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Gueguen M, Nicholas S, Poulet E, Schramm B, Szumilin E, Wolters L, Wapling J, Ajule E, Rakesh A, Mwenda R, Kiyaga C, Balkan S. Implementation and operational feasibility of SAMBA I HIV-1 semi-quantitative viral load testing at the point-of-care in rural settings in Malawi and Uganda. Trop Med Int Health 2020; 26:184-194. [PMID: 33159822 DOI: 10.1111/tmi.13519] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE We monitored a large-scale implementation of the Simple Amplification-Based Assay semi-quantitative viral load test for HIV-1 version I (SAMBA I Viral Load = SAMBA I VL) within Médecins Sans Frontières' HIV programmes in Malawi and Uganda, to assess its performance and operational feasibility. METHODS Descriptive analysis of routine programme data between August 2013 and December 2016. The dataset included samples collected for VL monitoring and tested using SAMBA I VL in five HIV clinics in Malawi (four peripheral health centres and one district hospital), and one HIV clinic in a regional referral hospital in Uganda. SAMBA I VL was used for VL testing in patients who had been receiving ART for between 6 months and ten years, to determine whether plasma VL was above or below 1000 copies/mL of HIV-1, reflecting ART failure or efficacy. Randomly selected samples were quantified with commercial VL assays. SAMBA I instruments and test performance, site throughput, and delays in communicating results to clinicians and patients were monitored. RESULTS Between August 2013 and December 2016 a total of 60 889 patient samples were analysed with SAMBA I VL. Overall, 0.23% of initial SAMBA I VL results were invalid; this was reduced to 0.04% after repeating the test once. Global test failure, including instrument failure, was 1.34%. Concordance with reference quantitative testing of VL was 2620/2727, 96.0% (1338/1382, 96.8% in Malawi; 1282/1345, 95.3% in Uganda). For Chiradzulu peripheral health centres and Arua Hospital HIV clinic, where testing was performed on-site, same-day results were communicated to clinicians for between 91% and 97% of samples. Same-day clinical review was obtained for 84.7% across the whole set of samples tested. CONCLUSIONS SAMBA I VL testing is feasible for monitoring cohorts of 1000 to 5000 ART-experienced patients. Same-day results can be used to inform rapid clinical decision-making at rural and remote health facilities, potentially reducing time available for development of resistance and conceivably helping to reduce morbidity and mortality.
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Mwenda R, Fong Y, Magombo T, Saka E, Midiani D, Mwase C, Kandulu J, Wang M, Thomas R, Sherman J, Vojnov L. Significant Patient Impact Observed Upon Implementation of Point-of-Care Early Infant Diagnosis Technologies in an Observational Study in Malawi. Clin Infect Dis 2019; 67:701-707. [PMID: 29490026 PMCID: PMC6093992 DOI: 10.1093/cid/ciy169] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [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: 11/10/2017] [Accepted: 02/26/2018] [Indexed: 12/25/2022] Open
Abstract
Background In Malawi in 2014, <20% of human immunodeficiency virus (HIV)–exposed infants received an early infant diagnosis (EID) test in the first 2 months of life and only 30% of HIV-infected children were on antiretroviral therapy (ART). We sought to understand the potential patient impact of improving timely infant diagnosis and treatment initiation through implementation of point-of-care (POC) EID technologies in Malawi. Methods In this observational study, POC EID technologies were introduced into routine services at 7 health facilities across Malawi in September 2015. The primary outcome was the proportion of HIV-infected infants initiating ART within 60 days of sample collection in the POC arm compared to the baseline arm with conventional laboratory-based EID testing. Results The time from sample collection to result received by the patient decreased significantly from 56 days (interquartile range [IQR], 30–81 days) in the baseline arm to <1 day in the POC arm (P < .001). Of the HIV-infected infants, the time between sample collection and ART initiation was reduced from 38 days (IQR, 30–54 days) in the baseline arm to <1 day (IQR, 0–1 day) in the POC arm (P = .019). Furthermore, the proportion of HIV-infected infants initiated on ART within 60 days of sample collection increased significantly from 41.9% to 91.1% after the introduction of POC (adjusted risk ratio, 2.28; P < .001). Conclusions ART initiation rates were significantly improved with the implementation of same-day POC EID testing compared with referred, longer-turnaround laboratory-based testing.
