNairy
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, NY, United States
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, United States
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9
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Tagliamonte MS, Mavian C, Zainabadi K, Cash MN, Lednicky JA, Magalis BR, Riva A, Deschamps MM, Liautaud B, Rouzier V, Fitzgerald DW, Pape JW, Morris JG, Salemi M. Rapid Emergence and Spread of Severe Acute Respiratory Syndrome Coronavirus 2 Gamma (P.1) Variant in Haiti. Clin Infect Dis 2022; 74:2057-2060. [PMID: 34471930 PMCID: PMC8524302 DOI: 10.1093/cid/ciab736] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Indexed: 11/25/2022] Open
Abstract
After an initial wave of coronavirus disease 2019 (COVID-19) in Haiti in summer 2020 (primarily lineage B.1), seropositivity for anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunoglobulin G (IgG) was ~40%. Variant P.1 (gamma) was introduced in February 2021, with an initially limited introduction followed by exponential local dissemination within this unvaccinated population with prior exposure to earlier SARS-CoV-2 lineages.
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Affiliation(s)
- Massimiliano S Tagliamonte
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida, USA
- Department of Pathology, Immunology, and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Carla Mavian
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida, USA
- Department of Pathology, Immunology, and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Kayvan Zainabadi
- Center for Global Health, Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Melanie N Cash
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida, USA
- Department of Pathology, Immunology, and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - John A Lednicky
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida, USA
- Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
| | - Brittany Rife Magalis
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida, USA
- Department of Pathology, Immunology, and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Alberto Riva
- Bioinformatics Core, Interdisciplinary Center for Biotechnology Research, University of Florida, Gainesville, Florida, USA
| | | | | | - Vanessa Rouzier
- Center for Global Health, Department of Medicine, Weill Cornell Medical College, New York, New York, USA
- Les Centres GHESKIO, Port-au-Prince, Haiti
| | - Daniel W Fitzgerald
- Center for Global Health, Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Jean William Pape
- Center for Global Health, Department of Medicine, Weill Cornell Medical College, New York, New York, USA
- Les Centres GHESKIO, Port-au-Prince, Haiti
| | - J Glenn Morris
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida, USA
- Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Marco Salemi
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida, USA
- Department of Pathology, Immunology, and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA
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10
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Walsh KF, Lee MH, Brejt JA, Reust MJ, Juste MJ, Hilaire G, Pape JW, Koenig S, Dupnik K. Prevalence of HTLV-I Infection and Its Association with Tuberculosis among Patients at an Urban Clinic in Haiti. Am J Trop Med Hyg 2022; 106:tpmd210702. [PMID: 35292587 PMCID: PMC9128705 DOI: 10.4269/ajtmh.21-0702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 12/30/2021] [Indexed: 11/07/2022] Open
Abstract
This retrospective case-control study examined the prevalence of HTLV-I and its association with tuberculosis among urban clinic patients in Haiti. Prevalence of HTLV-I among tuberculosis cases was 2.1% and among controls was 2.4%. Prevalence of HLTV-I was higher in females than males (odds ratio [OR] 2.45, P = 0.020). HTLV-I prevalence in those ≥ 50 years was 8.4% compared with 1.3% in those < 50 (OR 6.74, P < 0.001). We found no association between HTLV-I and tuberculosis in this population.
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Affiliation(s)
- Kathleen F. Walsh
- Center for Global Health, Weill Cornell Medicine, New York, New York
- Division of General Internal Medicine, Weill Cornell Medicine, New York, New York
| | - Myung Hee Lee
- Center for Global Health, Weill Cornell Medicine, New York, New York
| | - Josef A. Brejt
- Division of General Internal Medicine, Weill Cornell Medicine, New York, New York
| | - Mary J. Reust
- Center for Global Health, Weill Cornell Medicine, New York, New York
| | | | | | - Jean William Pape
- Center for Global Health, Weill Cornell Medicine, New York, New York
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, New York
- GHESKIO Centers, Port-au-Prince, Haiti
| | | | - Kathryn Dupnik
- Center for Global Health, Weill Cornell Medicine, New York, New York
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, New York
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11
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Jesson J, Crichton S, Quartagno M, Yotebieng M, Abrams EJ, Chokephaibulkit K, Le Coeur S, Aké‐Assi M, Patel K, Pinto J, Paul M, Vreeman R, Davies M, Ben‐Farhat J, Van Dyke R, Judd A, Mofenson L, Vicari M, Seage G, Bekker L, Essajee S, Gibb D, Penazzato M, Collins IJ, Wools‐Kaloustian K, Slogrove A, Powis K, Williams P, Matshaba M, Thahane L, Nyasulu P, Lukhele B, Mwita L, Kekitiinwa‐Rukyalekere A, Wanless S, Goetghebuer T, Thorne C, Warszawski J, Galli L, van Rossum AM, Giaquinto C, Marczynska M, Marques L, Prata F, Ene L, Okhonskaya L, Navarro M, Frick A, Naver L, Kahlert C, Volokha A, Chappell E, Pape JW, Rouzier V, Marcelin A, Succi R, Sohn AH, Kariminia A, Edmonds A, Lelo P, Lyamuya R, Ogalo EA, Odhiambo FA, Haas AD, Bolton C, Muhairwe J, Tweya H, Sylla M, D'Almeida M, Renner L, Abzug MJ, Oleske J, Purswani M, Teasdale C, Nuwagaba‐Biribonwoha H, Goodall R, Leroy V. Growth and CD4 patterns of adolescents living with perinatally acquired HIV worldwide, a CIPHER cohort collaboration analysis. J Int AIDS Soc 2022; 25:e25871. [PMID: 35255197 PMCID: PMC8901148 DOI: 10.1002/jia2.25871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 12/20/2021] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Adolescents living with HIV are subject to multiple co-morbidities, including growth retardation and immunodeficiency. We describe growth and CD4 evolution during adolescence using data from the Collaborative Initiative for Paediatric HIV Education and Research (CIPHER) global project. METHODS Data were collected between 1994 and 2015 from 11 CIPHER networks worldwide. Adolescents with perinatally acquired HIV infection (APH) who initiated antiretroviral therapy (ART) before age 10 years, with at least one height or CD4 count measurement while aged 10-17 years, were included. Growth was measured using height-for-age Z-scores (HAZ, stunting if <-2 SD, WHO growth charts). Linear mixed-effects models were used to study the evolution of each outcome between ages 10 and 17. For growth, sex-specific models with fractional polynomials were used to model non-linear relationships for age at ART initiation, HAZ at age 10 and time, defined as current age from 10 to 17 years of age. RESULTS A total of 20,939 and 19,557 APH were included for the growth and CD4 analyses, respectively. Half were females, two-thirds lived in East and Southern Africa, and median age at ART initiation ranged from <3 years in North America and Europe to >7 years in sub-Saharan African regions. At age 10, stunting ranged from 6% in North America and Europe to 39% in the Asia-Pacific; 19% overall had CD4 counts <500 cells/mm3 . Across adolescence, higher HAZ was observed in females and among those in high-income countries. APH with stunting at age 10 and those with late ART initiation (after age 5) had the largest HAZ gains during adolescence, but these gains were insufficient to catch-up with non-stunted, early ART-treated adolescents. From age 10 to 16 years, mean CD4 counts declined from 768 to 607 cells/mm3 . This decline was observed across all regions, in males and females. CONCLUSIONS Growth patterns during adolescence differed substantially by sex and region, while CD4 patterns were similar, with an observed CD4 decline that needs further investigation. Early diagnosis and timely initiation of treatment in early childhood to prevent growth retardation and immunodeficiency are critical to improving APH growth and CD4 outcomes by the time they reach adulthood.
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12
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Yan LD, Rouzier V, Dade E, Guiteau C, Pierre JL, St-Preux S, Metz M, Oparil S, Pape JW, McNairy M. Treatment of early hypertension among persons living with HIV in Haiti: Protocol for a randomized controlled trial. PLoS One 2021; 16:e0254740. [PMID: 34351939 PMCID: PMC8341523 DOI: 10.1371/journal.pone.0254740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 06/02/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND People living with HIV (PLWH) are at increased risk of cardiovascular disease (CVD) and death, with greater burdens of both HIV and CVD in lower-middle income countries. Treating prehypertension in PLWH may reduce progression to hypertension, CVD risk and potentially mortality. However, no trial has evaluated earlier blood pressure treatment for PLWH. We propose a randomized controlled trial to assess the feasibility, benefits, and risks of initiating antihypertensive treatment among PLWH with prehypertension, comparing prehypertension treatment to standard of care following current WHO guidelines. METHODS A total of 250 adults 18-65 years and living with HIV (PLWH) with viral suppression in the past 12 months, who have prehypertension will be randomized to prehypertension treatment versus standard of care. Prehypertension is defined as having a systolic blood pressure (SBP) 120-139 mmHg or diastolic blood pressure (DBP) 80-89 mmHg. In the prehypertension treatment arm, participants will initiate amlodipine 5 mg daily immediately. In the standard of care arm, participants will initiate amlodipine only if they develop hypertension defined as SBP ≥ 140 mmHg or DBP ≥ 90 mmHg. The primary outcome is the difference in mean change of SBP from enrollment to 12 months. Secondary outcomes include feasibility, acceptability, adverse effects, HIV viral suppression, and medication adherence. Qualitative in-depth interviews with providers and participants will explore attitudes about initiating amlodipine, satisfaction, perceived CVD risk, and implementation challenges. DISCUSSION PLWH have a higher CVD risk and may benefit from a lower BP threshold for initiation of antihypertensive treatment. TRIAL REGISTRATION Clinicaltrials.gov registration number NCT04692467, registration date December 15, 2020, protocol ID 20-03021735.
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Affiliation(s)
- Lily D. Yan
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York, United States of America
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, New York, United States of America
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Vanessa Rouzier
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, New York, United States of America
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Eliezer Dade
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Collette Guiteau
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Jean Lookens Pierre
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Stephano St-Preux
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Miranda Metz
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, New York, United States of America
| | - Suzanne Oparil
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Jean William Pape
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, New York, United States of America
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Margaret McNairy
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York, United States of America
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, New York, United States of America
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
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13
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Riviere C, Bell T, Cadot Y, Perodin C, Charles B, Bertil C, Cheung J, Bane S, Cheung HC, Pape JW, Deschamps MM. Success of community approach to HPV vaccination in school-based and non-school-based settings in Haiti. PLoS One 2021; 16:e0252310. [PMID: 34166437 PMCID: PMC8224934 DOI: 10.1371/journal.pone.0252310] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 05/13/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES To assess the success of a human papillomavirus (HPV) vaccination program among adolescent girls aged 9-14 years in Haiti and to understand predictors of completion of a two-dose HPV vaccination series. METHODS Data collection was conducted during HPV vaccination campaigns in Port-au-Prince between August 2016 and April 2017. Descriptive statistics and logistic regression models were used to examine characteristics associated with vaccination series completion of school based and non-school based vaccination delivery modalities. RESULTS Of the 2,445 adolescent girls who participated in the awareness program, 1,994 participants (1,307 in non-school program, 687 in school program) received the first dose of the vaccine; 1,199 (92%) in the non-school program and 673 (98%) in the school program also received the second dose. Menarche (OR: 1.87; 95% CI, 1.11-3.14), if the participant was a prior patient at the GHESKIO clinics (OR: 2.17; 95% CI, 1.32-3.58), and participating in the school-based program (OR: 4.17; 95% CI, 2.14-8.12) were significantly associated with vaccination completion. CONCLUSIONS Vaccination in school- and non-school-based settings was successful, suggesting that a nationwide HPV vaccination campaign using either approach would be successful using either approach.
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Affiliation(s)
| | | | | | | | | | | | - Jazreel Cheung
- Analysis Group, Inc., Boston, Massachusetts, United States of America
| | - Shalmali Bane
- Analysis Group, Inc., Boston, Massachusetts, United States of America
| | - Hoi Ching Cheung
- Analysis Group, Inc., Boston, Massachusetts, United States of America
| | - Jean William Pape
- GHESKIO Center, Port-au-Prince, Haiti
- Center for Global Health, Division of Infectious Diseases, Department of Medicine, Weill Cornell Medical College, New York, New York, United States of America
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Koenig SP, Pape JW. Necessary but Not Sufficient: The Need for Innovative Strategies to Enhance Retention and Viral Suppression After Rapid Initiation of Antiretroviral Therapy. Clin Infect Dis 2021; 71:2615-2617. [PMID: 31811286 DOI: 10.1093/cid/ciz1176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 12/06/2019] [Indexed: 12/30/2022] Open
Affiliation(s)
| | - Jean William Pape
- Division of Infectious Diseases, Department of Medicine, Center for Global Health, Weill Cornell Medical College, New York, New York, USA
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Dunbar W, Labat A, Raccurt C, Sohler N, Pape JW, Maulet N, Coppieters Y. A realist systematic review of stigma reduction interventions for HIV prevention and care continuum outcomes among men who have sex with men. Int J STD AIDS 2021; 31:712-723. [PMID: 32631213 DOI: 10.1177/0956462420924984] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
While stigma associated with human immunodeficiency virus (HIV) infection among men who have sex with men (MSM) is well recognized, there remains relatively limited intervention data on effective stigma reduction strategies. This systematic review was conducted to highlight the mechanisms through which sexual and HIV stigma is reduced in relation to HIV prevention and care engagement. Search of PubMed and Scopus resulted in 11 tested interventions to include in our preliminary model constructed from programme frameworks and recommendations. We refined the preliminary programme theory to identify whether, why, or how mitigation strategies produce observed outcomes. Our review showed that the interventions produced stigma reduction through three groups of mechanisms: (1) Self-acceptance, leadership, and motivational activation for behaviour change from intrapersonal strategies, such as education and mobile health strategies, which intervene on internalized and anticipated stigma; (2) socialization, knowledge sharing, and social empowerment from interpersonal strategies, such as peer support and training for care providers; and (3) community introspection, self-reflection, and humanistic activation from structural strategies such as community leaders' sensitization, which intervene on both anticipated and enacted stigma. Interventions mechanisms act complementarily and can be activated in different contexts in which MSM exposed to and infected with HIV are living.
