29 results on '"Kiularco Study Group"'
Search Results
2. Body mass index trends and its impact of under and overweight on outcome among PLHIV on antiretroviral treatment in rural Tanzania: A prospective cohort study.
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Aneth Vedastus Kalinjuma, Hannah Hussey, Getrud Joseph Mollel, Emilio Letang, Manuel Battegay, Tracy R Glass, Daniel Paris, Fiona Vanobberghen, Maja Weisser, and KIULARCO study group
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Medicine ,Science - Abstract
IntroductionIncreased body weight is an important risk factor for cardiovascular disease and is increasingly reported as a health problem in people living with HIV (PLHIV). There is limited data from rural sub-Saharan Africa, where malnutrition usually presents with both over- and undernutrition. We aimed to determine the prevalence and risk factors of underweight and overweight/obesity in PLHIV enrolled in a cohort in rural Tanzania before the introduction of integrase inhibitors.MethodsThis nested study of the prospective Kilombero and Ulanga Antiretroviral Cohort included adults aged ≥19 years initiated on antiretroviral therapy between 01/2013 and 12/2018 with follow-up through 06/2019. Body Mass Index (BMI) was classified as underweight (ResultsAmong 2,129 patients, 22,027 BMI measurements (median 9 measurements: interquartile range 5-15) were analysed. At baseline, 398 (19%) patients were underweight and 356 (17%) were overweight/obese. The majority of patients were female (n = 1249; 59%), and aged 35-44 years (779; 37%). During the first 9 months, for every three additional months on antiretroviral therapy, BMI increased by 2% (95% confidence interval 1-2%, p2 times the hazard of death/LTFU compared to participants with normal BMI.ConclusionWe found a double burden of malnutrition, with underweight being an independent predictor of mortality. Monitoring and measures to address both states of malnutrition among PLHIV should be integrated into routine HIV care.
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- 2023
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3. Prevalence, incidence and predictors of renal impairment in persons with HIV receiving protease-inhibitors in rural Tanzania.
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Herry Mapesi, James Okuma, Fabian Franzeck, Herieth Ismael Wilson, Elizabeth Senkoro, Theonestina Byakuzana, Robert Ndege, Fiona Vanobberghen, Tracy Renée Glass, Manuel Battegay, Maja Weisser, Daniel Henry Paris, and KIULARCO Study Group
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Medicine ,Science - Abstract
ObjectiveRitonavir-boosted protease inhibitors (bPI) in people living with HIV (PLWH) have been associated with renal impairment. Limited data are available from rural sub-Saharan Africa.MethodsUsing data from the Kilombero and Ulanga Antiretroviral Cohort Study (KIULARCO) in rural Tanzania from 2005-01/2020, we assessed the prevalence of renal impairment (estimated glomerular filtration rate ResultsRenal impairment was present in 52/687 PLWH (7.6%) at the switch to bPI. Among 556 participants with normal kidney function at switch, 41 (7.4%) developed renal impairment after a median time of 3.5 (IQR 1.6-5.1) years (incidence 22/1,000 person-years (95%CI 16.1-29.8)). Factors associated with renal impairment at switch were older age (adjusted odds ratio (aOR) 1.55 per 10 years; 95%CI 1.15-2.11), body mass index (BMI) ConclusionsIn PLWH in rural sub-Saharan Africa, prevalence and incidence of renal impairment among those who were switched from first-line to bPI-regimens were high. We found associations between renal impairment and older age, arterial hypertension, low BMI and time on ART.
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- 2021
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4. High failure rates of protease inhibitor-based antiretroviral treatment in rural Tanzania - A prospective cohort study.
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Rahel E Bircher, Alex J Ntamatungiro, Tracy R Glass, Dorcas Mnzava, Amina Nyuri, Herry Mapesi, Daniel H Paris, Manuel Battegay, Thomas Klimkait, Maja Weisser, and KIULARCO study group
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Medicine ,Science - Abstract
BACKGROUND:Poor adherence to antiretroviral drugs and viral resistance are the main drivers of treatment failure in HIV-infected patients. In sub-Saharan Africa, avoidance of treatment failure on second-line protease inhibitor therapy is critical as treatment options are limited. METHODS:In the prospective observational study of the Kilombero & Ulanga Antiretroviral Cohort in rural Tanzania, we assessed virologic failure (viral load ≥1,000 copies/mL) and drug resistance mutations in bio-banked plasma samples 6-12 months after initiation of a protease inhibitor-based treatment regimen. Additionally, viral load was measured before start of protease inhibitor, a second time between 1-5 years after start, and at suspected treatment failure in patients with available bio-banked samples. We performed resistance testing if viral load was ≥1000 copies/ml. Risk factors for virologic failure were analyzed using logistic regression. RESULTS:In total, 252 patients were included; of those 56% were female and 21% children. Virologic failure occurred 6-12 months after the start of a protease inhibitor in 26/199 (13.1%) of adults and 7/53 of children (13.2%). The prevalence of virologic failure did not change over time. Nucleoside reverse transcriptase inhibitors drug resistance mutation testing performed at 6-12 months showed a positive signal in only 9/16 adults. No cases of resistance mutations for protease inhibitors were seen at this time. In samples taken between 1-5 years protease inhibitor resistance was demonstrated in 2/7 adults. In adult samples before protease inhibitor start, resistance to nucleoside reverse transcriptase inhibitors was detected in 30/41, and to non-nucleoside reverse-transcriptase inhibitors in 35/41 patients. In 15/16 pediatric samples, resistance to both drug classes but not for protease inhibitors was present. CONCLUSION:Our study confirms high early failure rates in adults and children treated with protease inhibitors, even in the absence of protease inhibitors resistance mutations, suggesting an urgent need for adherence support in this setting.
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- 2020
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5. Extrapulmonary tuberculosis in HIV-infected patients in rural Tanzania: The prospective Kilombero and Ulanga antiretroviral cohort.
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Armon Arpagaus, Fabian Christoph Franzeck, George Sikalengo, Robert Ndege, Dorcas Mnzava, Martin Rohacek, Jerry Hella, Klaus Reither, Manuel Battegay, Tracy Renee Glass, Daniel Henry Paris, Farida Bani, Omary Ngome Rajab, Maja Weisser, and KIULARCO Study Group
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Medicine ,Science - Abstract
BACKGROUND:In sub-Saharan Africa, diagnosis and management of extrapulmonary tuberculosis (EPTB) in people living with HIV (PLHIV) remains a major challenge. This study aimed to characterize the epidemiology and risk factors for poor outcome of extrapulmonary tuberculosis in people living with HIV (PLHIV) in a rural setting in Tanzania. METHODS:We included PLHIV >18 years of age enrolled into the Kilombero and Ulanga antiretroviral cohort (KIULARCO) from 2013 to 2017. We assessed the diagnosis of tuberculosis by integrating prospectively collected clinical and microbiological data. We calculated prevalence- and incidence rates and used Cox regression analysis to evaluate the association of risk factors in extrapulmonary tuberculosis (EPTB) with a combined endpoint of lost to follow-up (LTFU) and death. RESULTS:We included 3,129 subjects (64.5% female) with a median age of 38 years (interquartile range [IQR] 31-46) and a median CD4+ cell count of 229/μl (IQR 94-421) at baseline. During the median follow-up of 1.25 years (IQR 0.46-2.85), 574 (18.4%) subjects were diagnosed with tuberculosis, whereof 175 (30.5%) had an extrapulmonary manifestation. Microbiological evidence by Acid-Fast-Bacillus stain (AFB-stain) or Xpert® MTB/RIF was present in 178/483 (36.9%) patients with pulmonary and in 28/175 (16.0%) of patients with extrapulmonary manifestations, respectively. Incidence density rates for pulmonary Tuberculosis (PTB and EPTB were 17.9/1000person-years (py) (95% CI 14.2-22.6) and 5.8/1000 py (95% CI 4.0-8.5), respectively. The combined endpoint of death and LTFU was observed in 1058 (33.8%) patients, most frequently in the subgroup of EPTB (47.2%). Patients with EPTB had a higher rate of the composite outcome of death/LTFU after TB diagnosis than with PTB [HR 1.63, (1.14-2.31); p = 0.006]. The adjusted hazard ratios [HR (95% CI)] for death/LTFU in EPTB patients were significantly increased for patients aged >45 years [HR 1.95, (1.15-3.3); p = 0.013], whereas ART use was protective [HR 0.15, (0.08-0.27); p
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- 2020
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6. Prevention of mother-to-child transmission of HIV Option B+ cascade in rural Tanzania: The One Stop Clinic model.
