Last data update: Nov 04, 2024. (Total: 48056 publications since 2009)
Records 1-30 (of 35 Records) |
Query Trace: Dokubo EK[original query] |
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Programme Science in PEPFAR: a pathway to a sustainable HIV response
Reid MJA , Bunnell R , Dokubo EK , Nkengasong J . J Int AIDS Soc 2024 27 Suppl 2 e26244 |
The association between HIV pretreatment drug resistance and virological outcomes in children and adults in sub-Saharan Africa: A systematic review and meta-analysis
Takem EN , Coox C , Shang J , Ndongmo C , Dokubo EK . PLoS One 2024 19 (4) e0300456 INTRODUCTION: Pretreatment drug resistance (PDR) could occur in antiretroviral treatment (ART) naïve individuals, those previously exposed to ART, or individuals re-initiating ARV after a long period of interruption. Few studies have shown its association with virological outcomes, although inconsistent. The objective of this review was to provide a synthesis of the association between PDR and virological outcomes (virological failure or suppression). METHODS: This report is presented following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The method was subdivided into three main phases: record identification, screening, and report inclusion. Record identification consisted of an initial search with search term "HIV pretreatment drug resistance". Another search was done using terms "Pretreatment drug resistance OR pre-treatment drug resistance OR Pretreatment drug resist* OR pre-treatment drug resist* OR pretreatment antiretroviral resistance OR pretreatment medic* OR pretreatment medic* resist*" and a list of all the countries in sub-Saharan Africa. After the electronic search, studies were screened from full list based on their title and abstract and then full articles retrieved and studies were assessed based on set criteria. Inclusion criteria involved observational studies that report the association between PDR and virological failure. Data from trials that reported the association were also included. Published articles like modelling studies and reviews, and studies with data that had been previously included in the review were excluded. The Mantel Haenszel method with odds ratios was used for synthesis (meta-analyses) with the weights of each study which depends on the number of events and totals. RESULTS: A total of 733 records(studies) were obtained from all database search of which 74 reported on PDR, virological outcomes in sub-Saharan Africa (SSA). Out of the 74 articles, 11 were excluded and 26 did not explicitly report data needed, and 5 did not meet the inclusion criteria. Of the remaining 32 studies, 19 studies that had complete data on the number of participants with PDR and no PDR according to virological failure (VF) were included in the metanalyses. The pooled results from eleven (13) of these studies showed those with PDR had higher odds of virological failure compared to those without PDR OR 3.64[95% CI 2.93, 4.52]. The result was similar when stratified in adults and in children. In six (6) studies that had Virological suppression (VS) as outcome, there was a reduction in the odds of VS in those with PDR compared to those without PDR, OR 0.42 (95% CI 0.30, 0.58). CONCLUSION: In conclusion, this systematic review indicates that PDR increases the risk of virological failure in sub-Saharan Africa. The risk could be reduced by PDR monitoring for NNRTIs and INSTIs. |
Seroprevalence of SARS-cov-2 in 10 regional capitals of Cameroon, October-December 2020
Sachathep K , Duong YT , Reid G , Dokubo EK , Shang JD , Ndongmo CB , Gabriel E , Tharp G , Dimite LE , N'Dir A , Okpu G , Ogollah FM , Nguafack D , Ntse MC , Hrusa G , Yuengling K , Tebbenhoff M , René E , Françoise NS , Felicity NT , Okomo MC , Bissek AZ , Harris TG . Influenza Other Respir Viruses 2024 18 (4) e13267 BACKGROUND: Cameroon was among the most affected African countries during the first wave of the COVID-19 pandemic; however, the true prevalence of SARS-CoV-2 remains unknown. METHODS: From October to December 2020, we conducted a cross-sectional, age-stratified SARS-CoV-2 seroepidemiological survey at 30 purposively selected community-based sites across Cameroon's 10 regional capitals, sampling 10,000 individuals aged 5 years or older. We employed a parallel SARS-CoV-2 antibody testing algorithm (WANTAI ELISA and Abbott Architect) to improve both the positive predictive value and negative predictive value of seroprevalence. RESULTS: The overall weighted and adjusted seroprevalence of SARS-CoV-2 antibodies across the 10 urban capitals of Cameroon was 10.5% (95% CI: 9.1%-12.0%) among participants aged ≥5 years. Of the 9332 participants, 730 males (13.1%, 95% CI: 11.5%-14.9%) had SARS-CoV-2 antibodies compared to 293 females (8.0%, 95% CI: 6.8%-9.3%). Among those who reported a comorbidity at the time of testing, 15.8% (95% CI: 12.8%-19.4%) were seropositive. We estimated that over 2 million SARS-CoV-2 infections occurred in the 10 regional capitals of Cameroon between October and December 2020, compared to 21,160 cases officially reported at that time translating to one laboratory-confirmed case being reported for every 110 SARS-CoV-2 infections across the 10 urban capitals. CONCLUSION: This study's findings point to extensive and under-reported circulation of SARS-CoV-2 in Cameroon-an almost 100-fold more cases compared to the number of cases reported to the World Health Organization. This finding highlights the importance of conducting serosurveys, especially in settings where access to testing may be limited and to repeat such surveys as part of pandemic tracking. |
The epidemiology of HIV population viral load in twelve sub-Saharan African countries
Hladik W , Stupp P , McCracken SD , Justman J , Ndongmo C , Shang J , Dokubo EK , Gummerson E , Koui I , Bodika S , Lobognon R , Brou H , Ryan C , Brown K , Nuwagaba-Biribonwoha H , Kingwara L , Young P , Bronson M , Chege D , Malewo O , Mengistu Y , Koen F , Jahn A , Auld A , Jonnalagadda S , Radin E , Hamunime N , Williams DB , Kayirangwa E , Mugisha V , Mdodo R , Delgado S , Kirungi W , Nelson L , West C , Biraro S , Dzekedzeke K , Barradas D , Mugurungi O , Balachandra S , Kilmarx PH , Musuka G , Patel H , Parekh B , Sleeman K , Domaoal RA , Rutherford G , Motsoane T , Bissek AZ , Farahani M , Voetsch AC . PLoS One 2023 18 (6) e0275560 BACKGROUND: We examined the epidemiology and transmission potential of HIV population viral load (VL) in 12 sub-Saharan African countries. METHODS: We analyzed data from Population-based HIV Impact Assessments (PHIAs), large national household-based surveys conducted between 2015 and 2019 in Cameroon, Cote d'Ivoire, Eswatini, Kenya, Lesotho, Malawi, Namibia, Rwanda, Tanzania, Uganda, Zambia, and Zimbabwe. Blood-based biomarkers included HIV serology, recency of HIV infection, and VL. We estimated the number of people living with HIV (PLHIV) with suppressed viral load (<1,000 HIV-1 RNA copies/mL) and with unsuppressed viral load (viremic), the prevalence of unsuppressed HIV (population viremia), sex-specific HIV transmission ratios (number female incident HIV-1 infections/number unsuppressed male PLHIV per 100 persons-years [PY] and vice versa) and examined correlations between a variety of VL metrics and incident HIV. Country sample sizes ranged from 10,016 (Eswatini) to 30,637 (Rwanda); estimates were weighted and restricted to participants 15 years and older. RESULTS: The proportion of female PLHIV with viral suppression was higher than that among males in all countries, however, the number of unsuppressed females outnumbered that of unsuppressed males in all countries due to higher overall female HIV prevalence, with ratios ranging from 1.08 to 2.10 (median: 1.43). The spatial distribution of HIV seroprevalence, viremia prevalence, and number of unsuppressed adults often differed substantially within the same countries. The 1% and 5% of PLHIV with the highest VL on average accounted for 34% and 66%, respectively, of countries' total VL. HIV transmission ratios varied widely across countries and were higher for male-to-female (range: 2.3-28.3/100 PY) than for female-to-male transmission (range: 1.5-10.6/100 PY). In all countries mean log10 VL among unsuppressed males was higher than that among females. Correlations between VL measures and incident HIV varied, were weaker for VL metrics among females compared to males and were strongest for the number of unsuppressed PLHIV per 100 HIV-negative adults (R2 = 0.92). CONCLUSIONS: Despite higher proportions of viral suppression, female unsuppressed PLHIV outnumbered males in all countries examined. Unsuppressed male PLHIV have consistently higher VL and a higher risk of transmitting HIV than females. Just 5% of PLHIV account for almost two-thirds of countries' total VL. Population-level VL metrics help monitor the epidemic and highlight key programmatic gaps in these African countries. |