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Affiliation(s)
- Willy Dunbar
- Health Systems and Policies - International Health, School of Public Health, Université Libre de Bruxelles (ULB), Brussels, Belgium.,Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Aline Labat
- Health Systems and Policies - International Health, School of Public Health, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Christian Raccurt
- Faculty of Health Sciences, Quisqueya University, Port-au-Prince, Haiti
| | - Nancy Sohler
- Community Health and Social Medicine, City University of New York, School of Medicine, New York, NY, USA
| | - Jean William Pape
- Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti.,Center for Global Health, Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Nathalie Maulet
- Ecole de Santé Publique, Université Catholique de Louvain, Brussels, Belgium
| | - Yves Coppieters
- Health Systems and Policies - International Health, School of Public Health, Université Libre de Bruxelles (ULB), Brussels, Belgium
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Hoffmann J, Chedid C, Ocheretina O, Masetti C, Joseph P, Mabou MM, Mathon JE, Francois EM, Gebelin J, Babin FX, Raskine L, Pape JW. Drug-resistant TB prevalence study in 5 health institutions in Haiti. PLoS One 2021; 16:e0248707. [PMID: 33735224 PMCID: PMC7971505 DOI: 10.1371/journal.pone.0248707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 03/04/2021] [Indexed: 11/19/2022] Open
Abstract
Objectives Tuberculosis (TB) is the leading infectious cause of death in the world. Multi-drug resistant TB (MDR-TB) is a major public health problem as treatment is long, costly, and associated to poor outcomes. Here, we report epidemiological data on the prevalence of drug-resistant TB in Haiti. Methods This cross-sectional prevalence study was conducted in five health centers across Haiti. Adult, microbiologically confirmed pulmonary TB patients were included. Molecular genotyping (rpoB gene sequencing and spoligotyping) and phenotypic drug susceptibility testing were used to characterize rifampin-resistant MTB isolates detected by Xpert MTB/RIF. Results Between April 2016 and February 2018, 2,777 patients were diagnosed with pulmonary TB by Xpert MTB/RIF screening and positive MTB cultures. A total of 74 (2.7%) patients were infected by a drug-resistant (DR-TB) M. tuberculosis strain. Overall HIV prevalence was 14.1%. Patients with HIV infection were at a significantly higher risk for infection with DR-TB strains compared to pan-susceptible strains (28.4% vs. 13.7%, adjusted odds ratio 2.6, 95% confidence interval 1.5–4.4, P = 0.001). Among the detected DR-TB strains, T1 (29.3%), LAM9 (13.3%), and H3 (10.7%) were the most frequent clades. In comparison with previous spoligotypes studies with data collected in 2000–2002 and in 2008–2009 on both sensitive and resistant strains of TB in Haiti, we observed a significant increase in the prevalence of the drug-resistant MTB Spoligo-International-Types (SIT) 137 (X2 clade: 8.1% vs. 0.3% in 2000–02 and 0.9% in 2008–09, p<0.001), 5 (T1 clade: 6.8% vs 1.9 in 2000–02 and 1.7% in 2008–09, P = 0.034) and 455 (T1 clade: 5.4% vs 1.6% and 1.1%, P = 0.029). Newly detected spoligotypes (SIT 6, 7, 373, 909 and 1624) were also recorded. Conclusion This study describes the genotypic and phenotypic characteristics of DR-TB strains circulating in Haiti from April 2016 to February 2018. Newly detected MTB clades harboring multi-drug resistance patterns among the Haitian population as well as the higher risk of MDR-TB infection in HIV-positive people highlights the epidemiological relevance of these surveillance data. The importance of detecting RIF-resistant patients, as proxy for MDR-TB in peripheral sites via molecular techniques, is particularly important to provide adequate patient case management, prevent the transmission of resistant strains in the community and to contribute to the surveillance of resistant strains.
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Affiliation(s)
- Jonathan Hoffmann
- Fondation Mérieux, Direction Médicale et Scientifique, Lyon, France
- * E-mail:
| | - Carole Chedid
- Fondation Mérieux, Direction Médicale et Scientifique, Lyon, France
- Département de Biologie, Ecole Normale Supérieure de Lyon, Lyon, France
| | - Oksana Ocheretina
- Division of Infectious Diseases, Department of Medicine, Center for Global Health, Weill Cornell Medical College, New York, New York, United States of America
- Les Centres GHESKIO, Port-au-Prince, Haiti
| | - Chloé Masetti
- Fondation Mérieux, Direction des Opérations Internationales, Lyon, France
| | | | | | | | | | - Juliane Gebelin
- Fondation Mérieux, Direction des Opérations Internationales, Lyon, France
| | | | - Laurent Raskine
- Fondation Mérieux, Direction des Opérations Internationales, Lyon, France
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17
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Dunbar W, Pape JW, Coppieters Y. HIV among men who have sex with men in the Caribbean: reaching the left behind. Rev Panam Salud Publica 2021; 45:e12. [PMID: 33708247 PMCID: PMC7939031 DOI: 10.26633/rpsp.2021.12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 11/06/2020] [Indexed: 02/03/2023] Open
Abstract
Objectives. To present the epidemiology, social and cultural factors driving the HIV epidemic among men who have sex with men (MSM) in the Caribbean region and to highlight the regional and national responses, and what remains to be addressed to close the gaps in order to ending AIDS by 2030. Methods. A literature review was performed in the following databases: PubMed and Scopus. Articles published in the past 10 years were selected. The outcomes of interest were sociocultural risk factors, description of regional and national efforts and potential challenges and barriers to effective control of the epidemic among MSM. This report concentrates exclusively on publications related to MSM living in the Caribbean countries. Results. 11 peer-reviewed studies, 9 grey literature reports and programme frameworks were thematically analysed. The prevalence of HIV among MSM is high and the rates also do vary among Caribbean countries. Several factors influence the epidemic among MSM in the Caribbean but stigma and discrimination underlie the social vulnerability and play a central role in driving the HIV epidemic. Conclusions. To end the AIDS epidemic by 2030, MSM can no longer be kept unchecked in the era of the Sustainable Development Goals with the motto ‘Leave no one behind’.
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Affiliation(s)
- Willy Dunbar
- Université libre de Bruxelles Brussels Belgium Université libre de Bruxelles, Brussels, Belgium
| | - Jean William Pape
- Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO) Port-au-Prince Haiti Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO), Port-au-Prince, Haiti
| | - Yves Coppieters
- Université libre de Bruxelles Brussels Belgium Université libre de Bruxelles, Brussels, Belgium
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18
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Ajayakumar J, Curtis AJ, Rouzier V, Pape JW, Bempah S, Alam MT, Alam MM, Rashid MH, Ali A, Morris JG. Exploring convolutional neural networks and spatial video for on-the-ground mapping in informal settlements. Int J Health Geogr 2021; 20:5. [PMID: 33494756 PMCID: PMC7831241 DOI: 10.1186/s12942-021-00259-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 01/10/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The health burden in developing world informal settlements often coincides with a lack of spatial data that could be used to guide intervention strategies. Spatial video (SV) has proven to be a useful tool to collect environmental and social data at a granular scale, though the effort required to turn these spatially encoded video frames into maps limits sustainability and scalability. In this paper we explore the use of convolution neural networks (CNN) to solve this problem by automatically identifying disease related environmental risks in a series of SV collected from Haiti. Our objective is to determine the potential of machine learning in health risk mapping for these environments by assessing the challenges faced in adequately training the required classification models. RESULTS We show that SV can be a suitable source for automatically identifying and extracting health risk features using machine learning. While well-defined objects such as drains, buckets, tires and animals can be efficiently classified, more amorphous masses such as trash or standing water are difficult to classify. Our results further show that variations in the number of image frames selected, the image resolution, and combinations of these can be used to improve the overall model performance. CONCLUSION Machine learning in combination with spatial video can be used to automatically identify environmental risks associated with common health problems in informal settlements, though there are likely to be variations in the type of data needed for training based on location. Success based on the risk type being identified are also likely to vary geographically. However, we are confident in identifying a series of best practices for data collection, model training and performance in these settings. We also discuss the next step of testing these findings in other environments, and how adding in the simultaneously collected geographic data could be used to create an automatic health risk mapping tool.
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Affiliation(s)
- Jayakrishnan Ajayakumar
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH USA
| | - Andrew J. Curtis
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH USA
| | - Vanessa Rouzier
- Les Centres Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Jean William Pape
- Les Centres Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Sandra Bempah
- Department of Geography, Kent State University, Kent, OH USA
| | - Meer Taifur Alam
- Emerging Pathogens Institute and Department of Medicine, College of Medicine, University of Florida, Gainesville, FL 32601 USA
- Emerging Pathogens Institute and Department of Environmental & Global Health, College of Public Health and Health Professions, University of Florida, Gainesville, FL 32601 USA
| | - Md. Mahbubul Alam
- Emerging Pathogens Institute and Department of Medicine, College of Medicine, University of Florida, Gainesville, FL 32601 USA
- Emerging Pathogens Institute and Department of Environmental & Global Health, College of Public Health and Health Professions, University of Florida, Gainesville, FL 32601 USA
| | - Mohammed H. Rashid
- Emerging Pathogens Institute and Department of Medicine, College of Medicine, University of Florida, Gainesville, FL 32601 USA
| | - Afsar Ali
- Emerging Pathogens Institute and Department of Medicine, College of Medicine, University of Florida, Gainesville, FL 32601 USA
- Emerging Pathogens Institute and Department of Environmental & Global Health, College of Public Health and Health Professions, University of Florida, Gainesville, FL 32601 USA
| | - John Glenn Morris
- Emerging Pathogens Institute and Department of Medicine, College of Medicine, University of Florida, Gainesville, FL 32601 USA
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Walsh KF, Vilbrun SC, Souroutzidis A, Delva S, Joissaint G, Mathurin L, Ocheretina O, Cremieux P, Pape JW, Koenig SP. Improved Outcomes With High-dose Isoniazid in Multidrug-resistant Tuberculosis Treatment in Haiti. Clin Infect Dis 2020; 69:717-719. [PMID: 30698688 DOI: 10.1093/cid/ciz039] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 01/14/2019] [Indexed: 11/13/2022] Open
Abstract
We report outcomes for a cohort of patients with multidrug-resistant tuberculosis who received high-dose isoniazid in Haiti. Patients who received high-dose isoniazid had a faster time to culture conversion and higher odds of successful outcome, despite high-level isoniazid resistance. This suggests high-dose isoniazid may have effectiveness even with phenotypic resistance.
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Affiliation(s)
- Kathleen F Walsh
- Center for Global Health, Weill Cornell Medicine, New York City, New York
| | - Stalz Charles Vilbrun
- The Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections, Port-au-Prince, Haiti
| | - Ariadne Souroutzidis
- Analysis Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sobieskye Delva
- The Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections, Port-au-Prince, Haiti
| | - Guy Joissaint
- The Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections, Port-au-Prince, Haiti
| | - Laurent Mathurin
- The Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections, Port-au-Prince, Haiti
| | - Oksana Ocheretina
- Center for Global Health, Weill Cornell Medicine, New York City, New York
| | - Pierre Cremieux
- Analysis Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jean William Pape
- The Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections, Port-au-Prince, Haiti
| | - Serena P Koenig
- Division of Global Health Equity, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Chen GL, Coates EE, Plummer SH, Carter CA, Berkowitz N, Conan-Cibotti M, Cox JH, Beck A, O’Callahan M, Andrews C, Gordon IJ, Larkin B, Lampley R, Kaltovich F, Gall J, Carlton K, Mendy J, Haney D, May J, Bray A, Bailer RT, Dowd KA, Brockett B, Gordon D, Koup RA, Schwartz R, Mascola JR, Graham BS, Pierson TC, Donastorg Y, Rosario N, Pape JW, Hoen B, Cabié A, Diaz C, Ledgerwood JE. Effect of a Chikungunya Virus-Like Particle Vaccine on Safety and Tolerability Outcomes: A Randomized Clinical Trial. JAMA 2020; 323:1369-1377. [PMID: 32286643 PMCID: PMC7156994 DOI: 10.1001/jama.2020.2477] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
IMPORTANCE Chikungunya virus (CHIKV) is a mosquito-borne Alphavirus prevalent worldwide. There are currently no licensed vaccines or therapies. OBJECTIVE To evaluate the safety and tolerability of an investigational CHIKV virus-like particle (VLP) vaccine in endemic regions. DESIGN, SETTING, AND PARTICIPANTS This was a randomized, placebo-controlled, double-blind, phase 2 clinical trial to assess the vaccine VRC-CHKVLP059-00-VP (CHIKV VLP). The trial was conducted at 6 outpatient clinical research sites located in Haiti, Dominican Republic, Martinique, Guadeloupe, and Puerto Rico. A total of 400 healthy adults aged 18 through 60 years were enrolled after meeting eligibility criteria. The first study enrollment occurred on November 18, 2015; the final study visit, March 6, 2018. INTERVENTIONS Participants were randomized 1:1 to receive 2 intramuscular injections 28 days apart (20 µg, n = 201) or placebo (n = 199) and were followed up for 72 weeks. MAIN OUTCOMES AND MEASURES The primary outcome was the safety (laboratory parameters, adverse events, and CHIKV infection) and tolerability (local and systemic reactogenicity) of the vaccine, and the secondary outcome was immune response by neutralization assay 4 weeks after second vaccination. RESULTS Of the 400 randomized participants (mean age, 35 years; 199 [50%] women), 393 (98%) completed the primary safety analysis. All injections were well tolerated. Of the 16 serious adverse events unrelated to the study drugs, 4 (25%) occurred among 4 patients in the vaccine group and 12 (75%) occurred among 11 patients in the placebo group. Of the 16 mild to moderate unsolicited adverse events that were potentially related to the drug, 12 (75%) occurred among 8 patients in the vaccine group and 4 (25%) occurred among 3 patients in the placebo group. All potentially related adverse events resolved without clinical sequelae. At baseline, there was no significant difference between the effective concentration (EC50)-which is the dilution of sera that inhibits 50% infection in viral neutralization assay-geometric mean titers (GMTs) of neutralizing antibodies of the vaccine group (46; 95% CI, 34-63) and the placebo group (43; 95% CI, 32-57). Eight weeks following the first administration, the EC50 GMT in the vaccine group was 2005 (95% CI, 1680-2392) vs 43 (95% CI, 32-58; P < .001) in the placebo group. Durability of the immune response was demonstrated through 72 weeks after vaccination. CONCLUSIONS AND RELEVANCE Among healthy adults in a chikungunya endemic population, a virus-like particle vaccine compared with placebo demonstrated safety and tolerability. Phase 3 trials are needed to assess clinical efficacy. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02562482.