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Anna Gamell, Lameck Bonaventure Luwanda, Aneth Vedastus Kalinjuma, Leila Samson, Alex John Ntamatungiro, Maja Weisser, Winfrid Gingo, Marcel Tanner, Christoph Hatz, Emilio Letang, Manuel Battegay, and KIULARCO Study Group
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Medicine ,Science - Abstract
Strategies to improve the uptake of Prevention of Mother-To-Child Transmission of HIV (PMTCT) are needed. We integrated HIV and maternal, newborn and child health services in a One Stop Clinic to improve the PMTCT cascade in a rural Tanzanian setting.The One Stop Clinic of Ifakara offers integral care to HIV-infected pregnant women and their families at one single place and time. All pregnant women and HIV-exposed infants attended during the first year of Option B+ implementation (04/2014-03/2015) were included. PMTCT was assessed at the antenatal clinic (ANC), HIV care and labour ward, and compared with the pre-B+ period. We also characterised HIV-infected pregnant women and evaluated the MTCT rate.1,579 women attended the ANC. Seven (0.4%) were known to be HIV-infected. Of the remainder, 98.5% (1,548/1,572) were offered an HIV test, 94% (1,456/1,548) accepted and 38 (2.6%) tested HIV-positive. 51 were re-screened for HIV during late pregnancy and one had seroconverted. The HIV prevalence at the ANC was 3.1% (46/1,463). Of the 39 newly diagnosed women, 35 (90%) were linked to care. HIV test was offered to >98% of ANC clients during both the pre- and post-B+ periods. During the post-B+ period, test acceptance (94% versus 90.5%, p
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- 2017
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7. Incidence and risk factors for hypertension among HIV patients in rural Tanzania - A prospective cohort study.
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Eduardo Rodríguez-Arbolí, Kim Mwamelo, Aneth Vedastus Kalinjuma, Hansjakob Furrer, Christoph Hatz, Marcel Tanner, Manuel Battegay, Emilio Letang, and KIULARCO Study Group
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Medicine ,Science - Abstract
INTRODUCTION:Scarce data are available on the epidemiology of hypertension among HIV patients in rural sub-Saharan Africa. We explored the prevalence, incidence and risk factors for incident hypertension among patients who were enrolled in a rural HIV cohort in Tanzania. METHODS:Prospective longitudinal study including HIV patients enrolled in the Kilombero and Ulanga Antiretroviral Cohort between 2013 and 2015. Non-ART naïve subjects at baseline and pregnant women during follow-up were excluded from the analysis. Incident hypertension was defined as systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg on two consecutive visits. Cox proportional hazards models were used to assess the association of baseline characteristics and incident hypertension. RESULTS:Among 955 ART-naïve, eligible subjects, 111 (11.6%) were hypertensive at recruitment. Ten women were excluded due to pregnancy. The remaining 834 individuals contributed 7967 person-months to follow-up (median 231 days, IQR 119-421) and 80 (9.6%) of them developed hypertension during a median follow-up of 144 days from time of enrolment into the cohort [incidence rate 120.0 cases/1000 person-years, 95% confidence interval (CI) 97.2-150.0]. ART was started in 630 (75.5%) patients, with a median follow-up on ART of 7 months (IQR 4-14). Cox regression models identified age [adjusted hazard ratio (aHR) 1.34 per 10 years increase, 95% CI 1.07-1.68, p = 0.010], body mass index (aHR per 5 kg/m2 1.45, 95% CI 1.07-1.99, p = 0.018) and estimated glomerular filtration rate (aHR < 60 versus ≥ 60 ml/min/1.73 m2 3.79, 95% CI 1.60-8.99, p = 0.003) as independent risk factors for hypertension development. CONCLUSIONS:The prevalence and incidence of hypertension were high in our cohort. Traditional cardiovascular risk factors predicted incident hypertension, but no association was observed with immunological or ART status. These data support the implementation of routine hypertension screening and integrated management into HIV programmes in rural sub-Saharan Africa.
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- 2017
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8. A decade of HIV care in rural Tanzania: Trends in clinical outcomes and impact of clinic optimisation in an open, prospective cohort.
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Fiona Vanobberghen, Emilio Letang, Anna Gamell, Dorcas K Mnzava, Diana Faini, Lameck B Luwanda, Herry Mapesi, Kim Mwamelo, George Sikalengo, Marcel Tanner, Christoph Hatz, Hansjakob Furrer, Manuel Battegay, Tracy R Glass, and KIULARCO Study Group
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Medicine ,Science - Abstract
Our objectives were to describe trends in enrolment and clinical outcomes in the open, prospective Kilombero and Ulanga Antiretroviral Cohort (KIULARCO) in the Morogoro region of southern Tanzania, and identify strengths and areas for improvement in the care of HIV-positive individuals in rural Tanzania.We included adults (≥15 years) and children (
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- 2017
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9. Decentralization of viral load testing to improve HIV care and treatment cascade in rural Tanzania: observational study from the Kilombero and Ulanga Antiretroviral Cohort
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Mnzava, D., Okuma, J., Ndege, R., Kimera, N., Ntamatungiro, A., Nyuri, A., Byakuzana, T., Abilahi, F., Mayeka, P., Temba, E., Fanuel, T., Glass, T. R., Klimkait, T., Vanobberghen, F., Weisser, M., and Kiularco Study Group
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INTRODUCTION: Monitoring HIV viral load (HVL) in people living with HIV (PLHIV) on antiretroviral therapy (ART) is recommended by the World Health Organization. Implementation of HVL testing programs have been affected by logistic and organizational challenges. Here we describe the HVL monitoring cascade in a rural setting in Tanzania and compare turnaround times (TAT) between an on-site and a referral laboratory. METHODS: In a nested study of the prospective Kilombero and Ulanga Antiretroviral Cohort (KIULARCO) we included PLHIV aged >/= 15 years, on ART for >/= 6 months after implementation of routine HVL monitoring in 2017. We assessed proportions of PLHIV with a blood sample taken for HVL, whose results came back, and who were virally suppressed (HVL /= 1000 copies/mL). We described the proportion of PLHIV with unsuppressed HVL and adequate measures taken as per national guidelines and outcomes among those with low-level viremia (LLV; 100-999 copies/mL). We compare TAT between on-site and referral laboratories by Wilcoxon rank sum tests. RESULTS: From 2017 to 2020, among 4,454 PLHIV, 4,238 (95%) had a blood sample taken and 4,177 (99%) of those had a result. Of those, 3,683 (88%) were virally suppressed. In the 494 (12%) unsuppressed PLHIV, 425 (86%) had a follow-up HVL (102 (24%) within 4 months and 158 (37%) had virologic failure. Of these, 103 (65%) were already on second-line ART and 32/55 (58%) switched from first- to second-line ART after a median of 7.7 months (IQR 4.7-12.7). In the 371 (9%) PLHIV with LLV, 327 (88%) had a follow-up HVL. Of these, 267 (82%) resuppressed to < 100 copies/ml, 41 (13%) had persistent LLV and 19 (6%) had unsuppressed HVL. The median TAT for return of HVL results was 21 days (IQR 13-39) at the on-site versus 59 days (IQR 27-99) at the referral laboratory (p < 0.001) with PLHIV receiving the HVL results after a median of 91 days (IQR 36-94; similar for both laboratories). CONCLUSION: Robust HVL monitoring is achievable in remote resource-limited settings. More focus is needed on care models for PLHIV with high viral loads to timely address results from routine HVL monitoring.
