24 research outputs found
Prevention of mother-to-child transmission of HIV Option B+ cascade in rural Tanzania: The One Stop Clinic model
BACKGROUND: Strategies to improve the uptake of Prevention of
Mother-To-Child Transmission of HIV (PMTCT) are needed. We
integrated HIV and maternal, newborn and child health services
in a One Stop Clinic to improve the PMTCT cascade in a rural
Tanzanian setting. METHODS: The One Stop Clinic of Ifakara
offers integral care to HIV-infected pregnant women and their
families at one single place and time. All pregnant women and
HIV-exposed infants attended during the first year of Option B+
implementation (04/2014-03/2015) were included. PMTCT was
assessed at the antenatal clinic (ANC), HIV care and labour
ward, and compared with the pre-B+ period. We also characterised
HIV-infected pregnant women and evaluated the MTCT rate.
RESULTS: 1,579 women attended the ANC. Seven (0.4%) were known
to be HIV-infected. Of the remainder, 98.5% (1,548/1,572) were
offered an HIV test, 94% (1,456/1,548) accepted and 38 (2.6%)
tested HIV-positive. 51 were re-screened for HIV during late
pregnancy and one had seroconverted. The HIV prevalence at the
ANC was 3.1% (46/1,463). Of the 39 newly diagnosed women, 35
(90%) were linked to care. HIV test was offered to >98% of
ANC clients during both the pre- and post-B+ periods. During the
post-B+ period, test acceptance (94% versus 90.5%, p<0.0001)
and linkage to care (90% versus 26%, p<0.0001) increased. Ten
additional women diagnosed outside the ANC were linked to care.
82% (37/45) of these newly-enrolled women started antiretroviral
treatment (ART). After a median time of 17 months, 27% (12/45)
were lost to follow-up. 79 women under HIV care became pregnant
and all received ART. After a median follow-up time of 19
months, 6% (5/79) had been lost. 5,727 women delivered at the
hospital, 20% (1,155/5,727) had unknown HIV serostatus. Of
these, 30% (345/1,155) were tested for HIV, and 18/345 (5.2%)
were HIV-positive. Compared to the pre-B+ period more women were
tested during labour (30% versus 2.4%, p<0.0001). During the
study, the MTCT rate was 2.2%. CONCLUSIONS: The implementation
of Option B+ through an integrated service delivery model
resulted in universal HIV testing in the ANC, high rates of
linkage to care, and MTCT below the elimination threshold.
However, HIV testing in late pregnancy and labour, and retention
during early ART need to be improved
Absence of hepatitis delta infection in a large rural HIV cohort in Tanzania
OBJECTIVES: The epidemiological and clinical determinants of
hepatitis delta virus (HDV) infection in Sub-Saharan Africa are
ill-defined. The prevalence of HDV infection was determined in
HIV/hepatitis B virus (HBV) co-infected individuals in rural
Tanzania. METHODS: All hepatitis B virus (HBV)-infected adults
under active follow-up in the Kilombero and Ulanga
Antiretroviral Cohort (KIULARCO) were screened for anti-HDV
antibodies. For positive samples, a second serological test and
nucleic acid amplification were performed. Demographic and
clinical characteristics at initiation of antiretroviral therapy
(ART) were compared between anti-HDV-negative and positive
patients. RESULTS: Among 222 HIV/HBV co-infected patients on
ART, 219 (98.6%) had a stored serum sample available and were
included in the study. Median age was 37 years, 55% were female,
46% had World Health Organization stage III/IV HIV disease, and
the median CD4 count was 179 cells/mul. The prevalence of
anti-HDV positivity was 5.0% (95% confidence interval 2.8-8.9%).
There was no significant predictor of anti-HDV positivity. HDV
could not be amplified in any of the anti-HDV-positive patients
and the second serological test was negative in all of them.
CONCLUSIONS: No confirmed case of HDV infection was found among
over 200 HIV/HBV co-infected patients in Tanzania. As
false-positive serology results are common, screening results
should be confirmed with a second test
Stigma-directed services (Stig2Health) to improve 'linkage to care' for people living with HIV in rural Tanzania: study protocol for a nested pre-post implementation study within the Kilombero and Ulanga Antiretroviral Cohort.