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Affiliation(s)
- Grace L. Chen
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Emily E. Coates
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Sarah H. Plummer
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Cristina A. Carter
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Nina Berkowitz
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Michelle Conan-Cibotti
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Josephine H. Cox
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Allison Beck
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Mark O’Callahan
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Charla Andrews
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Ingelise J. Gordon
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Brenda Larkin
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Rebecca Lampley
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Florence Kaltovich
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Jason Gall
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Kevin Carlton
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Jason Mendy
- Emergent BioSolutions, San Diego, California
| | - Doug Haney
- Emergent BioSolutions, San Diego, California
| | | | - Amy Bray
- The Emmes Company, Rockville, Maryland
| | - Robert T. Bailer
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Kimberly A. Dowd
- Laboratory of Viral Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Brittanie Brockett
- Laboratory of Viral Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - David Gordon
- Laboratory of Viral Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Richard A. Koup
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Richard Schwartz
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - John R. Mascola
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Barney S. Graham
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Theodore C. Pierson
- Laboratory of Viral Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Yeycy Donastorg
- Instituto Dermatologico y Cirugia de Piel (IDCP), Dominican Republic
| | | | - Jean William Pape
- The Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (Centres GHESKIO), Haiti
| | - Bruno Hoen
- INSERM Centre d’Investigation Clinique (CIC) 1424, Centre Hospitalier Universitaire (CHU) de la Guadeloupe, France
| | - André Cabié
- INSERM Centre d’Investigation Clinique (CIC) 1424, Centre Hospitalier Universitaire (CHU) de Martinique, France
| | - Clemente Diaz
- PR Clinical and Translational Research Consortium (PRCTRC), Puerto Rico
- University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Julie E. Ledgerwood
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
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Rivera VR, Lu L, Ocheretina O, Jean Juste MA, Julma P, Archange D, Moise CG, Homeus F, Phanor PD, Petión S, Cremieux PY, Fitzgerald DW, Pape JW, Koenig SP. Diagnostic yield of active case finding for tuberculosis at human immunodeficiency virus testing in Haiti. Int J Tuberc Lung Dis 2019; 23:1217-1222. [PMID: 31718759 PMCID: PMC7647668 DOI: 10.5588/ijtld.18.0835] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING: The Groupe Haïtien d'étude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO) Centres, Port-au-Prince, Haiti, facilitate "test and treat" strategies by screening all patients for tuberculosis (TB) at human immunodeficiency virus (HIV) testing.OBJECTIVE: 1) To determine the proportion of patients with chronic cough at HIV testing diagnosed with TB, stratified by HIV test results; and 2) to evaluate the additional diagnostic yield of Xpert® MTB/RIF vs. sputum microscopy.DESIGN: We conducted a retrospective cohort analysis including all adults tested for HIV at GHESKIO from August 2014 to July 2015.RESULTS: Of 29 233 adult patients tested for HIV, 2953 (10%) were diagnosed as HIV-positive. Chronic cough lasting ≥2 weeks was reported by 1116 (38%) HIV-positive patients; 984 (88%) were tested and 265 (27%) were diagnosed with TB. Chronic cough was reported by 5985 (23%) HIV-negative patients; 5654 (94%) were tested and 1179 (21%) were diagnosed with TB. Of all bacteriologically confirmed cases, 27% were smear-negative and Xpert-positive. Among all TB patients, 81% were HIV-negative.CONCLUSIONS: Screening for TB at HIV testing was high-yield, among both HIV-infected and HIV-negative individuals. Testing for both diseases should be conducted among patients who present with chronic cough at HIV testing.
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Affiliation(s)
- V R Rivera
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti, Division of Global Health, Weill Cornell Medical College, New York, NY, USA
| | - L Lu
- Analysis Group, Boston, MA, USA
| | - O Ocheretina
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti, Division of Global Health, Weill Cornell Medical College, New York, NY, USA
| | - M A Jean Juste
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - P Julma
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - D Archange
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - C G Moise
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - F Homeus
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - P D Phanor
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - S Petión
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | | | - D W Fitzgerald
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti, Division of Global Health, Weill Cornell Medical College, New York, NY, USA
| | - J W Pape
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti, Division of Global Health, Weill Cornell Medical College, New York, NY, USA
| | - S P Koenig
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti, Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
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22
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Walsh KF, Lee MH, Martelly S, Pierre MM, Joseph J, Gustin M, Peck RN, Fitzgerald DW, Pape JW, McNairy M. Integrating hypertension services at an HIV clinic in Port-au-Prince, Haiti: A report from the field. J Clin Hypertens (Greenwich) 2018; 20:1485-1492. [PMID: 30259642 DOI: 10.1111/jch.13392] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 07/05/2018] [Accepted: 07/15/2018] [Indexed: 01/01/2023]
Abstract
HIV-positive adults with hypertension have increased risk of mortality but HIV clinics often do not provide hypertension care. The authors integrated hypertension management into existing HIV services at a large clinic in Haiti. Of 1729 documented HIV-positive adults presenting for care at the GHESKIO HIV clinic between March and July 2016, 551 screened positive for hypertension, with systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg. A convenience sample of 100 patients from this group received integrated hypertension and HIV care for 6 months. At time of identification, patients were screened for proteinuria and initiated on antihypertensive medication. Hypertension and HIV visits coincided; medications were free. Outcomes were retention in care and change in blood pressure over 6 months. Average blood pressure over 6 months was described using linear mixed-effects model. Of 100 HIV-positive adults with hypertension referred for integrated care, three were ineligible due to comorbidities. Among 97 participants, 82% (N = 80) remained in care at 6 months from time of positive hypertension identification. 96% (N = 93) were on antiretroviral therapy with median CD4+ count of 442 cells/µL (IQR 257-640). Estimated average blood pressure over 6 months decreased from systolic 160 mmHg (CI 156, 165) to 146 mmHg (CI 141, 150), P-value <0.0001, and diastolic 105 mmHg (CI 102, 108) to 93 mmHg (CI 89, 96), P-value <0.0001. HIV and hypertension management were successfully integrated at a HIV clinic in Haiti. Integrated management is essential to combat the growing burden of cardiovascular disease among HIV-positive adults.
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Affiliation(s)
- Kathleen F Walsh
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York City, New York
| | - Myung Hee Lee
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York City, New York
| | - Shoria Martelly
- The Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Marie Melissa Pierre
- The Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Junon Joseph
- The Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Myrlene Gustin
- The Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Robert N Peck
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York City, New York
| | - Daniel W Fitzgerald
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York City, New York
| | - Jean William Pape
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York City, New York.,The Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Margaret McNairy
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York City, New York
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23
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Reif LK, Rivera V, Bertrand R, Rouzier V, Kutscher E, Walsh K, Charles B, Pape JW, Fitzgerald DW, Koenig SP, McNairy ML. Outcomes across the tuberculosis care continuum among adolescents in Haiti. Public Health Action 2018; 8:103-109. [PMID: 30271725 PMCID: PMC6147066 DOI: 10.5588/pha.18.0021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 06/04/2018] [Indexed: 11/10/2022] Open
Abstract
Setting: GHESKIO (Groupe Haitien d'Etude du Sarcome de Kaposi et des Infections Opportunistes) clinic, Port-au-Prince, Haiti. Objective: To evaluate tuberculosis (TB) care continuum outcomes among adolescents. Design: Among a retrospective cohort of 10-24 year olds diagnosed with active TB, we report completion of the following steps of the TB care continuum stratified by human immunodeficiency virus (HIV) status: diagnosis of microbiologically confirmed TB, initiation of anti-tuberculosis treatment, retention in care at 2 months on anti-tuberculosis treatment, and TB treatment success. Factors associated with attrition at each step were identified using multivariable regression. Results: A total of 1005 adolescents were diagnosed with active TB; 74 (7%) were HIV-positive at the time of TB diagnosis. HIV-positive patients had poorer outcomes than non-HIV-infected patients: 73% vs. 85% initiated anti-tuberculosis treatment (P < 0.01), 46% vs. 74% were retained in care at 2 months (P < 0.01), and 41% vs. 68% achieved TB treatment success (P < 0.01). Among those who initiated treatment, same-day initiation resulted in less treatment failure. Attrition before treatment initiation was associated with female sex and HIV coinfection. Attrition after treatment initiation was associated with age ⩾16 years and HIV coinfection. Conclusion: Outcomes across the TB care continuum are suboptimal among adolescents, with only two thirds of patients achieving treatment success. Interventions tailored to adolescents are needed to improve retention in care, particularly for those who are co-infected with HIV.
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Affiliation(s)
- L K Reif
- Center for Global Health, Weill Cornell Medical College, New York, New York, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - V Rivera
- Center for Global Health, Weill Cornell Medical College, New York, New York, USA
- Groupe Haitien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO), Port-au-Prince, Haiti
| | - R Bertrand
- Groupe Haitien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO), Port-au-Prince, Haiti
| | - V Rouzier
- Groupe Haitien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO), Port-au-Prince, Haiti
| | - E Kutscher
- Center for Global Health, Weill Cornell Medical College, New York, New York, USA
| | - K Walsh
- Center for Global Health, Weill Cornell Medical College, New York, New York, USA
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - B Charles
- Groupe Haitien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO), Port-au-Prince, Haiti
| | - J W Pape
- Center for Global Health, Weill Cornell Medical College, New York, New York, USA
- Groupe Haitien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO), Port-au-Prince, Haiti
| | - D W Fitzgerald
- Center for Global Health, Weill Cornell Medical College, New York, New York, USA
| | - S P Koenig
- Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - M L McNairy
- Center for Global Health, Weill Cornell Medical College, New York, New York, USA
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York, USA
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24
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Ahmad N, Ahuja SD, Akkerman OW, Alffenaar JWC, Anderson LF, Baghaei P, Bang D, Barry PM, Bastos ML, Behera D, Benedetti A, Bisson GP, Boeree MJ, Bonnet M, Brode SK, Brust JCM, Cai Y, Caumes E, Cegielski JP, Centis R, Chan PC, Chan ED, Chang KC, Charles M, Cirule A, Dalcolmo MP, D'Ambrosio L, de Vries G, Dheda K, Esmail A, Flood J, Fox GJ, Fréchet-Jachym M, Fregona G, Gayoso R, Gegia M, Gler MT, Gu S, Guglielmetti L, Holtz TH, Hughes J, Isaakidis P, Jarlsberg L, Kempker RR, Keshavjee S, Khan FA, Kipiani M, Koenig SP, Koh WJ, Kritski A, Kuksa L, Kvasnovsky CL, Kwak N, Lan Z, Lange C, Laniado-Laborín R, Lee M, Leimane V, Leung CC, Leung ECC, Li PZ, Lowenthal P, Maciel EL, Marks SM, Mase S, Mbuagbaw L, Migliori GB, Milanov V, Miller AC, Mitnick CD, Modongo C, Mohr E, Monedero I, Nahid P, Ndjeka N, O'Donnell MR, Padayatchi N, Palmero D, Pape JW, Podewils LJ, Reynolds I, Riekstina V, Robert J, Rodriguez M, Seaworth B, Seung KJ, Schnippel K, Shim TS, Singla R, Smith SE, Sotgiu G, Sukhbaatar G, Tabarsi P, Tiberi S, Trajman A, Trieu L, Udwadia ZF, van der Werf TS, Veziris N, Viiklepp P, Vilbrun SC, Walsh K, Westenhouse J, Yew WW, Yim JJ, Zetola NM, Zignol M, Menzies D. Treatment correlates of successful outcomes in pulmonary multidrug-resistant tuberculosis: an individual patient data meta-analysis. Lancet 2018; 392:821-834. [PMID: 30215381 PMCID: PMC6463280 DOI: 10.1016/s0140-6736(18)31644-1] [Citation(s) in RCA: 379] [Impact Index Per Article: 63.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 07/12/2018] [Accepted: 07/13/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Treatment outcomes for multidrug-resistant tuberculosis remain poor. We aimed to estimate the association of treatment success and death with the use of individual drugs, and the optimal number and duration of treatment with those drugs in patients with multidrug-resistant tuberculosis. METHODS In this individual patient data meta-analysis, we searched MEDLINE, Embase, and the Cochrane Library to identify potentially eligible observational and experimental studies published between Jan 1, 2009, and April 30, 2016. We also searched reference lists from all systematic reviews of treatment of multidrug-resistant tuberculosis published since 2009. To be eligible, studies had to report original results, with end of treatment outcomes (treatment completion [success], failure, or relapse) in cohorts of at least 25 adults (aged >18 years). We used anonymised individual patient data from eligible studies, provided by study investigators, regarding clinical characteristics, treatment, and outcomes. Using propensity score-matched generalised mixed effects logistic, or linear regression, we calculated adjusted odds ratios and adjusted risk differences for success or death during treatment, for specific drugs currently used to treat multidrug-resistant tuberculosis, as well as the number of drugs used and treatment duration. FINDINGS Of 12 030 patients from 25 countries in 50 studies, 7346 (61%) had treatment success, 1017 (8%) had failure or relapse, and 1729 (14%) died. Compared with failure or relapse, treatment success was positively associated with the use of linezolid (adjusted risk difference 0·15, 95% CI 0·11 to 0·18), levofloxacin (0·15, 0·13 to 0·18), carbapenems (0·14, 0·06 to 0·21), moxifloxacin (0·11, 0·08 to 0·14), bedaquiline (0·10, 0·05 to 0·14), and clofazimine (0·06, 0·01 to 0·10). There was a significant association between reduced mortality and use of linezolid (-0·20, -0·23 to -0·16), levofloxacin (-0·06, -0·09 to -0·04), moxifloxacin (-0·07, -0·10 to -0·04), or bedaquiline (-0·14, -0·19 to -0·10). Compared with regimens without any injectable drug, amikacin provided modest benefits, but kanamycin and capreomycin were associated with worse outcomes. The remaining drugs were associated with slight or no improvements in outcomes. Treatment outcomes were significantly worse for most drugs if they were used despite in-vitro resistance. The optimal number of effective drugs seemed to be five in the initial phase, and four in the continuation phase. In these adjusted analyses, heterogeneity, based on a simulated I2 method, was high for approximately half the estimates for specific drugs, although relatively low for number of drugs and durations analyses. INTERPRETATION Although inferences are limited by the observational nature of these data, treatment outcomes were significantly better with use of linezolid, later generation fluoroquinolones, bedaquiline, clofazimine, and carbapenems for treatment of multidrug-resistant tuberculosis. These findings emphasise the need for trials to ascertain the optimal combination and duration of these drugs for treatment of this condition. FUNDING American Thoracic Society, Canadian Institutes of Health Research, US Centers for Disease Control and Prevention, European Respiratory Society, Infectious Diseases Society of America.
