Identifying Most Effective Treatment Strategies to Control Arterial Hypertension in Sub-Saharan Africa

2019 ◽  
Author(s):  
Keyword(s):  
Arterial Hypertension ◽  
Effective Treatment ◽  
Treatment Strategies ◽  
Sub Saharan Africa ◽  
Sub Saharan

scholarly journals The coArtHA trial—identifying the most effective treatment strategies to control arterial hypertension in sub-Saharan Africa: study protocol for a randomized controlled trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Herry Mapesi ◽  
Ravi Gupta ◽  
Herieth Ismael Wilson ◽  
Blaise Lukau ◽  
Alain Amstutz ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Randomized Controlled Trial ◽  
Arterial Hypertension ◽  
Controlled Trial ◽  
Treatment Strategies ◽  
Standard Of Care ◽  
Sub Saharan Africa ◽  
Randomized Controlled ◽  
Link Type ◽  
Sub Saharan

Abstract Background Arterial hypertension is the most prevalent risk factor for cardiovascular disease in sub-Saharan Africa. Only a few and mostly small randomized trials have studied antihypertensive treatments in people of African descent living in sub-Saharan Africa. Methods In this open-label, three-arm, parallel randomized controlled trial conducted at two rural hospitals in Lesotho and Tanzania, we compare the efficacy and cost-effectiveness of three antihypertensive treatment strategies among participants aged ≥ 18 years. The study includes patients with untreated uncomplicated arterial hypertension diagnosed by a standardized office blood pressure ≥ 140/90 mmHg. The trial encompasses a superiority comparison between a triple low-dose antihypertensive drug combination versus the current standard of care (monotherapy followed by dual treatment), as well as a non-inferiority comparison for a dual drug combination versus standard of care with optional dose titration after 4 and 8 weeks for participants not reaching the target blood pressure. The sample size is 1268 participants with parallel allocation and a randomization ratio of 2:1:2 for the dual, triple and control arms, respectively. The primary endpoint is the proportion of participants reaching a target blood pressure at 12 weeks of ≤ 130/80 mmHg and ≤ 140/90 mmHg among those aged < 65 years and ≥ 65 years, respectively. Clinical manifestations of end-organ damage and cost-effectiveness at 6 months are secondary endpoints. Discussion This trial will help to identify the most effective and cost-effective treatment strategies for uncomplicated arterial hypertension among people of African descent living in rural sub-Saharan Africa and inform future clinical guidelines on antihypertensive management in the region. Trial registration Clinicaltrials.govNCT04129840. Registered on 17 October 2019 (https://www.clinicaltrials.gov/).

scholarly journals The coArtHA Trial - Identifying the Most Effective Treatment Strategies to Control Arterial Hypertension in Sub-Saharan Africa: Study Protocol for a Randomized Controlled Trial

2020 ◽  
Author(s):  
Herry Mapesi ◽  
Ravi Gupta ◽  
Herieth Ismael Wilson ◽  
Blaise Lukau ◽  
Alain Amstutz ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Randomized Controlled Trial ◽  
Cost Effectiveness ◽  
Arterial Hypertension ◽  
Controlled Trial ◽  
Treatment Strategies ◽  
Standard Of Care ◽  
Sub Saharan Africa ◽  
Randomized Controlled ◽  
Sub Saharan

