scholarly journals Temporal trends in pre-ART patient characteristics and outcomes before the Test and Treat era in Central Kenya

2020 ◽  
Author(s):  
Paul Wekesa ◽  
Angela McLigeyo ◽  
Kevin Owuor ◽  
Jonathan Mwangi ◽  
Linda Isavwa ◽  
...  
Keyword(s):  
Clinical Stage ◽  
Cohort Analysis ◽  
Temporal Trends ◽  
Patient Characteristics ◽  
Disease Stage ◽  
Care Clinic ◽  
Healthcare Facilities ◽  
Art Initiation ◽  
Central Kenya

Abstract Background Retention of patients who did not to initiate antiretroviral therapy (ART) has been persistently low compared to those initiated ART. Understanding the temporal trends in clinical outcomes prior to ART initiation is important to inform interventions targeting patients who do not initiate ART immediately after diagnosis. Methods A retrospective cohort analysis of known HIV-infected patients who did not initiate ART from healthcare facilities in Central Kenya was done to investigate temporal trends in characteristics, retention, and mortality outcomes. The data were sourced from the Comprehensive Care Clinic Patient Application Database (CPAD) and IQ care electronic patient-level databases for those enrolled between 2004 and 2014. Results A total of 13,779 HIV-infected patients were assessed, of whom 30.7% were men.There were statisitically significant differences in temporal trends relating to marital status, WHO clinical stage, and tuberculosis (TB) status from 2004 to 2014. The proportion of widowed patients decreased from 9.1% to 6.0%. By WHO clinical stage at enrollment in program, those in WHO stage I increased over time from 8.7% to 43.1%, while those in WHO stage III and IV reduced from 28.5% to 10.8% and 4.0% to 1.1% respectively. Those on TB treatment during their last known visit reduced from 8.3% to 3.9% while those with no TB signs increased from 58.5% to 86.8%. Trends in 6 and 12 month retention in the program, loss to follow-up (LTFU) and mortality were statistically significant. At 6 months, program retention ranged between 36.0% in 2004 to a high of 54.1% in 2013. LTFU at six months remained around 50.0% for most of the cohorts, while mortality at 6 months was 7.5% in 2004 but reduced to 3.8% in 2014. At 12 months, LTFU was above 50.0% across all the cohorts while mortality rate reached 3.9% in 2014. Conclusion Trends in pre ART enrollment suggested higher enrollment among patients who were women and at earlier WHO clinical stages. Retention and mortality outcomes at 6 and 12 months generally improved over the 11 year follow-up period, though dipped as enrollment in asymptomatic disease stage increased.

scholarly journals Temporal trends in pre-ART patient characteristics and outcomes before the Test and Treat era in Central Kenya

2020 ◽  
Author(s):  
Paul Wekesa ◽  
Angela McLigeyo ◽  
Kevin Owuor ◽  
Jonathan Mwangi ◽  
Linda Isavwa ◽  
...  
Keyword(s):  
Clinical Stage ◽  
Cohort Analysis ◽  
Temporal Trends ◽  
Patient Characteristics ◽  
Disease Stage ◽  
Care Clinic ◽  
Healthcare Facilities ◽  
Art Initiation ◽  
Central Kenya

Abstract Background Retention of patients who did not to initiate antiretroviral therapy (ART) has been persistently low compared to those initiated ART. Understanding the temporal trends in clinical outcomes prior to ART initiation is important to inform interventions targeting patients who do not initiate ART immediately after diagnosis. Methods A retrospective cohort analysis of known HIV-infected patients who did not initiate ART from healthcare facilities in Central Kenya was done to investigate temporal trends in characteristics, retention, and mortality outcomes. The data were sourced from the Comprehensive Care Clinic Patient Application Database (CPAD) and IQ care electronic patient-level databases for those enrolled between 2004 and 2014. Results A total of 13,779 HIV-infected patients were assessed, of whom 30.7% were men.There were statisitically significant differences in temporal trends relating to marital status, WHO clinical stage, and tuberculosis (TB) status from 2004 to 2014. The proportion of widowed patients decreased from 9.1–6.0%. By WHO clinical stage at enrollment in program, those in WHO stage I increased over time from 8.7–43.1%, while those in WHO stage III and IV reduced from 28.5–10.8% and 4.0–1.1% respectively. Those on TB treatment during their last known visit reduced from 8.3–3.9% while those with no TB signs increased from 58.5–86.8%. Trends in 6 and 12 month retention in the program, loss to follow-up (LTFU) and mortality were statistically significant. At 6 months, program retention ranged between 36.0% in 2004 to a high of 54.1% in 2013. LTFU at six months remained around 50.0% for most of the cohorts, while mortality at 6 months was 7.5% in 2004 but reduced to 3.8% in 2014. At 12 months, LTFU was above 50.0% across all the cohorts while mortality rate reached 3.9% in 2014. Conclusion Trends in pre ART enrollment suggested higher enrollment among patients who were women and at earlier WHO clinical stages. Retention and mortality outcomes at 6 and 12 months generally improved over the 11 year follow-up period, though dipped as enrollment in asymptomatic disease stage increased.

