1,147 results on '"Boulle, Andrew"'
Search Results
202. MOESM2 of A systematic review of qualitative evidence on factors enabling and deterring uptake of HIV self-testing in Africa
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Njau, Bernard, Covin, Christopher, Lisasi, Esther, Damian, Damian, Declare Mushi, Boulle, Andrew, and Mathews, Catherine
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Additional file 2: Data extraction form: Qualitative studies
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- 2019
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203. Additional file 1: of The effects of add-on corticosteroids on renal outcomes in patients with biopsy proven HIV associated nephropathy: a single centre study from South Africa
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Wearne, Nicola, Swanepoel, Charles, Duffield, Maureen, Davidson, Bianca, Manning, Kathryn, Tiffin, Nicki, Boulle, Andrew, Rayner, Brian, Naidu, Priyanka, and Ikechi Okpechi
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Table S1. CD4 count values and viral load non-suppression between baseline and 24â months. (DOCX 30 kb)
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- 2019
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204. A comparison of death recording by health centres and civil registration in south Africans receiving antiretroviral treatment
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Johnson, Leigh F., Dorrington, Rob E., Laubscher, Ria, Hoffmann, Christopher J., Wood, Robin, Fox, Matthew P., Cornell, Morna, Schomaker, Michael, Prozesky, Hans, Tanser, Frank, Davies, Mary-Ann, and Boulle, Andrew
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Mortality -- Analysis -- Research -- Risk factors -- South Africa ,Highly active antiretroviral therapy -- Analysis -- Research -- Health aspects ,HIV infections -- Research -- Care and treatment -- Complications and side effects ,Medical records -- Analysis -- Usage ,Health - Abstract
Introduction: There is uncertainty regarding the completeness of death recording by civil registration and by health centres in South Africa. This paper aims to compare death recording by the two systems, in cohorts of South African patients receiving antiretroviral treatment (ART). Methods: Completeness of death recording was estimated using a capture-recapture approach. Six ART programmes linked their patient record systems to the vital registration system using civil identity document (ID) numbers and provided data comparing the outcomes recorded in patient files and in the vital registration. Patients were excluded if they had missing/invalid IDs or had transferred to other ART programmes. Results: After exclusions, 91,548 patient records were included. Of deaths recorded in patients files after 2003, 94.0% (95% CI: 93.3-94.6%) were recorded by civil registration, with completeness being significantly higher in urban areas, older adults and females. Of deaths recorded by civil registration after 2003, only 35.0% (95% CI: 34.2-35.8%) were recorded in patient files, with this proportion dropping from 60% in 2004-2005 to 30% in 2010 and subsequent years. Recording of deaths in patient files was significantly higher in children and in locations within 50 km of the health centre. When the information from the two systems was combined, an estimated 96.2% of all deaths were recorded (93.5% in children and 96.2% in adults). Conclusions: South Africa's civil registration system has achieved a high level of completeness in the recording of mortality. However, the fraction of deaths recorded by health centres is low and information from patient records is insufficient by itself to evaluate levels and predictors of ART patient mortality. Previously documented improvements in ART mortality over time may be biased if based only on data from patient records. Keywords: antiretroviral therapy; HIV; vital statistics registration; South Africa. To access the supplementary material to this article please see Supplementary Files under Article Tools online., Introduction Antiretroviral treatment (ART) has had a significant impact on AIDS mortality in developing countries [1-4]. However, most of what is known regarding mortality after ART initiation in developing countries [...]
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- 2015
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205. Commentary: Factors affecting HIV/AIDS-related stigma and discrimination by medical professionals
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Deacon, Harriet and Boulle, Andrew
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- 2007
206. Antiretroviral therapy in resource-poor settings: scaling up inequalities?
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Egger, Matthias, Boulle, Andrew, Schechter, Mauro, and Miotti, Paolo
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- 2005
207. Promoting adherence to antiretroviral therapy: the experience from a primary care setting in Khayelitsha, South Africa
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Coetzee, David, Boulle, Andrew, Hildebrand, Katherine, Asselman, Valerie, Van Cutsem, Gilles, and Goemaere, Eric
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- 2004
208. Outcomes after two years of providing antiretroviral treatment in Khayelitsha, South Africa
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Coetzee, David, Hildebrand, Katherine, Boulle, Andrew, Maartens, Gary, Louis, Francoise, Labatala, Veliswa, Reuter, Hermann, Ntwana, Nonthutuzelo, and Goemaere, Eric
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- 2004
209. The Nervous System Effects of Occupational Exposure on Workers in a South African Manganese Smelter
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Myers, Jonathan E, Thompson, Mary Lou, Ramushu, Suzan, Young, Taryn, Jeebhay, Mohamed F, London, Leslie, Esswein, Eric, Renton, Kevin, Spies, Adri, Boulle, Andrew, Naik, Inakshi, Iregren, Anders, and Rees, David J
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- 2003
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210. A case study of using artificial neural networks for classifying cause of death from verbal autopsy
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Boulle, Andrew, Chandramohan, Daniel, and Weller, Peter
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- 2001
211. Temporal trends in TB notification rates during ART scale‐up in Cape Town: an ecological analysis
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Hermans, Sabine, Boulle, Andrew, Caldwell, Judy, Pienaar, David, and Wood, Robin
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Cape Town, South Africa -- Health aspects ,Highly active antiretroviral therapy -- Statistics ,Tuberculosis -- Statistics -- Risk factors ,HIV infection -- Statistics -- Drug therapy -- Educational aspects -- Risk factors ,Health - Abstract
Introduction: Although antiretroviral therapy (ART) reduces individual tuberculosis (TB) risk by two‐thirds, the population‐level impact remains uncertain. Cape Town reports high TB notification rates associated with endemic HIV. We examined population trends in TB notification rates during a 10‐year period of expanding ART. Methods: Annual Cape Town TB notifications were used as numerators and mid‐year Cape Town populations as denominators. HIV‐stratified population was calculated using overall HIV prevalence estimates from the Actuarial Society of South Africa AIDS and Demographic model. ART provision numbers from Western Cape government reports were used to calculate overall ART coverage. We calculated rates per 100,000 population over time, overall and stratified by HIV status. Rates per 100,000 total population were also calculated by ART use at treatment initiation. Absolute numbers of notifications were compared by age and sub‐district. Changes over time were described related to ART provision in the city as a whole (ART coverage) and by sub‐district (numbers on ART). Results: From 2003 to 2013, Cape Town's population grew from 3.1 to 3.7 million inhabitants, and estimated HIV prevalence increased from 3.6 to 5.2%. ART coverage increased from 0 to 63% in 2013. TB notification rates declined by 16% (95% confidence interval (CI), 14–17%) from a 2008 peak (851/100,000) to a 2013 nadir (713/100,000). Decreases were higher among the HIV‐positive (21% (95% CI, 19–23%)) than the HIV‐negative (9% (95% CI, 7–11%)) population. The number of HIV‐positive TB notifications decreased mainly among 0‐ to 4‐ and 20‐ to 34‐year‐olds. Total population rates on ART at TB treatment initiation increased over time but levelled off in 2013. Overall median CD4 counts increased from 146 cells/µl (interquartile range (IQR), 66, 264) to 178 cells/µl (IQR 75, 330; p Conclusions: HIV‐positive TB notification rates declined during a period of rapid scale‐up of ART. Nevertheless, both HIV‐positive and HIV‐negative TB notification rates remained very high. Decreases among HIV positives were likely blunted by TB remaining a major entry to the ART programme and occurring after delayed ART initiation., Introduction Antiretroviral therapy (ART) reduces the individual tuberculosis (TB) risk by two‐thirds [1]. This reduction is time‐ and CD4+ T‐cell (CD4) count‐dependent, however [2]. The TB risk is highest at [...]
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- 2015
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212. Superior virologic and treatment outcomes when viral load is measured at 3 months compared to 6 months on antiretroviral therapy
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Kerschberger, Bernhard, Boulle, Andrew M., Kranzer, Katharina, Hilderbrand, Katherine, Schomaker, Michael, Coetzee, David, Goemaere, Eric, and Van Cutsem, Gilles
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Viral load -- Research ,Antiretroviral agents -- Analysis -- Measurement -- Health aspects -- Research ,Health - Abstract
Introduction: Routine viral load (VL) monitoring is utilized to assess antiretroviral therapy (ART) adherence and virologic failure, and it is currently scaled-up in many resource-constrained settings. The first routine VL is recommended as late as six months after ART initiation for early detection of sub-optimal adherence. We aimed to assess the optimal timing of first VL measurement after initiation of ART. Methods: This was a retrospective, cohort analysis of routine monitoring data of adults enrolled at three primary care clinics in Khayelitsha, Cape Town, between January 2002 and March 2009. Primary outcomes were virologic failure and switch to secondline ART comparing patients in whom first VL done was at three months (VL3M) and six months (VL6M) after ART initiation. Adjusted hazard ratios (aHR) were estimated using Cox proportional hazard models. Results: In total, 6264 patients were included for the time to virologic failure and 6269 for the time to switch to second-line ART analysis. Patients in the VL3M group had a 22% risk reduction of virologic failure (aHR 0.78, 95% CI 0.64-0.95; p = 0.016) and a 27% risk reduction of switch to second-line ART (aHR 0.73, 95% CI 0.58-0.92; p = 0.008) when compared to patients in the VL6M group. For each additional month of delay of the first VL measurement (up to nine months), the risk of virologic failure increased by 9% (aHR 1.09, 95% CI 1.02-1.15; p =0.008) and switch to second-line ART by 13% (aHR 1.13, 95% CI 1.05-1.21; p < 0.001). Conclusions: A first VL at three months rather than six months with targeted adherence interventions for patients with high VL may improve long-term virologic suppression and reduce switches to costly second-line ART. ART programmes should consider the first VL measurement at three months after ART initiation. Keywords: viral load; HIV; treatment switching; virologic failure., Introduction An estimated 32.6 million people live with HIV/AIDS worldwide and 11.7 million received antiretroviral treatment (ART) in middle- and low-income countries in 2013 [1]. Antiretroviral treatment is effective [2] [...]
