Effectiveness and Acceptability of Delivery of Antiretroviral Treatment in Health Centres by Health Officers and Nurses in Ethiopia

2012 ◽  
Vol 17 (1) ◽  
pp. 24-29 ◽  
Author(s):  
Yibeltal Assefa ◽  
Abiyou Kiflie ◽  
Betru Tekle ◽  
Damen Haile Mariam ◽  
Marie Laga ◽  
...  
Keyword(s):  
Health Care Providers ◽  
Health Workers ◽  
Care Providers ◽  
Loss To Follow Up ◽  
Cell Counts ◽  
Cd4 Cell Counts ◽  
Health Centres ◽  
Cd4 Cell ◽  
Art Delivery

Objective The World Health Organization (WHO) recommends shifting tasks from physicians to lower cadres for the delivery of antiretroviral treatment (ART) for countries short of physicians. Our objective was to evaluate the effectiveness and acceptability of ART delivery by health officers and nurses in Ethiopia. Methods A retrospective cohort study to evaluate outcomes of ART services in 25 health centresstaffed with health officers and/or nurses and 30 hospitals staffed with physicians in 2009. Median CD4-cell counts, mortality, loss to follow-up and retention were the primary outcomes. Interviews and focus group discussions were conducted with people living with HIV/AIDS, AIDS programme managers and health care providers to identify the types and acceptability of the tasks conducted by the health officers, nurses and community health workers. Results Health officers and nurses were providing ART, including ART prescription, for non-severe cases. The management of severe cases was exclusively the task of physicians. Community health workers were involved in adherence counselling and defaulter tracing. The baseline median CD4-cell counts per micro-liter of blood were 117 (interquartiles [IQ] 64,188) and 119 (IQ 67,190) at health centres and hospitals respectively. After 24 months on ART, the median CD4-cell counts per micro-literof blood increased to 321 (IQ 242, 414) and 301 (IQ 217, 411) at health centres and hospitals respectively. Retention in care was higher in health centres (76%, 95% confidence interval [CI] [73%-79%]) than hospitals (67%, 95% CI [66%-68%]). This difference is mainly due to the higher loss to follow-up rate in hospitals (25% versus 13%). Mortality was higher in health centres than hospitals (11% versus 8%), but the difference is not statistically significant. Service delivery by non-physicians was accepted by patients, health care providers and programme managers. However, the absence of a regulatory framework for task shifting, the lack of extra remuneration for the additional roles assumed by nurses and health officers, and the high cost for training and mentorship were identified as weaknesses. Conclusion ART delivery in health centres, based on health officers and nurses is feasible, effective and acceptable in Ethiopia. However, issues related to regulation, remuneration and cost need to be addressed for the sustainable implementation of these delivery models.

scholarly journals Initiating antiretroviral therapy when presenting with higher CD4 cell counts results in reduced loss to follow-up in a resource-limited setting

AIDS ◽  
2013 ◽  
Vol 27 (4) ◽  
pp. 645-650 ◽  
Author(s):  
Kate Clouse ◽  
Audrey Pettifor ◽  
Mhairi Maskew ◽  
Jean Bassett ◽  
Annelies Van Rie ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Resource Limited Setting ◽  
Loss To Follow Up ◽  
Cell Counts ◽  
Resource Limited ◽  
Cd4 Cell Counts ◽  
Cd4 Cell ◽  
Limited Setting

scholarly journals Time-Dependent Predictors of Loss to Follow-Up in a Large HIV Treatment Cohort in Nigeria

2014 ◽  
Vol 1 (2) ◽  
Author(s):  
Seema Thakore Meloni ◽  
Charlotte Chang ◽  
Beth Chaplin ◽  
Holly Rawizza ◽  
Oluwatoyin Jolayemi ◽  
...  
Keyword(s):  
Viral Load ◽  
Hiv Treatment ◽  
Time Dependent ◽  
World Health ◽  
Loss To Follow Up ◽  
Cell Counts ◽  
Cd4 Cell Counts ◽  
Increased Risk ◽  
Cd4 Cell

