Early detection of Pre-XDR TB with line probe assay in a high TB burden country

Background - Worldwide, tuberculosis (TB) is one of the top 10 causes of death. Drug resistant tuberculosis has lately become a major public health problem that threatens progress made in Tuberculosis (TB) care and control worldwide. The aim of this study was to determine the prevalence of Pre-extensive drug resistant TB among MDR TB in North Central of Nigeria. Methods - This study was conducted from October, 2018 to August, 2019 with 150 samples. In Nigeria, guidelines for DR-TB as recommended by WHO is followed. All the samples from the patients who gave their consent were transported to a zonal reference TB laboratory (ZRL). Results - Mean age was 38.6 \ub1 13.4 years with peak age at 35-44. Out of these 103 samples processed with LPA, 101(98%) were rifampicin resistant and 2 were rifampicin sensitive, 99(96%) were INH resistant and 4 (4%) were INH sensitive, 5(5%) were fluoroquinolone resistant, 98(95%) were fluoroquinolone sensitive, 12 (12%) were Aminoglycoside + Capreomycin resistant, 91(83%) were Aminoglycoside + Capreomycin sensitive. Conclusion - Multidrug resistant TB and its severe forms (Pre-extensive & extensively drug resistant TB) can be detected early with rapid tool- Line Probe Assay rapid and prevented timely by early initiation on treatment

Long-Term Outcomes on Antiretroviral Therapy in a Large Scale-Up Program in Nigeria

Background: While there has been a rapid global scale-up of antiretroviral therapy programs over the past decade, there are limited data on long-term outcomes from large cohorts in resource-constrained settings. Our objective in this evaluation was to measure multiple outcomes during first-line antiretroviral therapy in a large treatment program in Nigeria. Methods: We conducted a retrospective multi-site program evaluation of adult patients (age ≥15 years) initiating antiretroviral therapy between June 2004 and February 2012 in Nigeria. The baseline characteristics of patients were described and longitudinal analyses using primary endpoints of immunologic recovery, virologic rebound, treatment failure and long-term adherence patterns were conducted. Results: Of 70,002 patients, 65.2% were female and median age was 35 (IQR: 29–41) years; 54.7% were started on a zidovudine-containing and 40% on a tenofovir-containing first-line regimen. Median CD4+ cell counts for the cohort started at 149 cells/mm3 (IQR: 78–220) and increased over duration of ART. Of the 70,002 patients, 1.8% were reported as having died, 30.1% were lost to follow-up, and 0.1% withdrew from treatment. Overall, of those patients retained and with viral load data, 85.4% achieved viral suppression, with 69.3% achieving suppression by month 6. Of 30,792 patients evaluated for virologic failure, 24.4% met criteria for failure and of 45,130 evaluated for immunologic failure, 34.0% met criteria for immunologic failure, with immunologic criteria poorly predicting virologic failure. In adjusted analyses, older age, ART regimen, lower CD4+ cell count, higher viral load, and inadequate adherence were all predictors of virologic failure. Predictors of immunologic failure differed slightly, with age no longer predictive, but female sex as protective; additionally, higher baseline CD4+ cell count was also predictive of failure. Evaluation of long-term adherence patterns revealed that the majority of patients retained through 84 months maintained ≥95% adherence. Conclusion: While improved access to HIV care and treatment remains a challenge in Nigeria, our study shows that a high quality of care was achieved as evidenced by strong long-term clinical, immunologic and virologic outcomes

Median follow-up time on ART by first-line ART regimen, ARV-naïve patients (N = 70,002).

<p>Median follow-up time on ART by first-line ART regimen, ARV-naïve patients (N = 70,002).</p

Immunologic, virologic and adherence patterns by baseline CD4+ cell count, previously ARV-naïve patients (N = 70,002).

<p>Immunologic, virologic and adherence patterns by baseline CD4+ cell count, previously ARV-naïve patients (N = 70,002).</p

First-line ART regimen by enrollment year, ARV-naïve patients (N = 70,002).

<p>First-line ART regimen by enrollment year, ARV-naïve patients (N = 70,002).</p

Characterization of treatment failure over time.

<p>A) Virologic and immunologic failure rates over duration on ART, 95% CI; and, B) Percentage of patients with virologic failure within first 18 months on ART by enrollment year.</p

Clinical and virologic outcomes over duration on ART, ARV-naïve patients.

<p>A) median CD4+ cell count (cells/mm³) over time on ART; and, B) percentage of patients with virologic suppression (≤400 copies/mL) over time on ART.</p

Baseline patient status by enrollment year, ARV-naïve patients.

<p>A) median baseline CD4+cell count (cell/mm³); and, B) percentage patients by WHO clinical stage.</p

Flowchart highlighting enrolled patient population.

<p>Flowchart highlighting enrolled patient population.</p