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- 2015
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213. High Rates of Recurrent Tuberculosis Disease: A Population-level Cohort Study.
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Hermans, Sabine M, Zinyakatira, Nesbert, Caldwell, Judy, Cobelens, Frank G J, Boulle, Andrew, and Wood, Robin
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TUBERCULOSIS epidemiology ,DRUG therapy for tuberculosis ,TUBERCULOSIS risk factors ,HIV infections ,CONFIDENCE intervals ,HEALTH status indicators ,DISEASE incidence ,REINFECTION ,DISEASE relapse ,RISK assessment ,DESCRIPTIVE statistics ,ANTITUBERCULAR agents ,LONGITUDINAL method ,PROBABILITY theory ,DISEASE complications - Abstract
Background Retreatment tuberculosis (TB) disease is common in high-prevalence settings. The risk of repeated episodes of recurrent TB is unknown. We calculated the rate of recurrent TB per subsequent episode by matching individual treatment episodes over a period of 13 years. Methods All recorded TB episodes in Cape Town between 2003 and 2016 were matched by probabilistic linkage of personal identifiers. Among individuals with a first episode notified in Cape Town and who completed their prior treatment successfully we estimated the recurrence rate stratified by subsequent episode and HIV status. We adjusted person-time to background mortality by age, sex, and HIV status. Results A total of 292 915 TB episodes among 263 848 individuals were included. The rate of recurrent TB was 16.4 per 1000 person-years (95% CI, 16.2–16.6), and increased per subsequent episode (8.4-fold increase, from 14.6 to 122.7 per 1000 from episode 2 to 6, respectively). These increases were similar stratified by HIV status. Rates among HIV positives were higher than among HIV negatives for episodes 2 and 3 (2- and 1.5-fold higher, respectively), and the same thereafter. Conclusions TB recurrence rates were high and increased per subsequent episode, independent of HIV status. This suggests that HIV infection is insufficient to explain the high burden of recurrence; it is more likely due to a high annual risk of infection combined with an increased risk of infection or progression to disease associated with a previous TB episode. The very high recurrence rates would justify increased TB surveillance of patients with >1 episode. [ABSTRACT FROM AUTHOR]
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- 2021
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214. High yield of culture-based diagnosis in a TB-endemic setting
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Demers Anne-Marie, Verver Suzanne, Boulle Andrew, Warren Robin, van Helden Paul, Behr Marcel A, and Coetzee David
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Tuberculosis ,Diagnosis ,Culture ,Microscopy ,Infectious and parasitic diseases ,RC109-216 - Abstract
Abstract Background In most of the world, microbiologic diagnosis of tuberculosis (TB) is limited to microscopy. Recent guidelines recommend culture-based diagnosis where feasible. Methods In order to evaluate the relative and absolute incremental diagnostic yield of culture-based diagnosis in a high-incidence community in Cape Town, South Africa, subjects evaluated for suspected TB had their samples processed for microscopy and culture over a 21 month period. Results For 2537 suspect episodes with 2 smears and 2 cultures done, 20.0% (508) had at least one positive smear and 29.9% (760) had at least one positive culture. One culture yielded 1.8 times more cases as 1 smear (relative yield), or an increase of 12.0% (absolute yield). Based on the latter value, the number of cultures needed to diagnose (NND) one extra case of TB was 8, compared to 19 if second specimens were submitted for microscopy. Conclusion In a high-burden setting, the introduction of culture can markedly increase TB diagnosis over microscopy. The concept of number needed to diagnose can help in comparing incremental yield of diagnosis methods. Although new promising diagnostic molecular methods are being implemented, TB culture is still the gold standard.
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- 2012
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215. Elevation and cholera: an epidemiological spatial analysis of the cholera epidemic in Harare, Zimbabwe, 2008-2009
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Luque Fernandez Miguel A, Schomaker Michael, Mason Peter R, Fesselet Jean F, Baudot Yves, Boulle Andrew, and Maes Peter
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Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background In highly populated African urban areas where access to clean water is a challenge, water source contamination is one of the most cited risk factors in a cholera epidemic. During the rainy season, where there is either no sewage disposal or working sewer system, runoff of rains follows the slopes and gets into the lower parts of towns where shallow wells could easily become contaminated by excretes. In cholera endemic areas, spatial information about topographical elevation could help to guide preventive interventions. This study aims to analyze the association between topographic elevation and the distribution of cholera cases in Harare during the cholera epidemic in 2008 and 2009. Methods We developed an ecological study using secondary data. First, we described attack rates by suburb and then calculated rate ratios using whole Harare as reference. We illustrated the average elevation and cholera cases by suburbs using geographical information. Finally, we estimated a generalized linear mixed model (under the assumption of a Poisson distribution) with an Empirical Bayesian approach to model the relation between the risk of cholera and the elevation in meters in Harare. We used a random intercept to allow for spatial correlation of neighboring suburbs. Results This study identifies a spatial pattern of the distribution of cholera cases in the Harare epidemic, characterized by a lower cholera risk in the highest elevation suburbs of Harare. The generalized linear mixed model showed that for each 100 meters of increase in the topographical elevation, the cholera risk was 30% lower with a rate ratio of 0.70 (95% confidence interval=0.66-0.76). Sensitivity analysis confirmed the risk reduction with an overall estimate of the rate ratio between 20% and 40%. Conclusion This study highlights the importance of considering topographical elevation as a geographical and environmental risk factor in order to plan cholera preventive activities linked with water and sanitation in endemic areas. Furthermore, elevation information, among other risk factors, could help to spatially orientate cholera control interventions during an epidemic.
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- 2012
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216. Mean CD4 cell count changes in patients failing a first-line antiretroviral therapy in resource-limited settings
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Calmy Alexandra, Balestre Eric, Bonnet Fabrice, Boulle Andrew, Sprinz Eduardo, Wood Robin, Delaporte Eric, Messou Eugène, McIntyre James, El Filali Kamal, Schechter Mauro, Kumarasamy N, Bangsberg David, McPhail Patrick, Van Der Borght Stefaan, Zala Carlos, Egger Matthias, Thiébaut Rodolphe, and Dabis François
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HIV-1 ,CD4 count ,CD4 slope ,HIV-RNA threshold ,Resource limited settings ,Infectious and parasitic diseases ,RC109-216 - Abstract
Abstract Background Changes in CD4 cell counts are poorly documented in individuals with low or moderate-level viremia while on antiretroviral treatment (ART) in resource-limited settings. We assessed the impact of on-going HIV-RNA replication on CD4 cell count slopes in patients treated with a first-line combination ART. Method Naïve patients on a first-line ART regimen with at least two measures of HIV-RNA available after ART initiation were included in the study. The relationships between mean CD4 cell count change and HIV-RNA at 6 and 12 months after ART initiation (M6 and M12) were assessed by linear mixed models adjusted for gender, age, clinical stage and year of starting ART. Results 3,338 patients were included (14 cohorts, 64% female) and the group had the following characteristics: a median follow-up time of 1.6 years, a median age of 34 years, and a median CD4 cell count at ART initiation of 107 cells/μL. All patients with suppressed HIV-RNA at M12 had a continuous increase in CD4 cell count up to 18 months after treatment initiation. By contrast, any degree of HIV-RNA replication both at M6 and M12 was associated with a flat or a decreasing CD4 cell count slope. Multivariable analysis using HIV-RNA thresholds of 10,000 and 5,000 copies confirmed the significant effect of HIV-RNA on CD4 cell counts both at M6 and M12. Conclusion In routinely monitored patients on an NNRTI-based first-line ART, on-going low-level HIV-RNA replication was associated with a poor immune outcome in patients who had detectable levels of the virus after one year of ART.
