scholarly journals Entry, Retention, and Virological Suppression in an HIV Cohort Study in India: Description of the Cascade of Care and Implications for Reducing HIV-Related Mortality in Low- and Middle-Income Countries

2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
Gerardo Alvarez-Uria ◽  
Raghavakalyan Pakam ◽  
Manoranjan Midde ◽  
Praveen Kumar Naik
Keyword(s):  
Cohort Study ◽  
Total Mortality ◽  
Hiv Treatment ◽  
Virological Suppression ◽  
Timely Initiation ◽  
Middle Income ◽  
Middle Income Countries ◽  
Art Initiation ◽  
Related Mortality ◽  
Low And Middle Income

HIV treatment, care, and support programmes in low- and middle-income countries have traditionally focused more on patients remaining in care after the initiation of antiretroviral therapy (ART) than on earlier stages of care. This study describes the cumulative retention from HIV diagnosis to the achievement of virological suppression after ART initiation in an HIV cohort study in India. Of all patients diagnosed with HIV, 70% entered into care within three months. 65% of patients ineligible for ART at the first assessment were retained in pre-ART care. 67% of those eligible for ART initiated treatment within three months. 30% of patients who initiated ART died or were lost to followup, and 82% achieved virological suppression in the last viral load determination. Most attrition occurred the in pre-ART stages of care, and it was estimated that only 31% of patients diagnosed with HIV engaged in care and achieved virological suppression after ART initiation. The total mortality attributable to pre-ART attrition was considerably higher than the mortality for not achieving virological suppression. This study indicates that early entry into pre-ART care along with timely initiation of ART is more likely to reduce HIV-related mortality compared to achieving virological suppression.

scholarly journals Predictors of Delayed Antiretroviral Therapy Initiation, Mortality, and Loss to Followup in HIV Infected Patients Eligible for HIV Treatment: Data from an HIV Cohort Study in India

2013 ◽  
Vol 2013 ◽  
pp. 1-10 ◽  
Author(s):  
Gerardo Alvarez-Uria ◽  
Raghavakalyan Pakam ◽  
Manoranjan Midde ◽  
Praveen Kumar Naik
Keyword(s):  
Cohort Study ◽  
Antiretroviral Therapy ◽  
Rural Areas ◽  
Hiv Treatment ◽  
Cd4 Count ◽  
Sub Saharan Africa ◽  
Hiv Patients ◽  
Disadvantaged Community ◽  
Timely Initiation ◽  
Art Initiation

Studies from Sub-Saharan Africa have shown that a substantial number of HIV patients eligible for antiretroviral therapy (ART) do not start treatment. However, data from other low- or middle-income countries are scarce. In this study, we describe the outcomes of 4105 HIV patients who became ART eligible from January 2007 to November 2011 in an HIV cohort study in India. After three years of ART eligibility, 78.4% started ART, 9.3% died before ART initiation, and 10.3% were lost to followup. Diagnosis of tuberculosis, being homeless, lower CD4 count, longer duration of pre-ART care, belonging to a disadvantaged community, being widowed, and not living near a town were associated with delayed ART initiation. Diagnosis of tuberculosis, being homeless, lower CD4 count, shorter duration of pre-ART care, belonging to a disadvantaged community, illiteracy, and age >45 years were associated with mortality. Being homeless, being single, not living near a town, having a CD4 count <150 cells/μL, and shorter duration of pre-ART care were associated with loss to followup. These results highlight the need to improve the timely initiation of ART in HIV programmes in India, especially in ART eligible patients with tuberculosis, low CD4 counts, living in rural areas, or having a low socioeconomic status.

What are the essential components of HIV treatment and care services in low and middle-income countries

AIDS ◽  
2012 ◽  
Vol 26 ◽  
pp. S97-S103 ◽  
Author(s):  
Paula Munderi ◽  
Heiner Grosskurth ◽  
Benson Droti ◽  
David A. Ross
Keyword(s):  
Hiv Treatment ◽  
Middle Income ◽  
Middle Income Countries ◽  
Care Services ◽  
Essential Components ◽  
Low And Middle Income

scholarly journals Evidence for Action on HIV treatment and care systems in low and middle-income countries

