62 results on '"Kerschberger, Bernhard"'
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52. The Effect of Complete Integration of HIV and TB Services on Time to Initiation of Antiretroviral Therapy: A Before-After Study
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Kerschberger, Bernhard, primary, Hilderbrand, Katherine, additional, Boulle, Andrew M., additional, Coetzee, David, additional, Goemaere, Eric, additional, De Azevedo, Virginia, additional, and Van Cutsem, Gilles, additional
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- 2012
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53. Time to Initiation of Antiretroviral Therapy Among Patients With HIV-Associated Tuberculosis in Cape Town, South Africa
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Lawn, Stephen D, primary, Campbell, Lucy, additional, Kaplan, Richard, additional, Boulle, Andrew, additional, Cornell, Morna, additional, Kerschberger, Bernhard, additional, Morrow, Carl, additional, Little, Francesca, additional, Egger, Matthias, additional, and Wood, Robin, additional
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- 2011
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54. Barriers and Facilitators to Combined ART Initiation in Pregnant Women With HIV: Lessons Learnt From a PMTCT B+ Pilot Program in Swaziland.
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Parker, Lucy A., Jobanputra, Kiran, Okello, Velephi, Nhlangamandla, Mpumelelo, Mazibuko, Sikhathele, Kourline, Tatiana, Kerschberger, Bernhard, Pavlopoulos, Elias, and Teck, Roger
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- 2015
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55. Successes and challenges in optimizing the viral load cascade to improve antiretroviral therapy adherence and rationalize second-line switches in Swaziland
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Etoori, David, Ciglenecki, Iza, Ndlangamandla, Mpumelelo, Edwards, Celeste G, Jobanputra, Kiran, Pasipamire, Munyaradzi, Maphalala, Gugu, Yang, Chunfu, Zabsonre, Inoussa, Kabore, Serge M, Goiri, Javier, Teck, Roger, and Kerschberger, Bernhard
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INTRODUCTION: As antiretroviral therapy (ART) is scaled up, more patients become eligible for routine viral load (VL) monitoring, the most important tool for monitoring ART efficacy. For HIV programmes to become effective, leakages along the VL cascade need to be minimized and treatment switching needs to be optimized. However, many HIV programmes in resource-constrained settings report significant shortfalls. METHODS: From a public sector HIV programme in rural Swaziland, we evaluated the VL cascade of adults (≥18 years) on ART from the time of the first elevated VL (>1000 copies/mL) between January 2013 and June 2014 to treatment switching by December 2015. We additionally described HIV drug resistance for patients with virological failure. We used descriptive statistics and Kaplan-Meier estimates to describe the different steps along the cascade and regression models to determine factors associated with outcomes. RESULTS AND DISCUSSION: Of 828 patients with a first elevated VL, 252 (30.4%) did not receive any enhanced adherence counselling (EAC). Six hundred and ninety-six (84.1%) patients had a follow-up VL measurement, and the predictors of receiving a follow-up VL were being a second-line patient (adjusted hazard ratio (aHR): 0.72; p = 0.051), Hlathikhulu health zone (aHR: 0.79; p = 0.013) and having received two EAC sessions (aHR: 1.31; p = 0.023). Four hundred and ten patients (58.9%) achieved VL re-suppression. Predictors of re-suppression were age 50 to 64 (adjusted odds ratio (aOR): 2.02; p = 0.015) compared with age 18 to 34 years, being on second-line treatment (aOR: 3.29; p = 0.003) and two (aOR: 1.66; p = 0.045) or three (aOR: 1.86; p = 0.003) EAC sessions. Of 278 patients eligible to switch to second-line therapy, 120 (43.2%) had switched by the end of the study. Finally, of 155 successfully sequenced dried blood spots, 144 (92.9%) were from first-line patients. Of these, 133 (positive predictive value: 92.4%) had resistance patterns that necessitated treatment switching. CONCLUSIONS: Patients on ART with high VLs were more likely to re-suppress if they received EAC. Failure to re-suppress after counselling was predictive of genotypically confirmed resistance patterns requiring treatment switching. Delays in switching were significant despite the ability of the WHO algorithm to predict treatment failure. Despite significant progress in recent years, enhanced focus on quality care along the VL cascade in resource-limited settings is crucial.