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- 2012
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217. Assessing the association between changing NRTIs when initiating second-line ART and treatment outcomes
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Rohr, Julia K, Ive, Prudence, Horsburgh, C Robert, Berhanu, Rebecca, Hoffmann, Christopher J, Wood, Robin, Boulle, Andrew, Giddy, Janet, Prozesky, Hans, Vinikoor, Michael, Mwanza, Mwanza Wa, Wandeler, Gilles, Davies, Mary-Ann, and Fox, Matthew P
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Adult ,Male ,Adolescent ,Anti-HIV Agents ,Zambia ,610 Medicine & health ,HIV Infections ,Article ,South Africa ,Young Adult ,360 Social problems & social services ,immune system diseases ,Antiretroviral Therapy, Highly Active ,Humans ,Aged ,Aged, 80 and over ,Salvage Therapy ,virus diseases ,Middle Aged ,Viral Load ,CD4 Lymphocyte Count ,Treatment Outcome ,Reverse Transcriptase Inhibitors ,Female - Abstract
BACKGROUND After first-line antiretroviral therapy (ART) failure, the importance of change in nucleoside reverse transcriptase inhibitor (NRTI) in second-line is uncertain due to the high potency of protease inhibitors used in second-line. SETTING We used clinical data from 6,290 adult patients in South Africa and Zambia from the International Epidemiologic Databases to Evaluate AIDS-Southern Africa cohort. METHODS We included patients who initiated on standard first-line ART and had evidence of first-line failure. We used propensity score-adjusted Cox proportional hazards models to evaluate the impact of change in NRTI on second-line failure compared to remaining on the same NRTI in second-line. In South Africa, where viral load monitoring was available, treatment failure was defined as two consecutive viral loads >1,000 copies/mL. In Zambia, it was defined as two consecutive CD4 counts
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- 2018
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218. Decreased risk of HIV‐associated TB during antiretroviral therapy expansion in rural Eswatini from 2009 to 2016: a cohort and population‐based analysis
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Kerschberger, Bernhard, primary, Schomaker, Michael, additional, Telnov, Alex, additional, Vambe, Debrah, additional, Kisyeri, Nicholas, additional, Sikhondze, Welile, additional, Pasipamire, Lorraine, additional, Ngwenya, Siphiwe Mavis, additional, Rusch, Barbara, additional, Ciglenecki, Iza, additional, and Boulle, Andrew, additional
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- 2019
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219. Effect of HIV Infection and Antiretroviral Treatment on Pregnancy Rates in the Western Cape Province of South Africa
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Johnson, Leigh F, primary, Mutemaringa, Themba, primary, Heekes, Alexa, primary, and Boulle, Andrew, primary
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- 2019
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220. The impact of delayed switch to second-line antiretroviral therapy on mortality, depending on failure time definition and CD4 count at failure
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Bell-Gorrod, Helen, primary, Fox, Matthew P, additional, Boulle, Andrew, additional, Prozesky, Hans, additional, Wood, Robin, additional, Tanser, Frank, additional, Davies, Mary-Ann, additional, and Schomaker, Michael, additional
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- 2019
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221. Peer Mentorship via Mobile Phones for Newly Diagnosed HIV-Positive Youths in Clinic Care in Khayelitsha, South Africa: Mixed Methods Study (Preprint)
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Hacking, Damian, primary, Mgengwana-Mbakaza, Zodwa, additional, Cassidy, Tali, additional, Runeyi, Pumeza, additional, Duran, Laura Trivino, additional, Mathys, Ruth Henwood, additional, and Boulle, Andrew, additional
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- 2019
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222. Programmatic outcomes and impact of rapid public sector antiretroviral therapy expansion in adults prior to introduction of the WHO treat‐all approach in rural Eswatini
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Kerschberger, Bernhard, primary, Schomaker, Michael, additional, Ciglenecki, Iza, additional, Pasipamire, Lorraine, additional, Mabhena, Edwin, additional, Telnov, Alex, additional, Rusch, Barbara, additional, Lukhele, Nomthandazo, additional, Teck, Roger, additional, and Boulle, Andrew, additional
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- 2019
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223. The Continuing Value of CD4 Cell Count Monitoring for Differential HIV Care and Surveillance
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Rice, Brian, primary, Boulle, Andrew, additional, Schwarcz, Sandra, additional, Shroufi, Amir, additional, Rutherford, George, additional, and Hargreaves, James, additional
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- 2019
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224. Stock-outs of antiretroviral and tuberculosis medicines in South Africa: A national cross-sectional survey
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Hwang, Bella, primary, Shroufi, Amir, additional, Gils, Tinne, additional, Steele, Sarah Jane, additional, Grimsrud, Anna, additional, Boulle, Andrew, additional, Yawa, Anele, additional, Stevenson, Sasha, additional, Jankelowitz, Lauren, additional, Versteeg-Mojanaga, Marije, additional, Govender, Indira, additional, Stephens, John, additional, Hill, Julia, additional, Duncan, Kristal, additional, and van Cutsem, Gilles, additional
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- 2019
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225. Reduced referral and case fatality rates for severe symptomatic hyperlactataemia in a South African public sector antiretroviral programme: a retrospective observational study
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Stead Dave, Boulle Andrew, Schutz Charlotte, Rebe Kevin, Osler Meg, and Meintjes Graeme
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Immunologic diseases. Allergy ,RC581-607 - Abstract
Abstract Background Interventions to promote prevention and earlier diagnosis of severe symptomatic hyperlactataemia (SHL) were implemented in the Western Cape provincial antiretroviral programme (South Africa) from 2004. Interventions included clinician education, point-of-care lactate meters, switch from stavudine to zidovudine in high risk patients and stavudine dose reduction. This study assessed trends in referral rate, severity at presentation and case fatality rate for severe SHL. Methods Retrospective study of severe SHL cases diagnosed at a referral facility from 1 January 2003 to 31 December 2008. Severe SHL was defined as patients with compatible symptoms and serum lactate ≥ 5 mmol/l attributable to antiretroviral therapy (ART). Cumulative ART exposure at referring ART clinics was used to calculate referral rates. Results There were 254 severe SHL cases. The referral rate (per thousand patient years [py] ART exposure) peaked in 2005 (20.4/1000py), but fell to 1.3/1000py by 2008 (incidence rate ratio [IRR] = 0.07, 95%CI 0.04-0.11). In 2003, 66.7% of cases presented with a standard bicarbonate (SHCO3) level Conclusions These trends suggest the interventions were associated with reduced referral, less severe metabolic acidosis at presentation and improved survival.
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- 2010
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226. Adherence to antiretroviral therapy in young children in Cape Town, South Africa, measured by medication return and caregiver self-report: a prospective cohort study
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Nuttall James, Fakir Tanzeem, Boulle Andrew, Davies Mary-Ann, and Eley Brian
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Pediatrics ,RJ1-570 - Abstract
Abstract Background Antiretroviral therapy (ART) dramatically improves outcomes for children in Africa; however excellent adherence is required for treatment success. This study describes the utility of different measures of adherence in detecting lapses in infants and young children in Cape Town, South Africa. Methods In a prospective cohort of 122 HIV-infected children commenced on ART, adherence was measured monthly during the first year of treatment by medication return (MR) for both syrups and tablets/capsules. A questionnaire was administered to caregivers after 3 months of treatment to assess experience with giving medication and self-reported adherence. Viral and immune response to treatment were assessed at the end of one year and associations with measured adherence determined. Results Medication was returned for 115/122 (94%) children with median age (IQR) of 37 (16 – 61) months. Ninety-one (79%) children achieved annual average MR adherence ≥ 90%. This was an important covariate associated with viral suppression after adjustment for disease severity (OR = 5.5 [95%CI: 0.8–35.6], p = 0.075), however was not associated with immunological response to ART. By 3 months on ART, 13 (10%) children had deceased and 11 (10%) were lost to follow-up. Questionnaires were completed by 87/98 (90%) of caregivers of those who remained in care. Sensitivity of poor reported adherence (missing ≥ 1 dose in the previous 3 days) for MR adherence Conclusion Excellent adherence to ART is possible in African infants and young children and the relatively simple low technology measure of adherence by MR strongly predicts viral response. Better socio-economic status and more palatable regimens are associated with better adherence.
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- 2008
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227. Streamlining tasks and roles to expand treatment and care for HIV: randomised controlled trial protocol
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van Vuuren Cloete, Uebel Kerry, Lombard Carl J, Zwarenstein Merrick F, Bachmann Max O, Fairall Lara R, Steyn Dewald, Boulle Andrew, and Bateman Eric D
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Medicine (General) ,R5-920 - Abstract
Abstract Background A major barrier to accessing free government-provided antiretroviral treatment (ART) in South Africa is the shortage of suitably skilled health professionals. Current South African guidelines recommend that only doctors should prescribe ART, even though most primary care is provided by nurses. We have developed an effective method of educational outreach to primary care nurses in South Africa. Evidence is needed as to whether primary care nurses, with suitable training and managerial support, can initiate and continue to prescribe and monitor ART in the majority of ART-eligible adults. Methods/design This is a protocol for a pragmatic cluster randomised trial to evaluate the effectiveness of a complex intervention based on and supporting nurse-led antiretroviral treatment (ART) for South African patients with HIV/AIDS, compared to current practice in which doctors are responsible for initiating ART and continuing prescribing. We will randomly allocate 31 primary care clinics in the Free State province to nurse-led or doctor-led ART. Two groups of patients aged 16 years and over will be included: a) 7400 registering with the programme with CD4 counts of ≤ 350 cells/mL (mainly to evaluate treatment initiation) and b) 4900 already receiving ART (to evaluate ongoing treatment and monitoring). The primary outcomes will be time to death (in the first group) and viral suppression (in the second group). Patients' survival, viral load and health status indicators will be measured at least 6-monthly for at least one year and up to 2 years, using an existing province-wide clinical database linked to the national death register. Trial registration Controlled Clinical Trials ISRCTN46836853
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- 2008
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228. Mortality in patients with HIV-1 infection starting antiretroviral therapy in south Africa, Europe, or North America: a collaborative analysis of prospective studies
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Boulle, Andrew, Schomaker, Michael, May, Margaret T., Hogg, Robert S., Shepherd, Bryan E., Monge, Susana, Keiser, Olivia, Lampe, Fiona C., Giddy, Janet, Ndirangu, James, Garone, Daniela, Fox, Matthew, Ingle, Suzanne M., Reiss, Peter, Dabis, Francois, Costagliola, Dominique, Castagna, Antonella, Ehren, Kathrin, Campbell, Colin, Gill, M. John, Saag, Michael, Justice, Amy C., Guest, Jodie, Crane, Heidi M., Egger, Matthias, and Sterne, Jonathan A.C.
