Last data update: Dec 02, 2024. (Total: 48272 publications since 2009)
Records 1-30 (of 125 Records) |
Query Trace: Boyd S[original query] |
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Real-world data versus probability surveys for estimating health conditions at the state level
Marker DA , Hilton C , Zelko J , Duke J , Rolka D , Kaufmann R , Boyd R . J Surv Stat Methodol 2024 12 (5) 1515-1530 Government statistical offices worldwide are under pressure to produce statistics rapidly and for more detailed geographies, to compete with unofficial estimates available from web-based big data sources or from private companies. Commonly suggested sources of improved health information are electronic health records and medical claims data. These data sources are collectively known as real-world data (RWD) because they are generated from routine health care processes, and they are available for millions of patients. It is clear that RWD can provide estimates that are more timely and less expensive to produce—but a key question is whether or not they are very accurate. To test this, we took advantage of a unique health data source that includes a full range of sociodemographic variables and compared estimates using all of those potential weighting variables versus estimates derived when only age and sex are available for weighting (as is common with most RWD sources). We show that not accounting for other variables can produce misleading and quite inaccurate health estimates. © 2024 American Association for Public Opinion Research. All rights reserved. |
Ongoing transmission of trachoma in low prevalence districts in Mozambique: results from four cross-sectional enhanced impact surveys, 2022
Sitoe HM , Oswald WE , Zita F , Fall M , Momade T , Adams MW , Flueckiger RM , McPherson S , Eyob S , Doan T , Lietman TM , Arnold BF , Wickens K , Gwyn S , Martin DL , Kasubi M , Boyd S , Bakhtiari A , Jimenez C , Solomon AW , Harding-Esch EM , Mwingira UJ , Ngondi JM . Sci Rep 2024 14 (1) 22842 Mozambique is making progress towards elimination of trachoma as a public health problem, but in some districts trachomatous inflammation-follicular (TF) prevalence remains above the 5% elimination threshold despite years of various interventions, including antibiotic mass drug administration. To characterize transmission in four districts, we incorporated testing of ocular infection and serology into routine trachoma impact surveys (TIS) in August 2022. We examined residents aged ≥ 1 year for trachoma and collected information on household water, sanitation, and hygiene. Among children aged 1-9 years, we tested conjunctival swabs for Chlamydia trachomatis nucleic acid and dried blood spots for C. trachomatis antibodies. We modeled age-dependent seroprevalence to estimate seroconversion rate (SCR). We examined 4841 children aged 1-9 years. TF prevalence ranged between 1.1 and 6.0% with three districts below the 5% threshold. PCR-confirmed infection prevalence ranged between 1.1 and 4.8%, and Pgp3 seroprevalence ranged between 8.8 and 24.3%. Pgp3 SCR was 1.9 per 100 children per year in the district with the lowest TF prevalence. Two other districts with TF < 5% had SCR of 5.0 and 4.7. The district with TF ≥ 5% had a SCR of 6.0. This enhanced TIS furthered understanding of transmission in these districts and provides information on additional indicators for monitoring trachoma programs. |
A multi-provincial outbreak of Salmonella Newport infections associated with red onions: A report of the largest Salmonella outbreak in Canada in over 20 years
Denich L , Cheng JM , Smith CR , Taylor M , Atkinson R , Boyd E , Chui L , Honish L , Isaac L , Kearney A , Liang JJ , Mah V , Manore AJW , McCormic ZD , Misfeldt C , Nadon C , Patel K , Sharma D , Todd A , Hexemer A . Epidemiol Infect 2024 152 e106 An investigation into an outbreak of Salmonella Newport infections in Canada was initiated in July 2020. Cases were identified across several provinces through whole-genome sequencing (WGS). Exposure data were gathered through case interviews. Traceback investigations were conducted using receipts, invoices, import documentation, and menus. A total of 515 cases were identified in seven provinces, related by 0-6 whole-genome multi-locus sequence typing (wgMLST) allele differences. The median age of cases was 40 (range 1-100), 54% were female, 19% were hospitalized, and three deaths were reported. Forty-eight location-specific case sub-clusters were identified in restaurants, grocery stores, and congregate living facilities. Of the 414 cases with exposure information available, 71% (295) had reported eating onions the week prior to becoming ill, and 80% of those cases who reported eating onions, reported red onion specifically. The traceback investigation identified red onions from Grower A in California, USA, as the likely source of the outbreak, and the first of many food recall warnings was issued on 30 July 2020. Salmonella was not detected in any tested food or environmental samples. This paper summarizes the collaborative efforts undertaken to investigate and control the largest Salmonella outbreak in Canada in over 20 years. |
Vaccination coverage by age 24 months among children born during 2017-2021 - U.S.-Affiliated Pacific Islands
Tippins A , Boyd EM , Coy KC , Mutamba G , Kriss JL . MMWR Morb Mortal Wkly Rep 2024 73 (38) 854-859 Childhood vaccination is one of the most successful public health interventions to improve life expectancy, decrease health care costs, and reduce the spread of preventable diseases. Using data from jurisdictional immunization information systems, vaccination coverage by age 24 months among children born during 2017-2021 in the U.S.-affiliated Pacific Islands was estimated for all vaccines included in jurisdictional programs. Progress toward the U.S. Healthy People 2030 and World Health Organization Immunization Agenda 2030 vaccination goals of ≥90% coverage by age 24 months with recommended vaccines was inconsistently met across jurisdictions. For example, coverage by age 24 months with ≥1 dose of measles, mumps, and rubella vaccine ranged from 68.2% to 91.6% by birth cohort in Federated States of Micronesia and from 87.4% to 96.6% in Palau; coverage with ≥4 doses of diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP) ranged from 39.6% to 60.6% in Federated States of Micronesia and from 73.4% to 85.4% in Palau. Coverage as of June 1, 2024, increased for all vaccines across all jurisdictions and birth cohorts, indicating catch-up vaccination after age 24 months. For example, coverage with ≥4 doses of DTaP by June 1, 2024, ranged from 74.0% to 84.4% in American Samoa by birth cohort and from 91.6% to 94.8% in Palau. This report is the first comprehensive analysis of trends in childhood vaccination coverage in the U.S.-affiliated Pacific Islands; data in this report can be used to determine where additional efforts are needed to assess reasons for delayed vaccination of children and strategies to mitigate vaccination delays, specific to each jurisdiction. |
Associations between Minority Health Social Vulnerability Index scores, rurality, and histoplasmosis incidence, 8 US States
Smith DJ , Rajeev M , Boyd K , Benedict K , Hennessee I , Rothfeldt L , Austin C , Steppig ME , Patel D , Reik R , Ireland M , Sedivy J , Gibbons-Burgener S , Calanan RM , Williams SL , Rockhill S , Toda M . Emerg Infect Dis 2024 30 (10) 2016-2024 To explore associations between histoplasmosis and race and ethnicity, socioeconomic status, and rurality, we conducted an in-depth analysis of social determinants of health and histoplasmosis in 8 US states. Using the Minority Health Social Vulnerability Index (MH SVI), we analyzed county-level histoplasmosis incidence (cases/100,000 population) from the 8 states by applying generalized linear mixed hurdle models. We found that histoplasmosis incidence was higher in counties with limited healthcare infrastructure and access as measured by the MH SVI and in more rural counties. Other social determinants of health measured by the MH SVI tool either were not significantly or were inconsistently associated with histoplasmosis incidence. Increased awareness of histoplasmosis, more accessible diagnostic tests, and investment in rural health services could address histoplasmosis-related health disparities. |