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Affiliation(s)
| | - Youyi Fong
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | | | | | | | | | - Melody Wang
- Clinton Health Access Initiative, Lilongwe, Malawi
| | | | | | - Lara Vojnov
- Clinton Health Access Initiative, Lilongwe, Malawi
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Diallo K, Kim AA, Lecher S, Ellenberger D, Beard RS, Dale H, Hurlston M, Rivadeneira M, Fonjungo PN, Broyles LN, Zhang G, Sleeman K, Nguyen S, Jadczak S, Abiola N, Ewetola R, Muwonga J, Fwamba F, Mwangi C, Naluguza M, Kiyaga C, Ssewanyana I, Varough D, Wysler D, Lowrance D, Louis FJ, Desinor O, Buteau J, Kesner F, Rouzier V, Segaren N, Lewis T, Sarr A, Chipungu G, Gupta S, Singer D, Mwenda R, Kapoteza H, Chipeta Z, Knight N, Carmona S, MacLeod W, Sherman G, Pillay Y, Ndongmo CB, Mugisa B, Mwila A, McAuley J, Chipimo PJ, Kaonga W, Nsofwa D, Nsama D, Mwamba FZ, Moyo C, Phiri C, Borget MY, Ya-Kouadio L, Kouame A, Adje-Toure CA, Nkengasong J. Early Diagnosis of HIV Infection in Infants - One Caribbean and Six Sub-Saharan African Countries, 2011-2015. MMWR Morb Mortal Wkly Rep 2016; 65:1285-1290. [PMID: 27880749 DOI: 10.15585/mmwr.mm6546a2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Pediatric human immunodeficiency virus (HIV) infection remains an important public health issue in resource-limited settings. In 2015, 1.4 million children aged <15 years were estimated to be living with HIV (including 170,000 infants born in 2015), with the vast majority living in sub-Saharan Africa (1). In 2014, 150,000 children died from HIV-related causes worldwide (2). Access to timely HIV diagnosis and treatment for HIV-infected infants reduces HIV-associated mortality, which is approximately 50% by age 2 years without treatment (3). Since 2011, the annual number of HIV-infected children has declined by 50%. Despite this gain, in 2014, only 42% of HIV-exposed infants received a diagnostic test for HIV (2), and in 2015, only 51% of children living with HIV received antiretroviral therapy (1). Access to services for early infant diagnosis of HIV (which includes access to testing for HIV-exposed infants and clinical diagnosis of HIV-infected infants) is critical for reducing HIV-associated mortality in children aged <15 years. Using data collected from seven countries supported by the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), progress in the provision of HIV testing services for early infant diagnosis was assessed. During 2011-2015, the total number of HIV diagnostic tests performed among HIV-exposed infants within 6 weeks after birth (tests for early infant diagnosis of HIV), as recommended by the World Health Organization (WHO) increased in all seven countries (Cote d'Ivoire, the Democratic Republic of the Congo, Haiti, Malawi, South Africa, Uganda, and Zambia); however, in 2015, the rate of testing for early infant diagnosis among HIV-exposed infants was <50% in five countries. HIV positivity among those tested declined in all seven countries, with three countries (Cote d'Ivoire, the Democratic Republic of the Congo, and Uganda) reporting >50% decline. The most common challenges for access to testing for early infant diagnosis included difficulties in specimen transport, long turnaround time between specimen collection and receipt of results, and limitations in supply chain management. Further reductions in HIV mortality in children can be achieved through continued expansion and improvement of services for early infant diagnosis in PEPFAR-supported countries, including initiatives targeted to reach HIV-exposed infants, ensure access to programs for early infant diagnosis of HIV, and facilitate prompt linkage to treatment for children diagnosed with HIV infection.
