9 research outputs found
Agroforestry : an appropriate and sustainable response to a changing climate in Southern Africa?
- Author
- Publication venue
- 'MDPI AG'
- Publication date
- 21/08/2020
- Field of study
Get PDFCITATION: Sheppard, Jonathan P. et al. 2020. Agroforestry : an appropriate and sustainable response to a changing climate in Southern Africa? Sustainability 12(17):6796, doi:10.3390/su12176796.The original publication is available at: https://www.mdpi.comENGLISH ABSTRACT: Agroforestry is often discussed as a strategy that can be used both for the adaptation to and
the mitigation of climate change e ects. The climate of southern Africa is predicted to be severely
a ected by such changes. With agriculture noted as the continentâs largest economic sector, issues
such as food security and land degradation are in the forefront. In the light of such concerns we
review the current literature to investigate if agroforestry systems (AFS) are a suitable response to the
challenges besetting traditional agricultural caused by a changing climate. The benefits bestowed by
AFS are multiple, o ering ecosystem services, influence over crop production and positive impacts on
rural livelihoods through provisioning and income generation. Nevertheless, knowledge gaps remain.
We identify outstanding questions requiring further investigation such as the interplay between trees
and crops and their combination, with a discussion of potential benefits. Furthermore, we identify
deficiencies in the institutional and policy frameworks that underlie the adoption and stimulus of
AFS in the southern African region. We uphold the concept that AFS remains an appropriate and
sustainable response for an increased resilience against a changing climate in southern Africa for the
benefit of livelihoods and multiple environmental values.Publisher's versio
Track D Social Science, Human Rights and Political Science
- Author
- Abdelrahman E.
- Abramovitz D.
- Aburto HernĂĄndez K.e.
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- Publication venue
- 'International AIDS Society'
- Publication date
- 01/10/2012
- Field of study
Full text linkPeer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/138414/1/jia218442.pd
Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK.
- Author
- Aban Marites
- Abayomi Fatola
- Abeyskera Kushala
- Aboagye Jeremy
- Adam Matthew
- Adams Kirsty
- Adamson James
- Adelaja Yemi A.
- Adlou Syed
- Ahmed Khatija
- Akhalwaya Saajida
- Akhalwaya Yasmeen
- Alcock Andrew
- Aley Parvinder K.
- Ali Aabidah
- Allen Elizabeth R.
- Allen Lauren
- Almeida Thamires C. D. S. C
- Alves Mariana P.S.
- Amorim Fabio
- Andritsou Foteini
- Angus Brian
- Anslow Rachel
- Appleby Matthew
- Arbe-Barnes Edward H.
- Ariaans Mark P.
- Arns Beatriz
- Arruda Laiana
- Awedetan Gbadebo
- Azi Lorena
- Azi Paula
- Babbage Gavin
- Bailey Catherine
- Baillie Vicky L.
- Baker Kenneth F.
- Baker Megan
- Baker Natalie
- Baker Philip
- Baldwin Lisa
- Baleanu Ioana
- Bandeira Danieli
- Bara Anna
- Barbosa Marcella A.S.
- Barker Debbie
- Barlow Gavin D.
- Barnabas Shaun L.
- Barnes Eleanor
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- Barrett Jessica
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- Bates Louise
- Batten Alexander
- Beadon Kirsten
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- Beckley Rebecca
- Belij-Rammerstorfer Sandra
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- Bellamy Duncan
- Bellei Nancy
- Belton Sue
- Berg Adam
- Bermejo Laura
- Berrie Eleanor
- Berry Lisa
- Berzenyi Daniella
- Beveridge Amy
- Bewley Kevin R.
- Bexhell Helen
- Bhikha Sutika
- Bhorat Asad E.
- Bhorat Qasim E.
- Bhorat Zaheda E.
- Bibi Sagida
- Bijker Else
- Birch Geeta
- Birch Sarah
- Bird Adam
- Bird Olivia
- Bisnauthsing Karen
- Bittaye Mustapha
- Blackstone Katherine
- Blackwell Luke
- Bletchly Heather
- Blundell Caitlin L.
- Blundell Susannah R.
- Bodalia Pritesh
- Boettger Bruno C.
