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4. Cost‐effectiveness analysis of alternative screening strategies for the detection of cervical cancer among women in rural areas of Western Kenya.

Author

Lobin, Christopher, Orang'o, Elkanah Omenge, Were, Edwin, Muthoka, Kapten, Singh, Kavita, De Allegri, Manuela, Obermann, Konrad, von Knebel Doeberitz, Magnus, and Bussmann, Hermann

Subjects
EARLY detection of cancer, HUMAN papillomavirus, RURAL women, WILLINGNESS to pay, INSPECTION & review
Abstract

While the incidence of cervical cancer has dropped in high‐income countries due to organized cytology‐based screening programs, it remains the leading cause of cancer death among women in Eastern Africa. Therefore, the World Health Organization (WHO) now urges providers to transition from widely prevalent but low‐performance visual inspection with acetic acid (VIA) screening to primary human papillomavirus (HPV) DNA testing. Due to high HPV prevalence, effective triage tests are needed to identify those lesions likely to progress and so avoid over‐treatment. To identify the optimal cost‐effective strategy, we compared the VIA screen‐and‐treat approach to primary HPV DNA testing with p16/Ki67 dual‐stain cytology or VIA as triage. We used a Markov model to calculate the budget impact of each strategy with incremental quality‐adjusted life years and incremental cost‐effectiveness ratios (ICER) as the main outcome. Deterministic cost‐effectiveness analyses show that the screen‐and‐treat approach is highly cost‐effective (ICER 2469 Int$), while screen, triage, and treat with dual staining is the most effective with favorable ICER than triage with VIA (ICER 9943 Int$ compared with 13,177 Int$). One‐way sensitivity analyses show that the results are most sensitive to discounting, VIA performance, and test prices. In the probabilistic sensitivity analyses, the triage option using dual stain is the optimal choice above a willingness to pay threshold of 7115 Int$ being cost‐effective as per WHO standards. The result of our analysis favors the use of dual staining over VIA as triage in HPV‐positive women and portends future opportunities and necessary research to improve the coverage and acceptability of cervical cancer screening programs. [ABSTRACT FROM AUTHOR]

Published
2024
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5. Home-based HPV self-sampling assisted by a cloud-based electronic data system: Lessons learnt from a pilot community cervical cancer screening campaign in rural Ethiopia

Author

Jede, Felix, Brandt, Theresa, Gedefaw, Molla, Wubneh, Solomon Berhe, Abebe, Tamrat, Teka, Brhanu, Alemu, Kassahun, Tilahun, Binyam, Azemeraw, Temesgen, Gebeyehu, Abebaw, Schmidt, Dietmar, Pesic, Aleksandra, Kaufmann, Andreas M., Abebe, Bewketu, Ayichew, Zelalem, Byczkowski, Michael, Vaucher, Timoté, Sartor, Heike, Andargie, Gashaw, Bärnighausen, Till, von Knebel Doeberitz, Magnus, and Bussmann, Hermann

Published
2020
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6. Correction: Geographic and Temporal Trends in the Molecular Epidemiology and Genetic Mechanisms of Transmitted HIV-1 Drug Resistance: An Individual-Patient- and Sequence-Level Meta-Analysis

Author

Rhee, Soo-Yon, Blanco, Jose Luis, Jordan, Michael R, Taylor, Jonathan, Lemey, Philippe, Varghese, Vici, Hamers, Raph L, Bertagnolio, Silvia, de Wit, Tobias F Rinke, Aghokeng, Avelin F, Albert, Jan, Avi, Radko, Avila-Rios, Santiago, Bessong, Pascal O, Brooks, James I, Boucher, Charles AB, Brumme, Zabrina L, Busch, Michael P, Bussmann, Hermann, Chaix, Marie-Laure, Chin, Bum Sik, D'Aquin, Toni T, De Gascun, Cillian F, Derache, Anne, Descamps, Diane, Deshpande, Alaka K, Djoko, Cyrille F, Eshleman, Susan H, Fleury, Herve, Frange, Pierre, Fujisaki, Seiichiro, Harrigan, P Richard, Hattori, Junko, Holguin, Africa, Hunt, Gillian M, Ichimura, Hiroshi, Kaleebu, Pontiano, Katzenstein, David, Kiertiburanakul, Sasisopin, Kim, Jerome H, Kim, Sung Soon, Li, Yanpeng, Lutsar, Irja, Morris, Lynn, Ndembi, Nicaise, Kee, Peng NG, Paranjape, Ramesh S, Peeters, Martine, Poljak, Mario, Price, Matt A, Ragonnet-Cronin, Manon L, Reyes-Terán, Gustavo, Rolland, Morgane, Sirivichayakul, Sunee, Smith, Davey M, Soares, Marcelo A, Soriano, Vincent V, Ssemwanga, Deogratius, Stanojevic, Maja, Stefani, Mariane A, Sugiura, Wataru, Sungkanuparph, Somnuek, Tanuri, Amilcar, Tee, Kok Keng, Truong, Hong-Ha M, van de Vijver, David AMC, Vidal, Nicole, Yang, Chunfu, Yang, Rongge, Yebra, Gonzalo, Ioannidis, John PA, Vandamme, Anne-Mieke, and Shafer, Robert W