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Mortality -- Analysis -- Risk factors -- North America -- Europe -- South Africa ,Antiviral agents -- Health aspects ,Highly active antiretroviral therapy -- Health aspects ,HIV patients -- Care and treatment ,HIV infection -- Patient outcomes -- Analysis -- Drug therapy -- Research ,Biological sciences - Abstract
Background: High early mortality in patients with HIV-1 starting antiretroviral therapy (ART) in sub-Saharan Africa, compared to Europe and North America, is well documented. Longer-term comparisons between settings have been limited by poor ascertainment of mortality in high burden African settings. This study aimed to compare mortality up to four years on ART between South Africa, Europe, and North America. Methods and Findings: Data from four South African cohorts in which patients lost to follow-up (LTF) could be linked to the national population register to determine vital status were combined with data from Europe and North America. Cumulative mortality, crude and adjusted (for characteristics at ART initiation) mortality rate ratios (relative to South Africa), and predicted mortality rates were described by region at 0-3, 3-6, 6-12, 12-24, and 24-48 months on ART for the period 20012010. Of the adults included (30,467 [South Africa], 29,727 [Europe], and 7,160 [North America]), 20,306 (67%), 9,961 (34%), and 824 (12%) were women. Patients began treatment with markedly more advanced disease in South Africa (median CD4 count 102, 213, and 172 cells/ml in South Africa, Europe, and North America, respectively). High early mortality after starting ART in South Africa occurred mainly in patients starting ART with CD4 count Conclusions: After accounting for under-ascertainment of mortality, with increasing duration on ART, the mortality rate on HIV treatment in South Africa declines to levels comparable to or below those described in participating North American cohorts, while substantially narrowing the differential with the European cohorts. Please see later in the article for the Editors' Summary., Introduction Antiretroviral therapy (ART) for HIV-infected patients has been routinely available in some Sub-Saharan African settings for more than a decade. Early analyses of treatment cohorts in this region focussed [...]
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- 2014
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229. A three‐tier framework for monitoring antiretroviral therapy in high HIV burden settings
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Osler, Meg, Hilderbrand, Katherine, Hennessey, Claudine, Arendse, Juanita, Goemaere, Eric, Ford, Nathan, and Boulle, Andrew
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Patient compliance -- Management ,Antiviral agents -- Dosage and administration ,Public health administration -- Evaluation ,HIV infection -- Drug therapy ,Company business management ,Health - Abstract
The provision of antiretroviral therapy (ART) in low and middle‐income countries is a chronic disease intervention of unprecedented magnitude and is the dominant health systems challenge for high‐burden countries, many of which rank among the poorest in the world. Substantial external investment, together with the requirement for service evolution to adapt to changing needs, including the constant shift to earlier ART initiation, makes outcome monitoring and reporting particularly important. However, there is growing concern at the inability of many high‐burden countries to report on the outcomes of patients who have been in care for various durations, or even the number of patients in care at a particular point in time. In many instances, countries can only report on the number of patients ever started on ART. Despite paper register systems coming under increasing strain, the evolution from paper directly to complex electronic medical record solutions is not viable in many contexts. Implementing a bridging solution, such as a simple offline electronic version of the paper register, can be a pragmatic alternative. This paper describes and recommends a three‐tiered monitoring approach in low‐ and middle‐income countries based on the experience implementing such a system in the Western Cape province of South Africa. A three‐tier approach allows Ministries of Health to strategically implement one of the tiers in each facility offering ART services. Each tier produces the same nationally required monthly enrolment and quarterly cohort reports so that outputs from the three tiers can be aggregated into a single database at any level of the health system. The choice of tier is based on context and resources at the time of implementation. As resources and infrastructure improve, more facilities will transition to the next highest and more technologically sophisticated tier. Implementing a three‐tier monitoring system at country level for pre‐antiretroviral wellness, ART, tuberculosis and mother and child health services can be an efficient approach to ensuring system‐wide harmonization and accurate monitoring of services, including long term retention in care, during the scale‐up of electronic monitoring solutions., Introduction The provision of antiretroviral therapy (ART) in low‐ and middle‐income countries is a chronic disease intervention of unprecedented magnitude [1–3] and is the dominant health systems challenge for countries [...]
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- 2014
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230. The cost-effectiveness of Antiretroviral Treatment in Khayelitsha, South Africa – a primary data analysis
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Boulle Andrew M, McIntyre Di, and Cleary Susan M
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Medicine (General) ,R5-920 - Abstract
Abstract Background Given the size of the HIV epidemic in South Africa and other developing countries, scaling up antiretroviral treatment (ART) represents one of the key public health challenges of the next decade. Appropriate priority setting and budgeting can be assisted by economic data on the costs and cost-effectiveness of ART. The objectives of this research were therefore to estimate HIV healthcare utilisation, the unit costs of HIV services and the cost per life year (LY) and quality adjusted life year (QALY) gained of HIV treatment interventions from a provider's perspective. Methods Data on service utilisation, outcomes and costs were collected in the Western Cape Province of South Africa. Utilisation of a full range of HIV healthcare services was estimated from 1,729 patients in the Khayelitsha cohort (1,146 No-ART patient-years, 2,229 ART patient-years) using a before and after study design. Full economic costs of HIV-related services were calculated and were complemented by appropriate secondary data. ART effects (deaths, therapy discontinuation and switching to second-line) were from the same 1,729 patients followed for a maximum of 4 years on ART. No-ART outcomes were estimated from a local natural history cohort. Health-related quality of life was assessed on a sub-sample of 95 patients. Markov modelling was used to calculate lifetime costs, LYs and QALYs and uncertainty was assessed through probabilistic sensitivity analysis on all utilisation and outcome variables. An alternative scenario was constructed to enhance generalizability. Results Discounted lifetime costs for No-ART and ART were US$2,743 and US$9,435 over 2 and 8 QALYs respectively. The incremental cost-effectiveness ratio through the use of ART versus No-ART was US$1,102 (95% CI 1,043-1,210) per QALY and US$984 (95% CI 913-1,078) per life year gained. In an alternative scenario where adjustments were made across cost, outcome and utilisation parameters, costs and outcomes were lower, but the ICER was similar. Conclusion Decisions to scale-up ART across sub-Saharan Africa have been made in the absence of incremental lifetime cost and cost-effectiveness data which seriously limits attempts to secure funds at the global level for HIV treatment or to set priorities at the country level. This article presents baseline cost-effectiveness data from one of the longest running public healthcare antiretroviral treatment programmes in Africa that could assist in enhancing efficient resource allocation and equitable access to HIV treatment.
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- 2006
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231. Long-term Mortality in HIV-Positive Individuals Virally Suppressed for >3 Years With Incomplete CD4 Recovery
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Engsig, Frederik N., Zangerle, Robert, Katsarou, Olga, Dabis, Francois, Reiss, Peter, Gill, John, Porter, Kholoud, Sabin, Caroline, Riordan, Andrew, Fätkenheuer, Gerd, Gutiérrez, Félix, Raffi, Francois, Kirk, Ole, Mary-Krause, Murielle, Stephan, Christoph, de Olalla, Patricia Garcia, Guest, Jodie, Samji, Hasina, Castagna, Antonella, d'Arminio Monforte, Antonella, Skaletz-Rorowski, Adriane, Ramos, Jose, Lapadula, Giuseppe, Mussini, Cristina, Force, Lluís, Meyer, Laurence, Lampe, Fiona, Boufassa, Faroudy, Bucher, Heiner C., De Wit, Stéphane, Burkholder, Greer A., Teira, Ramon, Justice, Amy C., Sterling, Tim R., M. Crane, Heidi, Gerstoft, Jan, Grarup, Jesper, May, Margaret, Chêne, Geneviève, Ingle, Suzanne M., Sterne, Jonathan, Obel, Niels, Burkholder, Greer, Justice, Amy, R Sterling, Tim, Crane, Heidi M., Boulle, Andrew, Brodt, Hans-Reinhard, Casabona, Jordi, Cavassini, Matthias, Costagliola, Dominique, Dabis, François, D'Arminio Monforte, Antonella, del Amo, Julia, Van Sighem, Ard, Hans-Ulrich Haerry, David, Hogg, Robert, Mocroft, Amanda, Kitahata, Mari, Saag, Michael, Williams, Matthew, Ingle, Suzanne, Touloumi, Giota, Warszawski, Josiane, Krause, Murielle Mary, Ghosn, Jade, Leport, Catherine, Wit, Ferdinand, Prins, Maria, Gibb, Diana, Del Amo, Julia, Thorne, Claire, Pérez-Hoyos, Santiago, Hamouda, Osamah, Gussenheimer-Bartmeyer, Barbara, Noguera-Julian, Antoni, Antinori, Andrea, Brockmeyer, Norbert, Ramos, José, Battegay, Manuel, Rauch, Andri, Tookey, Pat, Miró, Jose M., de Wit, Stephane, Goetghebuer, Tessa, Torti, Carlo, Garrido, Myriam, Judd, Ali, Conejo, Pablo Rojo, Haerry, David, Weller, Ian, d'Arminio-Monforte, Antonella, Colin, Céline, Schwimmer, Christine, Termote, Monique, Kjaer, Jesper, Campbell, Maria, Raben, Dorthe, Bohlius, Julia, Bouteloup, Vincent, Bucher, Heiner, Cozzi-Lepri, Alessandro, Dorrucci, Maria, Egger, Matthias, Engsig, Frederik, Furrer, Hansjakob, Lambotte, Olivier, Lewden, Charlotte, Lodi, Sara, Lodwick, Rebbeca, Matheron, Sophie, Miro, Jose, Monge, Susana, Nakagawa, Fumiyo, Paredes, Roger, Phillips, Andrew, Puoti, Massimo, Reekie, Joanne, Scherrer, Alexandra, Smit, Colette, Thiebaut, Rodolphe, and Wittkop, Linda
