Background In Cote d'Ivoire during 2004-2007, numbers of ART enrollees increased from <5,000 to 36,943. Trends in nationally representative ART program outcomes have not yet been reported. ...Methodology/Principal Findings We conducted a retrospective chart review to assess trends in patient characteristics and attrition death or loss to follow-up (LTFU) over time, among a nationally representative sample of 3,682 adults ( greater than or equal to 15 years) initiating ART during 2004-2007 at 34 health facilities. Among ART enrollees during 2004-2007, median age was 36, the proportion female was 67%, the proportion HIV-2-infected or dually HIV-1&2 reactive was 5%, and median baseline CD4+ T-cell (CD4) count was 135 cells/ mu L. Comparing cohorts initiating ART in 2004 with cohorts initiating ART in 2007, median baseline weight declined from 55 kg to 52 kg (p = 0.008) and the proportion weighing <45 kg increased from 17% to 22% (p = 0.014). During 2004-2007, pharmacy-based estimates of the percentage of new ART enrollees greater than or equal to 95% adherent to ART declined from 74% to 60% (p = 0.026), and twelve-month retention declined from 86% to 69%, due to increases in 12-month mortality from 2%-4% and LTFU from 12%-28%. In univariate analysis, year of ART initiation was associated with increasing rates of both LTFU and mortality. Controlling for baseline CD4, weight, adherence, and other risk factors, year of ART initiation was still strongly associated with LTFU but not mortality. In multivariate analysis, weight <45 kg and adherence <95% remained strong predictors of LTFU and mortality. Conclusions During 2004-2007, increasing prevalence among ART enrollees of measured mortality risk factors, including weight <45 kg and ART adherence <95%, might explain increases in mortality over time. However, the association between later calendar year and increasing LTFU is not explained by risk factors evaluated in this analysis. Undocumented transfers, political instability, and patient dissatisfaction with crowded facilities might explain increasing LTFU.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Background Since establishment of Zimbabwe's National Antiretroviral Therapy (ART) Programme in 2004, ART provision has expanded from <5,000 to 369,431 adults by 2011. However, patient outcomes are ...unexplored. Objective To determine improvement in health status, retention and factors associated with attrition among HIV-infected patients on ART. Methods A retrospective review of abstracted patient records of adults greater than or equal to 15 years who initiated ART from 2007 to 2009 was done. Frequencies and medians were calculated for rates of retention in care and changes in key health status outcomes at 6, 12, 24 and 36 months respectively. Cox proportional hazards models were used to determine factors associated with attrition. Results Of the 3,919 patients, 64% were female, 86% were either WHO clinical stage III or IV. Rates of patient retention at 6, 12, 24 and 36 months were 90.7%, 78.1%, 68.8% and 64.4%, respectively. After ART initiation, median weight gains at 6, 12, and 24 months were 3, 4.5, and 5.0 kgs whilst median CD4+ cell count gains at 6, 12 and 24 months were 122, 157 and 279 cells/ mu L respectively. Factors associated with an increased risk of attrition included male gender (AHR 1.2; 95% CI, 1.1-1.4), baseline WHO stage IV (AHR 1.7; 95% CI, 1.1-2.6), lower baseline body weight (AHR 2.0; 95% CI, 1.4-2. 8) and accessing care from higher level healthcare facilities (AHR 3.5; 95% 1.1-11.2). Conclusions Our findings with regard to retention as well as clinical and immunological improvements following uptake of ART, are similar to what has been found in other settings. Factors influencing attrition also mirror those found in other parts of sub-Saharan Africa. These findings suggest the need to strengthen earlier diagnosis and treatment to further improve treatment outcomes. Whilst decentralisation improves ART coverage it should be coupled with strategies aimed at improving patient retention.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Estimating HIV-1 incidence using biomarker assays in cross-sectional surveys is important for understanding the HIV pandemic. However, the utility of these estimates has been limited by uncertainty ...about what input parameters to use for False Recency Rate (FRR) and Mean Duration of Recent Infection (MDRI) after applying recent infection testing algorithm (RITA). This article shows how testing and diagnosis in a population reduce both FRR and MDRI compared to a treatment-naive population. Using self-reported testing history, a new method is proposed for calculating appropriate context-specific estimates of FRR and MDRI. The result of this is a new formula for incidence that depends only on reference FRR and MDRI parameters derived in an undiagnosed, treatment-naive, non-elite controller, non-AIDS-progressed population.
•COVID-19 among PLHIV has been associated with increased risk of mortality.•High SARS-CoV-2 seropositivity rates among PLHIV in South Sudan were observed.•SARS-CoV-2 antibody seroprevalence ranged ...1·4% to 53·3% during the study period.•SARS-CoV-2 surveillance strategies remain a public health priority.
The burden of SARS-CoV-2 infection among people living with HIV (PLHIV) in South Sudan is unknown.
We conducted a cross-sectional seroprevalence survey of SARS-CoV-2 IgG antibodies and other diseases of public health importance (strongyloidiasis, toxoplasmosis) among PLHIV in South Sudan during April 1, 2020–April 30, 2022. We used a multiplex SARS-CoV-2 immunoassay to detect immunoglobulin G (IgG) antibodies targeting the SARS-CoV-2 spike (S), receptor binding domain (RBD), and nucelocapsid (N) proteins, and antigens for other pathogens (Strongyloides stercoralis and Toxoplasma gondii).
Among 3,518 samples tested, seroprevalence of IgG antibodies to S and RBD591 S+ and nucleocapsid (N+) ranged between 1·4% (95% CI: 0·9–2·1%) in April–June 2020 to 53·3% (95% CI: 49·5–57·1%) in January-March 2022. Prevalence of S. stercoralis ranged between 27·3 % (95% CI: 23·4–31·5%) in October-December 2021 and 47·2% (95% CI: 37·8–56·8%) in July–September 2021, and for T. gondii ranged between 15·5% (95% CI: 13·3–17·9%) in April–June 2020 and 36·2% (95% CI: 27·4–46·2%) July–September 2021.
By early 2022, PLHIV in South Sudan had high rates of SARS-CoV-2 seropositivity. Surveillance of diseases of global health concern among PLHIV is crucial to estimate population-level exposure and inform public health responses.
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