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1. Experiences and expectations of patients living with HIV on their engagement with care in Western Kenya

Author

Wachira J, Genberg B, Kafu C, Braitstein P, Laws MB, and Wilson IB

Subjects
Patient engagement, HIV, Kenya, Medicine (General), R5-920
Abstract

Juddy Wachira,1,2 Becky Genberg,3 Catherine Kafu,2 Paula Braitstein,4 Michael Barton Laws,5 Ira B Wilson5 1Department of Behavioral Sciences, School of Medicine, Moi University, Eldoret, Kenya; 2Department of Epidemiology, Bloomberg School of Public Health, John Hopkins University, Baltimore, MD, USA; 3Academic Model Providing Access to Healthcare (AMPATH) Partnership, Eldoret, Kenya; 4Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; 5Department of Health Services, Policy and Practice, Brown University, Providence, RI, USA Purpose: In resource-limited HIV care settings, effective and innovative interventions that respond to the existing challenges along the HIV care continuum are urgently needed to realize the benefits of antiretroviral therapy (ART). Initiating effective ART adherence dialog in an environment that promotes patient engagement in care is key. It is therefore critical to enhance our understanding about how patients living with HIV in these regions conceptualize and experience patient engagement. This study explores HIV patients’ perceptions, experiences and expectations of their engagement in care. Materials and methods: We sampled 86 patients from three Academic Model for Providing Access to Healthcare (AMPATHplus) sites, one urban and two rural. We conducted 24 in-depth interviews and eight focus group discussions in either Swahili or English. Audio recordings of the interviews were transcribed, and then translated into English. We performed content analysis after thematic coding. Results: Patients living with HIV in Kenya desire active engagement with care. However, their engagement was inconsistent and varied depending on the provider. Patients had a sense of how provider’s interpersonal behaviors influenced their level of engagement. These included various aspects of provider–patient communication and relationship dynamics. Patients also highlighted relational boundaries that influenced the level and kind of information they shared with their providers. Aspects of their psychological, social or economic wellbeing were often viewed as personal and not discussed with their clinicians. Patients identified factors that would promote or impede their engagement with care including those related to patients themselves, providers, and the healthcare system. Conclusion: Patients living with HIV desired more active engagement in their care. In addition, they desired clinicians to engage in more social behaviors to promote patient engagement. To address existing patient engagement barriers, HIV care systems in the region should apply contextualized patient-centered interventions. Keywords: patient engagement, HIV, Kenya

Published
2018

13. The Causal Effect of Tracing by Peer Health Workers on Return to Clinic Among Patients Who Were Lost to Follow-up From Antiretroviral Therapy in Eastern Africa: A “Natural Experiment” Arising From Surveillance of Lost Patients

Author

Bershetyn, Anna, Odeny, Thomas A, Lyamuya, Rita, Nakiwogga-Muwanga, Alice, Diero, Lameck, Bwana, Mwebesa, Braitstein, Paula, Somi, Geoffrey, Kambugu, Andrew, Bukusi, Elizabeth, Hartogensis, Wendy, Glidden, David V, Wools-Kaloustian, Kara, Yiannoutsos, Constantin, Martin, Jeffrey, Geng, Elvin H, and Consortium, for the East Africa International Epidemiologic Databases to Evaluate AIDS

Subjects
Medical Microbiology, Biomedical and Clinical Sciences, Clinical Sciences, Sexually Transmitted Infections, Infectious Diseases, HIV/AIDS, Infection, Good Health and Well Being, Adult, Ambulatory Care Facilities, Anti-HIV Agents, Epidemiological Monitoring, Female, HIV Infections, Health Personnel, Humans, Kenya, Lost to Follow-Up, Male, Tanzania, Uganda, antiretroviral therapy, Africa, retention, loss to follow-up, East Africa International Epidemiologic Databases to Evaluate AIDS (EA-IeDEA) Consortium, loss to follow-up., Biological Sciences, Medical and Health Sciences, Microbiology, Clinical sciences
Abstract

Background.The effect of tracing human immunodeficiency virus (HIV)-infected patients who are lost to follow-up (LTFU) on reengagement has not been rigorously assessed. We carried out an ex post analysis of a surveillance study in which LTFU patients were randomly selected for tracing to identify the effect of tracing on reengagement.Methods.We evaluated HIV-infected adults on antiretroviral therapy who were LTFU (>90 days late for last visit) at 14 clinics in Uganda, Kenya, and Tanzania. A random sample of LTFU patients was selected for tracing by peer health workers. We assessed the effect of selection for tracing using Kaplan-Meier estimates of reengagement among all patients as well as the subset of LTFU patients who were alive, contacted in person by the tracer, and out of care.Results.Of 5781 eligible patients, 991 (17%) were randomly selected for tracing. One year after selection for tracing, 13.3% (95% confidence interval [CI], 11.1%-15.3%) of those selected for tracing returned compared with 10.0% (95% CI, 9.1%-10.8%) of those not randomly selected, an adjusted risk difference of 3.0% (95% CI, .7%-5.3%). Among patients found to be alive, personally contacted, and out of care, tracing increased the absolute probability of return at 1 year by 22% (95% CI, 7.1%-36.2%). The effect of tracing on rate of return to clinic decayed with a half-life of 7.0 days after tracing (95% CI, 2.6 %-12.9%).Conclusions.Tracing interventions increase reengagement, but developing methods for targeting LTFU patients most likely to benefit can make this practice more efficient.

Published
2017

14. The Production and Reproduction of Kinship in Charitable Children's Institutions in Uasin Gishu County, Kenya

Author

Gayapersad, Allison, Ombok, Caroline, Kamanda, Allan, Tarus, Carren, Ayuku, David, and Braitstein, Paula

Abstract

Background: The negative impact of institutionalization on children's development and well-being has led to a global recommendation for deinstitutionalization. In countries with weak infrastructure and family support, some children in institutional care have been found to have better outcomes, which may be due in part to the family-like environments created by some Charitable Children's Institutions (CCIs). Objective: The goal was to examine whether and how alternative kinship structures were reproduced in CCIs. Method: Qualitative data from 22 caregivers and 30 orphaned or separated children and adolescents (OSCAs) were collected using participant observation and in-depth interviews, and analysed using a symbolic interactionist theoretical framework. Results: Social interaction with caregivers contributed meaning towards the definition of family within some CCIs, particularly those modeled after a village and/or a single family. These CCIs created a family-like care environment, resulting in OSCAs redefining the traditional concept of family based on consanguinity to one composed of non-kin providing care and support. Social interaction through family-related activities produced novel familial identities, and some OSCAs felt they were part of a quasi-family. However, OSCAs lacked autonomy, feared consequences of not following the rules of behaviour, and felt re-traumatized and re-abandoned when they exited the CCIs at age 18. Conclusion: Some CCIs created an "alternative" kinship structure in which most children focused on their education, were provided with basic needs, and formed long-term positive relationships. Despite a number of challenges, family-like CCIs may be a supportive last resort for children without kin to care for them.