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- 2023
10. Repeated false-negative HIV rapid test results in a patient presenting to care with advanced HIV disease: a case report
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Chuwa, F., Kivuma, B., Ndege, R., and Kiularco Study Group
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Infectious Diseases - Abstract
Severe immunosuppression has been reported as one of the causes of a false-negative HIV rapid test result. Guidelines on what tests should be performed in adult patients presenting with severe immunosuppression despite a negative HIV rapid test result are lacking. This is the second case report of a false-negative HIV rapid test results in a patient presenting with advanced HIV disease in Tanzania.
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- 2023
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11. The Chronic Diseases Clinic of Ifakara (CDCI)-Establishing a Model Clinic for Chronic Care Delivery in Rural Sub-Saharan Africa
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Maja, Weisser, Martin, Rohacek, Robert, Ndege, Ezekiel, Luoga, Andrew, Katende, Getrud J, Mollel, Winfrid, Gingo, Fiona, Vanobberghen, Daniel H, Paris, Christoph, Hatz, Manuel, Battegay, and On Behalf Of The Kiularco Study Group
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The rollout of antiretroviral drugs in sub-Saharan Africa to address the huge health impact of the HIV pandemic has been one of the largest projects undertaken in medical history and is an unprecedented medical success story. However, the path has been and still is characterized by many far reaching implementational challenges. Here, we report on the building and maintaining of a role model clinic in Ifakara, rural Southwestern Tanzania, within a collaborative project to support HIV services within the national program, training for staff and integrated research to better understand local needs and improve patients’ outcomes.
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- 2022
12. Mortality in a cohort of people living with HIV in rural Tanzania, accounting for unseen mortality among those lost to follow-up
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Vanobberghen, F., Weisser, M., Kasuga, B., Katende, A., Battegay, M., Tanner, M., Glass, T. R., and Kiularco Study Group
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Mortality assessment in cohorts with high lost to follow-up (LTFU) is challenging in settings with limited civil registration systems. We aimed to assess mortality in a clinical cohort (KIULARCO) of HIV-infected persons in rural Tanzania, accounting for unseen deaths among participants LTFU. We included adults enrolled in 2005-2015 and traced a non-random sample of those LTFU. We estimated mortality using Kaplan-Meier methods with: A) routinely-captured data; B) crudely incorporating tracing data; C) weighting using tracing data to crudely correct for unobserved deaths among participants LTFU; and D) weighting using tracing data accounting for participant characteristics. We investigated associated factors using proportional hazards models. Among 7460 adults, 646 (9%) died, 883 (12%) transferred clinics, and 2911 (39%) were LTFU. Of 2010 (69%) traced participants, 325 (16%) were found: 131 (40%) died and 130 (40%) transferred. Five-year mortality estimates were A) 13.1%; B) 16.2%; C) 36.8%; D) 35.1%. Higher mortality was associated with male sex, referral as hospital in-patient, living close to the clinic, lower body mass index, more advanced WHO stage, lower CD4 count, and less time since antiretroviral therapy initiation. Adjusting for unseen deaths among participants LTFU approximately doubled the five-year mortality estimates. Our approach is applicable to other cohorts adopting targeted tracing.
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- 2021
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13. Mortality Rate in a Cohort of People Living With HIV in Rural Tanzania After Accounting for Unseen Deaths Among Those Lost to Follow-up
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Vanobberghen, Fiona, primary, Weisser, Maja, additional, Kasuga, Bryson, additional, Katende, Andrew, additional, Battegay, Manuel, additional, Tanner, Marcel, additional, and Glass on behalf of the KIULARCO Study Group, Tracy R, additional
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- 2020
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14. Recognition and management of clinically significant drug-drug interactions between antiretrovirals and co-medications in a cohort of people living with HIV in rural Tanzania: a prospective questionnaire-based study.
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Kuemmerle, Andrea, Sikalengo, George, Vanobberghen, Fiona, Ndege, Robert C, Foe, Gideon, Schlaeppi, Chloé, Burri, Christian, Battegay, Manuel, Paris, Daniel H, Glass, Tracy R, Weisser, Maja, Marzolini, Catia, Group, the KIULARCO Study, and KIULARCO Study Group
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HIV-positive persons ,DRUG interactions ,PHYSICIANS ,LONGITUDINAL method ,ADULTS ,HIV ,EFAVIRENZ ,ANTIRETROVIRAL agents - Abstract
Background: The extent to which drug-drug interactions (DDIs) between antiretrovirals (ARVs) and co-medications are recognized and managed has not been thoroughly evaluated in limited-resource settings.Objectives: This prospective questionnaire-based study aimed to determine the prevalence and risk factors for unrecognized/incorrectly managed DDIs in people living with HIV followed-up at the Chronic Diseases Clinic of Ifakara (CDCI) and enrolled in the Kilombero and Ulanga Antiretroviral Cohort (KIULARCO).Methods: We prospectively included ARV-treated adults receiving ≥1 co-medication coming for a follow-up visit at the CDCI between March and July 2017. Using a structured questionnaire, physicians were requested to identify potentially clinically significant DDIs in the prescribed treatment, to provide recommendations for their management and to indicate any hurdles to implement the recommendations. Prescriptions were subsequently screened for DDIs using the Liverpool DDIs database. Identified clinically significant DDIs and their recommended management according to the DDIs database were compared with the information provided in the questionnaires.Results: Among 334 participants, the median age was 47 years (IQR = 40-56 years), 69% were female and 82% had ≥1 non-communicable disease (NCD). Overall, 129 participants had ≥1 clinically relevant DDI, which was not recognized and/or incorrectly managed in 56 participants (43%). Of those, 6 (11%) were due to limited monitoring options or medication affordability issues. In the multivariable logistic regression, the presence of ≥1 NCD was associated with an increased risk for unrecognized/incorrect DDI management (OR = 15.8; 95% CI = 1.8-139.6).Conclusions: Recognition/appropriate management of DDIs is suboptimal, highlighting the need for educational programmes, pharmacovigilance activities and increased access to medications and monitoring options. This should become a focus of HIV programmes given the increasing burden of NCDs in sub-Saharan Africa. [ABSTRACT FROM AUTHOR]- Published
- 2021
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15. Cohort Profile: The Kilombero and Ulanga Antiretroviral Cohort (KIULARCO) - A Prospective HIV Cohort in Rural Tanzania
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Emilio, Letang, Aneth Vedastus, Kalinjuma, Tracy R, Glass, Anna, Gamell, Herry, Mapesi, George Rocky, Sikalengo, Lameck Bonaventure, Luwanda, Dorcas, Mnzava, Alex J, Ntamatungiro, Regina, Ndaki, Gideon, Francis, Fiona, Vanobberghen, Hansjakob, Furrer, Thomas, Klimkait, Ingrid, Felger, Marcel, Tanner, Christoph, Hatz, Maja, Weisser, Manuel, Battegay, and Kiularco Study Group
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Adult ,Male ,Rural Population ,medicine.medical_specialty ,Medication history ,Referral ,Adolescent ,030231 tropical medicine ,HIV Infections ,610 Medicine & health ,Tanzania ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Acquired immunodeficiency syndrome (AIDS) ,Pregnancy ,medicine ,Humans ,030212 general & internal medicine ,Prospective Studies ,Prospective cohort study ,Child ,Surveillance ,biology ,AIDS-Related Opportunistic Infections ,business.industry ,Infant ,General Medicine ,Middle Aged ,Patient Acceptance of Health Care ,medicine.disease ,biology.organism_classification ,Biobank ,Infectious Disease Transmission, Vertical ,Anti-Retroviral Agents ,Family medicine ,Child, Preschool ,Cohort ,Female ,business ,Cohort study - Abstract