Global responses to the COVID-19 pandemic
Cassell CH , Raghunathan PL , Henao O , Pappas-DeLuca KA , Rémy WL , Dokubo EK , Merrill RD , Marston BJ . Emerg Infect Dis 2022 28 (13) S4-s7 Confronted with a novel coronavirus, countries worldwide were forced to rapidly adjust their public health systems, platforms, and tools to respond to COVID-19. The US Centers for Disease Control and Prevention (CDC) and its global partners adapted health systems and programs originally developed for other purposes, such as controlling the HIV/AIDS pandemic through the US President’s Emergency Plan for AIDS Relief (PEPFAR), Global Health Security Agenda implementation, influenza surveillance, and vaccine-preventable disease elimination and eradication. This special supplement of Emerging Infectious Diseases highlights responses to the early phases of the COVID-19 pandemic from >80 countries, spanning 6 continents and representing >130 organizations. This article summarizes global adaptations of core public health functions during COVID-19: surveillance, information, and laboratory systems; workforce, institutional, and public health capacity; and clinical and health services delivery. |
Community-based referral for tuberculosis preventive therapy is effective for treatment completion
Shenoi SV , Kyriakides TC , Dokubo EK , Guddera V , Vranken P , Desai M , Friedland G , Moll AP . PLoS Glob Public Health 2022 2 (12) Expansion of tuberculous preventive therapy (TPT) is essential to curb TB incidence and mortality among people with HIV (PWH), yet implementation has been slow. Innovative strategies to operationalize TPT are urgently needed. Here we present an evaluation of community-based identification and referral of PWH on completion of a six-month course of isoniazid in a highly prevalent region in rural South Africa. Using a community-based TB/HIV intensive case finding strategy, a team of nurses and lay workers identified community members with HIV who were without fever, night sweats, weight loss, or cough and referred them to the government primary care clinics for daily oral isoniazid, the only available TPT regimen. We measured monthly adherence and six-month treatment completion in the community-based identification and referral (CBR) group compared to those already engaged in HIV care. Adherence was measured by self-report and urine isoniazid metabolite testing. A multivariable analysis was performed to identify independent predictors of TPT completion. Among 240 participants, 81.7% were female, median age 35 years (IQR 30-44), and 24.6% had previously been treated for TB. The median CD4 count in the CBR group was 457 (IQR 301-648), significantly higher than the clinic-based comparison group median CD4 of 344 (IQR 186-495, p<0.001). Independent predictors of treatment completion included being a woman (aOR 2.41, 95% 1.02-5.72) and community-based identification and referral for TPT (aOR 2.495, 95% 1.13-5.53). Among the CBR group, treatment completion was 90.0%, an absolute 10.8% higher than the clinic-based comparison group (79.2%, p = 0.02). Adherence was significantly greater in the CBR group than the clinic-based comparison group, as measured by self-report (p = 0.02) and urine isoniazid testing (p = 0.01). Among those not on ART at baseline, 10% of eligible PWH subsequently initiated ART. Community members living with HIV in TB endemic regions identified and referred for TPT demonstrated higher treatment completion and adherence compared to PWH engaged for TPT while receiving clinic-based care. Community-based identification and referral is an innovative adjunctive strategy to facilitate implementation of TB preventive therapy in people living with HIV. |
Building on Capacity Established through US Centers for Disease Control and Prevention Global Health Programs to Respond to COVID-19, Cameroon.
Dokubo EK , Shang JD , N'Dir A , Ndongmo CB , Okpu G , Fadil YM , Takang LE , Angumua C , Lyonga E , Mayer M , Ayukotabe T , Nkwoh TK , Hedje J , Etoundi GA , Njock RL . Emerg Infect Dis 2022 28 (13) S181-s190 The COVID-19 pandemic has highlighted the need for resilient health systems with the capacity to effectively detect and respond to disease outbreaks and ensure continuity of health service delivery. The pandemic has disproportionately affected resource-limited settings with inadequate health capacity, resulting in disruptions in health service delivery and worsened outcomes for key health indicators. As part of the US government's goal of ensuring health security, the US Centers for Disease Control and Prevention has used its scientific and technical expertise to build health capacity and address health threats globally. We describe how capacity developed through global health programs of the US Centers for Disease Control and Prevention in Cameroon was leveraged to respond to coronavirus disease and maintain health service delivery. The health system strengthening efforts in Cameroon can be applied in similar settings to ensure preparedness for future global public health threats and improve health outcomes. |
Protecting the gains: analysis of HIV treatment and service delivery programme data and interventions implemented in 19 African countries during COVID-19.
Bachanas PJ , Chun HM , Mehta N , Aberle-Grasse J , Parris K , Sherlock MW , Lloyd S , Zeh C , Makwepa DK , Kapanda ML , Dokubo EK , Bonono L , Balachandra S , Ehui E , Fonjungo P , Nkoso AM , Mazibuko S , Okello VN , Tefera F , Getachew M , Katiku EM , Mulwa A , Asiimwe FM , Tarumbiswa TF , Auld AF , Nyirenda R , Dos Santos De Louvado AP , Gaspar I , Hong SY , Ashipala L , Obanubi C , Ikpeazu A , Musoni C , Yoboka E , Mthethwa S , Pinini Z , Bunga S , Rumunu J , Magesa DJ , Mutayoba B , Nelson LJ , Katureebe C , Agolory S , Mulenga LB , Nyika P , Mugurungi O , Ellerbrock T , Mitruka K . J Int AIDS Soc 2022 25 (11) e26033 INTRODUCTION: The potential disruption in antiretroviral therapy (ART) services in Africa at the start of the COVID-19 pandemic raised concern for increased morbidity and mortality among people living with HIV (PLHIV). We describe HIV treatment trends before and during the pandemic and interventions implemented to mitigate COVID-19 impact among countries supported by the US Centers for Disease Control and Prevention (CDC) through the President's Emergency Plan for AIDS Relief (PEPFAR). METHODS: We analysed quantitative and qualitative data reported by 10,387 PEPFAR-CDC-supported ART sites in 19 African countries between October 2019 and March 2021. Trends in PLHIV on ART, new ART initiations and treatment interruptions were assessed. Viral load coverage (testing of eligible PLHIV) and viral suppression were calculated at select time points. Qualitative data were analysed to summarize facility- and community-based interventions implemented to mitigate COVID-19. RESULTS: The total number of PLHIV on ART increased quarterly from October 2019 (n = 7,540,592) to March 2021 (n = 8,513,572). The adult population (≥15 years) on ART increased by 14.0% (7,005,959-7,983,793), while the paediatric population (<15 years) on ART declined by 2.6% (333,178-324,441). However, the number of new ART initiations dropped between March 2020 and June 2020 by 23.4% for adults and 26.1% for children, with more rapid recovery in adults than children from September 2020 onwards. Viral load coverage increased slightly from April 2020 to March 2021 (75-78%) and viral load suppression increased from October 2019 to March 2021 (91-94%) among adults and children combined. The most reported interventions included multi-month dispensing (MMD) of ART, community service delivery expansion, and technology and virtual platforms use for client engagement and site-level monitoring. MMD of ≥3 months increased from 52% in October 2019 to 78% of PLHIV ≥ age 15 on ART in March 2021. CONCLUSIONS: With an overall increase in the number of people on ART, HIV programmes proved to be resilient, mitigating the impact of COVID-19. However, the decline in the number of children on ART warrants urgent investigation and interventions to prevent further losses experienced during the COVID-19 pandemic and future public health emergencies. |