Published
2019
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15. Correction to: Using the Implementation Research Logic Model as a Lens to View Experiences of Implementing HIV Prevention and Care Interventions with Adolescent Sexual Minority Men—A Global Perspective

Author

Nelson, LaRon E., Ogunbajo, Adedotun, Abu-Ba’are, Gamji Rabiu, Conserve, Donaldson F., Wilton, Leo, Ndenkeh, Jackson Junior, Braitstein, Paula, Dow, Dorothy, Arrington-Sanders, Renata, Appiah, Patrick, Tucker, Joe, Nam, Soohyun, and Garofalo, Robert

Published
2023
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16. Retention in Care and Patient-Reported Reasons for Undocumented Transfer or Stopping Care Among HIV-Infected Patients on Antiretroviral Therapy in Eastern Africa: Application of a Sampling-Based Approach

Author

Geng, Elvin H, Odeny, Thomas A, Lyamuya, Rita, Nakiwogga-Muwanga, Alice, Diero, Lameck, Bwana, Mwebesa, Braitstein, Paula, Somi, Geoffrey, Kambugu, Andrew, Bukusi, Elizabeth, Wenger, Megan, Neilands, Torsten B, Glidden, David V, Wools-Kaloustian, Kara, Yiannoutsos, Constantin, and Martin, Jeffrey

Subjects
Medical Microbiology, Biomedical and Clinical Sciences, Sexually Transmitted Infections, HIV/AIDS, Infectious Diseases, Clinical Research, 8.1 Organisation and delivery of services, Infection, Good Health and Well Being, Adult, Africa, Eastern, Anti-HIV Agents, Cohort Studies, Cross-Sectional Studies, Female, HIV Infections, Humans, Lost to Follow-Up, Male, antiretroviral therapy, Africa, retention, loss to follow-up, Biological Sciences, Medical and Health Sciences, Microbiology, Clinical sciences
Abstract

BackgroundImproving the implementation of the global response to human immunodeficiency virus requires understanding retention after starting antiretroviral therapy (ART), but loss to follow-up undermines assessment of the magnitude of and reasons for stopping care.MethodsWe evaluated adults starting ART over 2.5 years in 14 clinics in Uganda, Tanzania, and Kenya. We traced a random sample of patients lost to follow-up and incorporated updated information in weighted competing risks estimates of retention. Reasons for nonreturn were surveyed.ResultsAmong 18 081 patients, 3150 (18%) were lost to follow-up and 579 (18%) were traced. Of 497 (86%) with ascertained vital status, 340 (69%) were alive and, in 278 (82%) cases, updated care status was obtained. Among all patients initiating ART, weighted estimates incorporating tracing outcomes found that 2 years after ART, 69% were in care at their original clinic, 14% transferred (4% official and 10% unofficial), 6% were alive but out of care, 6% died in care (

Published
2016

17. Facility-Level Factors Influencing Retention of Patients in HIV Care in East Africa

Author

Rachlis, Beth, Bakoyannis, Giorgos, Easterbrook, Philippa, Genberg, Becky, Braithwaite, Ronald Scott, Cohen, Craig R, Bukusi, Elizabeth A, Kambugu, Andrew, Bwana, Mwebesa Bosco, Somi, Geoffrey R, Geng, Elvin H, Musick, Beverly, Yiannoutsos, Constantin T, Wools-Kaloustian, Kara, and Braitstein, Paula

Subjects
Biomedical and Clinical Sciences, Public Health, Health Sciences, Sexually Transmitted Infections, HIV/AIDS, Emerging Infectious Diseases, Clinical Research, Infectious Diseases, 7.1 Individual care needs, Infection, Good Health and Well Being, Adult, Anti-HIV Agents, CD4 Lymphocyte Count, Databases, Factual, Delivery of Health Care, Female, HIV, HIV Infections, Health Facilities, Humans, Kaplan-Meier Estimate, Kenya, Lost to Follow-Up, Male, Proportional Hazards Models, RNA, Viral, Reverse Transcriptase Polymerase Chain Reaction, Tanzania, Uganda, General Science & Technology
Abstract

Losses to follow-up (LTFU) remain an important programmatic challenge. While numerous patient-level factors have been associated with LTFU, less is known about facility-level factors. Data from the East African International epidemiologic Databases to Evaluate AIDS (EA-IeDEA) Consortium was used to identify facility-level factors associated with LTFU in Kenya, Tanzania and Uganda. Patients were defined as LTFU if they had no visit within 12 months of the study endpoint for pre-ART patients or 6 months for patients on ART. Adjusting for patient factors, shared frailty proportional hazard models were used to identify the facility-level factors associated with LTFU for the pre- and post-ART periods. Data from 77,362 patients and 29 facilities were analyzed. Median age at enrolment was 36.0 years (Interquartile Range: 30.1, 43.1), 63.9% were women and 58.3% initiated ART. Rates (95% Confidence Interval) of LTFU were 25.1 (24.7-25.6) and 16.7 (16.3-17.2) per 100 person-years in the pre-ART and post-ART periods, respectively. Facility-level factors associated with increased LTFU included secondary-level care, HIV RNA PCR turnaround time >14 days, and no onsite availability of CD4 testing. Increased LTFU was also observed when no nutritional supplements were provided (pre-ART only), when TB patients were treated within the HIV program (pre-ART only), and when the facility was open ≤4 mornings per week (ART only). Our findings suggest that facility-based strategies such as point of care laboratory testing and separate clinic spaces for TB patients may improve retention.

Published
2016

18. Patient-reported factors associated with reengagement among HIV-infected patients disengaged from care in East Africa.

Author

Camlin, Carol S, Neilands, Torsten B, Odeny, Thomas A, Lyamuya, Rita, Nakiwogga-Muwanga, Alice, Diero, Lameck, Bwana, Mwebesa, Braitstein, Paula, Somi, Geoffrey, Kambugu, Andrew, Bukusi, Elizabeth A, Glidden, David V, Wools-Kaloustian, Kara K, Wenger, Megan, Geng, Elvin H, and East Africa International Epidemiologic Databases to Evaluate AIDS (EA-IeDEA) Consortium

Subjects
East Africa International Epidemiologic Databases to Evaluate AIDS (EA-IeDEA) Consortium, Humans, HIV Infections, Patient Compliance, Adolescent, Adult, Aged, Middle Aged, Health Services Accessibility, Africa, Eastern, Female, Male, Young Adult, Africa, antiretroviral therapy, loss to follow-up, mortality, Mind and Body, Clinical Research, HIV/AIDS, 7.1 Individual care needs, 8.1 Organisation and delivery of services, Infection, Virology, Biological Sciences, Medical and Health Sciences, Psychology and Cognitive Sciences
Abstract

ObjectiveEngagement in care is key to successful HIV treatment in resource-limited settings; yet little is known about the magnitude and determinants of reengagement among patients out of care. We assessed patient-reported reasons for not returning to clinic, identified latent variables underlying these reasons, and examined their influence on subsequent care reengagement.DesignWe used data from the East Africa International Epidemiologic Databases to Evaluate AIDS to identify a cohort of patients disengaged from care (>3 months late for last appointment, reporting no HIV care in preceding 3 months) (n = 430) who were interviewed about reasons why they stopped care. Among the 399 patients for whom follow-up data were available, 104 returned to clinic within a median observation time of 273 days (interquartile range: 165-325).MethodsWe conducted exploratory and confirmatory factor analyses (EFA, CFA) to identify latent variables underlying patient-reported reasons, then used these factors as predictors of time to clinic return in adjusted Cox regression models.ResultsEFA and CFA findings suggested a six-factor structure that lent coherence to the range of barriers and motivations underlying care disengagement, including poverty, transport costs, and interference with work responsibilities; health system 'failures,' including poor treatment by providers; fearing disclosure of HIV status; feeling healthy; and treatment fatigue/seeking spiritual alternatives to medicine. Factors related to poverty and poor treatment predicted higher rate of return to clinic, whereas the treatment fatigue factor was suggestive of a reduced rate of return.ConclusionCertain barriers to reengagement appear easier to overcome than factors such as treatment fatigue. Further research will be needed to identify the easiest, least expensive interventions to reengage patients lost to HIV care systems. Interpersonal interventions may continue to play an important role in addressing psychological barriers to retention.