scholarly journals Temporal trends in pre-ART patient characteristics and outcomes before the test and treat era in Central Kenya

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
P. Wekesa ◽  
A. McLigeyo ◽  
K. Owuor ◽  
J. Mwangi ◽  
L. Isavwa ◽  
...  
Keyword(s):  
Clinical Stage ◽  
Cohort Analysis ◽  
Temporal Trends ◽  
Patient Characteristics ◽  
Disease Stage ◽  
Care Clinic ◽  
Healthcare Facilities ◽  
Art Initiation ◽  
Central Kenya

Abstract Background Retention of patients who did not initiate antiretroviral therapy (ART) has been persistently low compared to those who initiated ART. Understanding the temporal trends in clinical outcomes prior to ART initiation may inform interventions targeting patients who do not initiate ART immediately after diagnosis. Methods A retrospective cohort analysis of known HIV-infected patients who did not initiate ART from healthcare facilities in Central Kenya was done to investigate temporal trends in characteristics, retention, and mortality outcomes. The data were sourced from the Comprehensive Care Clinic Patient Application Database (CPAD) and IQ care electronic patient-level databases for those enrolled between 2004 and 2014. Results A total of 13,779 HIV-infected patients were assessed, of whom 30.7% were men.There were statisitically significant differences in temporal trends relating to marital status, WHO clinical stage, and tuberculosis (TB) status from 2004 to 2014. The proportion of widowed patients decreased from 9.1 to 6.0%. By WHO clinical stage at enrollment in program, those in WHO stage I increased over time from 8.7 to 43.1%, while those in WHO stage III and IV reduced from 28.5 to 10.8% and 4.0 to 1.1% respectively. Those on TB treatment during their last known visit reduced from 8.3 to 3.9% while those with no TB signs increased from 58.5 to 86.8%. Trends in 6 and 12 month retention in the program, loss to follow-up (LTFU) and mortality were statistically significant. At 6 months, program retention ranged between 36.0% in 2004 to a high of 54.1% in 2013. LTFU at 6 months remained around 50.0% for most of the cohorts, while mortality at 6 months was 7.5% in 2004 but reduced to 3.8% in 2014. At 12 months, LTFU was above 50.0% across all the cohorts while mortality rate reached 3.9% in 2014. Conclusion Trends in pre ART enrollment suggested higher enrollment among patients who were women and at earlier WHO clinical stages. Retention and mortality outcomes at 6 and 12 months generally improved over the 11 year follow-up period, though dipped as enrollment in asymptomatic disease stage increased.

Post-Transplant Therapy Is More Important Than Induction Regimen Choice in Autologous Hematopoietic Cell Transplantation (AHCT) Recipients for Multiple Myeloma (MM)

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 396-396 ◽  
Author(s):  
Robert Frank Cornell ◽  
Luciano J Costa ◽  
Adetola A. Kassim ◽  
Racquel Inns-Shelton ◽  
Amrita Krishnan ◽  
...  
Keyword(s):  
High Risk ◽  
Hematopoietic Cell Transplantation ◽  
Chromosomal Abnormalities ◽  
Conditioning Regimen ◽  
Patient Characteristics ◽  
Chromosome 1 ◽  
Disease Stage ◽  
Similar Response ◽  
Induction Regimen

