The "ART" of Linkage: Pre-Treatment Loss to Care after HIV Diagnosis at Two PEPFAR Sites in Durban, South Africa

BACKGROUND. Although loss to follow-up after antiretroviral therapy (ART) initiation is increasingly recognized, little is known about pre-treatment losses to care (PTLC) after an initial positive HIV test. Our objective was to determine PTLC in newly identified HIV-infected individuals in South Africa. METHODOLOGY/PRINCIPAL FINDINGS. We assembled the South African Test, Identify and Link (STIAL) Cohort of persons presenting for HIV testing at two sites offering HIV and CD4 count testing and HIV care in Durban, South Africa. We defined PTLC as failure to have a CD4 count within 8 weeks of HIV diagnosis. We performed multivariate analysis to identify factors associated with PTLC. From November 2006 to May 2007, of 712 persons who underwent HIV testing and received their test result, 454 (64%) were HIV-positive. Of those, 206 (45%) had PTLC. Infected patients were significantly more likely to have PTLC if they lived =10 kilometers from the testing center (RR=1.37; 95% CI: 1.11-1.71), had a history of tuberculosis treatment (RR=1.26; 95% CI: 1.00-1.58), or were referred for testing by a health care provider rather than self-referred (RR=1.61; 95% CI: 1.22-2.13). Patients with one, two or three of these risks for PTLC were 1.88, 2.50 and 3.84 times more likely to have PTLC compared to those with no risk factors. CONCLUSIONS/SIGNIFICANCE. Nearly half of HIV-infected persons at two high prevalence sites in Durban, South Africa, failed to have CD4 counts following HIV diagnosis. These high rates of pre-treatment loss to care highlight the urgent need to improve rates of linkage to HIV care after an initial positive HIV test.US National Institute of Allergy and Infectious Diseases (R01 AI058736, K24 AI062476, K23 AI068458); the Harvard University Center for AIDS Research (P30 AI42851); National Institutes of Health (K24 AR 02123); the Doris Duke Charitable Foundation (Clinical Scientist Development Award); the Harvard University Program on AID

Factors Associated with Self-Reported Repeat HIV Testing after a Negative Result in Durban, South Africa

Background: Routine screening for HIV infection leads to early detection and treatment. We examined patient characteristics associated with repeated screening in a high prevalence country. Methods: We analyzed data from a cohort of 5,229 adults presenting for rapid HIV testing in the outpatient departments of 2 South African hospitals from November 2006 to August 2010. Patients were eligible if they were ≥18 years, reported no previous diagnosis with HIV infection, and not pregnant. Before testing, participants completed a questionnaire including gender, age, HIV testing history, health status, and knowledge about HIV and acquaintances with HIV. Enrollment HIV test results and CD4 counts were abstracted from the medical record. We present prevalence of HIV infection and median CD4 counts by HIV testing history (first-time vs. repeat). We estimated adjusted relative risks (ARR’s) for repeat testing by demographics, health status, and knowledge of HIV and others with HIV in a generalized linear model. Results: Of 4,877 participants with HIV test results available, 26% (N = 1258) were repeat testers. Repeat testers were less likely than first-time testers to be HIV-infected (34% vs. 54%, p<0.001). Median CD4 count was higher among repeat than first-time testers (201/uL vs. 147/uL, p<0.001). Among those HIV negative at enrollment (N = 2,499), repeat testing was more common among those with family or friends living with HIV (ARR 1.50, 95% CI: 1.33–1.68), women (ARR: 1.24, 95% CI: 1.11–1.40), and those self-reporting very good health (ARR: 1.28, 95% CI: 1.12–1.45). Conclusions: In this high prevalence setting, repeat testing was common among those undergoing HIV screening, and was associated with female sex, lower prevalence of HIV infection, and higher CD4 counts at diagnosis

Global change, global trade, and the next wave of plant invasions

Copyright © 2012 Ecological Society of AmericaMany non-native plants in the US have become problematic invaders of native and managed ecosystems, but a new generation of invasive species may be at our doorstep. Here, we review trends in the horticultural trade and invasion patterns of previously introduced species and show that novel species introductions from emerging horticultural trade partners are likely to rapidly increase invasion risk. At the same time, climate change and water restrictions are increasing demand for new types of species adapted to warm and dry environments. This confluence of forces could expose the US to a range of new invasive species, including many from tropical and semiarid Africa as well as the Middle East. Risk assessment strategies have proven successful elsewhere at identifying and preventing invasions, although some modifications are needed to address emerging threats. Now is the time to implement horticulture import screening measures to prevent this new wave of plant invasions.National Science Foundatio

Handbook for SDG-Aligned Food Companies: Four Pillar Framework Standards

The world food system is in crisis. Outright hunger, unhealthy diets and malnutrition occur parallel to food losses and waste. Farming families in poor countries suffer from extreme poverty. And food production is environmentally unsustainable and increasingly vulnerable to extreme weather events caused by climate change. A historic change of direction is needed to bring about a new era of food system sustainability. Our work aims to help companies, investors and other stakeholders move towards a more sustainable food system that is aligned with the Sustainable Development Goals. Transforming the world food system to achieve sustainability in all its dimensions is a major challenge. Achieving the Sustainable Development Goals will require managing major changes to the global food system responsibly, involving hundreds of millions of farmers and their families, global supply chains, thousands of food producing companies, diverse food production systems and local ecologies, food processing and a great diversity of food traditions and cultures. Food companies are engaged in food production, trade, processing, and consumer sales around the world. While they have distinct roles “from farm to fork,” they all share the same responsibility: to be part of the global transformation towards food system sustainability. For more on CCSI and SDSN’s work on corporate alignment with the Sustainable Development Goals, see our framework defining SDG-aligned business practices in the energy sector

Will extreme climatic events facilitate biological invasions?