AIDS ◽  
2012 ◽  
Vol 26 ◽  
pp. S93-S95
Author(s):  
David A. Ross ◽  
Annabelle South ◽  
Ian Weller ◽  
James Hakim
Keyword(s):  
Hiv Treatment ◽  
Middle Income ◽  
Middle Income Countries ◽  
Care Systems ◽  
Low And Middle Income

scholarly journals Adapting CryoPen, a Non-Gas Based Cryotherapy System for Use in Low- and Middle-Income Countries

2016 ◽  
Vol 2 (3_suppl) ◽  
pp. 11s-12s ◽  
Author(s):  
Miriam Cremer ◽  
Mauricio Maza ◽  
Albert Zevallos ◽  
Manuel Alvarez ◽  
Luis Taxa ◽  
...  
Keyword(s):  
Conflicts Of Interest ◽  
Point Of Care ◽  
Intraepithelial Neoplasia ◽  
Convenience Sample ◽  
Middle Income ◽  
Middle Income Countries ◽  
Ablative Techniques ◽  
Ablative Procedures ◽  
Related Mortality ◽  
Low And Middle Income

Abstract 45 Background: Cervical cancer is a leading cause of cancer-related mortality among women in low- and middle-income countries (LMICs). Two point-of-care technologies that address the treatment gap are the LMIC-adapted CryoPen, with a core temperature of approximately −95°C, and the thermocoagulator, with a probe temperature of 100-120°C. Since there is scant data on the extent of CIN involvement in an underscreened population, determining mean cervical intraepithelial neoplasia (CIN) depth in an underscreened population will establish the depth of necrosis (DON) that ablative techniques need to achieve. The study aimed to establish the maximum depth of involvement of CIN3 and test whether the LMIC-adapted CryoPen and thermocoagulator reach the DON established as necessary for eradicating CIN3. Methods: A convenience sample of 107 CIN3 cases were reviewed by a pathologist at the National Cancer Institute (INEN, Peru) and a U.S. pathologist. Ten women had ablative procedures before non-cervical pathology indicated hysterectomy: a five-minute freeze with the CryoPen (n=5), or a 60-second, 100°C application of the thermocoagulator (n=5). The pathologists measured mean depth of involvement in the CIN3 cases and the local pathologist, blinded to ablative technique, measured maximum DON in both lips. Results: Mean depth of CIN3 involvement was 2.0mm among 107 cases. Mean depth was ≤3.0mm among 79.4%; ≤3.5mm among 89.7%; ≤4.0mm among 93.5%; and ≥5.0mm among 6.5%. The maximum DON achieved by the LMIC-adapted CryoPen was ≥3.0 in 80% of cases; ≥3.5mm in 80%; ≥4.0mm in 80%; ≥4.5mm in 40%; and ≥5.0mm in 20%. The maximum DON achieved by the thermocoagulator was ≥3.0mm in 80% of cases; ≥3.5mm in 80%; ≥4.0mm in 20%; and ≥4.5mm in 20%. Conclusion: The pathology review of CIN3 cases showed that 90% of CIN3 would be eradicated if DON reached at least 3.5mm. The mean DON of both the LMIC-adapted CryoPen and thermocoagulator exceeded 3.5mm. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: Miriam Cremer No relationship to disclose Mauricio Maza No relationship to disclose Albert Zevallos No relationship to disclose Manuel Alvarez No relationship to disclose Luis Taxa No relationship to disclose Philip E. Castle Honoraria: Roche Cepheid Consulting or Advisory Role: Cepheid, GE Healthcare, Guided Therapeutics, ClearPath, Merck, Genticel, Teva, Inovio Pharmaceuticals, Hologic Todd Alonzo No relationship to disclose Juan Felix No relationship to disclose

scholarly journals Cancer Control in Low- and Middle-Income Countries: Is It Time to Consider Screening?