Abstract Background: Modern therapies incorporating bortezomib (V), lenalidomide (R), cyclophosphamide (C) and dexamethasone (D) constitute the most common doublet (RD, VD) or triplet (VRD, CVD) initial induction regimens for transplant eligible MM in the US. These regimens produce an overall response rate of >80% but their impact on longer term post-AHCT outcomes are largely unknown. Patient and Methods: We evaluated the relative impact of pre- and post-AHCT treatment on 693 patients receiving upfront AHCT after induction with RD (178), VD (161), CVD (84) or VRD (270) using data prospectively reported to the CIBMTR from 2008-2013. Analysis was limited to those receiving one line of induction chemotherapy and a single transplant with 200 mg/m2 melphalan as conditioning regimen no later than 12 months from treatment initiation. Survival endpoints were evaluated from time of AHCT and the planned use of post-AHCT maintenance incorporating R or V was also considered. Results: The table shows patient characteristics. Median number of induction cycles were 4 (range, 2 to 16) and median time to transplant was 6.5 months. Median follow up was 36 months (3 to 82) from time of transplant. Age, disease stage, disease status at transplant and cytogenetic risk were similar between the 4 cohorts. Fourteen percent had high-risk chromosomal abnormalities [17pdel, t(4;14), t(14;16), chromosome 1 abnormalities and hypodiploidy]. CVD and VD were used more frequently in patients with renal failure. Doublet use was more common before 2010 (55%) and triplets after 2010 (85%). Use of R or V post-AHCT chemotherapy was higher in with VRD (79%) and CVD (81%) cohorts vs. RD (53%) and VD (67%). No differences in pre- or post-AHCT responses were seen with regard to choice of induction agents. Pre-AHCT responses ≥VGPR were 57% for VRD vs. 45/42/51% for CVD/RD/VD respectively. Corresponding post AHCT responses at day 100 were 65% for VRD and 58/63/65% respectively. In multivariate analysis of relapse, progression free (PFS) and overall survival (OS), there was no overall difference in these outcomes based on induction regimen. High risk cytogenetics (HR = 0.57, p=0.0004 for non-high risk) and absence of planned maintenance (HR=1.55, p=0.0008) were associated with higher risk of relapse. VRD was associated with a marginal benefit in relapse risk vs. CVD (HR=0.68, p=0.04). Non-relapse mortality was similar across cohorts. Those not receiving planned post-AHCT maintenance (HR 1.69, p<0.001) and high-risk MM had higher risk of progression/death (HR in non-high risk 0.58, p<0.001); OS was lower in those with low stage (DSS or ISS I/II) vs. stage III (HR 0.6, p=0.006) and with non-high risk cytogenetics (HR 0.5, p=0.001). Patients receiving planned post-AHCT therapy had significantly improved 3-year PFS vs. no post-AHCT therapy (55% vs. 39%, log-rank p=0.0001) (figure). Conclusions: Modern induction doublets and triplets induce similar response rates and post AHCT outcomes at a median follow-up of 36 mo. Although there is an increase in use of triplets after 2010 in transplant eligible patients, our analysis suggests that the choice of induction regimen is less important than the decision to use vs. not use planned post-AHCT maintenance therapy. Figure 1. Patient characteristics. Figure 1. Patient characteristics. Figure 2. PFS by planned post-AHCT therapy vs. not: Figure 2. PFS by planned post-AHCT therapy vs. not: Disclosures Krishnan: Janssen: Consultancy; BMS: Consultancy; Jazz: Consultancy; Millenium: Speakers Bureau; Celgene: Consultancy, Speakers Bureau; Onyx: Speakers Bureau. Gasparetto:Millennium: Honoraria, Other: Export Board Committee, Speakers Bureau; Celgene Corporation: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau. Hari:Celgene: Consultancy; Takeda: Consultancy; BMS: Consultancy; Janssen: Consultancy; Novartis: Consultancy; Spectrum: Consultancy; Sanofi: Consultancy.

scholarly journals Sidedness Determines Clinical Characteristics and Survival Outcomes in Medullary Adenocarcinoma of the Colon