Progress towards the UNAIDS 90-90-90 targets among persons aged 50 and older living with HIV in 13 African countries
Farley SM , Wang C , Bray RM , Low AJ , Delgado S , Hoos D , Kakishozi AN , Harris TG , Nyirenda R , Wadonda N , Li M , Amuri M , Juma J , Kancheya N , Pietersen I , Mutenda N , Natanael S , Aoko A , Ngugi EW , Asiimwe F , Lecher S , Ward J , Chikwanda P , Mugurungi O , Moyo B , Nkurunziza P , Aibo D , Kabala A , Biraro S , Ndagije F , Musuka G , Ndongmo C , Shang J , Dokubo EK , Dimite LE , McCullough-Sanden R , Bissek AC , Getaneh Y , Eshetu F , Nkumbula T , Tenthani L , Kayigamba FR , Kirungi W , Musinguzi J , Balachandra S , Kayirangwa E , Ayite A , West CA , Bodika S , Sleeman K , Patel HK , Brown K , Voetsch AC , El-Sadr WM , Justman JJ . J Int AIDS Soc 2022 25 Suppl 4 e26005 INTRODUCTION: Achieving optimal HIV outcomes, as measured by global 90-90-90 targets, that is awareness of HIV-positive status, receipt of antiretroviral (ARV) therapy among aware and viral load (VL) suppression among those on ARVs, respectively, is critical. However, few data from sub-Saharan Africa (SSA) are available on older people (50+) living with HIV (OPLWH). We examined 90-90-90 progress by age, 15-49 (as a comparison) and 50+ years, with further analyses among 50+ (55-59, 60-64, 65+ vs. 50-54), in 13 countries (Cameroon, Cote d'Ivoire, Eswatini, Ethiopia, Kenya, Lesotho, Malawi, Namibia, Rwanda, Tanzania, Uganda, Zambia and Zimbabwe). METHODS: Using data from nationally representative Population-based HIV Impact Assessments, conducted between 2015and 2019, participants from randomly selected households provided demographic and clinical information and whole blood specimens for HIV serology, VL and ARV testing. Survey weighted outcomes were estimated for 90-90-90 targets. Country-specific Poisson regression models examined 90-90-90 variation among OPLWH age strata. RESULTS: Analyses included 24,826 HIV-positive individuals (15-49 years: 20,170; 50+ years: 4656). The first, second and third 90 outcomes were achieved in 1, 10 and 5 countries, respectively, by those aged 15-49, while OPLWH achieved outcomes in 3, 13 and 12 countries, respectively. Among those aged 15-49, women were more likely to achieve 90-90-90 targets than men; however, among OPLWH, men were more likely to achieve first and third 90 targets than women, with second 90 achievement being equivalent. Country-specific 90-90-90 regression models among OPLWH demonstrated minimal variation by age stratum across 13 countries. Among OLPWH, no first 90 target differences were noted by age strata; three countries varied in the second 90 by older age strata but not in a consistent direction; one country showed higher achievement of the third 90 in an older age stratum. CONCLUSIONS: While OPLWH in these 13 countries were slightly more likely than younger people to be aware of their HIV-positive status (first 90), this target was not achieved in most countries. However, OPLWH achieved treatment (second 90) and VL suppression (third 90) targets in more countries than PLWH <50. Findings support expanded HIV testing, prevention and treatment services to meet ongoing OPLWH health needs in SSA. |
Lessons Learned from Programmatic Gains in HIV Service Delivery During the COVID-19 Pandemic - 41 PEPFAR-Supported Countries, 2020.
Fisher KA , Patel SV , Mehta N , Stewart A , Medley A , Dokubo EK , Shang JD , Wright J , Rodas J , Balachandra S , Kitenge F , Mpingulu M , García MC , Bonilla L , Quaye S , Melchior M , Banchongphanith K , Phokhasawad K , Nkanaunena K , Maida A , Couto A , Mizela J , Ibrahim J , Charles OO , Malamba SS , Musoni C , Bolo A , Bunga S , Lolekha R , Kiatchanon W , Bhatia R , Nguyen C , Aberle-Grasse J . MMWR Morb Mortal Wkly Rep 2022 71 (12) 447-452 The U.S. President's Emergency Plan for AIDS Relief (PEPFAR) supports country programs in identifying persons living with HIV infection (PLHIV), providing life-saving treatment, and reducing the spread of HIV in countries around the world (1,2). CDC used Monitoring, Evaluation, and Reporting (MER) data* to assess the extent to which COVID-19 mitigation strategies affected HIV service delivery across the HIV care continuum(†) globally during the first year of the COVID-19 pandemic. Indicators included the number of reported HIV-positive test results, the number of PLHIV who were receiving antiretroviral therapy (ART), and the rates of HIV viral load suppression. Percent change in performance was assessed between countries during the first 3 months of 2020, before COVID-19 mitigation efforts began (January-March 2020), and the last 3 months of the calendar year (October-December 2020). Data were reviewed for all 41 countries to assess total and country-level percent change for each indicator. Then, qualitative data were reviewed among countries in the upper quartile to assess specific strategies that contributed to programmatic gains. Overall, positive percent change was observed in PEPFAR-supported countries in HIV treatment (5%) and viral load suppression (2%) during 2020. Countries reporting the highest gains across the HIV care continuum during 2020 attributed successes to reducing or streamlining facility attendance through strategies such as enhancing index testing (offering of testing to the biologic children and partners of PLHIV)(§) and community- and home-based testing; treatment delivery approaches; and improvements in data use through monitoring activities, systems, and data quality checks. Countries that reported program improvements during the first year of the COVID-19 pandemic offer important information about how lifesaving HIV treatment might be provided during a global public health crisis. |
HIV-1 Recent Infection Testing Algorithm With Antiretroviral Drug Detection to Improve Accuracy of Incidence Estimates
Voetsch AC , Duong YT , Stupp P , Saito S , McCracken S , Dobbs T , Winterhalter FS , Williams DB , Mengistu A , Mugurungi O , Chikwanda P , Musuka G , Ndongmo CB , Dlamini S , Nuwagaba-Biribonwoha H , Pasipamire M , Tegbaru B , Eshetu F , Biraro S , Ward J , Aibo D , Kabala A , Mgomella GS , Malewo O , Mushi J , Payne D , Mengistu Y , Asiimwe F , Shang JD , Dokubo EK , Eno LT , Zoung-Kanyi Bissek AC , Kingwara L , Junghae M , Kiiru JN , Mwesigwa RCN , Balachandra S , Lobognon R , Kampira E , Detorio M , Yufenyuy EL , Brown K , Patel HK , Parekh BS . J Acquir Immune Defic Syndr 2021 87 S73-s80 BACKGROUND: HIV-1 incidence calculation currently includes recency classification by HIV-1 incidence assay and unsuppressed viral load (VL ≥ 1000 copies/mL) in a recent infection testing algorithm (RITA). However, persons with recent classification not virally suppressed and taking antiretroviral (ARV) medication may be misclassified. SETTING: We used data from 13 African household surveys to describe the impact of an ARV-adjusted RITA on HIV-1 incidence estimates. METHODS: HIV-seropositive samples were tested for recency using the HIV-1 Limiting Antigen (LAg)-Avidity enzyme immunoassay, HIV-1 viral load, ARVs used in each country, and ARV drug resistance. LAg-recent result was defined as normalized optical density values ≤1.5. We compared HIV-1 incidence estimates using 2 RITA: RITA1: LAg-recent + VL ≥ 1000 copies/mL and RITA2: RITA1 + undetectable ARV. We explored RITA2 with self-reported ARV use and with clinical history. RESULTS: Overall, 357 adult HIV-positive participants were classified as having recent infection with RITA1. RITA2 reclassified 55 (15.4%) persons with detectable ARV as having long-term infection. Those with detectable ARV were significantly more likely to be aware of their HIV-positive status (84% vs. 10%) and had higher levels of drug resistance (74% vs. 26%) than those without detectable ARV. RITA2 incidence was lower than RITA1 incidence (range, 0%-30% decrease), resulting in decreased estimated new infections from 390,000 to 341,000 across the 13 countries. Incidence estimates were similar using detectable or self-reported ARV (R2 > 0.995). CONCLUSIONS: Including ARV in RITA2 improved the accuracy of HIV-1 incidence estimates by removing participants with likely long-term HIV infection. |
Unawareness of HIV Infection Among Men Aged 15-59 Years in 13 Sub-Saharan African Countries: Findings From the Population-Based HIV Impact Assessments, 2015-2019