56. Predicting, Diagnosing, and Treating Acute and Early HIV Infection in a Public Sector Facility in Eswatini.
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Kerschberger B, Aung A, Mpala Q, Ntshalintshali N, Mamba C, Schomaker M, Tombo ML, Maphalala G, Sibandze D, Dube L, Kashangura R, Mthethwa-Hleza S, Telnov A, Tour R, Gonzalez A, Calmy A, and Ciglenecki I
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- Acute Disease, Adult, Cross-Sectional Studies, Early Diagnosis, Eswatini epidemiology, Female, HIV Core Protein p24, Humans, Predictive Value of Tests, Public Sector, Sensitivity and Specificity, Time Factors, Anti-Retroviral Agents therapeutic use, HIV Antibodies blood, HIV Infections diagnosis, HIV Infections drug therapy, HIV-1 immunology
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Background: The lack of acute and early HIV infection (AEHI) diagnosis and care contributes to high HIV incidence in resource-limited settings. We aimed to assess the yield of AEHI, predict and diagnose AEHI, and describe AEHI care outcomes in a public sector setting in Eswatini., Setting: This study was conducted in Nhlangano outpatient department from March 2019 to March 2020., Methods: Adults at risk of AEHI underwent diagnostic testing for AEHI with the quantitative Xpert HIV-1 viral load (VL) assay. AEHI was defined as the detection of HIV-1 VL on Xpert and either an HIV-seronegative or HIV-serodiscordant third-generation antibody-based rapid diagnostic test (RDT) result. First, the cross-sectional analysis obtained the yield of AEHI and established a predictor risk score for the prediction of AEHI using Lasso logistic regression. Second, diagnostic accuracy statistics described the ability of the fourth-generation antibody/p24 antigen-based Alere HIV-Combo RDT to diagnose AEHI (vs Xpert VL testing). Third, we described acute HIV infection care outcomes of AEHI-positive patients using survival analysis., Results: Of 795 HIV-seronegative/HIV-serodiscordant outpatients recruited, 30 (3.8%, 95% confidence interval: 2.6% to 5.3%) had AEHI. The predictor risk score contained several factors (HIV-serodiscordant RDT, women, feeling at risk of HIV, swollen glands, and fatigue) and had sensitivity and specificity of 83.3% and 65.8%, respectively, to predict AEHI. The HIV-Combo RDT had sensitivity and specificity of 86.2% and 99.9%, respectively, to diagnose AEHI. Of 30 AEHI-positive patients, the 1-month cumulative treatment initiation was 74% (95% confidence interval: 57% to 88%), and the 3-month viral suppression (<1000 copies/mL) was 87% (67% to 98%)., Conclusion: AEHI diagnosis and care seem possible in resource-limited settings., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc.)
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- 2021
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57. Dissonance of Choice: Biomedical and Lived Perspectives on HIV Treatment-Taking.
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Horter S, Seeley J, Bernays S, Kerschberger B, Lukhele N, and Wringe A
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- Anthropology, Medical, Asymptomatic Infections therapy, Eswatini, Humans, Patient Acceptance of Health Care, Practice Guidelines as Topic, Qualitative Research, Clinical Decision-Making, HIV Infections therapy, Health Personnel
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Treat-all recommends prompt treatment initiation for those diagnosed HIV positive, requiring adaptations to individuals' behavior and practice. Drawing on data from a longitudinal qualitative study in Eswatini, we examine the choice to initiate treatment when asymptomatic, the dissonance between the biomedical logic surrounding Treat-all and individuals' conceptions of treatment necessity, and the navigation over time of ongoing engagement with care. We reflect on the perspectives of healthcare workers, responsible for implementing Treat-all and holding a duty of care for their patients. We explore how the potentially differing needs and priorities of individuals and the public health agenda are navigated and reconciled. Rationalities regarding treatment-taking extend beyond the biomedical realm, requiring adjustments to sense of self and identity, and decision-making that is situated and socially embedded. Sense of choice and ownership for this process is important for individuals' engagement with treatment and care.
