116 results on '"Orne-Gliemann J"'
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2. Séroprévalence du VIH et facteurs associés chez les hommes ayant des rapports sexuels avec d’autres hommes au Togo
- Author
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Ekouevi, D.K., Dagnra, C.Y., Goilibe, K.B., Tchounga, B., Orne-Gliemann, J., Salou, M., Anato, S., Prince-David, M., and Pitche, V.P.
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- 2014
- Full Text
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3. Intervention de conseil VIH prénatal orienté vers le couple et communication conjugale autour du VIH (Essai ANRS 12127 Prenahtest)
- Author
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Plazy, M., Orne-Gliemann, J., Balestre, E., Miric, M., Darak, S., Butsashvili, M., Tchendjou, P., Dabis, F., and Desgrées du Loû, A.
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- 2013
- Full Text
- View/download PDF
4. Effect of systematic tuberculosis detection on mortality in young children with severe pneumonia in countries with high incidence of tuberculosis: a stepped-wedge cluster-randomised trial
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Marcy, O, Wobudeya, E, Font, H, Vessière, A, Chabala, C, Khosa, C, Taguebue, J-V, Moh, R, Mwanga-Amumpaire, J, Lounnas, M, Mulenga, V, Mavale, S, Chilundo, J, Rego, D, Nduna, B, Shankalala, P, Chirwa, U, De Lauzanne, A, Dim, B, Tiogouo Ngouana, E, Folquet Amorrissani, M, Cisse, L, Amon Tanoh Dick, F, Komena, EA, Kwedi Nolna, S, Businge, G, Natukunda, N, Cumbe, S, Mbekeka, P, Kim, A, Kheang, C, Pol, S, Maleche-Obimbo, E, Seddon, JA, Mao, TE, Graham, SM, Delacourt, C, Borand, L, Bonnet, M, Serre, A, Badrichani, A, Razafimanantsoa, M, Poublan, J, Roucher, C, Occelli, E, Beuscart, A, Charpin, A, Habiyambere, G, Mesnier, S, Balestre, E, Bhatta, B, Maillard, A-L, Orne-Gliemann, J, Baillet, E, Koskas, N, D'Elbée, M, Gabillard, D, Huyen, M, Espérou, H, Couffin-Cadiergues, S, Kuppers, A, Hamze, B, BORAND, L, de LAUZANNE, A, DIM, B, Keang, C, PRING, L, YIN, S, SARITH, C, PHAN, C, NHEUONG, S, LY, S, KAING, S, SRENG, V, LUN, E, SAY, L, SUOM, S, FERHY, R, SO, D, BORN, S, PAL, S, NANG, B, MAO, TE, KIM, A, Srey, V, Kan, P, Hout, L, Ith, S, Oum, S, Sau, S, Ho, KH, Kith, D, Nuch, N, Horm, CL, Sophon, C, Roeungdeth, B, MENG, C, RITH, R, PHY, S, SOR, C, SAO, V, KHAT, S, MAK, B, UY, A, KHAY, S, SOM, K, HACH, R, SOK, H, KUON, S, HENG, S, SENG, A, NIM, S, PAN, R, KIM, S, SREY LEAP, K, NET, B, NOUN, V, LAY, D, MANY, C, Seng, S, Ly, V, So, S, Oun, S, CHEY, S, CHHEA, R, BAONG, L, THOUNG, V, KHEANG, C, BY, B, Nguon, V, MEACH, E, Tek, S, Ngeav, S, Lun, T, HEM, D, CHUT, N, SARIK, S, NANG, H, MEACH, M, SRENG, S, SAR, D, KIN, R, ROS, P, DORN, C, KAK, C, Sambath, SL, Son, L, Bin, L, Pengong, E, Khutsorn, S, Seang, S, Soun, V, Vong, V, Khoeung, C, Um, P, Bou, S, Song Pich, S, Nim, P, Khat, S, Ban Si, N, Ream, S, Ing, S, Chann, P, Ngeth, S, Sun, M, Chhoeung, S, Sean, S, Prak, R, Amboua Schouame Onambele, A, Hycenth, N, Melingui, B, Nkembe Medounmga, A, Hougnang Tatmi, L, Etemgoua, N, Kouesso, V, Bugin, J, Nzedjom, C, Ngoya, R, Eyike, J, Loudjom, E, Lonsti, R, Dang, L, Bintar, E, Njayong, C, Ngonsoa O, C, Ndzeukap, I, Dzoyem, P, Dzokou, C, Dindo, B, Aka Bony, R, Kouadio, C, Danho, S, Goli, M, Folquet, M, Itchy, MV, Sidibé, A, Cissé, L, Ouattara, J, Konaté, M, Amon-Tanoh Dick, F, Cardena, M, Adonis-Koffi, L, Eugenie, D, Kouamé, F, Menan, H, Inwoley, A, Ouassa, T, Nguessan, MS, Manhiça, E, Zitha, A, Chiúle, V, Muxanga, E, Gune, I, Lima, Y, Ribeiro, J, Maxanguana, F, Morais, N, Manhiça, J, Give, J, Atumane, J, Lucas, G, Thai, A, Chave, A, Guambe, L, Issa, F, Carneiro, R, Pene, N, Florindo, N, Machel, D, Cumbane, C, Mendes, H, Kitungwa, M, Muianga, V, Tamele, H, Sulude, A, Mabota, R, Comandante, H, Massangaie, A, Businge, GB, Namulinda, F, Sserunjogi, R, Nassozi, R, Barungi, C, Aanyu, H, Muwonge, D, Kagoya, E, Aciparu, S, Chemutai, S, Ntambi, S, Wasswa, A, Nangozi, J, Tagoola, A, Kenneth, S, Lubega, JP, Nassali, A, Tagobera, J, Agwang, C, Kalembe, F, Ajambo, A, Aguti, E, Kasibante, S, Matende, H, Odongo, IO, Mwanga Amumpaire, J, Ngabirano, G, Kakwenza, P, Nuwamanya, S, Nyangoma, M, Nabbuto, J, Abok, F, Arinaitwe, R, Birungi, D, Mwesigwa, E, Atwine, D, Mbega, H, Orikiriza, P, Taremwa, I, Turyashemererwa, E, Derrick, H, Nyehangane, D, Kaitano, R, Logoose, S, Businge, S, Ntambi, C, Mugabi, J, Mzee, J, Besigye, J, Kanzira, S, Turyatemba, P, Twebaze, F, Hambulo, C, Kapotwe, V, Ngambi, M, Kasakwa, K, Kapula, C, Zulu, S, Nawakwi, G, Siasulingana, T, Chilonga, J, Chimbini, M, Chilanga, M, Inambao, M, Mwambazi, M, Halende, B, Mumba, W, Mankunshe, E, Silavwe, M, Chakopo, M, Moono, R, Marcy, O, Wobudeya, E, Font, H, Vessière, A, Chabala, C, Khosa, C, Taguebue, J-V, Moh, R, Mwanga-Amumpaire, J, Lounnas, M, Mulenga, V, Mavale, S, Chilundo, J, Rego, D, Nduna, B, Shankalala, P, Chirwa, U, De Lauzanne, A, Dim, B, Tiogouo Ngouana, E, Folquet Amorrissani, M, Cisse, L, Amon Tanoh Dick, F, Komena, EA, Kwedi Nolna, S, Businge, G, Natukunda, N, Cumbe, S, Mbekeka, P, Kim, A, Kheang, C, Pol, S, Maleche-Obimbo, E, Seddon, JA, Mao, TE, Graham, SM, Delacourt, C, Borand, L, Bonnet, M, Serre, A, Badrichani, A, Razafimanantsoa, M, Poublan, J, Roucher, C, Occelli, E, Beuscart, A, Charpin, A, Habiyambere, G, Mesnier, S, Balestre, E, Bhatta, B, Maillard, A-L, Orne-Gliemann, J, Baillet, E, Koskas, N, D'Elbée, M, Gabillard, D, Huyen, M, Espérou, H, Couffin-Cadiergues, S, Kuppers, A, Hamze, B, BORAND, L, de LAUZANNE, A, DIM, B, Keang, C, PRING, L, YIN, S, SARITH, C, PHAN, C, NHEUONG, S, LY, S, KAING, S, SRENG, V, LUN, E, SAY, L, SUOM, S, FERHY, R, SO, D, BORN, S, PAL, S, NANG, B, MAO, TE, KIM, A, Srey, V, Kan, P, Hout, L, Ith, S, Oum, S, Sau, S, Ho, KH, Kith, D, Nuch, N, Horm, CL, Sophon, C, Roeungdeth, B, MENG, C, RITH, R, PHY, S, SOR, C, SAO, V, KHAT, S, MAK, B, UY, A, KHAY, S, SOM, K, HACH, R, SOK, H, KUON, S, HENG, S, SENG, A, NIM, S, PAN, R, KIM, S, SREY LEAP, K, NET, B, NOUN, V, LAY, D, MANY, C, Seng, S, Ly, V, So, S, Oun, S, CHEY, S, CHHEA, R, BAONG, L, THOUNG, V, KHEANG, C, BY, B, Nguon, V, MEACH, E, Tek, S, Ngeav, S, Lun, T, HEM, D, CHUT, N, SARIK, S, NANG, H, MEACH, M, SRENG, S, SAR, D, KIN, R, ROS, P, DORN, C, KAK, C, Sambath, SL, Son, L, Bin, L, Pengong, E, Khutsorn, S, Seang, S, Soun, V, Vong, V, Khoeung, C, Um, P, Bou, S, Song Pich, S, Nim, P, Khat, S, Ban Si, N, Ream, S, Ing, S, Chann, P, Ngeth, S, Sun, M, Chhoeung, S, Sean, S, Prak, R, Amboua Schouame Onambele, A, Hycenth, N, Melingui, B, Nkembe Medounmga, A, Hougnang Tatmi, L, Etemgoua, N, Kouesso, V, Bugin, J, Nzedjom, C, Ngoya, R, Eyike, J, Loudjom, E, Lonsti, R, Dang, L, Bintar, E, Njayong, C, Ngonsoa O, C, Ndzeukap, I, Dzoyem, P, Dzokou, C, Dindo, B, Aka Bony, R, Kouadio, C, Danho, S, Goli, M, Folquet, M, Itchy, MV, Sidibé, A, Cissé, L, Ouattara, J, Konaté, M, Amon-Tanoh Dick, F, Cardena, M, Adonis-Koffi, L, Eugenie, D, Kouamé, F, Menan, H, Inwoley, A, Ouassa, T, Nguessan, MS, Manhiça, E, Zitha, A, Chiúle, V, Muxanga, E, Gune, I, Lima, Y, Ribeiro, J, Maxanguana, F, Morais, N, Manhiça, J, Give, J, Atumane, J, Lucas, G, Thai, A, Chave, A, Guambe, L, Issa, F, Carneiro, R, Pene, N, Florindo, N, Machel, D, Cumbane, C, Mendes, H, Kitungwa, M, Muianga, V, Tamele, H, Sulude, A, Mabota, R, Comandante, H, Massangaie, A, Businge, GB, Namulinda, F, Sserunjogi, R, Nassozi, R, Barungi, C, Aanyu, H, Muwonge, D, Kagoya, E, Aciparu, S, Chemutai, S, Ntambi, S, Wasswa, A, Nangozi, J, Tagoola, A, Kenneth, S, Lubega, JP, Nassali, A, Tagobera, J, Agwang, C, Kalembe, F, Ajambo, A, Aguti, E, Kasibante, S, Matende, H, Odongo, IO, Mwanga Amumpaire, J, Ngabirano, G, Kakwenza, P, Nuwamanya, S, Nyangoma, M, Nabbuto, J, Abok, F, Arinaitwe, R, Birungi, D, Mwesigwa, E, Atwine, D, Mbega, H, Orikiriza, P, Taremwa, I, Turyashemererwa, E, Derrick, H, Nyehangane, D, Kaitano, R, Logoose, S, Businge, S, Ntambi, C, Mugabi, J, Mzee, J, Besigye, J, Kanzira, S, Turyatemba, P, Twebaze, F, Hambulo, C, Kapotwe, V, Ngambi, M, Kasakwa, K, Kapula, C, Zulu, S, Nawakwi, G, Siasulingana, T, Chilonga, J, Chimbini, M, Chilanga, M, Inambao, M, Mwambazi, M, Halende, B, Mumba, W, Mankunshe, E, Silavwe, M, Chakopo, M, and Moono, R
- Abstract
Background: Tuberculosis diagnosis might be delayed or missed in children with severe pneumonia because this diagnosis is usually only considered in cases of prolonged symptoms or antibiotic failure. Systematic tuberculosis detection at hospital admission could increase case detection and reduce mortality. Methods: We did a stepped-wedge cluster-randomised trial in 16 hospitals from six countries (Cambodia, Cameroon, Côte d'Ivoire, Mozambique, Uganda, and Zambia) with high incidence of tuberculosis. Children younger than 5 years with WHO-defined severe pneumonia received either the standard of care (control group) or standard of care plus Xpert MTB/RIF Ultra (Xpert Ultra; Cepheid, Sunnyvale, CA, USA) on nasopharyngeal aspirate and stool samples (intervention group). Clusters (hospitals) were progressively switched from control to intervention at 5-week intervals, using a computer-generated random sequence, stratified on incidence rate of tuberculosis at country level, and masked to teams until 5 weeks before switch. We assessed the effect of the intervention on primary (12-week all-cause mortality) and secondary (including tuberculosis diagnosis) outcomes, using generalised linear mixed models. The primary analysis was by intention to treat. We described outcomes in children with severe acute malnutrition in a post hoc analysis. This study is registered with ClinicalTrials.gov (NCT03831906) and the Pan African Clinical Trial Registry (PACTR202101615120643). Findings: From March 21, 2019, to March 30, 2021, we enrolled 1401 children in the control group and 1169 children in the intervention group. In the intervention group, 1140 (97·5%) children had nasopharyngeal aspirates and 942 (80·6%) had their stool collected; 24 (2·1%) had positive Xpert Ultra. At 12 weeks, 110 (7·9%) children in the control group and 91 (7·8%) children in the intervention group had died (adjusted odds ratio [OR] 0·986, 95% CI 0·597–1·630, p=0·957), and 74 (5·3%) children in the control group
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- 2022
5. Knowledge, attitudes and practices on childhood TB among healthcare workers
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Joshi, B., primary, Font, H., additional, Wobudeya, E., additional, Nanfuka, M., additional, Kobusingye, A., additional, Mwanga-Amumpaire, J., additional, Natukunda, N., additional, Turyahabwe, S., additional, Borand, L., additional, Mao, T. E., additional, Dim, B., additional, Ferhi, R., additional, Moh, R., additional, Kouakou, J., additional, Aka Bony, R., additional, Breton, G., additional, Mustapha, A., additional, Matata, L., additional, Foray, L., additional, Detjen, A., additional, Verkuijl, S., additional, Sekadde, M., additional, Khosa, C., additional, Mbassa, V., additional, Taguebue, J-V., additional, Kwedi Nolna, S., additional, Bonnet, M., additional, Marcy, O., additional, and Orne-Gliemann, J., additional
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- 2022
- Full Text
- View/download PDF
6. Barriers to antiretroviral treatment initiation in rural KwaZulu-Natal, South Africa
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Plazy, M, Newell, M-L, Orne-Gliemann, J, Naidu, K, Dabis, F, and Dray-Spira, R
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- 2015
- Full Text
- View/download PDF
7. Early ART initiation improves HIV status disclosure and social support in people living with HIV, linked to care within a universal test and treat program in rural South Africa (ANRS 12249 TasP Trial)
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Fiorentino, M., Nishimwe, M., Protopopescu, C., Iwuji, C., Okesola, N., Spire, B., Orne-Gliemann, J., McGrath, N., Pillay, D., Dabis, F., Larmarange, Joseph, Boyer, S., and ANRS 12249 TaSP Study Group
