Last data update: May 13, 2024. (Total: 46773 publications since 2009)
Records 1-7 (of 7 Records) |
Query Trace: Allam R[original query] |
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Implementation of point-of-care testing and prevalence of cryptococcal antigenaemia among patients with advanced HIV disease in Mumbai, India
Acharya S , Allam RR , Karanjkar VK , Rathod D , Mahajan R , Deshpande P , Palkar A , Todmal S , Koli S , Dhande S , Dale J , Yeldandi VV , Harshana A , Agarwal R , Upadhyaya S , Nyendak M . BMJ Open 2023 13 (6) e070500 OBJECTIVES: To describe the implementation of screening for cryptococcal antigenaemia by point-of-care (POC) serum cryptococcal antigen (CrAg) lateral flow assay, measure the prevalence and factors associated with serum cryptococcal antigenaemia in the routine programmatic setting. DESIGN: Cross-sectional study. SETTING: Seventeen publicly funded antiretroviral therapy (ART) centres in Mumbai, India. PARTICIPANTS: Serum CrAg screening was offered to all adolescents (>10 years of age) and adults with advanced HIV disease (AHD) (CD4 <200 cells/mm(3) or with WHO clinical stage III/IV) regardless of symptoms of cryptococcal meningitis. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was to describe the implementation of serum CrAg screening and secondary outcome was to measure the prevalence of serum cryptococcal antigenaemia and its risk factors. RESULTS: A total of 2715 patients with AHD were tested for serum CrAg by POC assay. Of these, 25 (0.9%) had a CrAg positive result. Among CrAg-positive patients, only one had symptoms. Serum CrAg positivity was 3.6% (6/169) and 1.6% (6/520) among those presenting with CD4 <100 cells/mm(3) in the treatment naïve and treatment experienced group, respectively. On multivariable analysis, CD4 count <100 cells/mm(3) (OR: 2.3, 95% CI 1.01 to 5.3; p=0.05) and people living with HIV who were treatment naïve (OR: 2.5, 95% CI 1.04 to 6.0; p=0.04) were significantly associated with a positive serum CrAg result. Lumbar puncture was obtained in 20/25 patients within 4 days (range: 1-4 days) of positive serum CrAg result and one person was confirmed to have meningitis. All serum CrAg-positive patients who had a negative cerebrospinal fluid CrAg were offered pre-emptive therapy. CONCLUSIONS: Implementation of a POC CrAg assay was possible with existing ART centre staff. Initiation of pre-emptive therapy and management of cryptococcal antigenaemia are operationally feasible at ART centres. The Indian National AIDS Control Programme may consider reflexive CrAg screening of all AHD patients with CD4 <100 cells/mm(3). |
Utility of the lateral flow urine lipoarabinomannan tuberculosis assay in patients with advanced HIV disease at antiretroviral therapy centres in Mumbai, India
Acharya S , Deshpande P , Asirvatham ES , Palkar A , Sarman CJ , Laxmeshwar C , Setia MS , Rathod D , Koli S , Dale J , Yeldandi V , Allam R , Agarwal R , Verma S , Upadhyaya S , Nyendak M . PLoS One 2022 17 (9) e0273970 BACKGROUND: People with Advanced HIV Disease (AHD) are at higher risk of TB coinfection and mortality. However, there are challenges in TB diagnosis with the currently recommended diagnostic tools. WHO recommends lateral flow urine lipoarabinomannan (LF-LAM) assay to assist TB diagnosis among AHD patients. We assessed the utility and acceptability of using urine LF-LAM assay for TB diagnosis among patients at public Antiretroviral Therapy (ART) Centres in Mumbai. METHODS: The cross-sectional study was conducted among adult AHD patients accessing care from 17 ART centres during November,2020-June, 2021. Urine LF-LAM was offered as routine care for eligible patients in combination with standard diagnostic tests. We calculated the proportion of positive LF-LAM results by CD4 categories and TB symptoms and performed