BACKGROUND The Kilombero and Ulanga Antiretroviral Cohort (KIULARCO) is a single-site, open and ongoing prospective cohort of people living with human immunodeficiency virus (PLWHIV) established in 2005 at the Chronic Diseases Clinic of Ifakara (CDCI), within the Saint Francis Referral Hospital (SFRH) in Ifakara, Tanzania. The objectives of KIULARCO are to (i) provide patient and cohort-level information on the outcomes of HIV treatment; (ii) provide cohort-level information on opportunistic infections and comorbidities; (iii) evaluate aspects of human immunodeficiency virus (HIV) care and treatment that have national or international policy relevance; (iv) provide a platform for studies on improving HIV care and treatment in sub-Saharan Africa; and (v) contribute to generating local capacity to deal with the challenges posed by the HIV/AIDS pandemic in this region. Moreover, KIULARCO may serve as a model for other healthcare settings in rural sub-Saharan Africa. METHODS Since 2005, all patients diagnosed with HIV at the Saint Francis Referral Hospital are invited to participate in the cohort, including non-pregnant adults, pregnant women, adolescents, children and infants. The information collected includes demographics, baseline and follow-up clinical data, laboratory data, medication history, drug toxicities, diagnoses and outcomes. Real-time data are captured during the patient encounter through an electronic medical record system that allowed transition to a paperless clinic in 2013. In addition, KIULARCO is associated with a biobank of cryopreserved plasma samples and cell pellets collected from all participants before and at different time-points during antiretroviral treatment. RESULTS Up to the end of 2016, 12 185 PLWHIV have been seen at the CDCI; 9218 (76%) of whom have been enrolled into KIULARCO and 6965 (76%) of these have received ART from the clinic. Patients on ART attend at least every 3 months, with laboratory monitoring every 6 months. KIULARCO data have been used to generate relevant information regarding ART outcomes, opportunistic infections, non-AIDS comorbidities, prevention of mother-to-child transmission of HIV, paediatric HIV, and mortality and retention in care. Requests for collaborations on analyses can be submitted to the KIULARCO scientific committee. CONCLUSIONS KIULARCO provides a framework for improving the quality of care of people living with HIV in sub-Saharan Africa, to generate relevant information to evaluate ART programmes and to build local capacity to deal with HIV/AIDS. The comprehensiveness of the data collected, together with the biobank spanning over ten years has created a unique research platform in rural sub-Saharan Africa.
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- 2017
16. A Simple Visual Analog Scale is a Valuable Tool to Assess Self-Reported Adherence in HIV-Infected Patients on Antiretroviral Treatment in a Resource-Limited Setting
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S Erb, E Letang, TR Glass, A Natamatungiro, D Mnzava, H Mapesi, M Haschke, U Duthaler, B Berger, L Muri, J Bader, C Marzolini, L Elzi, T Klimkait, W Langewitz, M Battegay, and KIULARCO Study group
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medicine.medical_specialty ,medicine.diagnostic_test ,Visual analogue scale ,business.industry ,Immunology ,Dermatology ,Omics ,Adherence assessment ,Infectious Diseases ,Therapeutic drug monitoring ,Virology ,medicine ,Physical therapy ,Antiretroviral treatment ,Hiv infected patients ,Population study ,business ,Kappa - Abstract
Background: Adherence assessment in HIV-infected individuals under antiretroviral therapy (ART) is essential. The assessment tool should be reliable and easy to apply in routine clinical practice. The goal of this study was to evaluate a pictogram-enhanced visual analog scale (VAS) suitable for illiterate patients to assess self-reported adherence in ART-treated HIV-infected individuals in a resource-limited setting. Methods: Adherence of 299 HIV-infected individuals on ART for ≥ 6 months attending an HIV-clinic in rural Tanzania was prospectively assessed 1-3 months (visit V1) and 6-9 months (V2) after a healthcare provider training in patient-centered communication by various measures: 1) 1-10 pictogram-combined Likert VAS, 2) standardized questionnaire, 3) therapeutic drug monitoring (TDM) of ART-compounds and 4) plasma HIV-RNA. Results: 94% of the study population had no formal or only primary education. Individuals with non-adherence were detected in 17.2% by VAS (score ≤ 9) and in 10.7% by questionnaire (≥ 1 missed ART-dose/4weeks) at V1. The detection rate declined to a lesser extent with VAS (11.7%, p=0.06) compared to the questionnaire (5.7%, p=0.016) at V2. VAS strongly correlated with the questionnaire (kappa>0.50, p
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- 2017
17. Prevalence and Outcomes of Hepatitis B Coinfection and Associated Liver Disease Among Antiretroviral Therapy-Naive Individuals in a Rural Tanzanian Human Immunodeficiency Virus Cohort
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Ramírez-Mena, Adrià, Glass, Tracy R., Winter, Annja, Kimera, Namvua, Ntamatungiro, Alex J., Hatz, Christoph, Tanner, Marcel, Battegay, Manuel, Furrer, Hansjakob, Wandeler, Gilles, Letang, Emilio, and KIULARCO Study Group
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Hepatitis B virus ,HBsAg ,medicine.medical_specialty ,Cirrhosis ,610 Medicine & health ,medicine.disease_cause ,Tanzania ,Gastroenterology ,Major Articles ,03 medical and health sciences ,Liver disease ,0302 clinical medicine ,360 Social problems & social services ,Internal medicine ,VIH (Virus) ,Medicine ,030212 general & internal medicine ,Prospective cohort study ,APRI ,liver fibrosis ,HIV (Viruses) ,business.industry ,Virus de l'hepatitis B ,HIV ,virus diseases ,Hepatitis B ,Tanzània ,medicine.disease ,3. Good health ,Infectious Diseases ,Oncology ,Cohort ,Immunology ,Coinfection ,030211 gastroenterology & hepatology ,business ,hepatitis B virus - Abstract
Key findings include a high prevalence of APRI score indicating significant fibrosis/cirrhosis in ART-naïve individuals particularly among HIV/HBV-co-infected individuals and a regression of APRI to, Background. We evaluated the prevalence of chronic hepatitis B virus (HBV) infection and liver fibrosis/cirrhosis in human immunodeficiency virus (HIV)-infected individuals enrolled in a rural Tanzanian prospective cohort and assessed hepatic fibrosis progression 12–24 months after antiretroviral treatment (ART) initiation. Methods. All ART-naive HIV-infected adults ≥15-year-old enrolled in the Kilombero and Ulanga Antiretroviral Cohort who started ART between 2005 and 2015 were included. Pre-ART factors associated with significant liver fibrosis (aspartate aminotransferase-to-platelet ratio index [APRI] >1.5) and cirrhosis (APRI > 2.0) were identified using logistic regression. Results. Of 3097 individuals screened, 227 (7.3%; 95% CI, 6.4–8.2) were hepatitis B surface antigen (HBsAg) positive. Before ART initiation, 9.1% individuals had significant liver fibrosis and 5.3% had cirrhosis. Human immunodeficiency virus/HBV-coinfected individuals were more likely to have an APRI score indicating significant fibrosis (14.2% vs 8.7%, P = .03) and cirrhosis (9.2% vs 4.9%, P = .03) than HBV-uninfected patients. CD4 cell count
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- 2016
18. Age-related comorbidities and mortality in people living with HIV in rural Tanzania.
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Albrecht, Sascha, Franzeck, Fabian C., Mapesi, Herry, Hatz, Christoph, Kalinjuma, Aneth Vedastus, Glass, Tracy R., Mnzava, Dorcas, Letang, Emili, Paris, Daniel H., Battegay, Manuel, Weisser, Maja, and KIULARCO Study Group
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- 2019
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19. Strengthening HIV therapy and care in rural Tanzania affects rates of viral suppression.
