Search

Your search keyword '"B, Nachega"' showing total 268 results
Start Over Author "B, Nachega"
268 results on '"B, Nachega"'

51. Environmental and anthropogenic factors associated with increased malaria incidence in South‐Kivu Province, Democratic Republic of the Congo

Author

Doudou Batumbo, J. A. Ntaongo, Jean B. Nachega, P. D. M. C. Katoto, Nadia A. Sam-Agudu, R. N. Bigirinama, Didier Bompangue, K. Karume, Liliane N. Byamungu, Laboratoire Chrono-environnement - CNRS - UBFC (UMR 6249) (LCE), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), and Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)

Subjects
030231 tropical medicine, Attack rate, Population, Environment, 03 medical and health sciences, Spatio-Temporal Analysis, 0302 clinical medicine, Risk Factors, parasitic diseases, medicine, Humans, education, ComputingMilieux_MISCELLANEOUS, education.field_of_study, Anthropometry, Incidence, Incidence (epidemiology), Generalized additive model, Public Health, Environmental and Occupational Health, medicine.disease, Malaria, 3. Good health, Cross-Sectional Studies, Infectious Diseases, Geography, Malaria incidence, South kivu, Relative risk, [SDE]Environmental Sciences, Democratic Republic of the Congo, Parasitology, Demography
Abstract

To examine environmental and human factors that affect the spatial and temporal dynamism of malaria in DRC's South-Kivu province.In a cross-sectional study conducted between 1 January 2010 and 31 December 2015, spatial distribution was determined through thematic maps of malaria attack rate. SatScan ™ software and Monte Carlo test were used to identify spatial risk clusters. Temporal evolutions were analysed using the Cleveland algorithm. Generalized Additive Models for Location Scale and Shape and negative binomial regression were used to assess the independent human and environmental factors associated with incident malaria.The cumulative annual incidence of malaria increased from 10 968/100 000 in 2013 to 15 501/100 000 in 2015 (P for trend ˂0.001); malaria lethality increased from 0.1% in 2013 to 0.3% in 2015 (P for trend = 0.62). Between 2010 and 2015, 18 of 34 health zones consistently reported the highest attack rates, which ranged from 25 000 to 50 000/100 000. Four risk clusters areas were identified, with relative risk (RR) of 1.2 to 3.0, from which malaria was reported continuously during each year. Factors significantly associated with malaria cases were agro-pisciculture practices (Incidence Risk Ratio [IRR]: 1.96; 95% CI: 1.23-3.13) and the presence of a lake in the health zone (IRR: 2.48, 95% CI: 1.51-4.42).Malaria control in this setting must be intensified in peri-lacustrine areas and those in which the population is intensively engaged in standing water-associated activities.Examiner les facteurs environnementaux et humains qui affectent le dynamisme spatial et temporel du paludisme dans la province du Sud-Kivu en RDC. MÉTHODES: Dans une étude transversale menée entre le 1La lutte contre le paludisme dans ce contexte doit être intensifiée dans les zones péri-lacustres et celles dans lesquelles la population est intensément engagée dans des activités liées à l'eau stagnante.

Published
2020

52. Effectiveness and cost-effectiveness of group support psychotherapy delivered by trained lay health workers for depression treatment among people with HIV in Uganda: a cluster-randomised trial

Author

Micheal Etukoit, Jean B. Nachega, Ofir Harari, Etheldreda Nakimuli-Mpungu, Freddie Ssengooba, Josephine Birungi, Mastula Nanfuka, Kizito Wamala, Seggane Musisi, Sheila Ndyanabangi, Ramin Mojtabai, Chrispus Mayora, Edward J Mills, and James Okello

Subjects
Adult, Male, Rural Population, Psychotherapist, Cost effectiveness, Cost-Benefit Analysis, 030231 tropical medicine, Psychological intervention, HIV Infections, law.invention, 03 medical and health sciences, Social support, 0302 clinical medicine, Randomized controlled trial, law, Humans, Medicine, Uganda, 030212 general & internal medicine, Depression (differential diagnoses), Mini-international neuropsychiatric interview, Community Health Workers, Depression, business.industry, lcsh:Public aspects of medicine, Social Support, lcsh:RA1-1270, General Medicine, Middle Aged, Mental health, Clinical trial, Treatment Outcome, Psychotherapy, Group, Female, business
Abstract

Summary: Background: WHO recommends the use of psychological interventions as first-line treatment for depression in low-income and middle-income countries. However, evaluations of the effectiveness and cost-effectiveness of such interventions among people with HIV are scarce. Our aim was to establish the effectiveness of group support psychotherapy (GSP) delivered by lay health workers for depression treatment among people living with HIV in a rural area of Uganda on a large scale. Methods: In this cluster-randomised trial, we included 30 health centres offering HIV care. These were randomly assigned to deliver either GSP or group HIV education (GHE). Randomisation, in a ratio of 1:1, was achieved by health centre managers separately picking a paper containing the intervention allocation from a basket. Participants were people living with HIV, aged 19 years and older, with mild to moderate major depression assessed with the Mini International Neuropsychiatric Interview depression module, taking antiretroviral therapy, and antidepressant-naive. Group sessions were led by trained lay health workers once a week for 8 weeks. The primary outcomes were the proportion of participants with major depression and function scores at 6 months post-treatment, analysed by intention to treat by means of multilevel random effect regression analyses adjusting for clustering in health centres. This trial is registered with the Pan African Clinical Trials Registry, PACTR201608001738234. Findings: Between Sept 13 and Dec 15, 2016, we assessed 1473 individuals, of whom 1140 were recruited from health centres offering GSP (n=578 [51%]) or GHE (n=562 [49%]). Two (

Published
2020

53. Bacille Calmette-Guérin (BCG) vaccine and potential cross-protection against SARS-CoV-2 infection — Assumptions, knowns, unknowns and need for developing an accurate scientific evidence base

Author

Patrick D.M. Katoto, Jean B. Nachega, Nadia A. Sam-Agudu, Alimuddin Zumla, Markus Maeurer, and Jeremiah Chakaya

Subjects
Microbiology (medical), Tuberculosis, Cross Protection, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), medicine.medical_treatment, Infectious and parasitic diseases, RC109-216, Article, Scientific evidence, Immune system, Immunity, Pandemic, medicine, Humans, BCG, Pandemics, Protection, business.industry, SARS-CoV-2, COVID-19, General Medicine, medicine.disease, Infectious Diseases, Immunology, BCG Vaccine, business, Adjuvant, BCG vaccine
Abstract

After a century of controversies on its usefulness in protection against TB, underlying mechanisms of action, and benefits in various groups and geographical areas, the BCG vaccine is yet again a focus of global attention- this time due to the global COVID-19 pandemic caused by the novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Recent studies have shown that human CD4+ and CD8+ T-cells primed with a BCG-derived peptide developed high reactivity to its corresponding SARS-CoV-2-derived peptide. Furthermore, BCG vaccine has been shown to substantially increase interferon-gamma (IFN-g) production and its effects on CD4 + T-cells and these non-specific immune responses through adjuvant effect could be harnessed as cross protection against severe forms of COVID-19.The completion of ongoing BGG trials is important as they may shed light on the mechanisms underlying BCG-mediated immunity and could lead to improved efficacy, increased tolerance of treatment, and identification of other ways of combining BCG with other immunotherapies.

Published
2021

54. Global Tuberculosis Report 2020 - Reflections on the Global TB burden, treatment and prevention efforts

Author

Peter Mwaba, Razia Fatima, Sayoki Mfinanga, Alimuddin Zumla, André N.H. Bulabula, Simon Tiberi, Patrick D. M. C. Katoto, Timothy D. McHugh, Seyed E. Hasnain, Eleni Aklillu, Ibrahim Abubakar, Francine Ntoumi, Nathan Kapata, Mishal S Khan, Jeremiah Chakaya, Nadia A. Sam-Agudu, and Jean B. Nachega

Subjects
Adult, 0301 basic medicine, Microbiology (medical), Tuberculosis, 030106 microbiology, Psychological intervention, Nigeria, wa_395, Infectious and parasitic diseases, RC109-216, Disease, Article, wa_110, 03 medical and health sciences, 0302 clinical medicine, COVID-19, Prevention, Treatment, Global TB Report 2020, Environmental health, Pandemic, Humans, Medicine, 030212 general & internal medicine, wf_310, Child, China, Pandemics, Poverty, SARS-CoV-2, Tuberculosis, Miliary, business.industry, General Medicine, medicine.disease, Malnutrition, Infectious Diseases, Infectious disease (medical specialty), wf_140, RNA, Viral, wf_200, business
Abstract

The October 2020 Global TB report reviews TB control strategies and United Nations (UN) targets set in the political declaration at the September 2018 UN General Assembly high-level meeting on TB held in New York. Progress in TB care and prevention has been very slow. In 2019, TB remained the most common cause of death from a single infectious pathogen. Globally, an estimated 10.0 million people developed TB disease in 2019, and there were an estimated 1.2 million TB deaths among HIV-negative people and an additional 208, 000 deaths among people living with HIV. Adults accounted for 88% and children for 12% of people with TB. The WHO regions of South-East Asia (44%), Africa (25%), and the Western Pacific (18%) had the most people with TB. Eight countries accounted for two thirds of the global total: India (26%), Indonesia (8.5%), China (8.4%), the Philippines (6.0%), Pakistan (5.7%), Nigeria (4.4%), Bangladesh (3.6%) and South Africa (3.6%). Only 30% of the 3.5 million five-year target for children treated for TB was met. Major advances have been development of new all oral regimens for MDRTB and new regimens for preventive therapy. In 2020, the COVID-19 pandemic dislodged TB from the top infectious disease cause of mortality globally. Notably, global TB control efforts were not on track even before the advent of the COVID-19 pandemic. Many challenges remain to improve sub-optimal TB treatment and prevention services. Tuberculosis screening and diagnostic test services need to be ramped up. The major drivers of TB remain undernutrition, poverty, diabetes, tobacco smoking, and household air pollution and these need be addressed to achieve the WHO 2035 TB care and prevention targets. National programs need to include interventions for post-tuberculosis holistic wellbeing. From first detection of COVID-19 global coordination and political will with huge financial investments have led to the development of effective vaccines against SARS-CoV2 infection. The world now needs to similarly focus on development of new vaccines for TB utilizing new technological methods.

Published
2021

57. How COVID-19 has fundamentally changed clinical research in global health

Author

Jay J H Park, Jean B. Nachega, Gerald Smith, Etheldreda Nakimuli-Mpungu, Craig R. Rayner, Eric H Decloedt, Gilmar Reis, Fyezah Jehan, Edward J Mills, Jeanine Condo, and Robin Mogg

Subjects
Protocol (science), Biomedical Research, business.industry, 030231 tropical medicine, COVID-19, General Medicine, Public relations, Medical research, Global Health, Data sharing, Clinical trial, 03 medical and health sciences, 0302 clinical medicine, Incentive, Clinical research, Pandemic, Global health, Humans, 030212 general & internal medicine, Business, Randomized Controlled Trials as Topic
Abstract

Summary COVID-19 has had negative repercussions on the entire global population. Despite there being a common goal that should have unified resources and efforts, there have been an overwhelmingly large number of clinical trials that have been registered that are of questionable methodological quality. As the final paper of this Series, we discuss how the medical research community has responded to COVID-19. We recognise the incredible pressure that this pandemic has put on researchers, regulators, and policy makers, all of whom were doing their best to move quickly but safely in a time of tremendous uncertainty. However, the research community's response to the COVID-19 pandemic has prominently highlighted many fundamental issues that exist in clinical trial research under the current system and its incentive structures. The COVID-19 pandemic has not only re-emphasised the importance of well designed randomised clinical trials but also highlighted the need for large-scale clinical trials structured according to a master protocol in a coordinated and collaborative manner. There is also a need for structures and incentives to enable faster data sharing of anonymised datasets, and a need to provide similar opportunities to those in high-income countries for clinical trial research in low-resource regions where clinical trial research receives considerably less research funding.

Published
2021

58. COVID-19 travel restrictions and the International Health Regulations – Call for an open debate on easing of travel restrictions

Author

Davidson H. Hamer, David S.C. Hui, Richard Kock, Eskild Petersen, Marjorie P. Pollack, Natalia Pshenichnaya, Nathan Kapata, Alimuddin Zumla, Ziad A. Memish, Esam I. Azhar, Francine Ntoumi, Brian McCloskey, Jean B. Nachega, and Lawrence C. Madoff

Subjects
0301 basic medicine, Microbiology (medical), 2019-20 coronavirus outbreak, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Public health, 030106 microbiology, MEDLINE, General Medicine, Public administration, International Health Regulations, lcsh:Infectious and parasitic diseases, 03 medical and health sciences, 0302 clinical medicine, Infectious Diseases, Political science, medicine, lcsh:RC109-216, 030212 general & internal medicine, Citation, Coronavirus Infections
Abstract

CITATION: Petersen, E. et al. 2020. COVID-19 travel restrictions and the International Health Regulations : call for an open debate on easing of travel restrictions. International Journal of Infectious Diseases, 94:88–90, doi:10.1016/j.ijid.2020.04.029.

Published
2020

59. Evaluation of the Performance of Three Biomarker Assays for Recent HIV Infection Using a Well-Characterized HIV-1 Subtype C Incidence Cohort

Author

Elizabeth Gonese, Jean B. Nachega, Silvina Masciotra, Kuda Mutasa, Michele Owen, Yen Duong Pottinger, Cari van Schalkwyk, Robert Ntozini, Peter H. Kilmarx, John W. Hargrove, Bharat Parekh, Trudy Dobbs, Gert U. van Zyl, and Eduard Grebe

Subjects
medicine.medical_specialty, Immunology, Antibody Affinity, HIV Infections, HIV Antibodies, Gastroenterology, Cohort Studies, Immunoenzyme Techniques, Antigen, Virology, Internal medicine, HIV Seropositivity, Humans, Medicine, Avidity, biology, medicine.diagnostic_test, business.industry, Incidence, Incidence (epidemiology), Postpartum Period, AIDS Serodiagnosis, Viral Load, CD4 Lymphocyte Count, Infectious Diseases, Immunoassay, Africa, Cohort, HIV-1, biology.protein, Biomarker (medicine), Female, Antibody, business, Viral load, Biomarkers
Abstract

Biomarkers for detecting early HIV infection and estimating HIV incidence should minimize false-recent rates (FRRs) while maximizing mean duration of recent infection (MDRI). We compared HIV subtypes B, E and D (BED) capture enzyme immunoassay (BED), Sedia limiting antigen (LAg) avidity enzyme immunoassay, and Bio-Rad avidity incidence (BRAI) assays using samples from Zimbabwean postpartum women infected with clade C HIV. We calculated MDRIs using 590 samples from 351 seroconverting postpartum women, and FRRs using samples from 2,825 women known to be HIV positive for >12 months. Antibody kinetics were more predictable with LAg and had higher precision compared with BED or BRAI. BRAI also exhibited more variability, and avidity reversal in some cases. For BED, LAg, and BRAI, used alone or with viral load, MDRI values in days were: BED-188 and 170 at normalized optical density (ODn) 0.8; LAg-104 and 100 at ODn cutoff 1.5; BRAI-135 and 134 at avidity index cutoff 30%. Corresponding FRRs were: BRAI 1.1% and 1.0% and LAg 0.57% and 0.35%: these were 3.8-10.9 times lower than BED values of 4.8% and 3.8%. BRAI and LAg have significantly lower FRRs and MDRIs than in published studies, and much lower than BED and could be used to estimate incidence in perinatal women and to measure population-level HIV incidence in HIV control operations in Africa.

Published
2019

60. Prevalence, Predictors, and Successful Treatment Outcomes of Xpert MTB/RIF–identified Rifampicin-resistant Tuberculosis in Post-conflict Eastern Democratic Republic of the Congo, 2012–2017: A Retrospective Province-Wide Cohort Study

Author

Liliane Kitete, Jean B. Nachega, Grant Theron, Dieudonné Kalumuna, Michel K. Kaswa, Bertin C. Bisimwa, Patrick D. M. C. Katoto, Andreas H. Diacon, Nadia A. Sam-Agudu, Martin P. Grobusch, Karen R. Jacobson, Jacob Creswell, Maunank Shah, André N.H. Bulabula, Rhoderick Machekano, Eric M. Musafiri, Freddy M. Birembano, Jenna A. Nelson, Robin M. Warren, Jean Paul Chirambiza, Zacharie Kashongwe, Infectious diseases, AII - Infectious diseases, APH - Aging & Later Life, and APH - Global Health

Subjects
Adult, Microbiology (medical), medicine.medical_specialty, eastern DR Congo, Tuberculosis, prevalence, 030231 tropical medicine, treatment outcomes, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Interquartile range, Internal medicine, Drug Resistance, Bacterial, Tuberculosis, Multidrug-Resistant, medicine, Humans, 030212 general & internal medicine, Child, Articles and Commentaries, Antibiotics, Antitubercular, Tuberculosis, Pulmonary, Retrospective Studies, Proportional hazards model, business.industry, Hazard ratio, Sputum, Mycobacterium tuberculosis, Odds ratio, medicine.disease, multidrug-resistant TB, Confidence interval, 3. Good health, predictors, Treatment Outcome, Infectious Diseases, Democratic Republic of the Congo, Rifampin, medicine.symptom, business, Cohort study
Abstract

Background Multidrug-resistant tuberculosis (MDR-TB) jeopardizes global TB control. The prevalence and predictors of Rifampicin-resistant (RR) TB, a proxy for MDR-TB, and the treatment outcomes with standard and shortened regimens have not been assessed in post-conflict regions, such as the South Kivu province in the eastern Democratic Republic of the Congo (DRC). We aimed to fill this knowledge gap and to inform the DRC National TB Program. Methods of adults and children evaluated for pulmonary TB by sputum smear microscopy and Xpert MTB/RIF (Xpert) from February 2012 to June 2017. Multivariable logistic regression, Kaplan–Meier estimates, and multivariable Cox regression were used to assess independent predictors of RR-TB and treatment failure/death. Results Of 1535 patients Xpert-positive for TB, 11% had RR-TB. Independent predictors of RR-TB were a positive sputum smear (adjusted odds ratio [aOR] 2.42, 95% confidence interval [CI] 1.63–3.59), retreatment of TB (aOR 4.92, 95% CI 2.31–10.45), and one or more prior TB episodes (aOR 1.77 per episode, 95% CI 1.01–3.10). Over 45% of RR-TB patients had no prior TB history or treatment. The median time from Xpert diagnosis to RR-TB treatment initiation was 12 days (interquartile range 3–60.2). Cures were achieved in 30/36 (83%) and 84/114 (74%) of patients on 9- vs 20/24-month MDR-TB regimens, respectively (P = .06). Predictors of treatment failure/death were the absence of directly observed therapy (DOT; adjusted hazard ratio [aHR] 2.77, 95% CI 1.2–6.66) and any serious adverse drug event (aHR 4.28, 95% CI 1.88–9.71). Conclusions Favorable RR-TB cure rates are achievable in this post-conflict setting with a high RR-TB prevalence. An expanded Xpert scale-up; the prompt initiation of shorter, safer, highly effective MDR-TB regimens; and treatment adherence support are critically needed to optimize outcomes., In tuberculosis (TB) patients from post-conflict eastern Democratic Republic of the Congo, 11.1% had rifampicin-resistant TB, of whom 46.5% had no prior TB. Cures were achieved in 83% and 74% of patients on 9- and 20/24-month multidrug-resistant TB regimens, respectively.

Published
2019

61. Prevalence and Profile of Hepatitis B Virus Infection among HIV-Infected Adults at Panzi Referral Hospital, in the Post-Conflict South Kivu Province, Eastern Democratic Republic of Congo

Author

Dieudonné Bihehe Masemo, Aline Kusinza Byabène, Tony Akilimali Shindano, Théophile Kashosi Mitima, Jean B. Nachega, Narcisse Patrice Komas, Parvine Basimane Bisimwa, Andre Bulabula Nyandwe Hamama, Sioban Harlow, and Jean Paulin Mbo Mukonkole

Subjects
Hepatitis B virus, medicine.medical_specialty, medicine.diagnostic_test, business.industry, Viral encephalitis, medicine.medical_treatment, Physical examination, Immunosuppression, Jaundice, medicine.disease_cause, medicine.disease, Confidence interval, Serology, symbols.namesake, Internal medicine, medicine, symbols, medicine.symptom, business, Fisher's exact test
Abstract

Background: Little is known about the prevalence of co-infection with hepatitis B virus (HBV) and human immunodeficiency virus (HIV) in the post-conflict South-Kivu Province, Eastern Democratic Republic of the Congo. Therefore, we aimed to determine such data at Panzi Referral Hospital. Methods: We conducted a cross-sectional study of 198 HIV-positive patients seen in consultation from June to 31 November 2017. Socio-demographic and clinical data were collected by interview and clinical examination. Blood sample was taken for serological analyses. The presence of HBV serological markers was determined by enzyme linked immunoassay (ELISA) tests. CD4+ T cell counts were determined for all patients. Data analysis was done using the JMP 7.1 software. Proportions were compared using a Chi-square test or Fisher test. Results: Fourteen of 198 participants (7.07%, 95% confidence interval [CI]: 4.35 - 11.51) were HBsAg-positive. Overall, 33.33% of the subjects had been in contact with HBV and 36.87% were carriers of the immunization marker. Among co-infected patients, 28.57% had a chronic replicative viral B infection, 57.14% a chronic non-replicative infection and 14.29% were inactive carriers. No patient had an acute infection. Co-infection was higher in participants who were aged 55 and over (8.3%), men (12.90%, p = 0.0306), married (12.00%, p = 0.0063), or of Lega ethnicity (14.3%, p = 0.0100). Some clinical signs such as hepatomegaly and jaundice (p < 0.0001), fever (p = 0.0095), splenomegaly (p = 0.0007), ascites (p = 0.0173) and viral encephalitis (p ≤ 0.0001) were associated with co-infection. Severe immunosuppression (50.00%, p = 0.0110) and WHO clinical stage III/IV (10.64%; p = 0.0301) were associated with HIV/HBV co-infection. Conclusions: The relative high prevalence of HIV/HBV co-infection and chronic nature call for the need of integrating HBV screening programs into HIV routine care to reduce morbidity and mortality levels caused by HIV/HBV co-infection.

Published
2019

62. HIV Provider–Patient Communication Regarding Cardiovascular Risk

Author

Renslow Sherer MD, Suniti Solomon MD, Mauro Schechter MD, Jean B. Nachega MD, PhD, Jurgen Rockstroh MD, PhD, and Jose M. Zuniga PhD, MPH

Subjects
Diseases of the genitourinary system. Urology, RC870-923
Abstract

Design: Few global studies have assessed HIV clinician–patient communication regarding cardiovascular disease (CVD) risks. Methods: We conducted a multicountry, comparative, cross-sectional survey of HIV-infected individuals in 12 countries on 5 continents in 2010, with 100 to 200 enrollees per country. HIV-infected adults >17 years and on antiretroviral therapy were recruited in clinics and community organizations and surveyed via direct interview, telephone encounter, or online. Chi-square analyses were performed with an 80% power to detect a difference of >20%. Results: Of 2035 participants, 37% were women. Prevalence of self-reported CVD risk factors was 28% overall, and greater CVD risk was present in 55% of patients in North America, 12% in Africa, and 26% to 28% on other continents. Only 19% of patients ever discussed CVD with their physician, and 31% had ever discussed hypertension, hypercholesterolemia, family history of CVD, or smoking; these findings were true for HIV clinicians in all regions of the world. Forty-four percent of smokers reported never discussing smoking with their HIV clinician. Conclusion: We found that HIV clinicians worldwide are not sufficiently addressing CVD risk factors with their patients. Expanded training and education for HIV clinicians should include effective approaches to the mitigation of CV risk factors.

Published
2014
Full Text
View/download PDF

63. Mental health interventions for persons living with HIV in low- and middle-income countries: a systematic review

Author

Etheldreda Nakimuli-Mpungu, Ani Shakarishvili, Megan von Isenburg, Benedict Akimana, Anna V. Williams, Jean B. Nachega, Edward J Mills, John A. Joska, Colin M Smith, Seggane Musisi, Dixon Chibanda, and Marcelo Ribeiro

Subjects
medicine.medical_specialty, Psychological intervention, HIV Infections, CINAHL, PsycINFO, Review, low‐ and middle‐income countries, Stress Disorders, Post-Traumatic, 03 medical and health sciences, anti‐retroviral therapy theory of change, 0302 clinical medicine, Acquired immunodeficiency syndrome (AIDS), medicine, Humans, 030212 general & internal medicine, Developing Countries, Depression (differential diagnoses), 030505 public health, business.industry, Public Health, Environmental and Occupational Health, Supplement: Reviews, medicine.disease, Mental illness, Mental health, Clinical trial, psychotherapy, Infectious Diseases, Mental Health, Family medicine, HIV/AIDS, psychotropic, 0305 other medical science, business
Abstract

Introduction Addressing the intersection between mental health and HIV is critical for the wellbeing of persons living with HIV (PLWH). This systematic review synthesized the literature on mental health interventions for PLWH in low‐ and middle‐income countries (LMICs) to determine intervention components and explore their relationship with intervention effectiveness. Methods We included only controlled clinical trials of interventions aiming to improve the mental health of PLWH. We conducted a search in the following databases: PubMed, CINAHL, PsycINFO and EMBASE for eligible studies describing the evaluation of interventions for mental health problems among PLWH in LMICs published through August 2020. Two reviewers independently screened references in two successive stages of title/abstract screening and then full‐text screening for references meeting title/abstract criteria. Results We identified a total of 30 eligible articles representing 6477 PLWH who were assigned to either the intervention arm (n = 3182) or control arm (n = 3346). The mental health interventions evaluated were psychological (n = 17, 56.67%), pharmacological (n = 6, 20.00%), combined psychological and pharmacological (n = 1, 3.33%) and complementary/alternative treatments (n = 6, 20.00%). The mental health problems targeted were depression (n = 22, 73.33 %), multiple psychological symptoms (n = 1, 3.33%), alcohol and substance use problems (n = 4, 13.33%), post‐traumatic stress disorder (n = 1, 3.33%) and HIV‐related neuro‐cognitive impairment (n = 2, 6.67%). Studies of interventions with significant effects had significantly a higher number of active ingredients than those without significant effects [3.41 (2.24) vs. 1.84 (1.46) Mean (SD)] [Mean difference = −1.56, 95% CI = −3.03 to −0.09, p = 0.037]. Conclusions There continue to be advances in mental health interventions for PLWH with mental illness in LMICs. However, more research is needed to elucidate how intervention components lead to intervention effectiveness. We recommend scale up of culturally appropriate interventions that have been successfully evaluated in low‐ and middle‐income countries.