Published
2016

21. Patient-reported factors associated with reengagement among HIV-infected patients disengaged from care in East Africa

Author

Camlin, Carol S, Neilands, Torsten B, Odeny, Thomas A, Lyamuya, Rita, Nakiwogga-Muwanga, Alice, Diero, Lameck, Bwana, Mwebesa, Braitstein, Paula, Somi, Geoffrey, Kambugu, Andrew, Bukusi, Elizabeth A, Glidden, David V, Wools-Kaloustian, Kara K, Wenger, Megan, and Geng, Elvin H

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Health Sciences, Sexually Transmitted Infections, Infectious Diseases, Mental Health, Behavioral and Social Science, HIV/AIDS, Health Services, Prevention, Clinical Research, 7.1 Individual care needs, 8.1 Organisation and delivery of services, Good Health and Well Being, Adolescent, Adult, Africa, Eastern, Aged, Female, HIV Infections, Health Services Accessibility, Humans, Male, Middle Aged, Patient Compliance, Young Adult, Africa, antiretroviral therapy, loss to follow-up, mortality, East Africa International Epidemiologic Databases to Evaluate AIDS (EA-IeDEA) Consortium, Biological Sciences, Medical and Health Sciences, Psychology and Cognitive Sciences, Virology, Biomedical and clinical sciences, Health sciences
Abstract

ObjectiveEngagement in care is key to successful HIV treatment in resource-limited settings; yet little is known about the magnitude and determinants of reengagement among patients out of care. We assessed patient-reported reasons for not returning to clinic, identified latent variables underlying these reasons, and examined their influence on subsequent care reengagement.DesignWe used data from the East Africa International Epidemiologic Databases to Evaluate AIDS to identify a cohort of patients disengaged from care (>3 months late for last appointment, reporting no HIV care in preceding 3 months) (n = 430) who were interviewed about reasons why they stopped care. Among the 399 patients for whom follow-up data were available, 104 returned to clinic within a median observation time of 273 days (interquartile range: 165-325).MethodsWe conducted exploratory and confirmatory factor analyses (EFA, CFA) to identify latent variables underlying patient-reported reasons, then used these factors as predictors of time to clinic return in adjusted Cox regression models.ResultsEFA and CFA findings suggested a six-factor structure that lent coherence to the range of barriers and motivations underlying care disengagement, including poverty, transport costs, and interference with work responsibilities; health system 'failures,' including poor treatment by providers; fearing disclosure of HIV status; feeling healthy; and treatment fatigue/seeking spiritual alternatives to medicine. Factors related to poverty and poor treatment predicted higher rate of return to clinic, whereas the treatment fatigue factor was suggestive of a reduced rate of return.ConclusionCertain barriers to reengagement appear easier to overcome than factors such as treatment fatigue. Further research will be needed to identify the easiest, least expensive interventions to reengage patients lost to HIV care systems. Interpersonal interventions may continue to play an important role in addressing psychological barriers to retention.

Published
2015

22. Implementation and Operational Research

Author

Rachlis, Beth, Ochieng, Daniel, Geng, Elvin, Rotich, Elyne, Ochieng, Vincent, Maritim, Beryl, Ndege, Samson, Naanyu, Violet, Martin, Jeffrey N, Keter, Alfred, Ayuo, Paul, Diero, Lameck, Nyambura, Monicah, and Braitstein, Paula

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Health Sciences, HIV/AIDS, Infectious Diseases, Sexually Transmitted Infections, 7.1 Individual care needs, Infection, Good Health and Well Being, Adolescent, Adult, Child, Child, Preschool, Female, HIV Infections, Humans, Infant, Infant, Newborn, Kenya, Lost to Follow-Up, Male, Middle Aged, Young Adult, lost to follow-up, sampling, outreach, tracing, Public Health and Health Services, Virology, Clinical sciences, Epidemiology, Public health
Abstract

BackgroundAcademic Model Providing Access To Healthcare (AMPATH) program provides comprehensive HIV care and treatment services. Approximately, 30% of patients have become lost to follow-up (LTFU). We sought to actively trace and identify outcomes for a sample of these patients.MethodsLTFU was defined as missing a scheduled visit by ≥3 months. A randomly selected sample of 17% of patients identified as LTFU between January 2009 and June 2011 was generated, with sample stratification on age, antiretroviral therapy (ART) status at last visit, and facility. Chart reviews were conducted followed by active tracing. Tracing was completed by trained HIV-positive outreach workers July 2011 to February 2012. Outcomes were compared between adults and children and by ART status.ResultsOf 14,811 LTFU patients, 2540 were randomly selected for tracing (2179 adults, 1071 on ART). The chart reviews indicated that 326 (12.8%) patients were not actually LTFU. Outcomes for 71% of sampled patients were determined including 85% of those physically traced. Of those with known outcomes, 21% had died, whereas 29% had disengaged from care for various reasons. The remaining patients had moved away (n = 458, 25%) or were still receiving HIV care (n = 443 total, 25%).ConclusionsOur findings demonstrate the feasibility of a large-scale sampling-based approach. A significant proportion of patients were found not to be LTFU, and further, high numbers of patients who were LTFU could not be located. Over a quarter of patients disengaged from care for various reasons including access challenges and familial influences.

Published
2015

23. Estimation of mortality among HIV-infected people on antiretroviral treatment in east Africa: a sampling based approach in an observational, multisite, cohort study

Author

Geng, Elvin H, Odeny, Thomas A, Lyamuya, Rita E, Nakiwogga-Muwanga, Alice, Diero, Lameck, Bwana, Mwebesa, Muyindike, Winnie, Braitstein, Paula, Somi, Geoffrey R, Kambugu, Andrew, Bukusi, Elizabeth A, Wenger, Megan, Wools-Kaloustian, Kara K, Glidden, David V, Yiannoutsos, Constantin T, and Martin, Jeffrey N

Subjects
Public Health, Biomedical and Clinical Sciences, Clinical Sciences, Health Sciences, Infectious Diseases, Sexually Transmitted Infections, Clinical Research, HIV/AIDS, Infection, Good Health and Well Being, Adult, Anti-HIV Agents, Antiretroviral Therapy, Highly Active, CD4 Lymphocyte Count, Cohort Studies, Data Collection, Female, HIV Infections, Humans, Kenya, Male, Sampling Studies, Tanzania, Uganda, United States, Young Adult, Medical and Health Sciences, Biomedical and clinical sciences, Health sciences
Abstract

BackgroundMortality in HIV-infected people after initiation of antiretroviral treatment (ART) in resource-limited settings is an important measure of the effectiveness and comparative effectiveness of the global public health response. Substantial loss to follow-up precludes accurate accounting of deaths and limits our understanding of effectiveness. We aimed to provide a better understanding of mortality at scale and, by extension, the effectiveness and comparative effectiveness of public health ART treatment in east Africa.MethodsIn 14 clinics in five settings in Kenya, Uganda, and Tanzania, we intensively traced a sample of patients randomly selected using a random number generator, who were infected with HIV and on ART and who were lost to follow-up (>90 days late for last scheduled visit). We incorporated the vital status outcomes for these patients into analyses of the entire clinic population through probability-weighted survival analyses.FindingsWe followed 34 277 adults on ART from Mbarara and Kampala in Uganda, Eldoret, and Kisumu in Kenya, and Morogoro in Tanzania. The median age was 35 years (IQR 30-42), 11 628 (34%) were men, and median CD4 count count before therapy was 154 cells per μL (IQR 70-234). 5780 patients (17%) were lost to follow-up, 991 (17%) were selected for tracing between June 10, 2011, and Aug 27, 2012, and vital status was ascertained for 860 (87%). With incorporation of outcomes from the patients lost to follow-up, estimated 3 year mortality increased from 3·9% (95% CI 3·6-4·2) to 12·5% (11·8-13·3). The sample-corrected, unadjusted 3 year mortality across settings was lowest in Mbarara (7·2%) and highest in Morogoro (23·6%). After adjustment for age, sex, CD4 count before therapy, and WHO stage, the sample-corrected hazard ratio comparing the settings with highest and lowest mortalities was 2·2 (95% CI 1·5-3·4) and the risk difference for death at 3 years was 11% (95% CI 5·0-17·7).InterpretationA sampling-based approach is widely feasible and important to an understanding of mortality after initiation of ART. After adjustment for measured biological drivers, mortality differs substantially across settings despite delivery of a similar clinical package of treatment. Implementation research to understand the systems, community, and patients' behaviours driving these differences is urgently needed.FundingThe US National Institutes of Health and President's Emergency Fund for AIDS Relief.

