scholarly journals Advanced HIV Disease among Males and Females Initiating HIV Care in Rural Ethiopia

2019 ◽  
Vol 18 ◽  
pp. 232595821984719 ◽  
Author(s):  
Alan Raymond Lifson ◽  
Sale Workneh ◽  
Abera Hailemichael ◽  
Richard Fleming MacLehose ◽  
Keith Joseph Horvath ◽  
...  
Keyword(s):  
Sub Saharan Africa ◽  
World Health ◽  
Hiv Care ◽  
Stage Iii ◽  
Baseline Survey ◽  
Local Health ◽  
Hiv Disease ◽  
Rural Ethiopia ◽  
District Hospitals ◽  
Advanced Hiv Disease

Despite recommendations for rapidly initiating HIV treatment, many persons in sub-Saharan Africa present to care with advanced HIV disease. Baseline survey and clinical data were collected on 1799 adults newly enrolling at 32 district hospitals and local health HIV clinics in rural Ethiopia. Among those with complete HIV disease information, advanced HIV disease (defined as CD4 count <200 cells/mm3 or World Health Organization [WHO] HIV clinical stage III or IV disease) was present in 66% of males and 56% of females ( P < .001). Males (compared to females) had lower CD4 counts (287 cells/mm3 versus 345 cells/mm3), lower body mass index (19.3 kg/m2 versus 20.2 kg/m2), and more WHO stage III or IV disease (46% versus 37%), ( P < .001). Men reported more chronic diarrhea, fevers, cough, pain, fatigue, and weight loss ( P < .05). Most initiating care in this resource-limited setting had advanced HIV disease. Men had poorer health status, supporting the importance of earlier diagnosis, linkage to care, and initiation of antiretroviral therapy.

scholarly journals Disseminated Histoplasmosis; A Threat in Advanced HIV Disease Population in Sub-Saharan Africa?

2021 ◽  
pp. 115-144
Author(s):  
Christine E. Mandengue ◽  
Bassey Ewa Ekeng ◽  
Rita O. Oladele
Keyword(s):  
Histoplasma Capsulatum ◽  
Clinical Stage ◽  
Sub Saharan Africa ◽  
World Health ◽  
Hiv Disease ◽  
African Countries ◽  
Tb Treatment ◽  
Disseminated Histoplasmosis ◽  
Sub Saharan ◽  
Advanced Hiv Disease

Background: Histoplasmosis is a neglected acquired immune deficiency syndrome (AIDS)-defining disease in sub-Saharan African countries, which is commonly misdiagnosed as tuberculosis (TB) due to similar imagery and clinical features; patients usually receive presumptive anti-TB treatment that is considered as anti-TB treatment failure. Patients with advanced human immunodeficiency virus (HIV) disease (AHD), CD4<200/mm3 or World Health Organisation clinical stage 3 or 4, develop disseminated histoplasmosis (DH) diagnosed at a late stage or at post-mortem, owing to poor clinical suspicion, lack of rapid diagnosis tools to offer rapid and accurate results, and non-availability and accessibility of appropriate antifungal medications. We report 31 cases of DH amongst patients with AHD in sub-Saharan African population from the literature, highlighting the challenging care issue in sub-Saharan Africa. Results: Out of 31 reported cases 64.51% (20/31) were caused by Histoplasma capsulatum var capsulatum, 48.38% (15/31) being immigrants in Europe, Canada and Japan, with 41.93% (13/31) mortality, and 6 cases having no reported outcome. The poor index of suspicion on the part of clinicians; the lack of skilled laboratory personnel and rapid and accurate diagnosis tools of histoplasmosis for a proper detection of either classical or African histoplasmosis coexisting in many sub-Saharan African countries; and the non-availability and accessibility of appropriate antifungal medications were the most challenges in caring DH in advanced HIV disease population in sub-Saharan Africa. Conclusion: there is a need for prompt and routine screening of advanced HIV disease patients in sub-Saharan Africa for histoplasmosis as an AIDS-defining illness.

scholarly journals Longitudinal analysis of sociodemographic, clinical and therapeutic factors of HIV-infected individuals in Kinshasa at antiretroviral therapy initiation during 2006-2017