West CA , Chang GC , Currie DW , Bray R , Kinchen S , Behel S , McCullough-Sanden R , Low A , Bissek A , Shang JD , Ndongmo CB , Dokubo EK , Balachandra S , Lobognon LR , Dube L , Nuwagaba-Biribonwoha H , Li M , Pasipamire M , Getaneh Y , Lulseged S , Eshetu F , Kingwara L , Zielinski-Gutierrez E , Tlhomola M , Ramphalla P , Kalua T , Auld AF , Williams DB , Remera E , Rwibasira GN , Mugisha V , Malamba SS , Mushi J , Jalloh MF , Mgomella GS , Kirungi WL , Biraro S , Awor AC , Barradas DT , Mugurungi O , Rogers JH , Bronson M , Bodika SM , Ajiboye A , Gaffga N , Moore C , Patel HK , Voetsch AC . J Acquir Immune Defic Syndr 2021 87 S97-s106 BACKGROUND: Identifying men living with HIV in sub-Saharan Africa (SSA) is critical to end the epidemic. We describe the underlying factors of unawareness among men aged 15-59 years who ever tested for HIV in 13 SSA countries. METHODS: Using pooled data from the nationally representative Population-based HIV Impact Assessments, we fit a log-binomial regression model to identify characteristics related to HIV positivity among HIV-positive unaware and HIV-negative men ever tested for HIV. RESULTS: A total of 114,776 men were interviewed and tested for HIV; 4.4% were HIV-positive. Of those, 33.7% were unaware of their HIV-positive status, (range: 20.2%-58.7%, in Rwanda and Cote d'Ivoire). Most unaware men reported they had ever received an HIV test (63.0%). Age, region, marital status, and education were significantly associated with HIV positivity. Men who had HIV-positive sexual partners (adjusted prevalence ratio [aPR]: 5.73; confidence interval [95% CI]: 4.13 to 7.95) or sexual partners with unknown HIV status (aPR: 2.32; 95% CI: 1.89 to 2.84) were more likely to be HIV-positive unaware, as were men who tested more than 12 months compared with HIV-negative men who tested within 12 months before the interview (aPR: 1.58; 95% CI: 1.31 to 1.91). Tuberculosis diagnosis and not being circumcised were also associated with HIV positivity. CONCLUSION: Targeting subgroups of men at risk for infection who once tested negative could improve yield of testing programs. Interventions include improving partner testing, frequency of testing, outreach and educational strategies, and availability of HIV testing where men are accessing routine health services. |
Community intervention for child tuberculosis active contact investigation and management: study protocol for a parallel cluster randomized controlled trial.
Shenoi SV , Kyriakides TC , Dokubo EK , Guddera V , Vranken P , Desai M , Friedland G , Moll AP . Trials 2021 3 (1) 180 BACKGROUND:There are major gaps in the management of pediatric tuberculosis (TB) contact investigation for rapid identification of active tuberculosis and initiation of preventive therapy. This study aims to evaluate the impact of a community-based intervention as compared to facility-based model for the management of children in contact with bacteriologically confirmed pulmonary TB adults in low-resource high-burden settings.METHODS/DESIGN:This multicenter parallel open-label cluster randomized controlled trial is composed of three phases: I, baseline phase in which retrospective data are collected, quality of data recording in facility registers is checked, and expected acceptability and feasibility of the intervention is assessed; II, intervention phase with enrolment of index cases and contact cases in either facility- or community-based models; and III, explanatory phase including endpoint data analysis, cost-effectiveness analysis, and post-intervention acceptability assessment by healthcare providers and beneficiaries. The study uses both quantitative and qualitative analysis methods. The community-based intervention includes identification and screening of all household contacts, referral of contacts with TB-suggestive symptoms to the facility for investigation, and household initiation of preventive therapy with follow-up of eligible child contacts by community healthcare workers, i.e., all young (< 5 years) child contacts or older (5-14 years) child contacts living with HIV, and with no evidence of TB disease. Twenty clusters representing TB diagnostic and treatment facilities with their catchment areas are randomized in a 1:1 ratio to either the community-based intervention arm or the facility-based standard of care arm in Cameroon and Uganda. Randomization was stratified by country and constrained on the number of index cases per cluster. The primary endpoint is the proportion of eligible child contacts who initiate and complete the preventive therapy. The sample size is of 1500 child contacts to identify a 10% difference between the arms with the assumption that 60% of children will complete the preventive therapy in the standard of care arm.DISCUSSION:This study will provide evidence of the impact of a community-based intervention on household child contact screening and management of TB preventive therapy in order to improve care and prevention of childhood TB in low-resource high-burden settings.TRIAL REGISTRATION:ClinicalTrials.gov NCT03832023 . Registered on 6 February 2019. |
Systematic identification of facility-based stillbirths and neonatal deaths through the piloted use of an adapted RAPID tool in Liberia and Nepal
Greene-Cramer B , Boyd AT , Russell S , Hulland E , Tromble E , Widiati Y , Sharma S , Pun A , Roth Allen D , Dokubo EK , Handzel E . PLoS One 2019 14 (9) e0222583 Maternal, fetal, and neonatal health outcomes are interdependent. Designing public health strategies that link fetal and neonatal outcomes with maternal outcomes is necessary in order to successfully reduce perinatal and neonatal mortality, particularly in low- and middle- income countries. However, to date, there has been no standardized method for documenting, reporting, and reviewing facility-based stillbirths and neonatal deaths that links to maternal health outcomes would enable a more comprehensive understanding of the burden and determinants of poor fetal and neonatal outcomes. We developed and pilot-tested an adapted RAPID tool, Perinatal-Neonatal Rapid Ascertainment Process for Institutional Deaths (PN RAPID), to systematically identify and quantify facility-based stillbirths and neonatal deaths and link them to maternal health factors in two countries: Liberia and Nepal. This study found an absence of stillbirth timing documented in records, a high proportion of neonatal deaths occurring within the first 24 hours, and an absence of documentation of pregnancy-related and maternal factors that might be associated with fetal and neonatal outcomes. The use of an adapted RAPID methodology and tools was limited by these data gaps, highlighting the need for concurrent strengthening of death documentation through training and standardized record templates. |
Care of Ebola survivors and factors associated with clinical sequelae - Monrovia, Liberia
de St Maurice A , Ervin E , Orone R , Choi M , Dokubo EK , Rollin PE , Nichol ST , Williams D , Brown J , Sacra R , Fankhauser J , Knust B . Open Forum Infect Dis 2018 5 (10) ofy239 Background: The Eternal Love Winning Africa (ELWA) Clinic was the first clinic to provide free, comprehensive care to Ebola virus disease (EVD) survivors in Liberia. The objectives of this analysis were to describe the demographics and symptoms of EVD survivors at ELWA from January 2015 through March 2017 and to identify risk factors for development of sequelae. Methods: Patients' demographic and clinical information was collected by chart review in June 2016 and March 2017. Associations with clinical sequelae were analyzed using the chi-square test, t test, and multivariate logistic regression. Results: From January 2015 to March 2017, 329 EVD survivors were evaluated at ELWA. Most survivors experienced myalgia/arthralgia (73%; n = 239) and headache (53%; n = 173). The length of time from Ebola Treatment Unit (ETU) discharge to first clinic visit ranged from 0 to 30 months. Many visits (30%) occurred 24 or more months after ETU discharge. The proportion of visits for headache, weight loss, joint pain, visual problems, insomnia, fatigue, memory loss, decreased libido, depression, and uveitis decreased over time. More men than women had visits for depression; however, these differences were not significant. Symptom prevalence differed in adults and children; significantly more adults experienced myalgia/arthralgia (77% vs 44%), visual problems (41% vs 12%), post-EVD-related musculoskeletal pain (42% vs 15%), and insomnia (17% vs 2%). Conclusions: EVD survivors frequented ELWA for EVD-related symptoms many months after ETU discharge, indicating a long-term need for care. Reported symptoms changed over time, which may reflect eventual resolution of some sequelae. |
Outbreak of Neisseria meningitidis serogroup C outside the meningitis belt-Liberia, 2017: an epidemiological and laboratory investigation.