Subjects
Medical Microbiology, Biomedical and Clinical Sciences, Good Health and Well Being, Medical and Health Sciences, General & Internal Medicine, Biomedical and clinical sciences, Health sciences
Published
2015

8. Botswana's progress toward achieving the 2020 UNAIDS 90-90-90 antiretroviral therapy and virological suppression goals: a population-based survey

Author

Gaolathe, Tendani, Wirth, Kathleen E, Holme, Molly Pretorius, Makhema, Joseph, Moyo, Sikhulile, Chakalisa, Unoda, Yankinda, Etienne Kadima, Lei, Quanhong, Mmalane, Mompati, Novitsky, Vlad, Okui, Lillian, van Widenfelt, Erik, Powis, Kathleen M, Khan, Nealia, Bennett, Kara, Bussmann, Hermann, Dryden-Peterson, Scott, Lebelonyane, Refeletswe, el-Halabi, Shenaaz, Mills, Lisa A, Marukutira, Tafireyi, Wang, Rui, Tchetgen, Eric J Tchetgen, DeGruttola, Victor, Essex, M, and Lockman, Shahin

Published
2016
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10. Hybrid data capture for monitoring patients on highly active antiretroviral therapy (HAART) in urban Botswana

Author

Bussmann Hermann, Wester C William, Ndwapi Ndwapi, Vanderwarker Chris, Gaolathe Tendani, Tirelo Geoffrey, Avalos Ava, Moffat Howard, and Marlink Richard G

Subjects
Medical records, Medical records systems, Computerized, Data collection, Automatic data processing, Botswana, Public aspects of medicine, RA1-1270
Abstract

Individual patient care and programme evaluation are pivotal for the success of antiretroviral treatment programmes in resource-limited countries. While computer-aided documentation and data storage are indispensable for any large programme, several important issues need to be addressed including which data are to be collected, who collects it and how it is entered into an electronic database. We describe a patient-monitoring approach, which uses patient encounter forms (in hybrid paper + electronic format) based on optical character recognition, piloted at Princess Marina Hospital in Gaborone, Botswana's first public highly active antiretroviral therapy (HAART) outpatient clinic. Our novel data capture approach collects "key" data for tracking patient and programme outcomes. It saves physician time and does not detract from clinical care.

Published
2006

12. Pregnancy rates and birth outcomes among women of efavirenz-containing highly active antiretroviral therapy in Botswana

Author

Bussmann, Hermann, Wester, C. William, Wester, Carolyn N., Lekoko, Bright, Okezie, Okechukwu, Thomas, Ann Muir, DeGruttola, S.M. Victor, Makhema, Joseph, Essex, Max, and Marlink, Richard G.

Subjects
Efavirenz -- Risk factors, Efavirenz -- Care and treatment, Highly active antiretroviral therapy -- Evaluation, Pregnant women -- Care and treatment, Health
Abstract

Six initial highly active antiretroviral therapy (HAART) regimens enrolled in a clinical trial of which 3 contain efavirenz (EFV), pregnancy and birth outcomes among female participants are compared and evaluated. It is suggested that the risk of EFV in pregnancy can be strengthened if care providers in the field report all HAART and EFV exposure outcomes to the pregnancy exposure registry.

Published
2007

13. Serological evidence of HIV-associated infection among HIV-1-infected adults in Botswana

Author

Wester, C. William, Bussmann, Hermann, Moyo, Sikhulile, Avalos, Ava, Gaolathe, Tendani, Ndwapi, Ndwapi, Essex, Max, MacGregor, Rob Roy, and Marlink, Richard G.

Subjects
HIV infection -- Development and progression, HIV infection -- Research, Pathogenic microorganisms -- Analysis, Pathogenic microorganisms -- Physiological aspects, Serodiagnosis -- Usage, Health, Health care industry
Published
2006

14. Initial response to highly active antiretroviral therapy in HIV-1C-infected adults in a public sector treatment program in Botswana

Author

Wester, C. William, Bussmann, Hermann, Nadwapi, Nadwapi, Gaolathe, Tendani, Busang, Lesego, Kim, Soyeon, Avalos, Ava, Peter, Trevor F., Mujugira, Andrew, Mazonde, Patson, Cardiello, Peter, Johnson, Onalethata, Thior, Ibou, Moffat, Howard, Essex, Max, and Marlink, Richard

Subjects
Highly active antiretroviral therapy -- Health aspects, Antiviral agents -- Dosage and administration, HIV infection -- Care and treatment, Health
Abstract

The response to highly active antiretroviral treatment (HAART) in a public sector pilot antiretroviral treatment program in Botswana is described. An excellent response to HAART is observed among HIV-1C-infected patients, paralleling those seen elsewhere although high rates of toxicity is observed for ddI + d4T-containing regimens.

