Impact and Cost-Effectiveness of Hypothetical Strategies to Enhance Retention in Care within HIV Treatment Programs in East Africa

Abstract Introduction. GeneXpert® MTB/RIF (Xpert) is now widely distributed in high human immunodeficiency virus (HIV)/tuberculosis (TB)-burden countries. Yet, whether the test improves patient-important outcomes within HIV treatment programs in limited resource settings is unknown. Methods. To investigate whether use of Xpert for TB screening prior to initiation of antiretroviral treatment (ART) improves patient-important outcomes, in a pragmatic randomized controlled trial we assigned 424 patients to Xpert or fluorescence sputum smear microscopy (FM) at ART initiation. The primary endpoint was a composite of 3-month mortality and ART-associated TB. Results. There was no difference in overall TB diagnosis at ART initiation (20% [n = 43] Xpert vs 21% [n = 45] FM; P = .80), with most patients in both groups treated empirically. There was no difference in time to TB treatment initiation {5 days (interquartile range [IQR], 3–13) vs 8 days [IQR, 3–23; P = .26]} or loss to follow-up (32 [15%] vs 38 [18%]; P = 0.38). Although a nonsignificant reduction in mortality occurred in the Xpert group (11 [6%] vs 17 [10%]; 95% CI, −9% to 2%; P = .19), there was no difference in the composite outcome (9% [n = 17] Xpert vs 12% [n = 21] FM; difference −3%; 95% CI, −9% to 4%). Conclusions. Among HIV-infected initiating ART, centralized TB screening with Xpert did not reduce the rate of ART-associated TB and mortality, compared with fluorescence microscopy.

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Cost-effectiveness of hepatitis C screening and treatment linkage intervention in US methadone maintenance treatment programs

Drug and Alcohol Dependence ◽

10.1016/j.drugalcdep.2017.11.031 ◽

2018 ◽

Vol 185 ◽

pp. 411-420 ◽

Cited By ~ 13

Author(s):

Bruce R. Schackman ◽

Sarah Gutkind ◽

Jake R. Morgan ◽

Jared A. Leff ◽

Czarina N. Behrends ◽

...

Keyword(s):

Cost Effectiveness ◽

Hepatitis C ◽

Methadone Maintenance Treatment ◽

Maintenance Treatment ◽

Methadone Maintenance ◽

Treatment Programs

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A Simple Novel Method for Determining Mortality Rates in HIV Treatment Programs Worldwide

PLoS Medicine ◽

10.1371/journal.pmed.1000392 ◽

2011 ◽

Vol 8 (1) ◽

pp. e1000392

Author(s):

Gregory P. Bisson

Keyword(s):

Mortality Rates ◽

Hiv Treatment ◽

Treatment Programs ◽

Novel Method

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International Normalized Ratio (INR) Increases amongst Two Patients Living with HIV on Warfarin after Being Switched from a Nevirapine to a Dolutegravir-Based Antiretroviral Regimen

Case Reports in Infectious Diseases ◽

10.1155/2021/9384663 ◽

2021 ◽

Vol 2021 ◽

pp. 1-5

Author(s):

Natalie Sang ◽

Sonak Pastakia ◽

Samuel Nyanje

Keyword(s):

Drug Interactions ◽

International Normalized Ratio ◽

Hiv Treatment ◽

Treatment Programs ◽

Cytochrome P450 Enzyme ◽

Close Monitoring ◽

Medication Regimen ◽

Emergency Plan ◽

First Case ◽

Living With Hiv

The increased use of dolutegravir-based regimens in the treatment of HIV is unmasking drug interactions, particularly in patients who were previously on nevirapine. Nevirapine is an enzyme inducer and increases the dosing requirements for cytochrome P450 enzyme substrates including warfarin. Upon discontinuing nevirapine, close monitoring of drugs with narrow therapeutic indices is paramount since dosing requirements may significantly reduce, increasing the probability of toxicity development. We present two cases describing interactions experienced by patients living with HIV, while transitioning from nevirapine to dolutegravir-based HIV regimens. The first case describes a 70-year-old man living with HIV and diabetes, while the second case describes a 60-year-old woman living with HIV. They were diagnosed with unprovoked deep vein thrombi, and while receiving treatment with warfarin, their HIV medication regimen was changed from lamivudine, zidovudine, nevirapine, and septrin to lamivudine, tenofovir, dolutegravir, and septrin. During the weeks following this switch, warfarin requirements decreased resulting in supratherapeutic INRs. With the continued promotion of dolutegravir-based HIV regimens as the preferred option for the treatment of HIV in President’s Emergency Plan for AIDS Relief (PEPFAR) supported HIV treatment programs in Africa, clinicians must be aware of the potentially life-threatening consequences of switching antiretroviral regimens. It is hoped that a greater awareness of this potential side effect could lead to increased monitoring and prevention of the consequences of drug interactions.