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Virally suppressed HIV-positive individuals on combination antiretroviral therapy who do not achieve a CD4 count >200 cells/µL have substantially increased long-term mortality. The increased mortality was seen across different patient groups and for all causes of death
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- 2017
232. Tuberculosis in Pediatric Antiretroviral Therapy Programs in Low- and Middle-Income Countries: Diagnosis and Screening Practices
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Ballif, Marie, Renner, Lorna, Claude Dusingize, Jean, Leroy, Valeriane, Ayaya, Samuel, Wools-Kaloustian, Kara, Cortes, Claudia P., McGowan, Catherine C., Graber, Claire, Mandalakas, Anna M., Mofenson, Lynne M., Egger, Matthias, Kumara Wati, Ketut Dewi, Nallusamy, Revathy, Reubenson, Gary, Davies, Mary-Ann, Fenner, Lukas, Ajayi, Samuel, Anastos, Kathryn, Bashi, Jules, Bishai, William, Boulle, Andrew, Braitstein, Paula, Carriquiry, Gabriela, Carter, Jane E., Cegielski, Peter, Chimbetete, Cleophas, Conrad, Joseph, Cortes, Claudia, Diero, Lameck, Duda, Stephany, Durier, Nicolas, Dusingize, Jean Claude, Eboua, Tanoh F., Gasser, Adrian, Geng, Elvin, Gnokori, Joachim Charles, Hardwicke, Laura, Hoffmann, Chris, Huebner, Robin, Kancheya, Nzali, Kiertiburanakul, Sasisopin, Kim, Peter, Lameck, Diero, Leroy, Valériane, Lewden, Charlotte, Lindegren, Mary Lou, Mandalakas, Anna, Maskew, Mhairi, McKaig, Rosemary, Mofenson, Lynne, Mpoudi-Etame, Mireille, Okwara, Benson, Phiri, Sam, Prasitsuebsai, Wasana, Petit, April, Prozesky, Hans, Reid, Stewart E., Sohn, Annette, Sterling, Timothy, Vo, Quynh, Walker, Dana, Wehbe, Firas, Wejse, Christian, Wester, William, Williams, Carlie, Wood, Robin, Yao, Zhang, Yunihastuti, Evy, Abrams, Elaine, Ananworanich, Jintanat, Azondekon, Alain, Frieda Behets, Melanie Bacon, Cahn, Pedro, Cesar, Carina, Ciaranello, Andrea, Dabis, François, Edmonds, Andrew, Feinstein, Lydia, Hazra, Rohan, Hoover, Don, Keiser, Olivia, Magneres, Maria Cecilia, McGowan, Catherine, Messerschmidt, Liesl, Biribonwoha, Harriet Nuwagaba, Sharp, Gerald, Vreeman, Rachel, Worrell, Carol, Yiannoutsos, Constantine, and Zwickl, Beth
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Background The global burden of childhood tuberculosis (TB) is estimated to be 0.5 million new cases per year. Human immunodeficiency virus (HIV)-infected children are at high risk for TB. Diagnosis of TB in HIV-infected children remains a major challenge. Methods We describe TB diagnosis and screening practices of pediatric antiretroviral treatment (ART) programs in Africa, Asia, the Caribbean, and Central and South America. We used web-based questionnaires to collect data on ART programs and patients seen from March to July 2012. Forty-three ART programs treating children in 23 countries participated in the study. Results Sputum microscopy and chest Radiograph were available at all programs, mycobacterial culture in 40 (93%) sites, gastric aspiration in 27 (63%), induced sputum in 23 (54%), and Xpert MTB/RIF in 16 (37%) sites. Screening practices to exclude active TB before starting ART included contact history in 41 sites (84%), symptom screening in 38 (88%), and chest Radiograph in 34 sites (79%). The use of diagnostic tools was examined among 146 children diagnosed with TB during the study period. Chest Radiograph was used in 125 (86%) children, sputum microscopy in 76 (52%), induced sputum microscopy in 38 (26%), gastric aspirate microscopy in 35 (24%), culture in 25 (17%), and Xpert MTB/RIF in 11 (8%) children. Conclusions Induced sputum and Xpert MTB/RIF were infrequently available to diagnose childhood TB, and screening was largely based on symptom identification. There is an urgent need to improve the capacity of ART programs in low- and middle-income countries to exclude and diagnose TB in HIV-infected children
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- 2017
233. Record linkage augments cancer ascertainment in HIV cohorts in South Africa
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Sengayi, Mazvita, Spörri, Adrian, Rohner, Eliane, Vinikoor, Michael, Prozesky, Hans, Boulle, Andrew, Egger, Matthias, and Bohlius, Julia
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lcsh:HB848-3697 ,lcsh:Demography. Population. Vital events ,Article - Abstract
Background Sub-Saharan Africa is the region most heavily affected by the HIV/AIDS epidemic. HIV increases the risk of developing cancer but the ascertainment of cancers in patients attending antiretroviral therapy (ART) treatment programs might be incomplete. To estimate the under-ascertainment of cancer we compared incidence rates of AIDS-defining cancers in South African HIV cohorts with and without cancer case ascertainment through record linkage with the National Cancer Registry. Methods We used the data of adult (≥16 years) HIV-positive persons receiving care between 2004 and 2011 at one of four ART programs in South Africa. These programs collaborate with the International Epidemiologic Databases to Evaluate AIDS Southern Africa (www.iedea-sa.org) and collected data for AIDS-defining cancers but not for other cancers. To improve cancer ascertainment we probabilistically linked patient records (using first name, surname, age, and gender) from two HIV cohorts with the cancer records of the South African National Cancer Registry. We calculated incidence rates per 100,000 person-years after starting ART for the AIDS-defining cancers, i.e. Kaposi sarcoma (KS), invasive cervical cancer (ICC) and non-Hodgkin lymphoma (NHL). We compared incidence rates before and after inclusion of record linkage identified cancer cases using the attributable fraction of cancers identified with 95% confidence intervals (CI). Results A total of 49,207 adults starting ART in South Africa were included. 65% of patients were female, median age at starting ART was 35 years (interquartile range 30-41 years). We identified a total of 471 incident cancer cases. With record linkage the incidence increased from 81 to 292 for KS, from 1 to 119 for NHL and 12 to 497 for ICC per 100,000 person-years. The attributable fraction of cancers identified was 72% (95% CI 63-79%) for KS, 98% (95% CI 94-99%) for NHL and 98% (95% CI 95-99%) for ICC. Conclusion Ascertainment of cancer in HIV program data in African settings is incomplete. This case study has shown that probabilistic record linkage to cancer registries is both feasible and essential for cancer ascertainment in HIV cohorts in South Africa.
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- 2017
234. CD4:CD8 Ratio and CD8 Count as Prognostic Markers for Mortality in Human Immunodeficiency Virus\textendashInfected Patients on Antiretroviral Therapy: The Antiretroviral Therapy Cohort Collaboration (ART-CC)
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Trickey, Adam, May, Margaret T, Schommers, Philipp, Tate, Jan, Ingle, Suzanne M, Guest, Jodie L, Gill, M John, Zangerle, Robert, Saag, Mike, Reiss, Peter, Monforte, Antonella, Johnson, Margaret, Lima, Viviane D, Sterling, Tim R, Cavassini, Matthias, Wittkop, Linda, Costagliola, Dominique, Sterne, Jonathan a C, Boulle, Andrew, Stephan, Christoph, Miró, José M, Chêne, Geneviève, Dabis, François, Monforte, Antonella d'Arminio, Amo, Julia, van Sighem, Ard, Vehreschild, Jorg Janne, Gill, John, Guest, Jodie, Haerry, David Hans-Ulrich, Hogg, Robert, Justice, Amy, Shepherd, Leah, Obel, Niels, Crane, Heidi M, Smith, Colette, Saag, Michael, Sterling, Tim, Teira, Ramon, Williams, Matthew, Sterne, Jonathan, May, Margaret, Ingle, Suzanne, University of Bristol [Bristol], University Hospital of Cologne [Cologne], Yale University [New Haven], Atlanta Veterans Affairs Medical Center [Decatur, GA, États-Unis], University of Calgary, Innsbruck Medical University = Medizinische Universität Innsbruck (IMU), University of Alabama at Birmingham [ Birmingham] (UAB), University of Amsterdam [Amsterdam] (UvA), Amsterdam Institute for Global Health & Development [Amsterdam, The Netherlands], Università degli Studi di Milano = University of Milan (UNIMI), Royal Free London NHS Foundation Trust, University of British Columbia (UBC), Vanderbilt University School of Medicine [Nashville], Lausanne University Hospital, Université de Lausanne = University of Lausanne (UNIL), Epidémiologie et Biostatistique, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), School of Public Health and Family Medicine, University of Cape Town, Universitätsklinikum Frankfurt, CHU Bordeaux [Bordeaux], Team MORPH3EUS (INSERM U1219 - UB - ISPED), Bordeaux population health (BPH), Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU de Bordeaux Pellegrin [Bordeaux], VA Connecticut Healthcare System, Rigshospitalet [Copenhagen], Copenhagen University Hospital, University of Alabama [Tuscaloosa] (UA), AII - Infectious diseases, APH - Aging & Later Life, Global Health, AII - Amsterdam institute for Infection and Immunity, Antiretroviral Therapy Cohort Collaboration (ART-CC), Boulle, A., Stephan, C., Miro, J.M., Cavassini, M., Chêne, G., Costagliola, D., Dabis, F., Monforte, A.D., Del Amo, J., Van Sighem, A., Vehreschild, J.J., Gill, J., Guest, J., Haerry, D.H., Hogg, R., Justice, A., Shepherd, L., Obel, N., Crane, H.M., Smith, C., Reiss, P., Saag, M., Sterling, T., Teira, R., Williams, M., Zangerle, R., Sterne, J., May, M., Ingle, S., and Trickey, A.