Published
2021

64. Telomere length and outcome of treatment for pulmonary tuberculosis in a gold mining community

Author

Benoit Nemery, Krystal J. Godri Pollitt, Tony Kayembe-Kitenge, Jean B. Nachega, Manosij Ghosh, Dries S. Martens, Patrick D. M. C. Katoto, and Tim S. Nawrot

Subjects
0301 basic medicine, Male, Treatment outcome, Diseases, 010501 environmental sciences, 01 natural sciences, Biomarkers, Pharmacological, Medicine, Prospective Studies, Prospective cohort study, Child, Multidisciplinary, Hazard ratio, Middle Aged, Telomere, Occupational Diseases, Multidisciplinary Sciences, Child, Preschool, Democratic Republic of the Congo, Infectious diseases, Science & Technology - Other Topics, Female, Adult, medicine.medical_specialty, Adolescent, Science, Miners, DNA, Mitochondrial, Article, Mining, 03 medical and health sciences, Pulmonary tuberculosis, Internal medicine, Tuberculosis, Humans, Tuberculosis, Pulmonary, 0105 earth and related environmental sciences, Aged, Proportional Hazards Models, Science & Technology, business.industry, Cellular biomarkers, Telomere Homeostasis, 030104 developmental biology, Ageing, Gold, business, Tb treatment, Health occupations, Biomarkers
Abstract

Telomere length (TL) is a marker of ageing and mitochondrial DNA (mtDNA) is an early marker of inflammation caused by oxidative stress. We determined TL and mtDNA content among active pulmonary tuberculosis (PTB) patients to assess if these cellular biomarkers differed between artisanal miners and non-miners, and to assess if they were predictive of treatment outcome. We conducted a prospective cohort study from August 2018 to May 2019 involving newly diagnosed PTB patients at three outpatient TB clinics in a rural Democratic Republic of Congo. We measured relative TL and mtDNA content in peripheral blood leukocytes (at inclusion) via qPCR and assessed their association with PTB treatment outcome. We included 129 patients (85 miners and 44 non-miners) with PTB (median age 40 years; range 5-71 years, 22% HIV-coinfected). For each increase in year and HIV-coinfection, TL shortened by − 0.85% (− 0.19 to − 0.52) (p ≤ 0.0001) and − 14% (− 28.22 to − 1.79) (p = 0.02) respectively. Independent of these covariates, patients with longer TL were more likely to have successful TB treatment [adjusted hazard ratio; 95% CI 1.27 for a doubling of leucocyte telomere length at baseline; 1.05-1.44] than patients with a shorter TL. Blood mtDNA content was not predictive for PTB outcome. For a given chronological age, PTB patients with longer telomeres at time of diagnosis were more likely to have successful PTB treatment outcome. Pulmonary tuberculosis (PTB) kills almost 2 million individuals every year and is thus a leading cause of death among adults worldwide. Mycobacterium tuberculosis (Mtb) infects more than 10 million people each year 1-3. Mtb potently induces cytokines and chemokines from polymorphonuclear cells and monocytes, thus resulting in intense local inflammation in the lungs 4. Alveolar macrophages are anti-inflammatory in nature, but their function can be impaired by pollutants, including mineral dusts, thereby diminishing the body's ability to clear infections 5-8. This is probably why mineworkers are more susceptible to develop PTB. Telomere length (TL) reflects the history of oxidative stress and chronic inflammation, and is a marker for age-related disease susceptibility 9-12. In normal physiology, mitochondria are important in the cell as they generate most of the adenosine triphosphate (ATP) through the oxidative phosphorylation mechanism (OXPHOS), which is a critical energy supply for cellular processes and partially encoded with mitochondrial DNA (mtDNA). The OXPHOS mechanism uses dietary intake to produce ATP, but it also produces ROS which can destroy mitochon-drial DNA, impairs respiratory chain function and cause nuclear DNA damage 12-14. Further, Mitochondrial DNA (mtDNA) damage can result in genomic instability, cellular senescence and altered intercellular communication. Hallmarks of aging genomic instability and deregulated nutrient sensing can contribute to reduced mitochondrial OPEN Funding P.D.M.C.K was fellow of the Fonds Marc Vervenne of the KU Leuven (Belgium) and he is supported by the US National Institutes of Health (NIH)-Fogarty Postdoctoral Fellowship: Grant no. 1D43TW010937-01A1. D.S.M is a FWO postdoc, with funding number: FWO Grant 12X9620N. Fieldwork has been supported by the KU Leuven Alumni Association and the University of Antwerp-USOS via the CEGEMI of the Catholic University of Bukavu. The costs of measuring Telomere length and mtDNA were covered by a grant of the European Research Council (ENVIRONAGE). The funders had no role in the study design, data collection, analysis, interpretation, or writing of the report. The corresponding author had full access to all the study data and had final responsibility for the decision to submit for publication. Acknowledgements We thank Profs J. Balmes (UCSF), N. Lorent, E. André (KU Leuven), and C. Tonne (ISGlobal) for their critical appraisal of the manuscript. We are grateful to the study participants and their relatives, the TB clinics, and the DRC’s National/Provincial TB and HIV programs for their collaboration.

Published
2021

65. World Tuberculosis Day 2021 Theme - 'THE CLOCK IS TICKING' - and the world is running out of time to deliver the United Nations General Assembly commitments to End TB due to the COVID-19 pandemic

Author

Jeremiah Chakaya, Richard Kock, Mishal S Khan, Najmul Haider, Greg J. Fox, Michael King, Razia Fatima, Connie Lam, Christian Wejse, Eskild Petersen, Ben J. Marais, Markus Maeurer, Michael Knipper, Jean B. Nachega, Frauke Rudolf, Assiya Marat Issayeva, Farhana Amanullah, Suvanand Sahu, Ibrahim Abubakar, Vitali Sintchenko, Nathan L. Bachmann, Linda Petrone, Alimuddin Zumla, Miriam Orcutt, Sivakumar Shanmugam, Ferdinand Mugusi, Marc Lipman, Simon Tiberi, Alice Kizny Gordon, Delia Goletti, Nathan Kapata, Seif Al-Abri, Tumaini J. Nagu, Lara Goscé, Lucica Ditiu, and Aashifa Yaqoob

Subjects
Microbiology (medical), 2019-20 coronavirus outbreak, Economic growth, Tuberculosis, United Nations, Coronavirus disease 2019 (COVID-19), General assembly, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Infectious and parasitic diseases, RC109-216, Political science, Pandemic, wc_505, medicine, Humans, Pandemics, wa_105, SARS-CoV-2, COVID-19, General Medicine, medicine.disease, Coronavirus, Infectious Diseases, wf_200, Theme (narrative)
Published
2021

66. Opportunities and Challenges in North-South and South-South Global Health Collaborations During the COVID-19 Pandemic: The AFREhealth-CUGH Experience (as Reported at the CUGH 2021 Satellite Meeting)

Author

Peter H. Kilmarx, Quentin Eichbaum, Judy Khanyola, Nadia A. Sam-Agudu, Jean B. Nachega, Abigail Kazembe, Judith N. Wasserheit, and Elsie Kiguli-Malwadde

Subjects
2019-20 coronavirus outbreak, Economic growth, Biomedical Research, Universities, Coronavirus disease 2019 (COVID-19), International Cooperation, Global South, COVID-19, Infectious and parasitic diseases, RC109-216, General Medicine, Congresses as Topic, Global Health, Critical space, Political science, General partnership, Africa, Pandemic, Global health, Virtual conference, Humans, Public aspects of medicine, RA1-1270, Pandemics
Abstract

Sustainable and equitable partnerships and collaborations between the Global North and Global South (as well as within the Global South) have been aspirations (if seldom achieved) of the "global health" endeavor over the past couple of decades. The COVID-19 pandemic led to global lockdowns that disrupted international travel and severely challenged these partnerships, providing a critical space for self-reflection on global health as a discipline. One major global north-south partnership is that between the African Forum for Research and Education in Health (AFREhealth) and the Consortium of Universities for Global Health (CUGH). This article reports on a recent Satellite meeting of the AFREhealth-CUGH Working Group (ACWG) at the CUGH 2021 virtual conference in March 2021 that provided insights on North-South and South-South global health partnerships, against the backdrop of the COVID-19 pandemic. The authors describe challenges and opportunities for research and education in these partnerships (as discussed at this ACWG Satellite meeting), and implications for the field of global health going forward as we emerge from the pandemic.

Published
2021

67. Effect of SARS-CoV-2 Infection in Pregnancy on Maternal and Neonatal Outcomes in Africa: An AFREhealth Call for Evidence through Multicountry Research Collaboration

Author

Alimuddin Zumla, Nancy Mwongeli, Eduard J Mills, Onesmus Gachuno, Mukanire Ntakwinja, Jean B. Nachega, Don Jethro Mavungu Landu, Christian Bongo-Pasi Nswe, Jean-Jacques Muyembe Tamfum, Emily R. Smith, Samantha Budhram, John Ditekemena, Philippa Musoke, John O Otshudiema, Denis Mukwege, Jean-Marie Ntumba Kayembe, Lawal Waisu Umar, Priya Soma-Pillay, Nadia A. Sam-Agudu, Michel Tshiasuma Pipo, Daniel Katuashi Ishoso, Rhoderick Machekano, Taha E. Taha, Eduard Langenegger, Musa Sekikubo, John Kinuthia, Valerie Vannevel, Placide Mbala-Kingebeni, Birhanu Teshome Ayele, Evans Kofi Agbeno, and Lynne M. Mofenson

Subjects
Tuberculosis, 030231 tropical medicine, Population, MEDLINE, Context (language use), Perspective Piece, 03 medical and health sciences, 0302 clinical medicine, Pregnancy, Risk Factors, Virology, Environmental health, Humans, Medicine, Prospective Studies, Pregnancy Complications, Infectious, Prospective cohort study, education, Intersectoral Collaboration, Africa South of the Sahara, Retrospective Studies, education.field_of_study, Coinfection, SARS-CoV-2, business.industry, Transmission (medicine), Research, Infant, Newborn, COVID-19, medicine.disease, Infectious Disease Transmission, Vertical, Infectious Diseases, Socioeconomic Factors, Premature Birth, Female, Parasitology, Pregnant Women, business, Malaria
Abstract

In the African context, there is a paucity of data on SARS-CoV-2 infection and associated COVID-19 in pregnancy. Given the endemicity of infections such as malaria, HIV, and tuberculosis (TB) in sub-Saharan Africa (SSA), it is important to evaluate coinfections with SARS-CoV-2 and their impact on maternal/infant outcomes. Robust research is critically needed to evaluate the effects of the added burden of COVID-19 in pregnancy, to help develop evidence-based policies toward improving maternal and infant outcomes. In this perspective, we briefly review current knowledge on the clinical features of COVID-19 in pregnancy; the risks of preterm birth and cesarean delivery secondary to comorbid severity; the effects of maternal SARS-CoV-2 infection on the fetus/neonate; and in utero mother-to-child SARS-CoV-2 transmission. We further highlight the need to conduct multicountry surveillance as well as retrospective and prospective cohort studies across SSA. This will enable assessments of SARS-CoV-2 burden among pregnant African women and improve the understanding of the spectrum of COVID-19 manifestations in this population, which may be living with or without HIV, TB, and/or other coinfections/comorbidities. In addition, multicountry studies will allow a better understanding of risk factors and outcomes to be compared across countries and subregions. Such an approach will encourage and strengthen much-needed intra-African, south-to-south multidisciplinary and interprofessional research collaborations. The African Forum for Research and Education in Health’s COVID-19 Research Working Group has embarked upon such a collaboration across Western, Central, Eastern and Southern Africa.

Published
2020

68. The Current State of HIV and Aging: Findings Presented at the 10th International Workshop on HIV and Aging

Author

Thomas D. Marcotte, Erin E. Sundermann, Stephen Karpiak, Linda P. Fried, Jean B. Nachega, Maile Y. Karris, Alexis A Bender, Steven G. Deeks, Keri N. Althoff, Juhi Aggarwal, Jane A. O’Halloran, David J. Moore, Kristine M. Erlandson, Jason V. Baker, Joseph B. Margolick, and Stephanie Shiau

Subjects
0301 basic medicine, Gerontology, Male, Aging, Conference Summary, Demographics, Coronavirus disease 2019 (COVID-19), Clinical Sciences, Immunology, Human immunodeficiency virus (HIV), HIV Infections, Comorbidity, and over, medicine.disease_cause, comorbidities, 03 medical and health sciences, 0302 clinical medicine, Multidisciplinary approach, Virology, Pandemic, medicine, Prevalence, 80 and over, Humans, 030212 general & internal medicine, Aged, Aged, 80 and over, Community engagement, Loneliness, HIV, Disease Management, Middle Aged, Antiretroviral therapy, 030104 developmental biology, Good Health and Well Being, Phenotype, Infectious Diseases, HIV/AIDS, New York City, Female, Public Health, medicine.symptom, Psychology, Infection, multidisciplinary
Abstract

With increasing effectiveness of antiretroviral therapy, people with HIV (PWH) are living longer and the prevalence of older PWH continues to increase. Accordingly, PWH are experiencing an increased burden of age-related comorbidities. With this shifting demographics, clinicians and researchers face additional challenges in how to identify, address, and manage the complex intersections of HIV- and aging-related conditions. Established in 2009, the International Workshop on HIV and Aging brings together clinicians and researchers in cross-disciplinary fields along with community advocates and PWH to address the multidisciplinary nature of HIV and aging. This article summarizes plenary talks from the 10th Annual International Workshop on HIV and Aging, which took place in New York City on October 10 and 11, 2019. Presentation topics included the following: the burdens of HIV-associated comorbidities, aging phenotypes, community engagement, and loneliness; these issues are especially important for older PWH, considering the current COVID-19 pandemic. We also discuss broad questions and potential directions for future research necessary to better understand the interaction between HIV and aging.

Published
2020
Full Text
View/download PDF

69. Can Traditional Chinese Medicine provide insights into controlling the COVID-19 pandemic: Serpentinization-induced lithospheric long-wavelength magnetic anomalies in Proterozoic bedrocks in a weakened geomagnetic field mediate the aberrant transformation of biogenic molecules in COVID-19 via magnetic catalysis

Author

Nivitha Periyapatna, Yue Chen, Jean B. Nachega, Isabella Castronova, Yash Agarwal, Vanshika Narala, Sara Ho, Shivkumar Biradar, Moses T. Bility, and Cole Beatty

Subjects
2019-20 coronavirus outbreak, Environmental Engineering, 010504 meteorology & atmospheric sciences, Coronavirus disease 2019 (COVID-19), Proterozoic, Magnetic catalysis, SARS-CoV-2, Lithospheric magnetic field, COVID-19, Geophysics, 010501 environmental sciences, 01 natural sciences, Pollution, Article, Emerging epidemics/pandemics, Long wavelength, Earth's magnetic field, Lithosphere, Environmental Chemistry, Magnetic anomaly, Waste Management and Disposal, Geology, Geomagnetic field, 0105 earth and related environmental sciences
Abstract

Thoracic organs, namely, the lungs and kidneys in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-associated coronavirus disease 2019 (COVID-19), exhibit silicate/glass-like (hyaline) and iron oxides-like deposits, which are like serpentinization-induced minerals. The discovery of the chiral-induced spin selectivity effect suggests that a resonant external magnetic field could alter the spin state of electrons in biogenic molecules and result in the magnetic catalysis of aberrant molecules and disease. We propose here that carbon dioxide-rich water-peridotite (a ferromagnesian silicate) interactions generate abnormal lithospheric long-wavelength magnetic anomalies (LWMAs) via serpentinization, during conditions with increased terrestrial water storage and atmospheric carbon dioxide, and a weakened geomagnetic field. Furthermore, we provide evidence supporting a hypothesis, which posits, COVID-19 is a pathologic manifestation of resonant LWMAs-induced magnetic catalysis of iron oxides-silicate-like minerals from biogenic molecules and the coronavirus from endogenous viral elements, with the virus particles capable of replication and transmission to other hosts. We propose that those LWMAs are associated with the production of iron oxides-silicate rock minerals in tectonic plates with Proterozoic cratons. Thus, severe COVID-19 outbreaks are/will predominately occur in Eurasia and the Americas and are governed by the spatiotemporal dynamics of terrestrial water storage and the semiannual oscillation of the weakening geomagnetic magnetic field. We propose that the ferromagnetic-like iron stores in humans are the unifying determinant for COVID-19-induced morbidity and mortality. Furthermore, we propose that Nephrite-Jade amulets (a calcium-ferromagnesian silicate) developed by Neolithic Chinese Medicine to prevent thoracic organ disease, may prevent COVID-19., Graphical abstract Unlabelled Image, Highlights • Lethal COVID-19-like disease with SARS-CoV-2-like infection in a rat colony. • Severe COVID-19 outbreaks are coupled to serpentinization-associated water dynamics. • Severe COVID-19 outbreaks are coupled with magnetic anomalies in Proterozoic cratons. • The COVID-19 pandemic is coupled to dynamics in the geosphere via magnetic catalysis. • Nephrite-Jade amulets, a calcium-ferromagnesian silicate, may prevent COVID-19.

Published
2020

70. Medication possession ratio associated with short-term virologic response in individuals initiating antiretroviral therapy in Namibia.

Author

Steven Y Hong, Logan Jerger, Anna Jonas, Alfons Badi, Steven Cohen, Jean B Nachega, Jean-Jacques Parienti, Alice M Tang, Christine Wanke, Norma Terrin, Dawn Pereko, Abraham Blom, Andrew B Trotter, and Michael R Jordan

Subjects
Medicine, Science
Abstract

The visual-analogue scale (VAS), Likert item (rating scale), pills identification test (PIT), and medication possession ratio (MPR) provide estimates of antiretroviral therapy (ART) adherence which correlate with HIV viral suppression. These simple adherence measures are inexpensive and easy to administer; however, require validation and adjustment prior to implementation. The objective of this study was to define the optimal adherence assessment measure in Namibia to identify patients at risk for sub-optimal adherence and poor virologic response 6 months after ART initiation. We conducted a cross-sectional survey in HIV-infected adults receiving ART for 6-12 months prior to the adherence assessment. Adherence measures included 30-day VAS, 30-day Likert item, self-reported treatment interruptions, PIT, and MPR. Association of adherence measures with 6-month HIV-1 RNA level was assessed using two thresholds (1000 copies/mL and 5000 copies/mL). Adherence was assessed in 236 patients, mean age 37.3 years, 54% female. Mean adherence was 98.1% by 30-day VAS, 84.7% by 30-day Likert item, 97.0% by self-reported treatment interruptions, 90.6% by PIT, and 98.8% by MPR. Agreement between adherence measures was poor using kappa statistic. 76% had HIV-1 RNA

Published
2013
Full Text
View/download PDF

71. Cost-effectiveness of universal HIV testing and treatment: where next?

Author

Pascalina Chanda-Kapata, Jean B. Nachega, Ethan D. Borre, Elvin Geng, Susan Cleary, and David W. Dowdy

Subjects
Adult, Male, medicine.medical_specialty, Adolescent, Cost effectiveness, business.industry, Cost-Benefit Analysis, MEDLINE, Zambia, HIV Infections, General Medicine, Hiv testing, Article, HIV Testing, South Africa, Young Adult, Text mining, Anti-Retroviral Agents, Humans, Medicine, Female, Medical physics, business
Abstract

The HPTN 071 (PopART) trial showed that a combination HIV prevention package including universal HIV testing and treatment (UTT) reduced population-level incidence of HIV compared with standard care. However, evidence is scarce on the costs and cost-effectiveness of such an intervention.Using an individual-based model, we simulated the PopART intervention and standard care with antiretroviral therapy (ART) provided according to national guidelines for the 21 trial communities in Zambia and South Africa (for all individuals aged14 years), with model parameters and primary cost data collected during the PopART trial and from published sources. Two intervention scenarios were modelled: annual rounds of PopART from 2014 to 2030 (PopART 2014-30; as the UNAIDS Fast-Track target year) and three rounds of PopART throughout the trial intervention period (PopART 2014-17). For each country, we calculated incremental cost-effectiveness ratios (ICERs) as the cost per disability-adjusted life-year (DALY) and cost per HIV infection averted. Cost-effectiveness acceptability curves were used to indicate the probability of PopART being cost-effective compared with standard care at different thresholds of cost per DALY averted. We also assessed budget impact by projecting undiscounted costs of the intervention compared with standard care up to 2030.During 2014-17, the mean cost per person per year of delivering home-based HIV counselling and testing, linkage to care, promotion of ART adherence, and voluntary medical male circumcision via community HIV care providers for the simulated population was US$6·53 (SD 0·29) in Zambia and US$7·93 (0·16) in South Africa. In the PopART 2014-30 scenario, median ICERs for PopART delivered annually until 2030 were $2111 (95% credible interval [CrI] 1827-2462) per HIV infection averted in Zambia and $3248 (2472-3963) per HIV infection averted in South Africa; and $593 (95% CrI 526-674) per DALY averted in Zambia and $645 (538-757) per DALY averted in South Africa. In the PopART 2014-17 scenario, PopART averted one infection at a cost of $1318 (1098-1591) in Zambia and $2236 (1601-2916) in South Africa, and averted one DALY at $258 (225-298) in Zambia and $326 (266-391) in South Africa, when outcomes were projected until 2030. The intervention had almost 100% probability of being cost-effective at thresholds greater than $700 per DALY averted in Zambia, and greater than $800 per DALY averted in South Africa, in the PopART 2014-30 scenario. Incremental programme costs for annual rounds until 2030 were $46·12 million (for a mean of 341 323 people) in Zambia and $30·24 million (for a mean of 165 852 people) in South Africa.Combination prevention with universal home-based testing can be delivered at low annual cost per person but accumulates to a considerable amount when scaled for a growing population. Combination prevention including UTT is cost-effective at thresholds greater than $800 per DALY averted and can be an efficient strategy to reduce HIV incidence in high-prevalence settings.US National Institutes of Health, President's Emergency Plan for AIDS Relief, International Initiative for Impact Evaluation, BillMelinda Gates Foundation.

Published
2021

72. Xpert Mycobacterium tuberculosis/Rifampicin–Detected Rifampicin Resistance is a Suboptimal Surrogate for Multidrug-resistant Tuberculosis in Eastern Democratic Republic of the Congo: Diagnostic and Clinical Implications

Author

Bertin C. Bisimwa, Marcel Yotebieng, Freddy M. Birembano, Rosette Nyota, Steven Callens, Esto Bahizire, Andreas H. Diacon, John Z. Metcalfe, Robin M. Warren, Jean B. Nachega, Zacharie Kashongwe, Eric M. Musafiri, André N.H. Bulabula, Jean Paul Chirambiza, Maunank Shah, Patrick D.M.C. Katoto, Grant Theron, Nadia A. Sam-Agudu, Sifa Byadunia, and Michel K. Kaswa

Subjects
0301 basic medicine, rpoB mutations, Rifampicin resistance, Drug resistance, Medical and Health Sciences, 0302 clinical medicine, Tuberculosis, Multidrug-Resistant, polycyclic compounds, heterocyclic compounds, 030212 general & internal medicine, biology, Isoniazid, inhA mutations, Multidrug-Resistant, Biological Sciences, Infectious Diseases, Democratic Republic of the Congo, Population study, Rifampin, Infection, medicine.drug, Microbiology (medical), Adult, medicine.medical_specialty, GenoType MTBDRplus assay, Tuberculosis, 030106 microbiology, Microbial Sensitivity Tests, Microbiology, Sensitivity and Specificity, Mycobacterium tuberculosis, Vaccine Related, 03 medical and health sciences, Rare Diseases, Clinical Research, Internal medicine, Biodefense, medicine, Humans, Online Only Articles, drug resistance, business.industry, Prevention, DRC, biochemical phenomena, metabolism, and nutrition, medicine.disease, biology.organism_classification, bacterial infections and mycoses, Multiple drug resistance, Emerging Infectious Diseases, Good Health and Well Being, Cross-Sectional Studies, Mutation, Antimicrobial Resistance, business, Rifampicin
Abstract

Background Rifampicin (RIF) resistance is highly correlated with isoniazid (INH) resistance and used as proxy for multidrug-resistant tuberculosis (MDR-TB). Using MTBDRplus as a comparator, we evaluated the predictive value of Xpert MTB/RIF (Xpert)–detected RIF resistance for MDR-TB in eastern Democratic Republic of the Congo (DRC). Methods We conducted a cross-sectional study involving data from new or retreatment pulmonary adult TB cases evaluated between July 2013 and December 2016. Separate, paired sputa for smear microscopy and MTBDRplus were collected. Xpert testing was performed subject to the availability of Xpert cartridges on sample remnants after microscopy. Results Among 353 patients, 193 (54.7%) were previously treated and 224 (63.5%) were MTBDRplus TB positive. Of the 224, 43 (19.2%) were RIF monoresistant, 11 (4.9%) were INH monoresistant, 53 (23.7%) had MDR-TB, and 117 (52.2%) were RIF and INH susceptible. Overall, among the 96 samples detected by MTBDRplus as RIF resistant, 53 (55.2%) had MDR-TB. Xpert testing was performed in 179 (50.7%) specimens; among these, 163 (91.1%) were TB positive and 73 (44.8%) RIF resistant. Only 45/73 (61.6%) Xpert-identified RIF-resistant isolates had concomitant MTBDRplus-detected INH resistance. Xpert had a sensitivity of 100.0% (95% CI, 92.1–100.0) for detecting RIF resistance but a positive-predictive value of only 61.6% (95% CI, 49.5–72.8) for MDR-TB. The most frequent mutations associated with RIF and INH resistance were S531L and S315T1, respectively. Conclusions In this high-risk MDR-TB study population, Xpert had low positive-predictive value for the presence of MDR-TB. Comprehensive resistance testing for both INH and RIF should be performed in this setting.