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0259073
Author(s):  
Nadine Mayasi Ngongo ◽  
Gilles Darcis ◽  
Hippolyte Situakibanza Nanituna ◽  
Marcel Mbula Mambimbi ◽  
Nathalie Maes ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Early Detection ◽  
Hiv Infection ◽  
Median Time ◽  
Clinical Stage ◽  
Hiv Care ◽  
Hiv Disease ◽  
Art Initiation ◽  
Time To Initiation ◽  
Advanced Hiv Disease

Background The benefits of antiretroviral therapy (ART) underpin the recommendations for the early detection of HIV infection and ART initiation. Late initiation (LI) of antiretroviral therapy compromises the benefits of ART both individually and in the community. Indeed, it promotes the transmission of infection and higher HIV-related morbidity and mortality with complicated and costly clinical management. This study aims to analyze the evolutionary trends in the median CD4 count, the median time to initiation of ART, the proportion of patients with advanced HIV disease at the initiation of ART between 2006 and 2017 and their factors. Methods and findings HIV-positive adults (≥ 16 years old) who initiated ART between January 1, 2006 and December 31, 2017 in 25 HIV care facilities in Kinshasa, the capital of DRC, were eligible. The data were processed anonymously. LI is defined as CD4≤350 cells/μl and/or WHO clinical stage III or IV and advanced HIV disease (AHD), as CD4≤200 cells/μl and/or stage WHO clinic IV. Factors associated with advanced HIV disease at ART initiation were analyzed, irrespective of year of enrollment in HIV care, using logistic regression models. A total of 7278 patients (55% admitted after 2013) with an average age of 40.9 years were included. The majority were composed of women (71%), highly educated women (68%) and married or widowed women (61%). The median CD4 was 213 cells/μl, 76.7% of patients had CD4≤350 cells/μl, 46.1% had CD4≤200 cells/μl, and 59% of patients were at WHO clinical stages 3 or 4. Men had a more advanced clinical stage (p <0.046) and immunosuppression (p<0.0007) than women. Overall, 70% of patients started ART late, and 25% had AHD. Between 2006 and 2017, the median CD4 count increased from 190 cells/μl to 331 cells/μl (p<0.0001), and the proportions of patients with LI and AHD decreased from 76% to 47% (p< 0.0001) and from 18.7% to 8.9% (p<0.0001), respectively. The median time to initiation of ART after screening for HIV infection decreased from 40 to zero months (p<0.0001), and the proportion of time to initiation of ART in the month increased from 39 to 93.3% (p<0.0001) in the same period. The probability of LI of ART was higher in married couples (OR: 1.7; 95% CI: 1.3–2.3) (p<0.0007) and lower in patients with higher education (OR: 0.74; 95% CI: 0.64–0.86) (p<0.0001). Conclusion Despite increasingly rapid treatment, the proportions of LI and AHD remain high. New approaches to early detection, the first condition for early ART and a key to ending the HIV epidemic, such as home and work HIV testing, HIV self-testing and screening at the point of service, must be implemented.

scholarly journals Directrices para el tratamiento de la infección avanzada por el VIH y el inicio rápido del tratamiento antirretroviral

2018 ◽  
Keyword(s):  
Antiretroviral Therapy ◽  
World Health Organization ◽  
World Health ◽  
Hiv Disease ◽  
Sociedad Civil ◽  
Health Organization ◽  
Advanced Hiv Disease

En el 2016, la OMS publicó sus directrices unificadas sobre el uso de los antirretrovirales (ARV) en el tratamiento y la prevención de la infección por el VIH. Como parte de esta revisión, la OMS reconoce que, a medida que se amplíe la escala del tratamiento antirretroviral (TAR) y que los países adopten la política de “tratar a todos”, será necesario diferenciar los servicios de TAR para proporcionar conjuntos de intervenciones de atención de salud adaptados a las personas con infección por el VIH con necesidades clínicas diversas. Con este fin, se definen cuatro grupos de personas: 1) las que acuden por primera vez o regresan en busca de atención presentando una infección avanzada por el VIH; 2) las que acuden por primera vez o regresan en busca de atención encontrándose bien desde el punto de vista clínico; 3) las que se encuentran clínicamente estables mientras siguen el TAR; y 4) las que reciben un esquema de TAR que no está siendo eficaz...El público destinatario de estas directrices está constituido principalmente por directores de programas nacionales del VIH, que son los responsables de adaptar estas nuevas recomendaciones a nivel del país. Las directrices son también pertinentes para los médicos clínicos y otros interesados directos, como las personas con infección por el VIH, organizaciones nacionales de la sociedad civil, asociados para la implementación, organizaciones no gubernamentales y financiadores nacionales e internacionales de los programas del VIH. Versión oficial en español de la obra original en inglés: Guidelines for managing advanced HIV disease and rapid initiation of antiretroviral therapy, July 2017. © World Health Organization 2017. ISBN 978-92-4-155006-2.