Human papillomavirus vaccination coverage among adolescent girls aged 13-17 years - U.S.-Affiliated Pacific Islands, 2013-2023
Tippins A , Mutamba G , Boyd EM , Coy KC , Kriss JL . MMWR Morb Mortal Wkly Rep 2024 73 (33) 715-721 Worldwide, cervical cancer is the fourth most common cancer among women, and the World Health Organization (WHO) Western Pacific Region, where the U.S.-affiliated Pacific Islands (USAPI) are located, accounts for one quarter of all estimated cases. Human papillomavirus (HPV) vaccines are recommended at age 11-12 years to prevent most cervical cancers. HPV vaccines were introduced across USAPI during 2007-2016, predominantly provided through school-located vaccination programs. Retrospective analysis using data from jurisdictional immunization information systems was used to estimate vaccination coverage among adolescent girls as of the last day of each calendar year during 2013-2023. This analysis measured progress toward the WHO 2030 vaccination coverage goal of ≥90% completion of the HPV vaccination series among girls by age 15 years. As of December 2023, initiation of the HPV vaccination series among adolescent girls aged 13-17 years ranged from 58.0% in Palau to 97.2% in the Northern Mariana Islands, and HPV vaccination series completion coverage ranged from 43.4% in Palau to 91.8% in the Northern Mariana Islands. HPV vaccination series completion coverage is >90% in the Northern Mariana Islands and is on track to meet WHO goals by 2030 in American Samoa. Assessment of adolescent vaccination coverage can help immunization programs monitor progress toward regional goals and identify populations and areas with low coverage. Implementing evidence-based strategies to increase vaccine access and coverage would benefit jurisdictions with lagging coverage. |
Longitudinal viral load outcomes of adults with HIV after detectable viremia on tenofovir, lamivudine, and dolutegravir
Sodeke O , Milligan K , Ezeuko I , Oladipo A , Emeh A , Bashorun A , Orisawayi O , Danjuma S , Onotu D , Boyd AM , Abutu A , Chun H , Vallabhaneni S . Aids 2024 BACKGROUND: :To inform optimal management of HIV viremia on TLD, we examined viral load (VL) outcomes of a large cohort of adult PLHIV on TLD in Nigeria. METHODS: :We conducted a retrospective study of adult PLHIV who had ≥1 VL after initiating TLD during January 2017-February 2023. VLs were categorized as undetectable (≤50 copies/mL), low low-level viremia (LLV, 51-199 copies/mL), high LLV (200-999 copies/mL), virologic nonsuppression (VLNS, ≥1000 copies/mL), and virologic failure (VF, ≥2 consecutive VLNS results). Among patients with ≥2 VLs on TLD, we described how viremia changed over time and examined virologic outcomes after VF. We identified predictors of subsequent VLNS using mixed-effects logistic regression and conducted planned contrasts between levels of VL result and regimen types. RESULTS: :Analysis of 82,984 VL pairs from 47,531 patients demonstrated viral resuppression to ≤50 copies/mL at follow-up VL in 66.7% of those with initial low LLV, 59.1% of those with initial high LLV, and 48.9% of those with initial VLNS. Of 662 patients with a follow-up VL after VF, 94.6% stayed on TLD; of which 57.8% (359/621) were undetectable at next VL without regimen change. Previous low LLV (aOR 1.74, 1.56-1.93), high LLV (aOR 2.35, 2.08-2.65), and VLNS (aOR 6.45, 5.81-7.16) were associated with increasingly higher odds of subsequent VLNS, whereas a previously undetectable VL (aOR 1.08, 0.99-1.71) on TLD was not. CONCLUSIONS: :Despite increased odds of subsequent VLNS, most PLHIV with detectable viremia on TLD, including those with VF, will resuppress to an undetectable VL without a regimen change. |
Tropical data: Approach and methodology as applied to trachoma prevalence surveys
Harding-Esch EM , Burgert-Brucker CR , Jimenez C , Bakhtiari A , Willis R , Bejiga MD , Mpyet C , Ngondi J , Boyd S , Abdala M , Abdou A , Adamu Y , Alemayehu A , Alemayehu W , Al-Khatib T , Apadinuwe SC , Awaca N , Awoussi MS , Baayendag G , Badiane MD , Bailey RL , Batcho W , Bay Z , Bella A , Beido N , Bol YY , Bougouma C , Brady CJ , Bucumi V , Butcher R , Cakacaka R , Cama A , Camara M , Cassama E , Chaora SG , Chebbi AC , Chisambi AB , Chu B , Conteh A , Coulibaly SM , Courtright P , Dalmar A , Dat TM , Davids T , Djaker MEA , de Fátima Costa Lopes M , Dézoumbé D , Dodson S , Downs P , Eckman S , Elshafie BE , Elmezoghi M , Elvis AA , Emerson P , Epée EE , Faktaufon D , Fall M , Fassinou A , Fleming F , Flueckiger R , Gamael KK , Garae M , Garap J , Gass K , Gebru G , Gichangi MM , Giorgi E , Goépogui A , Gómez DVF , Gómez Forero DP , Gower EW , Harte A , Henry R , Honorio-Morales HA , Ilako DR , Issifou AAB , Jones E , Kabona G , Kabore M , Kadri B , Kalua K , Kanyi SK , Kebede S , Kebede F , Keenan JD , Kello AB , Khan AA , Khelifi H , Kilangalanga J , Kim SH , Ko R , Lewallen S , Lietman T , Logora MSY , Lopez YA , MacArthur C , Macleod C , Makangila F , Mariko B , Martin DL , Masika M , Massae P , Massangaie M , Matendechero HS , Mathewos T , McCullagh S , Meite A , Mendes EP , Abdi HM , Miller H , Minnih A , Mishra SK , Molefi T , Mosher A , M'Po N , Mugume F , Mukwiza R , Mwale C , Mwatha S , Mwingira U , Nash SD , Nassa C , Negussu N , Nieba C , Noah Noah JC , Nwosu CO , Olobio N , Opon R , Pavluck A , Phiri I , Rainima-Qaniuci M , Renneker KK , Saboyá-Díaz MI , Sakho F , Sanha S , Sarah V , Sarr B , Szwarcwald CL , Shah Salam A , Sharma S , Seife F , Serrano Chavez GM , Sissoko M , Sitoe HM , Sokana O , Tadesse F , Taleo F , Talero SL , Tarfani Y , Tefera A , Tekeraoi R , Tesfazion A , Traina A , Traoré L , Trujillo-Trujillo J , Tukahebwa EM , Vashist P , Wanyama EB , Warusavithana SDP , Watitu TK , West S , Win Y , Woods G , Yajima A , Yaya G , Zecarias A , Zewengiel S , Zoumanigui A , Hooper PJ , Millar T , Rotondo L , Solomon AW . Ophthalmic Epidemiol 2023 30 (6) 544-560 PURPOSE: Population-based prevalence surveys are essential for decision-making on interventions to achieve trachoma elimination as a public health problem. This paper outlines the methodologies of Tropical Data, which supports work to undertake those surveys. METHODS: Tropical Data is a consortium of partners that supports health ministries worldwide to conduct globally standardised prevalence surveys that conform to World Health Organization recommendations. Founding principles are health ministry ownership, partnership and collaboration, and quality assurance and quality control at every step of the survey process. Support covers survey planning, survey design, training, electronic data collection and fieldwork, and data management, analysis and dissemination. Methods are adapted to meet local context and needs. Customisations, operational research and integration of other diseases into routine trachoma surveys have also been supported. RESULTS: Between 29(th) February 2016 and 24(th) April 2023, 3373 trachoma surveys across 50 countries have been supported, resulting in 10,818,502 people being examined for trachoma. CONCLUSION: This health ministry-led, standardised approach, with support from the start to the end of the survey process, has helped all trachoma elimination stakeholders to know where interventions are needed, where interventions can be stopped, and when elimination as a public health problem has been achieved. Flexibility to meet specific country contexts, adaptation to changes in global guidance and adjustments in response to user feedback have facilitated innovation in evidence-based methodologies, and supported health ministries to strive for global disease control targets. |