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Social support ,South africa ,HIV ,Early antiretroviral treatment ,Test and treat ,HIV status disclosure - Abstract
We investigated the effect of early antiretroviral treatment (ART) initiation on HIV status disclosure and social support in a cluster-randomized, treatment-as-prevention (TasP) trial in rural South Africa. Individuals identified HIV-positive after home-based testing were referred to trial clinics where they were invited to initiate ART immediately irrespective of CD4 count (intervention arm) or following national guidelines (control arm). We used Poisson mixed effects models to assess the independent effects of (a) time since baseline clinical visit, (b) trial arm, and (c) ART initiation on HIV disclosure (n = 182) and social support (n = 152) among participants with a CD4 count > 500 cells/mm(3) at baseline. Disclosure and social support significantly improved over follow-up in both arms. Disclosure was higher (incidence rate ratio [95% confidence interval]: 1.24 [1.04; 1.48]), and social support increased faster (1.22 [1.02; 1.46]) in the intervention arm than in the control arm. ART initiation improved both disclosure and social support (1.50 [1.28; 1.75] and 1.34 [1.12; 1.61], respectively), a stronger effect being seen in the intervention arm for social support (1.50 [1.12; 2.01]). Besides clinical benefits, early ART initiation may also improve psychosocial outcomes. This should further encourage countries to implement universal test-and-treat strategies.
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- 2020
8. Temporal trends of population viral suppression in the context of Universal Test and Treat : the ANRS 12249 TasP trial in rural South Africa
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Larmarange, Joseph, Diallo, M. H., McGrath, N., Iwuji, C., Plazy, M., Thiebaut, R., Tanser, F., Barnighausen, T., Orne-Gliemann, J., Pillay, D., Dabis, F., March, Laura (collab.), and ANRS 12249 TasP Study Group
- Subjects
retention in care ,South Africa ,antiretroviral therapy ,HIV ,sustained viral suppression ,population health - Abstract
Introduction The universal test-and-treat (UTT) strategy aims to maximize population viral suppression (PVS), that is, the proportion of all people living with HIV (PLHIV) on antiretroviral treatment (ART) and virally suppressed, with the goal of reducing HIV transmission at the population level. This article explores the extent to which temporal changes in PVS explain the observed lack of association between universal treatment and cumulative HIV incidence seen in the ANRS 12249 TasP trial conducted in rural South Africa. Methods The TasP cluster-randomized trial (2012 to 2016) implemented six-monthly repeat home-based HIV counselling and testing (RHBCT) and referral of PLHIV to local HIV clinics in 2 x 11 clusters opened sequentially. ART was initiated according to national guidelines in control clusters and regardless of CD4 count in intervention clusters. We measured residency status, HIV status, and HIV care status for each participant on a daily basis. PVS was computed per cluster among all resident PLHIV (>= 16, including those not in care) at cluster opening and daily thereafter. We used a mixed linear model to explore time patterns in PVS, adjusting for sociodemographic changes at the cluster level. Results 8563 PLHIV were followed. During the course of the trial, PVS increased significantly in both arms (23.5% to 46.2% in intervention, +22.8, p < 0.001; 26.0% to 44.6% in control, +18.6, p < 0.001). That increase was similar in both arms (p = 0.514). In the final adjusted model, PVS increase was most associated with increased RHBCT and the implementation of local trial clinics (measured by time since cluster opening). Contextual changes (measured by calendar time) also contributed slightly. The effect of universal ART (trial arm) was positive but limited. Conclusions PVS was improved significantly but similarly in both trial arms, explaining partly the null effect observed in terms of cumulative HIV incidence between arms. The PVS gains due to changes in ART-initiation guidelines alone are relatively small compared to gains obtained by strategies to maximize testing and linkage to care. The achievement of the 90-90-90 targets will not be met if the operational and implementational challenges limiting access to care and treatment, often context-specific, are not properly addressed. Clinical trial number: NCT01509508 (clinicalTrials.gov)/DOH-27-0512-3974 (South African National Clinical Trials Register).
- Published
- 2019
9. Community-based assessment of infant feeding practices within a programme for prevention of mother-to-child HIV transmission in rural Zimbabwe
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Orne-Gliemann, J, Mukotekwa, T, Miller, A, Perez, F, Glenshaw, M, Nesara, P, and Dabis, F
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- 2006
10. Improved knowledge and practices among end-users of mother-to-child transmission of HIV prevention services in rural Zimbabwe
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Orne-Gliemann, J., Mukotekwa, T., Perez, F., Miller, A., Sakarovitch, C., Glenshaw, M., Engelsmann, B., and Dabis, F.
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- 2006
11. Improving child health: the role of research
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Dabis, F, Orne-Gliemann, J, Perez, F, Leroy, V, Newell, M L, Coutsoudis, A, and Coovadia, H
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- 2002
12. Universal test and treat and the HIV epidemic in rural South Africa : a phase 4, open-label, community cluster randomised trial
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Iwuji, C. C., Orne-Gliemann, J., Larmarange, Joseph, Balestre, E., Thiebaut, R., Tanser, F., Okesola, N., Makowa, T., Dreyer, J., Herbst, K., McGrath, N., Barnighausen, T., Boyer, S., De Oliveira, T., Rekacewicz, C., Bazin, B., Newell, M. L., Pillay, D., Dabis, F., and ANRS 12249 TasP Study Group
- Abstract
Background Universal antiretroviral therapy (ART), as per the 2015 WHO recommendations, might reduce population HIV incidence. We investigated the effect of universal test and treat on HIV acquisition at population level in a high prevalence rural region of South Africa. Methods We did a phase 4, open-label, cluster randomised trial of 22 communities in rural KwaZulu-Natal, South Africa. We included individuals residing in the communities who were aged 16 years or older. The clusters were composed of aggregated local areas (neighbourhoods) that had been identified in a previous study in the Hlabisa subdistrict. The study statisticians randomly assigned clusters (1:1) with MapInfo Pro (version 11.0) to either the control or intervention communities, stratified on the basis of antenatal HIV prevalence. We offered residents repeated rapid HIV testing during home-based visits every 6 months for about 4 years in four clusters, 3 years in six clusters, and 2 years in 12 clusters (58 cluster-years) and referred HIV-positive participants to trial clinics for ART (fixed-dose combination of tenofovir, emtricitabine, and efavirenz) regardless of CD4 cell count (intervention) or according to national guidelines (initially
- Published
- 2018
13. Men, masculinity, and engagement with treatment as prevention in KwaZulu-Natal, South Africa
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Chikovore, J., Gillepsie, N., McGrath, N., Orne-Gliemann, J., Zuma, T., Larmarange, Joseph, Sagaon Teyssier, LUis, and ANRS 12249 TasP Study Group
- Subjects
virus diseases - Abstract
Men's poorer engagement with healthcare generally and HIV care specifically, compared to women, is well-described. Within the HIV public health domain, interest is growing in universal test and treat (UTT) strategies. UTT strategies refer to the expansion of antiretroviral therapy (ART) in order to reduce onward transmission and incidence of HIV in a population, through a treatment as prevention (TasP). This paper focuses on how masculinity influences engagement with HIV care in the context of an on-going TasP trial. Data were collected in January-November 2013 using 20 in-depth interviews, 10 of them repeated thrice, and 4 focus group discussions, each repeated four times. Analysis combined inductive and deductive approaches for coding and the review and consolidation of emerging themes. The accounts detailed men's unwillingness to engage with HIV testing and care, seemingly tied to their pursuit of valued masculinity constructs such as having strength and control, being sexually competent, and earning income. Articulated through fears regarding getting an HIV-positive diagnosis, observations that men preferred traditional medicine and that primary health centres were not welcoming to men, descriptions that men used lay measures to ascertain HIV status, and insinuations by men that they were removed from HIV risk, the indisposition to HIV care contrasted markedly with an apparent readiness to test among women. Gendered tensions thus emerged which were amplified in the context where valued masculinity representations were constantly threatened. Amid the tensions, men struggled with disclosing their HIV status, and used various strategies to avoid or postpone disclosing, or disclose indirectly, while women's ability to access care readily, use condoms, or communicate about HIV appeared similarly curtailed. UTT and TasP promotion should heed and incorporate into policy and health service delivery models the intrapersonal tensions, and the conflict, and poor and indirect communication at the micro-relational levels of couples and families.
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- 2016
14. Les hommes qui ont des rapports sexuels avec d'autres hommes (HSH) et l'infection à VIH à Ouagadougou, Burkina Faso : connaissances, attitudes, pratiques et enquête de séroprévalence [+ Erratum, 1 p.]
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Dah, T.T.E, Orne-Gliemann, J., Guiard-Schmid, J.B., Becquet, R., and Larmarange, Joseph
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SIDA ,DEPISTAGE ,COMPORTEMENT SEXUEL ,ENQUETE ,POPULATION URBAINE ,HOMME ,EXCLUSION SOCIALE ,PREVALENCE - Abstract
Position du problème : A l'instar de plusieurs pays africains, la question des rapports sexuels entre hommes au Burkina Faso reste taboue et est parfois cause d'exclusion sociale. Cette population qui est vulnérable face au VIH sida est méconnue, car n'ayant pas souvent fait l'objet d'exploration scientifique. Objectif : L'objectif de notre étude était de caractériser les connaissances, attitudes, pratiques sexuelles et d'estimer la séroprévalence du VIH parmi les HSH à Ouagadougou. Méthodes : Une étude transversale à visée descriptive et analytique a été conduite auprès de HSH résidant à Ouagadougou recrutés par la technique de « boule de neige », âgés d'au moins 18 ans et acceptant de participer à l'étude. Les données ont été recueillies par un questionnaire administré en face-à-face par deux enquêteurs formés. Le test de dépistage du VIH a été systématiquement proposé aux enquêtés. Résultats : Au total, 142 HSH ont été recrutés durant la période d'étude. L'échantillon était constitué à majorité d'élèves ou d'étudiants (60,8 %), de célibataires (91 %) avec un âge compris entre 18 et 30 ans (96,5 %). Le score médian de connaissance vis-à-vis du VIH était de 8/10. La séroprévalence du VIH était estimée à 8,9 % (4,5–15,4). Conclusion : Notre étude confirme la vulnérabilité des HSH de Ouagadougou vis-à-vis du VIH vu la séroprévalence élevée de l'infection par le VIH. Des interventions ciblées de prévention, de prise en charge et de recherche scientifique s'imposent aux autorités afin de pérenniser les acquis nationaux de la lutte contre le VIH sida.