2021 ◽  
Author(s):  
Andrew M. Blakely ◽  
Rebecca A. Nelson ◽  
Stanley A. Hamilton ◽  
Lily L. Lai
Keyword(s):  
Treatment Guidelines ◽  
Cohort Analysis ◽  
Colon Adenocarcinoma ◽  
Patient Characteristics ◽  
Incidence Rates ◽  
Disease Stage ◽  
Annual Percent Change ◽  
Histologic Subtype ◽  
Molecular Features ◽  
Adjusted Incidence

Abstract Background: Colon medullary adenocarcinoma (MAC) is a rare histologic subtype. Clinical presentation and cancer outcomes of MAC, compared to colon adenocarcinoma (AC), remain incompletely described.Methods: Annual age-adjusted incidence rates were computed using Surveillance, Epidemiology, and End Results (2002–2017). A cohort analysis using the National Cancer Database (2010–2016) compared patient characteristics in an unmatched dataset and prognostic characteristics in a 1:1 matched subset. Results: Reported annual age-adjusted incidence of MAC has significantly increased, with an average annual percent change (APC) increase of 23.8% (95% CI: 19.2–28.6); concurrent AC incidence declined (APC: -2.8, 95% CI: -3.1– -2.8). Analyses of 1,018 MAC and 210,784 AC unmatched patients showed that MAC patients were more often older, female, and white, with higher disease stage, poorly-differentiated tumors, right-sided laterality, and lymphovascular invasion (all p<0.0001). Among those with known microsatellite status, instability was more prevalent among MAC than AC patients (82% vs. 24%, p<0.0001). Multivariate analyses of the matched dataset revealed that MAC histology was not independently associated with overall survival. However, when stratifying by laterality, left-sided MAC was associated with shorter survival when compared to right-sided MAC (HR 1.62, 95% CI: 1.13–2.32) and right-sided AC (HR 1.53, 95% CI: 1.12–2.11).Conclusions: The reported incidence of MAC is increasing, in contrast to the declining incidence of AC. MAC clinical and molecular features are distinct from AC and likely account for outcome differences. Overall, left-sided MAC was associated with the shortest OS. Molecular profiling may improve treatment guidelines for MAC.

scholarly journals Health Provider Perspectives of Health Facility Preparedness and Organization in Implementation of Option B+ among Pregnant and Lactating Women in Central Uganda: A Qualitative Study

2019 ◽  
Vol 18 ◽  
pp. 232595821983393
Author(s):  
Aggrey David Mukose ◽  
Hilde Bastiaens ◽  
Esther Buregyeya ◽  
Rose Naigino ◽  
Fredrick Makumbi ◽  
...  
Keyword(s):  
Essential Medicines ◽  
Health Providers ◽  
Care Clinic ◽  
Hiv Counseling ◽  
Art Initiation ◽  
Provider Perspectives ◽  
Counseling And Testing ◽  
Support Mechanisms ◽  
Mother To Child

Introduction: Uganda adopted Option B+ for prevention of mother-to-child transmission (PMTCT) of HIV in 2012. However, there is limited data on preparedness and organization of Option B+ services. These data are critical in informing PMTCT programs and provision of universal antiretroviral therapy (ART) for all populations. This study explored health providers’ experiences of preparedness and organization of Option B+ services in Central Uganda. Methods: Key informant interviews with 54 health providers from 6 health facilities in 3 districts were conducted. Thematic approach was employed to analyze data. Results: Themes identified on preparedness were training of frontline health providers and provision of Option B+ guidelines, supervision and mentorship, and provision of essential medicines and medical health supplies, whereas those concerning organization were HIV counseling and testing, ART initiation, follow-up, and patient support mechanisms. Innovations like use of expert clients, assessing women’s readiness to start Option B+, and retaining women in antenatal care clinic depending on the need are important in provision of Option B+. Conclusion: This study provides insights into preparedness and organization of Option B+ services which are important in provision of Option B+ and universal ART for all populations. Research around models of follow-up is recommended.

scholarly journals Outcome of antiretroviral therapy: a longitudinal study in Nalgonda district, Telangana

2018 ◽  
Vol 5 (12) ◽  
pp. 5096
Author(s):  
Misha Gorantla ◽  
Varun M. Malhotra ◽  
Kondagunta Nagaraj
Keyword(s):  
Risk Factors ◽  
Longitudinal Study ◽  
Antiretroviral Therapy ◽  
Opportunistic Infections ◽  
Economic Status ◽  
Clinical Stage ◽  
Good Health ◽  
Art Initiation ◽  
One Year