Abstract Background.  Most evaluations of loss to follow-up (LTFU) in human immunodeficiency virus (HIV) treatment programs focus on baseline predictors, prior to antiretroviral therapy (ART) initiation. As risk of LTFU is a continuous issue, the aim of this evaluation was to augment existing information with further examination of time-dependent predictors of loss. Methods.  This was a retrospective evaluation of data collected between 2004 and 2012 by the Harvard School of Public Health and the AIDS Prevention Initiative in Nigeria as part of PEPFAR-funded program in Nigeria. We used multivariate modeling methods to examine associations between CD4+ cell counts, viral load, and early adherence patterns with LTFU, defined as no refills collected for at least 2 months since the last scheduled appointment. Results.  Of 51 953 patients initiated on ART between 2004 and 2011, 14 626 (28%) were LTFU by 2012. Factors associated with increased risk for LTFU were young age, having nonincome-generating occupations or no education, being unmarried, World Health Organization (WHO) stage, having a detectable viral load, and lower CD4+ cell counts. In a subset analysis, adherence patterns during the first 3 months of ART were associated with risk of LTFU by month 12. Conclusions.  In settings with limited resources, early adherence patterns, as well as CD4+ cell counts and unsuppressed viral load, at any time point in treatment are predictive of loss and serve as effective markers for developing targeted interventions to reduce rates of attrition.

scholarly journals Atypical presentation of classic Kaposi sarcoma in circumcised penis presenting as an ulcerative nodule with human herpesvirus 8 (HHV8) positivity and successfully treated with only local excision

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Abdulaziz Alamri ◽  
B. K. Adiga
Keyword(s):  
Human Herpesvirus ◽  
Kaposi Sarcoma ◽  
Surgical Excision ◽  
Elderly Male ◽  
Cell Counts ◽  
Cd4 Cell Counts ◽  
Seronegative Patient ◽  
Classic Kaposi Sarcoma ◽  
Cd4 Cell

Abstract Introduction Although the Kaposi sarcoma (KS) is one of the AIDS defining entity and seen in almost one third of HIV infected patients with low CD4 cell counts, it is not uncommon in HIV seronegative persons, but genital KS is rare, particularly in people without risk factors for HIV infection. Isolated penile KS is an unusual manifestation, especially as solitary nodule with ulceration, in HIV seronegative patient. Case presentation We report such a case of Kaposi sarcoma showing HHV-8 positivity in an elderly male Arabian patient with a delay in prompt diagnosis, but treated successfully with 3 3 years follow-up after limited local surgical excision. Conclusion The general practitioners, venereologists and urologists should think of KS as a possibility in such lesion and consider early biopsy.

Immunologic Benefits of Enfuvirtide in Patients Enrolled in a Drug Assistance Program

2008 ◽  
Vol 42 (5) ◽  
pp. 621-626 ◽  
Author(s):  
Parya Saberi ◽  
Nikolai H Caswell ◽  
Cristina I Gruta ◽  
Jason N Tokumoto ◽  
Betty J Dong
Keyword(s):  
Cell Count ◽  
Viral Suppression ◽  
Cd4 Cell Count ◽  
Hiv Rna ◽  
Cell Counts ◽  
Background Regimen ◽  
Cd4 Cell Counts ◽  
Cd4 Cell ◽  
Cell Count Increase