- Bolam Emma
- Boland Elena
- Bormans Daan
- Borthwick Nicola
- Bowring Francesca
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- Bruce Scott
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- Bulbulia Yusuf A.
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- Buttigieg Karen R.
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- Castro Lucia Carratala
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- Cavey Ana
- Cerbino-Neto José
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- Charlton Sue
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- Chester Oliver
- Chita Sunder
- Cho Jee-Sun
- Cicconi Paola
- Cifuentes Liliana
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- Collins Sarah L.K.
- Conlon Christopher P.
- Connarty Sean
- Coombes Naomi
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- Davies Sarah L.
- Davis Elizabeth
- Davis John
- Davis Judith
- De Jager Jeanne
- De Nobrega Maristela M.D.
- De Oliveira Kalid Lis Moreno
- Dearlove David
- Demissie Tesfaye
- Desai Amisha
- Dheda Keertan
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- Di Maso Claudio
- Dinelli Maria I.S.
- Dinesh Tanya
- Docksey Claire
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- Dong Tao
- Donnellan Francesca R.
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- Douglas Naomi
- Downing Charlotte
- Drake Jonathan
- Drake-Brockman Rachael
- Driver Kimberley
- Drury Ruth
- Du Plessis Joan
- Dunachie Susanna J.
- Duncan Christopher J. A.
- Durham Benjamin S.
- Dutra Lidiana
- Easom Nicholas J.W.
- Edwards Mandy
- Edwards Nick J.
- El Muhanna Omar M.
- Elias Sean C.
- Elmore Mike
- Emary Katherine R. W.
- English Marcus
- Esmail Alisgair
- Essack Yakub Moosa
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- Fairlie Lee
- Farmer Eoghan
- Farooq Mutjaba
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- Farrugia Leonard
- Faulkner Beverley
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- Furze Julie
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- Galiza Eva
- Garlant Harriet
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- Gilbert Sarah C
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- Glynn Sharon
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- Harris Clair
- Harris Stephanie A.
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- Hartnell Birgit
- Hassan Shadin
- Haughney John
- Hawkins Sophia
- Hay Jodie
- Head Ian
- Heath Paul T.
- Henry John
- Hermosin Herrera Macarena
- Hettle David B.
- Hill Adrian V. S.
- Hill Catherine
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- Hodgson Susanne H. C.
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- Hurley Katrina
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- Ikram Sabina
- Ishwarbhai Alka
- Ivan Monica
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- Jackson Frederic
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- Jaumdally Shameem
- Jeffers Helen
- Jenkin Daniel
- Jesudason Natasha
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- Jones Christopher
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- Joshi Amar
- JĂșnior Eduardo A.M.S.
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- Larwood Jessica P.J.
- Law Rebecca
- Lawrie Alison M.
- Lazarus Erica M.
- Lazarus Rajeka
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- Lelliott Alice
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- Libri Vincenzo
- Lillie Patrick J.
- Linder Aline
- Lipworth Samuel
- Liu Shuchang
- Liu Xinxue
- Lloyd Adam
- Lloyd Stephanie
- Loew Lisa
- Lopez Ramon Raquel
- Lora Leandro
- Lowthorpe Vicki
- Luz Kleber
- MacDonald Jonathan C.
- MacGregor Gordon
- Madhavan Meera
- Madhi Shabir A.
- Mainwaring David O.
- Makambwa Edson
- Makinson Rebecca
- Malahleha Mookho
- Malamatsho Ross
- Mallett Garry
- Mallory Raburn
- Mansatta Kushal
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- McEwan Joanne
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- McInroy Lorna
- McIntyre Zoe
- McLenaghan Daniela
- McRobert Nicky
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- Taylor Iona Jennifer
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- te Water Naude Rebecca
- Themistocleous Andreas
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- Tiongson Gerlynn
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- Ulaszewska Marta
- Underwood Benjamin R.
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- Varughese Rachel
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- Verbart Dennis
- Verheul Marije
- Vichos Iason
- Vieira Taiane
- Villafana Tonya L.
- Voysey Merryn
- Waddington Claire S.
- Walker Laura
- Wallis Erica
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- Warimwe George
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- Watson Ekaterina
- Watson Marion E. E.
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- Webb-Bridges Alice
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- Wells Jeanette
- West Alison
- White Caroline
- White Rachel
- Williams Christopher J.