Published
2015

27. Trends in the clinical characteristics of HIV-infected patients initiating antiretroviral therapy in Kenya, Uganda and Tanzania between 2002 and 2009

Author

Geng, Elvin H, Hunt, Peter W, Diero, Lameck O, Kimaiyo, Sylvester, Somi, Geofrey R, Okong, Pius, Bangsberg, David R, Bwana, Mwebesa B, Cohen, Craig R, Otieno, Juliana A, Wabwire, Deo, Elul, Batya, Nash, Denis, Easterbrook, Philippa J, Braitstein, Paula, Musick, Beverly S, Martin, Jeffrey N, Yiannoutsos, Constantin T, and Wools-Kaloustian, Kara

Abstract

Abstract Background East Africa has experienced a rapid expansion in access to antiretroviral therapy (ART) for HIV-infected patients. Regionally representative socio-demographic, laboratory and clinical characteristics of patients accessing ART over time and across sites have not been well described. Methods We conducted a cross-sectional analysis of characteristics of HIV-infected adults initiating ART between 2002 and 2009 in Kenya, Uganda and Tanzania and in the International Epidemiologic Databases to Evaluate AIDS Consortium. Characteristics associated with advanced disease (defined as either a CD4 cell count level of less than 50 cells/mm3 or a WHO Stage 4 condition) at the time of ART initiation and use of stavudine (D4T) or nevirapine (NVP) were identified using a log-link Poisson model with robust standard errors. Results Among 48, 658 patients (69% from Kenya, 22% from Uganda and 9% from Tanzania) accessing ART at 30 clinic sites, the median age at the time of ART initiation was 37 years (IQR: 31-43) and 65% were women. Pre-therapy CD4 counts rose from 87 cells/mm3 (IQR: 26-161) in 2002-03 to 154 cells/mm3 (IQR: 71-233) in 2008-09 (p < 0.001). Accessing ART at advanced disease peaked at 35% in 2005-06 and fell to 27% in 2008-09. D4T use in the initial regimen fell from a peak of 88% in 2004-05 to 59% in 2008-09, and a greater extent of decline was observed in Uganda than in Kenya and Tanzania. Self-pay for ART peaked at 18% in 2003, but fell to less than 1% by 2005. In multivariable analyses, accessing ART at advanced immunosuppression was associated with male sex, women without a history of treatment for prevention of mother to child transmission (both as compared with women with such a history) and younger age after adjusting for year of ART initiation and country of residence. Receipt of D4T in the initial regimen was associated with female sex, earlier year of ART initiation, higher WHO stage, and lower CD4 levels at ART initiation and the absence of co-prevalent tuberculosis. Conclusions Public health ART services in east Africa have improved over time, but the fraction of patients accessing ART with advanced immunosuppression is still high, men consistently access ART with more advanced disease, and D4T continues to be common in most settings. Strategies to facilitate access to ART, overcome barriers among men and reduce D4T use are needed.

Published
2011

37. Youth participation in sexual and reproductive health: policy, practice, and progress in Malawi

Author

Wigle, Jannah, Paul, Stewart, Birn, Anne-Emanuelle, Gladstone, Brenda, and Braitstein, Paula

Abstract

Objectives: Ensuring youth participation in policymaking that affects their health and well-being is increasingly recognized as a strategy to improve young people’s reproductive health. This paper aimed to describe the policy context and analyze underlying factors that influence youth participation in sexual and reproductive health (SRH) policymaking in Malawi. Methods: This critical, focused ethnographic study is informed by postcolonial feminism and difference-centered citizenship theory, based on data collected from October 2017 to May 2018. Multiple research methods were employed: document analysis, focus group discussions, and “moderate” participant observation. Semi-structured interviews were conducted with key informants and youth, supplemented by open-ended drawing exercises with youth. Results: Progressive policies and the presence of youth in some policymaking structures indicate substantial headway in Malawi. However, underlying structural and societal factors circumscribe young people’s lived experiences of participation. Conclusions: Despite recent progress in involving young people in SRH policymaking, notable gaps remain between policy and practice. Recognizing and integrating young people in all stages of SRH policymaking is critical to catalyzing the social and political changes necessary to ensure their reproductive health and well-being.

Published
2024
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38. Piloting an evidence-based intervention for HIV prevention among street youth in Eldoret, Kenya

Author

Embleton, L., Di Ruggiero, E., Logie, C. H., Ayuku, D., and Braitstein, P.

Abstract

Objectives: This study presents findings from piloting an adapted evidence-based intervention, Stepping Stones and Creating Futures, to change street-connected young people’s HIV knowledge, condom-use self-efficacy, and sexual practices. Methods: Eighty street-connected young people participated in a pre- and post-test mixed methods design in Eldoret, Kenya. The primary outcome of interest was HIV knowledge. Secondary outcomes included condom-use self-efficacy and sexual practices. Multiple linear regression models for change scores with adjustment for socio-demographic variables were fitted. Qualitative and quantitative findings are presented together, where integration confirms, expands on, or uncovers discordant findings. Results: Participants had a significant increase in HIV knowledge from pre- to post-intervention. The median HIV knowledge score pre-intervention was 11 (IQR 8–13) and post-intervention 14 (IQR 12–16). Attendance was significantly associated with HIV knowledge change scores. Qualitatively participants reported increased HIV and condom-use knowledge and improved condom-use self-efficacy and health-seeking practices. Conclusions: Our findings support the potential for further testing with a rigorous study design to investigate how best to tailor the intervention, particularly by gender, and increase the overall effectiveness of the program.

Published
2024
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45. Optimal timing of HIV home-based counselling and testing rounds in Western Kenya

Author

Olney, JJ, Eaton, J, Braitstein, P, Hogan, J, Hallett, T, and Bill & Melinda Gates Foundation

Subjects
home-based counselling & testing, antiretroviral therapy, care cascade, HIV, 1199 Other Medical And Health Sciences, health care economics and organizations, mathematical model, HIV testing, treatment cascade
Abstract

Introduction: Weaknesses in care programmes providing anti‐retroviral therapy (ART) persist and are often instigated by late HIV diagnosis and poor linkage to care. We investigated the potential for a home‐based counselling and testing (HBCT) campaign to be improved through the optimal timing and enhancement of testing rounds to generate greater health outcomes at minimum cost. Methods: Using a mathematical model of HIV care calibrated to longitudinal data from The Academic Model Providing Access To Healthcare (AMPATH) in Kenya, we simulated HBCT campaigns between 2016 and 2036, assessing the impact and total cost of care for each, for a further 20 years. Results: We find that simulating five equally spaced rounds averts 1.53 million disability‐adjusted life‐years (DALYs) at a cost of $1617 million. By altering the timing of HBCT rounds, a four‐round campaign can produce greater impact for lower cost. With “front‐loaded” rounds, the cost per DALY averted is reduced by 12% as fewer rounds are required ($937 vs. $1060). Furthermore, improvements to HBCT coverage and linkage to care avert over two million DALYs at a cost per DALY averted of $621 (41% less than the reference scenario). Conclusions: Countries implementing HBCT can reduce costs by optimally timing rounds and generate greater health outcomes through improving linkage, coverage, and retention. Tailoring HBCT campaigns to individual settings can enhance patient outcomes for minimal cost.

Published
2018

46. Identifying Strategies to Advance Health Equity through Action on Social Determinants of Health and Human Rights for Street-Connected Children and Youth in Kenya.