scholarly journals COVID-19 and the HIV care continuum in Uganda: minimising collateral damage

2020 ◽  
Vol 3 ◽  
pp. 28
Author(s):  
Enock Kagimu ◽  
Emily M. Martyn ◽  
Jane Gakuru ◽  
John Kasibante ◽  
Morris K Rutakingirwa ◽  
...  
Keyword(s):  
Global Health ◽  
Sub Saharan Africa ◽  
World Health ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Collateral Damage ◽  
Hiv Care Continuum ◽  
African Region ◽  
Care Continuum ◽  
The World

The novel coronavirus, SARS-CoV-2, has spread across the world within months of its first description in Wuhan, China in December 2019, resulting in an unprecedented global health emergency. Whilst Europe and North America are the current epicentres of infection, the global health community are preparing for the potential effects of this new disease on the African continent. Modelling studies predict that factors such as a youthful and rural population may be protective in mitigating the spread of COVID-19 in the World Health Organisation (WHO) African Region, however, with 220 million infections and 4.6 million hospitalisations predicted in the first year of the pandemic alone, fragile health systems could still be placed under significant strain. Furthermore, subsequent disruptions to the provision of services for people living with HIV, or at risk of acquiring HIV, are predicted to lead to an extra 500,000 adult HIV deaths and a 2-fold increase in mother to child transmission of HIV in sub-Saharan Africa in 2020-2021. Ignoring these predictions may have severe consequences and we risk “stepping back in time” in AIDS-related deaths to numbers seen over a decade ago. Reflecting on our current experience of the COVID-19 pandemic in Uganda, we explore the potential impact of public health measures implemented to mitigate spread of COVID-19 on the HIV care continuum, and suggest areas of focus for HIV services, policy makers and governments to urgently address in order to minimise the collateral damage.

scholarly journals Reduction in Baseline CD4 Count Testing Following Human Immunodeficiency Virus “Treat All” Adoption in Uganda

2020 ◽  
Author(s):  
Esther Nasuuna ◽  
Mark W Tenforde ◽  
Alex Muganzi ◽  
Joseph N Jarvis ◽  
Yukari C Manabe ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
World Health Organization ◽  
Cd4 Count ◽  
World Health ◽  
Hiv Disease ◽  
Immunodeficiency Virus ◽  
Health Organization ◽  
Treat All ◽  
Advanced Hiv Disease ◽  
Cd4 Testing

Abstract Baseline CD4 testing rates declined from 73% to 21% between 2013 and 2018 with adoption of “Treat All” in Uganda. Advanced human immunodeficiency virus (HIV) disease (CD4 count &lt; 200 cells/µL) remained common (24% of those tested in 2018, 83% of whom had World Health Organization stage I/II disease). Despite frequent presentation with advanced HIV disease, CD4 testing has declined dramatically.

Increase in clinical prevalence of AIDS implies increase in unsafe medical injections

2009 ◽  
Vol 20 (5) ◽  
pp. 295-299 ◽  
Author(s):  
S Reid
Keyword(s):  
Hiv Infections ◽  
Transmission Efficiency ◽  
Mass Action ◽  
Sub Saharan Africa ◽  
World Health ◽  
Sub Saharan ◽  
Exposure Risks ◽  
Health Organization ◽  
A Minor ◽  
Advanced Hiv Disease