multivariable logistic regression to determine the factors associated with LF-LAM positivity. RESULTS: Among 2,390 patients, the majority (74.5%) had CD4 between 101-200 cells/mm3. The mean age was 43.7 years (SD:10.6), 68.6% were male, 8.4% had TB symptoms and 88.0% were on ART. The overall proportion of patients with urine LF-LAM positive results was 6.4%. Among PLHIV with CD4≤100 cells/mm3, the positivity was 43.0% and 7.7% in symptomatic and asymptomatic patients, respectively. Among PLHIV with a CD4>100 cells/mm3, the positivity was 26.7% and 2.7% in symptomatic and asymptomatic patients respectively. Urine LF-LAM positivity was higher among inpatients, ART naïve, patients on treatment for <6 months, symptomatic and in WHO clinical stage III/IV of HIV disease as compared to the reference categories. We detected an additional 131 TB cases with urine LF-LAM in combination with the standard diagnostic tests. CONCLUSION: The study demonstrated the utility of urine LF-LAM for TB diagnosis among AHD patients and the simple, user-friendly test was acceptable as part of routine care. Inclusion of urine LF-LAM test in the current diagnostic algorithm may facilitate early TB diagnosis among AHD patients. |
Clade distribution of Candida auris in South Africa using whole genome sequencing of clinical and environmental isolates.
Naicker SD , Maphanga TG , Chow NA , Allam M , Kwenda S , Ismail A , Govender NPfor Germs- SA . Emerg Microbes Infect 2021 10 (1) 1300-1308 In South Africa, Candida auris was the third most common cause of candidemia in 2016-2017. We performed single nucleotide polymorphism (SNP) genome-wide analysis of 115 C. auris isolates collected between 2009 and 2018 from national laboratory-based surveillance, an environmental survey at four hospitals and a colonization study during a neonatal unit outbreak. The first known South African C. auris strain from 2009 clustered in clade IV. Overall, 98 strains clustered within clade III (85%), 14 within clade I (12%) and three within clade IV (3%). All environmental and colonizing strains clustered in clade III. We also identified known clade-specific resistance mutations in the ERG11 and FKS1 genes. Identification of clade I strains between 2016 and 2018 suggests introductions from South Asia followed by local transmission. SNP analysis characterized most C. auris strains into clade III, the clade first reported from South Africa, but the presence of clades I and IV strains also suggest early introductions from other regions. |
Outbreak of Listeriosis in South Africa Associated with Processed Meat.
Thomas J , Govender N , McCarthy KM , Erasmus LK , Doyle TJ , Allam M , Ismail A , Ramalwa N , Sekwadi P , Ntshoe G , Shonhiwa A , Essel V , Tau N , Smouse S , Ngomane HM , Disenyeng B , Page NA , Govender NP , Duse AG , Stewart R , Thomas T , Mahoney D , Tourdjman M , Disson O , Thouvenot P , Maury MM , Leclercq A , Lecuit M , Smith AM , Blumberg LH . N Engl J Med 2020 382 (7) 632-643 BACKGROUND: An outbreak of listeriosis was identified in South Africa in 2017. The source was unknown. METHODS: We conducted epidemiologic, trace-back, and environmental investigations and used whole-genome sequencing to type Listeria monocytogenes isolates. A case was defined as laboratory-confirmed L. monocytogenes infection during the period from June 11, 2017, to April 7, 2018. RESULTS: A total of 937 cases were identified, of which 465 (50%) were associated with pregnancy; 406 of the pregnancy-associated cases (87%) occurred in neonates. Of the 937 cases, 229 (24%) occurred in patients 15 to 49 years of age (excluding those who were pregnant). Among the patients in whom human immunodeficiency virus (HIV) status was known, 38% of those with pregnancy-associated cases (77 of 204) and 46% of the remaining patients (97 of 211) were infected with HIV. Among 