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0301 basic medicine ,CD4-Positive T-Lymphocytes ,Male ,CD4:CD8 ratio ,[SDV]Life Sciences [q-bio] ,CD4-CD8 Ratio ,HIV Infections ,CD8-Positive T-Lymphocytes ,North America/epidemiology ,CD8 ratio ,CD8 count ,HIV ,antiretroviral therapy ,mortality [CD4] ,0302 clinical medicine ,Cause of Death ,030212 general & internal medicine ,Young adult ,Articles and Commentaries ,Cause of death ,Hazard ratio ,Middle Aged ,Viral Load ,Prognosis ,3. Good health ,Europe ,Infectious Diseases ,Cohort ,Female ,Viral load ,Microbiology (medical) ,Adult ,medicine.medical_specialty ,Adolescent ,Anti-HIV Agents ,HIV Infections/drug therapy ,Article ,Europe/epidemiology ,03 medical and health sciences ,Young Adult ,Internal medicine ,medicine ,Humans ,Lymphocyte Count ,Aged ,Proportional Hazards Models ,business.industry ,Proportional hazards model ,030112 virology ,mortality ,Confidence interval ,Anti-HIV Agents/therapeutic use ,North America ,business ,Biomarkers ,Biomarkers/blood - Abstract
Summary Associations of CD4:CD8 ratio or CD8 count with all-cause and cause-specific mortality were too small for them to be useful as independent prognostic markers in addition to CD4 count in virally suppressed patients on antiretroviral therapy with high CD4 count., Background We investigated whether CD4:CD8 ratio and CD8 count were prognostic for all-cause, AIDS, and non-AIDS mortality in virologically suppressed patients with high CD4 count. Methods We used data from 13 European and North American cohorts of human immunodeficiency virus–infected, antiretroviral therapy (ART)–naive adults who started ART during 1996–2010, who were followed from the date they had CD4 count ≥350 cells/μL and were virologically suppressed (baseline). We used stratified Cox models to estimate unadjusted and adjusted (for sex, people who inject drugs, ART initiation year, and baseline age, CD4 count, AIDS, duration of ART) all-cause and cause-specific mortality hazard ratios for tertiles of CD4:CD8 ratio (0–0.40, 0.41–0.64 [reference], >0.64) and CD8 count (0–760, 761–1138 [reference], >1138 cells/μL) and examined the shape of associations using cubic splines. Results During 276526 person-years, 1834 of 49865 patients died (249 AIDS-related; 1076 non-AIDS-defining; 509 unknown/unclassifiable deaths). There was little evidence that CD4:CD8 ratio was prognostic for all-cause mortality after adjustment for other factors: the adjusted hazard ratio (aHR) for lower vs middle tertile was 1.11 (95% confidence interval [CI], 1.00–1.25). The association of CD8 count with all-cause mortality was U-shaped: aHR for higher vs middle tertile was 1.13 (95% CI, 1.01–1.26). AIDS-related mortality declined with increasing CD4:CD8 ratio and decreasing CD8 count. There was little evidence that CD4:CD8 ratio or CD8 count was prognostic for non-AIDS mortality. Conclusions In this large cohort collaboration, the magnitude of adjusted associations of CD4:CD8 ratio or CD8 count with mortality was too small for them to be useful as independent prognostic markers in virally suppressed patients on ART.
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- 2017
235. Estimating the impact of antiretroviral treatment on adult mortality trends in South Africa: A mathematical modelling study
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Johnson, Leigh F, May, Margaret T, Cornell, Morna, Boulle, Andrew, Egger, Matthias, Davies, Mary-Ann, Centre for Infectious Disease Epidemiology and Research, and Faculty of Health Sciences
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AIDS ,South Africa ,Death rates ,HIV epidemiology ,HIV ,Tuberculosis ,HIV diagnosis and management ,Antiretroviral therapy - Abstract
Substantial reductions in adult mortality have been observed in South Africa since the mid-2000s, but there has been no formal evaluation of how much of this decline is attributable to the scale-up of antiretroviral treatment (ART), as previous models have not been calibrated to vital registration data. We developed a deterministic mathematical model to simulate the mortality trends that would have been expected in the absence of ART, and with earlier introduction of ART.
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- 2017
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236. Twelve-year mortality in adults initiating antiretroviral therapy in South Africa
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Egger, Matthias, Davies, Mary-Ann, Boulle, Andrew, Department of Public Health and Family Medicine, and Faculty of Health Sciences
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long-term ,viral suppression ,antiretroviral ,Africa ,gender ,outcomes ,mortality - Abstract
Introduction: South Africa has the largest number of individuals living with HIV and the largest antiretroviral therapy (ART) programme worldwide. In September 2016, ART eligibility was extended to all 7.1 million HIV-positive South Africans. To ensure that further expansion of services does not compromise quality of care, long-term outcomes must be monitored. Few studies have reported long-term mortality in resource-constrained settings, where mortality ascertainment is challenging. Combining site records with data linked to the national vital registration system, sites in the International Epidemiology Databases to Evaluate AIDS Southern Africa collaboration can identify >95% of deaths in patients with civil identification numbers (IDs). This study used linked data to explore long-term mortality and viral suppression among adults starting ART in South Africa.
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- 2017
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237. Pharmacovigilance: A public health priority for South Africa
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Mehta, Ushma, Kalk, Emma, Boulle, Andrew, Nkambule, Portia, Gouws, Joey, Rees, Helen, and Cohen, Karen
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Article - Abstract
South Africa has been engaged in pharmacovigilance (PV) activities to assess the impact of adverse drug reactions on public safety and health for 40 years. Activities have evolved from passive regulatory reporting to encompass active surveillance systems. The HIV and AIDS and TB epidemics stimulated pharmacoepidemiological research into the risks associated with medicines used in the standardised regimens of mass treatment programmes. Specific safety concerns, supported by robust local cohort data, have prompted major changes to national and international treatment policies. This chapter describes the expanding body of local knowledge and the historical and emergent surveillance systems that address the burden of drug-related harms, noting the challenges to health system responsiveness. The South African context presents a unique opportunity to characterise the scale and nature of such harms in mass HIV and AIDS and TB treatment programmes. The use of complex regimens at scale poses new PV challenges. There is an urgent need to develop cohesive, sustainable systems to support evidence-based decisions on appropriate regimen choices, while minimising medicine-associated risks. The increasing use of computerised clinical, laboratory and dispensing records, with unique patient identifiers facilitating data linkage, will increase PV surveillance capacity. A coherent national PV framework is an essential part of medicines policy, encompassing regulatory, programmatic and individual needs. Key pillars of this framework include: (i) consolidation and expansion of active and passive PV surveillance, optimising existing programmes; (ii) prioritising post-marketing monitoring within the new health products regulatory authority; and (iii) instilling a culture of active risk management in clinical practice through the creation of effective channels of communication and feedback into policy and practice.
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- 2017
238. Consolidating strategic information to monitor progress against the UNAIDS 90-90-90 targets: evaluating the operational feasibility of an electronic HIV testing register in Cape Town, South Africa.
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Jacob, Nisha, Rice, Brian, Kalk, Emma, Heekes, Alexa, Morgan, Jennie, Brinkmann, Samantha, Hargreaves, James, Orgill, Marsha, and Boulle, Andrew
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DATA libraries ,POINT-of-care testing ,COMMUNITY centers ,CROSS-sectional method - Abstract
Background: HIV diagnosis in South Africa is based on a point-of-care testing (PoCT) algorithm with paper-based record-keeping. Aggregated testing data are reported routinely. To facilitate improved HIV case-based surveillance, the Western Cape Province implemented a unique pilot intervention to digitise PoCT results, at an individual level, and generate an electronic register using the newly developed Provincial Health Data Centre (PHDC). We describe the intervention (phased) and present an evaluation of the operational feasibility of the intervention. We also offer implementation insights into establishing electronic capture of individual level testing data.Methods: Cross-sectional analyses were conducted on records of all patients attending a local Community Health Centre who had an HIV-PoCT during the study period. Data from the intervention were linked to the PHDC using a unique identifier and compared with aggregate data from the paper-based register. Correlation coefficients were calculated to quantify the correlation between the two monthly datasets. To support an understanding of the findings, the Department of Health project management team generated reflections on the implementation process, which were then grouped thematically into implementation lessons.Results: In total, 11,337 PoCT records were digitised (70% (7954) during Phase I; and 30% (3383) during Phase II). Linkage of forms to the PHDC was 96% in Phase I and 98% in Phase II. Comparison with aggregate data showed high correlation during Phase I, but notable divergence during Phase II. Divergence in Phase II was due to stringent data quality requirements and high clinical staff turnover. Factors supporting implementation success in Phase I included direct oversight of data capturing by a manager with clinical and operational insight. Implementation challenges included operational, health system, and high cost-related issues.Conclusions: We demonstrate that rapid digitisation of HIV PoCT data, without compromising currently collected aggregate data, is operationally feasible, and can contribute to person-level longitudinal HIV case-based surveillance. To take to scale, we will need to improve PoCT platforms and clerical and administrative systems. Although we highlight challenges, we demonstrate that electronic HIV testing registers can successfully replace manual registers and improve efforts to monitor and evaluate HIV testing strategies. [ABSTRACT FROM AUTHOR]- Published
- 2020
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239. Effect of HIV Infection and Antiretroviral Treatment on Pregnancy Rates in the Western Cape Province of South Africa.