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Affiliation(s)
- Nafees Ahmad
- Faculty of Pharmacy and Health Sciences, University of Baluchistan, Quetta, Pakistan
| | - Shama D Ahuja
- Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, NY, USA
| | - Onno W Akkerman
- Department of Pulmonary Diseases and Tuberculosis, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands; Tuberculosis Centre Beatrixoord, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands
| | - Jan-Willem C Alffenaar
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands
| | - Laura F Anderson
- Global Tuberculosis Program, World Health Organization, Geneva, Switzerland
| | - Parvaneh Baghaei
- Clinical Tuberculosis and Epidemiology Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Didi Bang
- Statens Serum Institut, Copenhagen, Denmark
| | - Pennan M Barry
- Tuberculosis Control Branch, Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, CA, USA
| | - Mayara L Bastos
- Social Medicine Institute, Epidemiology Department, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Digamber Behera
- Department of Pulmonary Medicine, World Health Organization Collaborating Centre for Research & Capacity Building in Chronic Respiratory Diseases, Chandigarh, India; Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Andrea Benedetti
- Montreal Chest Institute, McGill University Health Center Research Institute, McGill University, Montreal, QC, Canada
| | - Gregory P Bisson
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Martin J Boeree
- Department of Pulmonary Diseases, Radboud University Medicale Centre Nijmegen and Dekkerswald Radboudumc Groesbeek, Netherlands
| | - Maryline Bonnet
- Epicentre MSF, Paris, France; Institut de Recherche pour le Développement UM233, INSERM U1175, Université de Montpellier, Montpellier, France
| | - Sarah K Brode
- Department of Medicine, Division of Respirology, University of Toronto, West Park Healthcare Centre, University Health Network, and Sinai Health System, Toronto, ON, Canada
| | - James C M Brust
- Division of General Internal Medicine and Division of Infectious Diseases, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA
| | - Ying Cai
- Tuberculosis Research Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, US National Institutes of Health, Bethesda, MD, USA
| | - Eric Caumes
- AP-HP, Service des Maladies Infectieuses et Tropicales, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Paris, France
| | - J Peter Cegielski
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rosella Centis
- World Health Organization Collaborating Centre for Tuberculosis and Lung Diseases, Maugeri Care and Research Institute, Tradate, Italy
| | - Pei-Chun Chan
- Division of Chronic Infectious Diseases, Taiwan Centers for Disease Control, Taipei, Taiwan
| | - Edward D Chan
- Department of Medicine, University of Colorado Denver, Aurora, CO, USA; Department of Medicine, National Jewish Health, Denver, CO, USA; VA Medical Center, Denver, CO, USA
| | - Kwok-Chiu Chang
- Department of Health, Tuberculosis and Chest Service, Centre for Health Protection, Hong Kong Special Administrative Region, China
| | - Macarthur Charles
- Centers for Disease Control and Prevention, Haiti Country Office, Port-au-Prince, Haiti
| | - Andra Cirule
- Centre of TB and Lung Diseases, Riga East University Hospital, Riga, Latvia
| | | | - Lia D'Ambrosio
- World Health Organization Collaborating Centre for Tuberculosis and Lung Diseases, Maugeri Care and Research Institute, Tradate, Italy; Public Health Consulting Group, Lugano, Switzerland
| | - Gerard de Vries
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands; KNCV Tuberculosis Foundation, The Hague, Netherlands
| | - Keertan Dheda
- Centre for Lung Infection and Immunity, Department of Medicine & UCT Lung Institute, University of Cape Town, Cape Town, South Africa
| | - Aliasgar Esmail
- Centre for Lung Infection and Immunity, Department of Medicine & UCT Lung Institute, University of Cape Town, Cape Town, South Africa
| | - Jennifer Flood
- Tuberculosis Control Branch, Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, CA, USA
| | - Gregory J Fox
- Sydney Medical School, University of Sydney, NSW, Australia
| | | | - Geisa Fregona
- University Federal of Espirito Santo, Vitória, Brazil
| | | | - Medea Gegia
- Global Tuberculosis Program, World Health Organization, Geneva, Switzerland
| | | | - Sue Gu
- Department of Medicine, University of Colorado Denver, Aurora, CO, USA
| | - Lorenzo Guglielmetti
- AP-HP, Laboratoire de Bactériologie-Hygiène, Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Paris, France; Sorbonne Université, Centre d'Immunologie et des Maladies Infectieuses (CIMI; INSERM U1135/UMRS CR7/CNRS ERL 8255), Bactériologie, Faculté de Médecine Sorbonne Université, Paris, France; Sanatorium, Centre Hospitalier de Bligny, Briis-sous-Forges, France
| | - Timothy H Holtz
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Leah Jarlsberg
- Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, CA, USA
| | - Russell R Kempker
- Emory University School of Medicine, Division of Infectious Diseases, Atlanta, GA, USA
| | - Salmaan Keshavjee
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
| | - Faiz Ahmad Khan
- Montreal Chest Institute, McGill University Health Center Research Institute, McGill University, Montreal, QC, Canada
| | - Maia Kipiani
- National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia
| | - Serena P Koenig
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA; Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Won-Jung Koh
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Afranio Kritski
- Academic Tuberculosis Program, School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Liga Kuksa
- Department of MDR TB, Riga East University Hospital, Riga, Latvia
| | - Charlotte L Kvasnovsky
- Division of Pediatric Surgery, Cohen Children's Medical Center, Hofstra Northwell School of Medicine, New Hyde Park, NY, USA
| | - Nakwon Kwak
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Zhiyi Lan
- Montreal Chest Institute, McGill University Health Center Research Institute, McGill University, Montreal, QC, Canada
| | - Christoph Lange
- Division of Clinical Infectious Diseases, Research Center Borstel, Germany; German Center for Infection Research, Clinical Tuberculosis Unit, Borstel, Germany; International Health/Infectious Diseases, University of Luebeck, Luebeck, Germany; Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | | | - Myungsun Lee
- Clinical Research Section, International Tuberculosis Research Centre, Seoul, South Korea
| | - Vaira Leimane
- Centre of TB and Lung Diseases, Riga East University Hospital, Riga, Latvia
| | - Chi-Chiu Leung
- Department of Health, Tuberculosis and Chest Service, Centre for Health Protection, Hong Kong Special Administrative Region, China
| | - Eric Chung-Ching Leung
- Department of Health, Tuberculosis and Chest Service, Centre for Health Protection, Hong Kong Special Administrative Region, China
| | - Pei Zhi Li
- Montreal Chest Institute, McGill University Health Center Research Institute, McGill University, Montreal, QC, Canada
| | - Phil Lowenthal
- Tuberculosis Control Branch, Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, CA, USA
| | | | - Suzanne M Marks
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sundari Mase
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, GA, USA; Regional WHO Office, New Delhi, India
| | - 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, Hamilton, ON, Canada
| | - Giovanni B Migliori
- World Health Organization Collaborating Centre for Tuberculosis and Lung Diseases, Maugeri Care and Research Institute, Tradate, Italy
| | - Vladimir Milanov
- Medical Faculty, Medical University-Sofia, University Hospital for Respiratory Diseases "St. Sofia", Sofia, Bulgaria
| | - Ann C Miller
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Carole D Mitnick
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | | | - Erika Mohr
- Médecins Sans Frontières, Khayelitsha, South Africa
| | - Ignacio Monedero
- TB-HIV Department, International Union against Tuberculosis and Lung Diseases, Paris, France
| | - Payam Nahid
- Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, CA, USA
| | - Norbert Ndjeka
- National TB Programme, South African National Department of Health, Pretoria, South Africa
| | - Max R O'Donnell
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Medical Center, New York, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Nesri Padayatchi
- CAPRISA, MRC TB-HIV Treatment and Pathogenesis Research Unit, Durban, South Africa
| | - Domingo Palmero
- Pulmonology Division, Municipal Hospital F J Munĩz, Buenos Aires, Argentina
| | - Jean William Pape
- Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti; Center for Global Health, Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Laura J Podewils
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ian Reynolds
- Department of Medicine, University of Colorado Denver, Aurora, CO, USA
| | - Vija Riekstina
- Centre of TB and Lung Diseases, Riga East University Hospital, Riga, Latvia
| | - Jérôme Robert
- AP-HP, Laboratoire de Bactériologie-Hygiène, Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Paris, France; Sorbonne Université, Centre d'Immunologie et des Maladies Infectieuses (CIMI; INSERM U1135/UMRS CR7/CNRS ERL 8255), Bactériologie, Faculté de Médecine Sorbonne Université, Paris, France
| | | | - Barbara Seaworth
- Heartland National TB Center, University of Texas Health Science Center at Tyler, Tyler, TX, USA
| | | | - Kathryn Schnippel
- Faculty of Health Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Tae Sun Shim
- Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Seoul, South Korea
| | - Rupak Singla
- National Institute of Tuberculosis & Respiratory Diseases, New Delhi, India
| | - Sarah E Smith
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Giovanni Sotgiu
- Department of Medical, Surgical and Experimental Sciences, Clinical Epidemiology and Medical Statistics Unit, University of Sassari, Sassari, Italy
| | | | - Payam Tabarsi
- Clinical Tuberculosis and Epidemiology Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Simon Tiberi
- Royal London Hospital, Barts Health NHS Trust, London, UK; Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Anete Trajman
- Social Medicine Institute, Epidemiology Department, State University of Rio de Janeiro, Rio de Janeiro, Brazil; Montreal Chest Institute, McGill University Health Center Research Institute, McGill University, Montreal, QC, Canada; Academic Tuberculosis Program, School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Lisa Trieu
- Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, NY, USA
| | | | - Tjip S van der Werf
- Department of Pulmonary Diseases and Tuberculosis, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands; Department of Internal Medicine/Infectious Diseases, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands
| | - Nicolas Veziris
- AP-HP, Laboratoire de Bactériologie-Hygiène, Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Paris, France; Sorbonne Université, Centre d'Immunologie et des Maladies Infectieuses (CIMI; INSERM U1135/UMRS CR7/CNRS ERL 8255), Bactériologie, Faculté de Médecine Sorbonne Université, Paris, France
| | - Piret Viiklepp
- Estonian Tuberculosis Registry, National Institute for Health Development, Tallinn, Estonia
| | - Stalz Charles Vilbrun
- Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Kathleen Walsh
- Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Janice Westenhouse
- Tuberculosis Control Branch, Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, CA, USA
| | - Wing-Wai Yew
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Jae-Joon Yim
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | | | - Matteo Zignol
- Global Tuberculosis Program, World Health Organization, Geneva, Switzerland
| | - Dick Menzies
- Montreal Chest Institute, McGill University Health Center Research Institute, McGill University, Montreal, QC, Canada.
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Affiliation(s)
- Karine Sévère
- Les Centres GHESKIO, Port-au-Prince, Haiti. E-mails: , , , , , and
| | - Vanessa Rouzier
- Les Centres GHESKIO, Port-au-Prince, Haiti. E-mails: , , , , , and
| | | | - Claudin Bertil
- Les Centres GHESKIO, Port-au-Prince, Haiti. E-mails: , , , , , and
| | - Patrice Joseph
- Les Centres GHESKIO, Port-au-Prince, Haiti. E-mails: , , , , , and
| | | | | | - Peter F Wright
- Department of Pediatrics, Dartmouth Medical School, Hanover, New Hampshire. E-mail:
| | | | - Jean William Pape
- Center for Global Health, Department of Medicine, Weill Cornell Medical College, New York, New York. E-mail:
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Fox EL, Pelto GH, Bar H, Rasmussen KM, Young SL, Debrosse MG, Rouzier VA, Pape JW, Pelletier DL. Capturing Changes in HIV-Infected Breastfeeding Mothers' Cognitive Processes from Before Delivery to 5 Months Postpartum: An Application of the Pile-Sorting Technique in Haiti. Curr Dev Nutr 2018; 2:nzy017. [PMID: 29955729 PMCID: PMC6007337 DOI: 10.1093/cdn/nzy017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 02/16/2018] [Accepted: 03/20/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The cognitive processes involved in individuals' perceptions and prioritization of information, and how these change with experience or exposure to interventions, are rarely examined in the evaluation of nutrition interventions. Exclusive breastfeeding counseling is a common infant and young-child feeding intervention and is used to promote HIV-free survival in the prevention of mother-to-child transmission programs. However, it is often designed without adequate attention to the changes in mothers' perceptions over the course of their early breastfeeding experiences. OBJECTIVE The aim of this study was to identify HIV-infected breastfeeding mothers' cognitive structure (their organization of messages and ideas) of infant feeding messages and to characterize whether their cognitive organization of infant feeding messages changed from pregnancy through the first 5 mo postpartum. METHODS With the use of semistructured interviews and the cognitive mapping technique of pile sorting, we interviewed 30 HIV-infected breastfeeding mothers in Port-au-Prince, Haiti. We asked them to sort and rate 18 infant feeding messages 3 times (during pregnancy, 0- to 1-mo postpartum, and 3- to 5-mo postpartum). We analyzed their responses by using multidimensional scaling, property fitting, and partition analyses. RESULTS At all 3 visits, we found consistency in women's cognitive mapping of messages. For example, mothers consistently differentiated messages pertinent for exclusive breastfeeding compared with those that pertained to other practices. However, subtle variations in mothers' cognition over time were also evident, particularly at 0- to 1-mo postpartum, when message proximity was tightly clustered compared with the earlier and later periods. CONCLUSIONS We conclude that mothers share a common cognitive organization of infant feeding messages and that this organization changes over time. Attention to variations in cognition can support context-sensitive, patient-centered counseling by practitioners and improve the effectiveness of nutrition interventions. Pile sorting is an efficient, systematic technique to examine cognitive processes related to health and nutrition.
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Affiliation(s)
- Elizabeth L Fox
- Division of Nutritional Sciences, Cornell University, Ithaca, NY
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD
| | - Gretel H Pelto
- Division of Nutritional Sciences, Cornell University, Ithaca, NY
| | - Haim Bar
- Department of Statistics, University of Connecticut, Storrs, CT
| | | | - Sera L Young
- Department of Anthropology, Northwestern University, Evanston, IL
| | - Marie Guerda Debrosse
- Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO), Port-au-Prince, Haiti
| | - Vanessa A Rouzier
- Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO), Port-au-Prince, Haiti
| | - Jean William Pape
- Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO), Port-au-Prince, Haiti
- Center for Global Health, Weill Cornell Medical College, New York, NY
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27
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Rivera VR, Jean-Juste MA, Gluck SC, Reeder HT, Sainristil J, Julma P, Peck M, Joseph P, Ocheretina O, Perodin C, Secours R, Duran-Mendicuti M, Hashiguchi L, Cremieux PY, Koenig SP, Pape JW. Diagnostic yield of active case finding for tuberculosis and HIV at the household level in slums in Haiti. Int J Tuberc Lung Dis 2017; 21:1140-1146. [PMID: 29037294 PMCID: PMC5902800 DOI: 10.5588/ijtld.17.0049] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Haiti has the highest burden of tuberculosis (TB) in the Americas, with an estimated prevalence of 254 per 100 000 population. The Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes, GHESKIO) conducted active case finding (ACF) for TB at the household level in nine slums in Port-au-Prince. OBJECTIVE We report on the prevalence of undiagnosed TB detected through GHESKIO's ACF campaign. DESIGN From 1 August 2014 to 31 July 2015, we conducted a retrospective cohort analysis using GHESKIO's ACF campaign data. All individuals who reported chronic cough (cough 2 weeks) were tested for TB at GHESKIO, and those aged 10 years were included in the analyses. RESULTS Of 104 097 individuals screened in the community, 5598 (5%) reported chronic cough and satisfied the study inclusion criteria. A total of 1110 (20%) were diagnosed with active TB disease (prevalence of 1066/100 000). Of the 5472 (98%) patients tested for human immunodeficiency virus (HIV), 528 (10%) were HIV-positive; 143 (3%) patients were diagnosed with both diseases. CONCLUSION Household-level screening for cough with TB and HIV testing for symptomatic patients was a high-yield strategy, leading to the detection of a prevalence of undiagnosed disease exceeding national estimates by more than four-fold for TB, and by five-fold for HIV.