Author

EMBLETON, LONNIE, SHAH, POOJA, GAYAPERSAD, ALLISON AMIN, KIPTUI, REUBEN, AYUKU, DAVID, and BRAITSTEIN, PAULA

Subjects
CONCEPTUAL structures, HEALTH planning, HEALTH services accessibility, HEALTH status indicators, HUMAN rights, MEDICAL needs assessment, HEALTH policy, NEWSPAPERS, POLICY sciences, HEALTH & social status
Abstract

Despite the fact that street-connected children and youth (SCY) in low- and middle-income countries experience numerous social and health inequities, few evidence-based policies and interventions have been implemented to improve their circumstances. Our study analyzed strategies to advance health equity through action on the social determinants of health (SDH) for SCY in Kenya based on General Comment 21 of the United Nations Committee on the Rights of the Child. To identify policies and interventions, we analyzed archival newspaper articles and policy documents and elicited ideas from a diversity of social actors across Kenya. Our results identified three types of policies and interventions: repressive, welfare oriented, and child rights based. We then situated these strategies within the World Health Organization's conceptual framework on SDH inequities to understand their mechanism of impact on health equity. Our results demonstrate that a child rights approach provides a strong avenue for advancing health equity through action on the SDH for SCY in Kenya. As a result of these findings, we developed a checklist for policy makers and other stakeholders to assess how their policies and interventions are upholding human rights, addressing needs, and working to advance health equity for SCY. [ABSTRACT FROM AUTHOR]

Published
2020

47. Sex-based differences in antiretroviral therapy initiation, switching and treatment interruptions: global overview from the International Epidemiologic Databases to Evaluate AIDS (IeDEA)

Author

Giles, ML, Achhra, AC, Abraham, AG, Haas, AD, Gill, MJ, Lee, MP, Luque, M, McGowan, C, Cornell, M, Braitstein, P, de Rekeneire, N, Becquet, R, Wools-Kaloustian, K, Law, M, Giles, ML, Achhra, AC, Abraham, AG, Haas, AD, Gill, MJ, Lee, MP, Luque, M, McGowan, C, Cornell, M, Braitstein, P, de Rekeneire, N, Becquet, R, Wools-Kaloustian, K, and Law, M

Abstract

INTRODUCTION: In 2015, the World Health Organization recommended that all HIV-infected individuals consider ART initiation as soon as possible after diagnosis. Sex differences in choice of initial ART regimen, indications for switching, time to switching and choice of second-line regimens have not been well described. The aims of this study were to describe first-line ART and CD4 count at ART initiation by sex, calendar year and region, and to analyse time to change or interruption in first-line ART, according to sex in each region. METHODS: Participating cohorts included: Southern, East and West Africa (IeDEA-Africa), North America (NA-ACCORD), Caribbean, Central/South America (CCASAnet) and Asia-Pacific including Australia (IeDEA Asia-Pacific). The primary outcomes analysed for each region and according to sex were choice of initial ART, time to switching and time to discontinuation of the first-line regimen. RESULTS AND DISCUSSION: The combined cohort data set comprised of 715,252 participants across seven regions from low- to high-income settings. The median CD4 count at treatment initiation was lower in men compared with women in nearly all regions and time periods. Women from North America and Southern Africa were more likely to switch ART compared to men (p < 0.001) with approximately 90% of women reporting a major change after 10 years in North America. Overall, after 8 years on ART, >50% of HIV- positive men and women from Southern Africa, East Africa, South and Central America remained on their original regimen. Men were more likely to have a treatment interruption compared with women in low- and middle-income countries from the Asia/Pacific region (p < 0.001) as were men from Southern Africa (p < 0.001). Greater than 75% of men and women did not report a treatment interruption after 10 years on ART from all regions except North America and Southern Africa. CONCLUSIONS: There are regional variations in the ART regimen commenced at baseline and rates of maj

Published
2018

49. Implementation of Tuberculosis Intensive Case Finding, Isoniazid Preventive Therapy, and Infection Control ('Three I's') and HIV-Tuberculosis Service Integration in Lower Income Countries

Author

Charles, M.K., Lindegren, M.L., Wester, C.W., Blevins, M., Sterling, T.R., Dung, N.T., Dusingize, J.C., Avit-Edi, D., Durier, N., Castelnuovo, B., Nakigozi, G., Cortes, C.P., Ballif, M., Fenner, L., Ajayi, S., Anastos, K., Bashi, J., Bishai, W., Boulle, A., Braitstein, P., Carriquiry, G., Carter, J.E., Cegielski, P., Chimbetete, C., Davies, M.-A., Diero, L., Duda, S., Egger, M., Eboua, T.F., Gasser, A., Geng, E., Gnokori, J.C., Hardwicke, L., Hoffmann, C., Huebner, R., Kancheya, N., Kiertiburanakul, S., Kim, P., Lameck, D., Leroy, V., Lewden, C., Mandalakas, A., Maskew, M., McKaig, R., Mofenson, L., Mpoudi-Etame, M., Okwara, B., Phiri, S., Prasitsuebsai, W., Petit, A., Prozesky, H., Reid, S.E., Renner, L., Reubenson, G., Sohn, A., Vo, Q., Walker, D., Wehbe, F., Wejse, C., Williams, C., Wood, R., Wools-Kaloustian, K., Yao, Z., Yunihastuti, E., Zhang, F.J., Zhao, H.X., Han, N., Merati, T.P., Wirawan, D.N., Yuliana, F., Ditangco, R., Uy, E., Bantique, R., Phanuphak, P., Ruxrungtham, K., Avihingsanon, A., Khongphattanayothin, M., Sungkanuparph, S., Sanmeema, N., Chaiwarith, R., Sirisanthana, T., Kotarathititum, W., Pham, T.T., Cuong, D.D., Ha, H.L., Nguyen, V.K., Bui, V.H., Nguyen, T.D., Sohn, A.H., Petersen, B., Cooper, D.A., Law, M.G., Jiamsakul, A., Boettiger, D.C., Wati, D.K., Atmikasari, L.P.P., Malino, I.Y., Nallusamy, R., Chan, K.C., Lumbiganon, P., Kosalaraksa, P., Tharnprisan, P., Udomphanit, T., Phongsamart, W., Wittawatmongkol, O., Dung, K.T.K., Lam, N.V., An, P.N., Loan, N.T., Truong, H.K., Du, T.Q., Chau, N.H., Do, C.V., Ha, M.T., Nipathakosol, P., Kariminia, A., Mutimura, E., Gitembagara, A., Tatwangire, J., Izabelle, I., Niyongabo, T., Twizere, C., Baramperanye, E., Edmonds, A., Yotebieng, M., Azinyue, I., Ayangma, L., Dickinson, D., Eley, B., Fritz, C., Garone, D., Giddy, J., MacPhail, P., Moultrie, H., Ndirangu, J., Pestilli, S., Rabie, H., Stringer, J., Technau, K., Graber, C., Kaeser, F., Keiser, O., Cornell, M., Maxwell, N., Zannou, D.M., Ahouada, C., Akakpo, J., Ahomadegbé, C., Gougounon-Houéto, A., Azon-Kouanou, A., Houngbé, F., Sehonou, J., Koumakpaï, S., Alihonou, F., D'Almeida, M., Hodonou, I., Hounhoui, G., Sagbo, G., Tossa-Bagnan, L., Adjide, H., Drabo, J., Bognounou, R., Dienderé, A., Traore, E., Zoungrana, L., Zerbo, B., Sawadogo, A.B., Zoungrana, J., Héma, A., Soré, I., Bado, G., Tapsoba, A., Yé, D., Kouéta, F., Ouedraogo, S., Ouédraogo, R., Hiembo, W., Gansonré, M., Messou, E., Gnokoro, J.C., Koné, M., Kouakou, G.M., Bosse, C.A., Brou, K., Assi, A.I., Chenal, H., Hawerlander, D., Soppi, F., Minga, A., Abo, Y., Yoboue, J.-M., Eholié, S.P., Amego, M.D.N., Andavi, V., Diallo, Z., Ello, F., Tanon, A.K., Koule, S.O., Anzan, K.C., Guehi, C., Aka, E.A., Issouf, K.L., Kouakou, J.-C., N'Gbeche, M.-S., Pety, T., Kouakou, K., Moh, M., Yao, V.A., Folquet, M.A., Dainguy, M.-E., Kouakou, C., Méa-Assande, V.T., Oka-Berete, G., Zobo, N., Acquah, P., Kokora, M.-B., Timité-Konan, M., Ahoussou, L.D., Assouan, J.K., Sami, M.F., Kouadio, C., Goka, B., Welbeck, J., Sackey, A., Owiafe, S.N., Da Silva, Z.J., Paulo, J., Rodrigues, A., Da Silva, D., Medina, C., Oliviera-Souto, I., Østergaard, L., Laursen, A., Sodemann, M., Aaby, P., Fomsgaard, A., Erikstrup, C., Eugen-Olsen, J., Maïga, M.Y., Diakité, F.F., Kalle, A., Katile, D., Traore, H.A., Minta, D., Cissé, T., Dembelé, M., Doumbia, M., Fomba, M., Kaya, A.S., Traoré, A.M., Traoré, H., Toure, A.A., Dicko, F., Sylla, M., Berthé, A., Traoré, H.C., Koïta, A., Koné, N., N'Diaye, C., Coulibaly, S.T., Traoré, M., Traoré, N., Charurat, M., Alim, G., Dapiap, S., Otu, Igbinoba, F., Benson, O., Adebamowo, C., James, J., Obaseki, Osakede, P., Olasode, J., Seydi, M., Sow, P.S., Diop, B., Manga, N.M., Tine, J.M., Bassabi, C.C., Sy, H.S., Ba, A., Diagne, A., Dior, H., Faye, M., Gueye, R.D., Mbaye, A.D., Patassi, A., Kotosso, A., Kariyare, B.G., Gbadamassi, G., Komi, A., Mensah-Zukong, K.E., Pakpame, P., Lawson-Evi, A.K., Atakouma, Y., Takassi, E., Djeha, A., Ephoévigah, A., Djibril, S.E.-H., Dabis, F., Bissagnene, E., Arrivé, E., Coffie, P., Ekouevi, D., Jaquet, A., Sasco, A.J., Amani, D., Azani, J.-C., Balestre, E., Bessekon, S., Bohossou, F., Gilbert, C., Karcher, S., Gonsan, J.M., Le Carrou, J., Lenaud, S., Nchot, C., Malateste, K., Yao, A.R., Siloué, B., Clouet, G., Dosso, M., Doring, A., Kouakou, A., Rabourdin, E., Rivenc, J., Anglaret, X., Ba, B., Essanin, J.B., Ciaranello, A., Datté, S., Desmonde, S., Diby, J.-S.E., Gottlieb, G.S., Horo, A.G., Kangah, S.N., Malvy, D., Meless, D., Mounkaila-Harouna, A., Ndondoki, C., Shiboski, C., Tchounga, B., Thiébaut, R., Wandeler, G., McGowan, C., Cahn, P., Gotuzzo Herencia, José Eduardo, Reyes, M.W., Grinsztejn, B., Pape, J.W., Padgett, D., and Madero, J.S.