- Williams Paul
- Williams Rachel L.
- Winslow Rebecca
- Woodyer Mark
- Worth Andrew T.
- Wright Danny
- Wroblewska Marzena
- Yao Andy
- Zimmer Rafael
- Zizi Dalila
- Zuidewind Peter
- Publication venue
- 'Elsevier BV'
- Publication date
- 03/12/2020
- Field of study
Get PDFBACKGROUND: A safe and efficacious vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), if deployed with high coverage, could contribute to the control of the COVID-19 pandemic. We evaluated the safety and efficacy of the ChAdOx1 nCoV-19 vaccine in a pooled interim analysis of four trials. METHODS: This analysis includes data from four ongoing blinded, randomised, controlled trials done across the UK, Brazil, and South Africa. Participants aged 18 years and older were randomly assigned (1:1) to ChAdOx1 nCoV-19 vaccine or control (meningococcal group A, C, W, and Y conjugate vaccine or saline). Participants in the ChAdOx1 nCoV-19 group received two doses containing 5âĂâ1010 viral particles (standard dose; SD/SD cohort); a subset in the UK trial received a half dose as their first dose (low dose) and a standard dose as their second dose (LD/SD cohort). The primary efficacy analysis included symptomatic COVID-19 in seronegative participants with a nucleic acid amplification test-positive swab more than 14 days after a second dose of vaccine. Participants were analysed according to treatment received, with data cutoff on Nov 4, 2020. Vaccine efficacy was calculated as 1â-ârelative risk derived from a robust Poisson regression model adjusted for age. Studies are registered at ISRCTN89951424 and ClinicalTrials.gov, NCT04324606, NCT04400838, and NCT04444674. FINDINGS: Between April 23 and Nov 4, 2020, 23â848 participants were enrolled and 11â636 participants (7548 in the UK, 4088 in Brazil) were included in the interim primary efficacy analysis. In participants who received two standard doses, vaccine efficacy was 62·1% (95% CI 41·0-75·7; 27 [0·6%] of 4440 in the ChAdOx1 nCoV-19 group vs71 [1·6%] of 4455 in the control group) and in participants who received a low dose followed by a standard dose, efficacy was 90·0% (67·4-97·0; three [0·2%] of 1367 vs 30 [2·2%] of 1374; pinteraction=0·010). Overall vaccine efficacy across both groups was 70·4% (95·8% CI 54·8-80·6; 30 [0·5%] of 5807 vs 101 [1·7%] of 5829). From 21 days after the first dose, there were ten cases hospitalised for COVID-19, all in the control arm; two were classified as severe COVID-19, including one death. There were 74â341 person-months of safety follow-up (median 3·4 months, IQR 1·3-4·8): 175 severe adverse events occurred in 168 participants, 84 events in the ChAdOx1 nCoV-19 group and 91 in the control group. Three events were classified as possibly related to a vaccine: one in the ChAdOx1 nCoV-19 group, one in the control group, and one in a participant who remains masked to group allocation. INTERPRETATION: ChAdOx1 nCoV-19 has an acceptable safety profile and has been found to be efficacious against symptomatic COVID-19 in this interim analysis of ongoing clinical trials. FUNDING: UK Research and Innovation, National Institutes for Health Research (NIHR), Coalition for Epidemic Preparedness Innovations, Bill & Melinda Gates Foundation, Lemann Foundation, Rede D'Or, Brava and Telles Foundation, NIHR Oxford Biomedical Research Centre, Thames Valley and South Midland's NIHR Clinical Research Network, and AstraZeneca
Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK
- Author
- Aban Marites
- Abayomi Fatola
- Abeyskera Kushala
- Aboagye Jeremy
- Adam Matthew
- Adams Kirsty
- Adamson James
- Adelaja Yemi A.
- Adlou Syed
- Ahmed Khatija
- Akhalwaya Saajida
- Akhalwaya Yasmeen
- Alcock Andrew
- Aley Parvinder K.
- Ali Aabidah
- Allen Elizabeth R.
- Allen Lauren
- Almeida Thamires C. D. S. C
- Alves Mariana P.S.