Background: India is among the list of countries with highest HIV prevalence. Retention in care is vital to maintain good health and obtain antiretroviral therapy (ART) medicines on time. The objectives of the study were to study the clinico-demographic profile of study population and to study the outcome of ART after one year of treatment initiation.Methods: This is an observational follow up (longitudinal) study done on 142 patients which included all newly diagnosed (diagnosed on or after 1st January 2012), sero positive, adult patients, enrolled at an ART centre and started on treatment during the months of December 2012, January 2013, February 2013, using a pre-designed, pre-tested questionnaire. They were visited again a year after ART initiation and outcome was assessed along with determinants of poor outcome.Results: Mortality at the end of one year was 9.15%, rate of loss to follow up (LFU) was 7.6%.Therefore a total of 73.2% cases were retained in care and 26.8% were disengaged from care (LFU and dead) after one year of ART initiation. Risk factors found to have significant association with being disengaged from care were male sex, unmarried/widowed/divorced/separated individuals, lower socio economic status, illiteracy, unskilled occupation, spouse status negative for HIV, presence of addictions like alcoholism, smoking, experience of drug side effects, early WHO clinical stage, presence of opportunistic infections and low CD4 counts.Conclusions: Many of the risk factors are amenable for intervention and may be incorporated to strengthen the programme.

scholarly journals Virological Failure and Associated Risk Factors among HIV/AIDS Pediatric Patients at the ART Clinic of Jimma university Medical Center, Southwest Ethiopia

2020 ◽  
Vol 14 (1) ◽  
pp. 61-67
Author(s):  
Fozia T. Osman ◽  
Mengist A. Yizengaw
Keyword(s):  
Risk Factors ◽  
Virological Failure ◽  
Antiretroviral Treatment ◽  
Pediatric Patients ◽  
Medical Center ◽  
Clinical Stage ◽  
Art Initiation ◽  
Jimma University ◽  
Hiv Aids

Background: Pediatric antiretroviral treatment failure is an under-recognized issue that receives inadequate attention in the field of pediatrics and within HIV treatment programs. Despite the reduction in morbidity and mortality, a considerable proportion of patients fail to achieve a sustained virologic response to therapy. Thus virological failure is an increasing concern globally. Objective: This study aimed to assess the virological failure and associated risk factors among HIV/AIDS pediatric patients at Antiretroviral Treatment (ART) follow up clinic of Jimma University Medical Center, southwest Ethiopia. Methods: An institution based cross-sectional study was conducted at the ART follow-up clinic of Jimma University Medical Center. A structured English version checklist was developed and used for data extraction from patients’ charts from April -May 2019. Then the data was coded and entered using epi data 4.2 and exported to statistical package for social science (SPSS version 22) for analysis. Descriptive analysis was conducted for categorical as well as continuous variables. Multivariable logistic regression was performed in a backward, step-wise manner until a best-fit model was found. Results: Of 140 HIV/AIDS pediatric patients enrolled in this study, 72(51.4%) were male and the mean age was 9.7±3.3 Years. ABC-3TC-NVP was the commonly used ART medication in this population, which was 37.1% followed by AZT-3TC-EFV(32.1%). The mean duration of antiretroviral treatment (ART) follow-up was 63.8±29.4 months. Among the study population, 11.0% of them had virological failure. Weight at ART initiation [OR=1.104, 95 CI% [1.013-1.203], p=0.024] and WHO clinical stage 3 [AOR=0.325, 95CI, 0.107-0.991,P=0.048] were the significant risk factors for the virological failure. Conclusion: A significant proportion of HIV/AIDS pediatric patients had virological failure. Weight at ART initiation and patients having WHO clinical stage 3 were risk factors associated with virological failure in this study. Governmental and non-governmental concerned bodies should invest their effort to devise strategies for the achievement of HIV/AIDS treatment targets.

scholarly journals Work Outcomes after Intensity-Modulated Proton Therapy (IMPT) versus Intensity-Modulated Photon Therapy (IMRT) for Oropharyngeal Cancer