Monitoring and reporting the US COVID-19 vaccination effort
Scharf LG , Adeniyi K , Augustini E , Boyd D , Corvin L , Kalach RE , Fast H , Fath J , Harris L , Henderson D , Hicks-Thomson J , Jones-Jack N , Kellerman A , Khan AN , McGarvey SS , McGehee JE , EMiner C , Moore LB , Murthy BP , Myerburg S , Neuhaus E , Nguyen K , Parker M , Pierce-Richards S , Samchok D , Shaw LK , Spoto S , Srinivasan A , Stearle C , Thomas J , Winarsky M , Zell E . Vaccine 2023 Immunizations are an important tool to reduce the burden of vaccine preventable diseases and improve population health.(1) High-quality immunization data is essential to inform clinical and public health interventions and respond to outbreaks of vaccine-preventable diseases. To track COVID-19 vaccines and vaccinations, CDC established an integrated network that included vaccination provider systems, health information exchange systems, immunization information systems, pharmacy and dialysis systems, vaccine ordering systems, electronic health records, and tools to support mass vaccination clinics. All these systems reported data to CDC's COVID-19 response system (either directly or indirectly) where it was processed, analyzed, and disseminated. This unprecedented vaccine tracking effort provided essential information for public health officials that was used to monitor the COVID-19 response and guide decisions. This paper will describe systems, processes, and policies that enabled monitoring and reporting of COVID-19 vaccination efforts and share challenges and lessons learned for future public health emergency responses. |
High prevalence of trachomatous inflammation-follicular with no trachomatous trichiasis: can alternative indicators explain the epidemiology of trachoma in Côte d'Ivoire?
Atekem K , Harding-Esch EM , Martin DL , Downs P , Palmer SL , Kaboré A , Kelly M , Bovary A , Sarr A , Nguessan K , James F , Gwyn S , Wickens K , Bakhtiari A , Boyd S , Aba A , Senyonjo L , Courtright P , Meite A . Int Health 2023 15 ii3-ii11 Baseline trachoma surveys in Côte d'Ivoire (2019) identified seven evaluation units (EUs) with a trachomatous inflammation-follicular (TF) prevalence ≥10%, but a trachomatous trichiasis (TT) prevalence in individuals ≥15 y of age below the elimination threshold (0.2%). Two of these EUs, Bondoukou 1 and Bangolo 2, were selected for a follow-up survey to understand the epidemiology of trachoma using additional indicators of Chlamydia trachomatis infection (DNA from conjunctival swabs) and exposure (anti-Pgp3 and Ct694 antibodies from dried blood spots [DBSs]). A two-stage cluster sampling methodology was used to select villages and households. All individuals 1-9 y of age from each selected household were recruited, graded for trachoma and had a conjunctival swab and DBS collected. Conjunctival swabs and DBSs were tested using Cepheid GeneXpert and a multiplex bead assay, respectively. The age-adjusted TF and infection prevalence in 1- to 9-year-olds was <1% and <0.3% in both EUs. Age-adjusted seroprevalence was 5.3% (95% confidence interval [CI] 1.5 to 15.6) in Bondoukou 1 and 8.2% (95% CI 4.3 to 13.7) in Bangolo 2. The seroconversion rate for Pgp3 was low, at 1.23 seroconversions/100 children/year (95% CI 0.78 to 1.75) in Bondoukou 1 and 1.91 (95% CI 1.58 to 2.24) in Bangolo 2. Similar results were seen for CT694. These infection, antibody and clinical data provide strong evidence that trachoma is not a public health problem in either EU. |
Early serial echocardiographic and ultrasonographic findings in critically ill patients with COVID-19
Lanspa MJ , Dugar SP , Prigmore HL , Boyd JS , Rupp JD , Lindsell CJ , Rice TW , Qadir N , Lim GW , Shiloh AL , Dieiev V , Gong MN , Fox SW , Hirshberg EL , Khan A , Kornfield J , Schoeneck JH , Macklin N , Files DC , Gibbs KW , Prekker ME , Parsons-Moss D , Bown M , Olsen TD , Knox DB , Cirulis MM , Mehkri O , Duggal A , Tenforde MW , Patel MM , Self WH , Brown SM . CHEST Crit Care 2023 1 (1) 100002 BACKGROUND: Cardiac function of critically ill patients with COVID-19 generally has been reported from clinically obtained data. Echocardiographic deformation imaging can identify ventricular dysfunction missed by traditional echocardiographic assessment. RESEARCH QUESTION: What is the prevalence of ventricular dysfunction and what are its implications for the natural history of critical COVID-19? STUDY DESIGN AND METHODS: This is a multicenter prospective cohort of critically ill patients with COVID-19. We performed serial echocardiography and lower extremity vascular ultrasound on hospitalization days 1, 3, and 8. We defined left ventricular (LV) dysfunction as the absolute value of longitudinal strain of < 17% or left ventricle ejection fraction (LVEF) of < 50%. Primary clinical outcome was inpatient survival. RESULTS: We enrolled 110 patients. Thirty-nine (35.5%) died before hospital discharge. LV dysfunction was present at admission in 38 patients (34.5%) and in 21 patients (36.2%) on day 8 (P = .59). Median baseline LVEF was 62% (interquartile range [IQR], 52%-69%), whereas median absolute value of baseline LV strain was 16% (IQR, 14%-19%). Survivors and nonsurvivors did not differ statistically significantly with respect to day 1 LV strain (17.9% vs 14.4%; P = .12) or day 1 LVEF (60.5% vs 65%; P = .06). Nonsurvivors showed worse day 1 right ventricle (RV) strain than survivors (16.3% vs 21.2%; P = .04). INTERPRETATION: Among patients with critical COVID-19, LV and RV dysfunction is common, frequently identified only through deformation imaging, and early (day 1) RV dysfunction may be associated with clinical outcome. |
Effect of Test and Treat on clinical outcomes in Nigeria: A national retrospective study
Lavoie MC , Ehoche A , Blanco N , Ahmed El-Imam I , Oladipo A , Dalhatu I , Odafe S , Adebajo S , Ng AH , Rapoport L , Lawton JG , Obanubi C , Onotu D , Patel S , Ikpeazu A , Ashefor G , Adebobola B , Adetinuke Boyd M , Aliyu G , Stafford KA . PLoS One 2023 18 (8) e0284847 BACKGROUND: In Nigeria, results from the pilot of the Test and Treat strategy showed higher loss to follow up (LTFU) among people living with HIV compared to before its implementation. The aim of this evaluation was to assess the effects of antiretroviral therapy (ART) initiation within 14 days on LTFU at 12 months and viral suppression. METHODS: We conducted a retrospective cohort study using routinely collected de-identified patient-level data hosted on the Nigeria National Data Repository from 1,007 facilities. The study population included people living with HIV age ≥15. We used multivariable Cox proportional frailty hazard models to assess time to LTFU comparing ART initiation strategy and multivariable log-binomial regression for viral suppression. RESULTS: Overall, 26,937 (38.13%) were LTFU at 12 months. Among individuals initiated within 14 days, 38.4% were LTFU by 12 months compared to 35.4% for individuals initiated >14 days (p<0.001). In the adjusted analysis, individuals who were initiated ≤14 days after HIV diagnosis had a higher hazard of being LTFU (aHR 1.15, 95% CI 1.10-1.20) than individuals initiated after 14 days of HIV diagnosis. Among individuals with viral load results, 86.2% were virally suppressed. The adjusted risk ratio for viral suppression among individuals who were initiated ≤14 days compared to >14 days was not statistically significant. CONCLUSION: LTFU was higher among individuals who were initiated within 14 days compared to greater than 14 days after HIV diagnosis. There was no difference for viral suppression. The provision of early tailored interventions to support newly diagnosed people living may contribute to reducing LTFU. |
Reaching HIV epidemic control in Nigeria using a lower HIV viral load suppression cut-off