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Ntamatungiro, Alex J., Muri, Lukas, Glass, Tracy R., Erb, Stefan, Battegay, Manuel, Furrer, Hansjakob, Hatz, Christoph, Tanner, Marcel, Felger, Ingrid, Klimkait, Thomas, Letang, Emilio, and KIULARCO Study Group
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HIV-positive persons ,HIV infections ,MORTALITY ,THERAPEUTICS ,ANTIVIRAL agents ,MEDICAL care ,NEVIRAPINE ,ANTI-HIV agents ,HIV infection epidemiology ,REVERSE transcriptase inhibitors ,DRUG resistance in microorganisms ,DRUG administration ,HIV ,LONGITUDINAL method ,GENETIC mutation ,RNA ,RURAL population ,VIRAL load ,HIGHLY active antiretroviral therapy ,CROSS-sectional method ,CD4 lymphocyte count - Abstract
Objectives: To assess viral suppression rates, to assess prevalence of acquired HIV drug resistance and to characterize the spectrum of HIV-1 drug resistance mutations (HIV-DRM) in HIV-1-infected patients in a rural Tanzanian HIV cohort.Methods: This was a cross-sectional study nested within the Kilombero and Ulanga Antiretroviral Cohort. Virological failure was defined as HIV-1 RNA ≥50 copies/mL. Risk factors associated with virological failure and with the development of HIV-DRM were assessed using logistic regression.Results: This study included 304 participants with a median time on ART of 3.5 years (IQR = 1.7-5.3 years); 91% were on an NNRTI-based regimen and 9% were on a boosted PI-based regimen. Viral suppression was observed in 277/304 patients (91%). Of the remaining 27 patients, 21 were successfully genotyped and 17/21 (81%) harboured ≥1 clinically relevant HIV-DRM. Of these, 13/17 (76.5%) had HIV-1 plasma viral loads of >1000 copies/mL. CD4 cell count <200 cells/mm(3) at the time of recruitment was independently associated with a close to 8-fold increased odds of virological failure [adjusted OR (aOR) = 7.71, 95% CI = 2.86-20.78, P < 0.001] and with a >8-fold increased odds of developing HIV-DRM (aOR = 8.46, 95% CI = 2.48-28.93, P = 0.001).Conclusions: High levels of viral suppression can be achieved in rural sub-Saharan Africa when treatment and care programmes are well managed. In the absence of routine HIV sequencing, the WHO-recommended threshold of 1000 viral RNA copies/mL largely discriminates virological failure secondary to HIV-DRM. [ABSTRACT FROM AUTHOR]- Published
- 2017
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- View/download PDF
20. Development of HIV drug resistance and therapeutic failure in children and adolescents in rural Tanzania: an emerging public health concern.
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Muri, Lukas, Gamell, Anna, Ntamatungiro, Alex J., Glass, Tracy R., Luwanda, Lameck B., Battegay, Manuel, Furrer, Hansjakob, Hatz, Christoph, Tanner, Marcel, Felger, Ingrid, Klimkait, Thomas, Letang, Emilio, and KIULARCO Study Group
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- 2017
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21. Immune reconstitution inflammatory syndrome associated with dermatophytoses in two HIV-1 positive patients in rural Tanzania: a case report.
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Mapesi, Herry, Ramírez, Adrià, Tanner, Marcel, Hatz, Christoph, Letang, Emilio, and KIULARCO Study Group
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IMMUNE reconstitution inflammatory syndrome ,DERMATOMYCOSES ,HIV-positive persons ,PATIENT acceptance of health care ,HEALTH outcome assessment ,DIAGNOSIS - Abstract
Background: Immune reconstitution inflammatory syndrome associated with dermatophytoses (tinea-IRIS) may cause considerable morbidity. Yet, it has been scarcely reported and is rarely considered in the differential diagnosis of HIV associated cutaneous lesions in Africa. If identified, it responds well to antifungals combined with steroids. We present two cases of suspected tinea-immune reconstitution inflammatory syndrome from a large HIV clinic in rural Tanzania.Cases Presentation: A first case was a 33 years-old female newly diagnosed HIV patient with CD4 count of 4 cells/μL (0 %), normal complete blood count, liver and renal function tests was started on co-formulated tenofovir/emtricitabine/efavirenz and prophylactic cotrimoxazole. Two weeks later she presented with exaggerated inflammatory hyperpigmented skin plaques with central desquamation, active borders and scratch lesions on the face, trunk and lower limbs. Tinea-IRIS was suspected and fluconazole (150 mg daily) and prednisolone (1 mg/Kg/day tapered down after 1 week) were given. Her symptoms subsided completely after 8 weeks of treatment, and her next CD4 counts had increased to 134 cells/μL (11 %). The second case was a 35 years-old female newly diagnosed with HIV. She had 1 CD4 cell/μL (0 %), haemoglobin 9.8 g/dl, and normal renal and liver function tests. Esophageal candidiasis and normocytic-normochromic anaemia were diagnosed. She received fluconazole, prophylactic cotrimoxazole and tenofovir/emtricitabine/efavirenz. Seven weeks later she presented with inflammatory skin plaques with elevated margins and central hyperpigmentation on the trunk, face and limbs in the frame of a good general recovery and increased CD4 counts (188 cells/μL, 6 %). Tinea-IRIS was suspected and treated with griseofulvin 500 mg daily and prednisolone 1 mg/Kg tapered down after 1 week, with total resolution of symptoms in 2 weeks.Conclusion: The two cases had advanced immunosuppression and developed de-novo exaggerated manifestation of inflammatory lesions compatible with tinea corporis and tinea facies in temporal association with antiretroviral treatment initiation and good immunological response. This is compatible with unmasking tinea-IRIS, and reminds African clinicians about the importance of considering this entity in the differential diagnosis of patients with skin lesions developing after antiretroviral treatment initiation. [ABSTRACT FROM AUTHOR]- Published
- 2016
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- View/download PDF
22. Implementation and Operational Research: An Integrated and Comprehensive Service Delivery Model to Improve Pediatric and Maternal HIV Care in Rural Africa
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Gamell, Anna, Glass, Tracy R., Luwanda, Lameck B., Mapesi, Herry, Samson, Leila, Mtoi, Tom, Nyamtema, Angelo, Muri, Lukas, Ntamatungiro, Alex J., Tanner, Marcel, Hatz, Christoph, Battegay, Manuel, Letang, Emilio, and KIULARCO Study Group
- Subjects
0301 basic medicine ,Program evaluation ,Male ,Rural Population ,antiretroviral treatment ,Pediatrics ,Service delivery framework ,PMTCT ,Psychological intervention ,HIV Infections ,Tanzania ,0302 clinical medicine ,Pregnancy ,Pharmacology (medical) ,030212 general & internal medicine ,Prospective Studies ,Pregnancy Complications, Infectious ,Child ,Children ,education.field_of_study ,biology ,Delivery of Health Care, Integrated ,Medical record ,Clinical Science ,Infectious Diseases ,Child, Preschool ,ComputingMethodologies_DOCUMENTANDTEXTPROCESSING ,Female ,Adult ,medicine.medical_specialty ,Anti-HIV Agents ,Population ,03 medical and health sciences ,Acquired immunodeficiency syndrome (AIDS) ,children ,Nens ,medicine ,VIH (Virus) ,Humans ,education ,business.industry ,HIV (Viruses) ,Infant ,HIV ,biology.organism_classification ,medicine.disease ,030112 virology ,Infectious Disease Transmission, Vertical ,Africa ,Rural area ,business ,Program Evaluation - Abstract