2021 ◽  
Vol 8 (1) ◽  
pp. 319-327
Author(s):  
Grace L. Smith ◽  
Shuangshuang Fu ◽  
Matthew S. Ning ◽  
Diem-Khanh Nguyen ◽  
Paul M. Busse ◽  
...  
Keyword(s):  
Oropharyngeal Cancer ◽  
Temporal Trends ◽  
Work Productivity ◽  
Patient Characteristics ◽  
Work Outcomes ◽  
Activity Impairment ◽  
Intensity Modulated ◽  
Productivity Losses ◽  
Patient Reported

Abstract Purpose We compared work outcomes in patients with oropharyngeal cancer (OPC), randomized to intensity-modulated proton (IMPT) versus intensity-modulated photon therapy (IMRT) for chemoradiation therapy (CRT). Patients and Methods In 147 patients with stage II-IVB squamous cell OPC participating in patient-reported outcomes assessments, a prespecified secondary aim of a randomized phase II/III trial of IMPT (n = 69) versus IMRT (n = 78), we compared absenteeism, presenteeism (i.e., the extent to which an employee is not fully functional at work), and work productivity losses. We used the work productivity and activity impairment questionnaire at baseline (pre-CRT), at the end of CRT, and at 6 months, 1 year, and 2 years. A one-sided Cochran-Armitage test was used to analyze within-arm temporal trends, and a χ2 test was used to compare between-arm differences. Among working patients, at each follow-up point, a 1-sided Wilcoxon rank-sum test was used to compare work-productivity scores. Results Patient characteristics in IMPT versus IMRT arms were similar. In the IMPT arm, within-arm analysis demonstrated that an increasing proportion of patients resumed working after IMPT, from 60% (40 of 67) pre-CRT and 71% (30 of 42) at 1 year to 78% (18 of 23) at 2 years (P = 0.025). In the IMRT arm, the proportion remained stable, with 57% (43 of 76) pre-CRT, 54% (21 of 39) at 1 year, and 52% (13 of 25) working at 2 years (P = 0.47). By 2 years after CRT, the between-arm difference between patients who had IMPT and those who had IMRT trended toward significance (P = 0.06). Regardless of treatment arm, among working patients, the most severe work impairments occurred from treatment initiation to the end of CRT, with significant recovery from absenteeism, presenteeism, and productivity impairments by the 2-year follow-up (P &lt; 0.001 for all). Higher magnitudes of recovery from absenteeism (at 1 year, P = 0.05; and at 2 years, P = 0.04) and composite work impairment scores (at 1 year, P = 0.04; and at 2 years, P = 0.04) were seen in patients treated with IMPT versus those treated with IMRT. Conclusion In patients with OPC receiving curative CRT, patients randomized to IMPT demonstrated increasing work and productivity recovery trends. Studies are needed to identify mechanisms underlying head and neck CRT treatment causing work disability and impairment.

scholarly journals Lessons for test and treat in an antiretroviral programme after decentralisation in Uganda: a retrospective analysis of outcomes in public healthcare facilities within the Lablite project

2019 ◽  
Vol 12 (5) ◽  
pp. 429-443
Author(s):  
S Kiwuwa-Muyingo ◽  
G Abongomera ◽  
I Mambule ◽  
D Senjovu ◽  
E Katabira ◽  
...  
Keyword(s):  
Risk Factors ◽  
Primary Care ◽  
Central Region ◽  
Public Healthcare ◽  
Healthcare Facilities ◽  
Test And Treat ◽  
The North ◽  
Art Initiation ◽  
Care Facilities