Published
2005

16. Effect of Micronutrient Supplementation on Disease Progression in Asymptomatic, Antiretroviral-Naive, HIV-Infected Adults in Botswana: A Randomized Clinical Trial

Author

Baum, Marianna K., Campa, Adriana, Lai, Shenghan, Martinez, Sabrina Sales, Tsalaile, Lesedi, Burns, Patricia, Farahani, Mansour, Li, Yinghui, van Widenfelt, Erik, Page, John Bryan, Bussmann, Hermann, Fawzi, Wafaie W., Moyo, Sikhulele, Makhema, Joseph, Thior, Ibou, Essex, Myron, and Marlink, Richard

Published
2013
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20. Lifetime Prevalence of Cervical Cancer Screening in 55 Low- and Middle-Income Countries

Author

Lemp, Julia M., primary, De Neve, Jan-Walter, additional, Bussmann, Hermann, additional, Chen, Simiao, additional, Manne-Goehler, Jennifer, additional, Theilmann, Michaela, additional, Marcus, Maja-Emilia, additional, Ebert, Cara, additional, Probst, Charlotte, additional, Tsabedze-Sibanyoni, Lindiwe, additional, Sturua, Lela, additional, Kibachio, Joseph M., additional, Moghaddam, Sahar Saeedi, additional, Martins, Joao S., additional, Houinato, Dismand, additional, Houehanou, Corine, additional, Gurung, Mongal S., additional, Gathecha, Gladwell, additional, Farzadfar, Farshad, additional, Dryden-Peterson, Scott, additional, Davies, Justine I., additional, Atun, Rifat, additional, Vollmer, Sebastian, additional, Bärnighausen, Till, additional, and Geldsetzer, Pascal, additional

Published
2020
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21. Novel concepts in cervical cancer screening. A comparison of VIA, HPV DNA test and p16INK4a/Ki-67 dual stain cytology in Western Kenya.

Author

Orang’o, Elkanah Omenge, primary, Were, Edwin, additional, Rode, Oliver, additional, Muthoka, Kapten, additional, Byczkowski, Michael, additional, Sartor, Heike, additional, Broeck, Davy Vanden, additional, Schmidt, Dietmar, additional, Reuschenbach, Miriam, additional, Doeberitz, Magnus von Knebel, additional, and Bussmann, Hermann, additional

Published
2020
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27. Additional file 4: of Genital self-sampling for HPV-based cervical cancer screening: a qualitative study of preferences and barriers in rural Ethiopia

Author

Brandt, Theresa, Wubneh, Solomon, Simegnew Handebo, Getu Debalkie, Yohanes Ayanaw, Kassahun Alemu, Jede, Felix, Doeberitz, Magnus Knebel, and Bussmann, Hermann

Subjects
Data_FILES, ComputingMethodologies_DOCUMENTANDTEXTPROCESSING
Abstract

English language copy of the Interview and FGD Guides used as supplementary files. (PDF 396 kb)

Published
2019
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29. Universal Testing, Expanded Treatment, and Incidence of HIV Infection in Botswana

Author

Makhema, Joseph, primary, Wirth, Kathleen E., additional, Pretorius Holme, Molly, additional, Gaolathe, Tendani, additional, Mmalane, Mompati, additional, Kadima, Etienne, additional, Chakalisa, Unoda, additional, Bennett, Kara, additional, Leidner, Jean, additional, Manyake, Kutlo, additional, Mbikiwa, Atang M., additional, Simon, Selebaleng V., additional, Letlhogile, Rona, additional, Mukokomani, Kutlwano, additional, van Widenfelt, Erik, additional, Moyo, Sikhulile, additional, Lebelonyane, Refeletswe, additional, Alwano, Mary G., additional, Powis, Kathleen M., additional, Dryden-Peterson, Scott L., additional, Kgathi, Coulson, additional, Novitsky, Vlad, additional, Moore, Janet, additional, Bachanas, Pamela, additional, Abrams, William, additional, Block, Lisa, additional, El-Halabi, Shenaaz, additional, Marukutira, Tafireyi, additional, Mills, Lisa A., additional, Sexton, Connie, additional, Raizes, Elliot, additional, Gaseitsiwe, Simani, additional, Bussmann, Hermann, additional, Okui, Lillian, additional, John, Oaitse, additional, Shapiro, Roger L., additional, Pals, Sherri, additional, Michael, Haben, additional, Roland, Michelle, additional, DeGruttola, Victor, additional, Lei, Quanhong, additional, Wang, Rui, additional, Tchetgen Tchetgen, Eric, additional, Essex, M., additional, and Lockman, Shahin, additional

Published
2019
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30. Estimated age and gender profile of individuals missed by a home-based HIV testing and counselling campaign in a Botswana community

Author

Novitsky, Vlad, Bussmann, Hermann, Okui, Lillian, Logan, Andrew, Moyo, Sikhulile, Widenfelt, Erik, Mmalane, Mompati, Lei, Quanhong, Holme, Molly P., Makhema, Joseph, Lockman, Shahin, Degruttola, Victor, and Essex, M

Subjects
HIV testing -- Analysis, Antiviral agents -- Dosage and administration, Health behavior -- Analysis, HIV infection -- Risk factors -- Prevention, Health
Abstract