2019 ◽  
pp. 1-8 ◽  
Author(s):  
Shailja C. Shah ◽  
Violet Kayamba ◽  
Richard M. Peek ◽  
Douglas Heimburger
Keyword(s):  
Sustainable Development ◽  
Early Detection ◽  
Cancer Prevention ◽  
Cancer Control ◽  
Middle Income ◽  
Control Programs ◽  
Middle Income Countries ◽  
Life Years ◽  
Related Mortality ◽  
Low And Middle Income

The rising prevalence of noncommunicable diseases globally, with a strikingly disproportionate increase in prevalence and related mortality in low- and middle-income countries (LMICs), is a major threat to sustainable development. The epidemiologic trend of cancers in LMICs is of particular concern. Despite a lower incidence of cancer in LMICs compared with high-income countries, total cancer-related mortality is significantly higher in LMICs, especially in people younger than 65 years of age. The enormous economic impact of premature mortality and lost productive life years highlights the critical importance of galvanizing cancer prevention and management to achieve sustainable development. The rising burden of cancer in LMICs stresses an already weak health care and economic infrastructure and poses unique challenges. Although the WHO acknowledges that the effective management of cancer relies on early detection, accurate diagnosis, and access to appropriate multimodal therapy, the placement of priority on early detection cannot be assumed to be effective in LMICs, where limited downstream resources may be overwhelmed by the inevitable increases in number of diagnoses. This review discusses several factors and considerations that may compromise the success of cancer control programs in LMICs, particularly if the focus is only on early detection through screening and surveillance. It is intended to guide optimal implementation of cancer control programs by accentuating challenges common in LMICs and by emphasizing the importance of cancer prevention where relevant so that communities and stakeholders can work together to devise optimal means of combatting the growing burden of cancer.

scholarly journals SARS-Co-V2 infection in never, former, and current tobacco/nicotine users: a cohort study of 4040 Egyptian healthcare workers

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Aya Mostafa ◽  
Manal H. El-Sayed ◽  
Mahmoud El-Meteini ◽  
Ayman Saleh ◽  
Ashraf Omar ◽  
...  
Keyword(s):  
Cohort Study ◽  
Healthcare Workers ◽  
Specific Effect ◽  
Adverse Outcomes ◽  
Self Report ◽  
Positive Test ◽  
Test Results ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

Abstract Background Smoking negatively impacts COVID-19 severity and adverse outcomes. Evidence on whether smoking is associated with SARS-Co-V2 infection and having a positive test is scarce, particularly from low-and middle-income countries, where most of the world’s billion smokers live. The inconsistency in relevant findings calls for study designs and analyses to account for possible confounders including background characteristics and pre-existing co-morbidities, to disentangle the specific effect of smoking. In healthcare workers (HCWs) the frequency of exposure to COVID-19 cases adds another layer of risk that was not factored in previous studies. We examined the association of HCWs’ tobacco/nicotine use (never, former, and current use) with having a positive SARS-Co-V2 test result and symptoms suggestive of infection, accounting for demographics, exposures, and co-morbidities. Methods A prospective cohort study of 4040 healthcare workers with baseline and follow-up screening took place during April–June 2020 in 12 healthcare facilities in Cairo, Egypt. Data on demographics, tobacco/nicotine use (manufactured or roll-your-own cigarettes, waterpipe tobacco, and electronic devices), co-morbidities, symptoms, exposures, and SARS-Co-V2 investigations were analyzed. Multinomial and multivariable logistic regression analyses were performed. Results Overall, 270/4040 (6.7, 95%CI: 5.9–7.5) had positive SARS-CoV-2 tests, 479 (11.9%) were current and 79 (2.0%) were former tobacco/nicotine users. The proportion of positive tests was 7.0% (243/3482, 95%CI: 6.1–7.8) among never, 5.1% (4/79, 95%CI: 0.1–10.0) among former, and 4.8% (23/479, 95%CI: 2.9–6.7) among current users. HCWs’ SARS-CoV-2 test results did not vary significantly by single/multiple or daily/non-daily tobacco/nicotine use. Compared to never users, former users were more likely to self-report a pre-existing medical condition (ORadjusted1.87, 95%CI: 1.05–3.33, p = 0.033), and to experience symptoms suggestive of COVID-19 (ORadjusted1.76, 95%CI: 1.07–2.90, p = 0.027). After adjustment, former (ORadjusted0.45, 95%CI: 0.11–1.89, p = 0.273) and current (ORadjusted0.65, 95%CI: 0.38–1.09, p = 0.101) tobacco/nicotine use was not associated with HCWs’ SARS-CoV-2 positive test results. Conclusions This is the first report on this association from low- and middle-income countries with high tobacco/nicotine use prevalence. In this HCW cohort, having a positive SARS-CoV-2 test was not associated with tobacco/nicotine use after accounting for demographics, exposures, and co-morbidities. Additional population-based studies could use such preliminary evidence to investigate this controversial association.

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