- Published
- 2016
15. Access to HIV care in the context of universal test and treat : challenges within the ANRS 12249 TasP cluster-randomized trial in rural South Africa [+ supplementary files]
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Plazy, M., El Farouki, K., Iwuji, C., Okesola, N., Orne-Gliemann, J., Larmarange, Joseph, Lert, F., Newell, M.L., Dabis, F., and Dray-Spira, R.
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- 2016
16. Does a universal test and treat strategy impact ART adherence in rural South Africa ? ANRS 12249 TasP cluster-randomized trial
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Iwuji, C., Dray-Spira, R., Calmy, A., Larmarange, Joseph, Orne-Gliemann, J., Dabis, F., Pillay, D., and Porter, K.
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- 2015
17. Entry into care following universal home-based HIV testing in rural KwaZulu-Natal, South Africa : the ANRS TasP 12249 cluster-randomized trial
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Plazy, M., ElFarouki, K., Iwuji, C., Okesola, N., Orne-Gliemann, J., Larmarange, Joseph, Newell, M. L., Pillay, D., Dabis, F., and Dray-Spira, R.
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- 2015
18. Erratum à « les hommes qui ont des rapports sexuels avec d’autres hommes (HSH) et l’infection à VIH à Ouagadougou, Burkina Faso : connaissances, attitudes, pratiques et enquête de séroprévalence » [Rev. Epidemiol. Sante Pub. 64 (4) (2016) 295–300]
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Dah, T.-T.-E., primary, Orne-Gliemann, J., additional, Guiard-Schmid, J.-B., additional, Becquet, R., additional, and Larmarange, J., additional
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- 2016
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19. Enhanced prenatal HIV couple oriented counselling session and couple communication about HIV (ANRS 12127 Prenahtest Trial)
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Plazy, M., Orne-Gliemann, J., Balestre, E., Miric, M., Darak, S., Butsashvili, M., Tchendjou, P., Dabis, F., and du Lou, A. Desgrees
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TRANSMISSION ,Communication ,Prevention ,PARTNER ,Prenatal testing and counselling ,Couple ,virus diseases ,HIV ,HIV/AIDS ,WOMEN ,INTERVENTIONS - Abstract
Background. - The Prenahtest study investigated the efficacy of a couple-oriented HIV counselling session (COC) in encouraging couple HIV counselling and testing, and improving intra-couple communication about sexual and reproductive health. We report here on the effect of COC on intra-couple communication about HIV. Methods. - Within this 4-country trial (India, Georgia, Dominican Republic and Cameroon), 484 to 491 pregnant women per site were recruited and individually randomized to receive either the COC intervention, enhanced counselling with role playing, or standard post-test HIV counselling. Women were interviewed at recruitment, before HIV testing (T0), and 2 to 8 weeks after post-test HIV counselling (T1). Four dichotomous variables documented intra-couple communication about HIV at T1: 1) discussion about HIV, 2) discussion about condom use, 3) suggesting HIV testing and 4) suggesting couple HIV counselling to the partner. An intra-couple HIV communication index was created: low degree of communication ("yes'' response to zero or one of the four variables), intermediate degree of communication ("yes'' to two or three variables) or high degree of communication ("yes'' to the four variables). To estimate the impact of COC on the intra-couple HIV communication index, multivariable logistic regressions were conducted. Results. - One thousand six hundred and seven women were included in the analysis of whom 54 (3.4%) were HIV-infected (49 in Cameroon). In the four countries, the counselling group was associated with intra-couple HIV communication (P
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- 2013
20. Evaluation of the impact of immediate versus WHO recommendations-guided antiretroviral therapy initiation on HIV incidence : the ANRS 12249 TasP (treatment as prevention) trial in Hlabisa sub-district, KwaZulu-Natal, South Africa : study protocol for a cluster randomised controlled trial
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Iwuji, C.C., Orne-Gliemann, J., Tanser, F., Boyer, S., Lessells, R.J., Lert, F., Imrie, J., Bärnighausen, T., Rekacewicz, C., Bazin, B., Newell, M.L., Dabis, F., Okesola, N. (collab.), Bland, R. (collab.), de Oliveira, T. (collab.), Viljoen, J. (collab.), Newell, C. (collab.), Naidu, K. (collab.), Lert, F. (collab.), Dray-Spira, R. (collab.), Larmarange, Joseph (collab.), Spire, B. (collab.), Chaix, M.L. (collab.), Karcher, S. (collab.), Thiébaut, R. (collab.), and Freeberg, K. (collab.)
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RANDOMISATION ,ANTIRETROVIRAUX ,TOXICITE ,SIDA ,TRANSMISSION ,ESSAI CLINIQUE ,MEDICAMENT ,PREVENTION SANITAIRE ,CONTAMINATION ,DIAGNOSTIC ,EFFET SECONDAIRE ,INFECTION ,COMPORTEMENT SEXUEL ,ETUDE COMPARATIVE ,VIRUS ,EFFICACITE ,MILIEU RURAL ,COMPORTEMENT SOCIAL - Published
- 2013
21. Les femmes à l'épreuve du VIH dans les pays du Sud : genre et accès universel à la prise en charge
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Orne-Gliemann, J., Tchendjou, P.T., Miric, M., Gadgil, M., Butsahvili, M., Eboko, Fred, Perez-Then, E., Darak, S., Kulkarni, S., Kamkamidze, G., Balestre, E., Desgrées du Loû, Annabel, Dabis, F., Desclaux, Alice (dir.), Msellati, Philippe (dir.), and Sow, K. (dir.)
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SANTE DE LA REPRODUCTION ,SIDA ,FEMME ,GROSSESSE ,DEPISTAGE ,FAMILLE ,ANTHROPOLOGIE DE LA SANTE ,RELATION DE GENRE ,PREVENTION SANITAIRE ,EDUCATION SANITAIRE - Published
- 2011
22. Barriers to antiretroviral treatment initiation in rural Kwa Zulu- Natal, South Africa.
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Plazy, M, Newell, M‐L, Orne‐Gliemann, J, Naidu, K, Dabis, F, and Dray‐Spira, R
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ANTI-HIV agents ,HEALTH services accessibility ,HIV infections ,POPULATION geography ,RURAL conditions ,SEX distribution ,MULTIPLE regression analysis ,DESCRIPTIVE statistics ,TREATMENT delay (Medicine) - Abstract
Objectives Although antiretroviral therapy ( ART) has been freely available since 2004 in South Africa, not all those who are eligible initiate ART. We aimed to investigate individual and household characteristics as barriers to ART initiation in men and women in rural KwaZulu-Natal. Methods Adults ≥ 16 years old living within a sociodemographic surveillance area ( DSA) who accessed the local HIV programme between 2007 and 2011 were included in the study. Individual and household factors associated with ART initiation within 3 months of becoming eligible for ART were investigated using multivariable logistic regression stratified by sex and after exclusion of individuals who died before initiating ART. Results Of the 797 men and 1598 women initially included, 8% and 5.5%, respectively, died before ART initiation and were excluded from further analysis. Of the remaining 733 men and 1510 women, 68.2% and 60.2%, respectively, initiated ART ≤ 3 months after becoming eligible ( P = 0.34 after adjustment for CD4 cell count). In men, factors associated with a higher ART initiation rate were being a member of a household located < 2 km from the nearest HIV clinic and being resident in the DSA at the time of ART eligibility. In women, ART initiation was more likely in those who were not pregnant, in members of a household where at least one person was on ART and in those with a high wealth index. Conclusions In this rural South African setting, barriers to ART initiation differed for men and women. Supportive individual- and household-level interventions should be developed to guarantee rapid ART initiation taking account gender specificities. [ABSTRACT FROM AUTHOR]
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- 2015
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23. Couple-centred testing and counselling for HIV serodiscordant heterosexual couples in sub-Saharan Africa.
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Desgrées-du-Loû A and Orne-Gliemann J
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In Africa, a large proportion of HIV infections occur within stable relationships, either because of prior infection of one of the partners or because of infidelity. In five African countries at least two-thirds of couples with at least one HIV-positive partner were HIV serodiscordant; in half of them, the woman was the HIV-positive partner. Hence, there is an urgent need to define strategies to prevent HIV transmission within couple relationships. HIV counselling and testing have largely been organised on an individual and sex-specific basis, for pregnant women in programmes for prevention of mother-to-child transmission of HIV and in STI consultations and recently male circumcision for men. A couple-centred approach to HIV counselling and testing would facilitate communication about HIV status and adoption of preventive behaviours within couples. This paper reviews what is known about HIV serodiscordance in heterosexual couples in sub-Saharan Africa and what has been published about couple-centred initiatives for HIV counselling and testing since the early 1990s. Despite positive outcomes, couple-oriented programmes have not been implemented on a large scale. In order to stimulate and strengthen HIV prevention efforts, increased attention is required to promote prevention and testing and counselling for couples in stable relationships. [ABSTRACT FROM AUTHOR]
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- 2008
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24. Temporal trends of population viral suppression in the context of Universal Test and Treat: results from the ANRS 12,249 TasP trial in rural South Africa
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Joseph Larmarange, Diallo, M. H., Mcgrath, N., Iwuji, C., Plazy, M., Thiebaut, R., Tanser, F., Barnighausen, T., Orne-Gliemann, J., Pillay, D., Dabis, F., and Tasp Anrs, Study Grp
25. [Men who have sex with men (MSM) and HIV infection in Ouagadougou, Burkina Faso: Knowledge, attitudes, practices and seroprevalence survey]
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Tt, Dah, Orne-Gliemann J, Jb, Guiard-Schmid, Becquet R, and Joseph Larmarange
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Adult ,Male ,Health Knowledge, Attitudes, Practice ,Sexual Behavior ,HIV Infections ,Young Adult ,Cross-Sectional Studies ,Socioeconomic Factors ,HIV Seroprevalence ,Seroepidemiologic Studies ,Burkina Faso ,HIV-1 ,Humans ,Homosexuality, Male - Abstract
Like many African countries, the issue of sex between men in Burkina Faso remains taboo and sometimes result in social exclusion. This population which is vulnerable to HIV/AIDS is unknown, due to lack of scientific researches.Our study aimed to characterize knowledge, attitudes and sexual practices and to estimate HIV seroprevalence among men having sex with men (MSM) living in Ouagadougou.A cross-sectional study was conducted in order to describe and analyze MSM living in Ouagadougou. They were recruited by snowball sampling, aged at least 18 years, and accepted to participate at the study. Data were collected by qualified interviewers through administered questionnaire face to face. HIV test was systematically proposed.A total of 142 MSM were recruited during the study period. The sample was mostly composed of students or pupils (60.8%), single men (91%), with age range 18-30 years (96.5%). The HIV knowledge median score was 8/10. HIV seroprevalence was 8.9% (4.5-15.4).Our study confirms the vulnerability of MSM living in Ouagadougou about HIV/AIDS given the high rate of HIV seroprevalence. Targeted interventions for prevention, care and scientific research are challenges for the authorities to sustain the achievements of the national fight against HIV and AIDS.
26. A decade of child health in developing countries,Une décennie de recherche sur la santé de l'enfant dans les pays en développement
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Orne-Gliemann, J., Perez, F., Leroy, V., Marie-Louise Newell, and Dabis, F.
27. The impact of population dynamics on the population HIV care cascade: results from the ANRS 12249 Treatment as Prevention trial in rural KwaZulu-Natal (South Africa)
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Larmarange, J., Diallo, M.H., McGrath, N., Iwuji, C., Plazy, M., Thiébaut, R., Tanser, F., Bärnighausen, T., Pillay, D., Dabis, F., Orne-Gliemann, J., Larmarange, J., Diallo, M.H., McGrath, N., Iwuji, C., Plazy, M., Thiébaut, R., Tanser, F., Bärnighausen, T., Pillay, D., Dabis, F., and Orne-Gliemann, J.