Abstract Background Arterial hypertension is the most prevalent risk factor for cardiovascular disease in sub-Saharan Africa. Only a few and mostly small randomized trials have studied antihypertensive treatments in people of African descent living in sub-Saharan Africa. MethodsIn this open-label, three-arm, parallel randomized controlled trial conducted at two rural hospitals in Lesotho and Tanzania, we compare the efficacy and cost-effectiveness of three antihypertensive treatment strategies among participants aged ≥18 years. The study includes patients with untreated uncomplicated arterial hypertension diagnosed by a standardized office blood pressure ≥ 140/90mmHg. The trial encompasses a superiority comparison between a triple low-dose antihypertensive drug combination versus the current standard of care (monotherapy followed by dual treatment), as well as a non-inferiority comparison for a dual drug combination versus standard of care with optional dose titration after 4 and 8 weeks for participants not reaching the target blood pressure. The sample size is 1268 participants with parallel allocation and a randomization ratio of 2:1:2 for the dual, triple and control arms, respectively. The primary endpoint is the proportion of participants reaching a target blood pressure at 12 weeks of ≤130/80 mmHg and ≤140/90 mmHg among those aged <65 years and ≥65 years, respectively. Clinical manifestations of end-organ damage and cost-effectiveness at 6 months are secondary endpoints. DiscussionThis trial will help to identify the most effective and cost-effective treatment strategies for uncomplicated arterial hypertension among people of African descent living in rural sub-Saharan Africa and inform future clinical guidelines on antihypertensive management in the region. Trial registrationClinicaltrials.gov, NCT04129840. Registered on 17 October 2019 (https://www.clinicaltrials.gov/).

Stratifying Sepsis in Uganda Using Rapid Pathogen Diagnostics and Clinical Data: A Prospective Cohort Study

2021 ◽  
Author(s):  
Matthew J. Cummings ◽  
Barnabas Bakamutumaho ◽  
Nicholas Owor ◽  
John Kayiwa ◽  
Joyce Namulondo ◽  
...  
Keyword(s):  
Prospective Cohort ◽  
Treatment Strategies ◽  
Specific Treatment ◽  
Sub Saharan Africa ◽  
Rapid Diagnostics ◽  
Suspected Sepsis ◽  
Laboratory Capacity ◽  
Antimicrobial Management ◽  
Sub Saharan ◽  
Tb 32

The global burden of sepsis is concentrated in sub-Saharan Africa, where extensive pathogen diversity and limited laboratory capacity challenge targeted antimicrobial management of life-threatening infections. In this context, established and emerging rapid pathogen diagnostics may stratify sepsis patients into subgroups with prognostic and therapeutic relevance. In a prospective cohort of adults (age ≥18 years) hospitalized with suspected sepsis in Uganda, we stratified patients using rapid diagnostics for HIV, tuberculosis (TB), malaria, and influenza, and compared clinical characteristics and 30-day outcomes across these pathogen-driven subgroups. From April 2017 to August 2019, 301 adults were enrolled (median age, 32 years [interquartile range, 26–42 years]; female, n = 178 [59%]). A total of 157 patients (53%) were HIV infected. Sixty-one patients (20%) tested positive for malaria, 52 (17%), for TB (including 49 of 157 [31%] HIV-infected patients), and 17 (6%), for influenza. Co-infection was identified in 33 (11%) patients. The frequency of multi-organ failure, including shock and acute respiratory failure, was greatest among patients with HIV-associated TB. Mortality at 30 days was 19% among patients with malaria, 40% among patients with HIV-associated TB, 32% among HIV-infected patients without microbiological evidence of TB, 6% among patients with influenza, and 11% among patients without a pathogen identified. Despite improvements in anti-retroviral delivery, the burden of sepsis in Uganda remains concentrated among young, HIV-infected adults, with a high incidence of severe HIV-associated TB. In parallel with improvements in acute-care capacity, use of rapid pathogen diagnostics may enhance triage and antimicrobial management during emergency care for sepsis in sub-Saharan Africa, and could be used to enrich study populations when trialing pathogen-specific treatment strategies in the region.

scholarly journals PO 8719 INTRODUCING A NEW AFRICA MENINGITIS NETWORK – A NORTH-SOUTH COLLABORATION

2019 ◽  
Vol 4 (Suppl 3) ◽  
pp. A63.1-A63
Author(s):  
Mosepele Mosepele ◽  
Cecilia Kanyama ◽  
David Meya ◽  
Fiona Cresswell ◽  
Timothee Chammard ◽  
...  
Keyword(s):  
Treatment Strategies ◽  
Sub Saharan Africa ◽  
High Dose ◽  
Diagnostic Strategies ◽  
Cns Infections ◽  
Study Protocols ◽  
Sub Saharan ◽  
Novel Treatment Strategies ◽  
Set Up ◽  
Randomised Controlled