Published
2020

73. Chloroquine and Hydroxychloroquine for the Prevention or Treatment of COVID-19 in Africa: Caution for Inappropriate Off-label Use in Healthcare Settings

Author

Alimuddin Zumla, Eric H Decloedt, Prisca Olabisi Adejumo, Pascale M. Abena, Jean Jacques Muyembe Tamfum, Emmanuel Bottieau, Jean B. Nachega, Oscar Kallay, Nadia A. Sam-Agudu, Moussa Seydi, Fatima Suleman, Edward J. Mills, and Serge Eholié

Subjects
medicine.medical_specialty, 030231 tropical medicine, Pneumonia, Viral, Disease, Azithromycin, Off-label use, Antiviral Agents, law.invention, Perspective Piece, 03 medical and health sciences, Antimalarials, Betacoronavirus, 0302 clinical medicine, COVID-19 Testing, Randomized controlled trial, law, Chloroquine, Virology, Pandemic, medicine, Humans, Intensive care medicine, Pandemics, Randomized Controlled Trials as Topic, business.industry, Clinical Laboratory Techniques, SARS-CoV-2, Drug Repositioning, COVID-19, Hydroxychloroquine, Off-Label Use, medicine.disease, United States, Clinical trial, Infectious Diseases, Treatment Outcome, Antirheumatic Agents, Sample Size, Practice Guidelines as Topic, Parasitology, business, Coronavirus Infections, Malaria, medicine.drug
Abstract

The novel severe acute respiratory syndrome-coronavirus-2 pandemic has spread to Africa, where nearly all countries have reported laboratory-confirmed cases of novel coronavirus disease (COVID-19). Although there are ongoing clinical trials of repurposed and investigational antiviral and immune-based therapies, there are as yet no scientifically proven, clinically effective pharmacological treatments for COVID-19. Among the repurposed drugs, the commonly used antimalarials chloroquine (CQ) and hydroxychloroquine (HCQ) have become the focus of global scientific, media, and political attention despite a lack of randomized clinical trials supporting their efficacy. Chloroquine has been used worldwide for about 75 years and is listed by the WHO as an essential medicine to treat malaria. Hydroxychloroquine is mainly used as a therapy for autoimmune diseases. However, the efficacy and safety of CQ/HCQ for the treatment of COVID-19 remains to be defined. Indiscriminate promotion and widespread use of CQ/HCQ have led to extensive shortages, self-treatment, and fatal overdoses. Shortages and increased market prices leave all countries vulnerable to substandard and falsified medical products, and safety issues are especially concerning for Africa because of its healthcare system limitations. Much needed in Africa is a cross-continental collaborative network for coordinated production, distribution, and post-marketing surveillance aligned to low-cost distribution of any approved COVID-19 drug; this would ideally be piggybacked on existing global aid efforts. Meanwhile, African countries should strongly consider implementing prescription monitoring schemes to ensure that any off-label CQ/HCQ use is appropriate and beneficial during this pandemic.

Published
2020

74. Limiting the spread of COVID-19 in Africa: one size mitigation strategies do not fit all countries

Author

Jean B. Nachega, Shaheen Mehtar, Oscar Kallay, Abdoulaye Bousso, Jean Jacques Muyembe Tamfum, Alimuddin Zumla, Moussa Seydi, Wolfgang Preiser, and N A Lakhe

Subjects
Coronavirus disease 2019 (COVID-19), Viral Epidemiology, Extramural, business.industry, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), 030231 tropical medicine, Pneumonia, Viral, MEDLINE, COVID-19, General Medicine, Limiting, medicine.disease, Article, 03 medical and health sciences, Pneumonia, 0302 clinical medicine, Environmental health, Africa, Global health, Medicine, Humans, 030212 general & internal medicine, business, Coronavirus Infections, Pandemics
Abstract

CITATION: Mehtar, S. et al. 2020. Limiting the spread of COVID-19 in Africa : one size mitigation strategies do not fit all countries. Lancet Global Health, doi:10.1016/S2214-109X(20)30212-6.

Published
2020

75. Tuberculosis

Author

Richard E. Chaisson and Jean B. Nachega

Abstract

Tuberculosis is caused by organisms of the Mycobacterium tuberculosis complex, including M. tuberculosis (the most important), M. bovis, and M. africanum. It has been present since antiquity and is the leading infectious cause of death ahead of HIV infection. An estimated 2 billion people worldwide carry latent infection, when M. tuberculosis persists within cells and granulomas, with the potential to reactivate to cause disease decades later. Tubercle bacilli are transmitted between people by aerosols generated when an infectious person coughs. Proximity to an infectious person determines the risk of infection. Host immunity and factors affecting it—most importantly HIV infection but also diabetes, cigarette smoking, and alcohol and drug abuse—determine the risk of active disease following infection.

Published
2020

76. Causes and Predictors of Mortality among HIV-Exposed Infants in Rural North-Central Nigeria: Results of a Simple Verbal Autopsy Survey

Author

Chamberline E. Ozigbu, Salome Erekaha, Eric E. Chinaeke, Tongdiyen L. Jasper, Gift Nwanne, Miriam Bathnna, Jean B. Nachega, Elon W. Isaac, and Nadia A. Sam-Agudu

Abstract

Background HIV-exposed infants (HEI) who die before diagnosis or treatment initiation, or who die in spite of being HIV-free constitute missed opportunities for reducing infant mortality. Verbal autopsy (VA) has been successfully applied in the collection of data to determine symptoms and circumstances surrounding death among infants, children and adults among populations that lack vital registration systems. There is little available data on rates and causes of death among HIV-exposed infants (HEI) in Nigeria. We used VA to characterize attributable causes and predictors of mortality among HEI in rural North-Central Nigeria.Methods Pregnant women living with HIV and HEI were enrolled at rural primary healthcare facilities and followed-up for 12 months, post-delivery. A simple 21-item VA instrument was used to collect infant mortality information from mothers, other family members, mentor mothers, and/or healthcare workers. Attributable causes of death were determined by physician coding. Multivariate logistic regression was performed to determine independent predictors of mortality.Results Data from 455 HIV-exposed infected and uninfected fetus/infant-mother pairs were analyzed. All mothers received anti-retroviral therapy. Seventy-five (16.5%) fetuses/infants died during gestation and within 12 months post-delivery. Forty (53.3%) deaths occurred in utero . The 12-month infant mortality risk among HEI in our study was 88.7/1,000. Among the 35 live-born infants, birth asphyxia (6/17, 35.3%) and sepsis (7/18, 38.9%) were the most common causes of death in the neonatal and post-neonatal periods, respectively. Unadjusted estimates showed that a greater proportion of deceased infants had mothers who did not deliver at a health facility (53.3 vs 31.8%, p=0.003), and who were newly HIV-diagnosed during pregnancy (69.3 vs 50.8%, p=0.029). Infants receiving nevirapine prophylaxis within 72 hours were less likely to have died (aOR = 0.40, 95% CI: 0.2-0.9).Conclusions Early HIV diagnosis and treatment among women of child-bearing age, maternal access to facility delivery and timely infant antiretroviral prophylaxis should be programmatically strengthened to reduce HEI mortality. Additionally, robust monitoring and evaluation systems are needed to track and record deaths among HEI.

Published
2020

77. Mobile Health Technology for Enhancing the COVID-19 Response in Africa : A Potential Game Changer?

Author

Jean B. Nachega, Rory Leisegang, Edward J. Mills, Alimuddin Zumla, Richard T. Lester, and Oscar Kallay

Subjects
Telemedicine, Infectious Medicine, Coronavirus disease 2019 (COVID-19), Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), 030231 tropical medicine, Pneumonia, Viral, Biomedical Technology, Infektionsmedicin, 03 medical and health sciences, Betacoronavirus, 0302 clinical medicine, Virology, Humans, Marketing, Biomedical technology, Pandemics, SARS-CoV-2, Communication, Health technology, COVID-19, Public Health, Global Health, Social Medicine and Epidemiology, Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, Infectious Diseases, Editorial, Africa, Parasitology, Business, Citation, Potential game, Coronavirus Infections
Abstract

CITATION: Nachega, J. B. et al. 2020. Mobile health technology for enhancing the COVID-19 response in Africa : a potential game changer? American Journal of Tropical Medicine and Hygiene, doi:10.4269/ajtmh.20-0506.

Published
2020

78. Timing of HIV diagnosis in children with tuberculosis managed at a referral hospital in Cape Town, South Africa

Author

L. N. Byamungu, H S Schaaf, Elisabetta Walters, K du Preez, and Jean B. Nachega

Subjects
Male, 0301 basic medicine, Pulmonary and Respiratory Medicine, Pediatrics, medicine.medical_specialty, Time Factors, Tuberculosis, Referral, 030106 microbiology, HIV diagnosis, Antitubercular Agents, HIV Infections, South Africa, 03 medical and health sciences, 0302 clinical medicine, Cape, Prevalence, Humans, Medicine, 030212 general & internal medicine, Medical diagnosis, Child, Secondary Care Centers, Retrospective Studies, Coinfection, business.industry, Medical record, Infant, virus diseases, Retrospective cohort study, medicine.disease, Laboratory results, Treatment Outcome, Infectious Diseases, Anti-Retroviral Agents, Child, Preschool, Female, business
Abstract

SETTING Tygerberg Hospital, Western Cape Province, Cape Town, South Africa. OBJECTIVE To investigate the prevalence of and factors associated with simultaneous tuberculosis (TB) and human immunodeficiency virus (HIV) diagnoses in children. DESIGN Retrospective cohort study in TB-HIV co-infected children aged

Published
2018

79. Survival of HIV-infected adolescents on antiretroviral therapy in Uganda: findings from a nationally representative cohort in Uganda.

Author

Celestin Bakanda, Josephine Birungi, Robert Mwesigwa, Jean B Nachega, Keith Chan, Alexis Palmer, Nathan Ford, and Edward J Mills

Subjects
Medicine, Science
Abstract

BackgroundAdolescents have been identified as a high-risk group for poor adherence to and defaulting from combination antiretroviral therapy (cART) care. However, data on outcomes for adolescents on cART in resource-limited settings remain scarce.MethodsWe developed an observational study of patients who started cART at The AIDS Service Organization (TASO) in Uganda between 2004 and 2009. Age was stratified into three groups: children (≤10 years), adolescents (11-19 years), and adults (≥20 years). Kaplan-Meier survival curves were generated to describe time to mortality and loss to follow-up, and Cox regression used to model associations between age and mortality and loss to follow-up. To address loss to follow up, we applied a weighted analysis that assumes 50% of lost patients had died.FindingsA total of 23,367 patients were included in this analysis, including 810 (3.5%) children, 575 (2.5%) adolescents, and 21 982 (94.0%) adults. A lower percentage of children (5.4%) died during their cART treatment compared to adolescents (8.5%) and adults (10%). After adjusting for confounding, other features predicted mortality than age alone. Mortality was higher among males (pInterpretationThis study is the largest assessment of adolescents receiving cART in Africa. Adolescents did not have cART mortality outcomes different from adults or children.

Published
2011
Full Text
View/download PDF

80. Early mortality and AIDS progression despite high initial antiretroviral therapy adherence and virologic suppression in Botswana.

Author

Katherine T Steele, Andrew P Steenhoff, Craig W Newcomb, Tumelo Rantleru, Rudo Nthobatsang, Gloria Lesetedi, Scarlett L Bellamy, Jean B Nachega, Robert Gross, and Gregory P Bisson

Subjects
Medicine, Science
Abstract

BackgroundAdverse outcomes occurring early after antiretroviral therapy (ART) initiation are common in sub-Saharan Africa, despite reports of high levels of ART adherence in this setting. We sought to determine the relationship between very early ART adherence and early adverse outcomes in HIV-infected adults in Botswana.MethodsThis prospective cohort study of 402 ART-naïve, HIV-infected adults initiating ART at a public HIV clinic in Gaborone, Botswana evaluated the relationship between suboptimal early ART adherence and HIV treatment outcomes in the initial months after ART initiation. Early adherence during the interval between initial ART dispensation and first ART refill was calculated using pill counts. In the primary analysis patients not returning to refill and those with adherence ResultsSuboptimal early adherence was independently associated with loss to follow-up and death (adjusted OR 2.3, 95% CI 1.1-4.8) and with the secondary composite outcome including incident OIs and virologic failure (adjusted OR 2.6, 95% CI 1.4-4.7). However, of those with early adverse outcomes, less than one-third had suboptimal adherence and approximately two-thirds achieved virologic suppression. The PAR% relating suboptimal early adherence and primary and secondary outcomes were 14.7% and 17.7%, respectively.ConclusionsSuboptimal early adherence was associated with poor outcomes, but most early adverse outcomes occurred in patients with optimal early adherence. Clinical care and research efforts should focus on understanding early adverse outcomes that occur despite optimal adherence.

Published
2011
Full Text
View/download PDF

81. Pharmacy refill adherence compared with CD4 count changes for monitoring HIV-infected adults on antiretroviral therapy.

Author

Gregory P Bisson, Robert Gross, Scarlett Bellamy, Jesse Chittams, Michael Hislop, Leon Regensberg, Ian Frank, Gary Maartens, and Jean B Nachega

Subjects
Medicine
Abstract

World Health Organization (WHO) guidelines for monitoring HIV-infected individuals taking combination antiretroviral therapy (cART) in resource-limited settings recommend using CD4(+) T cell (CD4) count changes to monitor treatment effectiveness. In practice, however, falling CD4 counts are a consequence, rather than a cause, of virologic failure. Adherence lapses precede virologic failure and, unlike CD4 counts, data on adherence are immediately available to all clinics dispensing cART. However, the accuracy of adherence assessments for predicting future or detecting current virologic failure has not been determined. The goal of this study therefore was to determine the accuracy of adherence assessments for predicting and detecting virologic failure and to compare the accuracy of adherence-based monitoring approaches with approaches monitoring CD4 count changes.We conducted an observational cohort study among 1,982 of 4,984 (40%) HIV-infected adults initiating non-nucleoside reverse transcriptase inhibitor-based cART in the Aid for AIDS Disease Management Program, which serves nine countries in southern Africa. Pharmacy refill adherence was calculated as the number of months of cART claims submitted divided by the number of complete months between cART initiation and the last refill prior to the endpoint of interest, expressed as a percentage. The main outcome measure was virologic failure defined as a viral load > 1,000 copies/ml (1) at an initial assessment either 6 or 12 mo after cART initiation and (2) after a previous undetectable (i.e., < 400 copies/ml) viral load (breakthrough viremia). Adherence levels outperformed CD4 count changes when used to detect current virologic failure in the first year after cART initiation (area under the receiver operating characteristic [ROC] curves [AUC] were 0.79 and 0.68 [difference = 0.11; 95% CI 0.06 to 0.16; chi(2) = 20.1] respectively at 6 mo, and 0.85 and 0.75 [difference = 0.10; 95% CI 0.05 to 0.14; chi(2) = 20.2] respectively at 12 mo; p < 0.001 for both comparisons). When used to detect current breakthrough viremia, adherence and CD4 counts were equally accurate (AUCs of 0.68 versus 0.67, respectively [difference = 0.01; 95% CI -0.06 to 0.07]; chi(2) = 0.1, p > 0.5). In addition, adherence levels assessed 3 mo prior to viral load assessments were as accurate for virologic failure occurring approximately 3 mo later as were CD4 count changes calculated from cART initiation to the actual time of the viral load assessments, indicating the potential utility of adherence assessments for predicting future, rather than simply detecting current, virologic failure. Moreover, combinations of CD4 count and adherence data appeared useful in identifying patients at very low risk of virologic failure.Pharmacy refill adherence assessments were as accurate as CD4 counts for detecting current virologic failure in this cohort of patients on cART and have the potential to predict virologic failure before it occurs. Approaches to cART scale-up in resource-limited settings should include an adherence-based monitoring approach.

Published
2008
Full Text
View/download PDF

83. Adherence to HAART: a systematic review of developed and developing nation patient-reported barriers and facilitators.

Author

Edward J Mills, Jean B Nachega, David R Bangsberg, Sonal Singh, Beth Rachlis, Ping Wu, Kumanan Wilson, Iain Buchan, Christopher J Gill, and Curtis Cooper

Subjects
Medicine
Abstract

Adherence to highly active antiretroviral therapy (HAART) medication is the greatest patient-enabled predictor of treatment success and mortality for those who have access to drugs. We systematically reviewed the literature to determine patient-reported barriers and facilitators to adhering to antiretroviral therapy.We examined both developed and developing nations. We searched the following databases: AMED (inception to June 2005), Campbell Collaboration (inception to June 2005), CinAhl (inception to June 2005), Cochrane Library (inception to June 2005), Embase (inception to June 2005), ERIC (inception to June 2005), MedLine (inception to June 2005), and NHS EED (inception to June 2005). We retrieved studies conducted in both developed and developing nation settings that examined barriers and facilitators addressing adherence. Both qualitative and quantitative studies were included. We independently, in duplicate, extracted data reported in qualitative studies addressing adherence. We then examined all quantitative studies addressing barriers and facilitators noted from the qualitative studies. In order to place the findings of the qualitative studies in a generalizable context, we meta-analyzed the surveys to determine a best estimate of the overall prevalence of issues. We included 37 qualitative studies and 47 studies using a quantitative methodology (surveys). Seventy-two studies (35 qualitative) were conducted in developed nations, while the remaining 12 (two qualitative) were conducted in developing nations. Important barriers reported in both economic settings included fear of disclosure, concomitant substance abuse, forgetfulness, suspicions of treatment, regimens that are too complicated, number of pills required, decreased quality of life, work and family responsibilities, falling asleep, and access to medication. Important facilitators reported by patients in developed nation settings included having a sense of self-worth, seeing positive effects of antiretrovirals, accepting their seropositivity, understanding the need for strict adherence, making use of reminder tools, and having a simple regimen. Among 37 separate meta-analyses examining the generalizability of these findings, we found large heterogeneity.We found that important barriers to adherence are consistent across multiple settings and countries. Research is urgently needed to determine patient-important factors for adherence in developing world settings. Clinicians should use this information to engage in open discussion with patients to promote adherence and identify barriers and facilitators within their own populations.

Published
2006
Full Text
View/download PDF

84. Obésité, hypertension artérielle, hypercholestérolémie et diabète non traités chez les adultes infectés ou pas par le VIH à Mbuji-Mayi (République démocratique du Congo)

Author

Michel Moutschen, M Mutombo-Tshingwali, V Arendt, D. Mukeba-Tshialala, G Gilson, and J B Nachega

Subjects
0301 basic medicine, education.field_of_study, medicine.medical_specialty, business.industry, Cross-sectional study, 030106 microbiology, Population, Stavudine, Case-control study, Lamivudine, 030204 cardiovascular system & hematology, medicine.disease, Gastroenterology, Pathology and Forensic Medicine, 03 medical and health sciences, 0302 clinical medicine, Blood pressure, Diabetes mellitus, Internal medicine, Medicine, business, education, Dyslipidemia, medicine.drug
Abstract

Little is known about the major cardiovascular risk factors in HIV-infected as compared to the HIV-uninfected patients in the Democratic Republic of Congo (DR Congo). We determined the prevalence of hypertension, obesity (BMI ≥ 30 kg/m2), total cholesterol > 200 mg/dl, HDLcholesterol &≤ 40 mg/dl, and glycemia > 126 mg/dl. We also calculated the average and/or median of total cholesterol, HDL-cholesterol, and glycemia among HIV-infected and HIV-uninfected patients.We conducted a cross-sectional study that enrolled 592 HIV-uninfected and 445 HIV-infected patients of whom 425 (95.5%) were on first-line antiretroviral therapy based on stavudine-lamivudine-nevirapine. Clinical and laboratory data of the patients were collected. The results were analyzed by chi-square, t-student, and Wilcoxon rank sum tests. 11.5% of HIV-infected patients had an average blood pressure suggesting hypertension versus 10.6% of HIV-uninfected (P = 0.751). But in absolute value, HIVinfected patients had a median of diastolic blood pressure of 90 mmHg versus 85 mmHg of HIV-uninfected (P 200 mg/dl and HDL-cholesterol ≤ 40 mg/dl. Proactive screening and prompt management of dyslipidemia and hypertension in this population should be a priority.

Published
2017

85. Timing of initiation of antiretroviral therapy and adverse pregnancy outcomes: a systematic review and meta-analysis

Author

Edward J Mills, Shaffiq Essajee, Jean B. Nachega, Francoise Renaud, Meg Doherty, Olalekan A. Uthman, Steve Kanters, Jean Anderson, and Lynne M. Mofenson

Subjects
0301 basic medicine, Pediatrics, medicine.medical_specialty, Pregnancy, Epidemiology, business.industry, Birth weight, Immunology, MEDLINE, medicine.disease, 030112 virology, Clinical trial, 03 medical and health sciences, 0302 clinical medicine, Infectious Diseases, Virology, Meta-analysis, Relative risk, medicine, Small for gestational age, 030212 general & internal medicine, business, Prospective cohort study
Abstract

Summary Background Although lifelong combination antiretroviral therapy (ART) is recommended for all individuals with HIV, few data exist for pregnancy outcomes associated with ART initiation before conception. We assessed adverse pregnancy outcomes associated with ART initiated before conception compared with that of ART started after conception. Methods We did a systematic review of studies from low-income, middle-income, and high-income countries by searching the Cochrane Central Register of Controlled Trials, Embase, LILACS, MEDLINE, Toxline, Web of Knowledge, and WHO Global Index Medicus and trials in progress (International Clinical Trials Registry Platform) for randomised trials, quasi-randomised trials, and prospective cohort studies done between Jan 1, 1980, and June 1, 2016, in which timing of ART initiation in pregnant women living with HIV was reported. We used the risk ratio (RR) and corresponding 95% CIs as the primary measure to assess the association between the selected outcomes and ART initiation before conception versus after conception. We used a random-effects model to pool risk ratios. Findings We included 11 studies with 19 189 mother–infant pairs. Women who started ART before conception were significantly more likely to deliver preterm (pooled RR 1·20, 95% CI 1·01−1·44) or very preterm (1·53, 1·22−1·92), or to have low-birthweight infants (1·30, 1·04−1·62) than were those who began ART after conception. Few data exist for neonatal mortality. The risk of very low birthweight, small for gestational age, severe small for gestational age, stillbirth, and congenital anomalies did not differ significantly between women who were taking ART before conception and those who began ART after conception. Interpretation The benefits of ART for maternal health and prevention of perinatal transmission outweigh risks, but data for the extent and severity of these risks are scarce and of low quality. As use of ART before conception rapidly increases globally, monitoring for potential adverse pregnancy outcomes will be crucial. Funding WHO.

Published
2017

86. South African National Adherence Guidelines: need for revision?

Author

Jean B. Nachega, Najma Shaikh, Geoffrey Fatti, Peter Bock, and Ashraf Grimwood

Subjects
medicine.medical_specialty, South Africa, Infectious Diseases, business.industry, Family medicine, Public Health, Environmental and Occupational Health, MEDLINE, Medicine, Black People, Humans, Parasitology, HIV Infections, business
Published
2019

87. Agreement and Discrepancy on Emotional and Behavioral Problems Between Caregivers and HIV-Infected Children and Adolescents From Uganda

Author

Eugene Kinyanda, Vikram Patel, Leigh van den Heuvel, Richard Mpango, Soraya Seedat, Kenneth D. Gadow, Jean B. Nachega, and Jonathan Levin

Subjects
lcsh:RC435-571, Human immunodeficiency virus (HIV), medicine.disease_cause, Adolescent age, Child and adolescent, 03 medical and health sciences, 0302 clinical medicine, children, lcsh:Psychiatry, Hiv infected, discrepancy, medicine, adolescents, 10. No inequality, Original Research, caregiver report, Hiv stigma, Psychiatry, business.industry, 4. Education, HIV, self-report, Mental health, 030227 psychiatry, Psychiatry and Mental health, emotional problems, Hiv status, business, Psychosocial, 030217 neurology & neurosurgery, behavioral problems, Clinical psychology
Abstract

Background: HIV-infected children and adolescents (CA-HIV) face significant mental health challenges related to a broad range of biological and psychosocial factors. Data are scarce on the agreement and discrepancy between caregivers and CA-HIV regarding emotional and behavioral problems (EBPs) in CA-HIV. Objectives: We determined agreement between self- versus caregiver- reported EBPs and describe factors associated with informant discrepancy among caregiver–youth dyads who participated in the “Mental health among HIV-infected CHildren and Adolescents in KAmpala and Masaka, Uganda” (CHAKA) study. Methods: In a cross-sectional sample, caregiver-reported EBPs were assessed with the Child and Adolescent Symptom Inventory-5 (CASI-5), and self-reported problems were evaluated with the Youth Inventory-4 (YI-4) in 469 adolescents aged 12–17 years and the Child Inventory-4 (CI-4) in 493 children aged 8–11 years. Adolescents were questioned about experiences of HIV stigma. Caregiver psychological distress was assessed with the Self-Reporting Questionnaire (SRQ-20). Linear regression models were applied to identify variables associated with discrepancy scores. Results: Self-reported emotional problems (EPs) were present in 28.8% of adolescents and 36.9% of children, and 14.5% of adolescents self-reported behavioral problems (BPs). There was only a modest correlation (r ≤ 0.29) between caregiver- and CA-HIV-reported EBPs, with caregivers reporting more EPs whereas adolescents reported more BPs. Informant discrepancy between adolescents and caregivers for BPs was associated with adolescent age and caregiver’s employment and HIV status. Among adolescents, EP discrepancy scores were associated with adolescent’s WHO HIV clinical stage, caregiver level of education, and caregivers caring for other children. Among children, EP discrepancy scores were associated with child and caregiver age, caregiver level of education, and caregiver self-rated health status. HIV stigma and caregiver psychological distress were also associated with discrepancy, such that adolescents who experienced HIV stigma rated their EPs as more severe than their caregivers did and caregivers with increased psychological distress rated EBPs as more severe than CA-HIV self-rated. Conclusions: EBPs are frequently endorsed by CA-HIV, and agreement between informants is modest. Informant discrepancy is related to unique psychosocial and HIV-related factors. Multi-informant reports enhance the evaluation of CA-HIV and informant discrepancies can provide additional insights into the mental health of CA-HIV.