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Affiliation(s)
- V R Rivera
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti, Center for Global Health, Department of Medicine, Weill Cornell Medical College, New York, New York
| | - M-A Jean-Juste
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - S C Gluck
- Analysis Group, Boston, Massachusetts
| | | | - J Sainristil
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - P Julma
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - M Peck
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - P Joseph
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - O Ocheretina
- Center for Global Health, Department of Medicine, Weill Cornell Medical College, New York, New York
| | - C Perodin
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - R Secours
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | | | - L Hashiguchi
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | | | - S P Koenig
- Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - J W Pape
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti, Center for Global Health, Department of Medicine, Weill Cornell Medical College, New York, New York
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Judd A, Zangerle R, Touloumi G, Warszawski J, Meyer L, Dabis F, Mary Krause M, Ghosn J, Leport C, Wittkop L, Reiss P, Wit F, Prins M, Bucher H, Gibb D, Fätkenheuer G, Julia DA, Obel N, Thorne C, Mocroft A, Kirk O, Stephan C, Pérez-Hoyos S, Hamouda O, Bartmeyer B, Chkhartishvili N, Noguera-Julian A, Antinori A, d’Arminio Monforte A, Brockmeyer N, Prieto L, Rojo Conejo P, Soriano-Arandes A, Battegay M, Kouyos R, Mussini C, Tookey P, Casabona J, Miró JM, Castagna A, Konopnick D, Goetghebuer T, Sönnerborg A, Quiros-Roldan E, Sabin C, Teira R, Garrido M, Haerry D, de Wit S, Miró JM, Costagliola D, d’Arminio-Monforte A, Castagna A, del Amo J, Mocroft A, Raben D, Chêne G, Judd A, Pablo Rojo C, Barger D, Schwimmer C, Termote M, Wittkop L, Campbell M, Frederiksen CM, Friis-Møller N, Kjaer J, Raben D, Salbøl Brandt R, Berenguer J, Bohlius J, Bouteloup V, Bucher H, Cozzi-Lepri A, Dabis F, d’Arminio Monforte A, Davies MA, del Amo J, Dorrucci M, Dunn D, Egger M, Furrer H, Grabar S, Guiguet M, Judd A, Kirk O, Lambotte O, Leroy V, Lodi S, Matheron S, Meyer L, Miro JM, Mocroft A, Monge S, Nakagawa F, Paredes R, Phillips A, Puoti M, Rohner E, Schomaker M, Smit C, Sterne J, Thiebaut R, Thorne C, Torti C, van der Valk M, Wittkop L, Tanser F, Vinikoor M, Macete E, Wood R, Stinson K, Garone D, Fatti G, Giddy J, Malisita K, Eley B, Fritz C, Hobbins M, Kamenova K, Fox M, Prozesky H, Technau K, Sawry S, Benson CA, Bosch RJ, Kirk GD, Boswell S, Mayer KH, Grasso C, Hogg RS, Richard Harrigan P, Montaner JSG, Yip B, Zhu J, Salters K, Gabler K, Buchacz K, Brooks JT, Gebo KA, Moore RD, Moore RD, Rodriguez B, Horberg MA, Silverberg MJ, Thorne JE, Rabkin C, Margolick JB, Jacobson LP, D’Souza G, Klein MB, Rourke SB, Rachlis AR, Cupido P, Hunter-Mellado RF, Mayor AM, John Gill M, Deeks SG, Martin JN, Patel P, Brooks JT, Saag MS, Mugavero MJ, Willig J, Eron JJ, Napravnik S, Kitahata MM, Crane HM, Drozd DR, Sterling TR, Haas D, Rebeiro P, Turner M, Bebawy S, Rogers B, Justice AC, Dubrow R, Fiellin D, Gange SJ, Anastos K, Moore RD, Saag MS, Gange SJ, Kitahata MM, Althoff KN, Horberg MA, Klein MB, McKaig RG, Freeman AM, Moore RD, Freeman AM, Lent C, Kitahata MM, Van Rompaey SE, Crane HM, Drozd DR, Morton L, McReynolds J, Lober WB, Gange SJ, Althoff KN, Abraham AG, Lau B, Zhang J, Jing J, Modur S, Wong C, Hogan B, Desir F, Liu B, You B, Cahn P, Cesar C, Fink V, Sued O, Dell’Isola E, Perez H, Valiente J, Yamamoto C, Grinsztejn B, Veloso V, Luz P, de Boni R, Cardoso Wagner S, Friedman R, Moreira R, Pinto J, Ferreira F, Maia M, Célia de Menezes Succi R, Maria Machado D, de Fátima Barbosa Gouvêa A, Wolff M, Cortes C, Fernanda Rodriguez M, Allendes G, William Pape J, Rouzier V, Marcelin A, Perodin C, Tulio Luque M, Padgett D, Sierra Madero J, Crabtree Ramirez B, Belaunzaran P, Caro Vega Y, Gotuzzo E, Mejia F, Carriquiry G, McGowan CC, Shepherd BE, Sterling T, Jayathilake K, Person AK, Rebeiro PF, Giganti M, Castilho J, Duda SN, Maruri F, Vansell H, Ly PS, Khol V, Zhang FJ, Zhao HX, Han N, Lee MP, Li PCK, Lam W, Chan YT, Kumarasamy N, Saghayam S, Ezhilarasi C, Pujari S, Joshi K, Gaikwad S, Chitalikar A, Merati TP, Wirawan DN, Yuliana F, Yunihastuti E, Imran D, Widhani A, Tanuma J, Oka S, Nishijima T, Na S, Choi JY, Kim JM, Sim BLH, Gani YM, David R, Kamarulzaman A, Syed Omar SF, Ponnampalavanar S, Azwa I, Ditangco R, Uy E, Bantique R, Wong WW, Ku WW, Wu PC, Ng OT, Lim PL, Lee LS, Ohnmar PS, Avihingsanon A, Gatechompol S, Phanuphak P, Phadungphon C, Kiertiburanakul S, Sungkanuparph S, Chumla L, Sanmeema N, Chaiwarith R, Sirisanthana T, Kotarathititum W, Praparattanapan J, Kantipong P, Kambua P, Ratanasuwan W, Sriondee R, Nguyen KV, Bui HV, Nguyen DTH, Nguyen DT, Cuong DD, An NV, Luan NT, Sohn AH, Ross JL, Petersen B, Cooper DA, Law MG, Jiamsakul A, Boettiger DC, Ellis D, Bloch M, Agrawal S, Vincent T, Allen D, Smith D, Rankin A, Baker D, Templeton DJ, O’Connor CC, Thackeray O, Jackson E, McCallum K, Ryder N, Sweeney G, Cooper D, Carr A, Macrae K, Hesse K, Finlayson R, Gupta S, Langton-Lockton J, Shakeshaft J, Brown K, Idle S, Arvela N, Varma R, Lu H, Couldwell D, Eswarappa S, Smith DE, Furner V, Smith D, Cabrera G, Fernando S, Cogle A, Lawrence C, Mulhall B, Boyd M, Law M, Petoumenos K, Puhr R, Huang R, Han A, Gunathilake M, Payne R, O’Sullivan M, Croydon A, Russell D, Cashman C, Roberts C, Sowden D, Taing K, Marshall P, Orth D, Youds D, Rowling D, Latch N, Warzywoda E, Dickson B, Donohue W, Moore R, Edwards S, Boyd S, Roth NJ, Lau H, Read T, Silvers J, Zeng W, Hoy J, Watson K, Bryant M, Price S, Woolley I, Giles M, Korman T, Williams J, Nolan D, Allen A, Guelfi G, Mills G, Wharry C, Raymond N, Bargh K, Templeton D, Giles M, Brown K, Hoy J. Comparison of Kaposi Sarcoma Risk in Human Immunodeficiency Virus-Positive Adults Across 5 Continents: A Multiregional Multicohort Study. Clin Infect Dis 2017; 65:1316-1326. [PMID: 28531260 PMCID: PMC5850623 DOI: 10.1093/cid/cix480] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 05/19/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND We compared Kaposi sarcoma (KS) risk in adults who started antiretroviral therapy (ART) across the Asia-Pacific, South Africa, Europe, Latin, and North America. METHODS We included cohort data of human immunodeficiency virus (HIV)-positive adults who started ART after 1995 within the framework of 2 large collaborations of observational HIV cohorts. We present incidence rates and adjusted hazard ratios (aHRs). RESULTS We included 208140 patients from 57 countries. Over a period of 1066572 person-years, 2046 KS cases were diagnosed. KS incidence rates per 100000 person-years were 52 in the Asia-Pacific and ranged between 180 and 280 in the other regions. KS risk was 5 times higher in South African women (aHR, 4.56; 95% confidence intervals [CI], 2.73-7.62) than in their European counterparts, and 2 times higher in South African men (2.21; 1.34-3.63). In Europe, Latin, and North America KS risk was 6 times higher in men who have sex with men (aHR, 5.95; 95% CI, 5.09-6.96) than in women. Comparing patients with current CD4 cell counts ≥700 cells/µL with those whose counts were <50 cells/µL, the KS risk was halved in South Africa (aHR, 0.53; 95% CI, .17-1.63) but reduced by ≥95% in other regions. CONCLUSIONS Despite important ART-related declines in KS incidence, men and women in South Africa and men who have sex with men remain at increased KS risk, likely due to high human herpesvirus 8 coinfection rates. Early ART initiation and maintenance of high CD4 cell counts are essential to further reducing KS incidence worldwide, but additional measures might be needed, especially in Southern Africa.
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29
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Fox EL, Pelto GH, Rasmussen KM, Debrosse MG, Rouzier VA, Pape JW, Pelletier DL. Who knows what: An exploration of the infant feeding message environment and intracultural differences in Port-au-Prince, Haiti. Matern Child Nutr 2017; 14:e12537. [PMID: 28976068 DOI: 10.1111/mcn.12537] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 08/27/2017] [Accepted: 09/09/2017] [Indexed: 11/28/2022]
Abstract
Worldwide, mothers with young children receive many messages about infant feeding. Some messages are generated by health providers and others by the households, communities, and social contexts in which women live. We aimed to determine the scope of infant feeding messages in urban Haiti and to examine intracultural differences in salience of these messages and their alignment with international guidelines. We applied the method of free listing with 13 health workers and 15 human immunodeficiency virus (HIV)-infected and 15 HIV-uninfected mothers with infants 0-6 months old at Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes in Port-au-Prince, Haiti. Participants listed all messages women receive about infant feeding and specifically about HIV and infant feeding. Message salience was determined by frequency of mention and recall order; messages were coded for key themes. For all groups, the World Health Organization infant feeding recommendations were salient, especially those related to exclusive breastfeeding. Messages across all groups focused on infant health outcomes, with less emphasis on maternal outcomes. Cultural beliefs were also elicited and showed higher salience for mothers than health workers, particularly for consequences of poor maternal nutrition. Health workers' free lists were poorly correlated to those of mothers, whereas those of mothers were highly correlated, regardless of HIV status. Inasmuch as many salient messages were culturally generated, and differences existed between mothers and health workers, we conclude that it is important for health workers to acknowledge the broader infant feeding message environment, and discrepancies within that environment, to address successes and failures in the messages reaching mothers, given potential consequences for mothers' breastfeeding behaviours.
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Affiliation(s)
- Elizabeth L Fox
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA.,Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland, USA
| | - Gretel H Pelto
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA
| | | | - Marie Guerda Debrosse
- Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO), Port-au-Prince, Haïti
| | - Vanessa A Rouzier
- Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO), Port-au-Prince, Haïti
| | - Jean William Pape
- Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO), Port-au-Prince, Haïti.,Center for Global Health, Weill Cornell Medical College, New York, New York, USA
| | - David L Pelletier
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA
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Bristow CC, Mathelier P, Ocheretina O, Benoit D, Pape JW, Wynn A, Klausner JD. Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis screening and treatment of pregnant women in Port-au-Prince, Haiti. Int J STD AIDS 2017; 28:1130-1134. [PMID: 28134005 PMCID: PMC5837282 DOI: 10.1177/0956462416689755] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In Haiti, routine screening for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Trichomonas vaginalis (TV) among pregnant women is not conducted; yet these sexually transmitted infections (STIs) are associated with adverse birth and newborn health outcomes. We aimed to assess the acceptability and feasibility of screening and the prevalence of STIs among pregnant women in Port-au-Prince, Haiti. Pregnant women of at least 18 years of age who attend Haitian Study Group for Kaposi's sarcoma and Opportunistic Infections (GHESKIO) clinics in Port-au-Prince, Haiti provided self-collected vaginal swab specimens. Laboratory testing was done with Xpert® CT/NG and Xpert® TV. The results of this study showed that of the 322 pregnant women who visited GHESKIO for their regular scheduled appointments, 300 (93.2%) consented for CT, NG, and TV testing. Of those, 107 women (35.7%) tested positive for at least one STI. There were 42 (14.7%) cases of CT, 8 (2.8%) NG, and 83 (29.0%) TV infections. Most infections were treated - 122 of 133 (91.7%). In summary, we found that it was highly acceptable and feasible to implement CT, NG, and TV screening among pregnant women in Port-au-Prince, Haiti. We found high prevalence of STIs among pregnant women, which suggest that STI screening in this population may be warranted.
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Affiliation(s)
- Claire C. Bristow
- Division of Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA USA
| | | | - Oksana Ocheretina
- Weill Cornell Medical College, New York, USA
- Les Centres GHESKIO, Port-au-Prince, Haiti
| | | | - Jean William Pape
- Weill Cornell Medical College, New York, USA
- Les Centres GHESKIO, Port-au-Prince, Haiti
| | - Adriane Wynn
- University of California Los Angeles, Los Angeles CA, USA
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Bristow CC, Lee SJ, Severe L, William Pape J, Javanbakht M, Scott Comulada W, Klausner JD. Attributes of diagnostic tests to increase uptake of dual testing for syphilis and HIV in Port-au-Prince, Haiti. Int J STD AIDS 2016; 28:259-264. [PMID: 27037111 DOI: 10.1177/0956462416642340] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Syphilis and HIV screening is highly recommended for pregnant women and those at risk for infection. We used conjoint analysis to identify factors associated with testing preferences for HIV and syphilis infection. Methods We recruited 298 men and women 18 years and over seeking testing or care at GHESKIO (Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections) clinics. We created eight hypothetical dual HIV-syphilis test profiles varying across six dichotomous attributes. Participants were asked to rate each profile using Likert preference scales. An impact score was generated for each attribute by taking the difference between the preference scores for the preferred and non-preferred level of each attribute. Two-sided one-sample t-test was used to generate p values. Results Of 298 study participants, 61 (20.5%) were male. Of 237 females, 49 (20.7%) were pregnant. Cost (free vs. US$4; p < .0001) had the highest impact on willingness to test, followed by number of blood draws (1 vs. 2; p < .0001), blood draw method (fingerprick vs. venipuncture; p < .0001), test type (rapid vs. laboratory; p = .0005), and time-to-result (20 minutes vs. 1 week; p = .0139). Conclusion HIV and syphilis testing preferences for this study sample in Port-au-Prince prioritized cost, single fingerprick, laboratory-based testing and timeliness.