Chun HM , Milligan K , Boyd MA , Abutu A , Bachanas P , Dirlikov E . AIDS 2023 37 (13) 2081-2085 BACKGROUND: Virologic suppression (VS) has been defined using an HIV viral load (VL) of <1,000 copies/mL. Low-level viremia (51-999 copies/mL) is associated with an increased risk of virologic failure and HIV drug resistance. METHODS: Retrospective data from persons with HIV (PWH) who initiated ART between January 2016-September 2022 in Nigeria were analyzed for VS at cut-off values <1000 copies/mL. RESULTS: In 2022, VS at <1000 copies/mL was 95.7%. Using cut-off values of <400, <200 and <50 copies/mL, VS was 94.2%, 92.5%, and 87.0%, respectively. DISCUSSION: Monitoring VS using lower cut-off values, alongside differentiated management of low-level viremia, may help Nigeria achieve HIV epidemic control targets. |
SARS-CoV-2 outbreak among staff and evacuees at Operation Allies Welcome Safe Havens
Meeker JR , Gosdin L , Siu A , Turner L , Zusman BD , Sadigh KS , Carpenter R , Dopson S , Saindon J , Kyaw NTT , Segaloff HE , Pritchard N , Shahum A , Traboulsi R , Worrell MC , Beaucham C , Gandhi P , Winslow DL , Rotz L , Talley L , Mosites E , Boyd AT . Public Health Nurs 2023 40 (5) 758-761 We report on five SARS-CoV-2 congregate setting outbreaks at U.S. Operation Allies Welcome Safe Havens/military facilities. Outbreak data were collected, and attack rates were calculated for various populations. Even in vaccinated populations, there was rapid spread, illustrating the importance of institutional prevention and mitigation policies in congregate settings. |
High-resolution characterization of recent tuberculosis transmission in Botswana using geospatial and genomic data - the Kopanyo Study (preprint)
Baker CR , Barilar I , de Araujo LS , Rimoin AW , Parker DM , Boyd R , Tobias JL , Moonan PK , Click ES , Finlay A , Oeltmann JE , Minin VN , Modongo C , Zetola NM , Niemann S , Shin SS . medRxiv 2022 18 Introduction. Combining genomic and geospatial data can be useful for understanding Mycobacterium tuberculosis (Mtb) transmission in high tuberculosis burden settings. Methods. We performed whole genome sequencing (WGS) on Mtb DNA extracted from sputum cultures from a population-based tuberculosis study conducted in 2012-2016 in Gaborone, Botswana. We used kernel density estimation, spatial K-functions, and created spatial distributions of phylogenetic trees. WGS-based clusters of isolates <5 single nucleotide polymorphisms were considered recent transmission, and large WGS-based clusters (>10 members) were considered outbreaks. Results. We analyzed data from 1449 participants with culture-confirmed TB. Among these, 946 (65%) participants had both molecular and geospatial data. A total of 62 belonged to five large outbreaks (10-19 participants each). Geospatial clustering was detected in two of the five large outbreaks, suggesting heterogeneous spatial patterns within the community. Conclusions. Integration of genomic and geospatial data identified distinct patterns of tuberculosis transmission in a high-tuberculosis burden setting. Targeted interventions in these smaller geographies may interrupt on-going transmission. Copyright The copyright holder for this preprint is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-NC-ND 4.0 International license. |
From paper files to web-based application for data-driven monitoring of HIV programs: Nigeria's journey to a national data repository for decision-making and patient care
Dalhatu I , Aniekwe C , Bashorun A , Abdulkadir A , Dirlikov E , Ohakanu S , Adedokun O , Oladipo A , Jahun I , Murie L , Yoon S , Abdu-Aguye MG , Sylvanus A , Indyer S , Abbas I , Bello M , Nalda N , Alagi M , Odafe S , Adebajo S , Ogorry O , Akpu M , Okoye I , Kakanfo K , Onovo AA , Ashefor G , Nzelu C , Ikpeazu A , Aliyu G , Ellerbrock T , Boyd M , Stafford KA , Swaminathan M . Methods Inf Med 2023 62 130-139 BACKGROUND: Timely and reliable data are crucial for clinical, epidemiologic, and program management decision making. Electronic health information systems provide platforms for managing large longitudinal patient records. Nigeria implemented the National Data Repository (NDR) to create a central data warehouse of all people living with human immunodeficiency virus (PLHIV) while providing useful functionalities to aid decision making at different levels of program implementation. OBJECTIVE: We describe the Nigeria NDR and its development process, including its use for surveillance, research, and national HIV program monitoring toward achieving HIV epidemic control. METHODS: Stakeholder engagement meetings were held in 2013 to gather information on data elements and vocabulary standards for reporting patient-level information, technical infrastructure, human capacity requirements, and information flow. Findings from these meetings guided the development of the NDR. An implementation guide provided common terminologies and data reporting structures for data exchange between the NDR and the electronic medical record (EMR) systems. Data from the EMR were encoded in extensible markup language and sent to the NDR over secure hypertext transfer protocol after going through a series of validation processes. RESULTS: By June 30, 2021, the NDR had up-to-date records of 1,477,064 (94.4%) patients receiving HIV treatment across 1,985 health facilities, of which 1,266,512 (85.7%) patient records had fingerprint template data to support unique patient identification and record linkage to prevent registration of the same patient under different identities. Data from the NDR was used to support HIV program monitoring, case-based surveillance and production of products like the monthly lists of patients who have treatment interruptions and dashboards for monitoring HIV test and start. CONCLUSION: The NDR enabled the availability of reliable and timely data for surveillance, research, and HIV program monitoring to guide program improvements to accelerate progress toward epidemic control. |
Health Workers' Perspectives on the Outcomes, Enablers, and Barriers to the Implementation of HIV "Test and Treat" Guidelines in Abuja, Nigeria
Odafe S , Stafford KA , Gambo A , Onotu D , Swaminathan M , Dalhatu I , Ene U , Ademola O , Mukhtar A , Ramat I , Akipu E , Debem H , Boyd AT , Sunday A , Gobir B , Charurat ME . J AIDS HIV Treat 2019 1 (2) 33-45 We evaluated health workers' perspectives on the implementation of the 2016 HIV "Test and Treat" guidelines in Nigeria. Using semi-structured interviews, qualitative data was collected from twenty health workers meeting inclusion criteria in six study sites. Data exploration was conducted using thematic content analysis. Participants perceived that the "Test and Treat" guidelines improved care for PLHIV, though they also perceived possible congested clinics. Perceived key factors enabling guidelines use were perceived patient benefits, availability of policy document and trainings. Perceived key barriers to guidelines use were poverty among patients, inadequate human resources and stock-outs of HIV testing kits. Further improvements in uptake of guidelines could be achieved by effecting an efficient supply chain system for HIV testing kits, and improved guidelines distribution and capacity building prior to implementation. Additionally, implementing differentiated approaches that decongest clinics, and programs that economically empower patients, could improve guidelines use, as Nigeria scales "Test and Treat" nationwide. |
Use of high-resolution geospatial and genomic data to characterize recent tuberculosis transmission, Botswana