Published
2019

88. Rapid initiation of antiretroviral therapy for people living with HIV

Author

Alberto Mateo-Urdiales, Samuel Johnson, Rhodine Smith, Jean B Nachega, and Ingrid Eshun-Wilson

Subjects
0301 basic medicine, Adult, Male, medicine.medical_specialty, Time Factors, Adolescent, Psychological intervention, MEDLINE, HIV Infections, law.invention, Medication Adherence, Time-to-Treatment, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Pregnancy, Health care, Medicine, Humans, Pharmacology (medical), 030212 general & internal medicine, Pregnancy Complications, Infectious, Child, Developing Countries, Randomized Controlled Trials as Topic, Infectious disease, business.industry, HIV, 030112 virology, Clinical trial, Systematic review, Anti-Retroviral Agents, Meta-analysis, Family medicine, Relative risk, Female, business
Abstract

Background Despite antiretroviral therapy (ART) being widely available, HIV continues to cause substantial illness and premature death in low‐and‐middle‐income countries. High rates of loss to follow‐up after HIV diagnosis can delay people starting ART. Starting ART within seven days of HIV diagnosis (rapid ART initiation) could reduce loss to follow‐up, improve virological suppression rates, and reduce mortality. Objectives To assess the effects of interventions for rapid initiation of ART (defined as offering ART within seven days of HIV diagnosis) on treatment outcomes and mortality in people living with HIV. We also aimed to describe the characteristics of rapid ART interventions used in the included studies. Search methods We searched CENTRAL, the Cochrane Database of Systematic Reviews, MEDLINE, Embase, and four other databases up to 14 August 2018. There was no restriction on date, language, or publication status. We also searched ClinicalTrials.gov and the World Health Organization (WHO) International Clinical Trials Registry Platform, and websites for unpublished literature, including conference abstracts. Selection criteria We included randomized controlled trials (RCTs) that compared rapid ART versus standard care in people living with HIV. Children, adults, and adolescents from any setting were eligible for inclusion. Data collection and analysis Two review authors independently assessed the eligibility of the studies identified in the search, assessed the risk of bias and extracted data. The primary outcomes were mortality and virological suppression at 12 months. We have presented all outcomes using risk ratios (RR), with 95% confidence intervals (CIs). Where appropriate, we pooled the results in meta‐analysis. We assessed the certainty of the evidence using the GRADE approach. Main results We included seven studies with 18,011 participants in the review. All studies were carried out in low‐ and middle‐income countries in adults aged 18 years old or older. Only one study included pregnant women. In all the studies, the rapid ART intervention was offered as part of a package that included several cointerventions targeting individuals, health workers and health system processes delivered alongside rapid ART that aimed to facilitate uptake and adherence to ART. Comparing rapid ART with standard initiation probably results in greater viral suppression at 12 months (RR 1.18, 95% CI 1.10 to 1.27; 2719 participants, 4 studies; moderate‐certainty evidence) and better ART uptake at 12 months (RR 1.09, 95% CI 1.06 to 1.12; 3713 participants, 4 studies; moderate‐certainty evidence), and may improve retention in care at 12 months (RR 1.22, 95% CI 1.11 to 1.35; 5001 participants, 6 studies; low‐certainty evidence). Rapid ART initiation was associated with a lower mortality estimate, however the CIs included no effect when compared to standard of care (RR 0.72, 95% CI 0.51 to 1.01; 5451 participants, 7 studies; very low‐certainty evidence). It is uncertain whether rapid ART has an effect on modification of ART treatment regimens as data are lacking (RR 7.89, 95% CI 0.76 to 81.74; 977 participants, 2 studies; very low‐certainty evidence). There was insufficient evidence to draw conclusions on the occurrence of adverse events. Authors' conclusions RCTs that include initiation of ART within one week of diagnosis appear to improve outcomes across the HIV treatment cascade in low‐ and middle‐income settings. The studies demonstrating these effects delivered rapid ART combined with several setting‐specific cointerventions. This highlights the need for pragmatic research to identify feasible packages that assure the effects seen in the trials when delivered through complex health systems. 16 September 2019 Up to date All studies incorporated from most recent search All published trials found in the last search (14 Aug, 2018) were included, and we identified three ongoing studies, Plain language summary Effects of starting antiretroviral therapy within one week of diagnosis on people living with HIV What is the aim of this review? The aim was to determine whether starting antiretroviral therapy (ART) within one week of HIV diagnosis (rapid ART) resulted in a lower risk of dying or better suppression of the virus in people's blood than standard care; as well as studying the effect of this intervention on whether people start taking ART and continue to be engaged in care after 12 months. Key messages Offering ART to people living with HIV (PLWH) within one week of diagnosis probably increases the number of people initiating the therapy at 12 months and the number of PLWH whose virus has been suppressed in the blood at 12 months. It may also improve the number of people who are still in contact with healthcare services at 12 months. We don't know the effect this has on people dying. We found that several other changes need to be made alongside rapid ART for services to achieve these outcomes. What was studied in the review? HIV is a leading cause of death worldwide. Although more people are taking ART than ever before, there is a large percentage of PLWH who are not being treated. One of the reasons identified is the long period between being diagnosed with HIV and starting ART. Rapid ART has been proposed as a way to increase the number of PLWH being started on ART and improve HIV‐related outcomes. What are the main results of the review? We found seven studies that met the inclusion criteria of the review and assessed the effect of rapid ART on PLWH. Rapid ART probably increases the number of people being initiated on ART at 12 months and the number of PLWH with no detectable virus in their blood at 12 months (moderate‐certainty evidence). Based on low‐certainty evidence, rapid ART may increase the number of PLWH being retained in care. We don't know whether rapid ART has an effect on the number of deaths (very low‐certainty evidence). We found that if healthcare services aim to offer ART within a week of diagnosis, changes to how these systems operate will need to be made. How up to date is the review? We searched for relevant trials up to 14 August 2018.

Published
2019

89. Household Air Pollution as a Trigger of Chronic Cough After Completion of Mycobacterium Tuberculosis Treatment in Rural Democratic Republic of Congo

Author

Tony Kayembe-Kitenge, Jean B. Nachega, Kevin Mortimer, Z. Kashongwe, H.B. Lawin, Tim S. Nawrot, Aime Murhula, B. Casinga, Patrick D. M. C. Katoto, Sayoki Mfinanga, Bruce Kirenga, Benoit Nemery, and P. De Boever

Subjects
Mycobacterium tuberculosis, Chronic cough, biology, business.industry, Environmental health, Air pollution, Medicine, medicine.symptom, business, medicine.disease_cause, biology.organism_classification
Published
2019

90. Global Health Mentoring Toolkits: A Scoping Review Relevant for Low- and Middle-Income Country Institutions

Author

Chelsea Morroni, Dorairaj Prabhakaran, Jonathan K. Stiles, Adriane Wynn, Anna Kalbarczyk, Lee A. Wallis, Bhakti Hansoti, Joseph D. Tucker, Jean B. Nachega, and Mina C. Hosseinipour

Subjects
Cross-Cultural Comparison, Knowledge management, Asia, Biomedical Research, 030231 tropical medicine, Context (language use), Guidelines as Topic, Global Health, Education, 03 medical and health sciences, 0302 clinical medicine, Resource (project management), Mentorship, Professional Competence, Virology, Global health, Humans, Sociology, Adaptation (computer science), Developing Countries, Education economics, business.industry, 4. Education, Teaching, Professional development, Mentors, Capacity building, Mentoring, Articles, South America, United States, Infectious Diseases, Africa, Parasitology, business
Abstract

Capacity building in low- and middle-income country (LMIC) institutions hinges on the delivery of effective mentorship. This study presents an overview of mentorship toolkits applicable to LMIC institutions identified through a scoping review. A scoping review approach was used to 1) map the extent, range, and nature of mentorship resources and tools available and 2) to identify knowledge gaps in the current literature. To identify toolkits, we collected and analyzed data provided online that met the following criteria: written in English and from organizations and individuals involved in global health mentoring. We searched electronic databases, including PubMed, Web of Science, and Google Scholar, and Google search engine. Once toolkits were identified, we extracted the available tools and mapped them to pre-identified global health competencies. Only three of the 18 identified toolkits were developed specifically for the LMIC context. Most toolkits focused on individual mentor–mentee relationships. Most focused on the domains of communication and professional development. Fewer toolkits focused on ethics, overcoming resource limitations, and fostering institutional change. No toolkits discussed strategies for group mentoring or how to adapt existing tools to a local context. There is a paucity of mentoring resources specifically designed for LMIC settings. We identified several toolkits that focus on aspects of individual mentor–mentee relationships that could be adapted to local contexts. Future work should focus on adaptation and the development of tools to support institutional change and capacity building for mentoring.

Published
2019

91. Effectiveness and Cost-Effectiveness of Group Support Psychotherapy Delivered by Trained Lay Health Workers for Depression Treatment Among People with HIV in Uganda: A Cluster Randomized Trial

Author

Chrispus Mayora, Sheila Ndyanabangi, Micheal Etukoit, Jean B. Nachega, Ramin Mojtabai, Kizito Wamala, Josephine Birungi, James Okello, Etheldreda Nakimuli-Mpungu, Mastula Nanfuka, Freddie Ssengooba, Seggane Musisi, Edward J Mills, and Ofir Harari

Subjects
Clinical trial, Psychotherapist, Acquired immunodeficiency syndrome (AIDS), Informed consent, business.industry, Cost effectiveness, Psychological intervention, Medicine, Cluster randomised controlled trial, business, medicine.disease, Mental health, Depression (differential diagnoses)
Abstract

Background: There is a scarcity of data on integrating and scaling up mental health interventions for people living with HIV in sub-Saharan Africa. Methods: Thirty primary care health centres (PHCs) were randomized 1:1 to offer Group Support Psychotherapy (GSP) or Group HIV Education (GHE). Participants were followed up at 6 and 12 months thereafter. Primary outcomes were change in depression and function scores, analysed by intention-to-treat using multilevel random effects regression analyses adjusting for clustering in PHCs. Secondary outcomes were post-traumatic stress symptoms, hazardous alcohol use, suicide risk, adherence to antiretroviral therapy (ART), viral loads (VLs) and cost-effectiveness data. This trial is registered with The Pan African Clinical Trials Registry, numberPACTR201608001738234. Findings: Between September 13, and December 15, 2016, we assessed 1,473 individuals, of whom 1,140 were recruited from PHCs offering GSP (n=578) or GHE (n=562). At 6 months post- treatment, we observed a greater reduction in depression symptoms among GSP than GHE participants [β = -5·28; 95% CI -5·85 to -4·72, p= < 0·001; effect size=1·28]. This effect was greater at 12 months post-treatment [β= -7·31; 95% CI -7·89 to -6·72, p=< 0·001]. Additionally, function scores were higher among GSP than GHE participants at 6 months [β= 4·12; 95% CI 3·75 to 4·49, p= < 0·001; effect size=1·44] and 12 months post-treatment [β= 5·07; 95% CI 4·72 to 5·42; p= < 0·001]. Significantly more GSP than GHE participants reported reduced post-traumatic stress symptoms; lower suicide risk, less use of alcohol and better adherence to ART in the long-term. The improvement in VL suppression was comparable between both groups. The incremental cost per disability adjusted life year averted was US$11·4. A total of 36 participants experienced 63 serious adverse events. Interpretation: GSP delivered by lay health workers is a more cost-effective psychological treatment for HIV related depression compared to GHE. Trial Registration Number: This trial is registered with The Pan African Clinical Trials Registry, numberPACTR201608001738234. Funding: This study was funded by Grand Challenges Canada, Grant #0770-05. EN-M is supported by the MQ Mental Health Fellowship Award, Grant #MQ15FIP100024. Declaration of Interest: None declared. Ethical Approval: The study was submitted to and approved by the Makerere University College of Health Sciences Research Ethics Committee, The AIDS Support Organization Research Ethics Committee, and the Uganda National Council of Science and Technology. All study participants were required to provide written informed consent.

Published
2019

92. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980–2017: a systematic analysis for the Global Burden of Disease Study 2017

