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Background: Cryptococcal meningitis is a leading cause of death among HIV‐infected individuals in sub‐Saharan Africa. Recent developments include the availability of intravenous fluconazole, cryptococcal antigen assays and new data to support fluconazole pre‐emptive treatment. In this study, we describe the impact of screening HIV‐positive adult inpatients with serum cryptococcal antigen (CRAG) at a Tanzanian referral hospital. Methods: All adults admitted to the medical ward of Bugando Medical Centre are counseled and tested for HIV. In this prospective cohort study, we consecutively enrolled HIV‐positive patients admitted between September 2009 and January 2010. All patients were interviewed, examined and screened with serum CRAG. Patients with positive serum CRAG or signs of meningitis underwent lumbar puncture. Patients were managed according to standard World Health Organization treatment guidelines. Discharge diagnoses and in‐hospital mortality were recorded. Results: Of 333 HIV‐infected adults enrolled in our study, 15 (4.4%) had confirmed cryptococcal meningitis and 10 of these 15 (66%) died. All patients with cryptococcal meningitis had at least two of four classic symptoms and signs of meningitis: fever, headache, neck stiffness and altered mental status. Cryptococcal meningitis accounted for a quarter of all in‐hospital deaths. Conclusions: Despite screening of all HIV‐positive adult inpatients with the serum CRAG at the time of admission and prompt treatment with high‐dose intravenous fluconazole in those with confirmed cryptococcal meningitis, the in‐hospital mortality rate remained unacceptably high. Improved strategies for earlier diagnosis and treatment of HIV, implementation of fluconazole pre‐emptive treatment for high‐risk patients and acquisition of better resources for treatment of cryptococcal meningitis are needed., Background Cryptococcal meningitis is one of the most common and severe opportunistic infections among people infected with HIV: there are an estimated 720, 000 cases and 500, 000 deaths per [...]

A randomized clinical trial in Haiti was conducted determine if early initiation of antiretroviral therapy, as compared with the standard timing for the initiation of therapy improves survival. Early initiation of antiretroviral therapy was observed to decrease the rates of death and incident tuberculosis hence access to antiretroviral therapy should be expanded to include all HIV-infected adults who have CD4+ T-cell counts of less than 350 per cubic millimeter, including those who live in areas with limited resources.

After an initial wave of coronavirus disease 2019 (COVID-19) in Haiti in summer 2020 (primarily lineage B.1), seropositivity for anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunoglobulin G (IgG) was ~40%. Variant P.1 (gamma) was introduced in February 2021, with an initially limited introduction followed by exponential local dissemination within this unvaccinated population with prior exposure to earlier SARS-CoV-2 lineages. [ABSTRACT FROM AUTHOR]