Baker CR , Barilar I , de Araujo LS , Rimoin AW , Parker DM , Boyd R , Tobias JL , Moonan PK , Click ES , Finlay A , Oeltmann JE , Minin VN , Modongo C , Zetola NM , Niemann S , Shin SS . Emerg Infect Dis 2023 29 (5) 977-987 Combining genomic and geospatial data can be useful for understanding Mycobacterium tuberculosis transmission in high-burden tuberculosis (TB) settings. We performed whole-genome sequencing on M. tuberculosis DNA extracted from sputum cultures from a population-based TB study conducted in Gaborone, Botswana, during 2012-2016. We determined spatial distribution of cases on the basis of shared genotypes among isolates. We considered clusters of isolates with ≤5 single-nucleotide polymorphisms identified by whole-genome sequencing to indicate recent transmission and clusters of ≥10 persons to be outbreaks. We obtained both molecular and geospatial data for 946/1,449 (65%) participants with culture-confirmed TB; 62 persons belonged to 5 outbreaks of 10-19 persons each. We detected geospatial clustering in just 2 of those 5 outbreaks, suggesting heterogeneous spatial patterns. Our findings indicate that targeted interventions applied in smaller geographic areas of high-burden TB identified using integrated genomic and geospatial data might help interrupt TB transmission during outbreaks. |
Low-level viraemia among people living with HIV in Nigeria: a retrospective longitudinal cohort study
Chun HM , Abutu A , Milligan K , Ehoche A , Shiraishi RW , Odafe S , Dalhatu I , Onotu D , Okoye M , Oladipo A , Gwamna J , Ikpeazu A , Akpan NM , Ibrahim J , Aliyu G , Akanmu S , Boyd MA , Swaminathan M , Ellerbrock T , Stafford KA , Dirlikov E . Lancet Glob Health 2022 10 (12) e1815-e1824 BACKGROUND: HIV transmission can occur with a viral load of at least 200 copies per mL of blood and low-level viraemia can lead to virological failure; the threshold level at which risk for virological failure is conferred is uncertain. To better understand low-level viraemia prevalence and outcomes, we analysed retrospective longitudinal data from a large cohort of people living with HIV on antiretroviral therapy (ART) in Nigeria. METHODS: In this retrospective cohort study using previously collected longitudinal patient data, we estimated rates of virological suppression (≤50 copies per mL), low-level viraemia (51-999 copies per mL), virological non-suppression (≥1000 copies per mL), and virological failure (≥2 consecutive virological non-suppression results) among people living with HIV aged 18 years and older who initiated and received at least 24 weeks of ART at 1005 facilities in 18 Nigerian states. We analysed risk for low-level viraemia, virological non-suppression, and virological failure using log-binomial regression and mixed-effects logistic regression. FINDINGS: At first viral load for 402 668 patients during 2016-21, low-level viraemia was present in 64 480 (16·0%) individuals and virological non-suppression occurred in 46 051 (11·4%) individuals. Patients with low-level viraemia had increased risk of virological failure (adjusted relative risk 2·20, 95% CI 1·98-2·43; p<0·0001). Compared with patients with virological suppression, patients with low-level viraemia, even at 51-199 copies per mL, had increased odds of low-level viraemia and virological non-suppression at next viral load; patients on optimised ART (ie, integrase strand transfer inhibitors) had lower odds than those on non-integrase strand transfer inhibitors for the same low-level viraemia range (eg, viral load ≥1000 copies per mL following viral load 400-999 copies per mL, integrase strand transfer inhibitor: odds ratio 1·96, 95% CI 1·79-2·13; p<0·0001; non-integrase strand transfer inhibitor: 3·21, 2·90-3·55; p<0·0001). INTERPRETATION: Patients with low-level viraemia had increased risk of virological non-suppression and failure. Programmes should revise monitoring benchmarks and targets from less than 1000 copies per mL to less than 50 copies per mL to strengthen clinical outcomes and track progress to epidemic control. FUNDING: None. |
Individual and household factors associated with non-disclosure of positive HIV status in a population-based HIV serosurvey
Lawton J , Lavoie MC , Bashorun A , Dalhatu I , Ibrahim J , Agbakwuru C , Boyd M , Stafford K , Swaminathan M , Aliyu G , Charurat M . AIDS 2022 37 (1) 191-196 OBJECTIVES: Non-disclosure of positive HIV status in population-based surveys causes underestimation of national HIV diagnosis and biases inferences about engagement in the care continuum. This study investigated individual and household factors associated with HIV non-disclosure to survey interviewers in Nigeria. DESIGN: Secondary analysis of a cross sectional population-based household HIV survey. METHODS: We analyzed data from adults aged 15-64 years who tested positive for HIV and had antiretroviral drugs (ARVs) in their blood from a nationally representative HIV sero-survey conducted in Nigeria in 2018. We considered ARV use as a proxy for knowledge of HIV diagnosis; thus, respondents who self-reported to be unaware of their HIV status were classified as non-disclosers. We estimated the associations between non-disclosure and various sociodemographic, clinical, and household characteristics using weighted logistic regression. RESULTS: Among 1,266 respondents living with HIV who were taking ARVs, 503 (40%) did not disclose their HIV status to interviewers. In multivariable statistical analyses, the adjusted odds of non-disclosure were highest among respondents aged 15-24 years, those with less than a primary school education, and those who were the only person living with HIV in their household. CONCLUSIONS: Non-disclosure of positive HIV status to survey personnel is common among adults who are receiving treatment in Nigeria. These findings highlight the importance of validating self-reported HIV status in surveys using biomarkers of ARV use. Meanwhile, it is crucial to improve disclosure by strengthening interview procedures and tailoring strategies towards groups that are disproportionately likely to underreport HIV diagnoses. |
A national HIV clinical mentorship program: enabling Zambia to accelerate control of the HIV epidemic
Boyd MA , Fwoloshi S , Minchella PA , Simpungwe J , Siansalama T , Barradas DT , Shah M , Mulenga L , Agolory S . PLoS Glob Public Health 2022 2 (2) e0000074 Although Zambia has increased the proportion of people living with HIV (PLHIV) who are on antiretroviral therapy (ART) in recent years, progress toward HIV epidemic control remains inconsistent. Some districts are still failing to meet the UNAIDS 90/90/90 targets where 90% of PLHIV should know their status, 90% of those diagnosed should be on ART, and 90% of those on ART should achieve viral load suppression (VLS) by 2020. Providing consistently excellent HIV services at all ART health facilities is critical for achieving the UNAIDS 90/90/90 targets and controlling the HIV epidemic in Zambia. Zambia Ministry of Health, in collaboration with the U.S. Centers for Disease Control and Prevention (CDC), aimed to achieve these targets through establishing a national HIV clinical mentorship program in which government-employed mentors were assigned to specific facilities with a mandate to identify and ameliorate programmatic challenges. Mentors were hired, trained and deployed to individual facilities in four provinces to mentor staff on quality HIV clinical and program management. The pre-mentorship period was July 2018-September 2018 and the post-mentorship period was July 2019-September 2019. Review of key programmatic indicators from the pre and post-deployment periods revealed the proportion of people who had a positive HIV test result out of those tested increased from 4.2% to 6.8% (P < 0.001) as fewer HIV tests were needed despite the number of PLHIV being identified and placed on ART increasing from 492,613 to 521,775, and VLS increased from 84.8% to 90.1% (p < 0.001). Key considerations in the establishment of an HIV clinical mentorship program include having a government-led process of regular site level data review and continuous clinical mentorship underpinned by quality improvement methodology. |
Characterizing tuberculosis transmission dynamics in high-burden urban and rural settings.