Author

Gregory A Roth, Degu Abate, Kalkidan Hassen Abate, Solomon M Abay, Cristiana Abbafati, Nooshin Abbasi, Hedayat Abbastabar, Foad Abd-Allah, Jemal Abdela, Ahmed Abdelalim, Ibrahim Abdollahpour, Rizwan Suliankatchi Abdulkader, Haftom Temesgen Abebe, Molla Abebe, Zegeye Abebe, Ayenew Negesse Abejie, Semaw F Abera, Olifan Zewdie Abil, Haftom Niguse Abraha, Aklilu Roba Abrham, Laith Jamal Abu-Raddad, Manfred Mario Kokou Accrombessi, Dilaram Acharya, Abdu A Adamu, Oladimeji M Adebayo, Rufus Adesoji Adedoyin, Victor Adekanmbi, Olatunji O Adetokunboh, Beyene Meressa Adhena, Mina G Adib, Amha Admasie, Ashkan Afshin, Gina Agarwal, Kareha M Agesa, Anurag Agrawal, Sutapa Agrawal, Alireza Ahmadi, Mehdi Ahmadi, Muktar Beshir Ahmed, Sayem Ahmed, Amani Nidhal Aichour, Ibtihel Aichour, Miloud Taki Eddine Aichour, Mohammad Esmaeil Akbari, Rufus Olusola Akinyemi, Nadia Akseer, Ziyad Al-Aly, Ayman Al-Eyadhy, Rajaa M Al-Raddadi, Fares Alahdab, Khurshid Alam, Tahiya Alam, Animut Alebel, Kefyalew Addis Alene, Mehran Alijanzadeh, Reza Alizadeh-Navaei, Syed Mohamed Aljunid, Ala'a Alkerwi, François Alla, Peter Allebeck, Jordi Alonso, Khalid Altirkawi, Nelson Alvis-Guzman, Azmeraw T Amare, Leopold N Aminde, Erfan Amini, Walid Ammar, Yaw Ampem Amoako, Nahla Hamed Anber, Catalina Liliana Andrei, Sofia Androudi, Megbaru Debalkie Animut, Mina Anjomshoa, Hossein Ansari, Mustafa Geleto Ansha, Carl Abelardo T Antonio, Palwasha Anwari, Olatunde Aremu, Johan Ärnlöv, Amit Arora, Monika Arora, Al Artaman, Krishna K Aryal, Hamid Asayesh, Ephrem Tsegay Asfaw, Zerihun Ataro, Suleman Atique, Sachin R Atre, Marcel Ausloos, Euripide F G A Avokpaho, Ashish Awasthi, Beatriz Paulina Ayala Quintanilla, Yohanes Ayele, Rakesh Ayer, Peter S Azzopardi, Arefeh Babazadeh, Umar Bacha, Hamid Badali, Alaa Badawi, Ayele Geleto Bali, Katherine E Ballesteros, Maciej Banach, Kajori Banerjee, Marlena S Bannick, Joseph Adel Mattar Banoub, Miguel A Barboza, Suzanne Lyn Barker-Collo, Till Winfried Bärnighausen, Simon Barquera, Lope H Barrero, Quique Bassat, Sanjay Basu, Bernhard T Baune, Habtamu Wondifraw Baynes, Shahrzad Bazargan-Hejazi, Neeraj Bedi, Ettore Beghi, Masoud Behzadifar, Meysam Behzadifar, Yannick Béjot, Bayu Begashaw Bekele, Abate Bekele Belachew, Ezra Belay, Yihalem Abebe Belay, Michelle L Bell, Aminu K Bello, Derrick A Bennett, Isabela M Bensenor, Adam E Berman, Eduardo Bernabe, Robert S Bernstein, Gregory J Bertolacci, Mircea Beuran, Tina Beyranvand, Ashish Bhalla, Suraj Bhattarai, Soumyadeeep Bhaumik, Zulfiqar A Bhutta, Belete Biadgo, Molly H Biehl, Ali Bijani, Boris Bikbov, Ver Bilano, Nigus Bililign, Muhammad Shahdaat Bin Sayeed, Donal Bisanzio, Tuhin Biswas, Brigette F Blacker, Berrak Bora Basara, Rohan Borschmann, Cristina Bosetti, Kayvan Bozorgmehr, Oliver J Brady, Luisa C Brant, Carol Brayne, Alexandra Brazinova, Nicholas J K Breitborde, Hermann Brenner, Paul Svitil Briant, Gabrielle Britton, Traolach Brugha, Reinhard Busse, Zahid A Butt, Charlton S K H Callender, Ismael R Campos-Nonato, Julio Cesar Campuzano Rincon, Jorge Cano, Mate Car, Rosario Cárdenas, Giulia Carreras, Juan J Carrero, Austin Carter, Félix Carvalho, Carlos A Castañeda-Orjuela, Jacqueline Castillo Rivas, Chris D Castle, Clara Castro, Franz Castro, Ferrán Catalá-López, Ester Cerin, Yazan Chaiah, Jung-Chen Chang, Fiona J Charlson, Pankaj Chaturvedi, Peggy Pei-Chia Chiang, Odgerel Chimed-Ochir, Vesper Hichilombwe Chisumpa, Abdulaal Chitheer, Rajiv Chowdhury, Hanne Christensen, Devasahayam J Christopher, Sheng-Chia Chung, Flavia M Cicuttini, Liliana G Ciobanu, Massimo Cirillo, Aaron J Cohen, Leslie Trumbull Cooper, Paolo Angelo Cortesi, Monica Cortinovis, Ewerton Cousin, Benjamin C Cowie, Michael H Criqui, Elizabeth A Cromwell, Christopher Stephen Crowe, John A Crump, Matthew Cunningham, Alemneh Kabeta Daba, Abel Fekadu Dadi, Lalit Dandona, Rakhi Dandona, Anh Kim Dang, Paul I Dargan, Ahmad Daryani, Siddharth K Das, Rajat Das Gupta, José Das Neves, Tamirat Tesfaye Dasa, Aditya Prasad Dash, Adrian C Davis, Nicole Davis Weaver, Dragos Virgil Davitoiu, Kairat Davletov, Fernando Pio De La Hoz, Jan-Walter De Neve, Meaza Girma Degefa, Louisa Degenhardt, Tizta T Degfie, Selina Deiparine, Gebre Teklemariam Demoz, Balem Betsu Demtsu, Edgar Denova-Gutiérrez, Kebede Deribe, Nikolaos Dervenis, Don C Des Jarlais, Getenet Ayalew Dessie, Subhojit Dey, Samath D Dharmaratne, Daniel Dicker, Mesfin Tadese Dinberu, Eric L Ding, M Ashworth Dirac, Shirin Djalalinia, Klara Dokova, David Teye Doku, Christl A Donnelly, E Ray Dorsey, Pratik P Doshi, Dirk Douwes-Schultz, Kerrie E Doyle, Tim R Driscoll, Manisha Dubey, Eleonora Dubljanin, Eyasu Ejeta Duken, Bruce B Duncan, Andre R Duraes, Hedyeh Ebrahimi, Soheil Ebrahimpour, Dumessa Edessa, David Edvardsson, Anne Elise Eggen, Charbel El Bcheraoui, Maysaa El Sayed Zaki, Ziad El-Khatib, Hajer Elkout, Christian Lycke Ellingsen, Matthias Endres, Aman Yesuf Endries, Benjamin Er, Holly E Erskine, Babak Eshrati, Sharareh Eskandarieh, Reza Esmaeili, Alireza Esteghamati, Mahdi Fakhar, Hamed Fakhim, Mahbobeh Faramarzi, Mohammad Fareed, Farzaneh Farhadi, Carla Sofia E sá Farinha, Andre Faro, Maryam S Farvid, Farshad Farzadfar, Mohammad Hosein Farzaei, Valery L Feigin, Andrea B Feigl, Netsanet Fentahun, Seyed-Mohammad Fereshtehnejad, Eduarda Fernandes, Joao C Fernandes, Alize J Ferrari, Garumma Tolu Feyissa, Irina Filip, Samuel Finegold, Florian Fischer, Christina Fitzmaurice, Nataliya A Foigt, Kyle J Foreman, Carla Fornari, Tahvi D Frank, Takeshi Fukumoto, John E Fuller, Nancy Fullman, Thomas Fürst, João M Furtado, Neal D Futran, Silvano Gallus, Alberto L Garcia-Basteiro, Miguel A Garcia-Gordillo, William M Gardner, Abadi Kahsu Gebre, Tsegaye Tewelde Gebrehiwot, Amanuel Tesfay Gebremedhin, Bereket Gebremichael, Teklu Gebrehiwo Gebremichael, Tilayie Feto Gelano, Johanna M Geleijnse, Ricard Genova-Maleras, Yilma Chisha Dea Geramo, Peter W Gething, Kebede Embaye Gezae, Mohammad Rasoul Ghadami, Reza Ghadimi, Khalil Ghasemi Falavarjani, Maryam Ghasemi-Kasman, Mamata Ghimire, Katherine B Gibney, Paramjit Singh Gill, Tiffany K Gill, Richard F Gillum, Ibrahim Abdelmageed Ginawi, Maurice Giroud, Giorgia Giussani, Shifalika Goenka, Ellen M Goldberg, Srinivas Goli, Hector Gómez-Dantés, Philimon N Gona, Sameer Vali Gopalani, Taren M Gorman, Atsushi Goto, Alessandra C Goulart, Elena V Gnedovskaya, Ayman Grada, Giuseppe Grosso, Harish Chander Gugnani, Andre Luiz Sena Guimaraes, Yuming Guo, Prakash C Gupta, Rahul Gupta, Rajeev Gupta, Tanush Gupta, Reyna Alma Gutiérrez, Bishal Gyawali, Juanita A Haagsma, Nima Hafezi-Nejad, Tekleberhan B Hagos, Tewodros Tesfa Hailegiyorgis, Gessessew Bugssa Hailu, Arvin Haj-Mirzaian, Arya Haj-Mirzaian, Randah R Hamadeh, Samer Hamidi, Alexis J Handal, Graeme J Hankey, Hilda L Harb, Sivadasanpillai Harikrishnan, Josep Maria Haro, Mehedi Hasan, Hadi Hassankhani, Hamid Yimam Hassen, Rasmus Havmoeller, Roderick J Hay, Simon I Hay, Yihua He, Akbar Hedayatizadeh-Omran, Mohamed I Hegazy, Behzad Heibati, Mohsen Heidari, Delia Hendrie, Andualem Henok, Nathaniel J Henry, Claudiu Herteliu, Fatemeh Heydarpour, Pouria Heydarpour, Sousan Heydarpour, Desalegn Tsegaw Hibstu, Hans W Hoek, Michael K Hole, Enayatollah Homaie Rad, Praveen Hoogar, H Dean Hosgood, Seyed Mostafa Hosseini, Mehdi Hosseinzadeh, Mihaela Hostiuc, Sorin Hostiuc, Peter J Hotez, Damian G Hoy, Thomas Hsiao, Guoqing Hu, John J Huang, Abdullatif Husseini, Mohammedaman Mama Hussen, Susan Hutfless, Bulat Idrisov, Olayinka Stephen Ilesanmi, Usman Iqbal, Seyed Sina Naghibi Irvani, Caleb Mackay Salpeter Irvine, Nazrul Islam, Sheikh Mohammed Shariful Islam, Farhad Islami, Kathryn H Jacobsen, Leila Jahangiry, Nader Jahanmehr, Sudhir Kumar Jain, Mihajlo Jakovljevic, Moti Tolera Jalu, Spencer L James, Mehdi Javanbakht, Achala Upendra Jayatilleke, Panniyammakal Jeemon, Kathy J Jenkins, Ravi Prakash Jha, Vivekanand Jha, Catherine O Johnson, Sarah C Johnson, Jost B Jonas, Ankur Joshi, Jacek Jerzy Jozwiak, Suresh Banayya Jungari, Mikk Jürisson, Zubair Kabir, Rajendra Kadel, Amaha Kahsay, Rizwan Kalani, Manoochehr Karami, Behzad Karami Matin, André Karch, Corine Karema, Hamidreza Karimi-Sari, Amir Kasaeian, Dessalegn H Kassa, Getachew Mullu Kassa, Tesfaye Dessale Kassa, Nicholas J Kassebaum, Srinivasa Vittal Katikireddi, Anil Kaul, Zhila Kazemi, Ali Kazemi Karyani, Dhruv Satish Kazi, Adane Teshome Kefale, Peter Njenga Keiyoro, Grant Rodgers Kemp, Andre Pascal Kengne, Andre Keren, Chandrasekharan Nair Kesavachandran, Yousef Saleh Khader, Behzad Khafaei, Morteza Abdullatif Khafaie, Alireza Khajavi, Nauman Khalid, Ibrahim A Khalil, Ejaz Ahmad Khan, Muhammad Shahzeb Khan, Muhammad Ali Khan, Young-Ho Khang, Mona M Khater, Abdullah T Khoja, Ardeshir Khosravi, Mohammad Hossein Khosravi, Jagdish Khubchandani, Aliasghar A Kiadaliri, Getiye D Kibret, Zelalem Teklemariam Kidanemariam, Daniel N Kiirithio, Daniel Kim, Young-Eun Kim, Yun Jin Kim, Ruth W Kimokoti, Yohannes Kinfu, Adnan Kisa, Katarzyna Kissimova-Skarbek, Mika Kivimäki, Ann Kristin Skrindo Knudsen, Jonathan M Kocarnik, Sonali Kochhar, Yoshihiro Kokubo, Tufa Kolola, Jacek A Kopec, Parvaiz A Koul, Ai Koyanagi, Michael A Kravchenko, Kewal Krishan, Barthelemy Kuate Defo, Burcu Kucuk Bicer, G Anil Kumar, Manasi Kumar, Pushpendra Kumar, Michael J Kutz, Igor Kuzin, Hmwe Hmwe Kyu, Deepesh P Lad, Sheetal D Lad, Alessandra Lafranconi, Dharmesh Kumar Lal, Ratilal Lalloo, Tea Lallukka, Jennifer O Lam, Faris Hasan Lami, Van C Lansingh, Sonia Lansky, Heidi J Larson, Arman Latifi, Kathryn Mei-Ming Lau, Jeffrey V Lazarus, Georgy Lebedev, Paul H Lee, James Leigh, Mostafa Leili, Cheru Tesema Leshargie, Shanshan Li, Yichong Li, Juan Liang, Lee-Ling Lim, Stephen S Lim, Miteku Andualem Limenih, Shai Linn, Shiwei Liu, Yang Liu, Rakesh Lodha, Chris Lonsdale, Alan D Lopez, Stefan Lorkowski, Paulo A Lotufo, Rafael Lozano, Raimundas Lunevicius, Stefan Ma, Erlyn Rachelle King Macarayan, Mark T Mackay, Jennifer H MacLachlan, Emilie R Maddison, Fabiana Madotto, Hassan Magdy Abd El Razek, Muhammed Magdy Abd El Razek, Dhaval P Maghavani, Marek Majdan, Reza Majdzadeh, Azeem Majeed, Reza Malekzadeh, Deborah Carvalho Malta, Ana-Laura Manda, Luiz Garcia Mandarano-Filho, Helena Manguerra, Mohammad Ali Mansournia, Chabila Christopher Mapoma, Dadi Marami, Joemer C Maravilla, Wagner Marcenes, Laurie Marczak, Ashley Marks, Guy B Marks, Gabriel Martinez, Francisco Rogerlândio Martins-Melo, Ira Martopullo, Winfried März, Melvin B Marzan, Joseph R Masci, Benjamin Ballard Massenburg, Manu Raj Mathur, Prashant Mathur, Richard Matzopoulos, Pallab K Maulik, Mohsen Mazidi, Colm McAlinden, John J McGrath, Martin McKee, Brian J McMahon, Suresh Mehata, Man Mohan Mehndiratta, Ravi Mehrotra, Kala M Mehta, Varshil Mehta, Tefera C Mekonnen, Addisu Melese, Mulugeta Melku, Peter T N Memiah, Ziad A Memish, Walter Mendoza, Desalegn Tadese Mengistu, Getnet Mengistu, George A Mensah, Seid Tiku Mereta, Atte Meretoja, Tuomo J Meretoja, Tomislav Mestrovic, Haftay Berhane Mezgebe, Bartosz Miazgowski, Tomasz Miazgowski, Anoushka I Millear, Ted R Miller, Molly Katherine Miller-Petrie, G K Mini, Parvaneh Mirabi, Mojde Mirarefin, Andreea Mirica, Erkin M Mirrakhimov, Awoke Temesgen Misganaw, Habtamu Mitiku, Babak Moazen, Karzan Abdulmuhsin Mohammad, Moslem Mohammadi, Noushin Mohammadifard, Mohammed A Mohammed, Shafiu Mohammed, Viswanathan Mohan, Ali H Mokdad, Mariam Molokhia, Lorenzo Monasta, Ghobad Moradi, Maziar Moradi-Lakeh, Mehdi Moradinazar, Paula Moraga, Lidia Morawska, Ilais Moreno Velásquez, Joana Morgado-Da-Costa, Shane Douglas Morrison, Marilita M Moschos, Simin Mouodi, Seyyed Meysam Mousavi, Kindie Fentahun Muchie, Ulrich Otto Mueller, Satinath Mukhopadhyay, Kate Muller, John Everett Mumford, Jonah Musa, Kamarul Imran Musa, Ghulam Mustafa, Saravanan Muthupandian, Jean B Nachega, Gabriele Nagel, Aliya Naheed, Azin Nahvijou, Gurudatta Naik, Sanjeev Nair, Farid Najafi, Luigi Naldi, Hae Sung Nam, Vinay Nangia, Jobert Richie Nansseu, Bruno Ramos Nascimento, Gopalakrishnan Natarajan, Nahid Neamati, Ionut Negoi, Ruxandra Irina Negoi, Subas Neupane, Charles R J Newton, Frida N Ngalesoni, Josephine W Ngunjiri, Anh Quynh Nguyen, Grant Nguyen, Ha Thu Nguyen, Huong Thanh Nguyen, Long Hoang Nguyen, Minh Nguyen, Trang Huyen Nguyen, Emma Nichols, Dina Nur Anggraini Ningrum, Yirga Legesse Nirayo, Molly R Nixon, Nomonde Nolutshungu, Shuhei Nomura, Ole F Norheim, Mehdi Noroozi, Bo Norrving, Jean Jacques Noubiap, Hamid Reza Nouri, Malihe Nourollahpour Shiadeh, Mohammad Reza Nowroozi, Peter S Nyasulu, Christopher M Odell, Richard Ofori-Asenso, Felix Akpojene Ogbo, In-Hwan Oh, Olanrewaju Oladimeji, Andrew T Olagunju, Pedro R Olivares, Helen Elizabeth Olsen, Bolajoko Olubukunola Olusanya, Jacob Olusegun Olusanya, Kanyin L Ong, Sok King Sk Ong, Eyal Oren, Heather M Orpana, Alberto Ortiz, Justin R Ortiz, Stanislav S Otstavnov, Simon Øverland, Mayowa Ojo Owolabi, Raziye Özdemir, Mahesh P A, Rosana Pacella, Smita Pakhale, Abhijit P Pakhare, Amir H Pakpour, Adrian Pana, Songhomitra Panda-Jonas, Jeyaraj Durai Pandian, Andrea Parisi, Eun-Kee Park, Charles D H Parry, Hadi Parsian, Shanti Patel, Sanghamitra Pati, George C Patton, Vishnupriya Rao Paturi, Katherine R Paulson, Alexandre Pereira, David M Pereira, Norberto Perico, Konrad Pesudovs, Max Petzold, Michael R Phillips, Frédéric B Piel, David M Pigott, Julian David Pillay, Meghdad Pirsaheb, Farhad Pishgar, Suzanne Polinder, Maarten J Postma, Akram Pourshams, Hossein Poustchi, Ashwini Pujar, Swayam Prakash, Narayan Prasad, Caroline A Purcell, Mostafa Qorbani, Hedley Quintana, D Alex Quistberg, Kirankumar Waman Rade, Amir Radfar, Anwar Rafay, Alireza Rafiei, Fakher Rahim, Kazem Rahimi, Afarin Rahimi-Movaghar, Mahfuzar Rahman, Mohammad Hifz Ur Rahman, Muhammad Aziz Rahman, Rajesh Kumar Rai, Sasa Rajsic, Usha Ram, Chhabi Lal Ranabhat, Prabhat Ranjan, Puja C Rao, David Laith Rawaf, Salman Rawaf, Christian Razo-García, K Srinath Reddy, Robert C Reiner, Marissa B Reitsma, Giuseppe Remuzzi, Andre M N Renzaho, Serge Resnikoff, Satar Rezaei, Shahab Rezaeian, Mohammad Sadegh Rezai, Seyed Mohammad Riahi, Antonio Luiz P Ribeiro, Maria Jesus Rios-Blancas, Kedir Teji Roba, Nicholas L S Roberts, Stephen R Robinson, Leonardo Roever, Luca Ronfani, Gholamreza Roshandel, Ali Rostami, Dietrich Rothenbacher, Ambuj Roy, Enrico Rubagotti, Perminder S Sachdev, Basema Saddik, Ehsan Sadeghi, Hosein Safari, Mahdi Safdarian, Sare Safi, Saeid Safiri, Rajesh Sagar, Amirhossein Sahebkar, Mohammad Ali Sahraian, Nasir Salam, Joseph S Salama, Payman Salamati, Raphael De Freitas Saldanha, Zikria Saleem, Yahya Salimi, Sundeep Santosh Salvi, Inbal Salz, Evanson Zondani Sambala, Abdallah M Samy, Juan Sanabria, Maria Dolores Sanchez-Niño, Damian Francesco Santomauro, Itamar S Santos, João Vasco Santos, Milena M Santric Milicevic, Bruno Piassi Sao Jose, Abdur Razzaque Sarker, Rodrigo Sarmiento-Suárez, Nizal Sarrafzadegan, Benn Sartorius, Shahabeddin Sarvi, Brijesh Sathian, Maheswar Satpathy, Arundhati R Sawant, Monika Sawhney, Sonia Saxena, Mehdi Sayyah, Elke Schaeffner, Maria Inês Schmidt, Ione J C Schneider, Ben Schöttker, Aletta Elisabeth Schutte, David C Schwebel, Falk Schwendicke, James G Scott, Mario Sekerija, Sadaf G Sepanlou, Edson Serván-Mori, Seyedmojtaba Seyedmousavi, Hosein Shabaninejad, Katya Anne Shackelford, Azadeh Shafieesabet, Mehdi Shahbazi, Amira A Shaheen, Masood Ali Shaikh, Mehran Shams-Beyranvand, Mohammadbagher Shamsi, Morteza Shamsizadeh, Kiomars Sharafi, Mehdi Sharif, Mahdi Sharif-Alhoseini, Rajesh Sharma, Jun She, Aziz Sheikh, Peilin Shi, Mekonnen Sisay Shiferaw, Mika Shigematsu, Rahman Shiri, Reza Shirkoohi, Ivy Shiue, Farhad Shokraneh, Mark G Shrime, Si Si, Soraya Siabani, Tariq J Siddiqi, Inga Dora Sigfusdottir, Rannveig Sigurvinsdottir, Donald H Silberberg, Diego Augusto Santos Silva, João Pedro Silva, Natacha Torres Da Silva, Dayane Gabriele Alves Silveira, Jasvinder A Singh, Narinder Pal Singh, Prashant Kumar Singh, Virendra Singh, Dhirendra Narain Sinha, Karen Sliwa, Mari Smith, Badr Hasan Sobaih, Soheila Sobhani, Eugène Sobngwi, Samir S Soneji, Moslem Soofi, Reed J D Sorensen, Joan B Soriano, Ireneous N Soyiri, Luciano A Sposato, Chandrashekhar T Sreeramareddy, Vinay Srinivasan, Jeffrey D Stanaway, Vladimir I Starodubov, Vasiliki Stathopoulou, Dan J Stein, Caitlyn Steiner, Leo G Stewart, Mark A Stokes, Michelle L Subart, Agus Sudaryanto, Mu'awiyyah Babale Sufiyan, Patrick John Sur, Ipsita Sutradhar, Bryan L Sykes, P N Sylaja, Dillon O Sylte, Cassandra E I Szoeke, Rafael Tabarés-Seisdedos, Takahiro Tabuchi, Santosh Kumar Tadakamadla, Ken Takahashi, Nikhil Tandon, Segen Gebremeskel Tassew, Nuno Taveira, Arash Tehrani-Banihashemi, Tigist Gashaw Tekalign, Merhawi Gebremedhin Tekle, Mohamad-Hani Temsah, Omar Temsah, Abdullah Sulieman Terkawi, Manaye Yihune Teshale, Belay Tessema, Gizachew Assefa Tessema, Kavumpurathu Raman Thankappan, Sathish Thirunavukkarasu, Nihal Thomas, Amanda G Thrift, George D Thurston, Binyam Tilahun, Quyen G To, Ruoyan Tobe-Gai, Marcello Tonelli, Roman Topor-Madry, Anna E Torre, Miguel Tortajada-Girbés, Mathilde Touvier, Marcos Roberto Tovani-Palone, Bach Xuan Tran, Khanh Bao Tran, Suryakant Tripathi, Christopher E Troeger, Thomas Clement Truelsen, Nu Thi Truong, Afewerki Gebremeskel Tsadik, Derrick Tsoi, Lorainne Tudor Car, E Murat Tuzcu, Stefanos Tyrovolas, Kingsley N Ukwaja, Irfan Ullah, Eduardo A Undurraga, Rachel L Updike, Muhammad Shariq Usman, Olalekan A Uthman, Selen Begüm Uzun, Muthiah Vaduganathan, Afsane Vaezi, Gaurang Vaidya, Pascual R Valdez, Elena Varavikova, Tommi Juhani Vasankari, Narayanaswamy Venketasubramanian, Santos Villafaina, Francesco S Violante, Sergey Konstantinovitch Vladimirov, Vasily Vlassov, Stein Emil Vollset, Theo Vos, Gregory R Wagner, Fasil Shiferaw Wagnew, Yasir Waheed, Mitchell Taylor Wallin, Judd L Walson, Yanping Wang, Yuan-Pang Wang, Molla Mesele Wassie, Elisabete Weiderpass, Robert G Weintraub, Fitsum Weldegebreal, Kidu Gidey Weldegwergs, Andrea Werdecker, Adhena Ayaliew Werkneh, T Eoin West, Ronny Westerman, Harvey A Whiteford, Justyna Widecka, Lauren B Wilner, Shadrach Wilson, Andrea Sylvia Winkler, Charles Shey Wiysonge, Charles D A Wolfe, Shouling Wu, Yun-Chun Wu, Grant M A Wyper, Denis Xavier, Gelin Xu, Simon Yadgir, Ali Yadollahpour, Seyed Hossein Yahyazadeh Jabbari, Bereket Yakob, Lijing L Yan, Yuichiro Yano, Mehdi Yaseri, Yasin Jemal Yasin, Gökalp Kadri Yentür, Alex Yeshaneh, Ebrahim M Yimer, Paul Yip, Biruck Desalegn Yirsaw, Engida Yisma, Naohiro Yonemoto, Gerald Yonga, Seok-Jun Yoon, Marcel Yotebieng, Mustafa Z Younis, Mahmoud Yousefifard, Chuanhua Yu, Vesna Zadnik, Zoubida Zaidi, Sojib Bin Zaman, Mohammad Zamani, Zohreh Zare, Ayalew Jejaw Zeleke, Zerihun Menlkalew Zenebe, Anthony Lin Zhang, Kai Zhang, Maigeng Zhou, Sanjay Zodpey, Liesl Joanna Zuhlke, Mohsen Naghavi, and Christopher J L Murray., Rubagotti, Enrico, Abay, Solomon M., Roth, Gregory, Abd Allah, Foad, Abdela, Jemal, Abbastabar, Hedayat, and Abbasi, Nooshin

Subjects
Overview, Disease, Territory, Causes of death, humanities
Abstract

Global development goals increasingly rely on country-specific estimates for benchmarking a nation's progress. To meet this need, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 estimated global, regional, national, and, for selected locations, subnational cause-specific mortality beginning in the year 1980. Here we report an update to that study, making use of newly available data and improved methods. GBD 2017 provides a comprehensive assessment of cause-specific mortality for 282 causes in 195 countries and territories from 1980 to 2017. The Lancet Publishing Group

Published
2019

93. Better Virological Outcomes Among People Living With Human Immunodeficiency Virus (HIV) Initiating Early Antiretroviral Treatment (CD4 Counts ≥500 Cells/µL) in the HIV Prevention Trials Network 071 (PopART) Trial in South Africa

Author

Geoffrey, Fatti, Ashraf, Grimwood, Jean B, Nachega, Jenna A, Nelson, Kelsea, LaSorda, Gert, van Zyl, Nelis, Grobbelaar, Helen, Ayles, Richard, Hayes, Nulda, Beyers, Sarah, Fidler, and Peter, Bock

Subjects
Adult, HPTN 071 (PopART) Trial, Anti-HIV Agents, virological outcomes, HIV, HIV Infections, baseline CD4 cell count, Viral Load, CD4 Lymphocyte Count, South Africa, early antiretroviral treatment, Antiretroviral Therapy, Highly Active, Humans, HIV/AIDS, Prospective Studies, Articles and Commentaries
Abstract

Background There have been concerns about reduced adherence and human immunodeficiency virus (HIV) virological suppression (VS) among clinically well people initiating antiretroviral therapy (ART) with high pre-ART CD4 cell counts. We compared virological outcomes by pre-ART CD4 count, where universal ART initiation was provided in the HIV Prevention Trials Network 071 (PopART) trial in South Africa prior to routine national and international implementation. Methods This prospective cohort study included adults initiating ART at facilities providing universal ART since January 2014. VS (1000 copies/mL), and viral rebound were compared between participants in strata of baseline CD4 cell count. Results The sample included 1901 participants. VS was ≥94% among participants with baseline CD4 count ≥500 cells/µL at all 6-month intervals to 30 months. The risk of an elevated viral load (≥400 copies/mL) was independently lower among participants with baseline CD4 count ≥500 cells/µL (3.3%) compared to those with CD4 count 200–499 cells/µL (9.2%) between months 18 and 30 (adjusted relative risk, 0.30 [95% confidence interval, .12–.74]; P = .010). The incidence rate of VF was 7.0, 2.0, and 0.5 per 100 person-years among participants with baseline CD4 count, There are concerns that people initiating antiretroviral therapy (ART) with high CD4 counts may exhibit reduced HIV virological suppression. In this study, however, participants with CD4 count ≥500 cells/µL had excellent virological outcomes, better than those with lower CD4 counts.

Published
2018

94. Community-Based Interventions to Improve and Sustain Antiretroviral Therapy Adherence, Retention in HIV Care and Clinical Outcomes in Low- and Middle-Income Countries for Achieving the UNAIDS 90-90-90 Targets

Author

Robert H. Remien, Omar Galárraga, Jean B. Nachega, Amy W. Knowlton, Shabbar Jaffar, Edward J Mills, Karl Peltzer, Nathan Ford, Claude A. Mellins, Gilles van Cutsem, Elvin Geng, Mauro Schechter, Larry W. Chang, Frederick L. Altice, Olalekan A. Uthman, and Olatunji O. Adetokunboh

Subjects
0301 basic medicine, Pediatrics, medicine.medical_specialty, Patient Dropouts, Sustained Virologic Response, United Nations, Anti-HIV Agents, Cross-sectional study, Psychological intervention, HIV Infections, Health Services Accessibility, Article, Medication Adherence, law.invention, 03 medical and health sciences, 0302 clinical medicine, Acquired immunodeficiency syndrome (AIDS), Randomized controlled trial, law, Virology, Internal medicine, Humans, Medicine, 030212 general & internal medicine, Developing Countries, Health Education, Randomized Controlled Trials as Topic, business.industry, Community Health Centers, medicine.disease, 030112 virology, Observational Studies as Topic, Cross-Sectional Studies, Infectious Diseases, Relative risk, Health education, business, RA, Cohort study
Abstract

Little is known about the effect of community versus health facility-based interventions to improve and sustain antiretroviral therapy (ART) adherence, virologic suppression, and retention in care among HIV-infected individuals in low- and middle-income countries (LMICs). We systematically searched four electronic databases for all available randomized controlled trials (RCTs) and comparative cohort studies in LMICs comparing community versus health facility-based interventions. Relative risks (RRs) for pre-defined adherence, treatment engagement (linkage and retention in care), and relevant clinical outcomes were pooled using random effect models. Eleven cohort studies and eleven RCTs (N = 97,657) were included. Meta-analysis of the included RCTs comparing community- versus health facility-based interventions found comparable outcomes in terms of ART adherence (RR = 1.02, 95 % CI 0.99 to 1.04), virologic suppression (RR = 1.00, 95 % CI 0.98 to 1.03), and all-cause mortality (RR = 0.93, 95 % CI 0.73 to 1.18). The result of pooled analysis from the RCTs (RR = 1.03, 95 % CI 1.01 to 1.06) and cohort studies (RR = 1.09, 95 % CI 1.03 to 1.15) found that participants assigned to community-based interventions had statistically significantly higher rates of treatment engagement. Two studies found community-based ART delivery model either cost-saving or cost-effective. Community- versus facility-based models of ART delivery resulted in at least comparable outcomes for clinically stable HIV-infected patients on treatment in LMICs and are likely to be cost-effective.