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Zungu LI, Magombo T, Chikaonda T, Thomas R, Mwenda R, Kandulu J, Chilima B, Chiwaula M, Mbene A, Saka E. A national quality assurance programme for point-of-care testing in Malawi. Afr J Lab Med 2016; 5:540. [PMID: 28879130 PMCID: PMC5433829 DOI: 10.4102/ajlm.v5i2.540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 08/11/2016] [Indexed: 11/09/2022] Open
Affiliation(s)
- Lutho I Zungu
- Ministry of Health Directorate of Health Technical services - Diagnostics, Lilongwe, Malawi
| | | | - Tarsizio Chikaonda
- University of North Carolina (UNC) HIV/AIDS Research Project Laboratory, Lilongwe, Malawi
| | | | - Reuben Mwenda
- Ministry of Health Directorate of Health Technical services - Diagnostics, Lilongwe, Malawi
| | - James Kandulu
- Ministry of Health Directorate of Health Technical services - Diagnostics, Lilongwe, Malawi
| | - Benson Chilima
- National Reference Laboratories, Community Health Sciences Unit (CHSU), Lilongwe, Malawi
| | - Mavuto Chiwaula
- National Reference Laboratories, Community Health Sciences Unit (CHSU), Lilongwe, Malawi
| | - Alwin Mbene
- Northern Health Zone, Ministry of Health, Lilongwe, Malawi
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Witek-McManus S, Mathanga DP, Verney A, Mtali A, Ali D, Sande J, Mwenda R, Ndau S, Mazinga C, Phondiwa E, Chimuna T, Melody D, Roschnik N, Brooker SJ, Halliday KE. Design, implementation and evaluation of a training programme for school teachers in the use of malaria rapid diagnostic tests as part of a basic first aid kit in southern Malawi. BMC Public Health 2015; 15:904. [PMID: 26377070 PMCID: PMC4573472 DOI: 10.1186/s12889-015-2228-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [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: 02/02/2015] [Accepted: 09/04/2015] [Indexed: 11/12/2022] Open
Abstract
Background With increasing levels of enrolment, primary schools present a pragmatic opportunity to improve the access of school children to timely diagnosis and treatment of malaria, increasingly recognised as a major health problem within this age group. The expanded use of malaria rapid diagnostic tests (RDTs) and artemisinin combination therapy (ACT) by community health workers (CHWs) has raised the prospect of whether teachers can provide similar services for school children. We describe and evaluate the training of primary school teachers to use a first aid kit containing malaria RDTs and ACT for the diagnosis and treament of uncomplicated malaria in school children in southern Malawi. Methods We outline the development of the intervention as: (1) conception and design, (2) pilot training, (3) final training, and (4) 7-month follow up. The training materials were piloted at a four-day workshop in July 2013 following their design at national stakeholders meetings. The evaluation of the pilot training and materials were assessed in relation to increased knowledge and skill sets using checklist evaluations and questionnaires, the results of which informed the design of a final seven-day training programme held in December 2013. A follow up of trained teachers was carried out in July 2014 following 7 months of routine implementation. A total of 15 teachers were evaluated at four stages: pilot training, two weeks following pilot, final training and seven months following final training. Results A total of 15 and 92 teachers were trained at the pilot and final training respectively. An average of 93 % of the total steps required to use RDTs were completed correctly at the final training, declining to 87 % after 7 months. All teachers were observed correctly undertaking safe blood collection and handling, accurate RDT interpretation, and correct dispensing of ACT. The most commonly observed errors were a failure to wait 20 minutes before reading the test result, and adding an incorrect volume of buffer to the test cassette. Conclusion Following training, teachers are able to competently use RDTs and ACTs test and treat children at school for uncomplicated malaria safely and accurately. Teachers demonstrate a comparable level of RDT use relative to non-health professional users of RDTs, and sustain this competency over a period of seven months during routine implementation.