Subjects
0301 basic medicine, Program evaluation, Bacterial Diseases, poverty, Physiology, Antitubercular Agents, lcsh:Medicine, HIV Infections, Pathology and Laboratory Medicine, Occupational safety and health, Geographical Locations, 0302 clinical medicine, case finding, Health care, lowest income group, Medicine and Health Sciences, Coughing, Medicine, Infection control, 030212 general & internal medicine, lcsh:Science, fever, Multidisciplinary, antiretrovirus agent, adult, HIV diagnosis and management, sputum smear, Vaccination and Immunization, 3. Good health, Infectious Diseases, Caribbean Region, Tuberculosis Diagnosis and Management, protective equipment, tuberculosis control, Research Article, medicine.medical_specialty, isoniazid, Tuberculosis, Asia, integrated health care system, 030106 microbiology, HIV prevention, Immunology, Developing country, Antiretroviral Therapy, complication, 610 Medicine & health, World Health Organization, Article, 03 medical and health sciences, Signs and Symptoms, Tuberculosis diagnosis, Antiviral Therapy, Human immunodeficiency virus infection, night sweat, 360 Social problems & social services, Environmental health, parasitic diseases, Isoniazid, Humans, purl.org/pe-repo/ocde/ford#3.01.05 [https], human, coughing, Poverty, tuberculin test, Caribbean, Preventive medicine, Infection Control, AIDS-Related Opportunistic Infections, business.industry, screening, lcsh:R, Biology and Life Sciences, occupational safety, South America, medicine.disease, Tropical Diseases, Diagnostic medicine, mask, Public and occupational health, purl.org/pe-repo/ocde/ford#3.02.07 [https], People and Places, Africa, Physical therapy, tuberculostatic agent, lcsh:Q, weight reduction, business, Physiological Processes
Abstract

SETTING World Health Organization advocates for integration of HIV-tuberculosis (TB) services and recommends intensive case finding (ICF), isoniazid preventive therapy (IPT), and infection control ("Three I's") for TB prevention and control among persons living with HIV. OBJECTIVE To assess the implementation of the "Three I's" of TB-control at HIV treatment sites in lower income countries. DESIGN Survey conducted between March-July, 2012 at 47 sites in 26 countries: 6 (13%) Asia Pacific, 7 (15%), Caribbean, Central and South America, 5 (10%) Central Africa, 8 (17%) East Africa, 14 (30%) Southern Africa, and 7 (15%) West Africa. RESULTS ICF using symptom-based screening was performed at 38% of sites; 45% of sites used symptom-screening plus additional diagnostics. IPT at enrollment or ART initiation was implemented in only 17% of sites, with 9% of sites providing IPT to tuberculin-skin-test positive patients. Infection control measures varied: 62% of sites separated smear-positive patients, and healthcare workers used masks at 57% of sites. Only 12 (26%) sites integrated HIV-TB services. Integration was not associated with implementation of TB prevention measures except for IPT provision at enrollment (42% integrated vs. 9% non-integrated; p = 0.03). CONCLUSIONS Implementation of TB screening, IPT provision, and infection control measures was low and variable across regional HIV treatment sites, regardless of integration status.

Published
2016
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50. Variable impact on mortality of AIDS-defining events diagnosed during combination antiretroviral therapy : not all AIDS-defining conditions are created equal