Introduction: It would be useful to understand which populations are not reached by home‐based HIV‐1 testing and counselling (HTC) to improve strategies aimed at linking these individuals to care and reducing rates of onward HIV transmission. Methods: We present the results of a baseline home‐based HTC (HBHTC) campaign aimed at counselling and testing residents aged 16 to 64 for HIV in the north‐eastern sector of Mochudi, a community in Botswana with about 44,000 inhabitants. Collected data were compared with population references for Botswana, the United Nations (UN) estimates based on the National Census data and the Botswana AIDS Impact Survey IV (BAIS‐IV). Analyzed data and references were stratified by age and gender. Results: A total of 6238 age‐eligible residents were tested for HIV‐1; 1247 (20.0%; 95% CI 19.0 to 21.0%) were found to be HIV positive (23.7% of women vs. 13.4% of men). HIV‐1 prevalence peaked at 44% in 35‐ to 39‐year‐old women and 32% in 40‐ to 44‐year‐old men. A lower HIV prevalence rate, 10.9% (95% CI 9.5 to 12.5%), was found among individuals tested for the first time. A significant gender gap was evident in all analyzed subsets. The existing HIV transmission network was analyzed by combining phylogenetic mapping and household structure. Between 62.4 and 71.8% of all HIV‐positive individuals had detectable virus. When compared with the UN and BAIS‐IV estimates, the proportion of men missed by the testing campaign (48.5%; 95% CI 47.0 to 50.0%) was significantly higher than the proportion of missed women (14.2%; 95% CI 13.2 to 15.3%; p Conclusions: The HBHTC campaign seems to be an efficient tool for reaching individuals who have never been tested previously in southern African communities. However, about half of men from 16 to 64 years old were not reached by the HBHTC, including about 60% of men between 30 and 40 years old. Alternative HTC strategies should be developed to bring these men to care, which will contribute to reduction of HIV incidence in communities., Introduction The HIV‐1 prevalence rate in many southern African countries remains high and exceeds 15% in the general population [1–4]. The introduction and scale‐up of antiretroviral treatment (ART) programmes have [...]

Published
2015
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31. Novel concepts in cervical cancer screening: a comparison of VIA, HPV DNA test and p16INK4a/Ki-67 dual stain cytology in Western Kenya.

Author

Orang'o, Elkanah Omenge, Were, Edwin, Rode, Oliver, Muthoka, Kapten, Byczkowski, Michael, Sartor, Heike, Vanden Broeck, Davy, Schmidt, Dietmar, Reuschenbach, Miriam, von Knebel Doeberitz, Magnus, and Bussmann, Hermann

Subjects
DNA analysis, ACETIC acid, CONFIDENCE intervals, CYTOLOGY, IMMUNOHISTOCHEMISTRY, LONGITUDINAL method, METROPOLITAN areas, PAPILLOMAVIRUSES, CERVIX uteri tumors, DESCRIPTIVE statistics, EARLY detection of cancer, ODDS ratio
Abstract

Background: Screening of unvaccinated women remains essential to mitigate the high morbidity/mortality of cervical cancer. Here, we compared visual inspection with acetic acid (VIA), recommended by WHO as the most cost-effective screening approach in LMICs, with HPV-based screening, and usage of p16INK4a/Ki-67 dual stain cytology. Methods: We prospectively enrolled women participating in a VIA-based cervical cancer screening program in two peri-urban health centers of Kenya. Consenting women had a VIA examination preceded by collection of a liquid-based cytology sample from the cervix stored in PreservCyt medium (Hologic®). Analysis of all samples included a hrHPV DNA test and evaluation of a p16INK4a /Ki-67 (CINtecPLUS®) dual stained slide that was prepared using the ThinPrep® 2000 Processor and evaluated by a pathologist trained in the methodology. Results: In 701 of a total of 800 women aged 18–64 years, all three investigations were performed and data could be analyzed. The HPV, VIA and dual stain cytology positivity were 33%, 7%, and 2% respectively. The HPV positivity rate of VIA positive cases was 32%. The five most common HPV types were HPV16, 52, 68, 58 and 35. The OR among HIV infected women of an HPV infection, VIA positivity and positive dual stain cytology were 2.6 (95%CI 1.5–4.3), 1.9 (95%CI 0.89–4.4) and 3.4 (95%CI 1.07–10.9) respectively. The sensitivity of VIA to detect a p16INK4a/Ki-67 positive transforming infection was 13% (95%CI 2–38). Conclusions: Primary HPV testing appears feasible and should be considered as a primary screening test also in LMICs. The poor sensitivity of VIA renders it unsuitable as a triage test for HPV positive women. The utility of p16INK4a/Ki-67 dual stain cytology as a triage test for HPV positive women in LMICs should be further studied. [ABSTRACT FROM AUTHOR]

Published
2020
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33. Genome-Wide Analyses Reveal Gene Influence on HIV Disease Progression and HIV-1C Acquisition in Southern Africa

Author

Xie, Wen, primary, Agniel, Denis, additional, Shevchenko, Andrey, additional, Malov, Sergey V., additional, Svitin, Anton, additional, Cherkasov, Nikolay, additional, Baum, Marianna K., additional, Campa, Adriana, additional, Gaseitsiwe, Simani, additional, Bussmann, Hermann, additional, Makhema, Joseph, additional, Marlink, Richard, additional, Novitsky, Vladimir, additional, Lee, Tun-Hou, additional, Cai, Tianxi, additional, O'Brien, Stephen J., additional, and Essex, M., additional