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- 2020
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58. Field Suitability and Diagnostic Accuracy of the Biocentric Open Real-Time PCR Platform for Dried Blood Spot-Based HIV Viral Load Quantification in Eswatini.
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Kerschberger B, Ntshalintshali N, Mpala Q, Díaz Uribe PA, Maphalala G, Kalombola S, Telila AB, Chawinga T, Maphalala M, Jani A, Phugwayo N, de la Tour R, Nyoni N, Goiri J, Dlamini S, Ciglenecki I, and Fajardo E
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- Adult, Blood Specimen Collection, Dried Blood Spot Testing methods, Eswatini, Female, HIV-1 genetics, Humans, Male, RNA, Viral blood, Sensitivity and Specificity, Serologic Tests, HIV Infections blood, HIV Infections diagnosis, Plasma virology, Real-Time Polymerase Chain Reaction methods, Viral Load methods
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Background: To assess the performance and suitability of dried blood spot (DBS) sampling using filter paper to collect blood for viral load (VL) quantification under routine conditions., Methods: We compared performance of DBS VL quantification using the Biocentric method with plasma VL quantification using Roche and Biocentric as reference methods. Adults (≥18 years) were enrolled at 2 health facilities in Eswatini from October 12, 2016 to March 1, 2017. DBS samples were prepared through finger-prick by a phlebotomist (DBS-1), and through the pipetting of whole venous blood by a phlebotomist (DBS-2) and by a laboratory technologist (DBS-3). We calculated the VL-testing completion rate, correlation, and agreement, as well as diagnostic accuracy estimates at the clinical threshold of 1000 copies/mL., Results: Of 362 patients enrolled, 1066 DBS cards (DBS-1: 347; DBS-2: 359; DBS-3: 360) were tested. Overall, test characteristics were comparable between DBS-sampling methods, irrespective of the reference method. The Pearson correlation coefficients ranged from 0.67 to 0.82 (P < 0.001) for different types of DBS sampling using both reference methods, and the Bland-Altman difference ranged from 0.15 to 0.30 log10 copies/mL. Sensitivity estimates were from 85.3% to 89.2% and specificity estimates were from 94.5% to 98.6%. The positive predictive values were between 87.0% and 96.5% at a prevalence of 30% VL elevations, and negative predictive values were between 93.7% and 95.4%., Conclusions: DBS VL quantification using the newly configured Biocentric method can be part of contextualized VL-testing strategies, particularly for remote settings and populations with higher viral failure rates.
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- 2019
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59. "Is it making any difference?" A qualitative study examining the treatment-taking experiences of asymptomatic people living with HIV in the context of Treat-all in Eswatini.