Smith JP , Oeltmann JE , Hill AN , Tobias JL , Boyd R , Click ES , Finlay A , Mondongo C , Zetola NM , Moonan PK . Sci Rep 2022 12 (1) 6780 Mycobacterium tuberculosis transmission dynamics in high-burden settings are poorly understood. Growing evidence suggests transmission may be characterized by extensive individual heterogeneity in secondary cases (i.e., superspreading), yet the degree and influence of such heterogeneity is largely unknown and unmeasured in high burden-settings. We conducted a prospective, population-based molecular epidemiology study of TB transmission in both an urban and rural setting of Botswana, one of the highest TB burden countries in the world. We used these empirical data to fit two mathematical models (urban and rural) that jointly quantified both the effective reproductive number, [Formula: see text], and the propensity for superspreading in each population. We found both urban and rural populations were characterized by a high degree of individual heterogeneity, however such heterogeneity disproportionately impacted the rural population: 99% of secondary transmission was attributed to only 19% of infectious cases in the rural population compared to 60% in the urban population and the median number of incident cases until the first outbreak of 30 cases was only 32 for the rural model compared to 791 in the urban model. These findings suggest individual heterogeneity plays a critical role shaping local TB epidemiology within subpopulations. |
Tuberculosis attributed to transmission within healthcare facilities, Botswana-The Kopanyo Study.
Smith JP , Modongo C , Moonan PK , Dima M , Matsiri O , Fane O , Click ES , Boyd R , Finlay A , Surie D , Tobias JL , Zetola NM , Oeltmann JE . Infect Control Hosp Epidemiol 2022 43 (11) 1-7 OBJECTIVE: Healthcare facilities are a well-known high-risk environment for transmission of M. tuberculosis, the etiologic agent of tuberculosis (TB) disease. However, the link between M. tuberculosis transmission in healthcare facilities and its role in the general TB epidemic is unknown. We estimated the proportion of overall TB transmission in the general population attributable to healthcare facilities. METHODS: We combined data from a prospective, population-based molecular epidemiologic study with a universal electronic medical record (EMR) covering all healthcare facilities in Botswana to identify biologically plausible transmission events occurring at the healthcare facility. Patients with M. tuberculosis isolates of the same genotype visiting the same facility concurrently were considered an overlapping event. We then used TB diagnosis and treatment data to categorize overlapping events into biologically plausible definitions. We calculated the proportion of overall TB cases in the cohort that could be attributable to healthcare facilities. RESULTS: In total, 1,881 participants had TB genotypic and EMR data suitable for analysis, resulting in 46,853 clinical encounters at 338 healthcare facilities. We identified 326 unique overlapping events involving 370 individual patients; 91 (5%) had biologic plausibility for transmission occurring at a healthcare facility. A sensitivity analysis estimated that 3%-8% of transmission may be attributable to healthcare facilities. CONCLUSIONS: Although effective interventions are critical in reducing individual risk for healthcare workers and patients at healthcare facilities, our findings suggest that development of targeted interventions aimed at community transmission may have a larger impact in reducing TB. |
The shifting age distribution of people with HIV using antiretroviral therapy in the United States, 2020 to 2030
Althoff KN , Stewart CN , Humes E , Zhang J , Gerace L , Boyd CM , Wong C , Justice AC , Gebo K , Thorne JE , Rubtsova AA , Horberg MA , Silverberg MJ , Leng SX , Rebeiro PF , Moore RD , Buchacz K , Kasaie P . AIDS 2021 36 (3) 459-471 OBJECTIVE: To project the future age distribution of people with HIV using antiretroviral therapy (ART) in the US, under expected trends in HIV diagnosis and survival (baseline scenario) and achieving the Ending the HIV Epidemic (EHE) goals of a 75% reduction in HIV diagnoses from 2020-25 and sustaining levels to 2030 (EHE75% scenario). DESIGN: An agent-based simulation model with mathematical functions estimated from North American AIDS Cohort Collaboration on Research and Design data and parameters from the US Centers for Disease Control and Prevention's annual HIV surveillance reports. METHODS: The PEARL (ProjEcting Age, multimoRbidity, and poLypharmacy in adults with HIV) model simulated individuals in 15 subgroups of sex-and-HIV acquisition risk and race/ethnicity. Simulation outcomes from the baseline scenario are compared with outcomes from the EHE75% scenario. RESULTS: Under the baseline scenario, PEARL projects a substantial increase in number of ART-users over time, reaching a population of 909,638 [95%uncertaintyrange(UR):878,449-946,513] by 2030. The overall median age increased from 50 years (y) in 2020 to 52y in 2030, with 23% of ART-users age ≥65y in 2030. Under the EHE75% scenario, the projected number of ART-users was 718,348 [703,044-737,817] (median age=56y) in 2030, with a 70% relative reduction in ART-users <30y and a 4% relative reduction in ART-users age ≥65y compared to baseline, and persistent heterogeneities in projected numbers by sex-and-HIV acquisition risk group and race/ethnicity. CONCLUSIONS: It is critical to prepare healthcare systems to meet the impending demand of the US population aging with HIV. |
Tuberculosis treatment within differentiated service delivery models in global HIV/TB programming.
