scholarly journals Factors Associated with HIV Drug Resistance in Dar es Salaam, Tanzania: Analysis of a Complex Adaptive System

Pathogens ◽  
2021 ◽  
Vol 10 (12) ◽  
pp. 1535
Author(s):  
Anneleen Kiekens ◽  
Idda H. Mosha ◽  
Lara Zlatić ◽  
George M. Bwire ◽  
Ally Mangara ◽  
...  
Keyword(s):  
Drug Resistance ◽  
Dar Es Salaam ◽  
Feedback Loops ◽  
People Living With Hiv ◽  
Local Systems ◽  
Hiv Drug Resistance ◽  
Leverage Points ◽  
Factors Influencing ◽  
Sub Saharan ◽  
Living With Hiv

HIV drug resistance (HIVDR) is a complex problem with multiple interconnected and context dependent causes. Although the factors influencing HIVDR are known and well-studied, HIVDR remains a threat to the effectiveness of antiretroviral therapy. To understand the complexity of HIVDR, a comprehensive, systems approach is needed. Therefore, a local systems map was developed integrating all reported factors influencing HIVDR in the Dar es Salaam Urban Cohort Study area in Tanzania. The map was designed based on semi-structured interviews and workshops with people living with HIV and local actors who encounter people living with HIV during their daily activities. We visualized the feedback loops driving HIVDR, compared the local map with a systems map for Sub-Saharan Africa, previously constructed from interviews with international HIVDR experts, and suggest potential interventions to prevent HIVDR. We found several interconnected balancing and reinforcing feedback loops related to poverty, stigmatization, status disclosure, self-esteem, knowledge about HIVDR and healthcare system workload, among others, and identified three potential leverage points. Insights from this local systems map were complementary to the insights from the Sub-Saharan systems map showing that both viewpoints are needed to fully understand the system. This study provides a strong baseline for quantitative modelling, and for the identification of context-dependent, complexity-informed leverage points.

Evaluation of Acquired HIV Drug Resistance among People Living with HIV Who Have Taken Antiretroviral Therapy for 9–15 Months in 14 Triangular Clinics in Iran, 2015–2016

Intervirology ◽  
2018 ◽  
Vol 61 (6) ◽  
pp. 292-300 ◽  
Author(s):  
Minoo Mohraz ◽  
Katayoun Tayeri ◽  
Hengameh Namdari Tabar ◽  
Zahra Bayat Jozani ◽  
Leila Sadeghi ◽  
...  
Keyword(s):  
Drug Resistance ◽  
Antiretroviral Therapy ◽  
People Living With Hiv ◽  
Hiv Drug Resistance ◽  
Living With Hiv

scholarly journals Factors Influencing Adherence to Anti-retroviral Therapy among Persons Living with HIV/AIDS in Enugu State Southeast Nigeria

2019 ◽  
pp. 1-8
Author(s):  
C. P. Igweagu ◽  
O. H. Chime ◽  
O. C. Ekwueme
Keyword(s):  
Health Education ◽  
Sub Saharan Africa ◽  
Limiting Factors ◽  
People Living With Hiv ◽  
Factors Influencing ◽  
Persons Living With Hiv ◽  
Enugu State ◽  
Sub Saharan ◽  
Living With Hiv ◽  
Hiv Aids

Background: The Acquired Immune – deficiency syndrome (AIDS) is a terminal illness caused by a retrovirus known as the Human Immune-deficiency virus (HIV). HIV/AIDS is a leading cause of death in sub-saharan Africa. Nigeria has the second largest HIV epidemic in the world and one of the highest rates of new infection in sub-Saharan Africa with 1.9 million people living HIV in 2018. Antiretroviral therapy (ART) has significantly reduced morbidity and mortality, prolonged life expectancy and improved quality of life among people living with HIV/AIDS infection (PLWHA). To be most effective ART requires a near perfect level of adherence. Poor adherence compromises treatment effectiveness, leading to treatment failure and development of drug resistance. Non-adherence is also characterized by increased morbidity, mortality and great economic loss. This study assessed the effect of health education on factors influencing adherence to ART among PLWHAs in Enugu State. Methodology: A health education intervention was carried out among 312 persons living with HIV/AIDS receiving ART in Enugu metropolis to improve their perception and adherence to antiretroviral therapy. A structured questionnaire was used to collect data from 312 people living with HIV/AIDS (156 each in the study and control groups), who were selected by multistage sampling. Subsequently, health education was conducted among the study group. Three months after this intervention its effects were assessed through a survey using the same structured questionnaires employed in the baseline survey. Results: Knowledge of supportive and limiting factors of adherence improved significantly among the study group than the controls post-intervention (P<0.001). The factors that facilitated adherence included follow-up visits, adequate information education/counseling and supportive relationships. The limiting factors were drug side-effects, forgetfulness, finance and travel time to clinic. Conclusion: Health education improved knowledge of supportive factors of ART adherence among PLWHAs in Enugu State, and this should be promoted.

scholarly journals Identifying mechanisms behind HIV drug resistance in Sub-Saharan Africa: a systems approach