A mass action model developed by the World Health Organization (WHO) estimates that the re-use of contaminated syringes for medical care accounted for 2.5% of HIV infections in sub-Saharan Africa in 2000. The WHO's model applies the population prevalence of HIV infection rather than the clinical prevalence to calculate patients' frequency of exposure to contaminated injections. This approach underestimates iatrogenic exposure risks when progression to advanced HIV disease is widespread. This sensitivity analysis applies the clinical prevalence of HIV to the model and re-evaluates the transmission efficiency of HIV in injections. These adjustments show that no less than 12–17%, and up to 34–47%, of new HIV infections in sub-Saharan Africa may be attributed to medical injections. The present estimates undermine persistent claims that injection safety improvements would have only a minor impact on HIV incidence in Africa.

scholarly journals Diagnosis and Management of Central Nervous System Cryptococcal Infections in HIV-Infected Adults

2019 ◽  
Vol 5 (3) ◽  
pp. 65 ◽  
Author(s):  
Caleb Skipper ◽  
Mahsa Abassi ◽  
David R Boulware
Keyword(s):  
Clinical Trial ◽  
Central Nervous System ◽  
Nervous System ◽  
Intracranial Pressure ◽  
Cryptococcal Meningitis ◽  
Sub Saharan Africa ◽  
Hiv Disease ◽  
Diagnosis And Management ◽  
Sub Saharan ◽  
Advanced Hiv Disease

Cryptococcal meningitis persists as a significant source of morbidity and mortality in persons with HIV/AIDS, particularly in sub-Saharan Africa. Despite increasing access to antiretrovirals, persons presenting with advanced HIV disease remains common, and Cryptococcus remains the most frequent etiology of adult meningitis. We performed a literature review and herein present the most up-to-date information on the diagnosis and management of cryptococcosis. Recent advances have dramatically improved the accessibility of timely and affordable diagnostics. The optimal initial antifungal management has been newly updated after the completion of a landmark clinical trial. Beyond antifungals, the control of intracranial pressure and mitigation of toxicities remain hallmarks of effective treatment. Cryptococcal meningitis continues to present challenging complications and continued research is needed.

scholarly journals Impact of Immediate ART Initiation and Patient Health Expenditures: A Stepped-Wedge Randomised Trial

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
J I Steinert ◽  
P Geldsetzer
Keyword(s):  
Healthcare Providers ◽  
Standard Of Care ◽  
Economic Benefits ◽  
Sub Saharan Africa ◽  
World Health ◽  
Hiv Care ◽  
Stepped Wedge ◽  
Healthcare Expenditures ◽  
Art Initiation ◽  
The Impact

Abstract Background Healthcare expenditures for HIV care pose a major economic burden on households in sub-Saharan Africa. While immediate initiation of antiretroviral therapy (ART) for all HIV-positive patients has important health benefits, it is unknown how this profound change in HIV care provision will affect patients' healthcare expenditures. This study, therefore, aims to determine the causal impact of immediate ART initiation on patients' healthcare expenditures in Eswatini. Methods This stepped-wedge cluster-randomised controlled trial enrolled fourteen public-sector healthcare facilities in rural and semi-urban Eswatini. Facilities were randomly assigned to transition at one of seven time points from the standard of care (ART eligibility at CD4 counts of &lt; 500 cells/mm3) to the immediate ART for all intervention (EAAA). The primary outcome was total patient-borne healthcare expenditures during the preceding 12 months. We used mixed-effects negative binomial regressions adjusted for secular trends and clustering at the facility level. Results 2261 participants were interviewed over the study period. Participants in the EAAA phase reported a 45% decrease (RR: 0.55, 95% CI: 0.39, 0.77, p &lt; 0.001) in their total past-year healthcare expenditures compared to the standard-of-care phase. Patients' healthcare expenditures for private and traditional healthcare providers were 93% (RR 0.07, 95% CI: 0.01, 0.77, p &lt; 0.001) lower in the EAAA than the standard of care phase. Self-reported health status was similar between study phases. Conclusions Despite a higher frequency of HIV care visits for newly initiated ART patients, immediate ART initiation lowered patients' healthcare expenditures because they sought less care from private and traditional healthcare providers. This study adds an important economic argument to the World Health Organisation's recommendation for countries to abolish CD4-count-based eligibility thresholds for ART. Key messages This is the first experimental study to examine the impact of immediate ART initiation on patients’ healthcare expenditures and thus obtain a causal estimate of the economic benefits of immediate ART. Immediate ART initiation in Eswatini reduced HIV patients’ healthcare expenditures, at least partially through decreasing care-seeking from traditional and private healthcare providers.