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Introduction The universal test and treat strategy (UTT) was developed to maximize the proportion of all HIV‐positive individuals on antiretroviral treatment (ART) and virally suppressed, assuming that it will lead to a reduction in HIV incidence at the population level. The evolution over time of the cross‐sectional HIV care cascade is determined by individual longitudinal trajectories through the HIV care continuum and underlying population dynamics. The purpose of this paper is to quantify the contribution of each component of population change (in‐ and out‐migration, HIV seroconversion, ageing into the cohort and definitive exit such as death) on the HIV care cascade in the context of the ANRS 12249 Treatment as Prevention (TasP) cluster‐randomized trial, investigating UTT in rural KwaZulu‐Natal, South Africa, between 2012 and 2016. Methods HIV test results and information on clinic visits, ART prescriptions, viral load and CD4 count, migration and deaths were used to calculate residency status, HIV status and HIV care status for each individual on a daily basis. Position within the HIV care continuum was considered as a score ranging from 0 (undiagnosed) to 4 (virally suppressed). We compared the cascade score of each individual joining or leaving the population of resident adults living with HIV with the average score of their cluster at the time of entry or exit. Then, we computed the contribution of each entry or exit on the average cascade score and their annualized total contribution, by component of change. Results While the average cascade score increased over time in all clusters, that increase was constrained by population dynamics. Permanent exits and ageing into the people living with HIV cohort had a marginal effect. Both in‐migrants and out‐migrants were less likely to be retained at each step of the HIV care continuum. However, their overall impact on the cross‐sectional cascade was limited as the effect of in‐ and out‐migration balanced each othe
28. Linkage to primary care after homebased blood pressure screening in rural KwaZulu-Natal, South Africa: A population-based cohort study
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Siedner, M.J., Baisley, K., Orne-Gliemann, J., Pillay, D., Koole, O., Wong, E.B., Matthews, P., Tanser, F., Herbst, K., Barnighausen, T., Bachmann, M., Siedner, M.J., Baisley, K., Orne-Gliemann, J., Pillay, D., Koole, O., Wong, E.B., Matthews, P., Tanser, F., Herbst, K., Barnighausen, T., and Bachmann, M.
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Objectives The expanding burden of non-communicable diseases (NCDs) globally will require novel public health strategies. Community-based screening has been promoted to augment efficiency of diagnostic services, but few data are available on the downstream impact of such programmes. We sought to assess the impact of a home-based blood pressure screening programme on linkage to hypertension care in rural South Africa. Setting We conducted home-based blood pressure screening withinin a population cohort in rural KwaZulu-Natal, using the WHO Stepwise Approach to Surveillance (STEPS) protocol. Participants Individuals meeting criteria for raised blood pressure (≥140 systolic or ≥90 diastolic averaged over two readings) were referred to local health clinics and included in this analysis. We defined linkage to care based on self-report of presentation to clinic for hypertension during the next 2 years of cohort observation. We estimated the population proportion of successful linkage to care with inverse probability sampling weights, and fit multivariable logistic regression models to identify predictors of linkage following a positive hypertension screen. Results Of 11 694 individuals screened, 14.6% (n=1706) were newly diagnosed with elevated pressure. 26.9% (95% CI 24.5% to 29.4%) of those sought hypertension care in the following 2 years, and 38.1% (95% CI 35.6% to 40.7%) did so within 5 years. Women (adjusted OR (aOR) 2.41, 95% CI 1.68 to 3.45), those of older age (aOR 11.49, 95% CI 5.87 to 22.46, for 45–59 years vs <30) and those unemployed (aOR 1.71, 95% CI 1.10 to 2.65) were more likely to have linked to care. Conclusions Linkage to care after home-based identification of elevated blood pressure was rare in rural South Africa, particularly among younger individuals, men and the employed. Improved understanding of barriers and facilitators to NCD care is needed to enhance the effectiveness of blood pressure screening in the region.
29. Couple-oriented prenatal HIV counseling for HIV primary prevention: an acceptability study
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Kamkamidze George, Kulkarni Sanjeevani, Darak Shrinivas, Perez-Then Eddy, Eboko Fred, Butsashvili Maia, Gadgil Mukta, Miric Marija, Tchendjou Patrice T, Orne-Gliemann Joanna, Balestre Eric, du Loû Annabel, and Dabis Francois
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Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background A large proportion of the 2.5 million new adult HIV infections that occurred worldwide in 2007 were in stable couples. Feasible and acceptable strategies to improve HIV prevention in a conjugal context are scarce. In the preparatory phase of the ANRS 12127 Prenahtest multi-site HIV prevention trial, we assessed the acceptability of couple-oriented post-test HIV counseling (COC) and men's involvement within prenatal care services, among pregnant women, male partners and health care workers in Cameroon, Dominican Republic, Georgia and India. Methods Quantitative and qualitative research methods were used: direct observations of health services; in-depth interviews with women, men and health care workers; monitoring of the COC intervention and exit interviews with COC participants. Results In-depth interviews conducted with 92 key informants across the four sites indicated that men rarely participated in antenatal care (ANC) services, mainly because these are traditionally and programmatically a woman's domain. However men's involvement was reported to be acceptable and needed in order to improve ANC and HIV prevention services. COC was considered by the respondents to be a feasible and acceptable strategy to actively encourage men to participate in prenatal HIV counseling and testing and overall in reproductive health services. Conclusions One of the keys to men's involvement within prenatal HIV counseling and testing is the better understanding of couple relationships, attitudes and communication patterns between men and women, in terms of HIV and sexual and reproductive health; this conjugal context should be taken into account in the provision of quality prenatal HIV counseling, which aims at integrated PMTCT and primary prevention of HIV.
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- 2010
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30. Universal test and treat and the HIV epidemic in rural South Africa: a phase 4, open-label, community cluster randomised trial
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Collins C Iwuji, Joanna Orne-Gliemann, Joseph Larmarange, Eric Balestre, Rodolphe Thiebaut, Frank Tanser, Nonhlanhla Okesola, Thembisa Makowa, Jaco Dreyer, Kobus Herbst, Nuala McGrath, Till Bärnighausen, Sylvie Boyer, Tulio De Oliveira, Claire Rekacewicz, Brigitte Bazin, Marie-Louise Newell, Deenan Pillay, François Dabis, Collins Iwuji, Kevi Naidu, Tulio de Oliveira, Tamsen Rochat, Johannes Viljoen, Thembelihle Zuma, Sophie Karcher, Melanie Plazy, Mélanie Prague, Rodolphe Thiébaut, Thierry Tiendrebeogo, Hermann Donfouet, Andrea Gosset, Laura March, Camelia Protopopescu, Bruno Spire, Alexandra Calmy, Maxime Inghels, Hassimiou Diallo, Vincent Calvez, Anne Derache, Anne-Geneviève Marcelin, Rosemary Dray-Spira, France Lert, Kamal El Farouki, Richard Lessells, Kenneth Freedberg, John Imrie, Marie-Laure Chaix, Colin Newell, Jan Hontelez, Africa Health Research Institute [Durban/Mtubatuba] (AHRI), Bordeaux population health (BPH), Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Statistics In System biology and Translational Medicine (SISTM), Inria Bordeaux - Sud-Ouest, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria)- Bordeaux population health (BPH), Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Agence Nationale de Recherches sur le Sida et les Hépatites Virales (ANRS), University of Southampton, Brighton and Sussex Medical School (BSMS), Research Department of Infection and Population Health [London], University College of London [London] (UCL), Santé, vulnérabilités et relations de genre au sud (SAGESUD - ERL Inserm U1244), Centre population et développement (CEPED - UMR_D 196), Institut de Recherche pour le Développement (IRD)-Université Paris Descartes - Paris 5 (UPD5)-Institut de Recherche pour le Développement (IRD)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut de Recherche pour le Développement (IRD)-Université Paris Descartes - Paris 5 (UPD5), School of nursing and public health [Durban, KwaZulu-Natal, South Africa], University of KwaZulu-Natal (UKZN), Academic Unit of Primary Care and Population Sciences [Southampton, UK] (Department of Social statistics & Demography), Department of Global Health and Population [Boston, MA, USA] (Harvard School of Public Health), Harvard University [Cambridge], Institute of Public Health [Heidelberg, Germany] (Medical School), Ruprecht-Karls-University [Heidelberg, Germany], Nelson R Mandela School of Medicine [Durban, KwaZulu-Natal, South Africa] (College of Health Sciences), Human Health and Development [Southampton, UK] (Global Health Research Institute), Division of Infection and Immunity [London, UK], Epidémiologie et Biostatistique [Bordeaux], Université Bordeaux Segalen - Bordeaux 2-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), ANRS 12249 TasP Study Group : Bärnighausen T, Herbst K, Iwuji C, Makowa T, Naidu K, Newell ML, Okesola N, de Oliveira T, Pillay D, Rochat T, Tanser F, Viljoen J, Zuma T, McGrath N, Balestre E, Dabis F, Karcher S, Orne-Gliemann J, Plazy M, Prague M, Thiébaut R, Tiendrebeogo T, Boyer S, Donfouet H, Gosset A, March L, Protopopescu C, Spire B, Calmy A, Larmarange J, Inghels M, Diallo H, Calvez V, Derache A, Marcelin AG, Dray-Spira R, Lert F, El Farouki K, Lessells R, Freedberg K, Imrie J, Chaix ML, Newell C, Hontelez J, Bazin B, Rekacewicz C., Institut de Recherche pour le Développement (IRD)-Université Paris Cité (UPCité), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre population et développement (CEPED - UMR_D 196), Institut de Recherche pour le Développement (IRD)-Université Paris Cité (UPCité)-Institut de Recherche pour le Développement (IRD)-Université Paris Cité (UPCité), School of nursing and public health, University of KwaZulu-Natal [Durban, Afrique du Sud] (UKZN), Harvard School of Public Health, Global Health Research Institute, Division of Immunity and Infection, The Medical School, Edgbaston, Dupuis, Christine, and Harvard University
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0301 basic medicine ,Cyclopropanes ,Male ,Epidemiology ,HIV Infections ,TaSP ,law.invention ,chemistry.chemical_compound ,South Africa ,0302 clinical medicine ,Randomized controlled trial ,law ,[SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases ,HIV Seropositivity ,Emtricitabine ,Mass Screening ,030212 general & internal medicine ,education.field_of_study ,Incidence (epidemiology) ,Incidence ,Hazard ratio ,Middle Aged ,3. Good health ,SISTM ,Infectious Diseases ,Treatment Outcome ,Research Design ,Alkynes ,[SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases ,Female ,medicine.drug ,Adult ,medicine.medical_specialty ,Efavirenz ,Adolescent ,Anti-HIV Agents ,Immunology ,Population ,IDLIC ,03 medical and health sciences ,Young Adult ,Virology ,medicine ,Humans ,education ,Tenofovir ,Mass screening ,business.industry ,030112 virology ,Benzoxazines ,chemistry ,[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie ,business ,Demography - Abstract
BackgroundUniversal antiretroviral therapy (ART), as per the 2015 WHO recommendations, might reduce population HIV incidence. We investigated the effect of universal test and treat on HIV acquisition at population level in a high prevalence rural region of South Africa.MethodsWe did a phase 4, open-label, cluster randomised trial of 22 communities in rural KwaZulu-Natal, South Africa. We included individuals residing in the communities who were aged 16 years or older. The clusters were composed of aggregated local areas (neighbourhoods) that had been identified in a previous study in the Hlabisa subdistrict. The study statisticians randomly assigned clusters (1:1) with MapInfo Pro (version 11.0) to either the control or intervention communities, stratified on the basis of antenatal HIV prevalence. We offered residents repeated rapid HIV testing during home-based visits every 6 months for about 4 years in four clusters, 3 years in six clusters, and 2 years in 12 clusters (58 cluster-years) and referred HIV-positive participants to trial clinics for ART (fixed-dose combination of tenofovir, emtricitabine, and efavirenz) regardless of CD4 cell count (intervention) or according to national guidelines (initially ≤350 cells per μL and FindingsBetween March 9, 2012, and June 30, 2016, we contacted 26 518 (93%) of 28 419 eligible individuals. Of 17 808 (67%) individuals with a first negative dried blood spot test, 14 223 (80%) had subsequent dried blood spot tests, of whom 503 seroconverted after follow-up of 22 891 person-years. Estimated HIV incidence was 2·11 per 100 person-years (95% CI 1·84–2·39) in the intervention group and 2·27 per 100 person-years (2·00–2·54) in the control group (adjusted hazard ratio 1·01, 95% CI 0·87–1·17; p=0·89). We documented one case of suicidal attempt in a woman following HIV seroconversion. 128 patients on ART had 189 life-threatening or grade 4 clinical events: 69 (4%) of 1652 in the control group and 59 (4%) of 1367 in the intervention group (p=0·83).InterpretationThe absence of a lowering of HIV incidence in universal test and treat clusters most likely resulted from poor linkage to care. Policy change to HIV universal test and treat without innovation to improve health access is unlikely to reduce HIV incidence.FundingANRS, GiZ, and 3ie.
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- 2018
31. Effect of decentralising childhood tuberculosis diagnosis to primary health centre versus district hospital levels on disease detection in children from six high tuberculosis incidence countries: an operational research, pre-post intervention study.