- Amorim Fabio
- Andritsou Foteini
- Angus Brian
- Anslow Rachel
- Appleby Matthew
- Arbe-Barnes Edward H.
- Ariaans Mark P.
- Arns Beatriz
- Arruda Laiana
- Awedetan Gbadebo
- Azi Lorena
- Azi Paula
- Babbage Gavin
- Bailey Catherine
- Baillie Vicky L.
- Baker Kenneth F.
- Baker Megan
- Baker Natalie
- Baker Philip
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- Baleanu Ioana
- Bandeira Danieli
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- Barbosa Marcella A.S.
- Barker Debbie
- Barlow Gavin D.
- Barnabas Shaun L.
- Barnes Eleanor
- Barr Andrew S.
- Barrett Jessica
- Barrett Jordan R.
- Bates Louise
- Batten Alexander
- Beadon Kirsten
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- Beckley Rebecca
- Belij-Rammerstorfer Sandra
- Bell Jonathan
- Bellamy Duncan
- Bellei Nancy
- Belton Sue
- Berg Adam
- Bermejo Laura
- Berrie Eleanor
- Berry Lisa
- Berzenyi Daniella
- Beveridge Amy
- Bewley Kevin R.
- Bexhell Helen
- Bhikha Sutika
- Bhorat Asad E.
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- Bhorat Zaheda E.
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- Cerbino-Neto José
- Chadwick Jim
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- Charlton Sue
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- Chester Oliver
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- Conlon Christopher P.
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- Ikram Sabina
- Ishwarbhai Alka
- Ivan Monica
- Iveson Poppy
- Iyer Vidyashankara
- Izu Alane
- Jackson Frederic
- Jackson Susan
- Jaumdally Shameem
- Jeffers Helen
- Jenkin Daniel
- Jesudason Natasha
- Joe Carina C. D.
- Jones Bryony
- Jones Christopher
- Jones Elizabeth
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- Jose Aylin
- Joshi Amar
- JĂșnior Eduardo A.M.S.
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- Lias Amelia M.
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- Libri Vincenzo
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- Linder Aline
- Lipworth Samuel
- Liu Shuchang
- Liu Xinxue
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- Loew Lisa
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- MacGregor Gordon
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- Makambwa Edson
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- Mallett Garry
- Mallory Raburn
- Mansatta Kushal
- Maoko Takalani
- Mapetla Katlego
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- McGregor Alastair
- McInroy Lorna
- McIntyre Zoe
- McLenaghan Daniela
- McRobert Nicky
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- Mpelembue Mushiya
- Msomi Sibekezelo
- Mugodi Yvonne
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- Muller Jilly
- Munro Alasdair
- Munro Claire
- Murphy Sarah
- Mweu Philomena
- Myasaki Celia Hatsuko
- Naik Gurudutt
- Naker Kush
- Nana Anusha
- Nastouli Eleni
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- Ndlovu Bongani
- Neffa Fabio
- Njenga Cecilia
- Noal Helena
- Novaes Gabrielle
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- O'Brien Katie
- O'Connor Daniel
- O'Reilly Paula
- O'Reilly Peter J.
- Odam Miranda
- Oelofse Suzette
- Oguti Blanche
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- Oldfield Neil J.
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- Pacurar Mihaela
- Padayachee Sherman D.
- Paiva Brenda V.B.
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- Parkinson Sivapriyai
- Parracho Helena M.R.T.
- Parsons Karen
- Patel Bhumika
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- Patel Faeezah
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- Perring James
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- Perumal Rubeshan
- Petkar Sahir
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- Pickup Lorinda
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- Ramasamy Maheshi N.
- Ramos Lopez Fernando
- Ramos Alberto San Francisco
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- Ratcliffe Helen
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- Tiongson Gerlynn
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- Ulaszewska Marta
- Underwood Benjamin R.
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- Varughese Rachel
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- Verbart Dennis
- Verheul Marije
- Vichos Iason
- Vieira Taiane
- Villafana Tonya L.
- Voysey Merryn
- Waddington Claire S.
- Walker Laura
- Wallis Erica
- Wand Matthew
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- Warimwe George
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- Watkins Bridget
- Watson Ekaterina
- Watson Marion E. E.
- Webb Stewart
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- Weckx Lily Y.