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Horter S, Wringe A, Thabede Z, Dlamini V, Kerschberger B, Pasipamire M, Lukhele N, Rusch B, and Seeley J
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- Adult, Eswatini, Female, HIV Infections diagnosis, HIV Infections virology, HIV-1 drug effects, HIV-1 genetics, HIV-1 isolation & purification, HIV-1 physiology, Humans, Longitudinal Studies, Male, Middle Aged, Qualitative Research, Viral Load drug effects, Anti-HIV Agents administration & dosage, Asymptomatic Diseases therapy, HIV Infections drug therapy
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Introduction: Treat-all is being implemented in several African settings, in accordance with 2015 World Health Organisation guidelines. The factors known to undermine adherence to antiretroviral therapy (ART) may change in the context of Treat-all, where people living with HIV (PLHIV) increasingly initiate ART at earlier, asymptomatic stages of disease, soon after diagnosis. This paper aimed to examine the asymptomatic PLHIV's experiences engaging with early ART initiation under the Treat-all policy, including how they navigate treatment-taking over the longer term., Methods: A longitudinal qualitative study was conducted within a Médecins Sans Frontières/Ministry of Health Treat-all pilot in Shiselweni, southern Eswatini. The Treat-all pilot began in October 2014, adopted into national policy in October 2016. Participants were recruited purposively to include newly diagnosed, clinically asymptomatic PLHIV with a range of treatment-taking experiences, and healthcare workers (HCW) with various roles. This analysis drew upon a sub-sample of 17 PLHIV who had been on ART for at least 12 months, with mean 20 months on ART at first interview, and who undertook three interviews each. Additionally, 20 HCWs were interviewed once. Interviews were conducted from August 2016 to September 2017. Data were analysed thematically using coding, drawing upon principles of grounded theory, and aided by Nvivo 11., Results: It was important for PLHIV to perceive the need for treatment, and to have evidence of its effectiveness to motivate their treatment-taking, thereby supporting engagement with care. For some, coming to terms with a HIV diagnosis or re-interpreting past illnesses as signs of HIV could point to the need for ART to prevent health deterioration and prolong life. However, others doubted the accuracy of an HIV diagnosis and the need for treatment in the absence of symptoms or signs of ill health, with some experimenting with treatment-taking as a means of seeking evidence of their need for treatment and its effect. Viral load monitoring appeared important in offering a view of the effect of treatment on the level of the virus, thereby motivating continued treatment-taking., Conclusions: These findings highlight the importance of PLHIV perceiving need for treatment and having evidence of the difference that ART is making to them for motivating treatment-taking. Patient support should be adapted to address these concerns, and viral load monitoring made routinely available within Treat-all care, with communication of suppressed results emphasized to patients., (© 2019 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society.)
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- 2019
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60. Implementation and Operational Research: Barriers and Facilitators to Combined ART Initiation in Pregnant Women With HIV: Lessons Learnt From a PMTCT B+ Pilot Program in Swaziland.
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Parker LA, Jobanputra K, Okello V, Nhlangamandla M, Mazibuko S, Kourline T, Kerschberger B, Pavlopoulos E, and Teck R
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- Adolescent, Adult, Cohort Studies, Eswatini, Female, HIV Infections prevention & control, HIV Infections transmission, Humans, Infectious Disease Transmission, Vertical prevention & control, Middle Aged, Pregnancy, Prospective Studies, Young Adult, Anti-Retroviral Agents administration & dosage, Antiretroviral Therapy, Highly Active, HIV Infections drug therapy, Pregnancy Complications, Infectious drug therapy
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Background: In January 2013, Swaziland launched a prevention of mother-to-child transmission of HIV (PMTCT) B+ implementation study in rural Shiselweni. We aimed to identify patient and health service determinants of combined antiretroviral therapy (ART) initiation to help guide national implementation of PMTCT B+., Methods: This prospective cohort study uses routine data from registers and patient files in the PMTCT B+ pilot zone and a neighboring health zone where PMTCT A was the standard of care. All HIV-positive women not on combined ART at the first antenatal care visit between January 28, 2013 and December 31, 2013 were included., Results: 399 women from the PMTCT B+ zone and 183 from the PMTCT A zone are included. The overall proportion of women who had not started an antiretroviral intervention before 32 weeks' gestation was lower in the PMTCT A zone (13% vs 25%, P = 0.003), yet a higher proportion women with CD4 <350 initiated combined ART in the PMTCT B+ zone (86% vs 74%, P = 0.032). Within the PMTCT B+ pilot, initiation rates were highly variable between health facilities; while at patient level, ART initiation was significantly higher among women with CD4 <350 compared with CD4 >350 (80% vs 59%, P < 0.001). Among women with CD4 <350, those recorded as newly diagnosed were more likely to initiate combined ART. Although lower educational level and occupational barriers seemed to hinder combined ART initiation among women with CD4 >350, high proportions of missing socio-demographic data made it impossible to make any firm conclusions to this respect., Conclusions: This study not only demonstrates challenges in initiating pregnant women on ART, but also identifies opportunities offered by PMTCT B+ for improving treatment initiation among women with lower CD4 counts.