Published
2016

95. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015

Author

Haidong, Wang, Mohsen, Naghavi, Christine, Allen, Ryan M, Barber Zulfi, qar A, Bhutta, Austin, Carter, Daniel C, Casey Fiona, J Charlson, Alan Zian, Chen Matthew, M Coates, Megan, Coggeshall, Lalit, Dandona, Daniel J, Dicker Holly, E Erskine, Alize J, Ferrari, Christina, Fitzmaurice, Kyle, Foreman, Mohammad H, Forouzanfar Maya, S Fraser, Nancy, Fullman, Peter W, Gething Ellen, M Goldberg, Nicholas, Graetz, Juanita A, Haagsma Simon, I Hay, Chantal, Huynh, Catherine O, Johnson Nicholas, J Kassebaum, Yohannes, Kinfu, Xie Rachel, Kulikoff, Michael, Kutz, Hmwe H, Kyu Heidi, J Larson, Janni, Leung, Xiaofeng, Liang, Stephen S, Lim, Margaret, Lind, Rafael, Lozano, Neal, Marquez, George A, Mensah, Joe, Mikesell, Ali H, Mokdad Meghan, D Mooney, Grant, Nguyen, Elaine, Nsoesie, David M, Pigott, Christine, Pinho, Gregory A, Roth Joshua, A Salomon, Logan, Sandar, Naris, Silpakit, Amber, Sligar, Reed J, D Sorensen, Jeff rey, Stanaway, Caitlyn, Steiner, Stephanie, Teeple, Bernadette A, Thomas, Christopher, Troeger, Amelia, VanderZanden, Stein Emil, Vollset, Valentine, Wanga, Harvey A, Whiteford, Timothy, Wolock, Leo, Zoeckler, Kalkidan Hassen, Abate, Cristiana, Abbafati, Kaja M, Abbas, Foad, Abd-Allah, Semaw Ferede, Abera Daisy, M X, Abreu Laith, J Abu-Raddad, Gebre Yitayih, Abyu, Tom, Achoki, Ademola Lukman, Adelekan Zanfi, na Ademi, Arsène Kouablan, Adou José, C Adsuar, Kossivi Agbelenko, Afanvi, Ashkan, Afshin, Emilie Elisabet, Agardh, Arnav, Agarwal, Anurag, Agrawal, Aliasghar Ahmad, Kiadaliri Oluremi, N Ajala, Ali Shafqat, Akanda Rufus, Olusola Akinyemi, Tomi F, Akinyemiju, Nadia, Akseer, Faris Hasan, Al Lami, Samer, Alabed, Ziyad, Al-Aly, Khurshid, Alam, Noore K, M Alam, Deena, Alasfoor, Saleh Fahed, Aldhahri Robert, William Aldridge, Miguel Angel, Alegretti Alicia, V Aleman, Zewdie Aderaw, Alemu Lily, T Alexander, Samia, Alhabib, Raghib, Ali, Ala’a, Alkerwi, François, Alla, Peter, Allebeck, Rajaa, Al-Raddadi, Ubai, Alsharif, Khalid A, Altirkawi Elena, Alvarez Martin, Nelson, Alvis-Guzman, Azmeraw T, Amare Adeladza, Kofi Amegah, Emmanuel A, Ameh, Heresh, Amini, Walid, Ammar, Stephen Marc, Amrock Hjalte, H Andersen, Benjamin O, Anderson Gregory, M Anderson, Carl Abelardo, T Antonio, Atsede Fantahun, Aregay, Johan, Ärnlöv, Valentina S, Arsic Arsenijevic, Al, Artaman, Hamid, Asayesh, Rana Jawad, Asghar, Suleman, Atique, Euripide Frinel, G Arthur, Avokpaho, Ashish, Awasthi, Peter, Azzopardi, Umar, Bacha, Alaa, Badawi, Maria C, Bahit, Kalpana, Balakrishnan, Amitava, Banerjee, Aleksandra, Barac, Suzanne L, Barker-Collo, Till, Bärnighausen, Lars, Barregard, Lope H, Barrero, Arindam, Basu, Sanjay, Basu, Yibeltal Tebekaw, Bayou, Shahrzad, Bazargan-Hejazi, Justin, Beardsley, Neeraj, Bedi, Ettore, Beghi, Haileeyesus Adamu, Belay, Brent, Bell, Michelle L, Bell Aminu, K Bello, Derrick A, Bennett Isabela, M Bensenor, Adugnaw, Berhane, Eduardo, Bernabé, Balem Demtsu, Betsu Addisu, Shunu Beyene, Neeraj, Bhala, Ashish, Bhalla, Sibhatu, Biadgilign, Boris, Bikbov, Aref A, Bin Abdulhak, Brian J, Biroscak, Stan, Biryukov, Espen, Bjertness, Jed D, Blore Christopher, D Blosser, Megan A, Bohensky, Rohan, Borschmann, Dipan, Bose, Rupert R, A Bourne, Michael, Brainin, Carol E, G Brayne, Alexandra, Brazinova, Nicholas J, K Breitborde, Hermann, Brenner, Jerry D, Brewer, Alexandria, Brown, Jonathan, Brown, Traolach S, Brugha Geoff, rey Colin, Buckle Zahid, A Butt, Bianca, Calabria, Ismael Ricardo, Campos-Nonato Julio, Cesar Campuzano, Jonathan R, Carapetis, Rosario, Cárdenas, David O, Carpenter Juan, Jesus Carrero, Carlos A, Castañeda-Orjuela Jacqueline, Castillo Rivas, Ferrán, Catalá-López, Fiorella, Cavalleri, Kelly, Cercy, Jorge, Cerda, Wanqing, Chen, Adrienne, Chew, Peggy Pei-Chia, Chiang, Mirriam, Chibalabala, Chioma Ezinne, Chibueze, Odgerel, Chimed-Ochir, Vesper Hichilombwe, Chisumpa Jee-Young, Jasmine Choi, Rajiv, Chowdhury, Hanne, Christensen, Devasahayam Jesudas, Christopher Liliana, G Ciobanu, Cirillo Massimo, Aaron J, Cohen, Valentina, Colistro, Mercedes, Colomar, Samantha M, Colquhoun, Cyrus, Cooper, Leslie Trumbull, Cooper, Monica, Cortinovis, Benjamin C, Cowie John, A Crump, James, Damsere-Derry, Hadi, Danawi, Rakhi, Dandona, Farah, Daoud, Sarah C, Darby Paul, I Dargan, José das, Neves, Gail, Davey, Adrian C, Davis Dragos, V Davitoiu, E Filipa, de Castro, Pieter de, Jager Diego, De Leo, Louisa, Degenhardt, Robert P, Dellavalle, Kebede, Deribe, Amare, Deribew, Samath D, Dharmaratne Preet, K Dhillon, Cesar, Diaz-Torné, Eric L, Ding Kadine, Priscila Bender, dos Santos, Edem, Dossou, Tim R, Driscoll, Leilei, Duan, Manisha, Dubey, Bruce Bartholow, Duncan Richard, G Ellenbogen, Christian Lycke, Ellingsen, Iqbal, Elyazar, Aman Yesuf, Endries Sergey, Petrovich Ermakov, Babak, Eshrati, Alireza, Esteghamati, Kara, Estep, Imad D, A Faghmous, Saman, Fahimi, Emerito Jose, Aquino Faraon, Talha A, Farid Carla, Sofi a, e Sa, Farinha, André, Faro, Maryam S, Farvid, Farshad, Farzadfar, Valery L, Feigin, Seyed-Mohammad, Fereshtehnejad, Jeff erson, G Fernandes, Joao C, Fernandes, Florian, Fischer, Joseph R, A Fitchett, Abraham, Flaxman, Nataliya, Foigt, F Gerry, R Fowkes, Elisabeth Barboza, Franca Richard, C Franklin, Joseph, Friedman, Joseph, Frostad, Thomas, Fürst, Neal D, Futran Seana, L Gall, Ketevan, Gambashidze, Amiran, Gamkrelidze, Parthasarathi, Ganguly, Fortuné Gbètoho, Gankpé, Teshome, Gebre, Tsegaye Tsewelde, Gebrehiwot Amanuel, Tesfay Gebremedhin, Alemseged Aregay, Gebru Johanna, M Geleijnse, Bradford D, Gessner Aloke, Gopal Ghoshal, Katherine B, Gibney Richard, F Gillum, Stuart, Gilmour, Ababi Zergaw, Giref, Maurice, Giroud, Melkamu Dedefo, Gishu, Giorgia, Giussani, Elizabeth, Glaser, William W, Godwin, Hector, Gomez-Dantes, Philimon, Gona, Amador, Goodridge, Sameer Vali, Gopalani Richard, A Gosselin, Carolyn C, Gotay, Atsushi, Goto, Hebe N, Gouda, Felix, Greaves, Harish Chander, Gugnani, Rahul, Gupta, Rajeev, Gupta, Vipin, Gupta, Reyna A, Gutiérrez, Nima, Hafezi-Nejad, Demewoz, Haile, Alemayehu Desalegne, Hailu Gessessew, Bugssa Hailu, Yara A, Halasa Randah, Ribhi Hamadeh, Samer, Hamidi, Jamie, Hancock, Alexis J, Handal Graeme, J Hankey, Yuantao, Hao, Hilda L, Harb, Sivadasanpillai, Harikrishnan, Josep Maria, Haro, Rasmus, Havmoeller, Susan R, Heckbert Ileana, Beatriz Heredia-Pi, Pouria, Heydarpour, Henk B, M Hilderink, Hans W, Hoek Robert, S Hogg, Masako, Horino, Nobuyuki, Horita, H Dean, Hosgood Peter, J Hotez, Damian G, Hoy, Mohamed, Hsairi, Aung Soe, Htet Maung, Maung Than, Htike, Guoqing, Hu, Cheng, Huang, Hsiang, Huang, Laetitia, Huiart, Abdullatif, Husseini, Inge, Huybrechts, Grace, Huynh, Kim Moesgaard, Iburg, Kaire, Innos, Manami, Inoue, Veena J, Iyer Troy, A Jacobs, Kathryn H, Jacobsen, Nader, Jahanmehr, Mihajlo B, Jakovljevic, Peter, James, Mehdi, Javanbakht, Sudha P, Jayaraman Achala, Upendra Jayatilleke, Panniyammakal, Jeemon, Paul N, Jensen, Vivekanand, Jha, Guohong, Jiang, Ying, Jiang, Tariku, Jibat, Aida, Jimenez-Corona, Jost B, Jonas Tushar, Kant Joshi, Zubair, Kabir, Ritul, Kamal, Haidong, Kan, Surya, Kant, André, Karch, Corine Kakizi, Karema, Chante, Karimkhani, Dimitris, Karletsos, Ganesan, Karthikeyan, Amir, Kasaeian, Marzieh, Katibeh, Anil, Kaul, Norito, Kawakami, Jeanne Françoise, Kayibanda Peter, Njenga Keiyoro, Laura, Kemmer, Andrew Haddon, Kemp Andre, Pascal Kengne, Andre, Keren, Maia, Kereselidze, Chandrasekharan Nair, Kesavachandran Yousef, Saleh Khader, Ibrahim A, Khalil Abdur, Rahman Khan, Ejaz Ahmad, Khan, Young-Ho, Khang, Sahil, Khera, Tawfi k, Ahmed Muthafer, Khoja, Christian, Kieling, Daniel, Kim, Yun Jin, Kim Brett, M Kissela, Niranjan, Kissoon, Luke D, Knibbs Ann, Kristin Knudsen, Yoshihiro, Kokubo, Dhaval, Kolte, Jacek A, Kopec, Soewarta, Kosen, Parvaiz A, Koul, Ai, Koyanagi, Norun Hjertager, Krog Barthelemy, Kuate Defo, Burcu Kucuk, Bicer Andreas, A Kudom, Ernst J, Kuipers Veena, S Kulkarni, G Anil, Kumar Gene, F Kwan, Aparna, Lal, Dharmesh Kumar, Lal, Ratilal, Lalloo, Hilton, Lam, Jennifer O, Lam Sinead, M Langan, Van C, Lansingh, Anders, Larsson, Dennis Odai, Laryea Asma, Abdul Latif, Alicia Elena, Beatriz Lawrynowicz, James, Leigh, Miriam, Levi, Yongmei, Li, M Patrice, Lindsay Steven, E Lipshultz, Patrick Y, Liu, Shiwei, Liu, Yang, Liu, Loon-Tzian, Lo, Giancarlo, Logroscino, Paulo A, Lotufo Robyn, M Lucas, Raimundas, Lunevicius, Ronan A, Lyons, Stefan, Ma, Vasco Manuel, Pedro Machado, Mark T, Mackay Jennifer, H MacLachlan, Hassan Magdy, Abd El, Razek Mohammed, Magdy Abd, El Razek, Marek, Majdan, Azeem, Majeed, Reza, Malekzadeh, Wondimu Ayele, Ayele Manamo, John, Mandisarisa, Srikanth, Mangalam, Chabila C, Mapoma, Wagner, Marcenes, David Joel, Margolis Gerard, Robert Martin, Jose, Martinez-Raga, Melvin Barrientos, Marzan, Felix, Masiye, Amanda J, Mason-Jones, João, Massano, Richard, Matzopoulos, Bongani M, Mayosi Stephen, Theodore McGarvey, John J, McGrath, Martin, McKee, McMahon Peter, A Meaney, Alem, Mehari, Man Mohan, Mehndiratta, Fabiola, Mejia-Rodriguez, Alemayehu B, Mekonnen Yohannes, Adama Melaku, Peter, Memiah, Ziad A, Memish, Walter, Mendoza, Atte, Meretoja, Tuomo J, Meretoja Francis, Apolinary Mhimbira, Renata, Micha, Ted R, Miller Mojde, Mirarefi n, Awoke, Misganaw, Charles N, Mock Karzan, Abdulmuhsin Mohammad, Alireza, Mohammadi, Shafi u, Mohammed, Viswanathan, Mohan, Glen Liddell, D Mola, Lorenzo, Monasta, Julio Cesar, Montañez Hernandez, Pablo, Montero, Marcella, Montico, Thomas J, Montine, Maziar, Moradi-Lakeh, Lidia, Morawska, Katherine, Morgan, Rintaro, Mori, Dariush Mozaff, arian Ulrich, O Mueller, Gudlavalleti Venkata, Satyanarayana Murthy, Srinivas, Murthy, Kamarul Imran, Musa Jean, B Nachega, Gabriele, Nagel, Kovin S, Naidoo, Nitish, Naik, Luigi, Naldi, Vinay, Nangia, Denis, Nash, Chakib, Nejjari, Subas, Neupane, Charles R, Newton John, N Newton, Marie, Ng, Frida Namnyak, Ngalesoni Jean, de Dieu, Ngirabega Quyen, Le Nguyen, Muhammad Imran, Nisar Patrick, Martial Nkamedjie, Pete, Marika, Nomura, Ole F, Norheim Paul, E Norman, Bo, Norrving, Luke, Nyakarahuka, Felix Akpojene, Ogbo, Takayoshi, Ohkubo, Foluke Adetola, Ojelabi Pedro, R Olivares, Bolajoko Olubukunola, Olusanya Jacob, Olusegun Olusanya, John Nelson, Opio, Eyal, Oren, Alberto, Ortiz, Majdi, Osman, Erika, Ota, Raziye, Ozdemir, Mahesh, PA, Jeyaraj D, Pandian Puspa, Raj Pant, Christina, Papachristou, Eun-Kee, Park, Jae-Hyun, Park, Charles D, Parry, Mahboubeh, Parsaeian, Angel J, Paternina Caicedo, Scott B, Patten George, C Patton, Vinod K, Paul, Neil, Pearce, João Mário, Pedro Ljiljana, Pejin Stokic, Pereira, Norberto, Perico, Konrad, Pesudovs, Max, Petzold, Michael Robert, Phillips Frédéric, B Piel, Julian David, Pillay, Dietrich, Plass, James A, Platts-Mills, Suzanne, Polinder, C Arden, Pope, Svetlana, Popova, Richie G, Poulton, Farshad, Pourmalek, Dorairaj, Prabhakaran, Mostafa, Qorbani, Justice, Quame-Amaglo, D Alex, Quistberg, Anwar, Rafay, Kazem, Rahimi, Vafa, Rahimi-Movaghar, Mahfuzar, Rahman, Mohammad Hifz, Ur Rahman, Sajjad Ur, Rahman Rajesh, Kumar Rai, Zhale, Rajavi, Sasa, Rajsic, Murugesan, Raju, Ivo, Rakovac, Saleem M, Rana Chhabi, L Ranabhat, Thara, Rangaswamy, Puja, Rao, Sowmya R, Rao Amany, H Refaat, Jürgen, Rehm, Marissa B, Reitsma, Giuseppe, Remuzzi, Serge Resnikoff, Antonio L, Ribeiro, Stefano, Ricci, Maria Jesus, Rios Blancas, Bayard, Roberts, Anna, Roca, David, Rojas-Rueda, Luca, Ronfani, Gholamreza, Roshandel, Dietrich, Rothenbacher, Ambuj, Roy, Nawal K, Roy George, Mugambage Ruhago, Rajesh, Sagar, Sukanta, Saha, Ramesh, Sahathevan, Muhammad Muhammad, Saleh Juan, R Sanabria, Maria Dolores, Sanchez-Niño, Lidia, Sanchez-Riera, Itamar S, Santos, Rodrigo, Sarmiento-Suarez, Benn, Sartorius, Maheswar, Satpathy, Miloje, Savic, Monika, Sawhney, Michael P, Schaub Maria, Inês Schmidt, Ione J, C Schneider, Ben, Schöttker, Aletta E, Schutte David, C Schwebel, Soraya, Seedat, Sadaf G, Sepanlou Edson, E Servan-Mori, Katya A, Shackelford, Gavin, Shaddick, Amira, Shaheen, Saeid, Shahraz, Masood Ali, Shaikh, Marina, Shakh-Nazarova, Rajesh, Sharma, Jun, She, Sara, Sheikhbahaei, Jiabin, Shen, Ziyan, Shen, Donald S, Shepard Kevin, N Sheth, Balakrishna P, Shetty, Peilin, Shi, Kenji, Shibuya, Min-Jeong, Shin, Rahman, Shiri, Ivy, Shiue, Mark G, Shrime Inga, Dora Sigfusdottir, Donald H, Silberberg Diego, Augusto Santos, Silva Dayane, Gabriele Alves, Silveira Jonathan, I Silverberg, Edgar P, Simard, Abhishek, Singh, Gitanjali M, Singh Jasvinder, A Singh, Om Prakash, Singh Prashant, Kumar Singh, Virendra, Singh, Samir, Soneji, Kjetil, Søreide, Joan B, Soriano Luciano, A Sposato, Chandrashekhar T, Sreeramareddy, Vasiliki, Stathopoulou, Dan J, Stein Murray, B Stein, Saverio, Stranges, Konstantinos, Stroumpoulis, Bruno F, Sunguya, Patrick, Sur, Soumya, Swaminathan, Bryan L, Sykes Cassandra, E I, Szoeke, Rafael, Tabarés-Seisdedos, Karen M, Tabb, Ken, Takahashi, Jukka S, Takala Roberto, Tchio Talongwa, Nikhil, Tandon, Mohammad, Tavakkoli, Bineyam, Taye, Hugh R, Taylor Braden, J Te, Ao Bemnet, Amare Tedla, Worku Mekonnen, Tefera Margreet, Ten Have, Abdullah Sulieman, Terkawi Fisaha, Haile Tesfay, Gizachew Assefa, Tessema Alan, J Thomson, Andrew L, Thorne-Lyman Amanda, G Thrift, George D, Thurston, Taavi, Tillmann, David L, Tirschwell, Marcello, Tonelli, Roman, Topor-Madry, Fotis, Topouzis, Allen Towbin, Traebert Bach, Xuan Tran, Thomas, Truelsen, Ulises, Trujillo, Abera Kenay, Tura Emin, Murat Tuzcu, Uche S, Uchendu Kingsley, N Ukwaja, Eduardo A, Undurraga Olalekan, A Uthman, Rita Van, Dingenen Aaron, van Donkelaar, Tommi, Vasankari, Ana Maria, Nogales Vasconcelos, Narayanaswamy, Venketasubramanian, Ramesh, Vidavalur, Lakshmi, Vijayakumar, Salvador, Villalpando, Francesco S, Violante Vasiliy, Victorovich Vlassov, Joseph A, Wagner Gregory, R Wagner, Mitchell T, Wallin, Linhong, Wang, David A, Watkins, Scott, Weichenthal, Elisabete, Weiderpass, Robert G, Weintraub, Andrea, Werdecker, Ronny, Westerman, Richard A, White, Tissa, Wijeratne, James D, Wilkinson Hywel, C Williams, Charles Shey, Wiysonge Solomon, Meseret Woldeyohannes, A Wolfe, Sungho, Won, John Q, Wong Anthony, D Woolf, Denis, Xavier, Qingyang, Xiao, Gelin, Xu, Bereket, Yakob, Ayalnesh Zemene, Yalew Lijing, L Yan, Yuichiro, Yano, Mehdi, Yaseri, Pengpeng, Ye, Henock Gebremedhin, Yebyo, Paul, Yip, Biruck Desalegn, Yirsaw, Naohiro, Yonemoto, Gerald, Yonga, Mustafa Z, Younis, Shicheng, Yu, Zoubida, Zaidi, Maysaa El, Sayed Zaki, Faiez, Zannad, Diego E, Zavala, Hajo, Zeeb, Berihun M, Zeleke, Hao, Zhang, Sanjay, Zodpey, David, Zonies, Liesl Joanna, Zuhlke, Theo, Vos, Alan D, Lopez Christopher, J L, Murray., Haidong, Wang, Mohsen, Naghavi, Christine, Allen, Ryan, M, Barber, Zulfi, Qar, A, Bhutta, Austin, Carter, Daniel, C, Casey, Fiona, J, Charlson, Alan, Zian, Chen, Matthew, M, Coate, Megan, Coggeshall, Lalit, Dandona, Daniel, J, Dicker, Holly, E, Erskine, Alize, J, Ferrari, Christina, Fitzmaurice, Kyle, Foreman, Mohammad, H, Forouzanfar, Maya, S, Fraser, Nancy, Fullman, Peter, W, Gething, Ellen, M, Goldberg, Nicholas, Graetz, Juanita, A, Haagsma, Simon, I, Hay, Chantal, Huynh, Catherine, O, Johnson, Nichola, J, Kassebaum, Yohannes, Kinfu, Xie, Rachel, Kulikoff, Michael, Kutz, Hmwe, H, Kyu, Heidi, J, Larson, Janni, Leung, Xiaofeng, Liang, Stephen, S, Lim, Margaret, Lind, Rafael, Lozano, Neal, Marquez, George, A, Mensah, Joe, Mikesell, Ali, H, Mokdad, Meghan, D, Mooney, Grant, Nguyen, Elaine, Nsoesie, David, M, Pigott, Christine, Pinho, Gregory, A, Roth, Joshua, A, Salomon, Logan, Sandar, Naris, Silpakit, Amber, Sligar, Reed, J, D, Sorensen, Jeff, Rey, Stanaway, Caitlyn, Steiner, Stephanie, Teeple, Bernadette, A, Thomas, Christopher, Troeger, Amelia, Vanderzanden, Stein, Emil, Vollset, Valentine, Wanga, Harvey, A, Whiteford, Timothy, Wolock, Leo, Zoeckler, Kalkidan, Hassen, Abate, Cristiana, Abbafati, Kaja, M, Abbas, Foad, Abd-Allah, Semaw, Ferede, Abera, Daisy, M, X, Abreu, Laith, J, Abu-Raddad, Gebre, Yitayih, Abyu, Tom, Achoki, Ademola, Lukman, Adelekan, Zanfi, Na, Ademi, Arsène, Kouablan, Adou, José, C, Adsuar, Kossivi, Agbelenko, Afanvi, Ashkan, Afshin, Emilie, Elisabet, Agardh, Arnav, Agarwal, Anurag, Agrawal, Aliasghar, Ahmad, Kiadaliri, Oluremi, N, Ajala, Ali, Shafqat, Akanda, Rufu, Olusola, Akinyemi, Tomi, F, Akinyemiju, Nadia, Akseer, Faris, Hasan, Al, Lami, Samer, Alabed, Ziyad, Al-Aly, Khurshid, Alam, Noore, K, M, Alam, Deena, Alasfoor, Saleh, Fahed, Aldhahri, Robert, William, Aldridge, Miguel, Angel, Alegretti, Alicia, V, Aleman, Zewdie, Aderaw, Alemu, Lily, T, Alexander, Samia, Alhabib, Raghib, Ali, Ala’A, Alkerwi, François, Alla, Peter, Allebeck, Rajaa, Al-Raddadi, Ubai, Alsharif, Khalid, A, Altirkawi, Elena, Alvarez, Martin, Nelson, Alvis-Guzman, Azmeraw, T, Amare, Adeladza, Kofi, Amegah, Emmanuel, A, Ameh, Heresh, Amini, Walid, Ammar, Stephen, Marc, Amrock, Hjalte, H, Andersen, Benjamin, O, Anderson, Gregory, M, Anderson, Carl, Abelardo, T, Antonio, Atsede, Fantahun, Aregay, Johan, Ärnlöv, Valentina, S, Arsic, Arsenijevic, Al, Artaman, Hamid, Asayesh, Rana, Jawad, Asghar, Suleman, Atique, Euripide, Frinel, G, Arthur, Avokpaho, Ashish, Awasthi, Peter, Azzopardi, Umar, Bacha, Alaa, Badawi, Maria, C, Bahit, Kalpana, Balakrishnan, Amitava, Banerjee, Aleksandra, Barac, Suzanne, L, Barker-Collo, Till, Bärnighausen, Lars, Barregard, Lope, H, Barrero, Arindam, Basu, Sanjay, Basu, Yibeltal, Tebekaw, Bayou, Shahrzad, Bazargan-Hejazi, Justin, Beardsley, Neeraj, Bedi, Ettore, Beghi, Haileeyesus, Adamu, Belay, Brent, Bell, Michelle, L, Bell, Aminu, K, Bello, Derrick, A, Bennett, Isabela, M, Bensenor, Adugnaw, Berhane, Eduardo, Bernabé, Balem, Demtsu, Betsu, Addisu, Shunu, Beyene, Neeraj, Bhala, Ashish, Bhalla, Sibhatu, Biadgilign, Boris, Bikbov, Aref, A, Bin, Abdulhak, Brian, J, Biroscak, Stan, Biryukov, Espen, Bjertne, Jed, D, Blore, Christopher, D, Blosser, Megan, A, Bohensky, Rohan, Borschmann, Dipan, Bose, Rupert, R, A, Bourne, Michael, Brainin, Carol, E, G, Brayne, Alexandra, Brazinova, Nicholas, J, K, Breitborde, Hermann, Brenner, Jerry, D, Brewer, Alexandria, Brown, Jonathan, Brown, Traolach, S, Brugha, Geoff, Rey, Colin, Buckle, Zahid, A, Butt, Bianca, Calabria, Ismael, Ricardo, Campos-Nonato, Julio, Cesar, Campuzano, Jonathan, R, Carapetis, Rosario, Cárdena, David, O, Carpenter, Juan, Jesus, Carrero, Carlos, A, Castañeda-Orjuela, Jacqueline, Castillo, Riva, Ferrán, Catalá-López, Fiorella, Cavalleri, Kelly, Cercy, Jorge, Cerda, Wanqing, Chen, Adrienne, Chew, Peggy, Pei-Chia, Chiang, Mirriam, Chibalabala, Chioma, Ezinne, Chibueze, Odgerel, Chimed-Ochir, Vesper, Hichilombwe, Chisumpa, Jee-Young, Jasmine, Choi, Rajiv, Chowdhury, Hanne, Christensen, Devasahayam, Jesuda, Christopher, Liliana, G, Ciobanu, Cirillo, Massimo, Aaron, J, Cohen, Valentina, Colistro, Mercedes, Colomar, Samantha, M, Colquhoun, Cyrus, Cooper, Leslie, Trumbull, Cooper, Monica, Cortinovi, Benjamin, C, Cowie, John, A, Crump, James, Damsere-Derry, Hadi, Danawi, Rakhi, Dandona, Farah, Daoud, Sarah, C, Darby, Paul, I, Dargan, José, Da, Neves, Gail, Davey, Adrian, C, Davis, Drago, V, Davitoiu, E, Filipa, De, Castro, Pieter, De, Jager, Diego, De, Leo, Louisa, Degenhardt, Robert, P, Dellavalle, Kebede, Deribe, Amare, Deribew, Samath, D, Dharmaratne, Preet, K, Dhillon, Cesar, Diaz-Torné, Eric, L, Ding, Kadine, Priscila, Bender, Dos, Santo, Edem, Dossou, Tim, R, Driscoll, Leilei, Duan, Manisha, Dubey, Bruce, Bartholow, Duncan, Richard, G, Ellenbogen, Christian, Lycke, Ellingsen, Iqbal, Elyazar, Aman, Yesuf, Endries, Sergey, Petrovich, Ermakov, Babak, Eshrati, Alireza, Esteghamati, Kara, Estep, Imad, D, A, Faghmou, Saman, Fahimi, Emerito, Jose, Aquino, Faraon, Talha, A, Farid, Carla, Sofi, A, E, Sa, Farinha, André, Faro, Maryam, S, Farvid, Farshad, Farzadfar, Valery, L, Feigin, Seyed-Mohammad, Fereshtehnejad, Jeff, Erson, G, Fernande, Joao, C, Fernandes, Florian, Fischer, Joseph, R, A, Fitchett, Abraham, Flaxman, Nataliya, Foigt, F, Gerry, R, Fowke, Elisabeth, Barboza, Franca, Richard, C, Franklin, Joseph, Friedman, Joseph, Frostad, Thomas, Fürst, Neal, D, Futran, Seana, L, Gall, Ketevan, Gambashidze, Amiran, Gamkrelidze, Parthasarathi, Ganguly, Fortuné, Gbètoho, Gankpé, Teshome, Gebre, Tsegaye, Tsewelde, Gebrehiwot, Amanuel, Tesfay, Gebremedhin, Alemseged, Aregay, Gebru, Johanna, M, Geleijnse, Bradford, D, Gessner, Aloke, Gopal, Ghoshal, Katherine, B, Gibney, Richard, F, Gillum, Stuart, Gilmour, Ababi, Zergaw, Giref, Maurice, Giroud, Melkamu, Dedefo, Gishu, Giorgia, Giussani, Elizabeth, Glaser, William, W, Godwin, Hector, Gomez-Dante, Philimon, Gona, Amador, Goodridge, Sameer, Vali, Gopalani, Richard, A, Gosselin, Carolyn, C, Gotay, Atsushi, Goto, Hebe, N, Gouda, Felix, Greave, Harish, Chander, Gugnani, Rahul, Gupta, Rajeev, Gupta, Vipin, Gupta, Reyna, A, Gutiérrez, Nima, Hafezi-Nejad, Demewoz, Haile, Alemayehu, Desalegne, Hailu, Gessessew, Bugssa, Hailu, Yara, A, Halasa, Randah, Ribhi, Hamadeh, Samer, Hamidi, Jamie, Hancock, Alexis, J, Handal, Graeme, J, Hankey, Yuantao, Hao, Hilda, L, Harb, Sivadasanpillai, Harikrishnan, Josep, Maria, Haro, Rasmus, Havmoeller, Susan, R, Heckbert, Ileana, Beatriz, Heredia-Pi, Pouria, Heydarpour, Henk, B, M, Hilderink, Hans, W, Hoek, Robert, S, Hogg, Masako, Horino, Nobuyuki, Horita, H, Dean, Hosgood, Peter, J, Hotez, Damian, G, Hoy, Mohamed, Hsairi, Aung, Soe, Htet, Maung, Maung, Than, Htike, Guoqing, Hu, Cheng, Huang, Hsiang, Huang, Laetitia, Huiart, Abdullatif, Husseini, Inge, Huybrecht, Grace, Huynh, Kim, Moesgaard, Iburg, Kaire, Inno, Manami, Inoue, Veena, J, Iyer, Troy, A, Jacob, Kathryn, H, Jacobsen, Nader, Jahanmehr, Mihajlo, B, Jakovljevic, Peter, Jame, Mehdi, Javanbakht, Sudha, P, Jayaraman, Achala, Upendra, Jayatilleke, Panniyammakal, Jeemon, Paul, N, Jensen, Vivekanand, Jha, Guohong, Jiang, Ying, Jiang, Tariku, Jibat, Aida, Jimenez-Corona, Jost, B, Jonas, Tushar, Kant, Joshi, Zubair, Kabir, Ritul, Kamal, Haidong, Kan, Surya, Kant, André, Karch, Corine, Kakizi, Karema, Chante, Karimkhani, Dimitris, Karletso, Ganesan, Karthikeyan, Amir, Kasaeian, Marzieh, Katibeh, Anil, Kaul, Norito, Kawakami, Jeanne, Françoise, Kayibanda, Peter, Njenga, Keiyoro, Laura, Kemmer, Andrew, Haddon, Kemp, Andre, Pascal, Kengne, Andre, Keren, Maia, Kereselidze, Chandrasekharan, Nair, Kesavachandran, Yousef, Saleh, Khader, Ibrahim, A, Khalil, Abdur, Rahman, Khan, Ejaz, Ahmad, Khan, Young-Ho, Khang, Sahil, Khera, Tawfi, K, Ahmed, Muthafer, Khoja, Christian, Kieling, Daniel, Kim, Yun, Jin, Kim, Brett, M, Kissela, Niranjan, Kissoon, Luke, D, Knibbs, Ann, Kristin, Knudsen, Yoshihiro, Kokubo, Dhaval, Kolte, Jacek, A, Kopec, Soewarta, Kosen, Parvaiz, A, Koul, Ai, Koyanagi, Norun, Hjertager, Krog, Barthelemy, Kuate, Defo, Burcu, Kucuk, Bicer, Andrea, A, Kudom, Ernst, J, Kuipers, Veena, S, Kulkarni, G, Anil, Kumar, Gene, F, Kwan, Aparna, Lal, Dharmesh, Kumar, Lal, Ratilal, Lalloo, Hilton, Lam, Jennifer, O, Lam, Sinead, M, Langan, Van, C, Lansingh, Anders, Larsson, Dennis, Odai, Laryea, Asma, Abdul, Latif, Alicia, Elena, Beatriz, Lawrynowicz, James, Leigh, Miriam, Levi, Yongmei, Li, M, Patrice, Lindsay, Steven, E, Lipshultz, Patrick, Y, Liu, Shiwei, Liu, Yang, Liu, Loon-Tzian, Lo, Giancarlo, Logroscino, Paulo, A, Lotufo, Robyn, M, Luca, Raimundas, Luneviciu, Ronan, A, Lyons, Stefan, Ma, Vasco, Manuel, Pedro, Machado, Mark, T, Mackay, Jennifer, H, Maclachlan, Hassan, Magdy, Abd, El, Razek, Mohammed, Magdy, Abd, El, Razek, Marek, Majdan, Azeem, Majeed, Reza, Malekzadeh, Wondimu, Ayele, Ayele, Manamo, John, Mandisarisa, Srikanth, Mangalam, Chabila, C, Mapoma, Wagner, Marcene, David, Joel, Margolis, Gerard, Robert, Martin, Jose, Martinez-Raga, Melvin, Barriento, Marzan, Felix, Masiye, Amanda, J, Mason-Jones, João, Massano, Richard, Matzopoulo, Bongani, M, Mayosi, Stephen, Theodore, Mcgarvey, John, J, Mcgrath, Martin, Mckee, Mcmahon, Peter, A, Meaney, Alem, Mehari, Man, Mohan, Mehndiratta, Fabiola, Mejia-Rodriguez, Alemayehu, B, Mekonnen, Yohanne, Adama, Melaku, Peter, Memiah, Ziad, A, Memish, Walter, Mendoza, Atte, Meretoja, Tuomo, J, Meretoja, Franci, Apolinary, Mhimbira, Renata, Micha, Ted, R, Miller, Mojde, Mirarefi, N, Awoke, Misganaw, Charles, N, Mock, Karzan, Abdulmuhsin, Mohammad, Alireza, Mohammadi, Shafi, U, Mohammed, Viswanathan, Mohan, Glen, Liddell, D, Mola, Lorenzo, Monasta, Julio, Cesar, Montañez, Hernandez, Pablo, Montero, Marcella, Montico, Thomas, J, Montine, Maziar, Moradi-Lakeh, Lidia, Morawska, Katherine, Morgan, Rintaro, Mori, Dariush, Mozaff, Arian, Ulrich, O, Mueller, Gudlavalleti, Venkata, Satyanarayana, Murthy, Srinivas, Murthy, Kamarul, Imran, Musa, Jean, B, Nachega, Gabriele, Nagel, Kovin, S, Naidoo, Nitish, Naik, Luigi, Naldi, Vinay, Nangia, Denis, Nash, Chakib, Nejjari, Subas, Neupane, Charles, R, Newton, John, N, Newton, Marie, Ng, Frida, Namnyak, Ngalesoni, Jean, De, Dieu, Ngirabega, Quyen, Le, Nguyen, Muhammad, Imran, Nisar, Patrick, Martial, Nkamedjie, Pete, Marika, Nomura, Ole, F, Norheim, Paul, E, Norman, Bo, Norrving, Luke, Nyakarahuka, Felix, Akpojene, Ogbo, Takayoshi, Ohkubo, Foluke, Adetola, Ojelabi, Pedro, R, Olivare, Bolajoko, Olubukunola, Olusanya, Jacob, Olusegun, Olusanya, John, Nelson, Opio, Eyal, Oren, Alberto, Ortiz, Majdi, Osman, Erika, Ota, Raziye, Ozdemir, Mahesh, Pa, Jeyaraj, D, Pandian, Puspa, Raj, Pant, Christina, Papachristou, Eun-Kee, Park, Jae-Hyun, Park, Charles, D, Parry, Mahboubeh, Parsaeian, Angel, J, Paternina, Caicedo, Scott, B, Patten, George, C, Patton, Vinod, K, Paul, Neil, Pearce, João, Mário, Pedro, Ljiljana, Pejin, Stokic, Pereira, Norberto, Perico, Konrad, Pesudov, Max, Petzold, Michael, Robert, Phillips, Frédéric, B, Piel, Julian, David, Pillay, Dietrich, Pla, James, A, Platts-Mills, Suzanne, Polinder, C, Arden, Pope, Svetlana, Popova, Richie, G, Poulton, Farshad, Pourmalek, Dorairaj, Prabhakaran, Mostafa, Qorbani, Justice, Quame-Amaglo, D, Alex, Quistberg, Anwar, Rafay, Kazem, Rahimi, Vafa, Rahimi-Movaghar, Mahfuzar, Rahman, Mohammad, Hifz, Ur, Rahman, Sajjad, Ur, Rahman, Rajesh, Kumar, Rai, Zhale, Rajavi, Sasa, Rajsic, Murugesan, Raju, Ivo, Rakovac, Saleem, M, Rana, Chhabi, L, Ranabhat, Thara, Rangaswamy, Puja, Rao, Sowmya, R, Rao, Amany, H, Refaat, Jürgen, Rehm, Marissa, B, Reitsma, Giuseppe, Remuzzi, Serge, Resnikoff, Antonio, L, Ribeiro, Stefano, Ricci, Maria, Jesu, Rios, Blanca, Bayard, Robert, Anna, Roca, David, Rojas-Rueda, Luca, Ronfani, Gholamreza, Roshandel, Dietrich, Rothenbacher, Ambuj, Roy, Nawal, K, Roy, George, Mugambage, Ruhago, Rajesh, Sagar, Sukanta, Saha, Ramesh, Sahathevan, Muhammad, Muhammad, Saleh, Juan, R, Sanabria, Maria, Dolore, Sanchez-Niño, Lidia, Sanchez-Riera, Itamar, S, Santos, Rodrigo, Sarmiento-Suarez, Benn, Sartoriu, Maheswar, Satpathy, Miloje, Savic, Monika, Sawhney, Michael, P, Schaub, Maria, Inês, Schmidt, Ione, J, C, Schneider, Ben, Schöttker, Aletta, E, Schutte, David, C, Schwebel, Soraya, Seedat, Sadaf, G, Sepanlou, Edson, E, Servan-Mori, Katya, A, Shackelford, Gavin, Shaddick, Amira, Shaheen, Saeid, Shahraz, Masood, Ali, Shaikh, Marina, Shakh-Nazarova, Rajesh, Sharma, Jun, She, Sara, Sheikhbahaei, Jiabin, Shen, Ziyan, Shen, Donald, S, Shepard, Kevin, N, Sheth, Balakrishna, P, Shetty, Peilin, Shi, Kenji, Shibuya, Min-Jeong, Shin, Rahman, Shiri, Ivy, Shiue, Mark, G, Shrime, Inga, Dora, Sigfusdottir, Donald, H, Silberberg, Diego, Augusto, Santo, Silva, Dayane, Gabriele, Alve, Silveira, Jonathan, I, Silverberg, Edgar, P, Simard, Abhishek, Singh, Gitanjali, M, Singh, Jasvinder, A, Singh, Om, Prakash, Singh, Prashant, Kumar, Singh, Virendra, Singh, Samir, Soneji, Kjetil, Søreide, Joan, B, Soriano, Luciano, A, Sposato, Chandrashekhar, T, Sreeramareddy, Vasiliki, Stathopoulou, Dan, J, Stein, Murray, B, Stein, Saverio, Strange, Konstantinos, Stroumpouli, Bruno, F, Sunguya, Patrick, Sur, Soumya, Swaminathan, Bryan, L, Sykes, Cassandra, E, I, Szoeke, Rafael, Tabarés-Seisdedo, Karen, M, Tabb, Ken, Takahashi, Jukka, S, Takala, Roberto, Tchio, Talongwa, Nikhil, Tandon, Mohammad, Tavakkoli, Bineyam, Taye, Hugh, R, Taylor, Braden, J, Te, Ao, Bemnet, Amare, Tedla, Worku, Mekonnen, Tefera, Margreet, Ten, Have, Abdullah, Sulieman, Terkawi, Fisaha, Haile, Tesfay, Gizachew, Assefa, Tessema, Alan, J, Thomson, Andrew, L, Thorne-Lyman, Amanda, G, Thrift, George, D, Thurston, Taavi, Tillmann, David, L, Tirschwell, Marcello, Tonelli, Roman, Topor-Madry, Fotis, Topouzi, Allen, Towbin, Traebert, Bach, Xuan, Tran, Thomas, Truelsen, Ulises, Trujillo, Abera, Kenay, Tura, Emin, Murat, Tuzcu, Uche, S, Uchendu, Kingsley, N, Ukwaja, Eduardo, A, Undurraga, Olalekan, A, Uthman, Rita, Van, Dingenen, Aaron, Van, Donkelaar, Tommi, Vasankari, Ana, Maria, Nogales, Vasconcelo, Narayanaswamy, Venketasubramanian, Ramesh, Vidavalur, Lakshmi, Vijayakumar, Salvador, Villalpando, Francesco, S, Violante, Vasiliy, Victorovich, Vlassov, Joseph, A, Wagner, Gregory, R, Wagner, Mitchell, T, Wallin, Linhong, Wang, David, A, Watkins, Scott, Weichenthal, Elisabete, Weiderpa, Robert, G, Weintraub, Andrea, Werdecker, Ronny, Westerman, Richard, A, White, Tissa, Wijeratne, James, D, Wilkinson, Hywel, C, William, Charles, Shey, Wiysonge, Solomon, Meseret, Woldeyohanne, A, Wolfe, Sungho, Won, John, Q, Wong, Anthony, D, Woolf, Denis, Xavier, Qingyang, Xiao, Gelin, Xu, Bereket, Yakob, Ayalnesh, Zemene, Yalew, Lijing, L, Yan, Yuichiro, Yano, Mehdi, Yaseri, Pengpeng, Ye, Henock, Gebremedhin, Yebyo, Paul, Yip, Biruck, Desalegn, Yirsaw, Naohiro, Yonemoto, Gerald, Yonga, Mustafa, Z, Younis, Shicheng, Yu, Zoubida, Zaidi, Maysaa, El, Sayed, Zaki, Faiez, Zannad, Diego, E, Zavala, Hajo, Zeeb, Berihun, M, Zeleke, Hao, Zhang, Sanjay, Zodpey, David, Zonie, Liesl, Joanna, Zuhlke, Theo, Vo, Alan, D, Lopez, Christopher, J, L, Murra, Y., Wang, Haidong, Naghavi, Mohsen, Allen, Christine, Barber, Ryan M, Bhutta, Zulfiqar A, Carter, Austin, Casey, Daniel C, Charlson, Fiona J, Chen, Alan Zian, Coates, Matthew M, Coggeshall, Megan, Dandona, Lalit, Dicker, Daniel J, Erskine, Holly E, Ferrari, Alize J, Fitzmaurice, Christina, Foreman, Kyle, Forouzanfar, Mohammad H, Fraser, Maya S, Fullman, Nancy, Gething, Peter W, Goldberg, Ellen M, Graetz, Nichola, Haagsma, Juanita A, Hay, Simon I, Huynh, Chantal, Johnson, Catherine O, Kassebaum, Nicholas J, Kinfu, Yohanne, Kulikoff, Xie Rachel, Kutz, Michael, Kyu, Hmwe H, Larson, Heidi J, Leung, Janni, Liang, Xiaofeng, Lim, Stephen S, Lind, Margaret, Lozano, Rafael, Marquez, Neal, Mensah, George A, Mikesell, Joe, Mokdad, Ali H, Mooney, Meghan D, Nguyen, Grant, Nsoesie, Elaine, Pigott, David M, Pinho, Christine, Roth, Gregory A, Salomon, Joshua A, Sandar, Logan, Silpakit, Nari, Sligar, Amber, Sorensen, Reed J D, Stanaway, Jeffrey, Steiner, Caitlyn, Teeple, Stephanie, Thomas, Bernadette A, Troeger, Christopher, Vanderzanden, Amelia, Vollset, Stein Emil, Wanga, Valentine, Whiteford, Harvey A, Wolock, Timothy, Zoeckler, Leo, Abate, Kalkidan Hassen, Abbafati, Cristiana, Abbas, Kaja M, Abd-Allah, Foad, Abera, Semaw Ferede, Abreu, Daisy M X, Abu-Raddad, Laith J, Abyu, Gebre Yitayih, Achoki, Tom, Adelekan, Ademola Lukman, Ademi, Zanfina, Adou, Arsène Kouablan, Adsuar, José C, Afanvi, Kossivi Agbelenko, Afshin, Ashkan, Agardh, Emilie Elisabet, Agarwal, Arnav, Agrawal, Anurag, Kiadaliri, Aliasghar Ahmad, Ajala, Oluremi N, Akanda, Ali Shafqat, Akinyemi, Rufus Olusola, Akinyemiju, Tomi F, Akseer, Nadia, Lami, Faris Hasan Al, Alabed, Samer, Al-Aly, Ziyad, Alam, Khurshid, Alam, Noore K M, Alasfoor, Deena, Aldhahri, Saleh Fahed, Aldridge, Robert William, Alegretti, Miguel Angel, Aleman, Alicia V, Alemu, Zewdie Aderaw, Alexander, Lily T, Alhabib, Samia, Ali, Raghib, Alkerwi, Ala'A, Alla, Françoi, Allebeck, Peter, Al-Raddadi, Rajaa, Alsharif, Ubai, Altirkawi, Khalid A, Martin, Elena Alvarez, Alvis-Guzman, Nelson, Amare, Azmeraw T, Amegah, Adeladza Kofi, Ameh, Emmanuel A, Amini, Heresh, Ammar, Walid, Amrock, Stephen Marc, Andersen, Hjalte H, Anderson, Benjamin O, Anderson, Gregory M, Antonio, Carl Abelardo T, Aregay, Atsede Fantahun, Ärnlöv, Johan, Arsenijevic, Valentina S Arsic, Artaman, Al, Asayesh, Hamid, Asghar, Rana Jawad, Atique, Suleman, Avokpaho, Euripide Frinel G Arthur, Awasthi, Ashish, Azzopardi, Peter, Bacha, Umar, Badawi, Alaa, Bahit, Maria C, Balakrishnan, Kalpana, Banerjee, Amitava, Barac, Aleksandra, Barker-Collo, Suzanne L, Bärnighausen, Till, Barregard, Lar, Barrero, Lope H, Basu, Arindam, Basu, Sanjay, Bayou, Yibeltal Tebekaw, Bazargan-Hejazi, Shahrzad, Beardsley, Justin, Bedi, Neeraj, Beghi, Ettore, Belay, Haileeyesus Adamu, Bell, Brent, Bell, Michelle L, Bello, Aminu K, Bennett, Derrick A, Bensenor, Isabela M, Berhane, Adugnaw, Bernabé, Eduardo, Betsu, Balem Demtsu, Beyene, Addisu Shunu, Bhala, Neeraj, Bhalla, Ashish, Biadgilign, Sibhatu, Bikbov, Bori, Abdulhak, Aref A Bin, Biroscak, Brian J, Biryukov, Stan, Bjertness, Espen, Blore, Jed D, Blosser, Christopher D, Bohensky, Megan A, Borschmann, Rohan, Bose, Dipan, Bourne, Rupert R A, Brainin, Michael, Brayne, Carol E G, Brazinova, Alexandra, Breitborde, Nicholas J K, Brenner, Hermann, Brewer, Jerry D, Brown, Alexandria, Brown, Jonathan, Brugha, Traolach S, Buckle, Geoffrey Colin, Butt, Zahid A, Calabria, Bianca, Campos-Nonato, Ismael Ricardo, Campuzano, Julio Cesar, Carapetis, Jonathan R, Cárdenas, Rosario, Carpenter, David O, Carrero, Juan Jesu, Castañeda-Orjuela, Carlos A, Rivas, Jacqueline Castillo, Catalá-López, Ferrán, Cavalleri, Fiorella, Cercy, Kelly, Cerda, Jorge, Chen, Wanqing, Chew, Adrienne, Chiang, Peggy Pei-Chia, Chibalabala, Mirriam, Chibueze, Chioma Ezinne, Chimed-Ochir, Odgerel, Chisumpa, Vesper Hichilombwe, Choi, Jee-Young Jasmine, Chowdhury, Rajiv, Christensen, Hanne, Christopher, Devasahayam Jesuda, Ciobanu, Liliana G, Cohen, Aaron J, Colistro, Valentina, Colomar, Mercede, Colquhoun, Samantha M, Cooper, Cyru, Cooper, Leslie Trumbull, Cortinovis, Monica, Cowie, Benjamin C, Crump, John A, Damsere-Derry, Jame, Danawi, Hadi, Dandona, Rakhi, Daoud, Farah, Darby, Sarah C, Dargan, Paul I, das Neves, José, Davey, Gail, Davis, Adrian C, Davitoiu, Dragos V, de Castro, E Filipa, de Jager, Pieter, Leo, Diego De, Degenhardt, Louisa, Dellavalle, Robert P, Deribe, Kebede, Deribew, Amare, Dharmaratne, Samath D, Dhillon, Preet K, Diaz-Torné, Cesar, Ding, Eric L, dos Santos, Kadine Priscila Bender, Dossou, Edem, Driscoll, Tim R, Duan, Leilei, Dubey, Manisha, Duncan, Bruce Bartholow, Ellenbogen, Richard G, Ellingsen, Christian Lycke, Elyazar, Iqbal, Endries, Aman Yesuf, Ermakov, Sergey Petrovich, Eshrati, Babak, Esteghamati, Alireza, Estep, Kara, Faghmous, Imad D A, Fahimi, Saman, Faraon, Emerito Jose Aquino, Farid, Talha A, Farinha, Carla Sofia e Sa, Faro, André, Farvid, Maryam S, Farzadfar, Farshad, Feigin, Valery L, Fereshtehnejad, Seyed-Mohammad, Fernandes, Jefferson G, Fernandes, Joao C, Fischer, Florian, Fitchett, Joseph R A, Flaxman, Abraham, Foigt, Nataliya, Fowkes, F Gerry R, Franca, Elisabeth Barboza, Franklin, Richard C, Friedman, Joseph, Frostad, Joseph, Fürst, Thoma, Futran, Neal D, Gall, Seana L, Gambashidze, Ketevan, Gamkrelidze, Amiran, Ganguly, Parthasarathi, Gankpé, Fortuné Gbètoho, Gebre, Teshome, Gebrehiwot, Tsegaye Tsewelde, Gebremedhin, Amanuel Tesfay, Gebru, Alemseged Aregay, Geleijnse, Johanna M, Gessner, Bradford D, Ghoshal, Aloke Gopal, Gibney, Katherine B, Gillum, Richard F, Gilmour, Stuart, Giref, Ababi Zergaw, Giroud, Maurice, Gishu, Melkamu Dedefo, Giussani, Giorgia, Glaser, Elizabeth, Godwin, William W, Gomez-Dantes, Hector, Gona, Philimon, Goodridge, Amador, Gopalani, Sameer Vali, Gosselin, Richard A, Gotay, Carolyn C, Goto, Atsushi, Gouda, Hebe N, Greaves, Felix, Gugnani, Harish Chander, Gupta, Rahul, Gupta, Rajeev, Gupta, Vipin, Gutiérrez, Reyna A, Hafezi-Nejad, Nima, Haile, Demewoz, Hailu, Alemayehu Desalegne, Hailu, Gessessew Bugssa, Halasa, Yara A, Hamadeh, Randah Ribhi, Hamidi, Samer, Hancock, Jamie, Handal, Alexis J, Hankey, Graeme J, Hao, Yuantao, Harb, Hilda L, Harikrishnan, Sivadasanpillai, Haro, Josep Maria, Havmoeller, Rasmu, Heckbert, Susan R, Heredia-Pi, Ileana Beatriz, Heydarpour, Pouria, Hilderink, Henk B M, Hoek, Hans W, Hogg, Robert S, Horino, Masako, Horita, Nobuyuki, Hosgood, H Dean, Hotez, Peter J, Hoy, Damian G, Hsairi, Mohamed, Htet, Aung Soe, Htike, Maung Maung Than, Hu, Guoqing, Huang, Cheng, Huang, Hsiang, Huiart, Laetitia, Husseini, Abdullatif, Huybrechts, Inge, Huynh, Grace, Iburg, Kim Moesgaard, Innos, Kaire, Inoue, Manami, Iyer, Veena J, Jacobs, Troy A, Jacobsen, Kathryn H, Jahanmehr, Nader, Jakovljevic, Mihajlo B, James, Peter, Javanbakht, Mehdi, Jayaraman, Sudha P, Jayatilleke, Achala Upendra, Jeemon, Panniyammakal, Jensen, Paul N, Jha, Vivekanand, Jiang, Guohong, Jiang, Ying, Jibat, Tariku, Jimenez-Corona, Aida, Jonas, Jost B, Joshi, Tushar Kant, Kabir, Zubair, Kamal, Ritul, Kan, Haidong, Kant, Surya, Karch, André, Karema, Corine Kakizi, Karimkhani, Chante, Karletsos, Dimitri, Karthikeyan, Ganesan, Kasaeian, Amir, Katibeh, Marzieh, Kaul, Anil, Kawakami, Norito, Kayibanda, Jeanne Françoise, Keiyoro, Peter Njenga, Kemmer, Laura, Kemp, Andrew Haddon, Kengne, Andre Pascal, Keren, Andre, Kereselidze, Maia, Kesavachandran, Chandrasekharan Nair, Khader, Yousef Saleh, Khalil, Ibrahim A, Khan, Abdur Rahman, Khan, Ejaz Ahmad, Khang, Young-Ho, Khera, Sahil, Khoja, Tawfik Ahmed Muthafer, Kieling, Christian, Kim, Daniel, Kim, Yun Jin, Kissela, Brett M, Kissoon, Niranjan, Knibbs, Luke D, Knudsen, Ann Kristin, Kokubo, Yoshihiro, Kolte, Dhaval, Kopec, Jacek A, Kosen, Soewarta, Koul, Parvaiz A, Koyanagi, Ai, Krog, Norun Hjertager, Defo, Barthelemy Kuate, Bicer, Burcu Kucuk, Kudom, Andreas A, Kuipers, Ernst J, Kulkarni, Veena S, Kumar, G Anil, Kwan, Gene F, Lal, Aparna, Lal, Dharmesh Kumar, Lalloo, Ratilal, Lam, Hilton, Lam, Jennifer O, Langan, Sinead M, Lansingh, Van C, Larsson, Ander, Laryea, Dennis Odai, Latif, Asma Abdul, Lawrynowicz, Alicia Elena Beatriz, Leigh, Jame, Levi, Miriam, Li, Yongmei, Lindsay, M Patrice, Lipshultz, Steven E, Liu, Patrick Y, Liu, Shiwei, Liu, Yang, Lo, Loon-Tzian, Logroscino, Giancarlo, Lotufo, Paulo A, Lucas, Robyn M, Lunevicius, Raimunda, Lyons, Ronan A, Ma, Stefan, Machado, Vasco Manuel Pedro, Mackay, Mark T, Maclachlan, Jennifer H, Razek, Hassan Magdy Abd El, Magdy, Mohammed, Razek, Abd El, Majdan, Marek, Majeed, Azeem, Malekzadeh, Reza, Manamo, Wondimu Ayele Ayele, Mandisarisa, John, Mangalam, Srikanth, Mapoma, Chabila C, Marcenes, Wagner, Margolis, David Joel, Martin, Gerard Robert, Martinez-Raga, Jose, Marzan, Melvin Barriento, Masiye, Felix, Mason-Jones, Amanda J, Massano, João, Matzopoulos, Richard, Mayosi, Bongani M, Mcgarvey, Stephen Theodore, Mcgrath, John J, Mckee, Martin, Mcmahon, Brian J, Meaney, Peter A, Mehari, Alem, Mehndiratta, Man Mohan, Mejia-Rodriguez, Fabiola, Mekonnen, Alemayehu B, Melaku, Yohannes Adama, Memiah, Peter, Memish, Ziad A, Mendoza, Walter, Meretoja, Atte, Meretoja, Tuomo J, Mhimbira, Francis Apolinary, Micha, Renata, Miller, Ted R, Mirarefin, Mojde, Misganaw, Awoke, Mock, Charles N, Mohammad, Karzan Abdulmuhsin, Mohammadi, Alireza, Mohammed, Shafiu, Mohan, Viswanathan, Mola, Glen Liddell D, Monasta, Lorenzo, Hernandez, Julio Cesar Montañez, Montero, Pablo, Montico, Marcella, Montine, Thomas J, Moradi-Lakeh, Maziar, Morawska, Lidia, Morgan, Katherine, Mori, Rintaro, Mozaffarian, Dariush, Mueller, Ulrich O, Murthy, Gudlavalleti Venkata Satyanarayana, Murthy, Sriniva, Musa, Kamarul Imran, Nachega, Jean B, Nagel, Gabriele, Naidoo, Kovin S, Naik, Nitish, Naldi, Luigi, Nangia, Vinay, Nash, Deni, Nejjari, Chakib, Neupane, Suba, Newton, Charles R, Newton, John N, Ng, Marie, Ngalesoni, Frida Namnyak, de Dieu Ngirabega, Jean, Nguyen, Quyen Le, Nisar, Muhammad Imran, Pete, Patrick Martial Nkamedjie, Nomura, Marika, Norheim, Ole F, Norman, Paul E, Norrving, Bo, Nyakarahuka, Luke, Ogbo, Felix Akpojene, Ohkubo, Takayoshi, Ojelabi, Foluke Adetola, Olivares, Pedro R, Olusanya, Bolajoko Olubukunola, Olusanya, Jacob Olusegun, Opio, John Nelson, Oren, Eyal, Ortiz, Alberto, Osman, Majdi, Ota, Erika, Ozdemir, Raziye, Pa, Mahesh, Pandian, Jeyaraj D, Pant, Puspa Raj, Papachristou, Christina, Park, Eun-Kee, Park, Jae-Hyun, Parry, Charles D, Parsaeian, Mahboubeh, Caicedo, Angel J Paternina, Patten, Scott B, Patton, George C, Paul, Vinod K, Pearce, Neil, Pedro, João Mário, Stokic, Ljiljana Pejin, Pereira, David M, Perico, Norberto, Pesudovs, Konrad, Petzold, Max, Phillips, Michael Robert, Piel, Frédéric B, Pillay, Julian David, Plass, Dietrich, Platts-Mills, James A, Polinder, Suzanne, Pope, C Arden, Popova, Svetlana, Poulton, Richie G, Pourmalek, Farshad, Prabhakaran, Dorairaj, Qorbani, Mostafa, Quame-Amaglo, Justice, Quistberg, D Alex, Rafay, Anwar, Rahimi, Kazem, Rahimi-Movaghar, Vafa, Rahman, Mahfuzar, Rahman, Mohammad Hifz Ur, Rahman, Sajjad Ur, Rai, Rajesh Kumar, Rajavi, Zhale, Rajsic, Sasa, Raju, Murugesan, Rakovac, Ivo, Rana, Saleem M, Ranabhat, Chhabi L, Rangaswamy, Thara, Rao, Puja, Rao, Sowmya R, Refaat, Amany H, Rehm, Jürgen, Reitsma, Marissa B, Remuzzi, Giuseppe, Resnikoff, Serge, Ribeiro, Antonio L, Ricci, Stefano, Blancas, Maria Jesus Rio, Roberts, Bayard, Roca, Anna, Rojas-Rueda, David, Ronfani, Luca, Roshandel, Gholamreza, Rothenbacher, Dietrich, Roy, Ambuj, Roy, Nawal K, Ruhago, George Mugambage, Sagar, Rajesh, Saha, Sukanta, Sahathevan, Ramesh, Saleh, Muhammad Muhammad, Sanabria, Juan R, Sanchez-Niño, Maria Dolore, Sanchez-Riera, Lidia, Santos, Itamar S, Sarmiento-Suarez, Rodrigo, Sartorius, Benn, Satpathy, Maheswar, Savic, Miloje, Sawhney, Monika, Schaub, Michael P, Schmidt, Maria Inê, Schneider, Ione J C, Schöttker, Ben, Schutte, Aletta E, Schwebel, David C, Seedat, Soraya, Sepanlou, Sadaf G, Servan-Mori, Edson E, Shackelford, Katya A, Shaddick, Gavin, Shaheen, Amira, Shahraz, Saeid, Shaikh, Masood Ali, Shakh-Nazarova, Marina, Sharma, Rajesh, She, Jun, Sheikhbahaei, Sara, Shen, Jiabin, Shen, Ziyan, Shepard, Donald S, Sheth, Kevin N, Shetty, Balakrishna P, Shi, Peilin, Shibuya, Kenji, Shin, Min-Jeong, Shiri, Rahman, Shiue, Ivy, Shrime, Mark G, Sigfusdottir, Inga Dora, Silberberg, Donald H, Silva, Diego Augusto Santo, Silveira, Dayane Gabriele Alve, Silverberg, Jonathan I, Simard, Edgar P, Singh, Abhishek, Singh, Gitanjali M, Singh, Jasvinder A, Singh, Om Prakash, Singh, Prashant Kumar, Singh, Virendra, Soneji, Samir, Søreide, Kjetil, Soriano, Joan B, Sposato, Luciano A, Sreeramareddy, Chandrashekhar T, Stathopoulou, Vasiliki, Stein, Dan J, Stein, Murray B, Stranges, Saverio, Stroumpoulis, Konstantino, Sunguya, Bruno F, Sur, Patrick, Swaminathan, Soumya, Sykes, Bryan L, Szoeke, Cassandra E I, Tabarés-Seisdedos, Rafael, Tabb, Karen M, Takahashi, Ken, Takala, Jukka S, Talongwa, Roberto Tchio, Tandon, Nikhil, Tavakkoli, Mohammad, Taye, Bineyam, Taylor, Hugh R, Ao, Braden J Te, Tedla, Bemnet Amare, Tefera, Worku Mekonnen, Have, Margreet Ten, Terkawi, Abdullah Sulieman, Tesfay, Fisaha Haile, Tessema, Gizachew Assefa, Thomson, Alan J, Thorne-Lyman, Andrew L, Thrift, Amanda G, Thurston, George D, Tillmann, Taavi, Tirschwell, David L, Tonelli, Marcello, Topor-Madry, Roman, Topouzis, Foti, Towbin, Jeffrey Allen, Traebert, Jefferson, Tran, Bach Xuan, Truelsen, Thoma, Trujillo, Ulise, Tura, Abera Kenay, Tuzcu, Emin Murat, Uchendu, Uche S, Ukwaja, Kingsley N, Undurraga, Eduardo A, Uthman, Olalekan A, Dingenen, Rita Van, van Donkelaar, Aaron, Vasankari, Tommi, Vasconcelos, Ana Maria Nogale, Venketasubramanian, Narayanaswamy, Vidavalur, Ramesh, Vijayakumar, Lakshmi, Villalpando, Salvador, Violante, Francesco S, Vlassov, Vasiliy Victorovich, Wagner, Joseph A, Wagner, Gregory R, Wallin, Mitchell T, Wang, Linhong, Watkins, David A, Weichenthal, Scott, Weiderpass, Elisabete, Weintraub, Robert G, Werdecker, Andrea, Westerman, Ronny, White, Richard A, Wijeratne, Tissa, Wilkinson, James D, Williams, Hywel C, Wiysonge, Charles Shey, Woldeyohannes, Solomon Meseret, Wolfe, Charles D A, Won, Sungho, Wong, John Q, Woolf, Anthony D, Xavier, Deni, Xiao, Qingyang, Xu, Gelin, Yakob, Bereket, Yalew, Ayalnesh Zemene, Yan, Lijing L, Yano, Yuichiro, Yaseri, Mehdi, Ye, Pengpeng, Yebyo, Henock Gebremedhin, Yip, Paul, Yirsaw, Biruck Desalegn, Yonemoto, Naohiro, Yonga, Gerald, Younis, Mustafa Z, Yu, Shicheng, Zaidi, Zoubida, Zaki, Maysaa El Sayed, Zannad, Faiez, Zavala, Diego E, Zeeb, Hajo, Zeleke, Berihun M, Zhang, Hao, Zodpey, Sanjay, Zonies, David, Zuhlke, Liesl Joanna, Vos, Theo, Lopez, Alan D, and Murray, Christopher J L