Bozio CH , Vuong J , Dokubo EK , Fallah MP , McNamara LA , Potts CC , Doedeh J , Gbanya M , Retchless AC , Patel JC , Clark TA , Kohar H , Nagbe T , Clement P , Katawera V , Mahmoud N , Djingarey HM , Perrocheau A , Naidoo D , Stone M , George RN , Williams D , Gasasira A , Nyenswah T , Wang X , Fox LM . Lancet Infect Dis 2018 18 (12) 1360-1367 BACKGROUND: On April 25, 2017, a cluster of unexplained illnesses and deaths associated with a funeral was reported in Sinoe County, Liberia. Molecular testing identified Neisseria meningitidis serogroup C (NmC) in specimens from patients. We describe the epidemiological investigation of this cluster and metagenomic characterisation of the outbreak strain. METHODS: We collected epidemiological data from the field investigation and medical records review. Confirmed, probable, and suspected cases were defined on the basis of molecular testing and signs or symptoms of meningococcal disease. Metagenomic sequences from patient specimens were compared with 141 meningococcal isolate genomes to determine strain lineage. FINDINGS: 28 meningococcal disease cases were identified, with dates of symptom onset from April 21 to April 30, 2017: 13 confirmed, three probable, and 12 suspected. 13 patients died. Six (21%) patients reported fever and 23 (82%) reported gastrointestinal symptoms. The attack rate for confirmed and probable cases among funeral attendees was 10%. Metagenomic sequences from six patient specimens were similar to a sequence type (ST) 10217 (clonal complex [CC] 10217) isolate genome from Niger, 2015. Multilocus sequencing identified five of seven alleles from one specimen that matched ST-9367, which is represented in the PubMLST database by one carriage isolate from Burkina Faso, in 2011, and belongs to CC10217. INTERPRETATION: This outbreak featured high attack and case fatality rates. Clinical presentation was broadly consistent with previous meningococcal disease outbreaks, but predominance of gastrointestinal symptoms was unusual compared with previous African meningitis epidemics. The outbreak strain was genetically similar to NmC CC10217, which caused meningococcal disease outbreaks in Niger and Nigeria. CC10217 had previously been identified only in the African meningitis belt. FUNDING: US Global Health Security. |
Persistence of Ebola virus after the end of widespread transmission in Liberia: an outbreak report.
Dokubo EK , Wendland A , Mate SE , Ladner JT , Hamblion EL , Raftery P , Blackley DJ , Laney AS , Mahmoud N , Wayne-Davies G , Hensley L , Stavale E , Fakoli L , Gregory C , Chen TH , Koryon A , Roth Allen D , Mann J , Hickey A , Saindon J , Badini M , Baller A , Clement P , Bolay F , Wapoe Y , Wiley MR , Logue J , Dighero-Kemp B , Higgs E , Gasasira A , Williams DE , Dahn B , Kateh F , Nyenswah T , Palacios G , Fallah MP . Lancet Infect Dis 2018 18 (9) 1015-1024 BACKGROUND: Outbreak response efforts for the 2014-15 Ebola virus disease epidemic in west Africa brought widespread transmission to an end. However, subsequent clusters of infection have occurred in the region. An Ebola virus disease cluster in Liberia in November, 2015, that was identified after a 15-year-old boy tested positive for Ebola virus infection in Monrovia, raised the possibility of transmission from a persistently infected individual. METHODS: Case investigations were done to ascertain previous contact with cases of Ebola virus disease or infection with Ebola virus. Molecular investigations on blood samples explored a potential linkage between Ebola virus isolated from cases in this November, 2015, cluster and epidemiologically linked cases from the 2014-15 west African outbreak, according to the national case database. FINDINGS: The cluster investigated was the family of the index case (mother, father, three siblings). Ebola virus genomes assembled from two cases in the November, 2015, cluster, and an epidemiologically linked Ebola virus disease case in July, 2014, were phylogenetically related within the LB5 sublineage that circulated in Liberia starting around August, 2014. Partial genomes from two additional individuals, one from each cluster, were also consistent with placement in the LB5 sublineage. Sequencing data indicate infection with a lineage of the virus from a former transmission chain in the country. Based on serology and epidemiological and genomic data, the most plausible scenario is that a female case in the November, 2015, cluster survived Ebola virus disease in 2014, had viral persistence or recurrent disease, and transmitted the virus to three family members a year later. INTERPRETATION: Investigation of the source of infection for the November, 2015, cluster provides evidence of Ebola virus persistence and highlights the risk for outbreaks after interruption of active transmission. These findings underscore the need for focused prevention efforts among survivors and sustained capacity to rapidly detect and respond to new Ebola virus disease cases to prevent recurrence of a widespread outbreak. FUNDING: US Centers for Disease Control and Prevention, Defense Threat Reduction Agency, and WHO. |
High uptake of antiretroviral therapy among HIV-positive TB patients receiving co-located services in Swaziland
Pathmanathan I , Pasipamire M , Pals S , Dokubo EK , Preko P , Ao T , Mazibuko S , Ongole J , Dhlamini T , Haumba S . PLoS One 2018 13 (5) e0196831 BACKGROUND: Swaziland has the highest adult HIV prevalence and second highest rate of TB/HIV coinfection globally. Recently, the Ministry of Health and partners have increased integration and co-location of TB/HIV services, but the timing of antiretroviral therapy (ART) relative to TB treatment-a marker of program quality and predictor of outcomes-is unknown. METHODS: We conducted a retrospective analysis of programmatic data from 11 purposefully-sampled facilities to evaluate timely ART provision for HIV-positive TB patients enrolled on TB treatment between July-November 2014. Timely ART was defined as within two weeks of TB treatment initiation for patients with CD4<50/muL or missing, and within eight weeks otherwise. Descriptive statistics were estimated and logistic regression used to assess factors independently associated with timely ART. RESULTS: Of 466 HIV-positive TB patients, 51.5% were male, median age was 35 (interquartile range [IQR]: 29-42), and median CD4 was 137/muL (IQR: 58-268). 189 (40.6%) were on ART prior to, and five (1.8%) did not receive ART within six months of TB treatment initiation. Median time to ART after TB treatment initiation was 15 days (IQR: 14-28). Almost 90% started ART within eight weeks, and 45.5% of those with CD4<50/muL started within two weeks. Using thresholds for "timely ART" according to baseline CD4 count, 73.3% of patients overall received timely ART after TB treatment initiation. Patients with CD4 50-200/muL or >/=200/muL had significantly higher odds of timely ART than patients with CD4<50/muL, with adjusted odds ratios of 11.5 (95% confidence interval [CI]: 5.0-26.6) and 9.6 (95% CI: 4.6-19.9), respectively. TB cure or treatment completion was achieved by 71.1% of patients at six months, but this was not associated with timely ART. CONCLUSIONS: This study demonstrates the relative success of integrated and co-located TB/HIV services in Swaziland, and shows that timely ART uptake for HIV-positive TB patients can be achieved in resource-limited, but integrated settings. Gaps remain in getting patients with CD4<50/muL to receive ART within the recommended two weeks post TB treatment initiation. |
Cross-Border Transmission of Ebola Virus as the Cause of a Resurgent Outbreak in Liberia in April 2016.