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Johnson, Leigh F, Mutemaringa, Themba, Heekes, Alexa, and Boulle, Andrew
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HIV infections ,HIV ,PROPORTIONAL hazards models ,PREGNANCY ,HIV infection epidemiology ,COMMUNICABLE disease epidemiology ,ANTI-HIV agents ,FAMILY planning ,COMMUNICABLE diseases ,BIRTH rate ,DISEASE incidence ,PREGNANCY complications ,QUESTIONNAIRES ,MEDICAL needs assessment - Abstract
Background: Previous studies suggest that untreated human immunodeficiency virus (HIV) infection is associated with a reduced incidence of pregnancy, but studies of the effect of antiretroviral treatment (ART) on pregnancy incidence have been inconsistent.Methods: Routine data from health services in the Western Cape province of South Africa were linked to identify pregnancies during 2007-2017 and maternal HIV records. The time from the first (index) pregnancy outcome date to the next pregnancy was modeled using Cox proportional hazards models.Results: During 2007-2017, 1 042 647 pregnancies were recorded. In all age groups, pregnancy incidence rates were highest in women who had started ART, lower in HIV-negative women, and lowest in ART-naive HIV-positive women. In multivariable analysis, after controlling for the most recent CD4+ T-cell count, pregnancy incidence rates in HIV-positive women receiving ART were higher than those in untreated HIV-positive women (adjusted hazard ratio, 1.63; 95% confidence interval, 1.59-1.67) and those in HIV-negative women.Conclusion: Among women who have recently been pregnant, receipt of ART is associated with high rates of second pregnancy. Better integration of family planning into HIV care services is needed. [ABSTRACT FROM AUTHOR]- Published
- 2020
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240. Population‐wide differentials in HIV service access and outcomes in the Western Cape for men as compared to women, South Africa: 2008 to 2018: a cohort analysis.
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Osler, Meg, Cornell, Morna, Ford, Nathan, Hilderbrand, Katherine, Goemaere, Eric, and Boulle, Andrew
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HEALTH services accessibility ,HIV-positive men ,HIV-positive women ,ANTIRETROVIRAL agents ,MEDICAL care ,CD4 lymphocyte count ,COHORT analysis ,PROPORTIONAL hazards models - Abstract
Introduction: Few studies have systematically described population‐level differences comparing men and women across the continuum of routine HIV care. This study quantifies differentials in HIV care, treatment and mortality outcomes for men and women over time in South Africa. Methods: We analysed population‐wide linked anonymized data, including vital registration linkage, for the Western Cape Province, from the time of first CD4 count. Three antiretroviral therapy guideline eligibility periods were defined: 1 January 2008 to 31 July 2011 (CD4 cell count <200 cells/µL), 1 August 2011 to 31 December 2014 (<350 cells/µL), 1 January 2015 to 31 August 2016 (<500 cells/µL). We estimated care uptake based on service attendance, and modelled associations for men and women with ART initiation and overall, pre‐ART and ART mortality. Separate Cox proportional hazard models were built for each outcome and eligibility period, adjusted for tuberculosis, pregnancy, CD4 count and age. Results: Adult men made up 49% of the population and constituted 37% of those living with HIV. In 2009, 46% of men living with HIV attended health services, rising to 67% by 2015 compared to 54% and 77% of women respectively. Men contributed <35% of all CD4 cell counts over 10 years and presented with more advanced disease (39% of all first presentation CD4 cell counts from men were <200 cells/µL compared to 25% in women). ART access was lower in men compared to women (AHR 0.79 (0.77 to 0.80) summarized for Period 2) over the entire study). Mortality was greater in men irrespective of ART (AHR 1.08 (1.01 to 1.16) Period 3) and after ART start (AHR 1.15 (1.05 to 1.20) Period 3) with mortality differences decreasing over time. Conclusions: Compared to women, men presented with more advanced disease, were less likely to attend health care services annually, were less likely to initiate ART and had higher mortality overall and while receiving ART care. People living with HIV were more likely to initiate ART if they had acute reasons to access healthcare beyond HIV, such as being pregnant or being co‐infected with tuberculosis. Our findings point to missed opportunities for improving access to and outcomes from interventions for men along the entire HIV cascade. [ABSTRACT FROM AUTHOR]
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- 2020
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241. Virologic response to efavirenz-based first-line antiretroviral therapy in children with previous exposure to antiretrovirals to prevent mother-to-child transmission.
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Nyakato, Patience, Davies, Mary-Ann, Technau, Karl-Gunter, Fatti, Geoffrey, Rabie, Helena, Tanser, Frank, Boulle, Andrew, Wood, Robin, Eley, Brian, Sawry, Shobna, Giddy, Janet, Sipambo, Nosisa, Kuhn, Louise, and Fairlie, Lee
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EFAVIRENZ ,NON-nucleoside reverse transcriptase inhibitors ,ANTIRETROVIRAL agents ,LOGISTIC regression analysis ,ODDS ratio ,VIRAL load - Abstract
Efavirenz-based first-line regimens have been widely used for children ≥3 years of age starting antiretroviral therapy, despite possible resistance with prior exposure to non-nucleoside reverse transcriptase inhibitors for prevention of mother-to-child transmission (PMTCT). We used logistic regression to examine the association between PMTCT exposure and viral failure (VF) defined as two consecutive viral loads (VL)>1000 copies/ml between 6–18 months on ART. Children with previous nevirapine exposure for PMTCT were not at higher risk of VF compared to unexposed children (adjusted Odds Ratio (aOR): 0.79; 95% CI:0.56, 1.11). [ABSTRACT FROM AUTHOR]
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- 2020
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242. Long‐term virologic responses to antiretroviral therapy among HIV‐positive patients entering adherence clubs in Khayelitsha, Cape Town, South Africa: a longitudinal analysis.
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Kehoe, Kathleen, Boulle, Andrew, Tsondai, Priscilla R, Euvrard, Jonathan, Davies, Mary Ann, and Cornell, Morna
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PATIENT compliance , *ANTIRETROVIRAL agents , *PROPORTIONAL hazards models , *VIRAL load - Abstract
Introduction: In South Africa, an estimated 4.6 million people were accessing antiretroviral therapy (ART) in 2018. As universal Test and Treat is implemented, these numbers will continue to increase. Given the need for lifelong care for millions of individuals, differentiated service delivery models for ART services such as adherence clubs (ACs) for stable patients are required. In this study, we describe long‐term virologic outcomes of patients who have ever entered ACs in Khayelitsha, Cape Town. Methods: We included adult patients enrolled in ACs in Khayelitsha between January 2011 and December 2016 with a recorded viral load (VL) before enrolment. Risk factors for an elevated VL (VL >1000 copies/mL) and confirmed virologic failure (two consecutive VLs >1000 copies/mL one year apart) were estimated using Cox proportional hazards models. VL completeness over time was assessed. Results: Overall, 8058 patients were included in the analysis, contributing 16,047 person‐years of follow‐up from AC entry (median follow‐up time 1.7 years, interquartile range [IQR]:0.9 to 2.9). At AC entry, 74% were female, 46% were aged between 35 and 44 years, and the median duration on ART was 4.8 years (IQR: 3.0 to 7.2). Among patients virologically suppressed at AC entry (n = 8058), 7136 (89%) had a subsequent VL test, of which 441 (6%) experienced an elevated VL (median time from AC entry 363 days, IQR: 170 to 728). Older age (adjusted hazard ratio [aHR] 0.64, 95% confidence interval [CI] 0.46 to 0.88), more recent year of AC entry (aHR 0.76, 95% CI 0.68 to 0.84) and higher CD4 count (aHR 0.67, 95% CI 0.54 to 0.84) were protective against experiencing an elevated VL. Among patients with an elevated VL, 52% (150/291) with a repeat VL test subsequently experienced confirmed virologic failure in a median time of 112 days (IQR: 56 to 168). Frequency of VL testing was constant over time (82 to 85%), with over 90% of patients remaining virologically suppressed. Conclusions: This study demonstrates low prevalence of elevated VLs and confirmed virologic failure among patients who entered ACs. Although ACs were expanded rapidly, most patients were well monitored and remained stable, supporting the continued rollout of this model. [ABSTRACT FROM AUTHOR]
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- 2020
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243. Feasibility of an HIV self-testing intervention: a formative qualitative study among individuals, community leaders, and HIV testing experts in northern Tanzania.
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Njau, Bernard, Lisasi, Esther, Damian, Damian J., Mushi, Declare L., Boulle, Andrew, and Mathews, Catherine
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DIAGNOSIS of HIV infections ,PATIENT self-monitoring ,HEALTH facilities ,DATA analysis ,HIV infection epidemiology ,PILOT projects ,FOCUS groups ,ATTITUDE (Psychology) ,MEDICAL screening ,SELF-efficacy ,SOCIAL context ,PATIENTS' attitudes ,QUALITATIVE research ,HEALTH self-care - Abstract
Background: Achieving the 95-95-95 global targets by 2030, innovative HIV testing models, such as HIV self-testing are needed for people, who are unaware of their HIV status. We aimed to explore key informants, mountain climbing porters, and female bar workers' attitudes, perceived norms, and personal agency related to HIV self-testing.Methods: This was a formative qualitative study to inform the design of an HIV self-testing intervention in Northern Tanzania. Informed by the Integrated Behaviour Model, we conducted four focus group discussions, and 18 in-depth interviews with purposively selected participants. Data were analyzed using the framework method.Results: We recruited 55 participants. Most participants had positive attitudes towards HIVST, in that they anticipated positive consequences related to the introduction and uptake of HIVST. These included privacy and convenience, avoidance of long queues at health facilities, reduced counselor workload, and reduced indirect costs (given that transport to health facilities might not be required). Participants expressed the belief that significant people in their social environment, such as parents and peers, would approve their uptake of HIVST, and that they would accept HIVST. Additionally, features of HIVST that might facilitate its uptake were that it could be performed in private and would obviate visits to health facilities. Most participants were confident in their capacity to use HIVST kits, while a few were less confident about self-testing while alone. Strategies to maximize beliefs about personal agency and facilitate uptake included supplying the self-test kits in a way that was easy to access, and advocacy. Perceived potential constraints to the uptake of HIVST were the cost of buying the self-test kits, poverty, illiteracy, poor eyesight, fear of knowing one's HIV status, lack of policy/ guidelines for HIVST, and the absence of strategies for linkage to HIV care, treatment, and support.Conclusions: The findings suggest that HIVST may be feasible to implement in this study setting, with the majority of participants reporting positive attitudes, supportive perceived norms, and self-efficacy. Hence, future HIVST interventions should address the negative beliefs, and perceived barriers towards HIVST to increase HIV testing among the target population in Northern Tanzania. [ABSTRACT FROM AUTHOR]- Published
- 2020
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244. HIV programmatic outcomes following implementation of the 'Treat‐All' policy in a public sector setting in Eswatini: a prospective cohort study.