Subjects
VITAL-STATISTICS, INTEGRATED APPROACH, ECONOMIC-DEVELOPMENT, DEVELOPMENT ASSISTANCE, UNITED-STATES, Global Health, Communicable Disease, Communicable Diseases, cause of death, Medicine, General & Internal, Life Expectancy, General & Internal Medicine, Humans, Mortality, Medicine(all), Science & Technology, Mortality, Premature, Medicine (all), EPIDEMIOLOGIC TRANSITION, GBD 2015 Mortality and Causes of Death Collaborators, CIVIL REGISTRATION, Public Health, Global Health, Social Medicine and Epidemiology, Articles, 11 Medical And Health Sciences, ROAD TRAFFIC INJURIES, ALZHEIMERS-DISEASE, Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, VERBAL AUTOPSY, Life Sciences & Biomedicine, Human
Abstract

Background Improving survival and extending the longevity of life for all populations requires timely, robust evidence on local mortality levels and trends. The Global Burden of Disease 2015 Study (GBD 2015) provides a comprehensive assessment of all-cause and cause-specific mortality for 249 causes in 195 countries and territories from 1980 to 2015. These results informed an in-depth investigation of observed and expected mortality patterns based on sociodemographic measures. Methods We estimated all-cause mortality by age, sex, geography, and year using an improved analytical approach originally developed for GBD 2013 and GBD 2010. Improvements included refinements to the estimation of child and adult mortality and corresponding uncertainty, parameter selection for under-5 mortality synthesis by spatiotemporal Gaussian process regression, and sibling history data processing. We also expanded the database of vital registration, survey, and census data to 14 294 geography-year datapoints. For GBD 2015, eight causes, including Ebola virus disease, were added to the previous GBD cause list for mortality. We used six modelling approaches to assess cause-specific mortality, with the Cause of Death Ensemble Model (CODEm) generating estimates for most causes. We used a series of novel analyses to systematically quantify the drivers of trends in mortality across geographies. First, we assessed observed and expected levels and trends of cause-specific mortality as they relate to the Socio-demographic Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility. Second, we examined factors affecting total mortality patterns through a series of counterfactual scenarios, testing the magnitude by which population growth, population age structures, and epidemiological changes contributed to shifts in mortality. Finally, we attributed changes in life expectancy to changes in cause of death. We documented each step of the GBD 2015 estimation processes, as well as data sources, in accordance with Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER). Findings Globally, life expectancy from birth increased from 61.7 years (95% uncertainty interval 61.4-61.9) in 1980 to 71.8 years (71.5-72.2) in 2015. Several countries in sub-Saharan Africa had very large gains in life expectancy from 2005 to 2015, rebounding from an era of exceedingly high loss of life due to HIV/AIDS. At the same time, many geographies saw life expectancy stagnate or decline, particularly for men and in countries with rising mortality from war or interpersonal violence. From 2005 to 2015, male life expectancy in Syria dropped by 11.3 years (3.7-17.4), to 62.6 years (56.5-70.2). Total deaths increased by 4.1% (2.6-5.6) from 2005 to 2015, rising to 55.8 million (54.9 million to 56.6 million) in 2015, but age-standardised death rates fell by 17.0% (15.8-18.1) during this time, underscoring changes in population growth and shifts in global age structures. The result was similar for non-communicable diseases (NCDs), with total deaths from these causes increasing by 14.1% (12.6-16.0) to 39.8 million (39.2 million to 40.5 million) in 2015, whereas age-standardised rates decreased by 13.1% (11.9-14.3). Globally, this mortality pattern emerged for several NCDs, including several types of cancer, ischaemic heart disease, cirrhosis, and Alzheimer's disease and other dementias. By contrast, both total deaths and age-standardised death rates due to communicable, maternal, neonatal, and nutritional conditions significantly declined from 2005 to 2015, gains largely attributable to decreases in mortality rates due to HIV/AIDS (42.1%, 39.1-44.6), malaria (43.1%, 34.7-51.8), neonatal preterm birth complications (29.8%, 24.8-34.9), and maternal disorders (29.1%, 19.3-37.1). Progress was slower for several causes, such as lower respiratory infections and nutritional deficiencies, whereas deaths increased for others, including dengue and drug use disorders. Age-standardised death rates due to injuries significantly declined from 2005 to 2015, yet interpersonal violence and war claimed increasingly more lives in some regions, particularly in the Middle East. In 2015, rotaviral enteritis (rotavirus) was the leading cause of under-5 deaths due to diarrhoea (146 000 deaths, 118 000-183 000) and pneumococcal pneumonia was the leading cause of under-5 deaths due to lower respiratory infections (393 000 deaths, 228 000-532 000), although pathogen-specific mortality varied by region. Globally, the effects of population growth, ageing, and changes in age-standardised death rates substantially differed by cause. Our analyses on the expected associations between cause-specific mortality and SDI show the regular shifts in cause of death composition and population age structure with rising SDI. Country patterns of premature mortality (measured as years of life lost [YLLs]) and how they differ from the level expected on the basis of SDI alone revealed distinct but highly heterogeneous patterns by region and country or territory. Ischaemic heart disease, stroke, and diabetes were among the leading causes of YLLs in most regions, but in many cases, intraregional results sharply diverged for ratios of observed and expected YLLs based on SDI. Communicable, maternal, neonatal, and nutritional diseases caused the most YLLs throughout sub-Saharan Africa, with observed YLLs far exceeding expected YLLs for countries in which malaria or HIV/AIDS remained the leading causes of early death. Interpretation At the global scale, age-specific mortality has steadily improved over the past 35 years; this pattern of general progress continued in the past decade. Progress has been faster in most countries than expected on the basis of development measured by the SDI. Against this background of progress, some countries have seen falls in life expectancy, and age-standardised death rates for some causes are increasing. Despite progress in reducing age-standardised death rates, population growth and ageing mean that the number of deaths from most non-communicable causes are increasing in most countries, putting increased demands on health systems. Copyright (C) The Author(s). Published by Elsevier Ltd.

Published
2016

96. Caregiver and youth self-reported emotional and behavioural problems in Ugandan HIV-infected children and adolescents

Author

Soraya Seedat, Vikram Patel, Eugene Kinyanda, Jean B. Nachega, Jonathan Levin, Kenneth D. Gadow, Richard Mpango, and Leigh van den Heuvel

Subjects
education.field_of_study, Congress Abstract, business.industry, lcsh:RC435-571, Population, lcsh:Mental healing, Logistic regression, medicine.disease, Mental health, lcsh:RZ400-408, Psychiatry and Mental health, Schizophrenia, Hiv infected, lcsh:Psychiatry, 8. Economic growth, medicine, Anxiety, medicine.symptom, education, business, Psychosocial, Depression (differential diagnoses), Clinical psychology
Abstract

Introduction: We determined the prevalence of, and factors associated with, self-rated emotional and behavioural problems (EBPs) and assessed the agreement between self-rated and caregiver-rated EBPs in the ‘Mental health among HIV-infected Children and Adolescents (CA-HIV) in Kampala and Masaka, Uganda’ (CHAKA) study. Existing literature demonstrates that CA-HIV face increased mental health challenges related to a broad range of biological and psychosocial factors. There is scarce data on self-reported EBPs in CA-HIV. Methods: In a cross-sectional sample, caregiver-reported EBPs were assessed with the Child and Adolescent Symptom Inventory-5 (CASI-5), and self-reported problems were evaluated with the Youth Inventory-4 (YI-4) in 469 adolescents aged 12–17 years and the Child Inventory-4 (CI-4) in 493 children aged 8–11 years. Logistic regression models were utilised to determine factors related to self-reported EBPs. Results: Self-reported emotional problems (EPs) were present in 28.8% of the adolescents and were associated with caregivers being separated and having a lower level of education. Among adolescents, 14.5% had self-reported behavioural problems (BPs), and these were associated with caregiver unemployment and food insecurity. Self-reported EPs were reported by 36.9% of children and were associated with rural study sites, having missed school and caregivers having a lower level of education. There was only modest agreement (maximum r = 0.29) between caregiver- and CA-HIV-reported EBPS, with caregivers reporting more EPs and adolescents reporting more BPs. Conclusion: Self-reported EBPs are frequently endorsed by CA-HIV, and these problems are related to unique psychosocial factors. Including CA-HIV, self-report measures can assist in identifying problems that caregivers may not be aware of, particularly BPs.

Published
2018

97. Recruitment and Baseline Characteristics of Participants in the Social, Emotional, and Economic Empowerment Through Knowledge of Group Support Psychotherapy Study (SEEK-GSP): Cluster Randomized Controlled Trial

Author

Josephine Birungi, Ramin Mojtabai, Mastula Nanfuka, Etheldreda Nakimuli-Mpungu, Jean B. Nachega, Michael Etukoit, Seggane Musisi, Edward J Mills, Kizito Wamala, James Okello, Sheila Ndyanabangi, and Ofir Harari

Subjects
Psychotherapist, 020205 medical informatics, Psychological intervention, 02 engineering and technology, lay health workers, law.invention, 03 medical and health sciences, Social support, 0302 clinical medicine, Randomized controlled trial, law, 0202 electrical engineering, electronic engineering, information engineering, psychosocial stressors, Medicine, Uganda, 030212 general & internal medicine, Cluster randomised controlled trial, Socioeconomic status, persons living with HIV/AIDS, Original Paper, business.industry, General Medicine, medicine.disease, Clinical trial, recruitment, depression, cluster randomized trial, Major depressive disorder, group support psychotherapy, business, Psychosocial
Abstract

Background: Psychosocial characteristics, including self-esteem, perceived social support, coping skills, stigma, discrimination, and poverty, are strongly correlated with depression symptoms. However, data on the extent of these correlations among persons living with HIV and the associations between psychosocial characteristics and HIV treatment outcomes are limited in sub-Saharan Africa. Objective: This paper aims to describe the recruitment process and baseline characteristics associated with depression in a sample of HIV-positive people in a cluster randomized trial of group support psychotherapy (GSP) for depression delivered by trained lay health workers (LHWs). Methods: Thirty eligible primary care health centers across three districts in Uganda were randomly allocated to have their LHWs trained to deliver GSP (intervention arm) or group HIV education and treatment as usual (control arm) to persons living with HIV comorbid with depression. Baseline demographic, socioeconomic, and psychosocial characteristics were collected via interviewer-administered questionnaires. Among eligible participants, differences between those enrolled versus those who refused enrollment were assessed using chi square for categorical variables and t tests for continuous variables. Spearman rank order correlation analyses were conducted to determine associations between baseline depression symptoms and adherence to antiretroviral therapy (ART), viral load suppression, and other psychosocial variables. Results: The study screened 1473 people and 1140 were found to be eligible and enrolled over 14 weeks. Participants recruited comprised 95% of the target sample size of 1200. The sample’s mean age was 38.5 (SD 10.9) years and both genders were well represented (males: 46.32%, 528/1140). Most participants met the diagnostic criteria for major depressive disorder (96.92%, 1105/1140), had significant posttraumatic stress symptoms (72.46%, 826/1140), reported moderate suicide risk (52.54%, 599/1140), had primary or no formal education (86.22%, 983/1140), and reported no income-generating activity (72.63%, 828/1140) and no food insecurity (81.67%, 931/1140). Among eligible participants, 48 of 1140 (4.21%) refused to participate in the interventions; these participants were more likely to be males (χ21=4.0, P=.045) and have significantly lower depression symptoms scores (t2=2.36, P=.01) than those who participated in the interventions. There was a significant positive correlation between viral load and number of traumatic experiences (ρ=.12, P=.05). Adherence to ART was positively correlated with perceived social support (ρ=.15, P

Published
2018

98. Comparison of Antiretroviral Therapy Adherence Among HIV-Infected Older Adults with Younger Adults in Africa: Systematic Review and Meta-analysis

Author

Jean B. Nachega, Najeebullah Soomro, Grace Fitzgerald, Janet Seeley, Enid Schatz, and Joel Negin

Subjects
medicine.medical_specialty, Social Psychology, Anti-HIV Agents, Population, Psychological intervention, MEDLINE, HIV Infections, CINAHL, Medication Adherence, 03 medical and health sciences, 0302 clinical medicine, Quality of life, Internal medicine, medicine, Odds Ratio, Humans, 030212 general & internal medicine, education, education.field_of_study, Original Paper, 030505 public health, business.industry, Public Health, Environmental and Occupational Health, Age Factors, HIV, Odds ratio, Infectious Diseases, Anti-Retroviral Agents, Adherence, Meta-analysis, Older adults, Africa, Systematic review, Quality of Life, 0305 other medical science, business, ART, Cohort study
Abstract

As access to antiretroviral treatment in low- and middle-income countries improves, the number of older adults (aged ≥ 50 years) living with HIV is increasing. This study compares the adherence to antiretroviral treatment among older adults to that of younger adults living in Africa. We searched PubMed, Medline, Cochrane CENTRAL, CINAHL, Google Scholar and EMBASE for keywords (HIV, ART, compliance, adherence, age, Africa) on publications from 1st Jan 2000 to 1st March 2016. Eligible studies were pooled for meta-analysis using a random-effects model, with the odds ratio as the primary outcome. Twenty studies were included, among them were five randomised trials and five cohort studies. Overall, we pooled data for 148,819 individuals in two groups (older and younger adults) and found no significant difference in adherence between them [odds ratio (OR) 1.01; 95% CI 0.94–1.09]. Subgroup analyses of studies using medication possession ratio and clinician counts to measure adherence revealed higher proportions of older adults were adherent to medication regimens compared with younger adults (OR 1.06; 95% CI 1.02–1.11). Antiretroviral treatment adherence levels among older and younger adults in Africa are comparable. Further research is required to identify specific barriers to adherence in the aging HIV affected population in Africa which will help in development of interventions to improve their clinical outcomes and quality of life.

Published
2018

99. Prevalence and risk factors of metabolic syndrome in HIV-infected adults at three urban clinics in a post-conflict setting, eastern Democratic Republic of the Congo

Author

Patrick D. M. C. Katoto, Tonya M. Esterhuizen, Dieudonné M. Bihehe, André N.H. Bulabula, Jean B. Nachega, Pierre P. M. Lunjwire, Aime Murhula, and Friedrich Thienemann

Subjects
Adult, Male, medicine.medical_specialty, Urban Population, Medically Underserved Area, HIV Infections, 030204 cardiovascular system & hematology, Logistic regression, 03 medical and health sciences, 0302 clinical medicine, Interquartile range, Risk Factors, Internal medicine, Prevalence, Medicine, Humans, 030212 general & internal medicine, National Cholesterol Education Program, Metabolic Syndrome, business.industry, Medical record, Public Health, Environmental and Occupational Health, Odds ratio, Armed Conflicts, Middle Aged, medicine.disease, Regimen, Infectious Diseases, Cross-Sectional Studies, Democratic Republic of the Congo, Population study, Parasitology, Female, Metabolic syndrome, business
Abstract

OBJECTIVE: To determine the prevalence of and risk factors for metabolic syndrome (MS) in HIV-infected adults at three urban clinics in Bukavu, Democratic Republic of the Congo. DESIGN: Cross-sectional study. METHODS: From July to September 2016, baseline socio-demographics, risk factors and clinical characteristics were collected using a structured questionnaire or extracted from medical records. Fasting blood sugar and lipids were measured. MS was defined per the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) and the International Diabetes Federation (IDF) criteria. Adjusted odds ratio (OR) was generated through multivariate logistic regression models. RESULTS: Of 495 participants, 356 (72%) were women and 474 (95.8%) were receiving antiretroviral therapy (ART). The median age (years) [interquartile range (IQR)] was 43 [36-51]. The overall prevalence of MS per NECP/ATP III and IDF criteria was 27% [95% CI: 20-35%] or 30% [95% CI: 23-38%], respectively. In a multivariate logistic regression, low physical activity (OR 2.47, 95% CI: 1.40-4.36); daily exposure to biomass fuel smoke (BMF) for more than 2 h (OR 2.18, 95% CI: 1.01-4.68); protease inhibitor containing ART (OR: 2.96, 95% CI: 1.07-8.18); and stavudine-containing ART regimen (OR: 2.57, 95% CI: 1.11-5.93) were independently associated with MS. CONCLUSIONS: MS was highly prevalent in this hospital-based study population. Beside known traditional risk factors and contribution of specific ART regimens to MS, daily exposure to BMF is new and of specific concern, necessitating targeted urgent prevention and management interventions.

Published
2018

100. Rapid initiation of antiretroviral therapy for people living with HIV

Author

Alberto Mateo-Urdiales, Samuel Johnson, Jean B Nachega, and Ingrid Eshun-Wilson

Subjects
Medicine General & Introductory Medical Sciences, 0301 basic medicine, qv_268.5, 03 medical and health sciences, wc_503_2, 0302 clinical medicine, education, wc_503, Pharmacology (medical), 030212 general & internal medicine, 030112 virology
Abstract

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows:\ud To assess the effects of rapid initiation of ART on treatment outcomes and mortality in PLWH.

Published
2018

Catalog

Books, media, physical & digital resources
See catalog results