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- 2015
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61. Impact and programmatic implications of routine viral load monitoring in Swaziland.
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Jobanputra K, Parker LA, Azih C, Okello V, Maphalala G, Jouquet G, Kerschberger B, Mekeidje C, Cyr J, Mafikudze A, Han W, Lujan J, Teck R, Antierens A, van Griensven J, and Reid T
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- Adolescent, Adult, CD4 Lymphocyte Count, Child, Cohort Studies, Cost-Benefit Analysis, Counseling, Eswatini, Female, HIV Infections economics, Humans, Male, Medication Adherence, Retrospective Studies, Statistics, Nonparametric, Viral Load, Young Adult, Anti-HIV Agents administration & dosage, HIV Infections drug therapy, HIV Infections virology, HIV-1 isolation & purification
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Objective: To assess the programmatic quality (coverage of testing, counseling, and retesting), cost, and outcomes (viral suppression, treatment decisions) of routine viral load (VL) monitoring in Swaziland., Design: Retrospective cohort study of patients undergoing routine VL monitoring in Swaziland (October 1, 2012 to March 31, 2013)., Results: Of 5563 patients eligible for routine VL testing monitoring in the period of study, an estimated 4767 patients (86%) underwent testing that year. Of 288 patients with detectable VL, 210 (73%) underwent enhanced adherence counseling and 202 (70%) had a follow-up VL within 6 months. Testing coverage was slightly lower in children, but coverage of retesting was similar between and age groups and sexes. Of those with a follow-up test, 126 (62%) showed viral suppression. The remaining 78 patients had World Health Organization-defined virologic failure; 41 (53%) were referred by the doctor for more adherence counseling, and 13 (15%) were changed to second-line therapy, equating to an estimated rate of 1.2 switches per 100 patient-years. Twenty-four patients (32%) were transferred out, lost to follow-up, or not reviewed by doctor. The "fully loaded" cost of VL monitoring was $35 per patient-year., Conclusions: Achieving good quality VL monitoring is feasible and affordable in resource-limited settings, although close supervision is needed to ensure good coverage of testing and counseling. The low rate of switch to second-line therapy in patients with World Health Organization-defined virologic failure seems to reflect clinician suspicion of ongoing adherence problems. In our study, the main impact of routine VL monitoring was reinforcing adherence rather than increasing use of second-line therapy.
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- 2014
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62. Time to initiation of antiretroviral therapy among patients with HIV-associated tuberculosis in Cape Town, South Africa.
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Lawn SD, Campbell L, Kaplan R, Boulle A, Cornell M, Kerschberger B, Morrow C, Little F, Egger M, and Wood R
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- AIDS-Related Opportunistic Infections epidemiology, Adolescent, Adult, Anti-HIV Agents therapeutic use, Antitubercular Agents therapeutic use, CD4 Lymphocyte Count, Cohort Studies, Female, HIV Infections epidemiology, Humans, Male, Middle Aged, South Africa epidemiology, Time Factors, Tuberculosis drug therapy, Tuberculosis epidemiology, Young Adult, AIDS-Related Opportunistic Infections drug therapy, Anti-HIV Agents administration & dosage, HIV Infections complications, HIV Infections drug therapy, Tuberculosis complications
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We studied the time interval between starting tuberculosis treatment and commencing antiretroviral treatment (ART) in HIV-infected patients (n = 1433; median CD4 count 71 cells per microliter, interquartile range: 32-132) attending 3 South African township ART services between 2002 and 2008. The overall median delay was 2.66 months (interquartile range: 1.58-4.17). In adjusted analyses, delays varied between treatment sites but were shorter for patients with lower CD4 counts and those treated in more recent calendar years. During the most recent period (2007-2008), 4.7%, 19.7%, and 51.1% of patients started ART within 2, 4, and 8 weeks of tuberculosis treatment, respectively. Operational barriers must be tackled to permit further acceleration of ART initiation as recommended by 2010 WHO ART guidelines.
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- 2011
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