Author

Antiretroviral Therapy Cohort Collaboration Mocroft A, Sterne JA, Egger M, May M, Grabar S, Furrer H, Sabin C, Fatkenheuer G, Justice A, Reiss P, d'Arminio Monforte A, Gill J, Hogg R, Bonnet F, Kitahata M, Staszewski S, Casabona J, Harris R, Saag M, Chêne G, Costagliola D, Dabis F, D'Arminio Monforte A, de Wolf F, Ledergerber B, Mocroft A, Phillips A, Weller I, Sterne J, Abgrall S, Barin F, Bentata M, Billaud E, Boué F, Burty C, Cabié A, Cotte L, De Truchis P, Duval X, Duvivier C, Enel P, Fredouille Heripret L, Gasnault J, Gaud C, Gilquin J, Katlama C, Khuong MA, Lang JM, Lascaux AS, Launay O, Mahamat A, Mary Krause M, Matheron S, Meynard JL, Pavie J, Pialoux G, Pilorgé F, Poizot Martin I, Pradier C, Reynes J, Rouveix E, Simon A, Tattevin P, Tissot Dupont H, Viard JP, Viget N, Pariente Khayat A, Salomon V, Jacquemet N, Rivet A, Guiguet M, Kousignian I, Lanoy E, Lièvre L, Potard V, Selinger Leneman H, Bouvet E, Crickx B, Ecobichon JL, Leport C, Picard Dahan C, Yeni P, Tisne Dessus D, Weiss L, Salmon D, Sicard D, Auperin I, Roudière L, Fior R, Delfraissy JF, Goujard C, Jung C, Lesprit P, Desplanque N, Meyohas MC, Picard O, Cadranel J, Mayaud C, Bricaire F, Herson S, Clauvel JP, Decazes JM, Gerard L, Molina JM, Diemer M, Sellier P, Berthé H, Dupont C, Chandemerle C, Mortier E, Honoré P, Jeantils V, Tassi S, Mechali D, Taverne B, Gourdon F, Laurichesse H, Fresard A, Lucht F, Eglinger P, Faller JP, Bazin C, Verdon R, Boibieux A, Peyramond D, Livrozet JM, Touraine JL, Trepo C, Ravaux I, Delmont JP, Moreau J, Gastaut JA, Retornaz F, Soubeyrand J, Allegre T, Blanc PA, Galinier A, Ruiz JM, Lepeu G, Granet Brunello P, Esterni JP, Pelissier L, Cohen Valensi R, Nezri M, Chadapaud S, Laffeuillade A, May T, Rabaud C, Raffi F, Arvieux C, Michelet C, Borsa Lebas F, Caron F, Fraisse P, Rey D, Arlet Suau E, Cuzin L, Massip P, Thiercelin Legrand MF, Yasdanpanah Y, Pradinaud R, Sobesky M, Contant M, Montroni M, Scalise G, Braschi MC, Riva A, Tirelli U, Martellotta F, Pastore G, Ladisa N, Suter F, Arici C, Chiodo F, Colangeli V, Fiorini C, Carosi G, Cristini G, Torti C, Minardi C, Bertelli D, Quirino T, Manconi PE, Piano P, Cosco L, Scerbo A, Vecchiet J, D'Alessandro M, Santoro D, Pusterla L, Carnevale G, Lorenzotti S, Viganò P, Mena M, Ghinelli F, Sighinolfi L, Leoncini F, Mazzotta F, Pozzi M, Lo Caputo S, Grisorio B, Ferrara S, Grima P, Grima PF, Pagano G, Cassola G, Alessandrini A, Piscopo R, Toti M, Trezzi M, Soscia F, Tacconi L, Orani A, Perini P, Scasso A, Vincenti A, Chiodera F, Castelli P, Scalzini A, Palvarini L, Moroni M, Lazzarin A, Rizzardini G, Caggese L, Cicconi P, Galli A, Merli S, Pastecchia C, Moioli MC, Esposito R, Mussini C, Abrescia N, Chirianni A, Izzo CM, Piazza M, De Marco M, Viglietti R, Manzillo E, Colomba A, Abbadessa V, Prestileo T, Mancuso S, Ferrari C, Pizzaferri P, Filice G, Minoli L, Bruno R, Novati S, Baldelli F, Camanni G, Petrelli E, Cioppi A, Alberici F, Ruggieri A, Menichetti F, Martinelli C, De Stefano C, La Gala A, Ballardini G, Rizzo E, Magnani G, Ursitti MA, Arlotti M, Ortolani P, Cauda R, Dianzani F, Ippolito G, Antinori A, Antonucci G, Ciardi M, Narciso P, Petrosillo N, Vullo V, De Luca A, Zaccarelli M, Acinapura R, De Longis P, Trotta MP, Noto P, Lichtner M, Capobianchi MR, Carletti F, Girardi E, Pezzotti P, Rezza G, Mura MS, Mannazzu M, Caramello P, Di Perri G, Orofino GC, Sciandra M, Grossi PA, Basilico C, Poggio A, Bottari G, Raise E, Ebo F, Pellizzer G, Buonfrate D, Resta F, Loso K, Cozzi Lepri A, Battegay M, Bernasconi E, Böni J, Bucher H, Bürgisser P, Cattacin S, Cavassini M, Dubs R, Elzi L, Erb P, Fischer M, Flepp M, Fontana A, Francioli P, Gorgievski M, Günthard H, Hirsch H, Hirschel B, Hösli I, Kahlert C, Kaiser L, Karrer U, Kind C, Klimkait T, Martinetti G, Martinez B, Müller N, Nadal D, Opravil M, Paccaud F, Pantaleo G, Rickenbach M, Rudin C, Schmid P, Schultze D, Schüpbach J, Speck R, Taffé P, Tarr P, Telenti A, Trkola A, Vernazza P, Weber R, Yerly S, Gras LA, van Sighem AI, Smit C, Bronsveld W, Hillebrand Haverkort ME, Prins JM, Branger J, Eeftinck Schattenkerk JK, Gisolf J, Godfried MH, Lange JM, Lettinga KD, van der Meer JT, Nellen FJ, van der Poll T, Ruys TA, Steingrover R, Vermeulen JN, Vrouenraets SM, van Vugt M, Wit FW, Kuijpers TW, Pajkrt D, Scherpbier HJ, van Eeden A, Brinkman K, van den Berk GE, Blok WL, Frissen PH, Roos JC, Schouten WE, Mulder JW, van Gorp EC, Wagenaar J, Veenstra J, Danner SA, Van Agtmael MA, Claessen FA, Perenboom RM, Rijkeboer A, van Vonderen MG, Richter C, van der Berg J, Vriesendorp R, Jeurissen FJ, Kauffmann RH, Pogány K, Bravenboer B, ten Napel CH, Kootstra GJ, Sprenger HG, van Assen S, van Leeuwen JT, Doedens R, Scholvinck EH, ten Kate RW, Soetekouw R, van Houte D, Polée MB, Kroon FP, van den Broek PJ, van Dissel JT, Schippers EF, Schreij G, van der Geest S, Lowe S, Verbon A, Koopmans PP, Van Crevel R, de Groot R, Keuter M, Post F, van der Ven AJ, Warris A, van der Ende ME, Gyssens IC, van der Feltz M, Nouwen JL, Rijnders BJ, de Vries TE, Driessen G, van der Flier M, Hartwig NG, Juttman JR, van Kasteren ME, Van de Heul C, Hoepelman IM, Schneider MM, Bonten MJ, Borleffs JC, Ellerbroek PM, Jaspers CA, Mudrikove T, Schurink CA, Gisolf EH, Geelen SP, Wolfs TF, Faber T, Tanis AA, Groeneveld PH, den Hollander JG, Duits AJ, Winkel K, Back NK, Bakker ME, Berkhout B, Jurriaans S, Zaaijer HL, Cuijpers T, Rietra PJ, Roozendaal KJ, Pauw W, van Zanten AP, Smits PH, von Blomberg BM, Savelkoul P, Pettersson A, Swanink CM, Franck PF, Lampe AS, Jansen CL, Hendriks R, Benne CA, Veenendaal D, Storm H, Weel J, van Zeijl JH, Kroes AC, Claas HC, Bruggeman CA, Goossens VJ, Galama JM, Melchers WJ, Poort YA, Doornum GJ, Niesters MG, Osterhaus AD, Schutten M, Buiting AG, Swaans CA, Boucher CA, Schuurman R, Boel E, Jansz AF, Veldkamp A, Beijnen JH, Huitema AD, Burger DM, Hugen PW, van Kan HJ, Losso M, Duran A, Vetter N, Karpov I, Vassilenko A, Mitsura VM, Suetnov O, Clumeck N, De Wit S, Poll B, Colebunders R, Kostov K, Begovac J, Machala L, Rozsypal H, Sedlacek D, Nielsen J, Lundgren J, Benfield T, Kirk O, Gerstoft J, Katzenstein T, Hansen AB, Skinhøj P, Pedersen C, Oestergaard L, Zilmer K, Ristola M, Girard