2021 ◽  
Author(s):  
Anneleen Kiekens ◽  
Bernadette Dierckx de Casterlé ◽  
Giampietro Pellizzer ◽  
Idda Mosha ◽  
Fausta Mosha ◽  
...  
Keyword(s):  
Drug Resistance ◽  
Systems Approach ◽  
Local Population ◽  
Population Level ◽  
Sub Saharan Africa ◽  
Structured Interviews ◽  
Hiv Drug Resistance ◽  
Factors Influencing ◽  
Literature Evidence ◽  
Sub Saharan

Abstract IntroductionHIV drug resistance (HIVDR) continues to threaten the effectiveness of worldwide antiretroviral therapy (ART). Emergence and transmission of HIVDR is driven by several interconnected factors. Though much has been done to uncover factors influencing HIVDR, overall interconnectedness between these factors remain unclear and African policy makers encounter difficulties setting priorities combating HIVDR. By employing a systems approach, involving multi-disciplinary HIVDR experts, we aimed to gain a deeper understanding of key determinants and their interactions driving HIVDR. MethodsWe designed a detailed system map of factors influencing HIVDR based on semi-structured interviews with 15 international HIVDR experts from or with experience in Sub-Saharan Africa. from different disciplinary backgrounds and institutions. The resulting detailed system map was conceptualized into three main HIVDR feedback loops and further strengthened with literature evidence.ResultsFactors influencing HIVDR in SSA and their interactions were sorted in five categories: biology, individual, social context, healthcare system and ‘overarching’. We identified three causal loops cross-cutting these layers, which relate to three interconnected subsystems of mechanisms influencing HIVDR. The ‘adherence motivation’ subsystem consists of opposite forces that ultimately create a balancing loop leading to a different set-point of adherence per individual which may vary over time. The ‘healthcare burden’ subsystem consists of a reinforcing loop leading to an increased HIVDR at local population level. The ‘ART overreliance’ subsystem is a balancing feedback loop leading to complacency among program managers when there is overreliance on ART with a perceived low risk to drug resistance. The three subsystems are interconnected at different levels. ConclusionsInterconnectedness of the three subsystems underlines the need to act on the entire system of factors surrounding HIVDR in Sub-Saharan Africa in order to target interventions and to prevent unwanted effects on other parts of the system.

scholarly journals Cohort profile: The International epidemiology Databases to Evaluate AIDS (IeDEA) in sub-Saharan Africa, 2012-2019

2019 ◽  
Author(s):  
Frédérique Chammartin ◽  
Cam Ha Dao Ostinelli ◽  
Kathryn Anastos ◽  
Antoine Jaquet ◽  
Ellen Brazier ◽  
...  
Keyword(s):  
Drug Resistance ◽  
Antiretroviral Therapy ◽  
Sub Saharan Africa ◽  
People Living With Hiv ◽  
Loss To Follow Up ◽  
Sub Saharan ◽  
Treat All ◽  
Living With Hiv ◽  
International Epidemiology

ABSTRACTPurposeThe objectives of the International epidemiology Databases to Evaluate AIDS (IeDEA) are to (i) evaluate the delivery of combination antiretroviral therapy (ART) in children, adolescents and adults in sub-Saharan Africa, (ii) to describe ART regimen effectiveness, durability and tolerability, (iii) to examine HIV-related comorbidities and co-infections, and (iv) to examine the pregnancy- and HIV-related outcomes of women on ART and their infants exposed to HIV or antiretroviral therapy in utero or via breastmilk.ParticipantsIeDEA is organized in four regions (Central, East, Southern and West Africa), with 240 treatment and care sites, six data centres at African, European and US universities, and almost 1.4 million children, adolescents and adult people living with HIV (PLWHIV) enrolled.Findings to dateThe data include socio-demographic characteristics, clinical outcomes, opportunistic events, treatment regimens, clinic visits and laboratory measurements. They have been used to analyse outcomes in people living with HIV-1 or HIV-2 who initiate ART, including determinants of mortality, of switching to second-line and third-line ART, drug resistance, loss to follow-up and the immunological and virological response to different ART regimens. Programme-level estimates of mortality have been corrected for loss to follow-up. We examined the impact of co-infection with hepatitis B and C, and the epidemiology of different cancers and of (multi-drug resistant) tuberculosis, renal disease and of mental illness. The adoption of “Treat All”, making ART available to all PLWHIV regardless of CD4+ cell count or clinical stage was another important research topic.Future plansIeDEA has formulated several research priorities for the “Treat All” era in sub-Saharan Africa. It recently obtained funding to set up sentinel sites where additional data are prospectively collected on cardiometabolic risks factors as well as mental health and liver diseases, and is planning to create a drug resistance database.

scholarly journals Addressing Pediatric HIV Pretreatment Drug Resistance and Virologic Failure in Sub-Saharan Africa: A Cost-Effectiveness Analysis of Diagnostic-Based Strategies in Children ≥3 Years Old