Supplemental Digital Content is Available in the Text., Background: Strategies to improve HIV diagnosis and linkage into care, antiretroviral treatment coverage, and treatment outcomes of mothers and children are urgently needed in sub-Saharan Africa. Methods: From December 2012, we implemented an intervention package to improve prevention of mother-to-child transmission (PMTCT) and pediatric HIV care in our rural Tanzanian clinic, consisting of: (1) creation of a PMTCT and pediatric unit integrated within the reproductive and child health clinic; (2) implementation of electronic medical records; (3) provider-initiated HIV testing and counseling in the hospital wards; and (4) early infant diagnosis test performed locally. To assess the impact of this strategy, clinical characteristics and outcomes were compared between the period before (2008–2012) and during/after the implementation (2013–2014). Results: After the intervention, the number of mothers and children enrolled into care almost doubled. Compared with the pre-intervention period (2008–2012), in 2013–2014, children presented lower CD4% (16 vs. 16.8, P = 0.08) and more advanced disease (World Health Organization stage 3/4 72% vs. 35%, P < 0.001). The antiretroviral treatment coverage rose from 80% to 98% (P < 0.001), the lost-to-follow-up rate decreased from 20% to 11% (P = 0.002), and mortality ascertainment improved. During 2013–2014, 261 HIV-exposed infants were enrolled, and the early mother-to-child transmission rate among mother–infant pairs accessing PMTCT was 2%. Conclusions: This strategy resulted in an increased number of mothers and children diagnosed and linked into care, a higher detection of children with AIDS, universal treatment coverage, lower loss to follow-up, and an early mother-to-child transmission rate below the threshold of elimination. This study documents a feasible and scalable model for family-centered HIV care in sub-Saharan Africa.
23. Immune reconstitution inflammatory syndrome associated with dermatophytoses in two HIV-1 positive patients in rural Tanzania: a case report
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Mapesi, Herry, Ramírez, Adrià, Tanner, Marcel, Hatz, Christoph, Letang, Emilio, and KIULARCO Study Group
- Subjects
0301 basic medicine ,CD4-Positive T-Lymphocytes ,Cyclopropanes ,Male ,medicine.medical_treatment ,tiña ,humanos ,benzoxacinas ,HIV Infections ,Case Report ,Esophageal candidiasis ,Deoxycytidine ,Tanzania ,030207 dermatology & venereal diseases ,chemistry.chemical_compound ,0302 clinical medicine ,Tinea ,Immune Reconstitution Inflammatory Syndrome ,Antiretroviral Therapy, Highly Active ,medicine.diagnostic_test ,Immunosuppression ,adulto ,linfocitos T CD4-positivos ,Infectious Diseases ,Alkynes ,Prednisolone ,Female ,VIH-1 ,medicine.drug ,Adult ,medicine.medical_specialty ,Efavirenz ,030106 microbiology ,Organophosphonates ,Emtricitabine ,03 medical and health sciences ,adenina ,síndrome inflamatorio de reconstitución inmunitaria ,Immune reconstitution inflammatory syndrome ,medicine ,VIH (Virus) ,Humans ,Immunosupressió ,business.industry ,HIV (Viruses) ,Adenine ,HIV ,medicine.disease ,Dermatology ,desoxicitidina ,Benzoxazines ,CD4 Lymphocyte Count ,recuento de linfocitos CD4 ,chemistry ,Immunology ,Africa ,HIV-1 ,Liver function ,infecciones por VIH ,organofosfonatos ,business ,Liver function tests - Abstract
Background: Immune reconstitution inflammatory syndrome associated with dermatophytoses (tinea-IRIS) may cause considerable morbidity. Yet, it has been scarcely reported and is rarely considered in the differential diagnosis of HIV associated cutaneous lesions in Africa. If identified, it responds well to antifungals combined with steroids. We present two cases of suspected tinea-immune reconstitution inflammatory syndrome from a large HIV clinic in rural Tanzania. Cases presentation: A first case was a 33 years-old female newly diagnosed HIV patient with CD4 count of 4 cells/mu L (0 %), normal complete blood count, liver and renal function tests was started on co-formulated tenofovir/emtricitabine/efavirenz and prophylactic cotrimoxazole. Two weeks later she presented with exaggerated inflammatory hyperpigmented skin plaques with central desquamation, active borders and scratch lesions on the face, trunk and lower limbs. Tinea-IRIS was suspected and fluconazole (150 mg daily) and prednisolone (1 mg/Kg/day tapered down after 1 week) were given. Her symptoms subsided completely after 8 weeks of treatment, and her next CD4 counts had increased to 134 cells/mu L (11 %). The second case was a 35 years-old female newly diagnosed with HIV. She had 1 CD4 cell/ muL (0 %), haemoglobin 9.8 g/dl, and normal renal and liver function tests. Esophageal candidiasis and normocytic-normochromic anaemia were diagnosed. She received fluconazole, prophylactic cotrimoxazole and tenofovir/emtricitabine/efavirenz. Seven weeks later she presented with inflammatory skin plaques with elevated margins and central hyperpigmentation on the trunk, face and limbs in the frame of a good general recovery and increased CD4 counts (188 cells/mu L, 6 %). Tinea-IRIS was suspected and treated with griseofulvin 500 mg daily and prednisolone 1 mg/Kg tapered down after 1 week, with total resolution of symptoms in 2 weeks. Conclusion: The two cases had advanced immunosuppression and developed de-novo exaggerated manifestation of inflammatory lesions compatible with tinea corporis and tinea facies in temporal association with antiretroviral treatment initiation and good immunological response. This is compatible with unmasking tinea-IRIS, and reminds African clinicians about the importance of considering this entity in the differential diagnosis of patients with skin lesions developing after antiretroviral treatment initiation., We would like to acknowledge the contribution made by Nora Tan from Stanford University in reviewing the manuscript. We would like to acknowledge the contributions from all members of Kilombero and Ulanga Antiretroviral Cohort (KIULARCO) study group. The KIULARCO and the Chronic Diseases Clinic of Ifakara (CDCI) receive financial support from the Government of the Canton of Basel, Switzerland, the Swiss Tropical and Public Health Institute, the Ifakara Health Institute, the Government of Tanzania, and USAID through TUNAJALI-Deloitte. The members of the KIULARCO Study Group are: Aschola Asantiel, Manuel Battegay, AdolphinaChale, Diana Faini, Ingrid Felger, Gideon Francis, Hansjakob Furrer, Anna Gamell, Tracy Glass, Christoph Hatz, Specioza Hwaya, Bryson Kasuga, Namvua Kimera, Yassin Kisunga, Thomas Klimkait, Emilio Letang, Antonia Luhombero, Lameck B Luwanda, Herry Mapesi, Leticia Mbwile, Mengi Mkulila, Julius Mkumbo, Margareth Mkusa, Dorcus K Mnzava, Germana Mossad, Dolores Mpundunga, Athumani Mtandanguo, Kim D Mwamelo, Selerine Myeya, Sanula Nahota, Regina Ndaki, Agatha Ngulukila, Alex John Ntamatungiro, Leila Samson, George Sikalengo, Marcel Tanner, Fiona Vanobberghen, Aneth V Kalinjuma and Maja Weisser.
