ART initiation among women newly diagnosed with HIV in a contraceptive trial in sub-Saharan Africa

The latest HIV data for 2007 has recently been published for the United Kingdom (UK). During the year, an estimated 6,840 (95% confidence intervals 6,600-7,050) persons (adjusted for reporting delays) were newly diagnosed with HIV in the UK. This represents a 12% decline from a peak of new HIV diagnoses reported in 2005 (7,800). Almost all this decline in new HIV diagnoses was in HIV-infected heterosexuals from sub-Saharan Africa who were probably infected in their country of origin.

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Target organ damage in newly diagnosed hypertensive individuals in Yaoundé, sub Saharan Africa

Archives of Cardiovascular Diseases Supplements ◽

10.1016/j.acvdsp.2018.10.224 ◽

2019 ◽

Vol 11 (1) ◽

pp. 101-102

Author(s):

C. Nganou-Gnindjio ◽

B. Hamadou ◽

A. Tankeu ◽

J.P. Essomba ◽

J. Boombhi ◽

...

Keyword(s):

Target Organ Damage ◽

Organ Damage ◽

Target Organ ◽

Sub Saharan Africa ◽

Newly Diagnosed ◽

Sub Saharan

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Evaluating the Integrated Methadone and Anti-Retroviral Therapy Strategy in Tanzania Using the RE-AIM Framework

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16050728 ◽

2019 ◽

Vol 16 (5) ◽

pp. 728

Author(s):

Saria Hassan ◽

Alexis Cooke ◽

Haneefa Saleem ◽

Dorothy Mushi ◽

Jessie Mbwambo ◽

...

Keyword(s):

Care Delivery ◽

Sub Saharan Africa ◽

Hiv Care ◽

Hiv Positive ◽

Initiation Rate ◽

Hiv Services ◽

Art Initiation ◽

Care Integration ◽

Therapy Strategy ◽

Sub Saharan

There are an estimated 50,000 people who inject drugs in Tanzania, with an HIV prevalence in this population of 42%. The Integrated Methadone and Anti-Retroviral Therapy (IMAT) strategy was developed to integrate HIV services into an opioid treatment program (OTP) in sub-Saharan Africa and increase anti-retroviral therapy (ART) initiation rates. In this paper, we evaluate the IMAT strategy using an implementation science framework to inform future care integration efforts in the region. IMAT centralized HIV services into an OTP clinic in Dar Es Salaam, Tanzania: HIV diagnosis, ART initiation, monitoring and follow up. A mixed-methods, concurrent design, was used for evaluation: quantitative programmatic data and semi-structured interviews with providers and clients addressed 4 out of 5 components of the RE-AIM framework: reach, effectiveness, adoption, implementation. Results showed high reach: 98% of HIV-positive clients received HIV services; effectiveness: 90-day ART initiation rate doubled, from 41% pre-IMAT to 87% post-IMAT (p < 0.001); proportion of HIV-positive eligible clients on ART increased from 71% pre-IMAT to 98% post-IMAT (p < 0.001). There was high adoption and implementation protocol fidelity. Qualitative results informed barriers and facilitators of RE-AIM components. In conclusion, we successfully integrated HIV care into an OTP clinic in sub-Saharan Africa with increased rates of ART initiation. The IMAT strategy represents an effective care integration model to improve HIV care delivery for OTP clients.

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Malnutrition and associated factors among adults starting on antiretroviral therapy at PASADA Hospital in Temeke District, Tanzania

Tanzania Journal of Health Research ◽

10.4314/thrb.v20i2.5 ◽

2018 ◽

Vol 20 (2) ◽

Author(s):

Titus K. Kabalimu ◽

Edson Sungwa ◽

Warles C. Lwabukuna

Keyword(s):