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Affiliation(s)
- Stefan Witek-McManus
- Save the Children International, Zomba, Malawi. .,Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.
| | - Don P Mathanga
- Malaria Alert Centre, College of Medicine, University of Malawi, Blantyre, Malawi.
| | | | | | - Doreen Ali
- National Malaria Control Programme, Ministry of Health, Lilongwe, Malawi.
| | - John Sande
- National Malaria Control Programme, Ministry of Health, Lilongwe, Malawi.
| | - Reuben Mwenda
- Health Technical Support Services-Diagnostics, Ministry of Health, Lilongwe, Malawi.
| | - Saidi Ndau
- Zomba District Health Office, Ministry of Health, Zomba, Malawi.
| | - Charles Mazinga
- Department of School Health, Nutrition, HIV & AIDS, Ministry of Education, Science & Technology, Lilongwe, Malawi.
| | - Emmanuel Phondiwa
- Zomba District Education Office, Ministry of Education, Science & Technology, Zomba, Malawi.
| | | | | | | | - Simon J Brooker
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.
| | - Katherine E Halliday
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.
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Rutstein SE, Golin CE, Wheeler SB, Kamwendo D, Hosseinipour MC, Weinberger M, Miller WC, Biddle AK, Soko A, Mkandawire M, Mwenda R, Sarr A, Gupta S, Mataya R. On the front line of HIV virological monitoring: barriers and facilitators from a provider perspective in resource-limited settings. AIDS Care 2015; 28:1-10. [PMID: 26278724 DOI: 10.1080/09540121.2015.1058896] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Scale-up of viral load (VL) monitoring for HIV-infected patients on antiretroviral therapy (ART) is a priority in many resource-limited settings, and ART providers are critical to effective program implementation. We explored provider-perceived barriers and facilitators of VL monitoring. We interviewed all providers (n = 17) engaged in a public health evaluation of dried blood spots for VL monitoring at five ART clinics in Malawi. All ART clinics were housed within district hospitals. We grouped themes at patient, provider, facility, system, and policy levels. Providers emphasized their desire for improved ART monitoring strategies, and frustration in response to restrictive policies for determining which patients were eligible to receive VL monitoring. Although many providers pled for expansion of monitoring to include all persons on ART, regardless of time on ART, the most salient provider-perceived barrier to VL monitoring implementation was the pressure of work associated with monitoring activities. The work burden was exacerbated by inefficient data management systems, highlighting a critical interaction between provider-, facility-, and system-level factors. Lack of integration between laboratory and clinical systems complicated the process for alerting providers when results were available, and these communication gaps were intensified by poor facility connectivity. Centralized second-line ART distribution was also noted as a barrier: providers reported that the time and expenses required for patients to collect second-line ART frequently obstructed referral. However, provider empowerment emerged as an unexpected facilitator of VL monitoring. For many providers, this was the first time they used an objective marker of ART response to guide clinical management. Providers' knowledge of a patient's virological status increased confidence in adherence counseling and clinical decision-making. Results from our study provide unique insight into provider perceptions of VL monitoring and indicate the importance of policies responsive to individual and environmental challenges of VL monitoring program implementation. Findings may inform scale-up by helping policy-makers identify strategies to improve feasibility and sustainability of VL monitoring.