Mate SE , Wiley MR , Ladner JT , Dokubo EK , Fakoli L , Fallah M , Nyenswah TG , DiClaro JW , Deboer JT , Williams DE , Bolay F , Palacios G . Clin Infect Dis 2018 67 (7) 1147-1149 We present new information regarding an outbreak of Ebola virus (EBOV) disease (EVD) in Liberia in early 2016 that was associated with a resurgent outbreak (“flare-up”) in N’zérékoré, Guinea, described by Diallo et al [1]. During the course of the Guinean flare-up, 3 EVD cases were diagnosed in Monrovia, Liberia. We describe genomic and epidemiologic evidence demonstrating that the Liberian cases were the result of cross-border transmission from the N’zérékoré flare-up [1]. On 31 March 2016, an oropharyngeal swab sample from a deceased 30-year-old Liberian woman (patient A) tested positive for EBOV RNA by quantitative reverse-transcription polymerase chain reaction performed at the National Reference Laboratory in Liberia. Blood samples collected from her 2 children, 5-year-old and 2-year-old boys, also tested EBOV positive on 2 April (patient B) and 5 April (patient C) by quantitative reverse-transcription polymerase chain reaction. Genetic and epidemiologic investigations were initiated to distinguish among 3 potential modes of infection: (1) transmission from a persistently infected survivor within Liberia, (2) reintroduction from active transmission of EBOV ongoing in Guinea, and (3) an independent spillover from a nonhuman reservoir. |
Ebola response impact on public health programs, West Africa, 2014-2017
Marston BJ , Dokubo EK , van Steelandt A , Martel L , Williams D , Hersey S , Jambai A , Keita S , Nyenswah TG , Redd JT . Emerg Infect Dis 2017 23 (13) S25-32 Events such as the 2014-2015 West Africa epidemic of Ebola virus disease highlight the importance of the capacity to detect and respond to public health threats. We describe capacity-building efforts during and after the Ebola epidemic in Liberia, Sierra Leone, and Guinea and public health progress that was made as a result of the Ebola response in 4 key areas: emergency response, laboratory capacity, surveillance, and workforce development. We further highlight ways in which capacity-building efforts such as those used in West Africa can be accelerated after a public health crisis to improve preparedness for future events. |
Rapid field response to a cluster of illnesses and deaths - Sinoe County, Liberia, April-May, 2017
Doedeh J , Frimpong JA , Yealue KDM 2nd , Wilson HW , Konway Y , Wiah SQ , Doedeh V , Bao U , Seneh G , Gorwor L , Toe S , Ghartey E , Larway L , Gweh D , Gonotee P , Paasewe T , Tamatai G , Yarkeh J , Smith S , Brima-Davis A , Dauda G , Monger T , Gornor-Pewu LW , Lombeh S , Naiene J , Dovillie N , Korvayan M , George G , Kerwillain G , Jetoh R , Friesen S , Kinkade C , Katawera V , Amo-Addae M , George RN , Gbanya MZ , Dokubo EK . MMWR Morb Mortal Wkly Rep 2017 66 (42) 1140-1143 On April 25, 2017, the Sinoe County Health Team (CHT) notified the Liberia Ministry of Health (MoH) and the National Public Health Institute of Liberia of an unknown illness among 14 persons that resulted in eight deaths in Sinoe County. On April 26, the National Rapid Response Team and epidemiologists from CDC, the World Health Organization (WHO) and the African Field Epidemiology Network (AFENET) in Liberia were deployed to support the county-led response. Measures were immediately implemented to identify all cases, ascertain the cause of illness, and control the outbreak. Illness was associated with attendance at a funeral event, and laboratory testing confirmed Neisseria meningitidis in biologic specimens from cases. The 2014-2015 Ebola virus disease (Ebola) outbreak in West Africa devastated Liberia's already fragile health system, and it took many months for the country to mount an effective response to control the outbreak. Substantial efforts have been made to strengthen Liberia's health system to prevent, detect, and respond to health threats. The rapid and efficient field response to this outbreak of N. meningitidis resulted in implementation of appropriate steps to prevent a widespread outbreak and reflects improved public health and outbreak response capacity in Liberia. |
Rapid laboratory identification of Neisseria meningitidis serogroup C as the cause of an outbreak - Liberia, 2017
Patel JC , George J , Vuong J , Potts CC , Bozio C , Clark TA , Thomas J , Schier J , Chang A , Waller JL , Diaz MH , Whaley M , Jenkins LT , Fuller S , Williams DE , Redd JT , Arthur RR , Taweh F , Vera Walker Y , Hardy P , Freeman M , Katawera V , Gwesa G , Gbanya MZ , Clement P , Kohar H , Stone M , Fallah M , Nyenswah T , Winchell JM , Wang X , McNamara LA , Dokubo EK , Fox LM . MMWR Morb Mortal Wkly Rep 2017 66 (42) 1144-1147 On April 25, 2017, a cluster of unexplained illness and deaths among persons who had attended a funeral during April 21-22 was reported in Sinoe County, Liberia (1). Using a broad initial case definition, 31 cases were identified, including 13 (42%) deaths. Twenty-seven cases were from Sinoe County (1), and two cases each were from Grand Bassa and Monsterrado counties, respectively. On May 5, 2017, initial multipathogen testing of specimens from four fatal cases using the Taqman Array Card (TAC) assay identified Neisseria meningitidis in all specimens. Subsequent testing using direct real-time polymerase chain reaction (PCR) confirmed N. meningitidis in 14 (58%) of 24 patients with available specimens and identified N. meningitidis serogroup C (NmC) in 13 (54%) patients. N. meningitidis was detected in specimens from 11 of the 13 patients who died; no specimens were available from the other two fatal cases. On May 16, 2017, the National Public Health Institute of Liberia and the Ministry of Health of Liberia issued a press release confirming serogroup C meningococcal disease as the cause of this outbreak in Liberia. |
Rates of virological suppression and drug resistance in adult HIV-1-positive patients attending primary healthcare facilities in KwaZulu-Natal, South Africa
Hunt GM , Dokubo EK , Takuva S , de Oliveira T , Ledwaba J , Dube N , Moodley P , Sabatier J , Deyde V , Morris L , Raizes E . J Antimicrob Chemother 2017 72 (11) 3141-3148 Background: KwaZulu-Natal (KZN) Province in South Africa has the highest HIV disease burden in the country, with an estimated population prevalence of 24.7%. A pilot sentinel surveillance project was undertaken in KZN to classify the proportion of adult patients failing first-line ART and to describe the patterns of drug resistance mutations (DRMs) in patients with virological failure (VF). Methods: Cross-sectional surveillance of acquired HIV drug resistance was conducted in 15 sentinel ART clinics between August and November 2013. Two population groups were surveyed: on ART for 12-15 months (Cohort A) or 24-36 months (Cohort B). Plasma specimens with viral load ≥1000 copies/mL were defined as VF and genotyped for DRMs. Results: A total of 1299 adults were included in the analysis. The prevalence of VF was 4.0% (95% CI 1.8-8.8) among 540 adults in Cohort A and 7.7% (95% CI 4.4-13.0) of 759 adults in Cohort B. Treatment with efavirenz was more likely to suppress viral load in Cohort A ( P = 0.005). Independent predictors of VF for Cohort B included male gender, advanced WHO stage at ART initiation and treatment with stavudine or zidovudine compared with tenofovir. DRMs were detected in 89% of 123 specimens with VF, including M184I/V, K103N/S, K65N/R, V106A/M and Y181C. Conclusions: VF in adults in KZN was <8% up to 3 years post-ART initiation but was associated with a high frequency of DRMs. These data identify key groups for intensified adherence counselling and highlight the need to optimize first-line regimens to maintain viral suppression. |