Nutritional Assessment ◽

The Body ◽

Sub Saharan Africa ◽

Severe Malnutrition ◽

People Living With Hiv ◽

Cross Sectional ◽

Cd4 Cell Count ◽

Art Initiation ◽

Sub Saharan ◽

Hiv Aids

Background: Malnutrition is known to play a significant role in HIV/AIDS progression. Severe malnutrition has been previously found to be associated with early mortality among people living with HIV/AIDS (PLHIV) undergoing anti-retroviral therapy (ART) in Sub-Saharan Africa. The objective of this study was to determine the prevalence and factors associated with malnutrition among adult PLHIV attending care and treatment centre (CTC) in Temeke District, Tanzania.Methods: The cross-sectional descriptive study involved consecutive eligible patients attending the CTC for initiating in ART, between January and April, 2014. All participants who agreed to sign a consent form were enrolled. The participants had undergone baseline workup for ART initiation (by CTC), which included blood tests for liver and renal function tests, and CD4+ cell count, using calibrated instruments and standard techniques. In all patients the weight and height were measured to calculate the body mass index (BMI), denoting the nutritional status. This parameter was recorded in the study instrument together with the CD4+ count for each patient. A structured questionnaire was used to obtain more information, namely demographic and lifestyle data.Results: A total of 125 patients were included in this study. The prevalence of malnutrition among participants was 19.4%. Those with severe malnutrition comprised of 9%. Significant association was noted between malnutrition and irregular income (OR= 3.8, CI: 1.2-11.5) and also inability to get at least two meals a day (OR= 3.4, CI: 1.2-9.2). Severe malnutrition was significantly associated with the CD4+ counts of <200 cells/mm(OR =7.6; CI: 1.7-34.6).Conclusion: About 19% of participants were malnourished at the time of initiation of ART and among them 9% were severely malnourished. The most important risks for malnutrition were found to be irregular income and inability to get adequate feeding. This calls for routine nutritional assessment at CTCs prior to initiation of ART so as to identify those who need immediate intervention, including those with severe malnutrition.

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High levels of resistance to nucleoside/nucleotide reverse transcriptase inhibitors in newly-diagnosed antiretroviral treatment naive children in sub-Saharan Africa

AIDS ◽

10.1097/qad.0000000000002580 ◽

2020 ◽

Vol Publish Ahead of Print ◽

Author(s):

Seth C. Inzaule ◽

Michael R. Jordan ◽

George Bello ◽

Nellie Wadonda-Kabondo ◽

Salou Mounerou ◽

...

Keyword(s):

Reverse Transcriptase ◽

Antiretroviral Treatment ◽

Sub Saharan Africa ◽

Newly Diagnosed ◽

Reverse Transcriptase Inhibitors ◽

Treatment Naïve ◽

Sub Saharan

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Self-reported dietary intake and appetite predict early treatment outcome among low-BMI adults initiating HIV treatment in sub-Saharan Africa

Public Health Nutrition ◽

10.1017/s1368980012002960 ◽

2012 ◽

Vol 16 (3) ◽

pp. 549-558 ◽

Cited By ~ 14

Author(s):

John R Koethe ◽

Meridith Blevins ◽

Claire Bosire ◽

Christopher Nyirenda ◽

Edmond K Kabagambe ◽

...

Keyword(s):

Treatment Outcome ◽

Dietary Intake ◽

Lymphocyte Count ◽

Hiv Treatment ◽

Sub Saharan Africa ◽

Cox Models ◽

Relative Contribution ◽

Art Initiation ◽

Low Bmi ◽

Sub Saharan

AbstractObjectiveLow BMI is a major risk factor for early mortality among HIV-infected persons starting antiretrovial therapy (ART) in sub-Saharan Africa and the common patient belief that antiretroviral medications produce distressing levels of hunger is a barrier to treatment adherence. We assessed relationships between appetite, dietary intake and treatment outcome 12 weeks after ART initiation among HIV-infected adults with advanced malnutrition and immunosuppression.DesignA prospective, observational cohort study. Dietary intake was assessed using a 24 h recall survey. The relationships of appetite, intake and treatment outcome were analysed using time-varying Cox models.SettingA public-sector HIV clinic in Lusaka, Zambia.SubjectsOne hundred and forty-two HIV-infected adults starting ART with BMI <16 kg/m2and/or CD4+lymphocyte count <50 cells/μl.ResultsMedian age, BMI and CD4+lymphocyte count were 32 years, 16 kg/m2and 34 cells/μl, respectively. Twenty-five participants (18 %) died before 12 weeks and another thirty-three (23 %) were lost to care. A 500 kJ/d higher energy intake at any time after ART initiation was associated with an approximate 16 % reduction in the hazard of death (adjusted hazard ratio = 0·84;P= 0·01), but the relative contribution of carbohydrate, protein or fat to total energy was not a significant predictor of outcome. Appetite normalized gradually among survivors and hunger was rarely reported.ConclusionsPoor early ART outcomes were strikingly high in a cohort of HIV-infected adults with advanced malnutrition and mortality was predicted by lower dietary intake. Intervention trials to promote post-ART intake in this population may benefit survival and are warranted.