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Affiliation(s)
- S E Rutstein
- a Department of Health Policy and Management , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA.,b Department of Medicine , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - C E Golin
- c Department of Health Behavior , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - S B Wheeler
- a Department of Health Policy and Management , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | | | - M C Hosseinipour
- b Department of Medicine , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA.,d UNC Project , Lilongwe , Malawi
| | - M Weinberger
- a Department of Health Policy and Management , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - W C Miller
- b Department of Medicine , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA.,e Department of Epidemiology , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - A K Biddle
- a Department of Health Policy and Management , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - A Soko
- d UNC Project , Lilongwe , Malawi
| | - M Mkandawire
- f School of Public Health , Loma Linda University , Loma Linda , CA , USA
| | - R Mwenda
- g Ministry of Health , Lilongwe , Malawi
| | - A Sarr
- h Centers for Disease Control , Lilongwe , Malawi
| | - S Gupta
- h Centers for Disease Control , Lilongwe , Malawi
| | - R Mataya
- f School of Public Health , Loma Linda University , Loma Linda , CA , USA
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Abstract
Background Malawi has a high burden of infectious disease. The expansion of programmes targeting these diseases requires a strong laboratory infrastructure to support both diagnosis and treatment. Objectives To assess the use of laboratory test results in patient management and to determine the requirements for improving laboratory services. Methods: A cross-sectional study was conducted in 2012 to survey practising clinicians. Two hospitals were purposively selected for observations of clinicians ordering laboratory tests. Twelve management-level key informants were interviewed. Descriptive statistics were conducted. Results A total of 242 clinicians were identified and 216 (89%) were interviewed. Of these, 189 (87%) reported doubting laboratory test results at some point. Clinicians most often doubted the quality of haematology (67%), followed by malaria (53%) and CD4 (22%) test results. A total of 151 (70%) clinicians reported using laboratory tests results in patient management. Use of laboratory test results at all times in patient management varied by the type of health facility (P < 0.001). Ninety-one percent of clinicians reported that laboratories required infrastructure improvement. During 97 observations of clinicians’ use of laboratory test results, 80 tests were ordered, and 73 (91%) of these were used in patient management. Key informants reported that the quality of laboratory services was good and useful, but that services were often unavailable. Conclusion Gaps in the public laboratory system were evident. Key recommendations to enhance the use of laboratory test results in patient management were to strengthen the supply chain, reduce turn-around times, improve the test menu and improve the laboratory infrastructure.
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Affiliation(s)
- Kundai Moyo
- Howard University, Technical Assistance Project, Lilongwe, Malawi
| | - Carol Porter
- Howard University, Technical Assistance Project, Lilongwe, Malawi
| | - Ben Chilima
- Preventive Health Services, Ministry of Health, Lilongwe, Malawi
| | - Reuben Mwenda
- Health Technical Support Services (Diagnostics), Lilongwe, Malawi
| | - Mark Kabue
- Howard University, Technical Assistance Project, Lilongwe, Malawi
| | - Lutho Zungu
- Health Technical Support Services (Diagnostics), Lilongwe, Malawi
| | - Abdoulaye Sarr
- Senior Laboratory Advisor, Centers for Disease Control and Prevention, Lilongwe, Malawi
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Rutstein SE, Hosseinipour MC, Kamwendo D, Soko A, Mkandawire M, Biddle AK, Miller WC, Weinberger M, Wheeler SB, Sarr A, Gupta S, Chimbwandira F, Mwenda R, Kamiza S, Hoffman I, Mataya R. Dried blood spots for viral load monitoring in Malawi: feasible and effective. PLoS One 2015; 10:e0124748. [PMID: 25898365 PMCID: PMC4405546 DOI: 10.1371/journal.pone.0124748] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [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: 01/19/2015] [Accepted: 03/05/2015] [Indexed: 11/24/2022] Open
Abstract
Objectives To evaluate the feasibility and effectiveness of dried blood spots (DBS) use for viral load (VL) monitoring, describing patient outcomes and programmatic challenges that are relevant for DBS implementation in sub-Saharan Africa. Methods We recruited adult antiretroviral therapy (ART) patients from five district hospitals in Malawi. Eligibility reflected anticipated Ministry of Health VL monitoring criteria. Testing was conducted at a central laboratory. Virological failure was defined as >5000 copies/ml. Primary outcomes were program feasibility (timely result availability and patient receipt) and effectiveness (second-line therapy initiation). Results We enrolled 1,498 participants; 5.9% were failing at baseline. Median time from enrollment to receipt of results was 42 days; 79.6% of participants received results within 3 months. Among participants with confirmed elevated VL, 92.6% initiated second-line therapy; 90.7% were switched within 365 days of VL testing. Nearly one-third (30.8%) of participants with elevated baseline VL had suppressed (<5,000 copies/ml) on confirmatory testing. Median period between enrollment and specimen testing was 23 days. Adjusting for relevant covariates, participants on ART >4 years were more likely to be failing than participants on therapy 1–4 years (RR 1.7, 95% CI 1.0-2.8); older participants were less likely to be failing (RR 0.95, 95% CI 0.92-0.98). There was no difference in likelihood of failure based on clinical symptoms (RR 1.17, 95% CI 0.65-2.11). Conclusions DBS for VL monitoring is feasible and effective in real-world clinical settings. Centralized DBS testing may increase access to VL monitoring in remote settings. Programmatic outcomes are encouraging, especially proportion of eligible participants switched to second-line therapy.
