scholarly journals Integrating health services for HIV infection, diabetes and hypertension in sub-Saharan Africa: a cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. e053412
Author(s):  
Josephine Birungi ◽  
Sokoine Kivuyo ◽  
Anupam Garrib ◽  
Levicatus Mugenyi ◽  
Gerald Mutungi ◽  
...  
Keyword(s):  
Cohort Study ◽  
Viral Load ◽  
Hiv Infection ◽  
Integrated Care ◽  
Plasma Viral Load ◽  
Integrated Management ◽  
Retention In Care ◽  
Health Facilities ◽  
Sub Saharan Africa ◽  
Sub Saharan

BackgroundHIV, diabetes and hypertension have a high disease burden in sub-Saharan Africa. Healthcare is organised in separate clinics, which may be inefficient. In a cohort study, we evaluated integrated management of these conditions from a single chronic care clinic.ObjectivesTo determined the feasibility and acceptability of integrated management of chronic conditions in terms of retention in care and clinical indicators.Design and settingProspective cohort study comprising patients attending 10 health facilities offering primary care in Dar es Salaam and Kampala.InterventionClinics within health facilities were set up to provide integrated care. Patients with either HIV, diabetes or hypertension had the same waiting areas, the same pharmacy, were seen by the same clinical staff, had similar provision of adherence counselling and tracking if they failed to attend appointments.Primary outcome measuresRetention in care, plasma viral load.FindingsBetween 5 August 2018 and 21 May 2019, 2640 patients were screened of whom 2273 (86%) were enrolled into integrated care (832 with HIV infection, 313 with diabetes, 546 with hypertension and 582 with multiple conditions). They were followed up to 30 January 2020. Overall, 1615 (71.1%)/2273 were female and 1689 (74.5%)/2266 had been in care for 6 months or more. The proportions of people retained in care were 686/832 (82.5%, 95% CI: 79.9% to 85.1%) among those with HIV infection, 266/313 (85.0%, 95% CI: 81.1% to 89.0%) among those with diabetes, 430/546 (78.8%, 95% CI: 75.4% to 82.3%) among those with hypertension and 529/582 (90.9%, 95% CI: 88.6 to 93.3) among those with multimorbidity. Among those with HIV infection, the proportion with plasma viral load <100 copies/mL was 423(88.5%)/478.ConclusionIntegrated management of chronic diseases is a feasible strategy for the control of HIV, diabetes and hypertension in Africa and needs evaluation in a comparative study.

scholarly journals Integrating Health Services for HIV-Infection, Diabetes and Hypertension in Sub Saharan Africa: A Cohort Study

2020 ◽  
Author(s):  
Josephine Birungi ◽  
Sokoine L. Kivuyo ◽  
Anupam V. Garrib ◽  
Levicatus Mugenyi ◽  
Gerald Mutungi ◽  
...  
Keyword(s):  
Cohort Study ◽  
Health Services ◽  
Hiv Infection ◽  
Sub Saharan Africa ◽  
Sub Saharan

scholarly journals Long-term outcomes of early initiated antiretroviral therapy in sub-Saharan children: a Cameroonian cohort study (ANRS-12140 Pediacam study, 2008–2013, Cameroon)

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Francis Ateba Ndongo ◽  
Mathurin Cyrille Tejiokem ◽  
Calixte Ida Penda ◽  
Suzie Tetang Ndiang ◽  
Jean-Audrey Ndongo ◽  
...  
Keyword(s):  
Cohort Study ◽  
Viral Load ◽  
Antiretroviral Therapy ◽  
Antiretroviral Treatment ◽  
Viral Suppression ◽  
Virologic Response ◽  
Sub Saharan Africa ◽  
Factors Associated ◽  
Sub Saharan

Abstract Background In most studies, the virological response is assessed during the first two years of antiretroviral treatment initiated in HIV-infected infants. However, early initiation of antiretroviral therapy exposes infants to very long-lasting treatment. Moreover, maintaining viral suppression in children is difficult. We aimed to assess the virologic response and mortality in HIV-infected children after five years of early initiated antiretroviral treatment (ART) and identify factors associated with virologic success in Cameroon. Methods In the ANRS-12140 Pediacam cohort study, 2008–2013, Cameroon, we included all the 149 children who were still alive after two years of early ART. Virologic response was assessed after 5 years of treatment. The probability of maintaining virologic success between two and five years of ART was estimated using Kaplan-Meier curve. The immune status and mortality were also studied at five years after ART initiation. Factors associated with a viral load < 400 copies/mL in children still alive at five years of ART were studied using logistic regressions. Results The viral load after five years of early ART was suppressed in 66.8% (60.1–73.5) of the 144 children still alive and in care. Among the children with viral suppression after two years of ART, the probability of maintaining viral suppression after five years of ART was 64.0% (54.0–74.0). The only factor associated with viral suppression after five years of ART was achievement of confirmed virological success within the first two years of ART (OR = 2.7 (1.1–6.8); p = 0.033). Conclusions The probability of maintaining viral suppression between two and five years of early initiated ART which was quite low highlights the difficulty of parents to administer drugs daily to their children in sub-Saharan Africa. It also stressed the importance of initial viral suppression for achieving and maintaining virologic success in the long-term. Further studies should focus on identifying strategies that would enhance better retention in care and improved adherence to treatment within the first two years of ART early initiated in Sub-Saharan HIV-infected children.