Background: Randomized clinical trials have demonstrated that enfuvirtide plus an optimized background regimen can cause a significant increase in CD4+ cell counts and a reduction in HIV RNA levels. Objective: To describe and anaiyze CD4+ cell count and HIV RNA changes in HIV-infected patients receiving enfuvirtide and a prescribed background regimen (PBR) in a primarily clinical setting. Methods: A retrospective review from September 1998 through August 2005 of CD4+ cell counts and HIV RNA changes from baseline was conducted in patients receiving enfuvirtide. Data were stratified and analyzed according to baseline CD4+ cell count and HIV RNA. Results: A mean CD4+ cell count increase of approximately 102 cells/mm3 was observed, regardless of baseline CD4+ cell count, in 187 patients receiving enfuvirtide during a mean of 19.4 months of follow-up. During 3 years of follow-up, patients initiating enfuvirtide at CD4+ cell counts less than 100 cells/mm3 never achieved absolute CD4+ cell counts comparable to the counts in patients starting enfuvirtide at CD4+ cell counts of 100 cells/mm3 or more. In 38.3% of patients achieving an undetectable HIV RNA level, a mean CD4+ cell count increase of 185 cells/mm3 was observed. An unexpected finding was that a mean CD4+ cell count increase of 76 cells/mm3 occurred in 61.7% of patients not achieving complete viral suppression. Conclusions: Immunologic benefits were observed in subjects continuing enfuvirtide plus a PBR irrespective of baseline CD4+ cell count, complete viral suppression, or antiretroviral susceptibility data. Dala suggest that initiation of enfuvirtide at CD4+ cell counts greater than 100 celis/mm3 may be immunologically advantageous and independent of complete virologic response.

scholarly journals Long-Term Follow-Up of HIV-Infected Individuals Who Have Significant Increases in CD4+ Cell Counts during Antiretroviral Therapy

2004 ◽  
Vol 39 (10) ◽  
pp. 1500-1506 ◽  
Author(s):  
S. L. Koletar ◽  
P. L. Williams ◽  
J. Wu ◽  
J. A. McCutchan ◽  
S. E. Cohn ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Cell Counts ◽  
Cd4 Cell Counts ◽  
Long Term Follow Up ◽  
Cd4 Cell

scholarly journals Virologic Outcomes among People Living with HIV with High Pre-Therapy Viral Load Burden Initiating on Common Core Agents

2021 ◽  
Author(s):  
Anthony M Mills ◽  
Kathy L Schulman ◽  
Jennifer S Fusco ◽  
Michael B Wohlfeiler ◽  
Julie L Priest ◽  
...  
Keyword(s):  
Common Core ◽  
Virologic Failure ◽  
People Living With Hiv ◽  
Factors Associated ◽  
Viral Loads ◽  
Cell Counts ◽  
Cd4 Cell Counts ◽  
Living With Hiv ◽  
Cd4 Cell

Abstract Background People living with HIV (PLWH) initiating antiretroviral therapy (ART) with viral loads (VL) ≥100,000 copies/mL are less likely to achieve virologic success, but few studies have characterized real-world treatment outcomes. Methods ART-naïve PLWH with VLs ≥100,000 copies/mL initiating dolutegravir (DTG), elvitegravir (EVG), raltegravir (RAL) or darunavir (DRV) between 12Aug2013 and 31July2017 were identified from the OPERA Database. Virologic failure was defined as (i) 2 consecutive VLs ≥200 copies/mL after 36 weeks of ART, or (ii) 1 VL ≥200 copies/mL with core agent discontinuation after 36 weeks, or (iii) 2 consecutive VL ≥200 copies/mL after suppression (≤50 copies/mL) before 36 weeks, or (iv) 1 VL ≥200 copies/mL with discontinuation after suppression before 36 weeks. Cox modelling estimated the association between regimen and virologic failure. Results There were 2,038 ART-naïve patients with high VL who initiated DTG (36%), EVG (46%), DRV (16%) or RAL (2%). Median follow-up was 18.1 months (IQR:12.4-28.9). EVG and DTG initiators were similar at baseline but RAL initiators were older and more likely to be female with low CD4 cell counts while DRV initiators differed notably on factors associated with treatment failure. Virologic failure was experienced by 9.2% DTG, 13.2% EVG, 18.4% RAL and 18.8% DRV initiators. Compared to DTG, the adjusted hazard ratio (95% CI) was 1.46 (1.05, 2.03) for EVG, 2.24 (1.50, 3.34) for DRV, and 4.13 (1.85, 9.24) for RAL. Conclusion ART-naïve PLWH with high VLs initiating on DTG were significantly less likely to experience virologic failure compared to EVG, RAL and DRV initiators.

scholarly journals Attrition during pre-ART and ART time periods among adolescents enrolled in Integrated HIV Care Programme in Myanmar, 2005–2017