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Affiliation(s)
- Sarah E. Rutstein
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
- * E-mail:
| | - Mina C. Hosseinipour
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
- University of North Carolina Project, Lilongwe, Malawi
| | | | - Alice Soko
- University of North Carolina Project, Lilongwe, Malawi
| | - Memory Mkandawire
- School of Public Health, Loma Linda University, Loma Linda, California, United States
| | - Andrea K. Biddle
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| | - William C. Miller
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| | - Morris Weinberger
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| | - Stephanie B. Wheeler
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| | | | | | | | | | | | - Irving Hoffman
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| | - Ronald Mataya
- School of Public Health, Loma Linda University, Loma Linda, California, United States
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Rutstein SE, Hosseinipour M, Soko A, Mkandawire M, Stein E, Mclendon C, Kamwendo D, Kadiwa M, Paladar E, Sarr A, Gupta S, Chimbwandira F, Mwenda R, Mataya R. 1570Low rates of virologic failure among previously unmonitored patients in Malawi. Open Forum Infect Dis 2014. [PMCID: PMC5781453 DOI: 10.1093/ofid/ofu052.1116] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Sarah E. Rutstein
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Alice Soko
- University of North Carolina Project, Lilongwe, Malawi
| | | | - Eva Stein
- University of North Carolina Project, Lilongwe, Malawi
| | | | | | - Mary Kadiwa
- University of North Carolina Project, Lilongwe, Malawi
| | | | - Abdoulaye Sarr
- Centers for Disease Control and Prevention Malawi, Lilongwe, Malawi
| | - Sundeep Gupta
- Centers for Disease Control and Prevention, Atlanta, GA
| | | | | | - Ronald Mataya
- School of Public Health, Loma Linda University, Loma Linda, CA
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10
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Rutstein SE, Kamwendo D, Lugali L, Thengolose I, Tegha G, Fiscus SA, Nelson JAE, Hosseinipour MC, Sarr A, Gupta S, Chimbwandira F, Mwenda R, Mataya R. Measures of viral load using Abbott RealTime HIV-1 Assay on venous and fingerstick dried blood spots from provider-collected specimens in Malawian District Hospitals. J Clin Virol 2014; 60:392-8. [PMID: 24906641 DOI: 10.1016/j.jcv.2014.05.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 05/06/2014] [Accepted: 05/10/2014] [Indexed: 01/13/2023]
Abstract
BACKGROUND Viral suppression is a key indicator of antiretroviral therapy (ART) response among HIV-infected patients. Dried blood spots (DBS) are an appealing alternative to conventional plasma-based virologic testing, improving access to monitoring in resource-limited settings. However, validity of DBS obtained from fingerstick in field settings remains unknown. OBJECTIVES Investigate feasibility and accuracy of DBS vs plasma collected by healthcare workers in real-world settings of remote hospitals in Malawi. Compare venous DBS to fingerstick DBS for identifying treatment failure. STUDY DESIGN We recruited patients from ART clinics at two district hospitals in Malawi, collecting plasma, venous DBS (vDBS), and fingerstick DBS (fsDBS) cards for the first 149 patients, and vDBS and fsDBS only for the subsequent 398 patients. Specimens were tested using Abbott RealTime HIV-1 Assay (lower detection limit 40 copies/ml (plasma) and 550 copies/ml (DBS)). RESULTS 21/149 (14.1%) had detectable viremia (>1.6 log copies/ml), 13 of which were detectable for plasma, vDBS, and fsDBS. Linear regression demonstrated high correlation for plasma vs. DBS (vDBS: β=1.19, R(2)=0.93 (p<0.0001); fsDBS β=1.20, R(2)=0.90 (p<0.0001)) and vDBS vs. fsDBS (β=0.88, R(2)=0.73, (p<0.0001)). Mean difference between plasma and vDBS was 1.1 log copies/ml [SD: 0.27] and plasma and fsDBS 1.1 log copies/ml [SD: 0.31]. At 5000 copies/ml, sensitivity was 100%, and specificity was 98.6% and 97.8% for vDBS and fsDBS, respectively, compared to plasma. CONCLUSIONS DBS from venipuncture and fingerstick perform well at the failure threshold of 5000 copies/ml. Fingerstick specimen source may improve access to virologic treatment monitoring in resource-limited settings given task-shifting in high-volume, low-resource facilities.