728 patients with a known outcome, 193 (27%) died. Clinical isolates from 609 patients were sequenced, and 567 (93%) were identified as sequence type 6 (ST6). In a case-control analysis, patients with ST6 infections were more likely to have eaten polony (a ready-to-eat processed meat) than those with non-ST6 infections (odds ratio, 8.55; 95% confidence interval, 1.66 to 43.35). Polony and environmental samples also yielded ST6 isolates, which, together with the isolates from the patients, belonged to the same core-genome multilocus sequence typing cluster with no more than 4 allelic differences; these findings showed that polony produced at a single facility was the outbreak source. A recall of ready-to-eat processed meat products from this facility was associated with a rapid decline in the incidence of L. monocytogenes ST6 infections. CONCLUSIONS: This investigation showed that in a middle-income country with a high prevalence of HIV infection, L. monocytogenes caused disproportionate illness among pregnant girls and women and HIV-infected persons. Whole-genome sequencing facilitated the detection of the outbreak and guided the trace-back investigations that led to the identification of the source. |
Implementation of the Treat All Policy among persons with HIV infection enrolled in care but not on antiretroviral therapy - India, May 2017-June 2018
Mitruka K , Bamrotiya M , Agarwal R , Parvez A , Allam RR , Sivalenka S , Deoraj P , Prasad R , Devi U , Keskar P , Acharya S , Kannan P , Ganti R , Shah M , Todmal S , Kumar P , Chava N , Rao A , Tanwar S , Nyendak M , Ellerbrock T , Holtz TH , Gupta RS . MMWR Morb Mortal Wkly Rep 2018 67 (47) 1305-1309 Since September 2015, the World Health Organization has recommended antiretroviral therapy (ART) for all persons with human immunodeficiency virus (HIV) infection, regardless of clinical stage or CD4 count (1). This Treat All policy was based on evidence that ART initiation early in HIV infection as opposed to waiting for the CD4 count to decline to certain levels (e.g., <500 cells/mm(3), per previous guidelines), was associated with reduced morbidity, mortality, and HIV transmission (2-4). Further, approximately half of persons enrolled in non-ART care that included monitoring for HIV disease progression (i.e., in pre-ART care) were lost to follow-up before becoming ART-eligible (5). India, the country with the third largest number of persons with HIV infection in the world (2.1 million), adopted the Treat All policy on April 28, 2017. This report describes implementation of Treat All during May 2017-June 2018, by India's National AIDS Control Organization (NACO) and partners, by facilitating ART initiation among persons previously in pre-ART care at 46 ART centers supported by the U.S. President's Emergency Plan for AIDS Relief (PEPFAR)* in six districts in the states of Maharashtra and Andhra Pradesh. Partners supported these 46 ART centers in identifying and attempting to contact persons who were enrolled in pre-ART care during January 2014-April 2017, and educating those reached about Treat All. ART center-based records were used to monitor implementation indicators, including ART initiation. A total of 9,898 (39.6%) of 25,007 persons previously enrolled in pre-ART care initiated ART; among these 9,898 persons, 6,315 (63.8%) initiated ART after being reached during May 2017-June 2018, including 1,635 (16.5%) who had been lost to follow-up before ART initiation. NACO scaled up efforts nationwide to build ART centers' capacity to implement Treat All. Active tracking and tracing of persons with HIV infection enrolled in care but not on ART, combined with education about the benefits of early HIV treatment, can facilitate ART initiation. |
Phylogenetic Analysis of Invasive Serotype 1 Pneumococcus in South Africa, 1989-2013.