Background: HIV-related stigma is a major barrier to the timely linkage and retention of patients in HIV care in sub-Saharan Africa, where most people living with HIV/AIDS reside. In this implementation study we aim to evaluate the effect of stigma-directed services on linkage to care and other health outcomes in newly diagnosed HIV-positive patients. Methods: In a nested project of the Kilombero and Ulanga Antiretroviral Cohort in rural Tanzania, we conduct a prospective observational pre-post study to assess the impact of a bundle of stigma-directed services for newly diagnosed HIV positive patients. Stigma-directed services, delivered by a lay person living with HIV, are i) post-test counseling, ii) post-test video-assisted teaching, iii) group support therapy and group health education, and iv) mobile health. Patients receiving stigma services (enrolled from 1 st February 2020 to 31 st August 2021) are compared to a historical control receiving the standard of care (enrolled from 1 st July 2017 to 1 st February 2019). The primary outcome is 'linkage to care'. Secondary endpoints are retention in care, viral suppression, death and clinical failure at 6-12 months (up to 31 st August 2022). Self-reported stigma and depression are assessed using the Berger Stigma scale and the PHQ-9 questionnaire, respectively. The sample size calculation was based on cohort data from 2018. Assuming a pre-intervention cohort of 511 newly diagnosed adults of whom 346 (68%) were in care and on antiretroviral treatment (ART) at 2 months, a 10% increase in linkage (from 70 to 80%), a two-sided type I error rate of 5%, and 90% power, 321 adults are required for the post-implementation group. Discussion: We expect that integration of stigma-directed services leads to an increase of proportions of patients in care and on ART. The findings will provide guidance on how to integrate stigma-directed services into routine care in rural sub-Saharan Africa
Prevalence and Evolution of Renal Impairment in People Living With HIV in Rural Tanzania
Background: We assessed the prevalence, incidence, and
predictors of renal impairment among people living with HIV
(PLWHIV) in rural Tanzania. Methods: In a cohort of PLWHIV aged
>/=15 years enrolled from January 2013 to June 2016, we
assessed the association between renal impairment (estimated
glomerural filtration rate < 90 mL/min/1.73 m(2)) at
enrollment and during follow-up with demographic and clinical
characteristcis using logistic regression and Cox proportional
hazards models. Results: Of 1093 PLWHIV, 172 (15.7%) had renal
impairment at enrollment. Of 921 patients with normal renal
function at baseline, 117 (12.7%) developed renal impairment
during a median follow-up (interquartile range) of 6.2
(0.4-14.7) months. The incidence of renal impairment was 110
cases per 1000 person-years (95% confidence interval [CI],
92-132). At enrollment, logistic regression identified older age
(adjusted odds ratio [aOR], 1.79; 95% CI, 1.52-2.11),
hypertension (aOR, 1.84; 95% CI, 1.08-3.15), CD4 count <200
cells/mm(3) (aOR, 1.80; 95% CI, 1.23-2.65), and World Health
Organization (WHO) stage III/IV (aOR, 3.00; 95% CI, 1.96-4.58)
as risk factors for renal impairment. Cox regression model
confirmed older age (adjusted hazard ratio [aHR], 1.85; 95% CI,
1.56-2.20) and CD4 count <200 cells/mm(3) (aHR, 2.05; 95% CI,
1.36-3.09) to be associated with the development of renal
impairment. Conclusions: Our study found a low prevalence of
renal impairment among PLWHIV despite high usage of tenofovir
and its association with age, hypertension, low CD4 count, and
advanced WHO stage. These important and reassuring safety data
stress the significance of noncommunicable disease surveillance
in aging HIV populations in sub-Saharan Africa
Statistical methods applied for the assessment of the HIV cascade and continuum of care: a systematic scoping review