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Affiliation(s)
- Sarah E Rutstein
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
| | | | | | | | | | - Susan A Fiscus
- UNC Center for AIDS Research and Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Julie A E Nelson
- UNC Center for AIDS Research and Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Mina C Hosseinipour
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; UNC Project, Lilongwe, Malawi
| | | | | | | | | | - Ronald Mataya
- School of Public Health, Loma Linda University, United States
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11
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Lin HH, Langley I, Mwenda R, Doulla B, Egwaga S, Millington KA, Mann GH, Murray M, Squire SB, Cohen T. A modelling framework to support the selection and implementation of new tuberculosis diagnostic tools [State of the art series. Operational research. Number 8 in the series]. Int J Tuberc Lung Dis 2011; 15:996-1004. [DOI: 10.5588/ijtld.11.0062] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- H-H. Lin
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan; International Union Against Tuberculosis and Lung Disease, Paris, France; and Department of Community Health, Mennonite Christian Hospital, Hualien,
Taiwan
| | - I. Langley
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - R. Mwenda
- Health Technical Support Services (Diagnostics), Ministry of Health, Lilongwe, Malawi
| | - B. Doulla
- National Tuberculosis and Leprosy Control Program, Ministry of Health and Social Welfare, Dar es Salaam, Tanzania
| | - S. Egwaga
- National Tuberculosis and Leprosy Control Program, Ministry of Health and Social Welfare, Dar es Salaam, Tanzania
| | | | - G. H. Mann
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - M. Murray
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
| | - S. B. Squire
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - T. Cohen
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA; and Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
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12
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Zachariah R, Harries AD, Spielmann MP, Arendt V, Nchingula D, Mwenda R, Courtielle O, Kirpach P, Mwale B, Salaniponi F. Changes in Escherichia coli resistance to co-trimoxazole in tuberculosis patients and in relation to co-trimoxazole prophylaxis in Thyolo, Malawi. Malawi Med J 2002; 14:10-2. [PMID: 27528931 DOI: 10.4314/mmj.v14i2.10759] [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] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In Thyolo district, Malawi, an operational research study is being conducted on the efficacy and feasibility of co-trimoxazole prophylaxis in preventing deaths in HIV-positive patients with tuberculosis (TB). A series of cross-sectional studies were carried out to determine i) whether faecal Escherichia coli (E.coli) resistance to co-trimoxazole in TB patients changed with time and ii) whether the resistance pattern was different in HIV positive TB patients who were taking co-trimoxazole prophylaxis. Co-trimoxazole resistance among E.coli isolates in TB patients at the time of registration was 60% in 1999 and 77% in 2001 (p<0.01). Resistance was 89% among HIV-infected TB patients (receiving co-trimoxazole), while in HIV negative patients (receiving anti-TB therapy alone) it was 62% (p<0.001). The study shows a significant increase of E.coli resistance to co-trimoxazole in TB patients which is particularly prominent in HIV infected patients on co-trimoxazole prophylaxis. Since a high degree of plasmid-mediated transfer of resistance exists between E.coli and the Salmonella species, these findings could herald limitations on the short and long term benefits to be anticipated from the use of co-trimoxazole prophylaxis in preventing non-typhoidal salmonella bacteraemia and enteritis in HIV infected TB patients in Malawi.