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Wobudeya E, Nanfuka M, Ton Nu Nguyet MH, Taguebue JV, Moh R, Breton G, Khosa C, Borand L, Mwanga-Amumpaire J, Mustapha A, Nolna SK, Komena E, Mugisha JR, Natukunda N, Dim B, de Lauzanne A, Cumbe S, Balestre E, Poublan J, Lounnas M, Ngu E, Joshi B, Norval PY, Terquiem EL, Turyahabwe S, Foray L, Sidibé S, Albert KK, Manhiça I, Sekadde M, Detjen A, Verkuijl S, Mao TE, Orne-Gliemann J, Bonnet M, and Marcy O
- Abstract
Background: Childhood tuberculosis (TB) remains underdiagnosed largely because of limited awareness and poor access to all or any of specimen collection, molecular testing, clinical evaluation, and chest radiography at low levels of care. Decentralising childhood TB diagnostics to district hospitals (DH) and primary health centres (PHC) could improve case detection., Methods: We conducted an operational research study using a pre-post intervention cross-sectional study design in 12 DHs and 47 PHCs of 12 districts across Cambodia, Cameroon, Côte d'Ivoire, Mozambique, Sierra Leone and Uganda. The intervention included 1) a comprehensive diagnosis package at patient-level with tuberculosis screening for all sick children and young adolescents <15 years, and clinical evaluation, Xpert Ultra-testing on respiratory and stool samples, and chest radiography for children with presumptive TB, and 2) two decentralisation approaches (PHC-focused or DH-focused) to which districts were randomly allocated at country level. We collected aggregated and individual data. We compared the proportion of tuberculosis detection in children and young adolescents <15 years pre-intervention (01 August 2018-30 November 2019) versus during intervention (07 March 2020-30 September 2021), overall and by decentralisation approach. This study is registered with ClinicalTrials.gov, NCT04038632., Findings: TB was diagnosed in 217/255,512 (0.08%) children and young adolescent <15 years attending care pre-intervention versus 411/179,581 (0.23%) during intervention, (OR: 3.59 [95% CI 1.99-6.46], p-value<0.0001; p-value = 0.055 after correcting for over-dispersion). In DH-focused districts, TB diagnosis was 80/122,570 (0.07%) versus 302/86,186 (0.35%) (OR: 4.07 [1.86-8.90]; p-value = 0.0005; p-value = 0.12 after correcting for over-dispersion); and 137/132,942 (0.10%) versus 109/93,395 (0.11%) in PHC-focused districts, respectively (OR: 2.92 [1.25-6.81; p-value = 0.013; p-value = 0.26 after correcting for over-dispersion)., Interpretation: Decentralising and strengthening childhood TB diagnosis at lower levels of care increases tuberculosis case detection but the difference was not statistically significant., Funding Source: Unitaid, Grant number 2017-15-UBx-TB-SPEED., Competing Interests: All authors declare no competing interests., (© 2024 World Health Organization.)
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- 2024
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32. Acceptability of decentralizing childhood tuberculosis diagnosis in low-income countries with high tuberculosis incidence: Experiences and perceptions from health care workers in Sub-Saharan Africa and South-East Asia.
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Joshi B, De Lima YV, Massom DM, Kaing S, Banga MF, Kamara ET, Sesay S, Borand L, Taguebue JV, Moh R, Khosa C, Breton G, Mwanga-Amumpaire J, Bonnet M, Wobudeya E, Marcy O, and Orne-Gliemann J
- Abstract
Decentralizing childhood tuberculosis services, including diagnosis, is now recommended by the WHO and could contribute to increasing tuberculosis detection in high burden countries. However, implementing microbiological tests and clinical evaluation could be challenging for health care workers (HCWs) in Primary Health Centers (PHCs) and even District Hospitals (DHs). We sought to assess the acceptability of decentralizing a comprehensive childhood tuberculosis diagnosis package from HCWs' perspective. We conducted implementation research nested within the TB-Speed Decentralization study. HCWs from two health districts of Cambodia, Cameroon, Côte d'Ivoire, Mozambique, Sierra Leone, and Uganda implemented systematic screening, nasopharyngeal aspirates (NPA) and stool sample collection with molecular testing, clinical evaluation and chest X-ray (CXR) interpretation. We investigated their experiences and perceptions in delivering the diagnostic package components in 2020-21 using individual semi-structured interviews. We conducted thematic analysis, supported by the Theoretical Framework of Acceptability. HCWs (n = 130, 55% female, median age 36 years, 53% nurses, 72% PHC-based) perceived that systematic screening, although increasing workload, was beneficial as it improved childhood tuberculosis awareness. Most HCWs shared satisfaction and confidence in performing NPA, despite procedure duration, need to involve parents/colleagues and discomfort for children. HCWs shared positive attitudes towards stool sample-collection but were frustrated by delayed stool collection associated with cultural practices, transport and distance challenges. Molecular testing, conducted by nurses or laboratory technicians, was perceived as providing quality results, contributing to diagnosis. Clinical evaluation and diagnosis raised self-efficacy issues and need for continuous training and clinical mentoring. HCWs valued CXR, however complained that technical and logistical problems limited access to digital reports. Referral from PHC to DH was experienced as burdensome. HCWs at DH and PHC-levels perceived and experienced decentralized childhood tuberculosis diagnosis as acceptable. Implementation however could be hampered by feasibility issues, and calls for innovative referral mechanisms for patients, samples and CXR., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Joshi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
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- 2023
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33. Protocol: Implementation evaluation of a combination intervention for sustainable blood pressure control in rural KwaZulu-Natal, South Africa (IMPACT BP): A three-arm, unblinded, parallel group individually randomized clinical trial.
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Sithole N, Castle A, Nxumalo S, Mazibuko L, Manyaapelo T, Abrahams-Gessel S, Dlamini S, Gareta D, Orne-Gliemann J, Baisley K, Bachmann M, Magula N, Gaziano TA, and Siedner MJ
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- Humans, Blood Pressure, South Africa, Blood Pressure Determination, Risk Factors, Randomized Controlled Trials as Topic, Hypertension diagnosis
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Background: Hypertension is the primary risk factor for stroke and heart disease, which are leading causes of death in South Africa. Despite the availability of treatments, there is an implementation gap in how best to deliver hypertension care in this resource-limited region., Methods: We describe a three-arm parallel group individually randomized control trial to evaluate the effectiveness and implementation of a technology-supported, community-based intervention to improve blood pressure control among people with hypertension in rural KwaZulu-Natal. The study will compare three strategies: 1) standard of care (SOC arm) clinic-based management, 2) home-based blood pressure management supported by community blood pressure monitors (CBPM arm) and a mobile health application to record blood pressure readings and enable clinic-based nurses to remotely manage care, and 3) an identical strategy to the CBPM arm, except that participants will use a cellular blood pressure cuff, which automatically transmits completed readings over cellular networks directly to clinic-based nurses (eCBPM+ arm). The primary effectiveness outcome is change in blood pressure from enrollment to 6 months. The secondary effectiveness outcome is the proportion of participants with blood pressure control at 6 months. Acceptability, fidelity, sustainability, and cost-effectiveness of the interventions will also be assessed., Conclusions: In this protocol, we report the development of interventions in partnership with the South Africa Department of Health, a description of the technology-enhanced interventions, and details of the study design so that our intervention and evaluation can inform similar efforts in rural, resource-limited settings., Protocol: Version 3 November 9th, 2022., Clinicaltrials: gov Trial Registration: NCT05492955 SAHPRA Trial Number: N20211201. SANCTR Number: DOH-27-112,022-4895., Competing Interests: Declaration of Competing Interest The authors declare no conflicts of interest., (Copyright © 2023. Published by Elsevier Inc.)
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- 2023
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34. Acceptability and feasibility of home and hospital follow-up in Burkina Faso and Guinea: A mixed-method study among patients of the COVID-19 Coverage-Africa clinical trial.
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Plazy M, Doucet MH, Timbo Songbono C, Sanon A, Issiaka B, Martin C, Da I, L'hostellier A, Marcy O, Malvy D, Poda A, Delamou A, Berthé A, and Orne-Gliemann J
- Abstract
Patient experiences and perspectives on trial participation and follow-up may influence their compliance with research procedures or negatively impact their well-being. We aimed to explore the acceptability and feasibility of home-based and hospital-based follow-up modalities among COVID-19 patients enrolled in the ANTICOV ANRS COV33 Coverage-Africa trial in Burkina Faso and Guinea. The trial (2021-2022) evaluated the efficacy of treatments to prevent clinical worsening among COVID-19 patients with mild to moderate symptoms. Patients were either based at home or hospitalized, as per national recommendations, and followed-up through face-to-face visits and phone calls. We conducted a mixed-methods sub-study administering a questionnaire to all consenting participants and individually interviewing purposively selected participants. We performed descriptive analyses of Likert scale questions for the questionnaires and thematic analysis for the interviews. We conducted framework analysis and interpretation. Of the 400 trial patients, 220 completed the questionnaire (n = 182 in Burkina Faso, n = 38 in Guinea) and 24 were interviewed (n = 16 and n = 8, respectively). Participants were mostly followed-up at home in Burkina Faso; all patients from Guinea were first hospitalized, then followed-up at home. Over 90% of participants were satisfied with follow-up. Home follow-up was considered acceptable if (i) participants perceived they were not severely ill, (ii) it was combined with telemedicine, and (iii) the risk of stigma could be avoided. Hospital-based follow-up was viewed as a way to prevent contamination of family members, but could be badly experienced when mandatory and conflicting with family responsibilities and commitments. Phone calls were seen as reassuring and as a way to ensure continuity of care. These overall positive findings support the development of home-based follow-up for mildly ill patients in West-Africa, provided that both emotional and cognitive factors at individual, familial/inter-relational, healthcare and national levels be addressed when planning the implementation of a trial, or developing any public health strategy., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Plazy et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
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- 2023
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35. Implementation and effectiveness of a linkage to HIV care intervention in rural South Africa (ANRS 12249 TasP trial).
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Plazy M, Diallo A, Hlabisa T, Okesola N, Iwuji C, Herbst K, Boyer S, Lert F, McGrath N, Pillay D, Dabis F, Larmarange J, and Orne-Gliemann J
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- Female, Humans, Male, HIV Testing, Referral and Consultation, Rural Population, South Africa epidemiology, Anti-HIV Agents therapeutic use, HIV Infections diagnosis, HIV Infections drug therapy, HIV Infections epidemiology
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Background: Timely linkage to care and ART initiation is critical to decrease the risks of HIV-related morbidity, mortality and HIV transmission, but is often challenging. We report on the implementation and effectiveness of a linkage-to-care intervention in rural KwaZulu-Natal, South Africa., Methods: In the ANRS 12249 TasP trial on Universal Testing and Treatment (UTT) implemented between 2012-2016, resident individuals ≥16 years were offered home-based HIV testing every six months. Those ascertained to be HIV-positive were referred to trial clinics. Starting May 2013, a linkage-to-care intervention was implemented in both trial arms, consisting of tracking through phone calls and/or home visits to "re-refer" people who had not linked to care to trial clinics within three months of the first home-based referral. Fidelity in implementing the planned intervention was described using Kaplan-Meier estimation to compute conditional probabilities of being tracked and of being re-referred by the linkage-to-care team. Effect of the intervention on time to linkage-to-care was analysed using a Cox regression model censored for death, migration, and end of data follow-up., Results: Among the 2,837 individuals (73.7% female) included in the analysis, 904 (32%) were tracked at least once, and 573 of them (63.4%) were re-referred. Probabilities of being re-referred was 17% within six months of first referral and 31% within twelve months. Compared to individuals not re-referred by the intervention, linkage-to-care was significantly higher among those with at least one re-referral through phone call (adjusted hazard ratio [aHR] = 1.82; 95% confidence interval [95% CI] = 1.47-2.25), and among those with re-referral through both phone call and home visit (aHR = 3.94; 95% CI = 2.07-7.48)., Conclusions: Phone calls and home visits following HIV testing were challenging to implement, but appeared effective in improving linkage-to-care amongst those receiving the intervention. Such patient-centred strategies should be part of UTT programs to achieve the UNAIDS 95-95-95 targets., Competing Interests: CI has received honoraria for consultancy services and grant funding from Gilead Sciences unrelated to the work described in the manuscript. This does not alter our adherence to PLOS ONE policies on sharing data and materials. All other authors declare no competing interests., (Copyright: © 2023 Plazy et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
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- 2023
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36. Perceptions of COVID-19 among communities of Conakry (Guinea): a qualitative study exploring the context of the ANRS COV33 Coverage-Africa therapeutic trial.