Objective To assess outcomes after antiretroviral therapy (ART) in adolescents and youth in Haiti, a country with a generalized epidemic of infection with HIV-1. Methods An assessment was made of survival, plasma HIV-1 ribonucleic acid (RNA) concentrations and HIV-1 drug resistance patterns after 12 months of ART in patients aged 13-25 years who presented to a clinic in Port-au-Prince, Haiti, with AIDS between 1 March 2003 and 31 December 2005. Participants received ART in accordance with WHO guidelines. Kaplan-Meier analysis was used to estimate survival probabilities and their 95% confidence intervals (Cl) for the period from ART initiation to death. Findings Of a total of 146 patients, 96 (66%) were female; the median CD4+ T-cell count at baseline was 129 cells/ml. By Kaplan-Meier analysis, 13% of the patients had died at 12 months, 17% at 24 months and 20% at 36 months. A plasma HIV-1 RNA concentration [greater than or equal to] 50 copies/ml was seen in 40 (51%) of 79 patients 12 months after treatment initiation and was associated. with poor ART adherence. Among 29 patients with > 1000 copies/ml at 12 months, resistance mutations to non-nucleoside reverse transcriptase inhibitors (NNRTIs) were detected in 23 cases (79%); to both NNRTIs and lamivudine in 21 (72%) cases; and to NNRTIs, lamivudine and other nucleoside reverse transcriptase inhibitors in 10 (35%) cases. One hundred and six participants (73%) reported sexual intercourse without condoms, and 35 of the 96 women (36%) were pregnant during follow-up. Conclusion Adolescents and youth with AIDS receiving ART are at risk of virologic failure and disease progression and can therefore transmit HIV-1 to sexual partners and infants. Strategies to target the special needs of this age group are urgently needed. Objectif Evaluer les issues du traitement antiretroviral (ART) chez des adolescents et des jeunes vivant en Haiti, pays victime d'une epidemie generalisee de VIH-1. Methodes On a effectue une evaluation de la survie, du taux d'acide ribonucleique (ARN) VIH-1 plasmatique et des schemas de pharmacoresistance du VIH-1 apres 12 mois de traitement ART chez des jeunes individus de 13 a 25 ans atteints de sida, accueillis dans un dispensaire de Port-au-Prince entre le ler mars 2003 et le 31 decembre 2005. Les sujets de l'etude ont recu des antiretroviraux conformement aux recommandations de I'OMS. On a utilise une analyse de Kaplan-Meier pour estimer les probabilites de survie et les intervalles de confiance a 95 % (IC) correspondants pour la periode allant du debut du traitement ART au deces des sujets. Resultats Sur les 146 malades, 96 (66 %) etaient des femmes ; la valeur mediane de reference pour la numeration des lymphocytes CD4+ etait de 129 cellules/ml. L'analyse de Kaplan-Meier a montre que 13 % des malades etaient decedes au bout de 12 mois, 17 % au bout de 24 mois et 20 % au bout de 36 mois. On a releve une concentration d'ARN VIH-1 plasmatique [greater than or equal to] 50 copies/ml chez 40 malades sur 79 (51%), 12 mois apres le debut du traitement, en association avec une mauvaise observance therapeutique. Chez 29 malades presentant plus de 1000 copies/mi au bout de 12 mois, on a detecte des mutations de resistance aux inhibiteurs non-nucleosidiques de la transcriptase inverse (NNRTI) dans 23 cas (79 %) ; a la fois aux NNRTI et a la lamivudine dans 21 cas (72 %) ; et aux NNRTI, a la lamivudine et a des inhibiteurs nucleosidiques de la transcriptase inverse dans 10 cas (35 %). Cent six participants ont rapporte avoir eu des rapports sexuels non proteges et 35 des 96 femmes (36 %) etaient enceintes pendant le suivi. Conclusion Les adolescents et les jeunes atteints de sida qui recoivent un traitement ART courent un risque d'echec virologique et de progression de la maladie et peuvent donc transmettre le VIH-1 a leurs partenaires sexuels et le cas echeant a leur enfant a natre. Il est urgent de disposer de strategies permettant de cibler les besoins specifiques de cette tranche d'ages. Objetivo Evaluar los resultados dei tratamiento antirretroviral (TAR) en adolescentes y adultos jovenes en Haiti, pais que sufre una epidemia generalizada de infeccion por VIH-1. Metodos Se hizo una evaluacion de la supervivencia, las concentraciones plasmaticas de acido ribonucleico (ARN) de VIH-1 y el perfil de farmacorresistencia del VIH-1 a los 12 meses de iniciada la TAR en pacientes de 13 a 25 anos que acudieron a un consultorio de Puerto Principe, Haiti, con SIDA entre el 1 de marzo de 2003 y el 31 de diciembre de 2005. Los participantes recibieron TAR con arreglo a las directrices de la OMS. Se utilizo el metodo de Kaplan-Meier para estimar las probabilidades de supervivencia y sus intervalos de confianza (IC) dei 95% para el periodo transcurrido entre el inicio dei TAR y la defuncion. Resultados De un total de 146 pacientes, 96 (66%) eran mujeres; la mediana dei recuento de linfocitos T CD4+ al comienzo dei estudio fue de 129 celulas/ml. Segun el analisis de KaplanMeier, el 13% de los pacientes habian muerto a los 12 meses, el 17% a los 24 meses, y el 20% a los 36 meses. En 40 de 79 pacientes (51%) se detecto una concentracion plasmatica de ARN de VIH-1 [greater than or equal to] 50 copias/ml a los 12 meses de iniciado el tratamiento, asociada a un escaso cumplimiento dei TAR. Entre los 29 pacientes con mas de 1000 copias/ml a los 12 meses, se detectaron mutaciones de resistencia a los inhibidores no nucleosidos de la transcriptasa inversa (NNRTI) en 23 casos (79%); tanto a los NNRTI como a la lamivudina en 21 casos (72%); y a los NNRTI, la lamivudina y otros inhibidores nucleosidos de la transcriptasa inversa en 10 casos (35%). En total, 106 participantes (73%) declararon que habian mantenido relaciones sexuales sin preservativo, y 35 de las 96 mujeres (36%) se encontraban embarazadas durante el seguimiento. Conclusion Los adolescentes y adultos jovenes con SIDA sometidos a TAR presentan un riesgo especial de fracaso virologico y de progresion de la enfermedad y pueden por consiguiente transmitir el VIH-1 a su pareja y a los lactantes. Se requieren urgentemente estrategias que aborden las necesidades especiales de ese grupo de edad., Introduction AIDS is the leading cause of death in adolescents and youth aged 13-25 years in sub-Saharan Africa and Caribbean countries that have generalized epidemics of infection with HIV-1. (1-3) [...]