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Affiliation(s)
- R Zachariah
- Medecins Sans Frontieres - Luxembourg, Thyolo district, Malawi
| | - A D Harries
- National Tuberculosis control program of Malawi / DFID
| | - M P Spielmann
- Medecins Sans Frontieres - Luxembourg, Thyolo district, Malawi
| | - V Arendt
- Tropical and Infectious Diseases Hospital and Reference laboratory, Luxembourg
| | | | - R Mwenda
- Queen Elizabeth Central Hospital regional reference laboratory services, Blantyre, Malawi
| | - O Courtielle
- Tropical and Infectious Diseases Hospital and Reference laboratory, Luxembourg
| | - P Kirpach
- Tropical and Infectious Diseases Hospital and Reference laboratory, Luxembourg
| | - B Mwale
- Queen Elizabeth Central Hospital regional reference laboratory services, Blantyre, Malawi
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13
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Kumwenda JJ, Mwenda R. An audit of urine culture results at Queen Elizabeth Central Hospital (QECH) in 1994-95 and 1999-2001. Malawi Med J 2002; 14:15-17. [PMID: 27528918 PMCID: PMC3345412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
We conducted a retrospective audit of urine cultures at the Queen Elizabeth Central Hospital (QECH), Blantyre. The aims of the audit were to determine the common organisms cultured from urine, in 1994-5 and in 1999-2001, and the sensitivity of these organisms to the first and second line drugs used in the management of urinary tract infection (UTI) in Malawi. A total of 401 samples were studied. One hundred and thirty-six of these grew isolates that were considered pathogenic. E. coli was isolated in 50% of the cultures. Isolates were sensitive to cotrimoxazole and nitrofurantoin (the recommended first-line treatments in Malawi) in only 13% and 48% of cultures, and sensitive to gentamicin in 40% and augmentin in 20% of cases. Levels of drug resistance did not differ between 1994 and 2001. Antibiotic policies for the management of UTI need to be reviewed in the light of the high isolate resistance to the two first line drugs used in the treatment of UTI in Malawi.
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Affiliation(s)
- J J Kumwenda
- Department of Medicine, College of Medicine, P/Bag 360, Blantyre 3
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14
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Zachariah R, Harries AD, Spielmann MP, Arendt V, Nchingula D, Mwenda R, Courtielle O, Kirpach P, Mwale B, Salaniponi FML. Changes in Escherichia coli resistance to co-trimoxazole in tuberculosis patients and in relation to co-trimoxazole prophylaxis in Thyolo, Malawi. Trans R Soc Trop Med Hyg 2002; 96:202-4. [PMID: 12055816 DOI: 10.1016/s0035-9203(02)90306-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In Thyolo district, Malawi, an operational research study is being conducted on the efficacy and feasibility of co-trimoxazole prophylaxis in preventing deaths in HIV-positive patients with tuberculosis (TB). A series of cross-sectional studies were carried out in 1999 and 2001 to determine (i) whether faecal Escherichia coli resistance to co-trimoxazole in TB patients changed with time, and (ii) whether the resistance pattern was different in HIV-positive TB patients who were taking co-trimoxazole prophylaxis. Co-trimoxazole resistance among E. coli isolates in TB patients at the time of registration was 60% in 1999 and 77% in 2001 (P < 0.01). Resistance was 89% among HIV-infected TB patients (receiving cotrimoxazole), while in HIV-negative patients (receiving anti-TB therapy alone) it was 62% (P < 0.001). The study shows a significant increase of E. coli resistance to co-trimoxazole in TB patients which is particularly prominent in HIV-infected patients on co-trimoxazole prophylaxis. Since a high degree of plasmid-mediated transfer of resistance exists between E. coli and the Salmonella species, these findings could herald limitations on the short- and long-term benefits to be expected from the use of co-trimoxazole prophylaxis in preventing non-typhoid Salmonella bacteraemia and enteritis in HIV-infected TB patients in Malawi.
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Affiliation(s)
- R Zachariah
- Médecins sans Frontières-Luxembourg, Thyolo District, Malawi.
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