High rates of loss to follow-up during the first year of pre-antiretroviral therapy for HIV patients at sites providing pre-ART care in Nigeria, 2004-2012
Agolory SG , Auld AF , Odafe S , Shiraishi RW , Dokubo EK , Swaminathan M , Dalhatu I , Onotu D , Abiri O , Debem H , Bashorun A , Ellerbrock TV . PLoS One 2017 12 (9) e0183823 BACKGROUND: With about 3.4 million HIV-infected persons, Nigeria has the second highest number of people living with HIV (PLHIV) in the world. However, antiretroviral treatment (ART) coverage in Nigeria remains low with only 748,846 (22%) of PLHIV on ART by the end of 2014. Retention of HIV-infected patients in pre-ART care is essential to ensure timely ART initiation. We assessed outcomes of patients enrolled in Nigeria's pre-ART program during 2004-2012. METHODS: We conducted a nationally representative retrospective cohort study among adults (≥15 years old), enrolling in pre-ART programs supported by the U.S. President's Emergency Plan for AIDS Relief in Nigeria. A total of 35 sites enrolling ≥50 patients in pre-ART were selected using probability proportional-to-size sampling; 2,415 eligible medical records at these sites were randomly selected for abstraction. Determinants of loss to follow-up (LTFU) and mortality during pre-ART care were estimated using Cox proportional hazards regression models. RESULTS: The median age at enrollment was 32 years (interquartile range (IQR) 27-40). A total of 1,216 (51.4%) initiated ART by the time of data abstraction. Among the remaining 1,199 patients, 898 (74.9%) had been LTFU, 180 (15.0%) were alive and in pre-ART care, 71 (5.9%) had died, 50 (4.2%) had transferred out or stopped care. Baseline markers of advanced disease, including weight <45 kg (adjusted hazard ration (AHR) = 4.23; 95% confidence interval (CI): 1.51-15.58) and more advanced WHO disease stage, were predictive of pre-ART mortality. Compared with patients aged 15-24, patients aged 35-44 (AHR = 0.67; 95% CI: 1.0.47-0.95) and age 45-54 (AHR = 0.66; 95% CI: 0.48-0.91) had lower LTFU rates. Compared with attending facilities in North Central geopolitical zone, attending facility locations in South East (AHR = 0.44; 95% CI: 0.24-0.83) was protective against LTFU. CONCLUSIONS: About half of patients enrolling in HIV program during 2004-2012 in Nigeria had not initiated ART by 2013. Key strategies to improve early ART initiation among pre-ART enrollees include implementation of the WHO test and treat guidelines, earlier HIV testing, and better monitoring to improve ART initiation rates. Further research to understand regional variations in pre-ART outcomes is warranted. |
Ebola virus disease contact tracing activities, lessons learned and best practices during the Duport Road outbreak in Monrovia, Liberia, November 2015
Wolfe CM , Hamblion EL , Schulte J , Williams P , Koryon A , Enders J , Sanor V , Wapoe Y , Kwayon D , Blackey D , Laney AS , Weston EJ , Dokubo EK , Davies-Wayne G , Wendland A , Daw VTS , Badini M , Clement P , Mahmoud N , Williams D , Gasasira A , Nyenswah TG , Fallah M . PLoS Negl Trop Dis 2017 11 (6) e0005597 BACKGROUND: Contact tracing is one of the key response activities necessary for halting Ebola Virus Disease (EVD) transmission. Key elements of contact tracing include identification of persons who have been in contact with confirmed EVD cases and careful monitoring for EVD symptoms, but the details of implementation likely influence their effectiveness. In November 2015, several months after a major Ebola outbreak was controlled in Liberia, three members of a family were confirmed positive for EVD in the Duport Road area of Monrovia. The cluster provided an opportunity to implement and evaluate modified approaches to contact tracing. METHODS: The approaches employed for improved contact tracing included classification and risk-based management of identified contacts (including facility based isolation of some high risk contacts, provision of support to persons being monitored, and school-based surveillance for some persons with potential exposure but not listed as contacts), use of phone records to help locate missing contacts, and modifications to data management tools. We recorded details about the implementation of these approaches, report the overall outcomes of the contact tracing efforts and the challenges encountered, and provide recommendations for management of future outbreaks. RESULTS: 165 contacts were identified (with over 150 identified within 48 hours of confirmation of the EVD cases) and all initially missing contacts were located. Contacts were closely monitored and promptly tested if symptomatic; no contacts developed disease. Encountered challenges related to knowledge gaps among contact tracing staff, data management, and coordination of contact tracing activities with efforts to offer Ebola vaccine. CONCLUSIONS: The Duport Road EVD cluster was promptly controlled. Missing contacts were effectively identified, and identified contacts were effectively monitored and rapidly tested. There is a persistent risk of EVD reemergence in Liberia; the experience controlling each cluster can help inform future Ebola control efforts in Liberia and elsewhere. |
Trends in prevalence of advanced HIV disease at antiretroviral therapy enrollment - 10 countries, 2004-2015
Auld AF , Shiraishi RW , Oboho I , Ross C , Bateganya M , Pelletier V , Dee J , Francois K , Duval N , Antoine M , Delcher C , Desforges G , Griswold M , Domercant JW , Joseph N , Deyde V , Desir Y , Van Onacker JD , Robin E , Chun H , Zulu I , Pathmanathan I , Dokubo EK , Lloyd S , Pati R , Kaplan J , Raizes E , Spira T , Mitruka K , Couto A , Gudo ES , Mbofana F , Briggs M , Alfredo C , Xavier C , Vergara A , Hamunime N , Agolory S , Mutandi G , Shoopala NN , Sawadogo S , Baughman AL , Bashorun A , Dalhatu I , Swaminathan M , Onotu D , Odafe S , Abiri OO , Debem HH , Tomlinson H , Okello V , Preko P , Ao T , Ryan C , Bicego G , Ehrenkranz P , Kamiru H , Nuwagaba-Biribonwoha H , Kwesigabo G , Ramadhani AA , Ng'wangu K , Swai P , Mfaume M , Gongo R , Carpenter D , Mastro TD , Hamilton C , Denison J , Wabwire-Mangen F , Koole O , Torpey K , Williams SG , Colebunders R , Kalamya JN , Namale A , Adler MR , Mugisa B , Gupta S , Tsui S , van Praag E , Nguyen DB , Lyss S , Le Y , Abdul-Quader AS , Do NT , Mulenga M , Hachizovu S , Mugurungi O , Barr BAT , Gonese E , Mutasa-Apollo T , Balachandra S , Behel S , Bingham T , Mackellar D , Lowrance D , Ellerbrock TV . MMWR Morb Mortal Wkly Rep 2017 66 (21) 558-563 Monitoring prevalence of advanced human immunodeficiency virus (HIV) disease (i.e., CD4+ T-cell count <200 cells/muL) among persons starting antiretroviral therapy (ART) is important to understand ART program outcomes, inform HIV prevention strategy, and forecast need for adjunctive therapies.*,dagger, section sign To assess trends in prevalence of advanced disease at ART initiation in 10 high-burden countries during 2004-2015, records of 694,138 ART enrollees aged ≥15 years from 797 ART facilities were analyzed. Availability of national electronic medical record systems allowed up-to-date evaluation of trends in Haiti (2004-2015), Mozambique (2004-2014), and Namibia (2004-2012), where prevalence of advanced disease at ART initiation declined from 75% to 34% (p<0.001), 73% to 37% (p<0.001), and 80% to 41% (p<0.001), respectively. Significant declines in prevalence of advanced disease during 2004-2011 were observed in Nigeria, Swaziland, Uganda, Vietnam, and Zimbabwe. The encouraging declines in prevalence of advanced disease at ART enrollment are likely due to scale-up of testing and treatment services and ART-eligibility guidelines encouraging earlier ART initiation. However, in 2015, approximately a third of new ART patients still initiated ART with advanced HIV disease. To reduce prevalence of advanced disease at ART initiation, adoption of World Health Organization (WHO)-recommended "treat-all" guidelines and strategies to facilitate earlier HIV testing and treatment are needed to reduce HIV-related mortality and HIV incidence. |