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- West Alison
- White Caroline
- White Rachel
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- Williams Paul
- Williams Rachel L.
- Winslow Rebecca
- Woodyer Mark
- Worth Andrew T.
- Wright Danny
- Wroblewska Marzena
- Yao Andy
- Zimmer Rafael
- Zizi Dalila
- Zuidewind Peter
- Publication venue
- 'Elsevier BV'
- Publication date
- 09/01/2021
- Field of study
Get PDFBackground
A safe and efficacious vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), if deployed with high coverage, could contribute to the control of the COVID-19 pandemic. We evaluated the safety and efficacy of the ChAdOx1 nCoV-19 vaccine in a pooled interim analysis of four trials.
Methods
This analysis includes data from four ongoing blinded, randomised, controlled trials done across the UK, Brazil, and South Africa. Participants aged 18 years and older were randomly assigned (1:1) to ChAdOx1 nCoV-19 vaccine or control (meningococcal group A, C, W, and Y conjugate vaccine or saline). Participants in the ChAdOx1 nCoV-19 group received two doses containing 5âĂâ1010 viral particles (standard dose; SD/SD cohort); a subset in the UK trial received a half dose as their first dose (low dose) and a standard dose as their second dose (LD/SD cohort). The primary efficacy analysis included symptomatic COVID-19 in seronegative participants with a nucleic acid amplification test-positive swab more than 14 days after a second dose of vaccine. Participants were analysed according to treatment received, with data cutoff on Nov 4, 2020. Vaccine efficacy was calculated as 1â-ârelative risk derived from a robust Poisson regression model adjusted for age. Studies are registered at ISRCTN89951424 and ClinicalTrials.gov, NCT04324606, NCT04400838, and NCT04444674.
Findings
Between April 23 and Nov 4, 2020, 23â848 participants were enrolled and 11â636 participants (7548 in the UK, 4088 in Brazil) were included in the interim primary efficacy analysis. In participants who received two standard doses, vaccine efficacy was 62·1% (95% CI 41·0â75·7; 27 [0·6%] of 4440 in the ChAdOx1 nCoV-19 group vs71 [1·6%] of 4455 in the control group) and in participants who received a low dose followed by a standard dose, efficacy was 90·0% (67·4â97·0; three [0·2%] of 1367 vs 30 [2·2%] of 1374; pinteraction=0·010). Overall vaccine efficacy across both groups was 70·4% (95·8% CI 54·8â80·6; 30 [0·5%] of 5807 vs 101 [1·7%] of 5829). From 21 days after the first dose, there were ten cases hospitalised for COVID-19, all in the control arm; two were classified as severe COVID-19, including one death. There were 74â341 person-months of safety follow-up (median 3·4 months, IQR 1·3â4·8): 175 severe adverse events occurred in 168 participants, 84 events in the ChAdOx1 nCoV-19 group and 91 in the control group. Three events were classified as possibly related to a vaccine: one in the ChAdOx1 nCoV-19 group, one in the control group, and one in a participant who remains masked to group allocation.
Interpretation
ChAdOx1 nCoV-19 has an acceptable safety profile and has been found to be efficacious against symptomatic COVID-19 in this interim analysis of ongoing clinical trials
Management Versus Preservation: Archaeological Heritage Management in a Transforming South Africa
- Author
- Publication venue
- 'Maney Publishing'
- Publication date
- Field of study
No full textAgroforestry: An Appropriate and Sustainable Response to a Changing Climate in Southern Africa?