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Affiliation(s)
- Claire C Bristow
- 1 Division of Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Sung-Jae Lee
- 2 Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA.,3 Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Jean William Pape
- 4 Les Centres GHESKIO, Port-au-Prince, Haiti.,5 Center for Global Health, Division of Infectious Diseases, Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Marjan Javanbakht
- 2 Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | - Warren Scott Comulada
- 3 Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Jeffrey D Klausner
- 2 Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA.,6 Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
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Bristow CC, Severe L, Pape JW, Javanbakht M, Lee SJ, Comulada WS, Klausner JD. Dual rapid lateral flow immunoassay fingerstick wholeblood testing for syphilis and HIV infections is acceptable and accurate, Port-au-Prince, Haiti. BMC Infect Dis 2016; 16:302. [PMID: 27316352 PMCID: PMC4912739 DOI: 10.1186/s12879-016-1574-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 05/17/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dual rapid tests for HIV and syphilis infections allow for detection of HIV infection and syphilis at the point-of-care. Those tests have been evaluated in laboratory settings and show excellent performance but have not been evaluated in the field. We evaluated the field performance of the SD BIOLINE HIV/Syphilis Duo test in Port-au-Prince, Haiti using whole blood fingerprick specimens. METHODS GHESKIO (Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections) clinic attendees 18 years of age or older were invited to participate. Venipuncture blood specimens were used for reference testing with standard commercially available tests for HIV and syphilis in Haiti. The sensitivity and specificity of the Duo test compared to the reference standard were calculated. The exact binomial method was used to determine 95 % confidence intervals (CI). RESULTS Of 298 study participants, 237 (79.5 %) were female, of which 49 (20.7 %) were pregnant. For the HIV test component, the sensitivity and specificity were 99.2 % (95 % CI: 95.8 %, 100 %) and 97.0 % (95 % CI: 93.2 %, 99.0 %), respectively; and for the syphilis component were 96.5 % (95 % CI: 91.2 %, 99.0 %) and 90.8 % (95 % CI: 85.7 %, 94.6 %), respectively. In pregnant women, the sensitivity and specificity of the HIV test component were 93.3 % (95 % CI: 68.0 %, 99.8 %) and 94.1 % (95 % CI: 80.3 %, 99.3 %), respectively; and for the syphilis component were 100 % (95 % CI:81.5 %, 100 %) and 96.8 % (95 % CI:83.3 %, 99.9 %), respectively. CONCLUSION The Standard Diagnostics BIOLINE HIV/Syphilis Duo dual test performed well in a field setting in Haiti and should be considered for wider use.
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Affiliation(s)
- Claire C Bristow
- Division of Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA. .,Division of Global Public Health, University of California San Diego, 9500 Gilman Drive 0507, La Jolla, CA, 92093-0507, USA.
| | | | - Jean William Pape
- Les Centres GHESKIO, Port-au-Prince, Haiti.,Center for Global Health, Division of Infectious Diseases, Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Marjan Javanbakht
- Department of Epidemiology, University of California Los Angeles, Los Angeles, CA, USA
| | - Sung-Jae Lee
- Department of Epidemiology, University of California Los Angeles, Los Angeles, CA, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Warren Scott Comulada
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Jeffrey D Klausner
- Department of Epidemiology, University of California Los Angeles, Los Angeles, CA, USA. .,Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA. .,UCLA David Geffen School of Medicine, Los Angeles, CA, USA.
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Sévère K, Rouzier V, Anglade SB, Bertil C, Joseph P, Deroncelay A, Mabou MM, Wright PF, Guillaume FD, Pape JW. Effectiveness of Oral Cholera Vaccine in Haiti: 37-Month Follow-Up. Am J Trop Med Hyg 2016; 94:1136-42. [PMID: 26928838 PMCID: PMC4856615 DOI: 10.4269/ajtmh.15-0700] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 12/11/2015] [Indexed: 11/07/2022] Open
Abstract
The first oral cholera vaccine (OCV) campaign, since its prequalification by the World Health Organization, in response to an ongoing cholera epidemic (reactive vaccination) was successfully conducted in a poor urban slum of approximately 70,000 inhabitants in Port-au-Prince, Haiti, in 2012. Vaccine coverage was 75% of the target population. This report documents the impact of OCV in reducing the number of culture-confirmed cases of cholera admitted to the Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO) cholera treatment center from that community in the 37 months postvaccination (April 2012-April 30, 2015). Of 1,788 patients with culture-confirmed cholera, 1,770 (99%) were either from outside the vaccine area (1,400 cases) or from the vaccinated community who had not received OCV (370 cases). Of the 388 people from the catchment area who developed culture-confirmed cholera, 370 occurred among the 17,643 people who had not been vaccinated (2.1%) and the remaining 18 occurred among the 52,357 people (0.034%) who had been vaccinated (P < 0.001), for an efficacy that approximates 97.5%. Despite not being designed as a randomized control trial, the very high efficacy is a strong evidence for the effectiveness of OCV as part of an integrated package for the control of cholera in outbreak settings.
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Affiliation(s)
- Karine Sévère
- Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes Centers, Port-au-Prince, Haiti; Center for Global Health, Department of Medicine, Weill Cornell Medical College, New York, New York; Division of Infectious Disease and International Health, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Ministry of Public Health and Population, Port-au-Prince, Haiti
| | - Vanessa Rouzier
- Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes Centers, Port-au-Prince, Haiti; Center for Global Health, Department of Medicine, Weill Cornell Medical College, New York, New York; Division of Infectious Disease and International Health, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Ministry of Public Health and Population, Port-au-Prince, Haiti
| | - Stravinsky Benedict Anglade
- Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes Centers, Port-au-Prince, Haiti; Center for Global Health, Department of Medicine, Weill Cornell Medical College, New York, New York; Division of Infectious Disease and International Health, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Ministry of Public Health and Population, Port-au-Prince, Haiti
| | - Claudin Bertil
- Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes Centers, Port-au-Prince, Haiti; Center for Global Health, Department of Medicine, Weill Cornell Medical College, New York, New York; Division of Infectious Disease and International Health, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Ministry of Public Health and Population, Port-au-Prince, Haiti
| | - Patrice Joseph
- Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes Centers, Port-au-Prince, Haiti; Center for Global Health, Department of Medicine, Weill Cornell Medical College, New York, New York; Division of Infectious Disease and International Health, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Ministry of Public Health and Population, Port-au-Prince, Haiti
| | - Alexandra Deroncelay
- Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes Centers, Port-au-Prince, Haiti; Center for Global Health, Department of Medicine, Weill Cornell Medical College, New York, New York; Division of Infectious Disease and International Health, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Ministry of Public Health and Population, Port-au-Prince, Haiti
| | - Marie Marcelle Mabou
- Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes Centers, Port-au-Prince, Haiti; Center for Global Health, Department of Medicine, Weill Cornell Medical College, New York, New York; Division of Infectious Disease and International Health, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Ministry of Public Health and Population, Port-au-Prince, Haiti
| | - Peter F Wright
- Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes Centers, Port-au-Prince, Haiti; Center for Global Health, Department of Medicine, Weill Cornell Medical College, New York, New York; Division of Infectious Disease and International Health, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Ministry of Public Health and Population, Port-au-Prince, Haiti
| | - Florence Duperval Guillaume
- Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes Centers, Port-au-Prince, Haiti; Center for Global Health, Department of Medicine, Weill Cornell Medical College, New York, New York; Division of Infectious Disease and International Health, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Ministry of Public Health and Population, Port-au-Prince, Haiti
| | - Jean William Pape
- Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes Centers, Port-au-Prince, Haiti; Center for Global Health, Department of Medicine, Weill Cornell Medical College, New York, New York; Division of Infectious Disease and International Health, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Ministry of Public Health and Population, Port-au-Prince, Haiti
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Batavia AS, Secours R, Espinosa P, Jean Juste MA, Severe P, Pape JW, Fitzgerald DW. Diagnosis of HIV-Associated Oral Lesions in Relation to Early versus Delayed Antiretroviral Therapy: Results from the CIPRA HT001 Trial. PLoS One 2016; 11:e0150656. [PMID: 26930571 PMCID: PMC4773149 DOI: 10.1371/journal.pone.0150656] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 02/16/2016] [Indexed: 12/30/2022] Open
Abstract
Oral mucosal lesions that are associated with HIV infection can play an important role in guiding the decision to initiate antiretroviral therapy (ART). The incidence of these lesions relative to the timing of ART initiation has not been well characterized. A randomized controlled clinical trial was conducted at the GHESKIO Center in Port-au-Prince, Haiti between 2004 and 2009. 816 HIV-infected ART-naïve participants with CD4 T cell counts between 200 and 350 cells/mm3 were randomized to either immediate ART initiation (early group; N = 408), or initiation when CD4 T cell count was less than or equal 200 cells/mm3 or with the development of an AIDS-defining condition (delayed group; N = 408). Every 3 months, all participants underwent an oral examination. The incidence of oral lesions was 4.10 in the early group and 17.85 in the delayed group (p-value <0.01). In comparison to the early group, there was a significantly higher incidence of candidiasis, hairy leukoplakia, herpes labialis, and recurrent herpes simplex in the delayed group. The incidence of oral warts in delayed group was 0.97 before therapy and 4.27 post-ART initiation (p-value <0.01). In the delayed group the incidence of oral warts post-ART initiation was significantly higher than that seen in the early group (4.27 versus 1.09; p-value <0.01). The incidence of oral warts increased after ART was initiated, and relative to the early group there was a four-fold increase in oral warts if ART was initiated following an AIDS diagnosis. Based upon our findings, candidiasis, hairy leukoplakia, herpes labialis, and recurrent herpes simplex indicate immune suppression and the need to start ART. In contrast, oral warts are a sign of immune reconstitution following ART initiation.
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Affiliation(s)
- Ashita S. Batavia
- Weill Cornell Medical Center, New York, New York, United States of America
- * E-mail:
| | - Rode Secours
- Groupe Haitien d’Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO), Port-au-Prince, Haiti
| | - Patrice Espinosa
- University of California San Francisco School of Dentistry, San Francisco, California, United States of America
| | - Marc Antoine Jean Juste
- Groupe Haitien d’Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO), Port-au-Prince, Haiti
| | - Patrice Severe
- Groupe Haitien d’Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO), Port-au-Prince, Haiti
| | - Jean William Pape
- Weill Cornell Medical Center, New York, New York, United States of America
- Groupe Haitien d’Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO), Port-au-Prince, Haiti
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Affiliation(s)
- Samuel Pierre
- Groupe Haïtien d’Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO), Port-au-Prince, Haiti
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Isa F, Collins S, Decome D, Dorvil N, Joseph P, Smith L, Salerno AQ, Wells M, Fischer S, Pape JW, Johnson W, Fitzgerald D, Rhee K. A Novel Urinary Biomarker of Tuberculosis and Response to Chemotherapy. Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv131.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Koenig SP, Bornstein A, Severe K, Fox E, Dévieux JG, Severe P, Joseph P, Marcelin A, Bright DA, Pham N, Cremieux P, Pape JW. A Second Look at the Association between Gender and Mortality on Antiretroviral Therapy. PLoS One 2015; 10:e0142101. [PMID: 26562018 PMCID: PMC4643042 DOI: 10.1371/journal.pone.0142101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 10/16/2015] [Indexed: 11/29/2022] Open
Abstract
Objective We assessed the association between gender and mortality on antiretroviral therapy (ART) using identical models with and without sex-specific categories for weight and hemoglobin. Design Cohort study of adult patients on ART. Setting GHESKIO Clinic in Port-au-Prince, Haiti. Participants 4,717 ART-naïve adult patients consecutively enrolled on ART at GHESKIO from 2003 to 2008. Main Outcome Measure Mortality on ART; multivariable analyses were conducted with and without sex-specific categories for weight and hemoglobin. Results In Haiti, male gender was associated with mortality (OR 1.61; 95% CI: 1.30–2.00) in multivariable analyses with hemoglobin and weight included as control variables, but not when sex-specific interactions with hemoglobin and weight were used. Conclusions If sex-specific categories are omitted, multivariable analyses indicate a higher risk of mortality for males vs. females of the same weight and hemoglobin. However, because males have higher normal values for weight and hemoglobin, the males in this comparison would generally have poorer health status than the females. This may explain why gender differences in mortality are sometimes observed after controlling for differences in baseline variables when gender-specific interactions with weight and hemoglobin are omitted.
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Affiliation(s)
- Serena P. Koenig
- Haitian Study Group for Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
- Division of Global Health Equity, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States of America
- * E-mail:
| | | | - Karine Severe
- Haitian Study Group for Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Elizabeth Fox
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, United States of America
| | - Jessy G. Dévieux
- AIDS Prevention Program, Florida International University, Miami, FL, United States of America
| | - Patrice Severe
- Haitian Study Group for Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Patrice Joseph
- Haitian Study Group for Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Adias Marcelin
- Haitian Study Group for Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Dgndy Alexandre Bright
- Haitian Study Group for Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Ngoc Pham
- Analysis Group, Boston, MA, United States of America
| | | | - Jean William Pape
- Haitian Study Group for Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
- Center for Global Health, Weill Cornell Medical College, New York, NY, United States of America
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Collins SE, Jean Juste MA, Koenig SP, Secours R, Ocheretina O, Bernard D, Riviere C, Calnan M, Dunning A, Hurtado Rúa SM, Johnson WD, Pape JW, Fitzgerald DW, Severe P. CD4 deficit and tuberculosis risk persist with delayed antiretroviral therapy: 5-year data from CIPRA HT-001. Int J Tuberc Lung Dis 2015; 19:50-7. [PMID: 25519790 DOI: 10.5588/ijtld.14.0217] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Port-au-Prince, Haiti. OBJECTIVE To determine long-term effects of early vs. delayed initiation of antiretroviral therapy (ART) on immune recovery and tuberculosis (TB) risk in human immunodeficiency virus (HIV) infected individuals. DESIGN Open-label randomized controlled trial of immediate ART in HIV-infected adults with CD4 counts between 200 and 350 cells/mm(3) vs. deferring ART until the CD4 count was <200 cells/mm(3). The primary comparisons were CD4 counts over time and risk for incident TB, with 5 years of follow-up. RESULTS A total of 816 participants were enrolled, with 408 in each treatment arm. The early treatment group started ART within 2 weeks, while the deferred treatment group started ART a median of 1.3 years after enrollment. After 5 years, the mean CD4 count in the early treatment group was significantly higher than in the deferred treatment group (496 cells/mm(3), 95% confidence interval [CI] 477-515 vs. 373 cells/mm(3), 95%CI 357-389; P < 0.0001). TB risk was higher in the deferred treatment group (unadjusted HR 2.41, 95%CI 1.56-3.74; P < 0.0001) and strongly correlated with lower CD4 counts in time-dependent multivariate analysis. CONCLUSION Delays in ART initiation for HIV-infected adults with CD4 counts of 200-350 cells/mm(3) can result in long-term immune dysfunction and persistent increased risk for TB.