ABSTRACT Background New rapid syphilis tests permit simple and immediate diagnosis and treatment at a single clinic visit. We compared the cost-effectiveness, projected health outcomes, and annual cost of screening [...]

The use of an educational video during the informed consent process for an HIV vaccine preparedness study conducted in Port-au-Prince, Haiti, is described. The results reveal that the informed consent using an educational video has ensured good comprehension in most of the volunteers.

The efficacy of antiretroviral therapy in the first 1004 consecutive patients with AIDS and without previous antiretroviral therapy who were treated beginning in March 2003 in Port-au-Prince, Haiti are studied. This report documents the feasibility of effective antiretroviral therapy in a large number of patients in an impoverished country.

The current study was conducted in Port au Prince, Haiti, to determine if information collected at HIV notification during voluntary counseling and testing (VCT) can predict patients' future adherence with risk reduction counseling and medical referral. Case histories describe HIV-infected patients with signs of depression during counseling who do not return for medical care, and women afraid of economic ruin and domestic violence who do not notify their sexual partners. Quantitative predictors of seeking medical care include: denial at the announcement of HIV test results (odds ratio [OR] 0.3, 95% confidence interval [CI] 0.1-0.6), belief that HIV can be transmitted by magic (OR 0.6, 95% CI 0.3-0.9), and having symptoms at the time of HIV testing (OR 1.9, 95% CI 1.6-2.3). Predictors of refusal to notify sexual partner of HIV status include: being poor (OR 1.8, 95% CI 1.1-2.5), female (OR 2.1, 95% CI 1.7-2.5), and belief that HIV can be transmitted by magic (OR 2.3, 95% CI 1.9-2.6) In conclusion, information collected during HIV counseling and testing can predict patients' future adherence with counseling and medical referral. Counselors can use information such as signs of severe depression, economic hardship, and denial of HIV disease to identify patients at risk for nonadherence and to provide them with specialized counseling and care.

HIV viral load (VL) monitoring can reinforce antiretroviral therapy (ART) adherence. Standard VL testing requires high laboratory capacity and coordination between clinic and laboratory which can delay results. A randomized trial comparing point-of-care (POC) VL testing to standard VL testing among 150 adolescents and young adults, ages 10-24 years, living with HIV in Haiti determined if POC VL testing could return faster results and improve ART adherence and viral suppression. Participants received a POC VL test with same-day result (POC arm) or a standard VL test with result given 1 month later (SOC arm). POC arm participants were more likely to receive a test result within 6 weeks than SOC arm participants (94.7% vs. 80.1%; p1000 copies/ml and low self-reported ART adherence was stronger in the POC arm (OR: 6.57; 95%CI: 2.12-25.21) than the SOC arm (OR: 2.62; 95%CI: 0.97-7.44) suggesting more accurate self-report in the POC arm. POC VL testing was effectively implemented in this low-resource setting with faster results and is a pragmatic intervention that may enable clinicians to identify those with high VL to provide enhanced counseling or regimen changes sooner. Trial registration: ClinicalTrials.gov identifier: NCT03288246. [ABSTRACT FROM AUTHOR]