24. Decentralization of viral load testing to improve HIV care and treatment cascade in rural Tanzania: observational study from the Kilombero and Ulanga Antiretroviral Cohort
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Dorcas Mnzava, James Okuma, Robert Ndege, Namvua Kimera, Alex Ntamatungiro, Amina Nyuri, Theonestina Byakuzana, Faraji Abilahi, Paul Mayeka, Emmy Temba, Teddy Fanuel, Tracy Renée Glass, Thomas Klimkait, Fiona Vanobberghen, Maja Weisser, and on behalf of the KIULARCO Study Group
- Subjects
HIV cascade ,Viral load testing ,Viral suppression ,Failure ,Low level viremia ,Infectious and parasitic diseases ,RC109-216 - Abstract
Abstract Introduction Monitoring HIV viral load (HVL) in people living with HIV (PLHIV) on antiretroviral therapy (ART) is recommended by the World Health Organization. Implementation of HVL testing programs have been affected by logistic and organizational challenges. Here we describe the HVL monitoring cascade in a rural setting in Tanzania and compare turnaround times (TAT) between an on-site and a referral laboratory. Methods In a nested study of the prospective Kilombero and Ulanga Antiretroviral Cohort (KIULARCO) we included PLHIV aged ≥ 15 years, on ART for ≥ 6 months after implementation of routine HVL monitoring in 2017. We assessed proportions of PLHIV with a blood sample taken for HVL, whose results came back, and who were virally suppressed (HVL
- Published
- 2023
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25. Cohort profile: The Kilombero and Ulanga Antiretroviral Cohort (KIULARCO)
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Emilio Letang, Aneth Vedastus Kalinjuma, Tracy R Glass, Anna Gamell, Herry Mapesi, George Sikalengo, Lameck Bonaventure Luwanda, Dorcas Mnzava, Alex J Ntamatungiro, Regina Ndaki, Gideon Francis, Fiona Vanobberghen, Hansjakob Furrer, Thomas Klimkait, Ingrid Felger, Marcel Tanner, Christoph Hatz, Maja Weisser, Manuel Battegay, and on behalf of the KIULARCO Study Group
- Subjects
AIDS ,cohort ,Cohort studies ,HIV ,Studies ,sub ,Medicine - Abstract
BACKGROUND The Kilombero and Ulanga Antiretroviral Cohort (KIULARCO) is a single-site, open and ongoing prospective cohort of people living with human immunodeficiency virus (PLWHIV) established in 2005 at the Chronic Diseases Clinic of Ifakara (CDCI), within the Saint Francis Referral Hospital (SFRH) in Ifakara, Tanzania. The objectives of KIULARCO are to (i) provide patient and cohort-level information on the outcomes of HIV treatment; (ii) provide cohort-level information on opportunistic infections and comorbidities; (iii) evaluate aspects of human immunodeficiency virus (HIV) care and treatment that have national or international policy relevance; (iv) provide a platform for studies on improving HIV care and treatment in sub-Saharan Africa; and (v) contribute to generating local capacity to deal with the challenges posed by the HIV/AIDS pandemic in this region. Moreover, KIULARCO may serve as a model for other healthcare settings in rural sub-Saharan Africa. METHODS Since 2005, all patients diagnosed with HIV at the Saint Francis Referral Hospital are invited to participate in the cohort, including non-pregnant adults, pregnant women, adolescents, children and infants. The information collected includes demographics, baseline and follow-up clinical data, laboratory data, medication history, drug toxicities, diagnoses and outcomes. Real-time data are captured during the patient encounter through an electronic medical record system that allowed transition to a paperless clinic in 2013. In addition, KIULARCO is associated with a biobank of cryopreserved plasma samples and cell pellets collected from all participants before and at different time-points during antiretroviral treatment. RESULTS Up to the end of 2016, 12 185 PLWHIV have been seen at the CDCI; 9218 (76%) of whom have been enrolled into KIULARCO and 6965 (76%) of these have received ART from the clinic. Patients on ART attend at least every 3 months, with laboratory monitoring every 6 months. KIULARCO data have been used to generate relevant information regarding ART outcomes, opportunistic infections, non-AIDS comorbidities, prevention of mother-to-child transmission of HIV, paediatric HIV, and mortality and retention in care. Requests for collaborations on analyses can be submitted to the KIULARCO scientific committee. CONCLUSIONS KIULARCO provides a framework for improving the quality of care of people living with HIV in sub-Saharan Africa, to generate relevant information to evaluate ART programmes and to build local capacity to deal with HIV/AIDS. The comprehensiveness of the data collected, together with the biobank spanning over ten years has created a unique research platform in rural sub-Saharan Africa.
- Published
- 2017
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26. Absence of hepatitis delta infection in a large rural HIV cohort in Tanzania
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Hansjakob Furrer, Namvua Kimera, Gilles Wandeler, Tracy R. Glass, Darius Moradpour, Frédéric Le Gal, Roland Sahli, Aneth Vedastus Kalinjuma, Emilio Letang, Alex J. Ntamatungiro, Annja Winter, and KIULARCO Study Group
- Subjects
Male ,Rural Population ,viruses ,HIV Infections ,medicine.disease_cause ,Tanzania ,Serology ,Cohort Studies ,0302 clinical medicine ,Risk Factors ,Epidemiology ,Prevalence ,030212 general & internal medicine ,Sub-Saharan Africa ,Coinfection ,Hepatitis D (hepatitis delta) ,virus diseases ,General Medicine ,Hepatitis B ,Hepatitis D ,Infectious Diseases ,Hepatitis delta ,Cohort ,Female ,Hepatitis Delta Virus ,Cohort study ,Adult ,Microbiology (medical) ,medicine.medical_specialty ,Demography ,False Positive Reactions ,HIV Infections/complications ,HIV Infections/epidemiology ,Hepatitis Antibodies/blood ,Hepatitis B/complications ,Hepatitis B/epidemiology ,Hepatitis D/epidemiology ,Hepatitis Delta Virus/immunology ,Humans ,Tanzania/epidemiology ,030231 tropical medicine ,Equity, gender, social determinants ,610 Medicine & health ,False-positive serology ,Emerging and Re-emerging Infectious Diseases ,03 medical and health sciences ,360 Social problems & social services ,Internal medicine ,VIH (Virus) ,medicine ,Hepatitis Antibodies ,Hepatitis B virus ,HIV (Viruses) ,business.industry ,HIV ,Virus de l'hepatitis delta ,biochemical phenomena, metabolism, and nutrition ,medicine.disease ,Virology ,business - Abstract
OBJECTIVES: The epidemiological and clinical determinants of hepatitis delta virus (HDV) infection in Sub-Saharan Africa are ill-defined. The prevalence of HDV infection was determined in HIV/hepatitis B virus (HBV) co-infected individuals in rural Tanzania. METHODS: All hepatitis B virus (HBV)-infected adults under active follow-up in the Kilombero and Ulanga Antiretroviral Cohort (KIULARCO) were screened for anti-HDV antibodies. For positive samples, a second serological test and nucleic acid amplification were performed. Demographic and clinical characteristics at initiation of antiretroviral therapy (ART) were compared between anti-HDV-negative and positive patients. RESULTS: Among 222 HIV/HBV co-infected patients on ART, 219 (98.6%) had a stored serum sample available and were included in the study. Median age was 37 years, 55% were female, 46% had World Health Organization stage III/IV HIV disease, and the median CD4 count was 179 cells/mul. The prevalence of anti-HDV positivity was 5.0% (95% confidence interval 2.8-8.9%). There was no significant predictor of anti-HDV positivity. HDV could not be amplified in any of the anti-HDV-positive patients and the second serological test was negative in all of them. CONCLUSIONS: No confirmed case of HDV infection was found among over 200 HIV/HBV co-infected patients in Tanzania. As false-positive serology results are common, screening results should be confirmed with a second test.