Abstract Background We describe the decentralisation of antiretroviral therapy (ART) alongside Option B+ roll-out in public healthcare facilities in the Lablite project in Uganda. Lessons learned will inform programmes now implementing universal test and treat (UTT). Methods Routine data were retrospectively extracted from ART registers between October 2012 and March 2015 for all adults and children initiating ART at two primary care facilities (spokes) and their corresponding district hospitals (hubs) in northern and central Uganda. We describe ART initiation over time and retention and use of Cox models to explore risk factors for attrition due to mortality and loss to follow-up. Results from tracing of patients lost to follow-up were used to correct retention estimates. Results Of 2100 ART initiations, 1125 were in the north, including 944 (84%) at the hub and 181 (16%) at the spokes; children comprised 95 (10%) initiations at the hubs and 14 (8%) at the spokes. Corresponding numbers were 642 (66%) at the hub and 333 (34%) at the spokes in the central region (77 [12%] and 22 [7%], respectively, in children). Children &lt;3 y of age comprised the minority of initiations in children at all sites. Twenty-three percent of adult ART initiations at the north hub were Option B+ compared with 45% at the spokes (25% and 65%, respectively, in the central region). Proportions retained in care in the north hub at 6 and 12 mo were 92% (95% CI 90 to 93) and 89% (895% CI 7 to 91), respectively. Corresponding corrected estimates in the north spokes were 87% (95% CI 78 to 93) and 82% (95% CI 72 to 89), respectively. In the central hub, corrected estimates were 84% (95% CI 80 to 87) and 78% (95% CI 74 to 82), and were 89% (95% CI 77.9 to 95.1) and 83% (95% CI 64.1 to 92.9) at the spokes, respectively. Among adults newly initiating ART, being older was independently associated with a lower risk of attrition (adjusted hazard ratio [aHR] 0.93 per 5 y [95% CI 0.88 to 0.97]). Other independent risk factors included initiating with a tenofovir-based regimen vs zidovudine (aHR 0.60 [95% CI 0.46 to 0.77]), year of ART initiation (2013 aHR 1.55 [95% CI 1.21 to 1.97], ≥2014 aHR 1.41 [95% CI 1.06 to 1.87]) vs 2012, hub vs spoke (aHR 0.35 [95% CI 0.29 to 0.43]) and central vs north (aHR 2.28 [95% CI 1.86 to 2.81]). Independently, patient type was associated with retention. Conclusions After ART decentralisation, people living with human immunodeficiency virus (HIV) were willing to initiate ART in rural primary care facilities. Retention on ART was variable across facilities and attrition was higher among some groups, including younger adults and women initiating ART during pregnancy/breastfeeding. Interventions to support these groups are required to optimise benefits of expanded access to HIV services under UTT.

scholarly journals Sidedness determines clinical characteristics and survival outcomes in medullary adenocarcinoma of the colon

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Andrew M. Blakely ◽  
Rebecca A. Nelson ◽  
Stanley A. Hamilton ◽  
Lily L. Lai
Keyword(s):  
Treatment Guidelines ◽  
Cohort Analysis ◽  
Colon Adenocarcinoma ◽  
Patient Characteristics ◽  
Incidence Rates ◽  
Disease Stage ◽  
Annual Percent Change ◽  
Histologic Subtype ◽  
Molecular Features ◽  
Adjusted Incidence

AbstractColon medullary adenocarcinoma (MAC) is a rare histologic subtype. Clinical presentation and cancer outcomes of MAC, compared to colon adenocarcinoma (AC), remain incompletely described. Annual age-adjusted incidence rates were computed using Surveillance, Epidemiology, and End Results (2002–2017). A cohort analysis using the National Cancer Database (2010–2016) compared patient characteristics in an unmatched dataset and prognostic characteristics in a 1:1 matched subset. Reported annual age-adjusted incidence of MAC has significantly increased, with an average annual percent change (APC) increase of 23.8% (95% CI: 19.2–28.6); concurrent AC incidence declined (APC: − 2.8, 95% CI: − 3.1 to − 2.8). Analyses of 1018 MAC and 210,784 AC unmatched patients showed that MAC patients were more often older, female, and white, with higher disease stage, poorly-differentiated tumors, right-sided laterality, and lymphovascular invasion (all p < 0.0001). Among those with known microsatellite status, instability was more prevalent among MAC than AC patients (82% vs. 24%, p < 0.0001). Multivariate analyses of the matched dataset revealed that MAC histology was not independently associated with overall survival. However, when stratifying by laterality, left-sided MAC was associated with shorter survival when compared to right-sided MAC (HR 1.66, 95% CI 1.16–2.38) and right-sided AC (HR 1.54, 95% CI 1.12–2.12). The reported incidence of MAC is increasing, in contrast to the declining incidence of AC. MAC clinical and molecular features are distinct from AC and likely account for outcome differences. Overall, left-sided MAC was associated with the shortest OS. Molecular profiling may improve treatment guidelines for MAC.

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