Diagnostics ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 567
Author(s):  
Mutita Siriruchatanon ◽  
Shan Liu ◽  
James G. Carlucci ◽  
Eva A. Enns ◽  
Horacio A. Duarte
Keyword(s):  
Drug Resistance ◽  
Cost Effectiveness ◽  
Virologic Failure ◽  
Pediatric Hiv ◽  
Sub Saharan Africa ◽  
Financial Investment ◽  
Switching Strategy ◽  
Wide Range ◽  
Sub Saharan ◽  
Living With Hiv

Improvement of antiretroviral therapy (ART) regimen switching practices and implementation of pretreatment drug resistance (PDR) testing are two potential approaches to improve health outcomes for children living with HIV. We developed a microsimulation model of disease progression and treatment focused on children with perinatally acquired HIV in sub-Saharan Africa who initiate ART at 3 years of age. We evaluated the cost-effectiveness of diagnostic-based strategies (improved switching and PDR testing), over a 10-year time horizon, in settings without and with pediatric dolutegravir (DTG) availability as first-line ART. The improved switching strategy increases the probability of switching to second-line ART when virologic failure is diagnosed through viral load testing. The PDR testing strategy involves a one-time PDR test prior to ART initiation to guide choice of initial regimen. When DTG is not available, PDR testing is dominated by the improved switching strategy, which has an incremental cost-effectiveness ratio (ICER) of USD 579/life-year gained (LY), relative to the status quo. If DTG is available, improved switching has a similar ICER (USD 591/LY) relative to the DTGstatus quo. Even when substantial financial investment is needed to achieve improved regimen switching practices, the improved switching strategy still has the potential to be cost-effective in a wide range of sub-Saharan African countries. Our analysis highlights the importance of strengthening existing laboratory monitoring systems to improve the health of children living with HIV.

scholarly journals Nationwide Study of Drug Resistance Mutations in HIV-1 Infected Individuals under Antiretroviral Therapy in Brazil

2021 ◽  
Vol 22 (10) ◽  
pp. 5304
Author(s):  
Ana Santos-Pereira ◽  
Vera Triunfante ◽  
Pedro M. M. Araújo ◽  
Joana Martins ◽  
Helena Soares ◽  
...  
Keyword(s):  
Drug Resistance ◽  
People Living With Hiv ◽  
Resistance Mutations ◽  
Subtype C ◽  
Viral Loads ◽  
Drug Resistance Mutations ◽  
Subtype B ◽  
Low Prevalence ◽  
Living With Hiv ◽  
Hiv 1

The success of antiretroviral treatment (ART) is threatened by the emergence of drug resistance mutations (DRM). Since Brazil presents the largest number of people living with HIV (PLWH) in South America we aimed at understanding the dynamics of DRM in this country. We analyzed a total of 20,226 HIV-1 sequences collected from PLWH undergoing ART between 2008–2017. Results show a mild decline of DRM over the years but an increase of the K65R reverse transcriptase mutation from 2.23% to 12.11%. This increase gradually occurred following alterations in the ART regimens replacing zidovudine (AZT) with tenofovir (TDF). PLWH harboring the K65R had significantly higher viral loads than those without this mutation (p < 0.001). Among the two most prevalent HIV-1 subtypes (B and C) there was a significant (p < 0.001) association of K65R with subtype C (11.26%) when compared with subtype B (9.27%). Nonetheless, evidence for K65R transmission in Brazil was found both for C and B subtypes. Additionally, artificial neural network-based immunoinformatic predictions suggest that K65R could enhance viral recognition by HLA-B27 that has relatively low prevalence in the Brazilian population. Overall, the results suggest that tenofovir-based regimens need to be carefully monitored particularly in settings with subtype C and specific HLA profiles.

scholarly journals Aging, Health, and Quality of Life for Older People Living With HIV in Sub-Saharan Africa: A Review and Proposed Conceptual Framework

2017 ◽  
Vol 31 (1) ◽  
pp. 109-138 ◽  
Author(s):  
Mark J. Siedner
Keyword(s):  
Quality Of Life ◽  
Conceptual Framework ◽  
Care Delivery ◽  
Sub Saharan Africa ◽  
People Living With Hiv ◽  
Sub Saharan ◽  
Living With Hiv ◽  
The Impact

Objective: The number of people living with HIV (PLWH) over 50 years old in sub-Saharan Africa is predicted to triple in the coming decades, to 6-10 million. Yet, there is a paucity of data on the determinants of health and quality of life for older PLWH in the region. Methods: A review was undertaken to describe the impact of HIV infection on aging for PLWH in sub-Saharan Africa. Results: We (a) summarize the pathophysiology and epidemiology of aging with HIV in resource-rich settings, and (b) describe how these relationships might differ in sub-Saharan Africa, (c) propose a conceptual framework to describe determinants of quality of life for older PLWH, and (d) suggest priority research areas needed to ensure long-term gains in quality of life for PLWH in the region. Conclusions: Differences in traditional, lifestyle, and envirnomental risk factors, as well as unique features of HIV epidemiology and care delivery appear to substantially alter the contribution of HIV to aging in sub-Saharan Africa. Meanwhile, unique preferences and conceptualizations of quality of life will require novel measurement and intervention tools. An expanded research and public health infrastructure is needed to ensure that gains made in HIV prevention and treamtent are translated into long-term benefits in this region.

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