CLINICAL outcomes and loss to follow-up among people living with HIV participating in the NAMWEZA intervention in Dar es Salaam, Tanzania: a prospective cohort study

Abstract ObjectivesMaintaining optimal adherence and viral suppression in people living with HIV (PLWHA) is essential to ensure both preventative and therapeutic benefits of antiretroviral therapy (ART). Prisoners bear a particularly high burden of HIV infection and are highly likely to transmit to others during and after incarceration. However, the level of treatment adherence and viral suppression in incarcerated populations in low-income countries is unknown. This study aimed to determine the prevalence of non-adherence and viral failure, and contributing factors amongst prisoners in South Ethiopia. MethodsA prospective cohort study was conducted between June 1, 2019 and May 31, 2020 to compare the level of adherence and viral suppression between incarcerated and non-incarcerated PLWHA. The study involved 74 inmates living with HIV (ILWHA) and 296 non-incarcerated PLWHA. Background information (including sociodemographic, socioeconomic, psychosocial, behavioural, and incarceration related characteristics) was collected using a structured questionnaire. Adherence was determined based on the participants’ self-report and pharmacy refill records. Plasma viral load measurements undertaken within the study period were prospectively extracted to determine viral suppression. Univariate and multivariate regression models were used to analyse data. ResultsWhile prisoners had a significantly higher pharmacy refill adherence compared to non-incarcerated PLWHA (89% vs 75%), they had a slightly lower dose adherence (81% vs 83%). The prevalence of viral failure (VF) was also slightly higher (6%) in ILWHA compared to non-incarcerated PLWHA (4.4%). The overall dose non-adherence (NA) was significantly associated with missing ART appointments, level of satisfaction with ART services, patient’s ability to comply with a specified medication schedule and types of methods used to monitor the schedule. In ILWHA specifically, accessing ART services from a hospital compared to a health centre, an inability to always attend clinic appointments, experience of depression and a lack of social support predicted NA. VF was significantly higher in males, people of age 31to 35 years and in those who experienced social stigma, regardless of their incarceration status. ConclusionsThis study revealed that HIV-infected prisoners in South Ethiopia were more likely to be non-adherent to ART doses and to develop viral failure compared to their non-incarcerated counterparts. A multitude of factors were found to be responsible for this requiring multilevel intervention strategies focusing on the specific needs of prisoners.

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Histoplasmosis, An Underdiagnosed Disease Affecting People Living With HIV/AIDS in Brazil: Results of a Multicenter Prospective Cohort Study Using Both Classical Mycology Tests and Histoplasma Urine Antigen Detection

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz073 ◽

2019 ◽

Vol 6 (4) ◽

Cited By ~ 7

Author(s):

Diego R Falci ◽

Alexandre A Monteiro ◽

Cassia Ferreira Braz Caurio ◽

Tulio C O Magalhães ◽

Melissa O Xavier ◽

...

Keyword(s):

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Antigen Detection ◽

People Living With Hiv ◽

Urine Antigen ◽

Multicenter Prospective Cohort Study ◽

Living With Hiv ◽

Multicenter Prospective Cohort ◽

Hiv Aids

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Clinical features and outcomes of discharged coronavirus disease 2019 patients: a prospective cohort study

QJM ◽

10.1093/qjmed/hcaa178 ◽

2020 ◽

Vol 113 (9) ◽

pp. 657-665 ◽

Cited By ~ 14

Author(s):

X Wang ◽

H Xu ◽

H Jiang ◽

L Wang ◽

C Lu ◽

...