2019 ◽  
Vol 147 ◽  
Author(s):  
T. Htun ◽  
K. W. Y. Kyaw ◽  
T. K. Aung ◽  
J. Moe ◽  
A. A. Mon ◽  
...  
Keyword(s):  
Hiv Care ◽  
Event Analysis ◽  
Care Programme ◽  
Attrition Rates ◽  
Cell Counts ◽  
Cd4 Cell Counts ◽  
Living With Hiv ◽  
Lost To Follow Up ◽  
Cd4 Cell

AbstractRetaining adolescents (aged 10–19 years), living with HIV (ALHIV) on antiretroviral therapy (ART) is challenging. In Myanmar, 1269 ALHIV were under an Integrated HIV Care (IHC) Programme by June 2017 and their attrition (death and lost to follow-up) rates were not assessed before. We undertook a cohort study using routinely collected data of ALHIV enrolled into HIV care from July 2005 to June 2017 and assessed their attrition rates in June 2018 by time-to-event analysis. Of 1269 enrolled, 197(16%) and of 1054 initiated ART, 224 (21%) had an attrition defining event. The pre-ART and ART attrition rates were 21.8 (95% CI 19.0–25.1) and 6.4 (95% CI 5.6–7.3) per 100 person-years follow-up, respectively. The factors ‘at enrolment’ that were associated with higher hazards of attrition were: (1) WHO stage 3 or 4; (2) haemoglobin <10 gm/dl; (3) no documented CD4 cell counts, hepatitis B and C test results; and (4) injection drug use. Baseline hazards were high during the initial 1–2 years and after 5–6 years. The pre-ART and ART attrition rates in ALHIV were lower than those in Africa but higher than the children under IHC. This warrants designing and implementing additional care tailored to the needs of ALHIV under IHC.

scholarly journals Impact of HBV and HCV coinfection on CD4 cells among HIV-infected patients: a longitudinal retrospective study

2018 ◽  
Vol 12 (11) ◽  
pp. 1009-1018
Author(s):  
Claudinei Mesquita da Silva ◽  
Leyde Daiane de Peder ◽  
Eraldo S Silva ◽  
Isolde Previdelli ◽  
Omar Cleo Neves Pereira ◽  
...  
Keyword(s):  
Genotype 3 ◽  
Cd4 Cell Count ◽  
Hcv Genotype ◽  
Cell Counts ◽  
Cd4 Cell Counts ◽  
Hcv Genotype 1 ◽  
Hcv Coinfection ◽  
Cd4 Cell ◽  
The Impact

Introduction: The impact of hepatitis B virus (HBV) and hepatitis C virus (HCV) coinfection on CD4 cells in patients with human immunodeficiency virus (HIV) is unclear. We aimed to examine the impact of HBV and HCV coinfection on CD4 cell count and CD4/CD8 ratio in adults with HIV. Methodology: We conducted a longitudinal retrospective study in Brazil between January 1, 2002, and June 30, 2016, including 205 patients with HIV monoinfection, 37 with HIV-HBV coinfection, 35 with HIV-HCV coinfection, and 62 with HIV-HCV (48 HCV genotype 1 and 14 HCV genotype 3). Results: Median duration of follow-up was 2,327 (interquartile range: 1,159–3,319) days. An increased CD4 cell count and CD4/CD8 ratio over time was observed in all groups receiving combined antiretroviral therapy (cART). Patients with HIV-HBV or HIV-HCV coinfection and those with HIV monoinfection, showed comparable CD4 cell counts and CD4/CD8 ratios during pre-ART. There was also no statistically significant difference in CD4/CD8 ratio between HIV-HBV or HIV-HCV coinfection groups and the HIV monoinfection group during follow-up on cART. However, CD4 cell counts were significantly lower in HIV-HCV patients than in HIV monoinfection patients during follow-up on cART. HIV patients with HCV genotype 3 coinfection showed significantly lower CD4/CD8 ratio during follow-up on cART than those coinfected with HCV genotype 1 coinfection. No statistically significant effect of coinfection was observed on the efficacy of cART. Conclusions: HIV-infected patients are more likely to show better immunological responses to cART when they are not coinfected with HCV.

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