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Cost-Effectiveness Studies in HIV Treatment with Lopinavir/Ritonavir: A Review

Global & Regional Health Technology Assessment Italian Northern Europe and Spanish ◽

10.5301/grhta.5000184 ◽

2014 ◽

Vol 1 (2) ◽

pp. GRHTA.5000184

Author(s):

Paola Codella ◽

Silvia Coretti ◽

Alessandra Fiore ◽

Giuliano Rizzardini ◽

Matteo Ruggeri

Keyword(s):

Cost Effectiveness ◽

Hiv Treatment ◽

Effectiveness Studies

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Can TasP Approaches Be Implemented in Correctional Settings?: A review of HIV testing and linkage to community HIV treatment programs

Journal of Health Care for the Poor and Underserved ◽

10.1353/hpu.2016.0047 ◽

2016 ◽

Vol 27 (2A) ◽

pp. 71-100 ◽

Cited By ~ 5

Author(s):

Katherine S. Elkington ◽

Jessica Jaiswal ◽

Anya Y. Spector ◽

Heidi Reukauf ◽

James M. Tesoriero ◽

...

Keyword(s):

Hiv Testing ◽

Hiv Treatment ◽

Treatment Programs ◽

Correctional Settings

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Improving Retention in Care and Promoting Adherence to HIV Treatment: Protocol for a Multisite Randomized Controlled Trial of Mobile Phone Text Messaging (Preprint)

10.2196/preprints.15680 ◽

2019 ◽

Author(s):

Elvis Asangbeng Tanue ◽

Dickson Shey Nsagha ◽

Nana Njamen Theophile ◽

Jules Clement Nguedia Assob

Keyword(s):

Health Care ◽

Health Outcomes ◽

Mobile Phones ◽

Text Messaging ◽

Care Delivery ◽

Retention In Care ◽

Hiv Treatment ◽

Text Messages ◽

Adherence To Treatment ◽

Randomized Controlled

BACKGROUND The World Health Organization has prioritized the use of new technologies to assist in health care delivery in resource-limited settings. Findings suggest that the use of SMS on mobile phones is an advantageous application in health care delivery, especially in communities with an increasing use of this device. OBJECTIVE The main aim of this trial is to assess whether sending weekly motivational text messages (SMS) through mobile phones versus no text messaging will improve retention in care and promote adherence to treatment and health outcomes among patients receiving HIV treatment in Fako Division of Cameroon. METHODS This is a multisite randomized controlled single-blinded trial. Computer-generated random block sizes shall be used to produce a randomization list. Participants shall be randomly allocated into the intervention and control groups determined by serially numbered sealed opaque envelopes. The 156 participants will either receive the mobile phone text message or usual standard of care. We hypothesize that sending weekly motivational SMS reminders will produce a change in behavior to enhance retention; treatment adherence; and, hence, health outcomes. Participants shall be evaluated and data collected at baseline and then at 2, 4, and 6 months after the launch of the intervention. Text messages shall be sent out, and the delivery will be recorded. Primary outcome measures are retention in care and adherence to treatment. Secondary outcomes are clinical (weight, body mass index), biological (virologic suppression, tuberculosis coinfection), quality of life, treatment discontinuation, and mortality. The analysis shall be by intention-to-treat. Analysis of covariates shall be performed to determine factors influencing outcomes. RESULTS Recruitment and random allocation are complete; 160 participants were allocated into 3 groups (52 in the single SMS, 55 in the double SMS, and 53 in the control). Data collection and analysis are ongoing, and statistical results will be available by the end of August 2019. CONCLUSIONS The interventions will contribute to an improved understanding of which intervention types can be feasible in improving retention in care and promoting adherence to antiretroviral therapy. CLINICALTRIAL Pan African Clinical Trial Registry in South Africa PACTR201802003035922; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=3035 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/15680

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