Published
2017
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34. Geographic and Temporal Trends in the Molecular Epidemiology and Genetic Mechanisms of Transmitted HIV-1 Drug Resistance

Author

Rhee, Soo Yon, Blanco, Jose Luis, Jordan, Michael R., Taylor, Jonathan, Lemey, Philippe, Varghese, Vici, Hamers, Raph L., Bertagnolio, Silvia, de Wit, Tobias F Rinke, Aghokeng, Avelin F., Albert, Jan, Avi, Radko, Avila-Rios, Santiago, Bessong, Pascal O., Brooks, James I., Boucher, Charles A B, Brumme, Zabrina L., Busch, Michael P., Bussmann, Hermann, Chaix, Marie Laure, Chin, Bum Sik, D’Aquin, Toni T., De Gascun, Cillian F., Derache, Anne, Descamps, Diane, Deshpande, Alaka K., Djoko, Cyrille F., Eshleman, Susan H., Fleury, Herve, Frange, Pierre, Fujisaki, Seiichiro, Harrigan, P. Richard, Hattori, Junko, Holguin, Africa, Hunt, Gillian M., Ichimura, Hiroshi, Kaleebu, Pontiano, Katzenstein, David, Kiertiburanakul, Sasisopin, Kim, Jerome H., Kim, Sung Soon, Li, Yanpeng, Lutsar, Irja, Morris, Lynn, Ndembi, Nicaise, NG, Kee Peng, Paranjape, Ramesh S., Peeters, Martine, Poljak, Mario, Price, Matt A., Ragonnet-Cronin, Manon L., Reyes-Terán, Gustavo, Rolland, Morgane, Sirivichayakul, Sunee, Smith, Davey M., Soares, Marcelo A., Soriano, Vincent V., Ssemwanga, Deogratius, Stanojevic, Maja, Stefani, Mariane A., Sugiura, Wataru, Sungkanuparph, Somnuek, Tanuri, Amilcar, Tee, Kok Keng, Truong, Hong Ha M, van de Vijver, David A M C, Vidal, Nicole, Yang, Chunfu, Yang, Rongge, Yebra, Gonzalo, Ioannidis, John P A, Vandamme, Anne Mieke, Shafer, Robert W., Global Health and Tropical Medicine (GHTM), Instituto de Higiene e Medicina Tropical (IHMT), and TB, HIV and opportunistic diseases and pathogens (THOP)

Subjects
SDG 3 - Good Health and Well-being, virus diseases, Cell Biology, Biochemistry, Molecular Biology, Biotechnology
Abstract

PMID: 25849352 WOS:000354825700001 Regional and subtype-specific mutational patterns of HIV-1 transmitted drug resistance (TDR) are essential for informing first-line antiretroviral (ARV) therapy guidelines and designing diagnostic assays for use in regions where standard genotypic resistance testing is not affordable. We sought to understand the molecular epidemiology of TDR and to identify the HIV-1 drug-resistance mutations responsible for TDR in different regions and virus subtypes.We reviewed all GenBank submissions of HIV-1 reverse transcriptase sequences with or without protease and identified 287 studies published between March 1, 2000, and December 31, 2013, with more than 25 recently or chronically infected ARV-naïve individuals. These studies comprised 50,870 individuals from 111 countries. Each set of study sequences was analyzed for phylogenetic clustering and the presence of 93 surveillance drug-resistance mutations (SDRMs). The median overall TDR prevalence in sub-Saharan Africa (SSA), south/southeast Asia (SSEA), upper-income Asian countries, Latin America/Caribbean, Europe, and North America was 2.8%, 2.9%, 5.6%, 7.6%, 9.4%, and 11.5%, respectively. In SSA, there was a yearly 1.09-fold (95% CI: 1.05–1.14) increase in odds of TDR since national ARV scale-up attributable to an increase in non-nucleoside reverse transcriptase inhibitor (NNRTI) resistance. The odds of NNRTI-associated TDR also increased in Latin America/Caribbean (odds ratio [OR] = 1.16; 95% CI: 1.06–1.25), North America (OR = 1.19; 95% CI: 1.12–1.26), Europe (OR = 1.07; 95% CI: 1.01–1.13), and upper-income Asian countries (OR = 1.33; 95% CI: 1.12–1.55). In SSEA, there was no significant change in the odds of TDR since national ARV scale-up (OR = 0.97; 95% CI: 0.92–1.02). An analysis limited to sequences with mixtures at less than 0.5% of their nucleotide positions—a proxy for recent infection—yielded trends comparable to those obtained using the complete dataset. Four NNRTI SDRMs—K101E, K103N, Y181C, and G190A—accounted for >80% of NNRTI-associated TDR in all regions and subtypes. Sixteen nucleoside reverse transcriptase inhibitor (NRTI) SDRMs accounted for >69% of NRTI-associated TDR in all regions and subtypes. In SSA and SSEA, 89% of NNRTI SDRMs were associated with high-level resistance to nevirapine or efavirenz, whereas only 27% of NRTI SDRMs were associated with high-level resistance to zidovudine, lamivudine, tenofovir, or abacavir. Of 763 viruses with TDR in SSA and SSEA, 725 (95%) were genetically dissimilar; 38 (5%) formed 19 sequence pairs. Inherent limitations of this study are that some cohorts may not represent the broader regional population and that studies were heterogeneous with respect to duration of infection prior to sampling.Most TDR strains in SSA and SSEA arose independently, suggesting that ARV regimens with a high genetic barrier to resistance combined with improved patient adherence may mitigate TDR increases by reducing the generation of new ARV-resistant strains. A small number of NNRTI-resistance mutations were responsible for most cases of high-level resistance, suggesting that inexpensive point-mutation assays to detect these mutations may be useful for pre-therapy screening in regions with high levels of TDR. In the context of a public health approach to ARV therapy, a reliable point-of-care genotypic resistance test could identify which patients should receive standard first-line therapy and which should receive a protease-inhibitor-containing regimen. publishersversion published