scholarly journals Effect of Community ART Groups on retention-in-care among patients on ART in Tete Province, Mozambique: a cohort study

BMJ Open ◽  
2017 ◽  
Vol 7 (8) ◽  
pp. e016800 ◽  
Author(s):  
Tom Decroo ◽  
Barbara Telfer ◽  
Carla Das Dores ◽  
Richard A White ◽  
Natacha Dos Santos ◽  
...  
Keyword(s):  
Cohort Study ◽  
Health Facility ◽  
Cox Regression ◽  
Retention In Care ◽  
Sub Saharan Africa ◽  
Community Art ◽  
Loss To Follow Up ◽  
Individual Care ◽  
Sub Saharan ◽  
Delivery Models

ObjectivesEstimate the effect of participation in Community ART Groups (CAG) versus individual care on retention-in-care (RIC) on antiretroviral therapy (ART).DesignRetrospective cohort study.SettingHigh levels of attrition (death or loss-to-follow-up (LTFU) combined) on ART indicate that delivery models need to adapt in sub-Saharan Africa. In 2008, patients more than 6 months on ART began forming CAG, and took turns to collect ART refills at the health facility, in Tete Province, Mozambique,.Participants2406 adult patients, retained in care for at least 6 months after starting ART, during the study period (date of CAG introduction at the health facility—30 April 2012).MethodsData up to 30 April 2012 were collected from patient records at eight health facilities. Survival analysis was used to compare RIC among patients in CAG and patients in individual care, with joining a CAG treated as an irreversible time-dependent variable. Multivariable Cox regression was used to estimate the effect of CAG on RIC, adjusted for age, sex and health facility type and stratified by calendar cohort.Results12-month and 24-monthRIC from the time of eligibility were, respectively, 89.5% and 82.3% among patients in individual care and 99.1% and 97.5% among those in CAGs (p<0.0001). CAG members had a greater than fivefold reduction in risk of dying or being LTFU (adjusted HR: 0.18, 95% CI 0.11 to 0.29).ConclusionsAmong patients on ART, RIC was substantially better among those in CAGs than those in individual care. This study confirms that patient-driven ART distribution through CAGs results in higher RIC among patients who are stable on ART.

scholarly journals Evaluation of near point‐of‐care viral load implementation in public health facilities across seven countries in sub‐Saharan Africa

2021 ◽  
Vol 24 (1) ◽  
Author(s):  
Caroline E Boeke ◽  
Jessica Joseph ◽  
Charles Atem ◽  
Clement Banda ◽  
Khady Diatou Coulibaly ◽  
...  
Keyword(s):  
Public Health ◽  
Viral Load ◽  
Point Of Care ◽  
Health Facilities ◽  
Sub Saharan Africa ◽  
Public Health Facilities ◽  
Sub Saharan

scholarly journals Predictors of Attrition in Patients Ineligible for Antiretroviral Therapy after Being Diagnosed with HIV: Data from an HIV Cohort Study in India

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Gerardo Alvarez-Uria ◽  
Manoranjan Midde ◽  
Raghavakalyan Pakam ◽  
Praveen Kumar Naik
Keyword(s):  
Cohort Study ◽  
Antiretroviral Therapy ◽  
Retention In Care ◽  
Sub Saharan Africa ◽  
Hiv Diagnosis ◽  
Disadvantaged Community ◽  
Middle Income ◽  
Cell Counts ◽  
Sub Saharan

In newly HIV-diagnosed patients, the CD4+ lymphocyte count is measured to determine the need for antiretroviral therapy (ART). Studies from Sub-Saharan Africa have shown that patients who are ART ineligible at the first assessment have poor retention in care, but data from other low- or middle-income countries are scarce. In this study we describe the retention in pre-ART care of 1696 patients who were ineligible for ART after being diagnosed with HIV in a cohort study in India. More than one-third of ART ineligible patients had poor retention in care, and the attrition was higher in those with longer follow-up periods. Of those patients with poor retention, only 10% came back to the clinics, and their CD4 cell counts were lower than the ones of patients retained in care. After 4.5 years of follow-up, the cumulative incidence of loss to follow-up was 50%. Factors associated with attrition were being homeless, being illiterate, belonging to a disadvantaged community, being symptomatic at the time of the HIV diagnosis, male gender, and not living near a town. Widows were given nutritional support and, therefore, had better retention in care. The results of this study highlight the need to improve the retention in care of ART ineligible patients in India.

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