Tran CH , Moore BK , Pathmanathan I , Lungu P , Shah NS , Oboho I , Al-Samarrai T , Maloney SA , Date A , Boyd AT . J Int AIDS Soc 2021 24 Suppl 6 e25809 INTRODUCTION: Providing more convenient and patient-centred options for service delivery is a priority within global HIV programmes. These efforts improve patient satisfaction and retention and free up time for providers to focus on new HIV diagnoses or severe illness. Recently, the coronavirus disease 2019 (COVID-19) pandemic precipitated expanded eligibility criteria for these differentiated service delivery (DSD) models to decongest clinics and protect patients and healthcare workers. This has resulted in dramatic scale-up of DSD for antiretroviral therapy, cotrimoxazole and tuberculosis (TB) preventive treatment. While TB treatment among people living with HIV (PLHIV) has traditionally involved frequent, facility-based management, TB treatment can also be adapted within DSD models. Such adaptations could include electronic tools to ensure appropriate clinical management, treatment support, adherence counselling and adverse event (AE) monitoring. In this commentary, we outline considerations for DSD of TB treatment among PLHIV, building on best practices from global DSD model implementation for HIV service delivery. DISCUSSION: In operationalizing TB treatment in DSD models, we consider the following: what activity is being done, when or how often it takes place, where it takes place, by whom and for whom. We discuss considerations for various programme elements including TB screening and diagnosis; medication dispensing; patient education, counselling and support; clinical management and monitoring; and reporting and recording. General approaches include multi-month dispensing for TB medications during intensive and continuation phases of treatment and standardized virtual adherence and AE monitoring. Lastly, we provide operational examples of TB treatment delivery through DSD models, including a conceptual model and an early implementation experience from Zambia. CONCLUSIONS: COVID-19 has catalysed the rapid expansion of differentiated patient-centred service delivery for PLHIV. Expanding DSD models to include TB treatment can capitalize on existing platforms, while providing high-quality, routine treatment, follow-up and patient education and empowerment. |
Comparative efficacy of rifapentine alone and in combination with isoniazid for latent tuberculosis infection: a translational pharmacokinetic-pharmacodynamic modelling study
Radtke KK , Ernest JP , Zhang N , Ammerman NC , Nuermberger E , Belknap R , Boyd R , Sterling TR , Savic RM . Antimicrob Agents Chemother 2021 65 (12) Aac0170521 Background Rifapentine has facilitated treatment shortening of latent tuberculosis infection (LTBI) in combination with isoniazid once weekly for 3 months (3HP) or daily for 1 month (1HP). Objective We determine the optimal rifapentine dose for a 6-week monotherapy regimen (6wP) and predict clinical efficacy. Methods Rifapentine and isoniazid pharmacokinetics were simulated in mice and humans. Mouse lung colony-forming unit data were used to characterize exposure-response relationships of 1HP, 3HP, and 6wP and translated to predict clinical efficacy. Results A 600 mg daily dose for 6wP delivered greater cumulative rifapentine exposure than 1HP or 3HP. The maximum regimen effect (E(max)) was 0.24 day(-1). The regimen potencies, measured as concentration at 50% of E(max) (EC(50)), were estimated as 2.12 mg/L for 3HP, 3.72 mg/L for 1HP, and 4.71 mg/L for 6wP, suggesting that isoniazid contributes little to 1HP efficacy. Clinical translation predicted that 6wP reduces bacterial load at a faster rate than 3HP and a greater extent than 3HP and 1HP. Conclusions 6wP (600 mg daily) is predicted to result in equal or better efficacy than 1HP and 3HP for LTBI treatment without the potential added toxicity of isoniazid. Results from ongoing and future clinical studies will be required to support these findings. |
Optimizing community linkage to care and antiretroviral therapy Initiation: Lessons from the Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS) and their adaptation in Nigeria ART Surge
Jahun I , Said I , El-Imam I , Ehoche A , Dalhatu I , Yakubu A , Greby S , Bronson M , Brown K , Bamidele M , Boyd AT , Bachanas P , Dirlikov E , Agbakwuru C , Abutu A , Williams-Sherlock M , Onotu D , Odafe S , Williams DB , Bassey O , Ogbanufe O , Onyenuobi C , Adeola A , Meribe C , Efuntoye T , Fagbamigbe OJ , Fagbemi A , Ene U , Nguhemen T , Mgbakor I , Alagi M , Asaolu O , Oladipo A , Amafah J , Nzelu C , Dakum P , Mensah C , Aliyu A , Okonkwo P , Oyeledun B , Oko J , Ikpeazu A , Gambo A , Charurat M , Ellerbrock T , Aliyu S , Swaminathan M . PLoS One 2021 16 (9) e0257476 BACKGROUND: Ineffective linkage to care (LTC) is a known challenge for community HIV testing. To overcome this challenge, a robust linkage to care strategy was adopted by the 2018 Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS). The NAIIS linkage to care strategy was further adapted to improve Nigeria's programmatic efforts to achieve the 1st 90 as part of the Nigeria Antiretroviral Therapy (ART) Surge initiative, which also included targeted community testing. In this paper we provide an overview of the NAIIS LTC strategy and describe the impact of this strategy on both the NAIIS and the Surge initiatives. METHODS: The NAIIS collaborated with community-based organizations (CBOs) and deployed mobile health (mHealth) technology with real-time dashboards to manage and optimize community LTC for people living with HIV (PLHIV) diagnosed during the survey. In NAIIS, CBOs' role was to facilitate linkage of identified PLHIV in community to facility of their choice. For the ART Surge, we modified the NAIIS LTC strategy by empowering both CBOs and mobile community teams as responsible for not only active LTC but also for community testing, ART initiation, and retention in care. RESULTS: Of the 2,739 PLHIV 15 years and above identified in NAIIS, 1,975 (72.1%) were either unaware of their HIV-positive status (N = 1890) or were aware of their HIV-positive status but not receiving treatment (N = 85). Of these, 1,342 (67.9%) were linked to care, of which 952 (70.9%) were initiated on ART. Among 1,890 newly diagnosed PLHIV, 1,278 (67.6%) were linked to care, 33.7% self-linked and 66.3% were linked by CBOs. Among 85 known PLHIV not on treatment, 64 (75.3%) were linked; 32.8% self-linked and 67.2% were linked by a CBO. In the ART Surge, LTC and treatment initiation rates were 98% and 100%, respectively. Three-month retention for monthly treatment initiation cohorts improved from 76% to 90% over 6 months. CONCLUSIONS: Active LTC strategies by local CBOs and mobile community teams improved LTC and ART initiation in the ART Surge initiative. The use of mHealth technology resulted in timely and accurate documentation of results in NAIIS. By deploying mHealth in addition to active LTC, CBOs and mobile community teams could effectively scale up ART with real-time documentation of client-level outcomes. |
Expanding access to HIV services during the COVID-19 pandemic-Nigeria, 2020.
Boyd AT , Jahun I , Dirlikov E , Greby S , Odafe S , Abdulkadir A , Odeyemi O , Dalhatu I , Ogbanufe O , Abutu A , Asaolu O , Bamidele M , Onyenuobi C , Efuntoye T , Fagbamigbe JO , Ene U , Fagbemi A , Tingir N , Meribe C , Ayo A , Bassey O , Nnadozie O , Boyd MA , Onotu D , Gwamna J , Okoye M , Abrams W , Alagi M , Oladipo A , Williams-Sherlock M , Bachanas P , Chun H , Carpenter D , Miller DA , Ijeoma U , Nwaohiri A , Dakum P , Mensah CO , Aliyu A , Oyeledun B , Okonkwo P , Oko JO , Ikpeazu A , Aliyu G , Ellerbrock T , Swaminathan M . AIDS Res Ther 2021 18 (1) 62 BACKGROUND: To accelerate progress toward the UNAIDS 90-90-90 targets, US Centers for Disease Control and Prevention Nigeria country office (CDC Nigeria) initiated an Antiretroviral Treatment (ART) Surge in 2019 to identify and link 340,000 people living with HIV/AIDS (PLHIV) to ART. Coronavirus disease 2019 (COVID-19) threatened to interrupt ART Surge progress following the detection of the first case in Nigeria in February 2020. To overcome this disruption, CDC Nigeria designed and implemented adapted ART Surge strategies during February-September 2020. METHODS: Adapted ART Surge strategies focused on continuing expansion of HIV services while mitigating COVID-19 transmission. Key strategies included an intensified focus on community-based, rather than facility-based, HIV case-finding; immediate initiation of newly-diagnosed PLHIV on 3-month ART starter packs (first ART dispense of 3 months of ART); expansion of ART distribution through community refill sites; and broadened access to multi-month dispensing (MMD) (3-6 months ART) among PLHIV established in care. State-level weekly data reporting through an Excel-based dashboard and individual PLHIV-level data from the Nigeria National Data Repository facilitated program monitoring. RESULTS: During February-September 2020, the reported number of PLHIV initiating ART per month increased from 11,407 to 25,560, with the proportion found in the community increasing from 59 to 75%. The percentage of newly-identified PLHIV initiating ART with a 3-month ART starter pack increased from 60 to 98%. The percentage of on-time ART refill pick-ups increased from 89 to 100%. The percentage of PLHIV established in care receiving at least 3-month MMD increased from 77 to 93%. Among PLHIV initiating ART, 6-month retention increased from 74 to 92%. CONCLUSIONS: A rapid and flexible HIV program response, focused on reducing facility-based interactions while ensuring delivery of lifesaving ART, was critical in overcoming COVID-19-related service disruptions to expand access to HIV services in Nigeria during the first eight months of the pandemic. High retention on ART among PLHIV initiating treatment indicates immediate MMD in this population may be a sustainable practice. HIV program infrastructure can be leveraged and adapted to respond to the COVID-19 pandemic. |
Derivation and external validation of a risk score for predicting HIV-associated tuberculosis to support case finding and preventive therapy scale-up: A cohort study.