Published
2015

35. The effect of micronutrient supplementation on active TB incidence early in HIV infection in Botswana

Author

Campa,Adriana, Baum,Marianna, Bussmann,Hermann, Martinez,Sabrina, Farahani,Mansour, van Widenfelt,Erik, Moyo,Sikhulile, Makhema,Joseph, Essex,Max, Marlink,Richard, Campa,Adriana, Baum,Marianna, Bussmann,Hermann, Martinez,Sabrina, Farahani,Mansour, van Widenfelt,Erik, Moyo,Sikhulile, Makhema,Joseph, Essex,Max, and Marlink,Richard

Abstract

Adriana Campa,1 Marianna K Baum,1 Hermann Bussmann,2 Sabrina Sales Martinez,1 Mansour Farahani,3 Erik van Widenfelt,2 Sikhulile Moyo,2,3 Joseph Makhema,2 Max Essex,2,3 Richard Marlink3 1Department of Dietetics and Nutrition, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA; 2Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana; 3The Harvard T.H. Chan School of Public Health, Boston, MA, USA Background: Coinfection with active tuberculosis (TB) is one of the leading causes of death in people living with HIV (PLWH) in Africa. This investigation explores the role of micronutrient supplementation in preventing active TB in PLWH. Methods: A randomized trial of nutritional supplementation was conducted among antiretroviral-naïve (without previous antiretroviral treatment [ART]) HIV-infected people in Botswana between 2004 and 2009. The study had a factorial design with four arms: the selenium (Se) alone arm, the multivitamins (MVT) alone arm that contained vitamin B complex and vitamins C and E, the combined Se+MVT group and the placebo group. Those participants with prior or current active TB were excluded, as were participants with advanced HIV disease (CD4 <250 cells/µL) or who had already qualified for ART. HIV-positive adults (N=878) were followed monthly for study pill dispensation, every 3 months for CD4 cell count and every 6 months for viral load during 24 months or until they were started on ART. Results: The participants’ characteristics were not significantly different among the four groups at baseline. Supplementation with Se alone (hazard ratio =0.20, 95% confidence interval: 0.04, 0.95, P=0.043) and the two combined SE groups (Se and Se+MVT) had significantly lower risk of developing incident TB disease compared with placebo in multivariate adjusted models (hazard ratio=0.32, 95% confidence interval: 0.11, 0.93, P=0.036). Multivitamins alone did not affec

Published
2017

36. Short Communication: Low False Recent Rate of Limiting Antigen-Avidity Assay Combined with HIV-1 RNA Data in Botswana

Author

Moyo, Sikhulile, primary, Kotokwe, Kenanao P., additional, Mohammed, Terence, additional, Boleo, Corretah, additional, Mupfumi, Lucy, additional, Chishala, Samuel, additional, Tsalaile, Lesedi, additional, Bussmann, Hermann, additional, Gaseitsiwe, Simani, additional, Musonda, Rosemary, additional, Makhema, Joseph, additional, Baum, Marianna, additional, Marlink, Richard, additional, Engelbrecht, Susan, additional, Essex, Max, additional, and Novitsky, Vladimir, additional

Published
2017
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37. Prognostic Value of HIV-1 RNA on CD4 Trajectories and Disease Progression Among Antiretroviral-Naive HIV-Infected Adults in Botswana: A Joint Modeling Analysis

Author

Farahani, Mansour, primary, Novitsky, Vladimir, additional, Wang, Rui, additional, Bussmann, Hermann, additional, Moyo, Sikhulile, additional, Musonda, Rosemary M., additional, Moeti, Themba, additional, Makhema, Joseph M., additional, Essex, Max, additional, and Marlink, Richard, additional

Published
2016
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38. Geographic and Temporal Trends in the Molecular Epidemiology and Genetic Mechanisms of Transmitted HIV-1 Drug Resistance: An Individual-Patient- and Sequence-Level Meta-Analysis