du Plessis M , Allam M , Tempia S , Wolter N , de Gouveia L , Mollendorf CV , Jolley KA , Mbelle N , Wadula J , Cornick JE , Everett DB , McGee L , Breiman RF , Gladstone RA , Bentley SD , Klugman KP , von Gottberg A . J Clin Microbiol 2016 54 (5) 1326-34 BACKGROUND: Serotype 1 is an important cause of invasive pneumococcal disease in South Africa and has declined following introduction of the 13-valent pneumococcal conjugate vaccine in 2011. METHODS: We genetically characterized 912 invasive serotype 1 isolates from 1989-2013. Simpson's diversity index and recombination ratios were calculated. Factors associated with sequence types (ST) were assessed. RESULTS: Clonal complex 217 represented 96% (872/912) of sampled isolates. Post PCV13, ST diversity increased in children <5 years (0.39 to 0.63, p=0.002) and individuals >14 years (0.35 to 0.54, p<0.001): ST-217 declined proportionately in children <5 years [153/203 (75%) vs. 21/37 (57%), p=0.027], and individuals >14 years [242/305 (79%) vs. 96/148 (65%), p=0.001], whereas ST-9067 increased [4/684 (0.6%) vs. 24/228 (11%), p<0.001]. Three sub-clades were identified within ST-217: ST-217C1 (353/382, 92%), ST-217C2 (15/382, 4%) and ST-217C3 (14/382, 4%). ST-217C2, ST-217C3 and single-locus variant (SLV) ST-8314 (20/912, 2%) were associated with non-susceptibility to chloramphenicol, tetracycline and co-trimoxazole. ST-8314 (20/912, 2%) was also associated with increased non-susceptibility to penicillin (p<0.001). ST-217C3 and newly reported ST-9067 had higher recombination ratios compared to ST-217C1 (4.344 vs. 0.091, p<0.001 and 0.086 vs. 0.013, p<0.001, respectively). CONCLUSIONS: Increases in genetic diversity were noted post PCV13, and lineages associated with antimicrobial non-susceptibility were identified. |
Cost-effectiveness analysis of the introduction of the pneumococcal conjugate vaccine (PCV-13) in the Egyptian national immunization program, 2013
Sibak M , Moussa I , El-Tantawy N , Badr S , Chaudhri I , Allam E , Baxter L , Abo Freikha S , Hoestlandt C , Lara C , Hajjeh R , Munier A . Vaccine 2015 33 Suppl 1 A182-91 INTRODUCTION: Pneumonia is one of the most important causes of morbidity and mortality in children under 5 in Egypt, and the Ministry of Health of Egypt is considering introducing pneumococcal conjugate vaccine (PCV) in its national immunization program. We performed an economic analysis to evaluate the cost-effectiveness of this vaccine in Egypt and to provide the decision-makers with needed evidence. METHODS: The analysis was done using the TRIVAC model. Data included demographic characteristics, burden of disease, coverage and efficacy of the vaccine, health resource utilization, and costs of pneumococcal disease vaccination and treatment. Whenever possible, we used national or regional data. Two alternatives were compared: (1) general vaccination of children younger than 5 years with the 13-valent pneumococcal conjugate vaccine (PCV13), using a three-dose schedule without booster, and (2) no vaccination. Outcomes of 10 cohorts from birth to 5 years were analyzed. The study was performed from the governmental perspective and selected public health providers. RESULTS: In comparison to no vaccine, the introduction of PCV13 would be cost-effective, with an incremental cost-effectiveness ratio of US$ 3916 per disability-adjusted life-year (DALY) averted (government perspective). The total incremental cost of the PCV vaccination program (10 cohorts) would be approximately US$ 1.09 billion. Over the 10 cohorts, the program would avert 8583 pneumococcal deaths - 42% of all pneumococcal-related deaths. CONCLUSION: The introduction of PCV13 would be a good value for money from the government perspective. It would represent a high-impact public health intervention for Egypt and respond to the National Immunization Technical Advisory Group (NITAG) resolution on reducing pneumonia burden and overall child mortality. Strengthening surveillance will be critical to generating high-quality national data, improving future economic analyses that support evidence-based decisions for introducing vaccines and public health interventions, and to monitoring their impact. |
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