Keyword(s):

Cohort Study ◽

Clinical Outcomes ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Close Contact ◽

Post Discharge ◽

Global Pandemic ◽

Discharged Patients ◽

Suspected Recurrence

Summary Background Coronavirus disease 2019 (COVID-19) is a global pandemic but the follow-up data of discharged patients was barely described. Aim To investigate clinical outcomes, distribution of quarantine locations and the infection status of the contacts of COVID-19 patients after discharge. Design A prospective cohort study. Methods Demographics, baseline characteristics of 131 COVID-19 patients discharged from 3 February 2020 to 21 February 2020 in Wuhan, China were collected and analyzed by reviewing the medical records retrospectively. Post-hospitalization data related to clinical outcomes, quarantine locations and close contact history were obtained by following up the patients every week up to 4 weeks. Results Fifty-three (40.05%) patients on discharge had cough (29.01%), fatigue (7.63%), expectoration (6.11%), chest tightness (6.11%), dyspnea (3.82%), chest pain (3.05%) and palpitation (1.53%). These symptoms constantly declined in 4 weeks post-discharge. Transient fever recurred in 11 (8.4%) patients. Among the discharged patients, 78 (59.5%) underwent chest CT and 2 (1.53%) showed deterioration. A total of 94 (71.8%) patients received SARS-CoV-2 retest and 8 (6.10%) reported positive. Seven (2.29%) patients were readmitted because of fever or positive SARS-CoV-2 retest. After discharge, 121 (92.37%) and 4 (3.05%) patients were self-quarantined at home or community spots, respectively, after a close contact with 167 persons in total who were free of COVID-19 at the endpoint of study. Conclusion The majority of COVID-19 patients after discharge were in the course of recovery. Readmission was required in rare cases due to suspected recurrence of COVID-19. Although no contacted infection observed, appropriate self-quarantine and regular re-examination are necessary, particularly for those who have recurred symptoms.

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Factors associated with pre-ART loss-to-follow up in adults in rural KwaZulu-Natal, South Africa: a prospective cohort study

BMC Public Health ◽

10.1186/s12889-016-3025-x ◽

2016 ◽

Vol 16 (1) ◽

Cited By ~ 4

Author(s):

Michael Evangeli ◽

Marie-Louise Newell ◽

Nuala McGrath

Keyword(s):

South Africa ◽

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Loss To Follow Up ◽

Factors Associated ◽

Kwazulu Natal

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Effectiveness of adenotonsillectomy in resolution of enuresis in children with sleep-disordered breathing: a hospital based prospective cohort study in Dar es Salaam, Tanzania

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20195707 ◽

2019 ◽

Vol 6 (1) ◽

pp. 155

Author(s):

Zephania S. Abraham ◽

Aveline A. Kahinga ◽

Kassim B. Mapondella ◽

Enica R. Massawe ◽

Emmanuel Ole Lengine ◽

...

Keyword(s):

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Nocturnal Enuresis ◽

Sleep Disordered Breathing ◽

Dar Es Salaam ◽

Adenotonsillar Hypertrophy ◽

History Of ◽

Disordered Breathing

Background: Adenotonsillar hypertrophy remains to be the commonest causes of sleep disordered breathing in paediatric patients and has been implicated as a cause of primary and secondary enuresis. The aim of this study was to determine the effectiveness of adenotonsillectomy in resolution of enuresis in children with sleep-disordered breathing.Methods: A hospital based prospective cohort study was conducted at Ekenywa Specialised Hospital in Dar es Salaam, from May 2018 to February 2019. Two hundred children aged 3 to 15 years with obstructive adenotonsillar hypertrophy who were admitted ready to undergo adenotonsillectomy were evaluated. Upon such evaluation, the primary outcome was the number of bedwetting incidents (nocturnal enuresis) post-operatively compared with pre-operative incidents. Patients were kept under follow-up for 3 months. Data were collected using structured questionnaires regarding number of bedwetting incidents, type of enuresis (primary or secondary) and family history of enuresis. Data was analyzed using SPSS version 21 and p-values <0.05 were considered to be statistically significant. Results: Of 200 children admitted for adenotonsillectomy, 80 (40%) had a positive history of preoperative enuresis, including 35 (43.8%) girls and 45 (56.2%) boys. All parents for the children consented to participate in the study. Three months after adenotonsillectomy, enuresis had resolved completely in 50 (62.5%) children and had shown relative improvement in 25 (31.3%) children. Enuresis had not improved in the remaining 5 (6.3%) children (p<0.05).Conclusions: Findings from this study indicates that adenotonsillectomy can improve nocturnal enuresis and day-time incontinence in the majority of children with adenotonsillar hypertrophy.

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