Objectives This scoping review aims to identify and synthesise existing statistical methods used to assess the progress of HIV treatment programmes in terms of the HIV cascade and continuum of care among people living with HIV (PLHIV).Design Systematic scoping review.Data sources Published articles were retrieved from PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL) Complete and Excerpta Medica dataBASE (EMBASE) databases between April and July 2022. We also strategically search using the Google Scholar search engine and reference lists of published articles.Eligibility criteria This scoping review included original English articles that estimated and described the HIV cascade and continuum of care progress in PLHIV. The review considered quantitative articles that evaluated either HIV care cascade progress in terms of the Joint United Nations Programme on HIV and AIDS targets or the dynamics of engagement in HIV care.Data extraction and synthesis The first author and the librarian developed database search queries and screened the retrieved titles and abstracts. Two independent reviewers and the first author extracted data using a standardised data extraction tool. The data analysis was descriptive and the findings are presented in tables and visuals.Results This review included 300 articles. Cross-sectional study design methods were the most commonly used to assess the HIV care cascade (n=279, 93%). In cross-sectional and longitudinal studies, the majority used proportions to describe individuals at each cascade stage (276/279 (99%) and 20/21 (95%), respectively). In longitudinal studies, the time spent in cascade stages, transition probabilities and cumulative incidence functions was estimated. The logistic regression model was common in both cross-sectional (101/279, 36%) and longitudinal studies (7/21, 33%). Of the 21 articles that used a longitudinal design, six articles used multistate models, which included non-parametric, parametric, continuous-time, time-homogeneous and discrete-time multistate Markov models.Conclusions Most literature on the HIV cascade and continuum of care arises from cross-sectional studies. The use of longitudinal study design methods in the HIV cascade is growing because such methods can provide additional information about transition dynamics along the cascade. Therefore, a methodological guide for applying different types of longitudinal design methods to the HIV continuum of care assessments is warranted
Incidence and risk factors for hypertension among HIV patients in rural Tanzania - A prospective cohort study.
INTRODUCTION:Scarce data are available on the epidemiology of hypertension among HIV patients in rural sub-Saharan Africa. We explored the prevalence, incidence and risk factors for incident hypertension among patients who were enrolled in a rural HIV cohort in Tanzania. METHODS:Prospective longitudinal study including HIV patients enrolled in the Kilombero and Ulanga Antiretroviral Cohort between 2013 and 2015. Non-ART naïve subjects at baseline and pregnant women during follow-up were excluded from the analysis. Incident hypertension was defined as systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg on two consecutive visits. Cox proportional hazards models were used to assess the association of baseline characteristics and incident hypertension. RESULTS:Among 955 ART-naïve, eligible subjects, 111 (11.6%) were hypertensive at recruitment. Ten women were excluded due to pregnancy. The remaining 834 individuals contributed 7967 person-months to follow-up (median 231 days, IQR 119-421) and 80 (9.6%) of them developed hypertension during a median follow-up of 144 days from time of enrolment into the cohort [incidence rate 120.0 cases/1000 person-years, 95% confidence interval (CI) 97.2-150.0]. ART was started in 630 (75.5%) patients, with a median follow-up on ART of 7 months (IQR 4-14). Cox regression models identified age [adjusted hazard ratio (aHR) 1.34 per 10 years increase, 95% CI 1.07-1.68, p = 0.010], body mass index (aHR per 5 kg/m2 1.45, 95% CI 1.07-1.99, p = 0.018) and estimated glomerular filtration rate (aHR < 60 versus ≥ 60 ml/min/1.73 m2 3.79, 95% CI 1.60-8.99, p = 0.003) as independent risk factors for hypertension development. CONCLUSIONS:The prevalence and incidence of hypertension were high in our cohort. Traditional cardiovascular risk factors predicted incident hypertension, but no association was observed with immunological or ART status. These data support the implementation of routine hypertension screening and integrated management into HIV programmes in rural sub-Saharan Africa
Incidence and risk factors for hypertension among HIV patients in rural Tanzania - A prospective cohort study
INTRODUCTION: Scarce data are available on the epidemiology of
hypertension among HIV patients in rural sub-Saharan Africa. We