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Affiliation(s)
- S E Collins
- Center for Global Health, Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - M A Jean Juste
- Groupe Haitien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO), Port au Prince, Haiti
| | - S P Koenig
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - R Secours
- Groupe Haitien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO), Port au Prince, Haiti
| | - O Ocheretina
- Center for Global Health, Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - D Bernard
- Groupe Haitien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO), Port au Prince, Haiti
| | - C Riviere
- Groupe Haitien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO), Port au Prince, Haiti
| | - M Calnan
- Analysis Group, Inc. Boston, Massachusetts, USA
| | - A Dunning
- Department of Public Health, Weill Cornell Medical College, New York, New York, USA
| | - S M Hurtado Rúa
- Department of Public Health, Weill Cornell Medical College, New York, New York, USA
| | - W D Johnson
- Center for Global Health, Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - J W Pape
- Center for Global Health, Department of Medicine, Weill Cornell Medical College, New York, New York, USA; Groupe Haitien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO), Port au Prince, Haiti
| | - D W Fitzgerald
- Center for Global Health, Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - P Severe
- Groupe Haitien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO), Port au Prince, Haiti
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Kojima N, Bristow CC, Pollock N, Crouse P, Theodore H, Bonhomme J, Gaston CF, Dévieux JG, Pape JW, Klausner JD. P18.03 Rapid training and implementation of the pollock technique, a safe, rapid and effective newborn circumcision procedure, in a low-resource setting. Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052270.626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Kojima N, Bristow CC, Pollock N, Crouse P, Theodore H, Bonhomme J, Gaston CFS, Dévieux JG, Pape JW, Klausner JD. Rapid Training and Implementation of the Pollock Technique, a Safe, Effective Newborn Circumcision Procedure, in a Low-Resource Setting. Glob Pediatr Health 2015; 2:2333794X15589114. [PMID: 27335959 PMCID: PMC4784613 DOI: 10.1177/2333794x15589114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Male circumcision is highly protective against urinary tract infections, inflammatory conditions of the penis, sexually transmitted infections, and urogenital cancers. We aimed to reintroduce newborn male circumcision through the creation of a training program in Port-au-Prince, Haiti-an area with a considerable burden of preventable urogenital infections, sexually transmitted infections, and low circumcision rate-after an earlier study reported that a majority of Haitian medical providers were in need of and wanted newborn circumcision training. The program was conducted at the GHESKIO Health Centers, a large, non-governmental clinic offering comprehensive pediatric and adult health services. Two Haitian obstetricians and seven nurses learned circumcision procedures. On training completion, one of two obstetricians achieved surgical competence. Introduction of a newborn male circumcision training program was feasible, achieving an acceptable rate of procedural competency and high-quality services. Permanent resources now exist in Haiti to train additional providers to perform newborn male circumcisions.
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Affiliation(s)
- Noah Kojima
- University of California Los Angeles, CA, USA
| | | | - Neil Pollock
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | | | - Jean William Pape
- Les Centres GHESKIO, Port-au-Prince, Haiti
- Weill Medical College of Cornell University, New York, NY, USA
| | - Jeffrey D. Klausner
- University of California Los Angeles, CA, USA
- David Geffen School of Medicine at UCLA, Division of Infectious Diseases and Department of Epidemiology, CA, USA
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Koenig SP, Rouzier V, Vilbrun SC, Morose W, Collins SE, Joseph P, Decome D, Ocheretina O, Galbaud S, Hashiguchi L, Pierrot J, Pape JW. Tuberculosis in the aftermath of the 2010 earthquake in Haiti. Bull World Health Organ 2015; 93:498-502. [PMID: 26170508 PMCID: PMC4490810 DOI: 10.2471/blt.14.145649] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 02/18/2015] [Accepted: 02/19/2015] [Indexed: 11/27/2022] Open
Abstract
Problem In 2010, Haiti sustained a devastating earthquake that crippled the health-care infrastructure in the capital city, Port-au-Prince, and left 1.5 million people homeless. Subsequently, there was an increase in reported tuberculosis in the affected population. Approach We conducted active tuberculosis case finding in a camp for internally displaced persons and a nearby slum. Community health workers screened for tuberculosis at the household level. People with persistent cough were referred to a physician. The National Tuberculosis Program continued its national tuberculosis reporting system. Local setting Even before the earthquake, Haiti had the highest tuberculosis incidence in the Americas. About half of the tuberculosis cases occur in the Port-au-Prince region. Relevant changes The number of reported tuberculosis cases in Haiti has increased after the earthquake, but data are too limited to determine if this is due to an increase in tuberculosis burden or to improved case detection. Compared to previous national estimates (230 per 100 000 population), undiagnosed tuberculosis was threefold higher in a camp for internally displaced persons (693 per 100 000) and fivefold higher in an urban slum (1165 per 100 000). With funding from the World Health Organization (WHO), active case finding is now being done systematically in slums and camps. Lessons learnt Household-level screening for prolonged cough was effective in identifying patients with active tuberculosis in this study. Without accurate data, early detection of rising tuberculosis rates is challenging; data collection should be incorporated into pragmatic disease response programmes.
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Affiliation(s)
- Serena P Koenig
- Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), 33 Boulevard Harry Truman, BP 15727, Port-au-Prince, Haiti
| | - Vanessa Rouzier
- Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), 33 Boulevard Harry Truman, BP 15727, Port-au-Prince, Haiti
| | - Stalz Charles Vilbrun
- Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), 33 Boulevard Harry Truman, BP 15727, Port-au-Prince, Haiti
| | - Willy Morose
- Haitian National Tuberculosis Program (Programme National de Lutte contre la Tuberculose, PNLT), Port-au-Prince, Haiti
| | - Sean E Collins
- Department of Medicine, Stanford University, Palo Alto, United States of America (USA)
| | - Patrice Joseph
- Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), 33 Boulevard Harry Truman, BP 15727, Port-au-Prince, Haiti
| | - Diessy Decome
- Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), 33 Boulevard Harry Truman, BP 15727, Port-au-Prince, Haiti
| | - Oksana Ocheretina
- Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), 33 Boulevard Harry Truman, BP 15727, Port-au-Prince, Haiti
| | - Stanislas Galbaud
- Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), 33 Boulevard Harry Truman, BP 15727, Port-au-Prince, Haiti
| | - Lauren Hashiguchi
- Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), 33 Boulevard Harry Truman, BP 15727, Port-au-Prince, Haiti
| | - Julma Pierrot
- Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), 33 Boulevard Harry Truman, BP 15727, Port-au-Prince, Haiti
| | - Jean William Pape
- Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), 33 Boulevard Harry Truman, BP 15727, Port-au-Prince, Haiti
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Fox E, Pelto G, Rouzier V, Debrosse MG, Rasmussen K, Young S, Strupp B, Pape JW, Pelletier D. The Message Environment and Salience of Infant and Young Child Feeding Messages for Health Workers, HIV‐infected and HIV‐uninfected Mothers in Urban Haiti. FASEB J 2015. [DOI: 10.1096/fasebj.29.1_supplement.898.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Elizabeth Fox
- Division of Nutritional SciencesCornell UniversityIthacaNYUnited States
| | - Gretel Pelto
- Division of Nutritional SciencesCornell UniversityIthacaNYUnited States
| | - Vanessa Rouzier
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections GHESKIO Port‐au‐PrinceHaiti
| | - Marie Guerda Debrosse
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections GHESKIO Port‐au‐PrinceHaiti
| | | | - Sera Young
- Division of Nutritional SciencesCornell UniversityIthacaNYUnited States
| | - Barbara Strupp
- Division of Nutritional SciencesCornell UniversityIthacaNYUnited States
| | - Jean William Pape
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections GHESKIO Port‐au‐PrinceHaiti
- Weill Medical College Cornell UniversityNew YorkNYUnited States
| | - David Pelletier
- Division of Nutritional SciencesCornell UniversityIthacaNYUnited States
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Beck-Sagué CM, Dévieux JG, Pinzón-Iregui MC, Abreu-Pérez R, Lerebours-Nadal L, Gaston S, Dean AG, Halpern M, Rouzier V, Bertrand R, Rosenberg R, Pape JW, Nicholas SW, Blasini I. Depression in caregivers of status-naïve pediatric HIV patients participating in a status disclosure study in Haiti and the Dominican Republic: preliminary report. J Trop Pediatr 2015; 61:65-8. [PMID: 25389181 PMCID: PMC4375385 DOI: 10.1093/tropej/fmu060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A pilot study is underway to assess safety and acceptability of an intervention to disclose their HIV infection status to status-naïve pediatric antiretroviral therapy patients in Hispaniola [the island shared by Haiti and the Dominican Republic (DR)]. Of 22 Haiti and 47 DR caregivers recruited to date, 68.2% Haiti and 34.0% DR caregivers had clinically significant depressive symptomatology at the time of enrollment (p = 0.008). Depressive symptom prevalence was higher in Haiti caregivers who were female (81.3% vs. 0 in males; p = 0.02) and in DR caregivers who were patients' mothers (50.0%) or grandmothers (66.7%; 56.0% combined) than others (9.1%), (p < 0.001). Internalized stigma was more commonly reported by Haiti (85.7%) than DR (53.2%; p = 0.01) caregivers; 56.4% of Haiti and DR caregivers reporting internalized stigma vs. 26.1% of caregivers denying it had depressive symptoms (p = 0.02). Depression is common in Hispaniola caregivers possibly affecting disclosure timing. Study participation presents opportunities for addressing caregiver depression.
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Affiliation(s)
- Consuelo M. Beck-Sagué
- Department of Health Promotion and Disease Prevention, Florida International University, Robert Stempel College of Public Health and Social Work, Miami, FL, USA 33199
| | - Jessy G. Dévieux
- Department of Health Promotion and Disease Prevention, Florida International University, Robert Stempel College of Public Health and Social Work, Miami, FL, USA 33199
| | - María Claudia Pinzón-Iregui
- Department of Health Promotion and Disease Prevention, Florida International University, Robert Stempel College of Public Health and Social Work, Miami, FL, USA 33199
| | - Rosa Abreu-Pérez
- Robert Reid Cabral Children’s Hospital, Santo Domingo, Dominican Republic (DR)
| | | | - Stephanie Gaston
- Groupe Haïtien d’Etude du Sarcoma de Kaposi et des Infections Opportunistes (GHESKIO), Department of Adolescent Medicine, Port-au-Prince, Haiti
| | - Andrew G. Dean
- Department of Epidemiology Voluntary Faculty, University of Miami, Miami, FL, USA 33136
| | - Mina Halpern
- Clínica de Familia La Romana, Department of Research, La Romana, DR
| | - Vanessa Rouzier
- Groupe Haïtien d’Etude du Sarcoma de Kaposi et des Infections Opportunistes (GHESKIO), Department of Adolescent Medicine, Port-au-Prince, Haiti
| | - Rachel Bertrand
- Groupe Haïtien d’Etude du Sarcoma de Kaposi et des Infections Opportunistes (GHESKIO), Department of Adolescent Medicine, Port-au-Prince, Haiti
| | - Rhonda Rosenberg
- Department of Health Promotion and Disease Prevention, Florida International University, Robert Stempel College of Public Health and Social Work, Miami, FL, USA 33199
| | - Jean William Pape
- Groupe Haïtien d’Etude du Sarcoma de Kaposi et des Infections Opportunistes (GHESKIO), Department of Adolescent Medicine, Port-au-Prince, Haiti,Cornell University School of Medicine, Cornell Medical College Center for Global Health, New York, NY, USA 10065
| | - Stephen W. Nicholas
- Clínica de Familia La Romana, Department of Research, La Romana, DR,Columbia College of Physicians and Surgeons, New York, NY, USA 10032
| | - Ileana Blasini
- Department of Pediatrics Voluntary Faculty, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico 00931-1839
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Hitti J, Halvas EK, Zheng L, Panousis CG, Kabanda J, Taulo F, Kumarasamy N, Pape JW, Lalloo U, Sprenger H, Klingman KL, Chan ES, McMahon D, Mellors JW. Frequency of Antiretroviral Resistance Mutations among Infants Exposed to Single-Dose Nevirapine and Short Course Maternal Antiretroviral Regimens: ACTG A5207. ACTA ACUST UNITED AC 2014; 5. [PMID: 26525108 PMCID: PMC4625799 DOI: 10.4172/2155-6113.1000371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background Intrapartum single-dose nevirapine (sdNVP) reduces HIV-1 perinatal transmission but selects NVP resistance among mothers and infants. We evaluated the frequency of antiretroviral resistance among infants with intrauterine HIV-1 infection exposed to sdNVP and maternal antenatal or breastfeeding antiretroviral therapy. Methods This analysis included 429 infants from sub-Saharan Africa, India and Haiti whose 422 mothers received sdNVP plus maternal study treatment. At entry mothers had CD4>250/μL and were ART-naïve except for antenatal ZDV per local standard of care. Maternal study treatment started intrapartum and included ZDV/3TC, TDF/FTC or LPV/r for 7 or 21 days in a randomized factorial design. Infants received sdNVP study treatment and ZDV if local standard of care. Infant HIV RNA or DNA PCR and samples for genotype were obtained at birth and weeks 2, 4 and 12; infants who ever breast-fed were also tested at weeks 16, 24, 48 and 96. Samples from HIV-1-infected infants were tested for drug resistance by population genotype (ViroSeq). NVP or NRTI resistance mutations were assessed using the IAS-USA mutation list. Results Perinatal HIV-1 transmission occurred in 17 (4.0%) infants including 12 intrauterine infections. Resistance mutations were detected among 5 (42%) intrauterine-infected infants; of these, 3 had mutations conferring resistance to NVP alone, 1 had resistance to NRTI alone, and 1 had dual-class resistance mutations. Among the 2 infants with NRTI mutations, one (K70R) was likely maternally transmitted and one (K65R) occurred in the context of breastfeeding exposure to maternal antiretroviral therapy. Conclusions Infants with intrauterine HIV infection are at risk of acquiring resistance mutations from exposure to maternal antiretroviral medications intrapartum and/or during breastfeeding. New approaches are needed to lower the risk of antiretroviral resistance in these infants.