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Doucet MH, Songbono CT, Plazy M, Martin C, Fritzell C, Sow MS, Traoré FA, Jaspard M, Poda A, Malvy D, Marcy O, Delamou A, and Orne-Gliemann J
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- Humans, Guinea epidemiology, Qualitative Research, Social Stigma, Africa, COVID-19
- Abstract
Objectives: To explore communities' perceptions about COVID-19 in the context of the ANRS COV33 Coverage-Africa clinical trial evaluating the efficacy of treatments in preventing clinical worsening of COVID-19., Design: Descriptive qualitative study using semistructured in-depth individual interviews conducted by telephone in French and Soussou between May and September 2021. Data were transcribed, translated in French when applicable and analysed with the thematic analysis method., Setting: The eight neighbourhoods most affected by COVID-19 in Conakry's urban context, capital of Guinea., Participants: 4 community leaders acting as key informants-providing insights regarding population's opinions-and six community members, who were exposed to an information session conducted as part of Coverage-Africa., Results: According to participants, community members have heterogeneous viewpoints about COVID-19: it exists and is dangerous; it is benign ('bad cold'); or it is fictitious (eg, government conspiracy). The fear of stigmatisation and social isolation of those sick or cured of COVID-19 was largely reported by participants, with illustrations of distressing situations for the victims. To avoid stigma, many patients seem to adopt strategies of discretion (eg, lying/hiding about the disease). Although community attitudes were reported to have evolved since the beginning of the epidemic, stigma remained a pervasive concern for many people., Conclusions: Community perceptions about COVID-19 in Conakry may be partly explained by the Guinean context of Ebola history and of sociopolitical tensions. Stigmatisation of COVID+ people seems to be aimed at protecting others against contamination. However, social avoidance can greatly affect the morale of stigmatised people, especially in collectivist cultures like Guinea. Further investigating stigma, including its role on seeking COVID-19 screening and treatment services, and its consequences on mental health among affected/exposed people, would contribute to identifying improved prevention and care interventions in preparation for future health threats, and to promoting participation in health research., Trial Registration Number: NCT04920838 (Pre-results stage)., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2022
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37. Implementing an outpatient clinical trial on COVID-19 treatment in an emergency epidemic context: a mixed methods study among operational and research stakeholders within the Coverage trial, Bordeaux (France).
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Grenier C, Loniewski M, Plazy M, Onaisi R, Doucet MH, Joseph JP, Duvignaud A, Malvy D, Anglaret X, and Orne-Gliemann J
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Background: The emergency set-up and implementation of outpatient clinical trials on epidemic emerging infectious diseases such as COVID-19 raise many issues in terms of research structuration, regulations, and health systems organization. We aimed to describe the experience and points of view of different stakeholders involved in a French home-based outpatient trial on COVID-19 and to identify the early barriers and facilitators to the trial implementation., Methods: We conducted a mixed-methods study in July 2020. A self-administered questionnaire was emailed to 213 clinical, operational and research stakeholders involved in the Coverage trial; individual semi-directed interviews were conducted among 14 stakeholders. Questionnaire data and written interview notes are presented together by key theme., Results: One hundred fifty six stakeholders responded to the questionnaire. 53.4% did not have prior experience in clinical research. The motivation of most stakeholders to participate in the Coverage trial was to feel useful during the pandemic. 87.9% agreed that the trial had an unusual set-up timeframe, and many regretted a certain lack of regulatory flexibility. Mobile medical teams and specific professional skills were perceived as instrumental for outpatient research., Conclusions: The implementation of a home-based outpatient clinical trial on COVID-19 was perceived as relevant and innovative although requiring important adaptations of usual professional responsibilities and standard research procedures. Lessons learned from the Coverage trial underline the need for improved networks between hospital and community medicine, and call for a dedicated and reactive outpatient research platform on emerging or threatening infectious diseases., (© 2022. The Author(s).)
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- 2022
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38. Early HIV treatment and survival over six years of observation in the ANRS 12249 Treatment as Prevention Trial.
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Baisley K, Orne-Gliemann J, Larmarange J, Plazy M, Collier D, Dreyer J, Mngomezulu T, Herbst K, Hanekom W, Dabis F, Siedner MJ, and Iwuji C
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- Humans, South Africa epidemiology, Anti-HIV Agents therapeutic use, HIV Infections epidemiology
- Abstract
Objectives: Population-based universal test and treat (UTT) trials have shown an impact on population-level virological suppression. We followed the ANRS 12249 TasP trial population for 6 years to determine whether the intervention had longer-term survival benefits., Methods: The TasP trial was a cluster-randomized trial in South Africa from 2012 to 2016. All households were offered 6-monthly home-based HIV testing. Immediate antiretroviral therapy (ART) was offered through trial clinics to all people living with HIV (PLHIV) in intervention clusters and according to national guidelines in control clusters. After the trial, individuals attending the trial clinics were transferred to the public ART programme. Deaths were ascertained through annual demographic surveillance. Random-effects Poisson regression was used to estimate the effect of trial arm on mortality among (i) all PLHIV; (ii) PLHIV aware of their status and not on ART at trial entry; and (iii) PHLIV who started ART during the trial., Results: Mortality rates among PLHIV were 9.3/1000 and 10.4/1000 person-years in the control and intervention arms, respectively. There was no evidence that the intervention decreased mortality among all PLHIV [adjusted rate ratio (aRR) = 1.10, 95% confidence interval (CI) = 0.85-1.43, p = 0.46] or among PLHIV who were aware of their status but not on ART. Among individuals who initiated ART, the intervention decreased mortality during the trial (aRR = 0.49, 95% CI = 0.28-0.85, p = 0.01), but not after the trial ended., Conclusions: The 'treat all' strategy reduced mortality among individuals who started ART but not among all PLHIV. To achieve maximum benefit of immediate ART, barriers to ART uptake and retention in care need to be addressed., (© 2022 The Authors. HIV Medicine published by John Wiley & Sons Ltd on behalf of British HIV Association.)
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- 2022
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39. Costs and economies of scale in repeated home-based HIV counselling and testing: Evidence from the ANRS 12249 treatment as prevention trial in South Africa.
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Bousmah MA, Iwuji C, Okesola N, Orne-Gliemann J, Pillay D, Dabis F, Larmarange J, and Boyer S
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- Clinical Trials as Topic, Humans, Referral and Consultation, Rural Population, South Africa epidemiology, Counseling economics, Counseling methods, HIV Infections diagnosis, HIV Infections epidemiology, HIV Infections prevention & control, Home Care Services economics, Mass Screening economics, Mass Screening methods
- Abstract
Universal HIV testing is now recommended in generalised HIV epidemic settings. Although home-based HIV counselling and testing (HB-HCT) has been shown to be effective in achieving high levels of HIV status awareness, little is still known about the cost implications of universal and repeated HB-HCT. We estimated the costs of repeated HB-HCT and the scale economies that can be obtained when increasing the population coverage of the intervention. We used primary data from the ANRS 12249 Treatment as Prevention (TasP) trial in rural South Africa (2012-2016), whose testing component included six-monthly repeated HB-HCT. We relied on the dynamic system generalised method of moments (GMM) approach to produce unbiased short- and long-run estimates of economies of scale, using the number of contacts made by HIV counsellors for HB-HCT as the scale variable. We also estimated the mediating effect of the contact quality - measured as the proportion of HIV tests performed among all contacts eligible for an HIV test - on scale economies. The mean cost (standard deviation) of universal and repeated HB-HCT was $24.2 (13.7) per contact, $1694.3 (1527.8) per new HIV diagnosis, and $269.2 (279.0) per appropriate referral to HIV care. The GMM estimations revealed the presence of economies of scale, with a 1% increase in the number of contacts for HB-HCT leading to a 0.27% decrease in the mean cost. Our results also suggested a significant long-run relationship between mean cost and scale, with a 1% increase in the scale leading to a 0.36% decrease in mean cost in the long run. Overall, we showed that significant cost savings can be made from increasing population coverage. Nevertheless, there is a risk that this gain is made at the expense of quality: the higher the quality of HB-HCT activities, the lower the economies of scale., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)
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- 2022
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40. Diagnostic Advances in Childhood Tuberculosis-Improving Specimen Collection and Yield of Microbiological Diagnosis for Intrathoracic Tuberculosis.
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Wobudeya E, Bonnet M, Walters EG, Nabeta P, Song R, Murithi W, Mchembere W, Dim B, Taguebue JV, Orne-Gliemann J, Nicol MP, and Marcy O
- Abstract
There is no microbiological gold standard for childhood tuberculosis (TB) diagnosis. The paucibacillary nature of the disease, challenges in sample collection in young children, and the limitations of currently available microbiological tests restrict microbiological confirmation of intrathoracic TB to the minority of children. Recent WHO guidelines recommend the use of novel rapid molecular assays as initial diagnostic tests for TB and endorse alternative sample collection methods for children. However, the uptake of these tools in high-endemic settings remains low. In this review, we appraise historic and new microbiological tests and sample collection techniques that can be used for the diagnosis of intrathoracic TB in children. We explore challenges and possible ways to improve diagnostic yield despite limitations, and identify research gaps to address in order to improve the microbiological diagnosis of intrathoracic TB in children.
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- 2022
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41. Couple oriented counselling improves male partner involvement in sexual and reproductive health of a couple: Evidence from the ANRS PRENAHTEST randomized trial.
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Kengne-Nde C, Tejiokem MC, Orne-Gliemann J, Melingui B, Koki Ndombo P, Essounga NA, Bissek AC, Cauchemez S, and Tchendjou PT
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- Adult, Aged, Female, HIV Infections epidemiology, HIV Infections transmission, Humans, Male, Middle Aged, Pregnancy, Pregnancy Complications, Infectious epidemiology, Counseling, HIV Infections prevention & control, HIV-1, Infectious Disease Transmission, Vertical prevention & control, Pregnancy Complications, Infectious prevention & control, Reproductive Health, Sexual Partners
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Background: Male partner involvement (MPI) has been recognized as a priority area to be strengthened in Prevention of Mother to Child Transmission (PMTCT) of HIV. We explored the impact of Couple Oriented Counselling (COC) in MPI in sexual and reproductive health and associated factors., Method: From February 2009 to October 2011, pregnant women were enrolled at their first antenatal care visit (ANC-1) and followed up until 6 months after delivery in the Mother and Child Center of the Chantal Biya Foundation within the randomized prenahtest multicentric trial. The MPI index was defined using sexual and reproductive health behaviour variables by using multiple correspondence analysis followed by mixed classification. Men were considered as highly involved if they had shared their HIV test results with their partner, had discussed on HIV or condom used, had contributed financially to ANC, had accompanied their wife to ANC or had practiced safe sex. Factors associated to MPI were investigated by the logistic model with GEE estimation approach., Results: A total of 484 pregnant women were enrolled. The median age of the women was 27 years (IQR: 23-31) and 55.23% had a gestational age greater than 16 weeks at ANC-1. Among them, HIV prevalence was 11.9% (95% CI: 9.0-15.4). The median duration of the women's relationship with their partner was 84 months (IQR: 48-120). MPI index at 6 months after delivery was significantly greater in the COC group than the classical counselling group (14.8% vs 8,82%; p = 0,043; Fig 1). The partners of the women who participated in the COC were more likely to be involved during follow up than others (aOR = 1.45; 95% CI = 1.00-2.10). Partners with no incoming activity (aOR = 2.90; 95% CI = 1.96-4.29), who did not used violence within the couple (aOR = 1.70; 95% CI = 1.07-2.68), and whose partner came early for ANC-1 (aOR = 1.37; 95% CI = 1.00-1.89) were more likely to be involved than others., Conclusion: MPI remains low in stable couples and COC improves partner involvement. Our findings also support the need of strengthening outreach towards "stable" couples and addressing barriers. This could go a long way to improve PMTCT outcomes in Cameroon., Trial Registration: PRENAHTEST, NCT01494961. Registered 15 December 2011-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT01494961., Competing Interests: The authors have declared that no competing interests exist.
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- 2021
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42. Early ART Initiation Improves HIV Status Disclosure and Social Support in People Living with HIV, Linked to Care Within a Universal Test and Treat Program in Rural South Africa (ANRS 12249 TasP Trial).
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Fiorentino M, Nishimwe M, Protopopescu C, Iwuji C, Okesola N, Spire B, Orne-Gliemann J, McGrath N, Pillay D, Dabis F, Larmarange J, and Boyer S
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- Disclosure, Humans, Social Support, South Africa epidemiology, Anti-HIV Agents therapeutic use, HIV Infections diagnosis, HIV Infections drug therapy
- Abstract
We investigated the effect of early antiretroviral treatment (ART) initiation on HIV status disclosure and social support in a cluster-randomized, treatment-as-prevention (TasP) trial in rural South Africa. Individuals identified HIV-positive after home-based testing were referred to trial clinics where they were invited to initiate ART immediately irrespective of CD4 count (intervention arm) or following national guidelines (control arm). We used Poisson mixed effects models to assess the independent effects of (a) time since baseline clinical visit, (b) trial arm, and (c) ART initiation on HIV disclosure (n = 182) and social support (n = 152) among participants with a CD4 count > 500 cells/mm
3 at baseline. Disclosure and social support significantly improved over follow-up in both arms. Disclosure was higher (incidence rate ratio [95% confidence interval]: 1.24 [1.04; 1.48]), and social support increased faster (1.22 [1.02; 1.46]) in the intervention arm than in the control arm. ART initiation improved both disclosure and social support (1.50 [1.28; 1.75] and 1.34 [1.12; 1.61], respectively), a stronger effect being seen in the intervention arm for social support (1.50 [1.12; 2.01]). Besides clinical benefits, early ART initiation may also improve psychosocial outcomes. This should further encourage countries to implement universal test-and-treat strategies.- Published
- 2021
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43. Home Treatment of Older People with Symptomatic SARS-CoV-2 Infection (COVID-19): A structured Summary of a Study Protocol for a Multi-Arm Multi-Stage (MAMS) Randomized Trial to Evaluate the Efficacy and Tolerability of Several Experimental Treatments to Reduce the Risk of Hospitalisation or Death in outpatients aged 65 years or older (COVERAGE trial).