Copyright © 2012 Ecological Society of AmericaExtreme climatic events (ECEs) – such as unusual heat waves, hurricanes, floods, and droughts – can dramatically affect ecological and evolutionary processes, and these events are projected to become more frequent and more intense with ongoing climate change. However, the implications of ECEs for biological invasions remain poorly understood. Using concepts and empirical evidence from invasion ecology, we identify mechanisms by which ECEs may influence the invasion process, from initial introduction through establishment and spread. We summarize how ECEs can enhance invasions by promoting the transport of propagules into new regions, by decreasing the resistance of native communities to establishment, and also sometimes by putting existing non-native species at a competitive disadvantage. Finally, we outline priority research areas and management approaches for anticipating future risks of unwanted invasions following ECEs. Given predicted increases in both ECE occurrence and rates of species introductions around the globe during the coming decades, there is an urgent need to understand how these two processes interact to affect ecosystem composition and functioning.National Science Foundatio

Integrated Assessment of Biological Invasions

As the main witnesses of the ecological and economic impacts of invasions on ecosystems around the world, ecologists seek to provide the relevant science that informs managers about the potential for invasion of specific organisms in their region(s) of interest. Yet, the assorted literature that could inform such forecasts is rarely integrated to do so, and further, the diverse nature of the data available complicates synthesis and quantitative prediction. Here we present a set of analytical tools for synthesizing different levels of distributional and/or demographic data to produce meaningful assessments of invasion potential that can guide management at multiple phases of ongoing invasions, from dispersal to colonization to proliferation. We illustrate the utility of data-synthesis and data-model assimilation approaches with case studies of three well-known invasive species—a vine, a marine mussel, and a freshwater crayfish—under current and projected future climatic conditions. Results from the integrated assessments reflect the complexity of the invasion process and show that the most relevant climatic variables can have contrasting effects or operate at different intensities across habitat types. As a consequence, for two of the study species climate trends will increase the likelihood of invasion in some habitats and decrease it in others. Our results identified and quantified both bottlenecks and windows of opportunity for invasion, mainly related to the role of human uses of the landscape or to disruption of the flow of resources. The approach we describe has a high potential to enhance model realism, explanatory insight, and predictive capability, generating information that can inform management decisions and optimize phase-specific prevention and control efforts for a wide range of biological invasions

Will Extreme Climatic Events Facilitate Biological Invasions?

Extreme climatic events (ECEs) – such as unusual heat waves, hurricanes, floods, and droughts – can dramatically affect ecological and evolutionary processes, and these events are projected to become more frequent and more intense with ongoing climate change. However, the implications of ECEs for biological invasions remain poorly understood. Using concepts and empirical evidence from invasion ecology, we identify mechanisms by which ECEs may influence the invasion process, from initial introduction through establishment and spread. We summarize how ECEs can enhance invasions by promoting the transport of propagules into new regions, by decreasing the resistance of native communities to establishment, and also sometimes by putting existing non-native species at a competitive disadvantage. Finally, we outline priority research areas and management approaches for anticipating future risks of unwanted invasions following ECEs. Given predicted increases in both ECE occurrence and rates of species introductions around the globe during the coming decades, there is an urgent need to understand how these two processes interact to affect ecosystem composition and functioning

The Linkage Outcomes of a Large-scale, Rapid Transfer of HIV-infected Patients From Hospital-based to Community-based Clinics in South Africa

Background: President's Emergency Plan for AIDS Relief (PEPFAR) funding changes have resulted in human immunodeficiency virus (HIV) clinic closures. We evaluated linkage to care following a large-scale patient transfer from a PEPFAR-funded, hospital-based HIV clinic to government-funded, community-based clinics in Durban. Methods: All adults were transferred between March and June 2012. Subjects were surveyed 5–10 months post-transfer to assess self-reported linkage to the target clinic. We validated self-reports by auditing records at 8 clinics. Overall success of transfer was estimated using linkage to care data for both reached and unreached subjects, adjusted for validation results. Results: Of the 3913 transferred patients, 756 (19%) were assigned to validation clinics; 659 (87%) of those patients were reached. Among those reached, 468 (71%) had a validated clinic record visit. Of the 46 who self-reported attending a different validation clinic than originally assigned, 39 (85%) had a validated visit. Of the 97 patients not reached, 59 (61%) had a validated visit at their assigned clinic. Based on the validation rates for reached and unreached patients, the estimated success of transfer for the cohort overall was 82%. Conclusions: Most patients reported successful transfer to a community-based clinic, though a quarter attended a different clinic than assigned. Validation of attendance highlights that nearly 20% of patients may not have linked to care and may have experienced a treatment interruption. Optimizing transfers of HIV care to community sites requires collaboration with receiving clinics to ensure successful linkage to care