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Affiliation(s)
- Jane Hitti
- University of Washington, Seattle, WA, USA
| | | | - Lu Zheng
- Harvard School of Public Health, Boston, MA, USA
| | | | | | - Frank Taulo
- Queen Elizabeth Ctrl Hospital, Blantyre, Malawi
| | | | - Jean William Pape
- Weill Cornell Medical College, New York, NY and Les Centres GHESKIO, Port-au-Prince, Haiti, Newyork, USA
| | | | | | | | - Ellen S Chan
- Harvard School of Public Health, Boston, MA, USA
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45
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Gauthier M, Somoskövi A, Berland JL, Ocheretina O, Mabou MM, Boncy J, Gutierrez C, Vernet G, Pape JW. Stepwise implementation of a new diagnostic algorithm for multidrug-resistant tuberculosis in Haiti. Int J Tuberc Lung Dis 2014; 18:220-6. [PMID: 24429317 DOI: 10.5588/ijtld.13.0513] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING The uptake of tests endorsed by the World Health Organization to detect and appropriately confirm multidrug-resistant tuberculosis (MDR-TB) in low-income countries remains insufficient. OBJECTIVE To validate the implementation of line-probe assays (LPA) and liquid culture to develop an algorithm to detect MDR-TB in the challenging setting of Haiti. METHODS Through an EXPAND-TB (Expanding Access to New Diagnostics for TB) partnership, proficiency testing and validation of 221 acid-fast bacilli positive specimens were performed. Sensitivity, cost and processing time were analysed. RESULTS Using liquid vs. solid culture shortened the turnaround time from 54 to 19 days, with a sensitivity of 100% vs. 98.6% and a total cost reduction of 13%. LPA detected all TB and MDR-TB cases at a lower cost than culture, in a mean time of 7.5 days. CONCLUSION The combined use of molecular and liquid culture techniques accelerates the accurate diagnosis of TB and susceptibility testing against first-line drugs in a significantly shorter time, and is less expensive. The implementation of this new algorithm could significantly and accurately improve the screening and treatment follow-up of patients affected with TB and MDR-TB.
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Affiliation(s)
- M Gauthier
- Laboratoire des Pathogènes Emergents, Fondation Mérieux, Lyon, France; Les Centres du Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes, Port-au-Prince, Haiti
| | - A Somoskövi
- Foundation for Innovative New Diagnostics, Geneva, Switzerland
| | - J-L Berland
- Laboratoire des Pathogènes Emergents, Fondation Mérieux, Lyon, France
| | - O Ocheretina
- Center for Global Health, Weill Cornell Medical College, New York, New York, USA
| | - M-M Mabou
- Les Centres du Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes, Port-au-Prince, Haiti
| | - J Boncy
- Laboratoire National de Santé Publique, Port-au-Prince, Haiti
| | - C Gutierrez
- Foundation for Innovative New Diagnostics, Geneva, Switzerland
| | - G Vernet
- Laboratoire des Pathogènes Emergents, Fondation Mérieux, Lyon, France
| | - J W Pape
- Les Centres du Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes, Port-au-Prince, Haiti; Center for Global Health, Weill Cornell Medical College, New York, New York, USA
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46
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Kim EJ, Lee D, Moon SH, Lee CH, Kim SJ, Lee JH, Kim JO, Song M, Das B, Clemens JD, Pape JW, Nair GB, Kim DW. Molecular insights into the evolutionary pathway of Vibrio cholerae O1 atypical El Tor variants. PLoS Pathog 2014; 10:e1004384. [PMID: 25233006 PMCID: PMC4169478 DOI: 10.1371/journal.ppat.1004384] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 08/05/2014] [Indexed: 01/22/2023] Open
Abstract
Pandemic V. cholerae strains in the O1 serogroup have 2 biotypes: classical and El Tor. The classical biotype strains of the sixth pandemic, which encode the classical type cholera toxin (CT), have been replaced by El Tor biotype strains of the seventh pandemic. The prototype El Tor strains that produce biotype-specific cholera toxin are being replaced by atypical El Tor variants that harbor classical cholera toxin. Atypical El Tor strains are categorized into 2 groups, Wave 2 and Wave 3 strains, based on genomic variations and the CTX phage that they harbor. Whole-genome analysis of V. cholerae strains in the seventh cholera pandemic has demonstrated gradual changes in the genome of prototype and atypical El Tor strains, indicating that atypical strains arose from the prototype strains by replacing the CTX phages. We examined the molecular mechanisms that effected the emergence of El Tor strains with classical cholera toxin-carrying phage. We isolated an intermediary V. cholerae strain that carried two different CTX phages that encode El Tor and classical cholera toxin, respectively. We show here that the intermediary strain can be converted into various Wave 2 strains and can act as the source of the novel mosaic CTX phages. These results imply that the Wave 2 and Wave 3 strains may have been generated from such intermediary strains in nature. Prototype El Tor strains can become Wave 3 strains by excision of CTX-1 and re-equipping with the new CTX phages. Our data suggest that inter-chromosomal recombination between 2 types of CTX phages is possible when a host bacterial cell is infected by multiple CTX phages. Our study also provides molecular insights into population changes in V. cholerae in the absence of significant changes to the genome but by replacement of the CTX prophage that they harbor.
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Affiliation(s)
- Eun Jin Kim
- Department of Pharmacy, College of Pharmacy, Hanyang University, Ansan, Korea
- Institute of Pharmacological Research, Hanyang University, Ansan, Korea
| | - Dokyung Lee
- Department of Pharmacy, College of Pharmacy, Hanyang University, Ansan, Korea
- Institute of Pharmacological Research, Hanyang University, Ansan, Korea
| | - Se Hoon Moon
- Department of Pharmacy, College of Pharmacy, Hanyang University, Ansan, Korea
- Institute of Pharmacological Research, Hanyang University, Ansan, Korea
| | - Chan Hee Lee
- Department of Pharmacy, College of Pharmacy, Hanyang University, Ansan, Korea
- Institute of Pharmacological Research, Hanyang University, Ansan, Korea
| | - Sang Jun Kim
- Department of Pharmacy, College of Pharmacy, Hanyang University, Ansan, Korea
| | - Jae Hyun Lee
- Department of Pharmacy, College of Pharmacy, Hanyang University, Ansan, Korea
| | - Jae Ouk Kim
- Laboratory Science Division, International Vaccine Institute, Seoul, Korea
| | - Manki Song
- Laboratory Science Division, International Vaccine Institute, Seoul, Korea
| | - Bhabatosh Das
- Translational Health Science and Technology Institute, Gurgaon, Haryana, India
| | - John D. Clemens
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
- UCLA Fielding School of Public Health, Los Angeles, California, United States of America
| | - Jean William Pape
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medical College, New York, New York, United States of America
- Les Centres GHESKIO, Port-au-Prince, Haïti
| | - G. Balakrish Nair
- Translational Health Science and Technology Institute, Gurgaon, Haryana, India
| | - Dong Wook Kim
- Department of Pharmacy, College of Pharmacy, Hanyang University, Ansan, Korea
- Institute of Pharmacological Research, Hanyang University, Ansan, Korea
- * E-mail:
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47
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Affiliation(s)
- Jean William Pape
- From Les Centres GHESKIO, Port-au-Prince, Haiti (J.W.P., V.R.); and Center for Global Health, Division of Infectious Diseases, Weil Cornell Medical College, New York (J.W.P.)
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Haas DW, Severe P, Jean Juste MA, Pape JW, Fitzgerald DW. Functional CYP2B6 variants and virologic response to an efavirenz-containing regimen in Port-au-Prince, Haiti. J Antimicrob Chemother 2014; 69:2187-90. [PMID: 24695352 DOI: 10.1093/jac/dku088] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES Efavirenz is widely prescribed for HIV-1 infection. Three polymorphisms in CYP2B6 define plasma efavirenz trough concentration strata that vary across an ∼10-fold range. We characterized associations between human genetic polymorphisms and virologic response among participants who received efavirenz-containing regimens in a prospective clinical trial. METHODS We genotyped 76 polymorphisms in CYP2B6 (including those that define efavirenz concentration strata), CYP2A6, CYP3A4, CYP3A5 and ABCB1 and week 48 virologic responses in 360 Haitians who initiated efavirenz-containing regimens in protocol HT 001. Associations were characterized by logistic regression analysis and Fisher's exact test. RESULTS Proportions with HIV-1 RNA <50 or <200 copies/mL did not differ across 10 CYP2B6 metabolizer strata. In analyses that combined strata into three metabolizer levels (extensive, intermediate and slow), the respective proportions were 0.79, 0.79 and 0.81 (<50 copies/mL cut-off) and 0.84, 0.86 and 0.87 (<200 copies/mL cut-off). Genetic associations were not identified after controlling for baseline variables or with other polymorphisms after adjusting for multiple comparisons. CONCLUSIONS Virologic failures in HT 001 were not explained by genetic polymorphisms known to define the lowest plasma efavirenz concentration stratum.
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Affiliation(s)
- David W Haas
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | | | | | - Jean William Pape
- GHESKIO Centers, Port-au-Prince, Haiti Weill Cornell Medical College, New York, NY, USA
| | - Daniel W Fitzgerald
- GHESKIO Centers, Port-au-Prince, Haiti Weill Cornell Medical College, New York, NY, USA
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Bristow CC, Desgrottes T, Cutler L, Cutler D, Devarajan K, Ocheretina O, Pape JW, Klausner JD. The aetiology of vaginal symptoms in rural Haiti. Int J STD AIDS 2013; 25:669-75. [PMID: 24352116 DOI: 10.1177/0956462413516300] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 11/13/2013] [Indexed: 11/17/2022]
Abstract
Vaginal symptoms are a common chief complaint amongst women visiting outpatient clinics in rural Haiti. A systematic sample of 206 consecutive women over age 18 with gynaecological symptoms underwent gynaecologic examination and laboratory testing for chlamydia, gonorrhoea, syphilis, HIV infection, trichomoniasis, candidiasis, and bacterial vaginosis. Among 206 women, 174 (84%) presented with vaginal discharge, 165 (80%) with vaginal itching, 123 (60%) with vaginal pain or dysuria, and 18 (9%) with non-traumatic vaginal sores or boils. Laboratory results were positive forChlamydia trachomatisin 5.4% (11/203), syphilis in 3.5% (7/202), HIV in 1.0% (2/200), andNeisseria gonorrhoeaein 1.0% (2/203). Among those that had microscopy, hyphae suggestive of candidiasis were visualized in 2.2% (1/45) and no cases of trichomoniasis were diagnosed 0% (0/45). Bacterial vaginosis was diagnosed in 28.3% (13/46). The prevalence of chlamydia was 4.9 (95% CI: 1.3-17.7) times greater among those 25 years of age and under (10.8%) than those older (2.3%). Chlamydia and bacterial vaginosis were the most common sexually transmitted infection and vaginal condition, respectively, in this study of rural Haitian adult women. The higher risk of chlamydia in younger women suggests education and screening programmes in young women should be considered.
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Affiliation(s)
| | | | - Lauren Cutler
- Dr. Henri Gerard Desgranges Foundation, Petit Goave, Haiti
| | - David Cutler
- University of California Los Angeles, Los Angeles, CA, USA
| | | | - Oksana Ocheretina
- Weill Cornell Medical College, New York, NY, USA Les Centres GHESKIO, Port-au-Prince, Haiti
| | - Jean William Pape
- Weill Cornell Medical College, New York, NY, USA Les Centres GHESKIO, Port-au-Prince, Haiti
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Deschamps MM, Zorrilla CD, Morgan CA, Donastorg Y, Metch B, Madenwald T, Joseph P, Severe K, Garced S, Perez M, Escamilia G, Swann E, Pape JW. Recruitment of Caribbean female commercial sex workers at high risk of HIV infection. Rev Panam Salud Publica 2013; 34:92-98. [PMID: 24096973 PMCID: PMC4008335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Accepted: 07/16/2013] [Indexed: 06/02/2023] Open
Abstract
OBJECTIVE To evaluate novel eligibility criteria and outreach methods to identify and recruit women at high risk of HIV-1 infection in the Caribbean. METHODS A prospective cohort study was conducted in 2009-2012 among 799 female commercial sex workers in the Dominican Republic, Haiti, and Puerto Rico. Minimum eligibility criteria included exchange of sex for goods, services, or money in the previous 6 months and unprotected vaginal or anal sex with a man during the same period. Sites used local epidemiology to develop more stringent eligibility criteria and recruitment strategies. Participants were asked questions about HIV/AIDS and their level of concern about participating in an HIV vaccine trial. Logistic regression modeling was used to assess predictors of prevalent HIV infection and willingness to participate in a future HIV vaccine study. RESULTS HIV prevalence at screening was 4.6%. Crack cocaine use [odds ratio (OR) = 4.2, 95% confidence interval (CI) (1.8-9.0)] was associated with and having sex with clients in a hotel or motel [OR = 0.5, CI (0.3-1.0)] was inversely associated with HIV infection. A total of 88.9% of enrolled women were definitely or probably willing to participate in a future HIV vaccine trial. CONCLUSIONS This study indicated that local eligibility criteria and recruitment methods can be developed to identify and recruit commercial sex workers with higher HIV prevalence than the general population who express willingness to join an HIV vaccine trial.
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Affiliation(s)
- Marie Marcelle Deschamps
- Groupe Haitien d’Etude du Sarcome de Kaposi et des Infections Opportunistes, Port au Prince, Haiti
| | - Carmen D. Zorrilla
- Maternal and Infant Studies Center, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
| | - Cecilia A. Morgan
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Yeycy Donastorg
- Unidad de Vacunas, Instituto Dermatologico y Cirugía de Piel (IDCP)/ Centro de Orientación e Investigación Integral (COIN) / Dirección Nacional de Control de Infecciones de Transmisión Sexual y SIDA (DIGECITSS), Santo Domingo, Dominican Republic
| | - Barbara Metch
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Tamra Madenwald
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Patrice Joseph
- Groupe Haitien d’Etude du Sarcome de Kaposi et des Infections Opportunistes, Port au Prince, Haiti
| | - Karine Severe
- Groupe Haitien d’Etude du Sarcome de Kaposi et des Infections Opportunistes, Port au Prince, Haiti
| | - Sheyla Garced
- Maternal and Infant Studies Center, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
| | - Marta Perez
- Unidad de Vacunas, Instituto Dermatologico y Cirugía de Piel (IDCP)/ Centro de Orientación e Investigación Integral (COIN) / Dirección Nacional de Control de Infecciones de Transmisión Sexual y SIDA (DIGECITSS), Santo Domingo, Dominican Republic
| | - Gina Escamilia
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Edith Swann
- Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Jean William Pape
- Center for Global Health, Weill Cornell Medical College, New York, New York, United States of America
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