Auld AF , Kerkhoff AD , Hanifa Y , Wood R , Charalambous S , Liu Y , Agizew T , Mathoma A , Boyd R , Date A , Shiraishi RW , Bicego G , Mathebula-Modongo U , Alexander H , Serumola C , Rankgoane-Pono G , Pono P , Finlay A , Shepherd JC , Ellerbrock TV , Grant AD , Fielding K . PLoS Med 2021 18 (9) e1003739 BACKGROUND: Among people living with HIV (PLHIV), more flexible and sensitive tuberculosis (TB) screening tools capable of detecting both symptomatic and subclinical active TB are needed to (1) reduce morbidity and mortality from undiagnosed TB; (2) facilitate scale-up of tuberculosis preventive therapy (TPT) while reducing inappropriate prescription of TPT to PLHIV with subclinical active TB; and (3) allow for differentiated HIV-TB care. METHODS AND FINDINGS: We used Botswana XPRES trial data for adult HIV clinic enrollees collected during 2012 to 2015 to develop a parsimonious multivariable prognostic model for active prevalent TB using both logistic regression and random forest machine learning approaches. A clinical score was derived by rescaling final model coefficients. The clinical score was developed using southern Botswana XPRES data and its accuracy validated internally, using northern Botswana data, and externally using 3 diverse cohorts of antiretroviral therapy (ART)-naive and ART-experienced PLHIV enrolled in XPHACTOR, TB Fast Track (TBFT), and Gugulethu studies from South Africa (SA). Predictive accuracy of the clinical score was compared with the World Health Organization (WHO) 4-symptom TB screen. Among 5,418 XPRES enrollees, 2,771 were included in the derivation dataset; 67% were female, median age was 34 years, median CD4 was 240 cells/μL, 189 (7%) had undiagnosed prevalent TB, and characteristics were similar between internal derivation and validation datasets. Among XPHACTOR, TBFT, and Gugulethu cohorts, median CD4 was 400, 73, and 167 cells/μL, and prevalence of TB was 5%, 10%, and 18%, respectively. Factors predictive of TB in the derivation dataset and selected for the clinical score included male sex (1 point), ≥1 WHO TB symptom (7 points), smoking history (1 point), temperature >37.5°C (6 points), body mass index (BMI) <18.5kg/m2 (2 points), and severe anemia (hemoglobin <8g/dL) (3 points). Sensitivity using WHO 4-symptom TB screen was 73%, 80%, 94%, and 94% in XPRES, XPHACTOR, TBFT, and Gugulethu cohorts, respectively, but increased to 88%, 87%, 97%, and 97%, when a clinical score of ≥2 was used. Negative predictive value (NPV) also increased 1%, 0.3%, 1.6%, and 1.7% in XPRES, XPHACTOR, TBFT, and Gugulethu cohorts, respectively, when the clinical score of ≥2 replaced WHO 4-symptom TB screen. Categorizing risk scores into low (<2), moderate (2 to 10), and high-risk categories (>10) yielded TB prevalence of 1%, 1%, 2%, and 6% in the lowest risk group and 33%, 22%, 26%, and 32% in the highest risk group for XPRES, XPHACTOR, TBFT, and Gugulethu cohorts, respectively. At clinical score ≥2, the number needed to screen (NNS) ranged from 5.0 in Gugulethu to 11.0 in XPHACTOR. Limitations include that the risk score has not been validated in resource-rich settings and needs further evaluation and validation in contemporary cohorts in Africa and other resource-constrained settings. CONCLUSIONS: The simple and feasible clinical score allowed for prioritization of sensitivity and NPV, which could facilitate reductions in mortality from undiagnosed TB and safer administration of TPT during proposed global scale-up efforts. Differentiation of risk by clinical score cutoff allows flexibility in designing differentiated HIV-TB care to maximize impact of available resources. |
Ensuring optimal community HIV testing services in Nigeria using an enhanced community case-finding package (ECCP), October 2019-March 2020: Acceleration to HIV epidemic control
Jahun I , Dirlikov E , Odafe S , Yakubu A , Boyd AT , Bachanas P , Nzelu C , Aliyu G , Ellerbrock T , Swaminathan M . HIV AIDS (Auckl) 2021 13 839-850 PURPOSE: The 2018 Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS) showed Nigeria's progress toward the UNAIDS 90-90-90 targets: 47% of HIV-positive individuals knew their status; of these, 96% were receiving antiretroviral therapy (ART); and of these, 81% were virally suppressed. To improve identification of HIV-positive individuals, Nigeria developed an Enhanced Community Case-Finding Package (ECCP). We describe ECCP implementation in nine states and assess its effect. METHODS: ECCP included four core strategies (small area estimation [SAE] of people living with HIV [PLHIV], map of HIV-positive patients by residence, HIV risk-screening tool [HRST], and index testing [IT]) and four supportive strategies (alternative healthcare outlets, performance-based incentives for field testers, Project Extension for Community Healthcare Outcomes, and interactive dashboards). ECCP was deployed in nine of 10 states prioritized for ART scale-up. Weekly program data (October 2019-March 2020) were tracked and analyzed. RESULTS: Of the total 774 LGAs in Nigeria, using SAE, 103 (13.3%) high-burden LGAs were identified, in which 2605 (28.0%) out of 9,294 hotspots were prioritized by mapping newly identified PLHIV by residential addresses. Over 22 weeks, among 882,449 individuals screened using HRST, 723,993 (82.0%) were eligible and tested for HIV (state range, 43.7-90.4%), out of which 20,616 were positive. Through IT, an additional 3,724 PLHIV were identified. In total, 24,340 PLHIV were identified and 97.4% were linked to life-saving antiretroviral therapy. The number of newly identified PLHIV increased 17-fold over 22 weeks (week 1: 89; week 22: 1,632). Overall mean HIV positivity rate by state was 3.3% (range, 1.8-6.4%). CONCLUSION: Using ECCP in nine states in Nigeria increased the number of PLHIV in the community who knew their status, allowing them to access life-saving care and decreasing the risk of HIV transmission. |
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