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Substantial impact of the HIV pandemic on migrant populations in Europe

Weekly releases (1997–2007) ◽

10.2807/esw.06.29.01922-en ◽

2002 ◽

Vol 6 (29) ◽

Author(s):

F F Hamers ◽

J Alix ◽

A M Downs

Keyword(s):

Hiv Infection ◽

Hiv Infections ◽

Sub Saharan Africa ◽

Newly Diagnosed ◽

The West ◽

Substantial Impact ◽

International Aids ◽

Migrant Populations ◽

Sub Saharan ◽

Reporting Data

An increasing and disproportionate share of the newly diagnosed HIV infections in Europe – at least in the west – is in migrants, especially in those from sub-Saharan Africa. This was the main conclusion of an analysis of European HIV case reporting data, presented to the XIV International AIDS conference in Barcelona last week (7-12 July 2002) (1). Migrant populations are often highly vulnerable to HIV infection and may experience strong barriers to prevention and care (2).

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The Problem of Late ART Initiation in Sub-Saharan Africa: A Transient Aspect of Scale-up or a Long-term Phenomenon?

Journal of Health Care for the Poor and Underserved ◽

10.1353/hpu.2013.0014 ◽

2013 ◽

Vol 24 (1) ◽

pp. 359-383 ◽

Cited By ~ 60

Author(s):

Maria Lahuerta ◽

Frances Ue ◽

Susie Hoffman ◽

Batya Elul ◽

Sarah Gorrell Kulkarni ◽

...

Keyword(s):

Scale Up ◽

Sub Saharan Africa ◽

Art Initiation ◽

Sub Saharan

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Preexisting morbidity profile of women newly diagnosed with breast cancer in sub‐Saharan Africa: African Breast Cancer—Disparities in Outcomes study

International Journal of Cancer ◽

10.1002/ijc.33387 ◽

2020 ◽

Author(s):

Oluwatosin A. Ayeni ◽

Shane A. Norris ◽

Maureen Joffe ◽

Herbert Cubasch ◽

Moses Galukande ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Disparities ◽

Sub Saharan Africa ◽

Newly Diagnosed ◽

Outcomes Study ◽

Sub Saharan ◽

Breast Cancer Disparities

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Transcriptomic biomarker pathways associated with death in HIV-infected patients with cryptococcal meningitis

BMC Medical Genomics ◽

10.1186/s12920-021-00914-1 ◽

2021 ◽

Vol 14 (1) ◽

Author(s):

Irina Vlasova-St Louis ◽

Abdu K. Musubire ◽

David B. Meya ◽

Henry W. Nabeta ◽

Hesham Mohei ◽

...

Keyword(s):

Oxidative Stress ◽

Gene Expression ◽

Innate Immunity ◽

Peripheral Blood ◽

Cryptococcal Meningitis ◽

Sub Saharan Africa ◽

Toll Like Receptor ◽

Systemic Oxidative Stress ◽

Art Initiation ◽

Sub Saharan

Abstract Background Cryptococcal meningitis (CM) is a major cause of death in HIV-infected patients in sub-Saharan Africa. Many CM patients experience cryptococcosis-associated immune reconstitution inflammatory syndrome (C-IRIS), which is often fatal. We sought to identify transcriptomic biomarker pathways in peripheral blood that are associated with or predict the development of death or fatal C-IRIS among patients with CM who were enrolled in the Cryptococcal Optimal ART Timing Trial. Methods We assessed peripheral blood gene expression using next-generation RNA sequencing in 4 groups of patients with CM: (1) no C-IRIS or Death; (2) C-IRIS survivors; (3) fatal C-IRIS; (4) Death without C-IRIS. Gene expression was assessed at the time of ART initiation, at 1, 4, and 8 weeks on ART, and at the time of C-IRIS events. Results We identified 12 inflammatory and stress response pathways, including interferon type 1 signaling, that were upregulated at the time of ART initiation in patients with future fatal C-IRIS, as compared with survivors. The upregulation of transcripts involved in innate immunity (inflammasome, Toll-like receptor signaling), was observed at the time of fatal or nonfatal C-IRIS events. At the time of fatal C-IRIS events, numerous transcripts within fMLP, Rho family GTPases, HMGB1, and other acute phase response signaling pathways were upregulated, which reflects the severity of inflammation and systemic oxidative stress. Patients who died without recognized C-IRIS also had increased expression of pathways associated with oxidative stress and tissue damage. Conclusions Our results showed that overactivated innate immunity, involving Toll-like receptor/inflammasome pathways, and inflammation-induced oxidative stress, are associated with fatal outcomes. The results of this study provide insight into the molecular drivers of death and fatal C-IRIS to inform future diagnostic test development or guide targeted treatments.

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