BackgroundCentral nervous system infections, including meningitis, continue to cause significant morbidity in Africa. HIV has contributed to the epidemiology of CNS infections in this setting. Notable advances in the study of CNS infections by several groups have demonstrated the utility of new diagnostic strategies and impact of novel treatment strategies. However, efforts to coordinate meningitis research in Africa, and between Africa and the rest of the world remain very limited.MethodsIn a bid to promote a coordinated study of CNS infections across Africa, and in collaboration with other meningitis groups globally, the researchers of the AMBITION study (High Dose Ambisome on a Fluconazole Backbone for Cryptococcal Meningitis Induction Therapy in Sub-saharan Africa: A Randomised Controlled Non-inferiority Trial) are leveraging the EDCTP support for the AMBITION trial to set up an Africa Meningitis Trials Network.ResultsThe Africa Meningitis Trials Network (AMNET) was launched in Malawi in early 2018. Main achievements since the launch of the network, include an internal review of meningitis research across network sites and launch of the network website. The network also has two study protocols pending ethics review at all sites. These studies will provide much needed information on resources available for meningitis care, research and provide a baseline epidemiology of meningitis in Africa.ConclusionAMNET provides a rare opportunity for investigators interested in meningitis research to leverage the ongoing AMBITION trial to conduct Africa-wide preliminary research on meningitis. The network is recruiting additional members in Africa and globally to collaborate on meningitis research, and also apply for research funding to support meningitis work. Anyone interested in knowing more about the network should contact the AMNET communications officer, Ms Phum’lani Machao, [email protected]

scholarly journals Cryptococcal antigenemia and its predictors among HIV infected patients in resource limited settings: a systematic review

2019 ◽  
Author(s):  
Awoke Derbie ◽  
Daniel Mekonnen ◽  
Yimtubeznash Woldeamanuel ◽  
Tamrat Abebe
Keyword(s):  
Grey Literature ◽  
Treatment Strategies ◽  
Cd4 Count ◽  
Sub Saharan Africa ◽  
Resource Limited Settings ◽  
Resource Limited ◽  
Cryptococcal Disease ◽  
Pooled Prevalence ◽  
Comprehensive Search ◽  
Sub Saharan

Abstract Background : Cryptococcosis is an opportunistic fungal infection that primarily affects people with advanced Human immunodeficiency virus (HIV) disease and is an important cause of morbidity and mortality around the globe. By far the most common presentation of the disease is cryptococcal meningitis (CM), which leads to an estimated 15-20% of all HIV related deaths worldwide, 3/4 of which are in sub-Saharan Africa. However, to the best of our knowledge there is quite limited reviewed data that on the epidemiology of cryptococcal antigenemia in a large HIV-infected population in resource limited settings. Methods : Articles published in English irrespective of the time of publication were systematically searched using comprehensive search strings from PubMed/Medline and SCOPUS. In addition, Google Scholar and Google databases were searched manually for grey literature. Two reviewers independently assessed study eligibility, extracted data, and assessed risk of bias. The magnitude of cryptococcal antigenemia and its predictors were presented with descriptive statistics and summary measures. The pooled prevalence of cryptococcal antigenemia was also determined with 95% confidence interval (CI). Result: A mong 2941 potential citations, we have included 22 studies with a total of 8,338 HIV positive individuals. The studies were reported in ten different countries during the year (2007-2018). Most of the articles reported the mean CD4 count of the participants <100 cells/µl. The pooled prevalence of cryptococcal antigenemia at different CD4 count and ART status was at 8% (95%CI: 6-10%) (ranged between 1.7% and 33%). Body mass index (BMI) <18.5kg/m 2 , CD4 count <100 cells, presenting with headache and male gender were reported by two or more articles as an important predictors of cryptococcal antigenemia. Conclusions : Implementing a targeted screening of HIV patients with low BMI, CD4 count <100 cells, having headache and males; and treatment for asymptomatic cryptococcal disease should be considered. Additional data is needed to better define the epidemiology of cryptococcal antigenemia and its predictors in resource limited settings in order to design prevention, diagnosis, and treatment strategies.

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