Incidence and predictors of tuberculosis among HIV-infected adults after initiation of antiretroviral therapy in Nigeria, 2004-2012
Pathmanathan I , Dokubo EK , Shiraishi RW , Agolory SG , Auld AF , Onotu D , Odafe S , Dalhatu I , Abiri O , Debem HC , Bashorun A , Ellerbrock T . PLoS One 2017 12 (3) e0173309 BACKGROUND: Nigeria had the most AIDS-related deaths worldwide in 2014 (170,000), and 46% were associated with tuberculosis (TB). Although treatment of people living with HIV (PLHIV) with antiretroviral therapy (ART) reduces TB-associated morbidity and mortality, incident TB can occur while on ART. We estimated incidence and characterized factors associated with TB after ART initiation in Nigeria. METHODS: We analyzed retrospective cohort data from a nationally representative sample of adult patients on ART. Data were abstracted from 3,496 patient records, and analyses were weighted and controlled for a complex survey design. We performed domain analyses on patients without documented TB disease and used a Cox proportional hazard model to assess factors associated with TB incidence after ART. RESULTS: At ART initiation, 3,350 patients (95.8%) were not receiving TB treatment. TB incidence after ART initiation was 0.57 per 100 person-years, and significantly higher for patients with CD4<50/muL (adjusted hazard ratio [AHR]: 4.2, 95% confidence interval [CI]: 1.4-12.7) compared with CD4≥200/muL. Patients with suspected but untreated TB at ART initiation and those with a history of prior TB were more likely to develop incident TB (AHR: 12.2, 95% CI: 4.5-33.5 and AHR: 17.6, 95% CI: 3.5-87.9, respectively). CONCLUSION: Incidence of TB among PLHIV after ART initiation was low, and predicted by advanced HIV, prior TB, and suspected but untreated TB. Study results suggest a need for improved TB screening and diagnosis, particularly among high-risk PLHIV initiating ART, and reinforce the benefit of early ART and other TB prevention efforts. |
Knowledge of human immunodeficiency virus status and seropositivity after a recently negative test in Malawi
Pathmanathan I , Lederer P , Shiraishi RW , Wadonda-Kabondo N , Date A , Matatiyo B , Dokubo EK . Open Forum Infect Dis 2017 4 (1) ofw231 Background. Awareness of human immunodeficiency virus (HIV) status among all people with HIV is critical for epidemic control. We aimed to assess accurate knowledge of HIV status, defined as concordance with serosurvey test results from the 2010 Malawi Demographic Health Survey (MDHS), and to identify risk factors for seropositivity among adults (aged 15-49) reporting a most recently negative test within 12 months. Methods. Data were analyzed from the 2010 MDHS. A logistic regression model was constructed to determine factors independently associated with HIV seropositivity after a recently negative test. All analyses controlled for the survey's complex design. Results. A total of 11 649 adults tested for HIV during this MDHS reported ever being sexually active. Among these, HIV seroprevalence was 12.0%, but only 61.7% had accurate knowledge of their status. Forty percent (40.3%; 95% confidence interval [CI], 36.8-43.8) of seropositive respondents reported a most recently negative test. Of those reporting that this negative test was within 12 months (n = 3630), seroprevalence was 7.2% for women (95% CI, 5.7-9.2), 5.2% for men (95% CI, 3.9-6.9), higher in the South, and higher in rural areas for men. Women with higher education and men in the richest quintile were at higher risk. More than 1 lifetime union was significantly associated with recent HIV infection, whereas never being married was significantly protective. Conclusions. Self-reported HIV status based on prior test results can underestimate seroprevalence. These results highlight the need for posttest risk assessment and support for people who test negative for HIV and repeat testing in people at high risk for HIV infection. |
Bolstering community cooperation in Ebola resurgence protocols: Combining field blood draw and point-of-care diagnosis
Fallah MP , Skrip LA , Raftery P , Kullie M , Borbor W , Laney AS , Blackley DJ , Christie A , Dokubo EK , Lo TQ , Coulter S , Baller A , Vonhm BT , Bemah P , Lomax S , Yeiah A , Wapoe-Sackie Y , Mann J , Clement P , Davies-Wayne G , Hamblion E , Wolfe C , Williams D , Gasasira A , Kateh F , Nyenswah TG , Galvani AP . PLoS Med 2017 14 (1) e1002227 Alison Galvani and colleagues describe a community-based protocol to improve cooperation with Ebola testing as well as contact tracing, quarantining, and treatment. |
Building and strengthening infection control strategies to prevent tuberculosis - Nigeria, 2015
Dokubo EK , Odume B , Lipke V , Muianga C , Onu E , Olutola A , Ukachukwu L , Igweike P , Chukwura N , Ubochioma E , Aniaku E , Ezeudu C , Agboeze J , Iroh G , Orji E , Godwin O , Raji HB , Aboje SA , Osakwe C , Debem H , Bello M , Onotu D , Maloney S . MMWR Morb Mortal Wkly Rep 2016 65 (10) 263-266 Tuberculosis (TB) is the leading cause of infectious disease mortality worldwide, accounting for more than 1.5 million deaths in 2014, and is the leading cause of death among persons living with human immunodeficiency virus (HIV) infection (1). Nigeria has the fourth highest annual number of TB cases among countries, with an estimated incidence of 322 per 100,000 population (1), and the second highest prevalence of HIV infection, with 3.4 million infected persons (2). In 2014, 100,000 incident TB cases and 78,000 TB deaths occurred among persons living with HIV infection in Nigeria (1). Nosocomial transmission is a significant source of TB infection in resource-limited settings (3), and persons with HIV infection and health care workers are at increased risk for TB infection because of their routine exposure to patients with TB in health care facilities (3-5). A lack of TB infection control in health care settings has resulted in outbreaks of TB and drug-resistant TB among patients and health care workers, leading to excess morbidity and mortality. In March 2015, in collaboration with the Nigeria Ministry of Health (MoH), CDC implemented a pilot initiative, aimed at increasing health care worker knowledge about TB infection control, assessing infection control measures in health facilities, and developing plans to address identified gaps. The approach resulted in substantial improvements in TB infection control practices at seven selected facilities, and scale-up of these measures across other facilities might lead to a reduction in TB transmission in Nigeria and globally. |
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