Risk Factors for Delayed Viral Suppression on First-Line Antiretroviral Therapy among Persons Living with HIV in Haiti, 2013-2017

Studies of viral suppression on first-line antiretroviral therapy (ART) in persons living with human immunodeficiency virus (PLHIV) in Haiti are limited, particularly among PLHIV outside of the Ouest department, where the capital Port-au-Prince is located. This study described the prevalence and risk factors for delayed viral suppression among PLHIV in all geographic departments of Haiti between 2013 and 2017. Individuals who received viral load testing 3 to 12 months after ART initiation were included. Data on demographics and clinical care were obtained from the Haitian Active Longitudinal Tracking of HIV database. Multivariable logistic regression was performed to predict delayed viral suppression, defined as a viral load ≥1000 HIV-1 RNA copies/mL after at least 3 months on ART. Viral load test results were available for 3,368 PLHIV newly-initiated on ART. Prevalence of delayed viral suppression was 40%, which is slightly higher than previous estimates in Haiti. In the multivariable analysis, delayed viral suppression was significantly associated with younger age, receiving of care in the Ouest department, treatment with lamivudine (3TC), zidovudine (AZT), and nevirapine (NVP) combined ART regimen, and CD4 counts below 200 cells/mm3. In conclusion, this study was the first to describe and compare differences in delayed viral suppression among PLHIV by geographic department in Haiti. We identified populations to whom public health interventions, such as more frequent viral load testing, drug resistance testing, and ART adherence counseling should be targeted

Attrition from antiretroviral treatment services among pregnant and non-pregnant patients following adoption of Option B plus in Haiti

TUAD02 - Optimizing PMTCT Programme Implementation (Oral Abstract Session)INTRODUCTION: Attrition from antiretroviral treatment (ART) services is an important determinant of HIV treatment outcomes. This study assessed factors associated with attrition among pregnant and non-pregnant patients initiating ART following adoption of Option B+ (universal ART eligibility for HIV-infected pregnant women) in October 2012 in Haiti. METHODS: Electronic medical records of adult patients initiated on ART from October 2012 to August 2014 at 73 health facilities (HF) from 8 of 10 Haitian administrative departments were analyzed. Within a survival analysis framework, attrition was defined as the first instance of failure to attend a HF visit for 90 days after a missed clinical or pharmacy-dispensing appointment, or an officially-recorded programme discontinuation, whichever came first. Known transfers to alternative HF were treated as censored observations, not attrition cases. ART initiations during or within 12 weeks after pregnancy were deemed Option B+ cases. The Kaplan-Meier method and Cox proportional hazards regression, stratified by HF, were used to determine attrition and associated factors. RESULTS: Among 17,084 patients who initiated ART, 7719 (45.2%) were non-pregnant women, 5920 (34.7%) were men and 3445 (20.2%) were pregnant women. At six months, attrition was 15.6% (95% confidence interval (CI): 14.8–16.4) for non-pregnant women, 17.0% (16.1–18.0) for men and 30.1% (28.5–31.7) for pregnant women. At 12 months, attrition was 31.8% (95% CI: 30.6–33.0), 34.5% (33.2–35.9) and 50.8% (49.0–52.6) respectively. Adjusted for patient-level factors and HF, attrition risk was 63% higher among pregnant women and 16% higher among men, compared to non-pregnant women (p<0.001). Significant protective factors included: receiving psychosocial counselling (hazard ratio (HR): 0.84, p<0.001); cotrimoxazole prophylaxis (HR: 0.83, p<0.001); tuberculosis treatment (HR: 0.88, p<0.001) before ART initiation; having an HIV-positive household member (HR: 0.80, p<0.05); living in the same commune as the HF (HR: 0.94, p<0.05), and greater duration of pre-ART enrolment (HR: 0.99 for each 30-day increase, p<0.001). CONCLUSIONS: Following adoption of Option B+, ART attrition in Haiti was higher than that described in published reports from other resource-limited settings. Early, sustained and tailored interventions are urgently needed to reduce ART attrition in Haiti, particularly among pregnant women.link_to_OA_fulltex

Glutathione and abscisic acid supplementation influences somatic embryo maturation and hormone endogenous levels during somatic embryogenesis in Podocarpus lambertii Klotzsch ex Endl.

Here we propose a protocol for embryogenic cultures induction, proliferation and maturation for the Brazilian conifer Podocarpus lambertii, and investigated the effect of abscisic acid (ABA) and glutathione (GSH) supplementation on the maturation phase. ABA, zeatin (Z) and salicylic acid (SA) endogenous levels were quantified. Number of somatic embryos obtained in ABA-supplemented treatment was signifi- cant higher than in ABA-free treatment, showing the relevance of ABA supplementation during somatic embryos maturation. Histological analysis showed the stereotyped sequence of developmental stages in conifer somatic embryos, reaching the late torpedo-staged embryo. GSH supplementation in maturation culture medium improved the somatic embryos number and morphological features. GSH 0 mM and GSH 0.1 mM treatments correlated with a decreased ABA endogenous level during maturation, while GSH 0.5 mM treatment showed constantlevels. Alltreatments resulted in decreased Z endogenous levels, supporting the concept that cytokinins are important during the initial cell division but not for the later stages of embryo development. The lowest SA levels found in GSH 0.5 mM treatment were coincident with early embryonic development, and this treatment resulted in the highest development of somatic embryos. Thus, a correlation between lower SA levels and improved somatic embryo formation can be hypothesized201

Glutathione and abscisic acid supplementation influences somatic embryo maturation and hormone endogenous levels during somatic embryogenesis in Podocarpus lambertii Klotzsch ex Endl.

Here we propose a protocol for embryogenic cultures induction, proliferation and maturation for the Brazilian conifer Podocarpus lambertii, and investigated the effect of abscisic acid (ABA) and glutathione (GSH) supplementation on the maturation phase. ABA, zeatin (Z) and salicylic acid (SA) endogenous levels were quantified. Number of somatic embryos obtained in ABA-supplemented treatment was signifi- cant higher than in ABA-free treatment, showing the relevance of ABA supplementation during somatic embryos maturation. Histological analysis showed the stereotyped sequence of developmental stages in conifer somatic embryos, reaching the late torpedo-staged embryo. GSH supplementation in maturation culture medium improved the somatic embryos number and morphological features. GSH 0 mM and GSH 0.1 mM treatments correlated with a decreased ABA endogenous level during maturation, while GSH 0.5 mM treatment showed constantlevels. Alltreatments resulted in decreased Z endogenous levels, supporting the concept that cytokinins are important during the initial cell division but not for the later stages of embryo development. The lowest SA levels found in GSH 0.5 mM treatment were coincident with early embryonic development, and this treatment resulted in the highest development of somatic embryos. Thus, a correlation between lower SA levels and improved somatic embryo formation can be hypothesize