- Published
- 2016
27. The Chronic Diseases Clinic of Ifakara (CDCI)-Establishing a Model Clinic for Chronic Care Delivery in Rural Sub-Saharan Africa.
- Author
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Weisser M, Rohacek M, Ndege R, Luoga E, Katende A, Mollel GJ, Gingo W, Vanobberghen F, Paris DH, Hatz C, Battegay M, and On Behalf Of The Kiularco Study Group
- Abstract
The rollout of antiretroviral drugs in sub-Saharan Africa to address the huge health impact of the HIV pandemic has been one of the largest projects undertaken in medical history and is an unprecedented medical success story. However, the path has been and still is characterized by many far reaching implementational challenges. Here, we report on the building and maintaining of a role model clinic in Ifakara, rural Southwestern Tanzania, within a collaborative project to support HIV services within the national program, training for staff and integrated research to better understand local needs and improve patients' outcomes.
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- 2022
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28. Mortality Rate in a Cohort of People Living With HIV in Rural Tanzania After Accounting for Unseen Deaths Among Those Lost to Follow-up.
- Author
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Vanobberghen F, Weisser M, Kasuga B, Katende A, Battegay M, Tanner M, and Glass On Behalf Of The Kiularco Study Group TR
- Subjects
- Adolescent, Adult, Anti-Retroviral Agents therapeutic use, Body Mass Index, CD4 Lymphocyte Count, Female, HIV Infections drug therapy, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Proportional Hazards Models, Referral and Consultation, Severity of Illness Index, Sex Factors, Socioeconomic Factors, Tanzania epidemiology, Young Adult, HIV Infections mortality, Lost to Follow-Up, Rural Population statistics & numerical data
- Abstract
Mortality assessment in cohorts with high numbers of persons lost to follow-up (LTFU) is challenging in settings with limited civil registration systems. We aimed to assess mortality in a clinical cohort (the Kilombero and Ulanga Antiretroviral Cohort (KIULARCO)) of human immunodeficiency virus (HIV)-infected persons in rural Tanzania, accounting for unseen deaths among participants LTFU. We included adults enrolled in 2005-2015 and traced a nonrandom sample of those LTFU. We estimated mortality using Kaplan-Meier methods 1) with routinely captured data (method A), 2) crudely incorporating tracing data (method B), 3) weighting using tracing data to crudely correct for unobserved deaths among participants LTFU (method C), and 4) weighting using tracing data accounting for participant characteristics (method D). We investigated associated factors using proportional hazards models. Among 7,460 adults, 646 (9%) died, 883 (12%) transferred to other clinics, and 2,911 (39%) were LTFU. Of 2,010 (69%) traced participants, 325 (16%) were found: 131 (40%) had died and 130 (40%) had transferred. Five-year mortality estimates derived using the 4 methods were 13.1% (A), 16.2% (B), 36.8% (C), and 35.1% (D), respectively. Higher mortality was associated with male sex, referral as a hospital inpatient, living close to the index clinic, lower body mass index, more advanced World Health Organization HIV clinical stage, lower CD4 cell count, and less time since initiation of antiretroviral therapy. Adjusting for unseen deaths among participants LTFU approximately doubled the 5-year mortality estimates. Our approach is applicable to other cohort studies adopting targeted tracing., (© The Author(s) 2020. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health.)
- Published
- 2021
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29. Cohort profile: The Kilombero and Ulanga Antiretroviral Cohort (KIULARCO) - A prospective HIV cohort in rural Tanzania.
- Author
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Letang E, Kalinjuma AV, Glass TR, Gamell A, Mapesi H, Sikalengo GR, Luwanda LB, Mnzava D, Ntamatungiro AJ, Ndaki R, Francis G, Vanobberghen F, Furrer H, Klimkait T, Felger I, Tanner M, Hatz C, Weisser M, Battegay M, and Kiularco Study Group
- Subjects
- Adolescent, Adult, Child, Child, Preschool, Female, HIV Infections complications, HIV Infections drug therapy, Humans, Infant, Infectious Disease Transmission, Vertical prevention & control, Infectious Disease Transmission, Vertical statistics & numerical data, Male, Middle Aged, Pregnancy, Prospective Studies, Tanzania epidemiology, Young Adult, AIDS-Related Opportunistic Infections epidemiology, Anti-Retroviral Agents therapeutic use, HIV Infections epidemiology, Patient Acceptance of Health Care statistics & numerical data, Rural Population statistics & numerical data
- Abstract
Background: The Kilombero and Ulanga Antiretroviral Cohort (KIULARCO) is a single-site, open and ongoing prospective cohort of people living with human immunodeficiency virus (PLWHIV) established in 2005 at the Chronic Diseases Clinic of Ifakara (CDCI), within the Saint Francis Referral Hospital (SFRH) in Ifakara, Tanzania. The objectives of KIULARCO are to (i) provide patient and cohort-level information on the outcomes of HIV treatment; (ii) provide cohort-level information on opportunistic infections and comorbidities; (iii) evaluate aspects of human immunodeficiency virus (HIV) care and treatment that have national or international policy relevance; (iv) provide a platform for studies on improving HIV care and treatment in sub-Saharan Africa; and (v) contribute to generating local capacity to deal with the challenges posed by the HIV/AIDS pandemic in this region. Moreover, KIULARCO may serve as a model for other healthcare settings in rural sub-Saharan Africa., Methods: Since 2005, all patients diagnosed with HIV at the Saint Francis Referral Hospital are invited to participate in the cohort, including non-pregnant adults, pregnant women, adolescents, children and infants. The information collected includes demographics, baseline and follow-up clinical data, laboratory data, medication history, drug toxicities, diagnoses and outcomes. Real-time data are captured during the patient encounter through an electronic medical record system that allowed transition to a paperless clinic in 2013. In addition, KIULARCO is associated with a biobank of cryopreserved plasma samples and cell pellets collected from all participants before and at different time-points during antiretroviral treatment., Results: Up to the end of 2016, 12 185 PLWHIV have been seen at the CDCI; 9218 (76%) of whom have been enrolled into KIULARCO and 6965 (76%) of these have received ART from the clinic. Patients on ART attend at least every 3 months, with laboratory monitoring every 6 months. KIULARCO data have been used to generate relevant information regarding ART outcomes, opportunistic infections, non-AIDS comorbidities, prevention of mother-to-child transmission of HIV, paediatric HIV, and mortality and retention in care. Requests for collaborations on analyses can be submitted to the KIULARCO scientific committee., Conclusions: KIULARCO provides a framework for improving the quality of care of people living with HIV in sub-Saharan Africa, to generate relevant information to evaluate ART programmes and to build local capacity to deal with HIV/AIDS. The comprehensiveness of the data collected, together with the biobank spanning over ten years has created a unique research platform in rural sub-Saharan Africa.
- Published
- 2017
- Full Text
- View/download PDF
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