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Kerschberger, Bernhard, Schomaker, Michael, Jobanputra, Kiran, Kabore, Serge M, Teck, Roger, Mabhena, Edwin, Mthethwa‐Hleza, Simangele, Rusch, Barbara, Ciglenecki, Iza, and Boulle, Andrew
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PUBLIC sector ,LONGITUDINAL method ,GOVERNMENT policy ,COHORT analysis ,HEALTH facilities - Abstract
Introduction: The Treat‐All policy – antiretroviral therapy (ART) initiation irrespective of CD4 cell criteria – increases access to treatment. Many ART programmes, however, reported increasing attrition and viral failure during treatment expansion, questioning the programmatic feasibility of Treat‐All in resource‐limited settings. We aimed to describe and compare programmatic outcomes between Treat‐All and standard of care (SOC) in the public sectors of Eswatini. Methods: This is a prospective cohort study of ≥16‐year‐old HIV‐positive patients initiated on first‐line ART under Treat‐All and SOC in 18 health facilities of the Shiselweni region, from October 2014 to March 2016. SOC followed the CD4 350 and 500 cells/mm3 treatment eligibility thresholds. Kaplan‐Meier estimates were used to describe crude programmatic outcomes. Multivariate flexible parametric survival models were built to assess associations of time from ART initiation with the composite unfavourable outcome of all‐cause attrition and viral failure. Results: Of the 3170 patients, 1888 (59.6%) initiated ART under Treat‐All at a median CD4 cell count of 329 (IQR 168 to 488) cells/mm3 compared with 292 (IQR 161 to 430) (p < 0.001) under SOC. Although crude programme retention at 36 months tended to be lower under Treat‐All (71%) than SOC (75%) (p = 0.002), it was similar in covariate‐adjusted analysis (adjusted hazard ratio [aHR] 1.06, 95% CI 0.91 to 1.23). The hazard of viral suppression was higher for Treat‐All (aHR 1.12, 95% CI 1.01 to 1.23), while the hazard of viral failure was comparable (Treat‐All: aHR 0.89, 95% CI 0.53 to 1.49). Among patients with advanced HIV disease (n = 1080), those under Treat‐All (aHR 1.13, 95% CI 0.88 to 1.44) had a similar risk of an composite unfavourable outcome to SOC. Factors increasing the risk of the composite unfavourable outcome under both interventions were aged 16 to 24 years, being unmarried, anaemia, ART initiation on the same day as HIV care enrolment and CD4 ≤ 100 cells/mm3. Under Treat‐All only, the risk of the unfavourable outcome was higher for pregnant women, WHO III/IV clinical stage and elevated creatinine. Conclusions: Compared to SOC, Treat‐All resulted in comparable retention, improved viral suppression and comparable composite outcomes of retention without viral failure. [ABSTRACT FROM AUTHOR]
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- 2020
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245. Earlier Antiretroviral Therapy Initiation and Decreasing Mortality Among HIV-infected Infants Initiating Antiretroviral Therapy Within 3 Months of Age in South Africa, 2006–2017.
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Iyun, Victoria, Technau, Karl-Gunter, Eley, Brian, Rabie, Helena, Boulle, Andrew, Fatti, Geoffrey, Egger, Matthias, Tanser, Frank, Wood, Robin, Fairlie, Lee, Cotton, Mark F., and Davies, Mary-Ann
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- 2020
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246. Quantifying the HIV treatment cascade in a South African health sub-district by gender: retrospective cohort study.
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Lurie, Mark N., Kirwa, Kipruto, Callaway, Julia, Cornell, Morna, Boulle, Andrew, Bengtson, Angela M., Smith, Mariette, Leon, Natalie, and Colvin, Christopher
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CD4 lymphocyte count ,HIV ,COHORT analysis ,GENDER - Abstract
Copyright of Tropical Medicine & International Health is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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- 2020
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247. A systematic review of qualitative evidence on factors enabling and deterring uptake of HIV self-testing in Africa.
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Njau, Bernard, Covin, Christopher, Lisasi, Esther, Damian, Damian, Mushi, Declare, Boulle, Andrew, and Mathews, Catherine
- Abstract
Background: More than 40% of adults in Sub-Saharan Africa are unaware of their HIV status. HIV self-testing (HIVST) is a novel approach with a potential to increase uptake of HIV testing and linkage to care for people who test HIV positive. We explored HIV stakeholder's perceptions about factors that enable or deter the uptake of HIV self-testing and experiences of self-testing of adult users in Africa.Methods: This systematic review of qualitative evidence included articles on qualitative studies published or made available between January 1998 to February 2018 on perspectives of key stakeholders, including HIV policymakers, HIV experts, health care providers, and adult men and women (18 years and above) about factors that enable or deter the uptake of HIV self-testing and experiences of self-testing among adult users. We searched CINAHL, MEDLINE in Pubmed, EMBASE, AJOL, PsycINFO, Social Science Citation Index (SSCI), and Web of Science for articles in English on HIVST with qualitative data from different African countries.Results: In total, 258 papers were retrieved, and only nine (9) studies conducted in 5 African countries were eligible and included in this synthesis. Perceived facilitators of the uptake of HIVST were autonomy and self-empowerment, privacy, confidentiality, convenience, opportunity to test, including couples HIV testing, and ease of use. The perceived barriers included the cost of buying self-test kits, perceived unreliability of test results, low literacy, fear and anxiety of a positive test result, and potential psychological and social harms. HIV stakeholder's concerns about HIVST included human right issues, lack of linkage to care, lack of face-to-face counseling, lack of regulatory and quality assurance systems, and quality of self-test kits. Actual HIVST users expressed preference of oral-fluid self-testing because of ease of use, and that it is less invasive and painless compared to finger-stick/whole blood-based HIV tests. Lack of clear instructions on how to use self-test kits, and existing different products of HIVST increases rates of user errors.Conclusions: Overcoming factors that may deter HIV testing, and HIVST, in particular, is complex and challenging, but it has important implications for HIV stakeholders, HIVST users, and public health in general. Research is warranted to explore the actual practices related to HIVST among different populations in Africa. [ABSTRACT FROM AUTHOR]- Published
- 2019
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248. Life expectancies of South African adults starting antiretroviral treatment: collaborative analysis of cohort studies
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Johnson, Leigh F., Mossong, Joel, Dorrington, Rob E., Schomaker, Michael, Hoffmann, Christopher J., Keiser, Olivia, Fox, Matthew P., Wood, Robin, Prozesky, Hans, Giddy, Janet, Garone, Daniela Belen, Cornell, Morna, Egger, Matthias, and Boulle, Andrew
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Antiviral agents -- Dosage and administration ,Drug interactions -- Research ,HIV patients -- Physiological aspects ,Biological sciences - Abstract
Background: Few estimates exist of the life expectancy of HIV-positive adults receiving antiretroviral treatment (ART) in low- and middle-income countries. We aimed to estimate the life expectancy of patients starting ART in South Africa and compare it with that of HIV-negative adults. Methods and Findings: Data were collected from six South African ART cohorts. Analysis was restricted to 37,740 HIV- positive adults starting ART for the first time. Estimates of mortality were obtained by linking patient records to the national population register. Relative survival models were used to estimate the excess mortality attributable to HIV by age, for different baseline CD4 categories and different durations. Non-HIV mortality was estimated using a South African demographic model. The average life expectancy of men starting ART varied between 27.6 y (95% CI: 25.2-30.2) at age 20 y and 10.1 y (95% CI: 9.3-10.8) at age 60 y, while estimates for women at the same ages were substantially higher, at 36.8 y (95% CI: 34.0-39.7) and 14.4 y (95% CI: 13.3-15.3), respectively. The life expectancy of a 20-y-old woman was 43.1 y (95% CI: 40.1-46.0) if her baseline CD4 count was [greater than or equal to] 200 cells/µl, compared to 29.5 y (95% CI: 26.2-33.0) if her baseline CD4 count was Conclusions: South African HIV-positive adults can have a near-normal life expectancy, provided that they start ART before their CD4 count drops below 200 cells/µl. These findings demonstrate that the near-normal life expectancies of HIV-positive individuals receiving ART in high-income countries can apply to low- and middle-income countries as well., Introduction Estimates of life expectancies of HIV-infected individuals are important in providing information to patients about their long-term prognosis, in projecting the future costs of HIV-related care, and in forecasting [...]
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- 2013
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249. Routine data underestimates the incidence of first-line antiretroviral drug discontinuations due to adverse drug reactions: Observational study in two South African cohorts
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de Waal, Reneé, primary, Cohen, Karen, additional, Boulle, Andrew, additional, Fox, Matthew P., additional, Maartens, Gary, additional, Igumbor, Ehimario U., additional, and Davies, Mary-Ann, additional
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- 2018
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250. Sodium Valproate use among pregnant women and women-of child-bearing potential in Western Cape, South Africa
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Mehta, Ushma, primary, Smith, Mariette, additional, Kalk, Emma, additional, Swart, Annoesjka, additional, Coetzee, Renier, additional, Boulle, Andrew, additional, and Blockman, Marc, additional
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- 2018
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