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Duvignaud A, Lhomme E, Pistone T, Onaisi R, Sitta R, Journot V, Nguyen D, Peiffer-Smadja N, Crémer A, Bouchet S, Darnaud T, Poitrenaud D, Piroth L, Binquet C, Michel JF, Lefèvre B, Lebeaux D, Lebel J, Dupouy J, Roussillon C, Gimbert A, Wittkop L, Thiébaut R, Orne-Gliemann J, Joseph JP, Richert L, Anglaret X, and Malvy D
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- Aged, Aged, 80 and over, Amides therapeutic use, Antihypertensive Agents therapeutic use, Antimalarials therapeutic use, Antiviral Agents therapeutic use, COVID-19, Coronavirus Infections epidemiology, Coronavirus Infections virology, Drug Tolerance, Feasibility Studies, France epidemiology, Hospitalization trends, Humans, Hydroxychloroquine therapeutic use, Imatinib Mesylate therapeutic use, Luxembourg epidemiology, Pandemics, Pneumonia, Viral epidemiology, Pneumonia, Viral virology, Protein Kinase Inhibitors therapeutic use, Pyrazines therapeutic use, Risk Reduction Behavior, SARS-CoV-2, Telmisartan therapeutic use, Treatment Outcome, Betacoronavirus genetics, Coronavirus Infections drug therapy, Outpatients statistics & numerical data, Pneumonia, Viral drug therapy, Therapies, Investigational statistics & numerical data
- Abstract
Objectives: To assess the efficacy of several repurposed drugs to prevent hospitalisation or death in patients aged 65 or more with recent symptomatic SARS-CoV-2 infection (COVID-19) and no criteria for hospitalisation., Trial Design: Phase III, multi-arm (5) and multi-stage (MAMS), randomized, open-label controlled superiority trial. Participants will be randomly allocated 1:1:1:1:1 to the following strategies: Arm 1: Control arm Arms 2 to 5: Experimental treatment arms Planned interim analyses will be conducted at regular intervals. Their results will be reviewed by an Independent Data and Safety Monitoring Board. Experimental arms may be terminated for futility, efficacy or toxicity before the end of the trial. New experimental arms may be added if new evidence suggests that other treatments should be tested. A feasibility and acceptability substudy as well as an immunological substudy will be conducted alongside the trial., Participants: Inclusion criteria are: 65-year-old or more; Positive test for SARS-CoV-2 on a nasopharyngeal swab; Symptoms onset within 3 days before diagnosis; No hospitalisation criteria; Signed informed consent; Health insurance. Exclusion criteria are: Inability to make an informed decision to participate (e.g.: dementia, guardianship); Rockwood Clinical Frailty Scale ≥7; Long QT syndrome; QTc interval > 500 ms; Heart rate <50/min; Kalaemia >5.5 mmol/L or <3.5 mmol/L; Ongoing treatment with piperaquine, halofantrine, dasatinib, nilotinib, hydroxyzine, domperidone, citalopram, escitalopram, potent inhibitors or inducers of cytochrome P450 CYP3A4 isoenzyme, repaglinide, azathioprine, 6-mercaptopurine, theophylline, pyrazinamide, warfarin; Known hypersensitivity to any of the trial drugs or to chloroquine and other 4-aminoquinolines, amodiaquine, mefloquine, glafenine, floctafenine, antrafenine, ARB; Hepatic porphyria; Liver failure (Child-Pugh stage ≥B); Stage 4 or 5 chronic kidney disease (GFR <30 mL/min/1.73 m²); Dialysis; Hypersentivity to lactose; Lactase deficiency; Abnormalities in galactose metabolism; Malabsorption syndrome; Glucose-6-phosphate dehydrogenase deficiency; Symptomatic hyperuricemia; Ileus; Colitis; Enterocolitis; Chronic hepatitis B virus disease. The trial is being conducted in France in the Bordeaux, Corse, Dijon, Nancy, Paris and Toulouse areas as well as in the Grand Duchy of Luxembourg. Participants are recruited either at home, nursing homes, general practices, primary care centres or hospital outpatient consultations., Intervention and Comparator: The four experimental treatments planned in protocol version 1.2 (April 8
th , 2020) are: (1) Hydroxychloroquine 200 mg, 2 tablets BID on day 0, 2 tablets QD from day 1 to 9; (2) Imatinib 400 mg, 1 tablet QD from day 0 to 9; (3) Favipiravir 200 mg, 12 tablets BID on day 0, 6 tablets BID from day 1 to 9; (4) Telmisartan 20 mg, 1 tablet QD from day 0 to 9. The comparator is a complex of vitamins and trace elements (AZINC Forme et Vitalité®), 1 capsule BID for 10 days, for which there is no reason to believe that they are active on the virus. In protocol version 1.2 (April 8th, 2020): People in the control arm will receive a combination of vitamins and trace elements; people in the experimental arms will receive hydroxychloroquine, or favipiravir, or imatinib, or telmisartan., Main Outcome: The primary outcome is the proportion of participants with an incidence of hospitalisation and/or death between inclusion and day 14 in each arm., Randomisation: Participants are randomized in a 1:1:1:1:1 ratio to each arm using a web-based randomisation tool. Participants not treated with an ARB or ACEI prior to enrolment are randomized to receive the comparator or one of the four experimental drugs. Participants already treated with an ARB or ACEI are randomized to receive the comparator or one of the experimental drugs except telmisartan (i.e.: hydroxychloroquine, imatinib, or favipiravir). Randomisation is stratified on ACEI or ARBs treatment at inclusion and on the type of residence (personal home vs. nursing home)., Blinding (masking): This is an open-label trial. Participants, caregivers, investigators and statisticians are not blinded to group assignment., Numbers to Be Randomised (sample Size): A total of 1057 participants will be enrolled if all arms are maintained until the final analysis and no additional arm is added. Three successive futility interim analyses are planned, when the number of participants reaches 30, 60 and 102 in the control arm. Two efficacy analyses (interim n°3 and final) will be performed successively., Trial Status: This describes the Version 1.2 (April 8th , 2020) of the COVERAGE protocol that was approved by the French regulatory authority and ethics committee. The trial was opened for enrolment on April 15th , 2020 in the Nouvelle Aquitaine region (South-West France). Given the current decline of the COVID-19 pandemic in France and its unforeseeable dynamic in the coming months, new trial sites in 5 other French regions and in Luxembourg are currently being opened. A revised version of the protocol was submitted to the regulatory authority and ethics committee on June 15th , 2020. It contains the following amendments: (i) Inclusion criteria: age ≥65 replaced by age ≥60; time since first symptoms <3 days replaced by time since first symptoms <5 days; (ii) Withdrawal of the hydroxychloroquine arm (due to external data); (iii) increase in the number of trial sites., Trial Registration: The trial was registered on Clinical Trials.gov on April 22nd , 2020 (Identifier: NCT04356495): and on EudraCT on April 10th , 2020 (Identifier: 2020-001435-27)., Full Protocol: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest of expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol. The study protocol has been reported in accordance with the Standard Protocol Items: Recommendations for Clinical Interventional Trials (SPIRIT) guidelines (Additional file 2).- Published
- 2020
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44. Retention-in-care in the PMTCT cascade: definitions matter! Analyses from the INSPIRE projects in Malawi, Nigeria and Zimbabwe.
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Font H, Rollins N, Essajee S, Becquet R, Foster G, Mangwiro AZ, Mwapasa V, Oyeledun B, Phiri S, Sam-Agudu NA, Bellare NB, and Orne-Gliemann J
- Subjects
- Adult, Ambulatory Care, Cross-Sectional Studies, Female, HIV Infections prevention & control, Humans, Malawi, Medication Adherence, Nigeria, Pregnancy, Pregnancy Complications, Infectious drug therapy, Zimbabwe, Anti-HIV Agents therapeutic use, HIV Infections drug therapy, HIV Infections transmission, Infectious Disease Transmission, Vertical prevention & control, Retention in Care
- Abstract
Introduction: Definitions of retention-in-care in Prevention of Mother-to-Child Transmission of HIV (PMTCT) vary substantially between studies and programmes. Some definitions are based on visits missed/made, others on a minimum total number of visits, or attendance at a final clinic visit at a specific time. An agreed definition could contribute to developing evidence-based interventions for improving retention-in-care. In this paper, we estimated retention-in-care rates according to different definitions, and we quantified and visualized the degree of agreement between definitions., Methods: We calculated retention in care rates using nine definitions in the six INSPIRE PMTCT intervention studies, conducted in three sub-Saharan African countries between 2013 and 2017. With data from one of the studies (E4E), we estimated the agreement between definitions using Gwet's agreement coefficient (AC1) and concordance. We calculated positive predictive values (PPV) and negative predictive values (NPV) for all definitions considering successively each definition as the reference standard. Finally, we used a Multiple Correspondence Analysis (MCA) to examine clustering of the way different definitions handle retention-in-care., Results: Retention-in-care rates among 5107 women ranged from 30% to 76% in the complete dataset with Gwet's AC1 being 0.56 [0.53; 0.59] indicating a moderate agreement between all definitions together. Two pairs of definitions with high inner concordance and agreement had either very high PPV or very high NPV, and appeared distinct from the other five definitions on the MCA figures. These pairs of definitions were also the ones resulting in the lowest and highest estimates of retention-in-care. The simplest definition, that only required a final clinic visit to classify women as retained in care, and classified 55% of women as retained in care, had a PPV ranging from 0.7 to 1 and a NPV ranging from 0.69 to 0.98 when excluding the two pairs afore-mentioned; it resulted in a moderate to substantial agreement and a 70% to 90% concordance with all other definitions., Conclusions: Our study highlights the variability of definitions in estimating retention-in-care. Some definitions are very stringent which may be required in some instances. A simple indicator such as attendance at a single time point may be sufficient for programme planning and evaluation., (© 2020 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society.)
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- 2020
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45. Test but not treat: Community members' experiences with barriers and facilitators to universal antiretroviral therapy uptake in rural KwaZulu-Natal, South Africa.
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Iwuji C, Chimukuche RS, Zuma T, Plazy M, Larmarange J, Orne-Gliemann J, Siedner M, Shahmanesh M, and Seeley J
- Subjects
- Adult, Anti-HIV Agents therapeutic use, Female, Focus Groups, Humans, Male, Mass Screening, Qualitative Research, Rural Population, Sexual Partners, Social Stigma, South Africa epidemiology, Antiretroviral Therapy, Highly Active trends, HIV Infections drug therapy, Health Services Accessibility trends
- Abstract
Introduction: Antiretroviral therapy (ART) has revolutionised the care of HIV-positive individuals resulting in marked decreases in morbidity and mortality, and markedly reduced transmission to sexual partners. However, these benefits can only be realised if individuals are aware of their HIV-positive status, initiated and retained on suppressive lifelong ART. Framed using the socio-ecological model, the present study explores factors contributing to poor ART uptake among community members despite high acceptance of HIV-testing within a Treatment as Prevention (TasP) trial. In this paper we identify barriers and facilitators to treatment across different levels of the socio-ecological framework covering individual, community and health system components., Methods: This research was embedded within a cluster-randomised trial (ClinicalTrials.gov, number NCT01509508) of HIV treatment as Prevention in rural KwaZulu-Natal, South Africa. Data were collected between January 2013 and July 2014 from resident community members. Ten participants contributed to repeat in-depth interviews whilst 42 participants took part in repeat focus group discussions. Data from individual interviews and focus group discussions were triangulated using community walks to give insights into community members' perception of the barriers and facilitators of ART uptake. We used thematic analysis guided by a socio-ecological framework to analyse participants' narratives from both individual interviews and focus group discussions., Results: Barriers and facilitators operating at the individual, community and health system levels influence ART uptake. Stigma was an over-arching barrier, across all three levels and expressed variably as fear of HIV disclosure, concerns about segregated HIV clinical services and negative community religious perceptions. Other barriers were individual (substance misuse, fear of ART side effects), community (alternative health beliefs). Facilitators cited by participants included individual (expectations of improved health and longer life expectancy following ART, single tablet regimens), community (availability of ART in the community through mobile trial facilities) and health system factors (fast and efficient service provided by friendly staff)., Discussion: We identified multiple barriers to achieving universal ART uptake. To enhance uptake in HIV care services, and achieve the full benefits of ART requires interventions that tackle persistent HIV stigma, and offer people with HIV respectful, convenient and efficient services. These interventions require evaluation in appropriately designed studies., Competing Interests: I have updated the competing interest statement in the text of the manuscript. Revised text below I have read the journal's policy and the authors of this manuscript have the following competing interests: CI received research grants, honoraria for consulting services and conference attendance support from Gilead Sciences. All other authors declare that they have no conflicts of interest. This does not alter our adherence to PLOS ONE policies on sharing data and materials.