Introduction: Adolescents account for over 40% of new HIV infections in Haiti. This analysis compares outcomes among HIV-positive adolescents before and after implementation of an adolescent HIV clinic in Port-au-Prince, Haiti. Methods: We conducted a cohort study using programmatic data among HIV-positive adolescents aged 13 to 19. Data from 41,218 adolescents who were HIV tested from January 2003 to December 2012 were included. Outcomes across the HIV care cascade were assessed before and after implementation of an adolescent clinic (2009), including HIV testing, enrolment in care, assessment for antiretroviral therapy (ART) eligibility, ART initiation and 12- month retention. Pre-ART outcomes were assessed 12 months after HIV testing. Factors associated with pre-ART and ART attrition were identified through multivariable competing risk and Cox proportional hazards regression modelling. Results: Cumulatively, 1672 (4.1%) adolescents tested HIV positive (80% female, median age 16 years). Retention by cascade step comparing pre- and post-clinic included the following: 86% versus 87% of patients enrolled in care, 61% versus 79% were assessed for ART eligibility, 85% versus 92% initiated ART and 68% versus 66% were retained 12 months after ART initiation. PreART attrition decreased from 61% pre-clinic to 50% post-clinic (p Conclusions: Implementation of a youth-friendly adolescent clinic improved retention in HIV care among adolescents, particularly in the assessment of ART eligibility and ART initiation. Additional interventions are needed to improve retention among pre-ART patients and support long-term retention among ART patients. Keywords: adolescent; attrition; epidemiology; HIV/AIDS; retention; youth., Introduction AIDS is the leading cause of death in adolescents and youth in sub-Saharan Africa and the Caribbean [1]. Globally between 2005 and 2012, AIDS-related deaths increased by 50% among [...]

Abstract Background We determined direct medical costs, overhead costs, societal costs, and personnel requirements for the provision of antiretroviral therapy (ART) to patients with AIDS in Haiti. Methods We examined data from 218 treatment-naïve adults who were consecutively initiated on ART at the GHESKIO Center in Port-au-Prince, Haiti between December 23, 2003 and May 20, 2004 and calculated costs and personnel requirements for the first year of ART. Results The mean total cost of treatment per patient was $US 982 including $US 846 in direct costs, $US 114 for overhead, and $US 22 for societal costs. The direct cost per patient included generic ART medications $US 355, lab tests $US 130, nutrition $US 117, hospitalizations $US 62, pre-ART evaluation $US 58, labor $US 51, non-ART medications $US 39, outside referrals $US 31, and telephone cards for patient retention $US 3. Higher treatment costs were associated with hospitalization, change in ART regimen, TB treatment, and survival for one year. We estimate that 1.5 doctors and 2.5 nurses are required to treat 1000 patients in the first year after initiating ART. Conclusion Initial ART treatment in Haiti costs approximately $US 1,000 per patient per year. With generic first-line antiretroviral drugs, only 36% of the cost is for medications. Patients who change regimens are significantly more expensive to treat, highlighting the need for less-expensive second-line drugs. There may be sufficient health care personnel to treat all HIV-infected patients in urban areas of Haiti, but not in rural areas. New models of HIV care are needed for rural areas using assistant medical officers and community health workers.

Background: Detection of subclinical cryptococcal disease using cryptococcal antigen screening among HIV‐positive individuals presents a potential opportunity for prevention of both clinical disease and death if patients with detectable cryptococcal antigen are identified and treated pre‐emptively. Recently developed point‐of‐care cryptococcal antigen tests may be useful for screening, particularly in resource‐limiting settings, but few studies have assessed their utility. Methodology: The objectives of this study were to determine the prevalence and factors associated with cryptococcal antigenemia in HIV‐positive patients with CD4[sup.+] T‐cell counts ≤200 cells/µL who were initiating ART, and also to evaluate the utility of the point‐of‐care urine lateral flow assay (LFA) cryptococcal antigen test using two different diluents, compared to gold standard serum antigen testing, as a screening tool. Urine and serum of outpatients initiating antiretroviral therapy at two hospitals in Mwanza were tested for cryptococcal antigen, and demographic and clinical characteristics were obtained using structured questionnaires and patients’ files. Patients with asymptomatic cryptococcal antigenemia received oral fluconazole in accordance with World Health Organization recommendations. Results: Among 140 patients screened, 10 (7.1%) had asymptomatic cryptococcal antigenemia with a positive serum cryptococcal antigen. Four of these ten patients had CD4 counts between 100 and 200 cells/µL. The prevalence of cryptococcal antigen detected in urine using a standard (older) and a test (newer) diluent were 44 (31.4%) and 19 (13.6%), with Kappa coefficients compared to serum of 0.28 and 0.51 (p Conclusions: Our findings suggest that HIV‐positive outpatients with CD4 counts, Introduction Cryptococcus neoformans is one of the leading opportunistic infections in people living with HIV/AIDS in sub‐Saharan Africa [1–4]. It is estimated that 3% of HIV‐positive individuals in sub‐Saharan Africa [...]