Author

Rhee, Soo-Yon, primary, Blanco, Jose Luis, additional, Jordan, Michael R., additional, Taylor, Jonathan, additional, Lemey, Philippe, additional, Varghese, Vici, additional, Hamers, Raph L., additional, Bertagnolio, Silvia, additional, de Wit, Tobias F. Rinke, additional, Aghokeng, Avelin F., additional, Albert, Jan, additional, Avi, Radko, additional, Avila-Rios, Santiago, additional, Bessong, Pascal O., additional, Brooks, James I., additional, Boucher, Charles A. B., additional, Brumme, Zabrina L., additional, Busch, Michael P., additional, Bussmann, Hermann, additional, Chaix, Marie-Laure, additional, Chin, Bum Sik, additional, D’Aquin, Toni T., additional, De Gascun, Cillian F., additional, Derache, Anne, additional, Descamps, Diane, additional, Deshpande, Alaka K., additional, Djoko, Cyrille F., additional, Eshleman, Susan H., additional, Fleury, Herve, additional, Frange, Pierre, additional, Fujisaki, Seiichiro, additional, Harrigan, P. Richard, additional, Hattori, Junko, additional, Holguin, Africa, additional, Hunt, Gillian M., additional, Ichimura, Hiroshi, additional, Kaleebu, Pontiano, additional, Katzenstein, David, additional, Kiertiburanakul, Sasisopin, additional, Kim, Jerome H., additional, Kim, Sung Soon, additional, Li, Yanpeng, additional, Lutsar, Irja, additional, Morris, Lynn, additional, Ndembi, Nicaise, additional, NG, Kee Peng, additional, Paranjape, Ramesh S., additional, Peeters, Martine, additional, Poljak, Mario, additional, Price, Matt A., additional, Ragonnet-Cronin, Manon L., additional, Reyes-Terán, Gustavo, additional, Rolland, Morgane, additional, Sirivichayakul, Sunee, additional, Smith, Davey M., additional, Soares, Marcelo A., additional, Soriano, Vincent V., additional, Ssemwanga, Deogratius, additional, Stanojevic, Maja, additional, Stefani, Mariane A., additional, Sugiura, Wataru, additional, Sungkanuparph, Somnuek, additional, Tanuri, Amilcar, additional, Tee, Kok Keng, additional, Truong, Hong-Ha M., additional, van de Vijver, David A. M. C., additional, Vidal, Nicole, additional, Yang, Chunfu, additional, Yang, Rongge, additional, Yebra, Gonzalo, additional, Ioannidis, John P. A., additional, Vandamme, Anne-Mieke, additional, and Shafer, Robert W., additional

Published
2015
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39. Non-Nucleoside Reverse Transcriptase Inhibitor Outcomes Among cART-Treated Adults in Botswana

Author

Wester, C. William, Thomas, Ann Muir, Bussmann, Hermann, Moyo, Sikhulile, Makhema, Joseph M., Gaolathe, Tendani, Novitsky, Vladimir, Essex, Max, deGruttola, Victor, and Marlink, Richard G.

Subjects
Adult, Male, Botswana, Anti-HIV Agents, HIV Infections, Article, Treatment Outcome, Pregnancy, Antiretroviral Therapy, Highly Active, Family Planning Services, HIV-1, Humans, Reverse Transcriptase Inhibitors, Drug Therapy, Combination, Female
Abstract

National initiatives offering non-nucleoside reverse transcriptase inhibitor (NNRTI)-based combination antiretroviral therapy (cART) have expanded in sub-Saharan Africa. The Tshepo study is the first clinical trial evaluating the long-term efficacy and tolerability of efavirenz versus nevirapine-based cART among adults in Botswana.A 3-year randomized study (n = 650) using a 3 x 2 x 2 factorial design comparing efficacy and tolerability among: (i) zidovudine/lamivudine versus zidovudine/didanosine versus stavudine/lamivudine; (ii) efavirenz versus nevirapine; and (iii) community-based supervision versus standard adherence strategies. This paper focuses on comparison (ii).There was no significant difference by assigned NNRTI in time to virological failure with resistance (log-rank P = 0.14), nevirapine versus efavirenz [risk ratio (RR) 1.54, 95% CI 0.86-2.70]. Rates of virological failure with resistance were 9.6% nevirapine-treated (95% CI 6.8-13.5) versus 6.6% efavirenz-treated (95% CI 4.2-10.0) at 3 years. Women receiving nevirapine-based cART trended towards higher virological failure rates when compared with efavirenz-treated women, Holm-corrected (log-rank P = 0.072), nevirapine versus efavirenz (RR 2.22, 95% CI 0.94-5.00). A total of 139 patients had 176 treatment-modifying toxicities, with a shorter time to event in nevirapine-treated versus efavirenz-treated patients (RR 1.85, 1.20-2.86; log-rank P = 0.0002).Tshepo-treated patients had excellent overall immunological and virological outcomes, and no significant differences were observed by randomized NNRTI comparison. Nevirapine-treated women trended towards higher virological failure with resistance compared with efavirenz-treated women. Nevirapine-treated adults had higher treatment modifying toxicity rates when compared with those receiving efavirenz. Nevirapine-based cART can continue to be offered to women in sub-Saharan Africa if patient education concerning toxicity is emphasized, routine safety monitoring chemistries are performed and the potential risk of efavirenz-related teratogenicity is considered.