PM, Vanhems P, Rockstroh J, Schmidt R, van Lunzen J, Degen O, Stellbrink HJ, Bogner J, Kosmidis J, Gargalianos P, Xylomenos G, Perdios J, Panos G, Filandras A, Karabatsaki E, Sambattakou H, Banhegyi D, Mulcahy F, Yust I, Turner D, Burke M, Pollack S, Hassoun G, Maayan S, Chiesi A, Mazeu I, Pristera R, Gabbuti A, Montesarchio E, Gargiulo M, Iacomi F, Vlassi C, Finazzi R, Galli M, Ridolfo A, Rozentale B, Aldins P, Chaplinskas S, Hemmer R, Staub T, Bruun J, Maeland A, Ormaasen V, Knysz B, Gasiorowski J, Horban A, Prokopowicz D, Wiercinska Drapalo A, Boron Kaczmarska A, Pynka M, Beniowski M, Mularska E, Trocha H, Antunes F, Valadas E, Mansinho K, Maltez F, Duiculescu D, Rakhmanova A, Vinogradova E, Buzunova S, Jevtovic D, Mokrás M, Staneková D, González Lahoz J, Soriano V, Martin Carbonero L, Labarga P, Clotet B, Jou A, Conejero J, Tural C, Gatell JM, Miró JM, Domingo P, Gutierrez M, Mateo G, Sambeat MA, Karlsson A, Persson PO, Flamholc L, Boffi E, Kravchenko E, Chentsova N, Barton S, Johnson AM, Mercey D, Johnson MA, Murphy M, Weber J, Scullard G, Fisher M, Brettle R, Gatell J, Gazzard B, Friis Møller N, Bannister W, Ellefson M, Borch A, Podlekareva D, Holkmann Olsen C, Kjaer J, Peters L, Reekie J, Raffanti S, Dieterch D, Becker S, Scarsella A, Fusco G, Most B, Balu R, Rana R, Beckerman R, Ising T, Fusco J, Irek R, Johnson B, Hirani A, DeJesus E, Pierone G, Lackey P, Irek C, Johnson A, Burdick J, Leon S, Arch J, Helm EB, Carlebach A, Müller A, Haberl A, Nisius G, Lennemann T, Stephan C, Bickel M, Mösch M, Gute P, Locher L, Lutz T, Klauke S, Knecht G, Khaykin P, Doerr HW, Stürmer M, Babacan E, von Hentig N, Beylot J, Dupon M, Longy Boursier M, Pellegrin JL, Ragnaud JM, Salamon R, Thiébaut R, Lewden C, Lawson Ayayi S, Mercié P, Moreau JF, Morlat P, Bernard N, Lacoste D, Malvy D, Neau D, Blaizeau MJ, Decoin M, Delveaux S, Hannapier C, Labarrère S, Lavignolle Aurillac V, Uwamaliya Nziyumvira B, Palmer G, Touchard D, Balestre E, Alioum A, Jacqmin Gadda H, Bonarek M, Coadou B, Gellie P, Nouts C, Bocquentin F, Dutronc H, Lafarie S, Aslan A, Pistonne T, Thibaut P, Vatan R, Chambon D, De La Taille C, Cazorla C, Ocho A, Viallard JF, Caubet O, Cipriano C, Lazaro E, Couzigou P, Castera L, Fleury H, Lafon ME, Masquelier B, Pellegrin I, Breilh D, Blanco P, Loste P, Caunègre L, Bonnal F, Farbos S, Ferrand M, Ceccaldi J, Tchamgoué S, De Witte S, Buy E, Alexander C, Barrios R, Braitstein P, Brumme Z, Chan K, Cote H, Gataric N, Geller J, Guillemi S, Harrigan PR, Harris M, Joy R, Levy A, Montaner J, Montessori V, Palepu A, Phillips E, Phillips P, Press N, Tyndall M, Wood E, Yip B, Bhagani S, Breen R, Byrne P, Carroll A, Cuthbertson Z, Dunleavy A, Geretti AM, Heelan B, Johnson M, Kinloch de Loes S, Lipman M, Madge S, Marshall N, Nair D, Nebbia G, Prinz B, Shah S, Swader L, Tyrer M, Youle M, Chaloner C, Grabowska H, Holloway J, Puradiredja J, Ransom D, Tsintas R, Bansi L, Fox Z, Harris E, Hill T, Lampe F, Lodwick R, Smith C, Amoah E, Booth C, Clewley G, Garcia Diaz A, Gregory B, Janossy G, Labbett W, Thomas M, Read R, Krentz H, Beckthold B, Schmeisser N, Alquézar A, Esteve A, Podzamczer D, Murillas J, Romero A, Agustí C, Agüero F, Ferrer E, Riera M, Segura F, Navarro G, Force L, Vilaró J, Masabeu A, García I, Guadarrama M, Montoliu A, Ortega N, Lazzari E, Puchol E, Sanchez M, Blanco JL, Garcia Alcaide F, Martinez E, Mallolas J, López Dieguez M, García Goez JF, Sirera G, Romeu J, Negredo E, Miranda C, Capitan MC, Olmo M, Barragan P, Saumoy M, Bolao F, Cabellos C, Peña C, Sala M, Cervantes M, Jose Amengual M, Navarro M, Penelo E, Barrufet P, Raper JL, Mugavero MJ, Willig JH, Schumacher J, Chang PW, Westfall AO, Cloud G, Lin HY, Acosta EP, Colette Kempf M, Allison JJ, Pisu M., NAPPA, SALVATORE, Mocroft, A, Mancuso, S, Antiretroviral Therapy Cohort Collaboration 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Subjects
Male, Infectious diseases and international health [NCEBP 13], Lymphoma, 030312 virology, Esophageal candidiasis, Cohort Studies, 0302 clinical medicine, Interquartile range, 030212 general & internal medicine, AIDS-Related, Lymphoma, AIDS-Related, 0303 health sciences, Mortality rate, Progressive multifocal leukoencephalopathy, Hazard ratio, Prognosis, 3. Good health, Pathogenesis and modulation of inflammation [N4i 1], Infectious Diseases, Combination, Drug Therapy, Combination, Female, Infection and autoimmunity [NCMLS 1], Human, Microbiology (medical), Adult, medicine.medical_specialty, Prognosi, Anti-HIV Agents, antiretroviral therapy, Infectious Disease, Article, AIDS-Related Opportunistic Infection, 03 medical and health sciences, Acquired immunodeficiency syndrome (AIDS), Drug Therapy, Internal medicine, medicine, Humans, AIDS-defining event, Proportional Hazards Models, AIDS-Related Opportunistic Infections/diagnosis/ mortality, Acquired Immunodeficiency Syndrome/complications/diagnosis/drug, therapy/ mortality, Anti-HIV Agents/ therapeutic use, AIDS-Related/diagnosis/mortality, Acquired Immunodeficiency Syndrome, AIDS-Related Opportunistic Infections, business.industry, Proportional hazards model, Poverty-related infectious diseases [N4i 3], Anti-HIV Agent, medicine.disease, mortality, Confidence interval, Immunology, Proportional Hazards Model, Cohort Studie, business
Abstract

Contains fulltext : 80963.pdf (Publisher’s version ) (Open Access) BACKGROUND: The extent to which mortality differs following individual acquired immunodeficiency syndrome (AIDS)-defining events (ADEs) has not been assessed among patients initiating combination antiretroviral therapy. METHODS: We analyzed data from 31,620 patients with no prior ADEs who started combination antiretroviral therapy. Cox proportional hazards models were used to estimate mortality hazard ratios for each ADE that occurred in >50 patients, after stratification by cohort and adjustment for sex, HIV transmission group, number of antiretroviral drugs initiated, regimen, age, date of starting combination antiretroviral therapy, and CD4+ cell count and HIV RNA load at initiation of combination antiretroviral therapy. ADEs that occurred in

Published
2009
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