- Author
- Publication venue
- MDPI
- Publication date
- 29/10/2020
- Field of study
Get PDFAgroforestry is often discussed as a strategy that can be used both for the adaptation to and the mitigation of climate change effects. The climate of southern Africa is predicted to be severely affected by such changes. With agriculture noted as the continentâs largest economic sector, issues such as food security and land degradation are in the forefront. In the light of such concerns we review the current literature to investigate if agroforestry systems (AFS) are a suitable response to the challenges besetting traditional agricultural caused by a changing climate. The benefits bestowed by AFS are multiple, offering ecosystem services, influence over crop production and positive impacts on rural livelihoods through provisioning and income generation. Nevertheless, knowledge gaps remain. We identify outstanding questions requiring further investigation such as the interplay between trees and crops and their combination, with a discussion of potential benefits. Furthermore, we identify deficiencies in the institutional and policy frameworks that underlie the adoption and stimulus of AFS in the southern African region. We uphold the concept that AFS remains an appropriate and sustainable response for an increased resilience against a changing climate in southern Africa for the benefit of livelihoods and multiple environmental values
Adolescents and Parentsâ Â Perceptions of Condom Distribution in Selected Secondary Schools in the High Density Suburbs of Bulawayo, Zimbabwe
- Author
- A Bankole
- A McKay
- B Stanton
- Brighton Ndlovu
- D Fallon
- DL Dell
- DM Shoop
- DW Dahl
- E Boohene
- E Coast
- E Mpofu
- E Tachiweyika
- F Mantula
- H de Graaf
- H Schaalma
- HN Boone
- IE Allen
- KK Holmes
- KM Grace
- L CastrĂŹ
- LR Clark
- M Kambarami
- MA Malina
- MK Smith
- Nicholas Mudonhi
- Nkosana Khumalo
- Oliver Dube
- P OâByrne
- P Pradhan
- RC Garner
- RD Masa
- RJ DiClemente
- RN Lancaster
- S Moore
- SH Hounton
- SM Kegeles
- T Trinh
- United Nations
- W Cates Jr
- W Pequegnat
- Wilfred Njabulo Nunu
- Publication venue
- 'Springer Science and Business Media LLC'
- Publication date
- Field of study
No full text8th IAS Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2015).
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- Abdel-Mohsen M
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- Vaudry W
- Veloso VG
- Veloso VG
- Venter F
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- Vermillion M
- Vernazza P
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- Vittinghoff E
- Volberding P
- Volokha A
- von Werder A
- Vu QD
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- Wainfen W
- Walker BD
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- Woelk G
- Wolf E
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- Wood E
- Wood E
- Wood E
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- Wu HL
- Wu V
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- Wylie JL
- Xaba T
- Xia G
- Xiao H
- Xing Y
- Xu D
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- Xu X
- Yang B
- Yang JC
- Yang L
- Yao KA
- Yassi A
- Yates N
- Yazdanpanah Y
- Yin M
- Yindom L-M
- Yotebieng M
- Young J
- Young P
- Youngleson M
- Yu Y
- Zablotska I
- Zamor P
- Zang O
- Zash R
- Zerbe A
- Zhang M
- Zhang Y
- Zhang Y
- Zhou S
- Zhuang M
- Ziegler JB
- Zink A
- Zink C
- Zolla-Pazner S
- Zolopa A
- Zolowere DB
- Zou H
- Zuma N
- ĂsbjörnsdĂłttir KH
- Ăvila-RĂos S
- Publication venue
- 'International AIDS Society'
- Publication date
- 01/01/2015
- Field of study
No full textEnhanced infection prophylaxis reduces mortality in severely immunosuppressed HIV-infected adults and older children initiating antiretroviral therapy in Kenya, Malawi, Uganda and Zimbabwe: the REALITY trial
- Author
- Abach J
- Abdallah J
- Abdallah S
- Abdallah S
- Aberle-Grasse J
- Abimiku A
- Abishev A
- Abongomera G
- Aboud M
- Aboud M
- Abramovitz D
- Abrams E
- Abrams E
- Abrams E
- Abrams E
- Abravaya K
- Abreu L
- Achra A
- Adera F
- Adetokunboh O
- Adeyemi O
- Adeyemi O
- Adipo T
- Affolabi D
- Agegnehu D
- Agius P