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- 2020
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46. Patient perspectives on interpersonal aspects of healthcare and patient-centeredness at primary health facilities: A mixed methods study in rural Eastern Uganda.
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Waweru E, Smekens T, Orne-Gliemann J, Ssengooba F, Broerse J, and Criel B
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- Ambulatory Care Facilities, Cross-Sectional Studies, Focus Groups, Humans, Interviews as Topic, Surveys and Questionnaires, Uganda, Patient-Centered Care, Patients psychology, Quality of Health Care
- Abstract
Introduction: Patient-centered care (PCC) is an approach to involve patients in health care delivery, to contribute to quality of care, and to strengthen health systems responsiveness. This article aims to highlight patient perspectives by showcasing their perceptions of their experience of PCC at primary health facilities in two districts in Uganda., Methods: A mixed methods cross-sectional study was conducted in three public and two private primary health care facilities in rural eastern Uganda. In total, 300 patient exit survey questionnaires, 31 semi-structured Interviews (SSIs), 5 Focus Group Discussions (FGDs) and 5 feedback meetings were conducted. Data analysis was guided by a conceptual framework focusing on (1) understanding patients' health needs, preferences and expectations, (2) describing patients perceptions of their care experience according to five distinct PCC dimensions, and (3) reporting patient reported outcomes and their recommendations on how to improve quality of care., Results: Patient expectations were shaped by their access to the facility, costs incurred and perceived quality of care. Patients using public facilities reported doing so because of their proximity (78.3% in public PHCs versus 23.3% in private PHCs) and because of the free services availed. On the other hand, patients attending private facilities did so because of their perception of better quality of care (84.2% in private PHCs versus 21.7% in public PHCs). Patients expectations of quality care were expressed as the availability of medication, shorter waiting times, flexible facility opening hours and courteous health workers. Analysis of the 300 responses from patients interviewed on their perception of the care they received, pointed to higher normalized scores for two out of the five PCC dimensions considered: namely, exploration of the patient's health and illness experience, and the quality of the relationship between patient and health worker (range 62.1-78.4 out of 100). The qualitative analysis indicated that patients felt that communication with health workers was enhanced where there was trust and in case of positive past experiences. Patients however felt uncomfortable discussing psychological or family matters with health workers and found it difficult to make decisions when they did not fully understand the care provided. In terms of outcomes, our findings suggest that patient enablement was more sensitive than patient satisfaction in measuring the effect of interpersonal patient experience on patient reported outcomes., Discussion and Conclusion: Our findings show that Ugandan patients have some understanding of PCC related concepts and express a demand for it. The results offer a starting point for small scale PCC interventions. However, we need to be cognizant of the challenges PCC implementation faces in resource constrained settings. Patients' expectations in terms of quality health care are still largely driven by biomedical and technical aspects. In addition, patients are largely unaware of their right to participate in the evaluation of health care. To mitigate these challenges, targeted health education focusing on patients' responsibilities and patient's rights are essential. Last but not least, all stakeholders must be involved in developing and validating methods to measure PCC., Competing Interests: The authors have declared that no competing interests exist.
- Published
- 2020
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47. Temporal trends of population viral suppression in the context of Universal Test and Treat: the ANRS 12249 TasP trial in rural South Africa.
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Larmarange J, Diallo MH, McGrath N, Iwuji C, Plazy M, Thiébaut R, Tanser F, Bärnighausen T, Orne-Gliemann J, Pillay D, and Dabis F
- Subjects
- Adult, Anti-HIV Agents administration & dosage, CD4 Lymphocyte Count, Counseling, Female, HIV Infections epidemiology, Humans, Incidence, Male, Mass Screening, Randomized Controlled Trials as Topic, Referral and Consultation, Rural Population, South Africa epidemiology, Anti-HIV Agents therapeutic use, Delivery of Health Care, HIV Infections drug therapy
- Abstract
Introduction: The universal test-and-treat (UTT) strategy aims to maximize population viral suppression (PVS), that is, the proportion of all people living with HIV (PLHIV) on antiretroviral treatment (ART) and virally suppressed, with the goal of reducing HIV transmission at the population level. This article explores the extent to which temporal changes in PVS explain the observed lack of association between universal treatment and cumulative HIV incidence seen in the ANRS 12249 TasP trial conducted in rural South Africa., Methods: The TasP cluster-randomized trial (2012 to 2016) implemented six-monthly repeat home-based HIV counselling and testing (RHBCT) and referral of PLHIV to local HIV clinics in 2 × 11 clusters opened sequentially. ART was initiated according to national guidelines in control clusters and regardless of CD4 count in intervention clusters. We measured residency status, HIV status, and HIV care status for each participant on a daily basis. PVS was computed per cluster among all resident PLHIV (≥16, including those not in care) at cluster opening and daily thereafter. We used a mixed linear model to explore time patterns in PVS, adjusting for sociodemographic changes at the cluster level., Results: 8563 PLHIV were followed. During the course of the trial, PVS increased significantly in both arms (23.5% to 46.2% in intervention, +22.8, p < 0.001; 26.0% to 44.6% in control, +18.6, p < 0.001). That increase was similar in both arms (p = 0.514). In the final adjusted model, PVS increase was most associated with increased RHBCT and the implementation of local trial clinics (measured by time since cluster opening). Contextual changes (measured by calendar time) also contributed slightly. The effect of universal ART (trial arm) was positive but limited., Conclusions: PVS was improved significantly but similarly in both trial arms, explaining partly the null effect observed in terms of cumulative HIV incidence between arms. The PVS gains due to changes in ART-initiation guidelines alone are relatively small compared to gains obtained by strategies to maximize testing and linkage to care. The achievement of the 90-90-90 targets will not be met if the operational and implementational challenges limiting access to care and treatment, often context-specific, are not properly addressed. Clinical trial number: NCT01509508 (clinicalTrials.gov)/DOH-27-0512-3974 (South African National Clinical Trials Register)., (© 2019 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society.)
- Published
- 2019
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48. Retention in Care Trajectories of HIV-Positive Individuals Participating in a Universal Test-and-Treat Program in Rural South Africa (ANRS 12249 TasP Trial).
- Author
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Gosset A, Protopopescu C, Larmarange J, Orne-Gliemann J, McGrath N, Pillay D, Dabis F, Iwuji C, and Boyer S
- Subjects
- Adolescent, Adult, Female, HIV Infections diagnosis, Humans, Male, Middle Aged, Social Support, South Africa, Young Adult, Anti-Retroviral Agents therapeutic use, HIV Infections drug therapy, Patient Compliance statistics & numerical data, Retention in Care statistics & numerical data, Rural Population statistics & numerical data
- Abstract
Objective: To study retention in care (RIC) trajectories and associated factors in patients eligible for antiretroviral therapy (ART) in a universal test-and-treat setting (TasP trial, South Africa, 2012-2016)., Design: A cluster-randomized trial whereby individuals identified HIV positive after home-based testing were invited to initiate ART immediately (intervention) or following national guidelines (control)., Methods: Exiting care was defined as ≥3 months late for a clinic appointment, transferring elsewhere, or death. Group-based trajectory modeling was performed to estimate RIC trajectories over 18 months and associated factors in 777 ART-eligible patients., Results: Four RIC trajectory groups were identified: (1) group 1 "remained" in care (reference, n = 554, 71.3%), (2) group 2 exited care then "returned" after [median (interquartile range)] 4 (3-9) months (n = 40, 5.2%), (3) group 3 "exited care rapidly" [after 4 (4-6) months, n = 98, 12.6%], and (4) group 4 "exited care later" [after 11 (9-13) months, n = 85, 10.9%]. Group 2 patients were less likely to have initiated ART within 1 month and more likely to be male, young (<29 years), without a regular partner, and to have a CD4 count >350 cells/mm. Group 3 patients were more likely to be women without social support, newly diagnosed, young, and less likely to have initiated ART within 1 month. Group 4 patients were more likely to be newly diagnosed and aged 39 years or younger., Conclusions: High CD4 counts at care initiation were not associated with a higher risk of exiting care. Prompt ART initiation and special support for young and newly diagnosed patients with HIV are needed to maximize RIC.
- Published
- 2019
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49. No effect of test and treat on sexual behaviours at population level in rural South Africa.
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Rolland M, McGrath N, Tiendrebeogo T, Larmarange J, Pillay D, Dabis F, and Orne-Gliemann J
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- Adolescent, Adult, Aged, Cross-Sectional Studies, Female, HIV Infections diagnosis, HIV Infections drug therapy, HIV Infections epidemiology, Health Policy, Humans, Male, Middle Aged, Prevalence, South Africa epidemiology, Surveys and Questionnaires, Young Adult, Anti-Retroviral Agents therapeutic use, Disease Management, Disease Transmission, Infectious prevention & control, HIV Infections prevention & control, Risk-Taking, Rural Population, Sexual Behavior statistics & numerical data
- Abstract
Context: Within the community-randomized ANRS 12249 Treatment-as-Prevention trial conducted in rural South Africa, we analysed sexual behaviours stratified by sex over time, comparing immediate antiretroviral therapy irrespective of CD4+ cell count vs. CD4+-guided antiretroviral therapy (start at CD4+ cell count > 350 cells/μl then >500 cells/μl) arms., Methods: As part of the 6-monthly home-based trial rounds, a sexual behaviour individual questionnaire was administered to all residents at least 16 years. We considered seven indicators: sexual intercourse in the past month; at least one regular sexual partner in the past 6 months; at least one casual sexual partner in the past 6 months and more than one sexual partner in the past 6 months; condom use at last sex (CLS) with regular partner, CLS with casual partner, and point prevalence estimate of concurrency. We conducted repeated cross-sectional analyses, stratified by sex. Generalized Estimating Equations models were used, including trial arm, trial time, calendar time and interaction between trial arm and trial time., Results: CLS with regular partner varied between 29-51% and 23-46% for men and women, respectively, with significantly lower odds among women in the control vs. intervention arm by trial end (P < 0.001). CLS with casual partner among men showed a significant interaction between arm and trial round, with no consistent pattern. Women declared more than one partner in the past 6 months in less than 1% of individual questionnaires; among men, rates varied between 5-12%, and odds significantly and continuously declined between calendar rounds 1 and 7 [odds ratio = 4.2 (3.24-5.45)]., Conclusion: Universal Test and Treat was not associated with increased sexual risk behaviours.
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- 2019
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50. Linkage to primary care after home-based blood pressure screening in rural KwaZulu-Natal, South Africa: a population-based cohort study.
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Siedner MJ, Baisley K, Orne-Gliemann J, Pillay D, Koole O, Wong EB, Matthews P, Tanser F, Herbst K, Barnighausen T, and Bachmann M
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- Adult, Age Factors, Aged, Cohort Studies, Cross-Sectional Studies, Female, Humans, Hypertension epidemiology, Hypertension therapy, Male, Middle Aged, Population Surveillance, Referral and Consultation statistics & numerical data, Sex Factors, South Africa, Blood Pressure Monitoring, Ambulatory, Hypertension diagnosis, Mass Screening, Primary Health Care, Rural Population
- Abstract
Objectives: The expanding burden of non-communicable diseases (NCDs) globally will require novel public health strategies. Community-based screening has been promoted to augment efficiency of diagnostic services, but few data are available on the downstream impact of such programmes. We sought to assess the impact of a home-based blood pressure screening programme on linkage to hypertension care in rural South Africa., Setting: We conducted home-based blood pressure screening withinin a population cohort in rural KwaZulu-Natal, using the WHO Stepwise Approach to Surveillance (STEPS) protocol., Participants: Individuals meeting criteria for raised blood pressure (≥140 systolic or ≥90 diastolic averaged over two readings) were referred to local health clinics and included in this analysis. We defined linkage to care based on self-report of presentation to clinic for hypertension during the next 2 years of cohort observation. We estimated the population proportion of successful linkage to care with inverse probability sampling weights, and fit multivariable logistic regression models to identify predictors of linkage following a positive hypertension screen., Results: Of 11 694 individuals screened, 14.6% (n=1706) were newly diagnosed with elevated pressure. 26.9% (95% CI 24.5% to 29.4%) of those sought hypertension care in the following 2 years, and 38.1% (95% CI 35.6% to 40.7%) did so within 5 years. Women (adjusted OR (aOR) 2.41, 95% CI 1.68 to 3.45), those of older age (aOR 11.49, 95% CI 5.87 to 22.46, for 45-59 years vs <30) and those unemployed (aOR 1.71, 95% CI 1.10 to 2.65) were more likely to have linked to care., Conclusions: Linkage to care after home-based identification of elevated blood pressure was rare in rural South Africa, particularly among younger individuals, men and the employed. Improved understanding of barriers and facilitators to NCD care is needed to enhance the effectiveness of blood pressure screening in the region., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY. Published by BMJ.)
- Published
- 2018
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