scholarly journals COVID-19 and the HIV care continuum in Uganda: minimising collateral damage

2021 ◽  
Vol 3 ◽  
pp. 28
Author(s):  
Enock Kagimu ◽  
Emily M. Martyn ◽  
Jane Gakuru ◽  
John Kasibante ◽  
Morris K Rutakingirwa ◽  
...  
Keyword(s):  
Global Health ◽  
Sub Saharan Africa ◽  
World Health ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Collateral Damage ◽  
Hiv Care Continuum ◽  
African Region ◽  
Care Continuum ◽  
The World

The novel coronavirus, SARS-CoV-2, has spread across the world within months of its first description in Wuhan, China in December 2019, resulting in an unprecedented global health emergency. Whilst Europe and North America are the current epicentres of infection, the global health community are preparing for the potential effects of this new disease on the African continent. Modelling studies predict that factors such as  youthful and rural population may be protective in mitigating the spread of COVID-19 in the World Health Organisation (WHO) African Region, however, with 220 million infections and 4.6 million hospitalisations predicted in the first year of the pandemic alone, fragile health systems could still be placed under significant strain. Furthermore, subsequent disruptions to the provision of services for people living with HIV, or at risk of acquiring HIV, are predicted to lead to an extra 500,000 adult HIV deaths and a 2-fold increase in mother to child transmission of HIV in sub-Saharan Africa in 2020-2021. Ignoring these predictions may have severe consequences and we risk “stepping back in time” in AIDS-related deaths to numbers seen over a decade ago. Reflecting on our current experience of the COVID-19 pandemic in Uganda, we explore the potential impact of public health measures implemented to mitigate spread of COVID-19 on the HIV care continuum, and suggest areas of focus for HIV services, policy makers and governments to urgently address in order to minimise the collateral damage.

scholarly journals The Population Impact of Late Presentation With Advanced HIV Disease and Delayed Antiretroviral Therapy in Adults Receiving HIV Care in Latin America

2019 ◽  
Vol 189 (6) ◽  
pp. 564-572 ◽  
Author(s):  
Pablo F Belaunzarán-Zamudio ◽  
Yanink N Caro-Vega ◽  
Bryan E Shepherd ◽  
Peter F Rebeiro ◽  
Brenda E Crabtree-Ramírez ◽  
...  
Keyword(s):  
Latin America ◽  
Antiretroviral Therapy ◽  
Population Attributable Fraction ◽  
Immune Deficiency Syndrome ◽  
Late Presentation ◽  
Hiv Care ◽  
Hiv Disease ◽  
Art Initiation ◽  
Advanced Hiv Disease ◽  
The Impact

Abstract Late presentation to care and antiretroviral therapy (ART) initiation with advanced human immunodeficiency virus (HIV) disease are common in Latin America. We estimated the impact of these conditions on mortality in the region. We included adults enrolled during 2001–2014 at HIV care clinics. We estimated the adjusted attributable risk (AR) and population attributable fraction (PAF) for all-cause mortality of presentation to care with advanced HIV disease (advanced LP), ART initiation with advanced HIV disease, and not initiating ART. Advanced HIV disease was defined as CD4 of &lt;200 cells/μL or acquired immune deficiency syndrome. AR and PAF were derived using marginal structural models. Of 9,229 patients, 56% presented with advanced HIV disease. ARs of death for advanced LP were 86%, 71%, and 58%, and PAFs were 78%, 58%, and 43% at 1, 5, and 10 years after enrollment. Among people without advanced LP, ARs of death for delaying ART were 39%, 32%, and 37% at 1, 5, and 10 years post-enrollment and PAFs were 20%, 14%, and 15%. Among people with advanced LP, ART decreased the hazard of death by 63% in the first year after enrollment, but 93% of these started ART; thus universal ART among them would reduce mortality by only 10%. Earlier presentation to care and earlier ART initiation would prevent most HIV deaths in Latin America.

Sign in / Sign up

Export Citation Format

Share Document