- Agolory S
- Agot K
- Agot K
- Agovi A-A
- Aguiar P
- Aguilar-Martinez J
- Agutu C
- Ahmed M
- Ahmed R
- Ahmed S
- Ahmed S
- Ahmed S
- Aizire J
- Ajibola G
- Ajok S
- Albert-Hope C
- Alejos B
- Alexander G
- Alicea C
- Allen H
- Allen M
- Allen S
- Allen S
- Allen S
- Alloui C
- Altice F
- Altice F
- Amara R
- Ambani A
- Ambrose K
- Amico R
- Amin J
- Amin T
- Amole C
- Amoros I
- Anahtar M
- Ananworanich J
- Ananworanich J
- Ancuta P
- Andama A
- Anderegg N
- Anderson A
- Anderson A
- Anderson E
- Anderson J
- Anderson J
- Anderson S
- Andersson M
- Andrade A
- Andrew E
- Andrew P
- Andrew P
- Andrews L
- Angel J
- Angelidou K
- Anglaret X
- Anoma C
- Ansari A
- Apetrei C
- Apetrei C
- Apetrei C
- Apetrei C
- Apetrei C
- Apollon A
- Apondi E
- Aptekar S
- Ardiet D
- Arellano G
- Arenas-Pinto A
- Arhel N
- Armstrong D
- Arthos J
- Artz L
- Arunmanakul A
- Asari V
- Asege L
- Asiimwe S
- Asiimwe S
- Asiimwe S
- Asokan M
- Aspin C
- Athiambo M
- Atuhumuza E
- Atujuna M
- Audet C
- Auerbach J
- Auld A
- Aung P
- Aurpibul L
- Aurpibul L
- Avalos A
- Avihingsanon A
- Avihingsanon A
- Avihingsanon A
- Awori Q
- Awotwi E
- Ayala V
- Ayalew M
- Ayaya S
- Ayieko J
- Ayieko J
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- Aylott A
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- Bwakura-Dangarembizi M
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- Chigayo M
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- Publication venue
- 'International AIDS Society'
- Publication date
- 01/01/2016
- Field of study
Get PDFMeeting abstract FRAB0101LB from 21st International AIDS Conference 18â22 July 2016, Durban, South Africa.
Introduction: Mortality from infections is high in the first 6 months of antiretroviral therapy (ART) among HIVâinfected adults and children with advanced disease in subâSaharan Africa. Whether an enhanced package of infection prophylaxis at ART initiation would reduce mortality is unknown.
Methods:
The REALITY 2Ă2Ă2 factorial openâlabel trial (ISRCTN43622374) randomized ARTânaĂŻve HIVâinfected adults and children >5 years with CD4 <100 cells/mm3. This randomization compared initiating ART with enhanced prophylaxis (continuous cotrimoxazole plus 12 weeks isoniazid/pyridoxine (antiâtuberculosis) and fluconazole (antiâcryptococcal/candida), 5 days azithromycin (antiâbacterial/protozoal) and singleâdose albendazole (antiâhelminth)), versus standardâofâcare cotrimoxazole. Isoniazid/pyridoxine/cotrimoxazole was formulated as a scored fixedâdose combination. Two other randomizations investigated 12âweek adjunctive raltegravir or supplementary food. The primary endpoint was 24âweek mortality.
Results:
1805 eligible adults (n = 1733; 96.0%) and children/adolescents (n = 72; 4.0%) (median 36 years; 53.2% male) were randomized to enhanced (n = 906) or standard prophylaxis (n = 899) and followed for 48 weeks (3.8% lossâtoâfollowâup). Median baseline CD4 was 36 cells/mm3 (IQR: 16â62) but 47.3% were WHO Stage 1/2. 80 (8.9%) enhanced versus 108(12.2%) standard prophylaxis died before 24 weeks (adjusted hazard ratio (aHR) = 0.73 (95% CI: 0.54â0.97) p = 0.03; Figure 1) and 98(11.0%) versus 127(14.4%) respectively died before 48 weeks (aHR = 0.75 (0.58â0.98) p = 0.04), with no evidence of interaction with the two other randomizations (p > 0.8). Enhanced prophylaxis significantly reduced incidence of tuberculosis (p = 0.02), cryptococcal disease (p = 0.01), oral/oesophageal candidiasis (p = 0.02), deaths of unknown cause (p = 0.02) and (marginally) hospitalisations (p = 0.06) but not presumed severe bacterial infections (p = 0.38). Serious and grade 4 adverse events were marginally less common with enhanced prophylaxis (p = 0.06). CD4 increases and VL suppression were similar between groups (p > 0.2).
Conclusions:
Enhanced infection prophylaxis at ART initiation reduces early mortality by 25% among HIVâinfected adults and children with advanced disease. The pill burden did not adversely affect VL suppression. Policy makers should consider adopting and implementing this lowâcost broad infection prevention package which could save 3.3 lives for every 100 individuals treated