Published
2010

40. Hybrid data capture for monitoring patients on highly active antiretroviral therapy (HAART) in urban Botswana

Author

Bussmann, Hermann, Wester, C. William, Ndwapi, Ndwapi, Vanderwarker, Chris, Gaolathe, Tendani, Tirelo, Geoffrey, Avalos, Ava, Moffat, Howard, and Marlink, Richard G.

Subjects
Electronic Data Processing, Botswana, Time Factors, Medical Records Systems, Computerized, HIV Infections, Optical Storage Devices, CD4 Lymphocyte Count, Antiretroviral Therapy, Highly Active, HIV-1, Database Management Systems, Humans, RNA, Viral, Drug Monitoring, Research Article, Program Evaluation
Abstract

Individual patient care and programme evaluation are pivotal for the success of antiretroviral treatment programmes in resource-limited countries. While computer-aided documentation and data storage are indispensable for any large programme, several important issues need to be addressed including which data are to be collected, who collects it and how it is entered into an electronic database. We describe a patient-monitoring approach, which uses patient encounter forms (in hybrid paper + electronic format) based on optical character recognition, piloted at Princess Marina Hospital in Gaborone, Botswana's first public highly active antiretroviral therapy (HAART) outpatient clinic. Our novel data capture approach collects "key" data for tracking patient and programme outcomes. It saves physician time and does not detract from clinical care.

Published
2006

42. Evaluation of the False Recent Classification Rates of Multiassay Algorithms in Estimating HIV Type 1 Subtype C Incidence

Author

Moyo, Sikhulile, primary, LeCuyer, Tessa, additional, Wang, Rui, additional, Gaseitsiwe, Simani, additional, Weng, Jia, additional, Musonda, Rosemary, additional, Bussmann, Hermann, additional, Mine, Madisa, additional, Engelbrecht, Susan, additional, Makhema, Joseph, additional, Marlink, Richard, additional, Baum, Marianna K., additional, Novitsky, Vladimir, additional, and Essex, M., additional

Published
2014
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43. Phylogenetic Relatedness of Circulating HIV-1C Variants in Mochudi, Botswana

Author

Novitsky, Vladimir, primary, Bussmann, Hermann, additional, Logan, Andrew, additional, Moyo, Sikhulile, additional, van Widenfelt, Erik, additional, Okui, Lillian, additional, Mmalane, Mompati, additional, Baca, Jeannie, additional, Buck, Lauren, additional, Phillips, Eleanor, additional, Tim, David, additional, McLane, Mary Fran, additional, Lei, Quanhong, additional, Wang, Rui, additional, Makhema, Joseph, additional, Lockman, Shahin, additional, DeGruttola, Victor, additional, and Essex, M., additional

Published
2013
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44. Persistently Elevated Serum Interleukin-6 Predicts Mortality Among Adults Receiving Combination Antiretroviral Therapy in Botswana: Results from a Clinical Trial

Author

McDonald, Bethan, primary, Moyo, Sikhulile, additional, Gabaitiri, Lesego, additional, Gaseitsiwe, Simani, additional, Bussmann, Hermann, additional, Koethe, John R., additional, Musonda, Rosemary, additional, Makhema, Joseph, additional, Novitsky, Vladimir, additional, Marlink, Richard G., additional, Wester, C. William, additional, and Essex, Max, additional

Published
2013
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47. Risk Factors for Symptomatic Hyperlactatemia and Lactic Acidosis Among Combination Antiretroviral Therapy-Treated Adults in Botswana: Results from a Clinical Trial

Author

Wester, C. William, primary, Eden, Svetlana K., additional, Shepherd, Bryan E., additional, Bussmann, Hermann, additional, Novitsky, Vladimir, additional, Samuels, David C., additional, Hendrickson, Sher L., additional, Winkler, Cheryl A., additional, O'Brien, Stephen J., additional, Essex, Max, additional, D'Aquila, Richard T., additional, deGruttola, Victor, additional, and Marlink, Richard G., additional

Published
2012
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49. Extended high viremics

Author

Novitsky, Vladimir, primary, Ndung’u, Thumbi, additional, Wang, Rui, additional, Bussmann, Hermann, additional, Chonco, Fundisiwe, additional, Makhema, Joseph, additional, De Gruttola, Victor, additional, Walker, Bruce D., additional, and Essex, M., additional

Published
2011
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50. Prevalence of Transmitted HIV Drug Resistance in Botswana: Lessons Learned from the HIVDR-Threshold Survey Conducted Among Women Presenting for Routine Antenatal Care as Part of the 2007 National Sentinel Survey

Author

Bussmann, Hermann, primary, de la Hoz Gomez, Florindo, additional, Roels, Thierry H., additional, Wester, C. William, additional, Bodika, Stephane M., additional, Moyo, Sikhulile, additional, Taffa, Negussie, additional, Anderson, Marina G., additional, Mine, Madisa, additional, Bile, Ebi–Celestin, additional, Yang, Chunfu, additional, Mphoyakgosi, Kereng, additional, Lehotzky, Erica Ann, additional, Mlotshwa, Busisiwe, additional, Mmelesi, Mpho, additional, Seipone, Khumo, additional, Makhema, Moeketsi J., additional, Marlink, Richard G., additional, Novitsky, Vladimir, additional, and Essex, M., additional

Published
2011
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