explored the prevalence, incidence and risk factors for incident
hypertension among patients who were enrolled in a rural HIV
cohort in Tanzania. METHODS: Prospective longitudinal study
including HIV patients enrolled in the Kilombero and Ulanga
Antiretroviral Cohort between 2013 and 2015. Non-ART naive
subjects at baseline and pregnant women during follow-up were
excluded from the analysis. Incident hypertension was defined as
systolic blood pressure >/= 140 mmHg and/or diastolic blood
pressure >/= 90 mmHg on two consecutive visits. Cox
proportional hazards models were used to assess the association
of baseline characteristics and incident hypertension. RESULTS:
Among 955 ART-naive, eligible subjects, 111 (11.6%) were
hypertensive at recruitment. Ten women were excluded due to
pregnancy. The remaining 834 individuals contributed 7967
person-months to follow-up (median 231 days, IQR 119-421) and 80
(9.6%) of them developed hypertension during a median follow-up
of 144 days from time of enrolment into the cohort [incidence
rate 120.0 cases/1000 person-years, 95% confidence interval (CI)
97.2-150.0]. ART was started in 630 (75.5%) patients, with a
median follow-up on ART of 7 months (IQR 4-14). Cox regression
models identified age [adjusted hazard ratio (aHR) 1.34 per 10
years increase, 95% CI 1.07-1.68, p = 0.010], body mass index
(aHR per 5 kg/m2 1.45, 95% CI 1.07-1.99, p = 0.018) and
estimated glomerular filtration rate (aHR /=
60 ml/min/1.73 m2 3.79, 95% CI 1.60-8.99, p = 0.003) as
independent risk factors for hypertension development.
CONCLUSIONS: The prevalence and incidence of hypertension were
high in our cohort. Traditional cardiovascular risk factors
predicted incident hypertension, but no association was observed
with immunological or ART status. These data support the
implementation of routine hypertension screening and integrated
management into HIV programmes in rural sub-Saharan Africa
Laboratory-reflex cryptococcal antigen screening is associated with a survival benefit in Tanzania
Cryptococcal antigen (CrAg) screening in persons with advanced HIV/AIDS is recommended to prevent death. Implementing CrAg screening only in outpatients may underestimate the true CrAg prevalence and decrease its potential impact. Our previous 12-month survival/retention in CrAg-positive persons not treated with fluconazole was 0%.; HIV testing was offered to all antiretroviral therapy-naive outpatients and hospitalized patients in Ifakara, Tanzania, followed by laboratory-reflex CrAg screening for CD4 <150 cells/μL. CrAg-positive individuals were offered lumbar punctures, and antifungals were tailored to the presence/absence of meningitis. We assessed the impact on survival and retention-in-care using multivariate Cox-regression models.; We screened 560 individuals for CrAg. The median CD4 count was 61 cells/μL (interquartile range 26-103). CrAg prevalence was 6.1% (34/560) among individuals with CD4 ≤150 and 7.5% among ≤100 cells/μL. CrAg prevalence was 2.3-fold higher among hospitalized participants than in outpatients (12% vs 5.3%, P = 0.02). We performed lumbar punctures in 94% (32/34), and 31% (10/34) had cryptococcal meningitis. Mortality did not differ significantly between treated CrAg-positive without meningitis and CrAg-negative individuals (7.3 vs 5.4 deaths per 100 person-years, respectively, P = 0.25). Independent predictors of 6-month death/lost to follow-up were low CD4, cryptococcal meningitis (adjusted hazard ratio 2.76, 95% confidence interval: 1.31 to 5.82), and no antiretroviral therapy initiation (adjusted hazard ratio 3.12, 95% confidence interval: 2.16 to 4.50).; Implementing laboratory-reflex CrAg screening among outpatients and hospitalized individuals resulted in a rapid detection of cryptococcosis and a survival benefit. These results provide a model of a feasible, effective, and scalable CrAg screening and treatment strategy integrated into routine care in sub-Saharan Africa
Cox regression analysis of risk factors for hypertension development.
<p>Cox regression analysis of risk factors for hypertension development.</p
Kaplan-Meier survival estimates of hypertension development according to the independent risk factors at baseline: age (left), body mass index (centre) and estimated glomerular filtration rate (right).
<p>BMI: body mass index; eGFR: estimated glomerular filtration rate.</p