Last data update: Apr 29, 2024. (Total: 46658 publications since 2009)
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Query Trace: Ekra A[original query] |
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HIV risk behaviour, viraemia, and transmission across HIV cascade stages including low-level viremia: Analysis of 14 cross-sectional population-based HIV Impact Assessment surveys in sub-Saharan Africa
Edun O , Okell L , Chun H , Bissek AZ , Ndongmo CB , Shang JD , Brou H , Ehui E , Ekra AK , Nuwagaba-Biribonwoha H , Dlamini SS , Ginindza C , Eshetu F , Misganie YG , Desta SL , Achia TNO , Aoko A , Jonnalagadda S , Wafula R , Asiimwe FM , Lecher S , Nkanaunena K , Nyangulu MK , Nyirenda R , Beukes A , Klemens JO , Taffa N , Abutu AA , Alagi M , Charurat ME , Dalhatu I , Aliyu G , Kamanzi C , Nyagatare C , Rwibasira GN , Jalloh MF , Maokola WM , Mgomella GS , Kirungi WL , Mwangi C , Nel JA , Minchella PA , Gonese G , Nasr MA , Bodika S , Mungai E , Patel HK , Sleeman K , Milligan K , Dirlikov E , Voetsch AC , Shiraishi RW , Imai-Eaton JW . PLOS Glob Public Health 2024 4 (4) e0003030 As antiretroviral treatment (ART) coverage for people living with HIV (PLHIV) increases, HIV programmes require up-to-date information about evolving HIV risk behaviour and transmission risk, including those with low-level viremia (LLV; >50 to ≤1000 copies/mL), to guide prevention priorities. We aimed to assess differences in sexual risk behaviours, distribution of viral load (VL) and proportion of transmission across PLHIV subgroups. We analysed data from Population-based HIV Impact Assessment surveys in 14 sub-Saharan African countries during 2015-2019. We estimated adjusted prevalence ratios (aPR) of self-reported HIV high-risk behaviour (multiple partners and condomless sex) across cascade stages via generalised estimation equations. We modelled the proportions of transmission from each subgroup using relative self-reported sexual risk, a Hill function for transmission rate by VL, and proportions within cascade stages from surveys and UNAIDS country estimates for 2010-2020. Compared to PLHIV with undetectable VL (≤50 copies/mL), undiagnosed PLHIV (aPR women: 1.28 [95% CI: 1.08-1.52]; men: 1.61 [1.33-1.95]) and men diagnosed but untreated (2.06 [1.52-2.78]) were more likely to self-report high-risk sex. High-risk behaviour was not significantly associated with LLV. Mean VL was similar among undiagnosed, diagnosed but untreated, and on ART but non-suppressed sub-groups. Across surveys, undiagnosed and diagnosed but untreated contributed most to transmission (40-91% and 1-41%, respectively), with less than 1% from those with LLV. Between 2010 and 2020, the proportion of transmission from individuals on ART but non-suppressed increased. In settings with high ART coverage, effective HIV testing, ART linkage, and retention remain priorities to reduce HIV transmission. Persons with LLV are an increasing share of PLHIV but their contribution to HIV transmission was small. Improving suppression among PLHIV on ART with VL ≥1000 copies/mL will become increasingly important. |
Retention and predictors of attrition among HIV-infected children on antiretroviral therapy in Cte d'Ivoire between 2012 and 2016
Touré F , Etheredge GD , Brennan C , Parris K , Diallo MO , Ouffoue AF , Ekra A , Prao H , Assamoua NV , Gnongoue C , Kone F , Koffi C , Kamagaté F , Rivadeneira E , Carpenter D . Pediatr Infect Dis J 2023 42 (4) 299-304 BACKGROUND: An estimated 21,000 children aged 0-14 years were living with HIV in Côte d'Ivoire in 2020, of whom only 49% have been diagnosed and are receiving antiretroviral therapy (ART). Retention in HIV care and treatment is key to optimize clinical outcomes. We evaluated pediatric retention in select care and treatment centers (CTCs) in Côte d'Ivoire. METHODS: We retrospectively reviewed medical records using 2-stage cluster sampling for children under 15 years initiated on ART between 2012 and 2016. Kaplan-Meier time-to-event analysis was done to estimate cumulative attrition rates per total person-years of observation. Cox proportional hazard regression was performed to identify factors associated with attrition. RESULTS: A total of 1198 patient records from 33 CTCs were reviewed. Retention at 12, 24, 36, 48 and 60 months after ART initiation was 91%, 84%, 74%, 72% and 70%, respectively. A total of 309 attrition events occurred over 3169 person-years of follow-up [266 children were lost to follow-up (LTFU), 29 transferred to another facility and 14 died]. LTFU determinants included attending a "public-private" CTC [adjusted hazard ratio (aHR) 6.05; 95% confidence interval (CI): 4.23-8.65], receiving care at a CTC without an on-site laboratory (aHR: 4.01; 95% CI: 1.70-9.46) or attending a CTC without an electronic medical record (EMR) system (aHR: 2.22; 95% CI: 1.59-3.12). CONCLUSIONS: In Cote d'Ivoire, patients attending a CTC that is public-private, does not have on-site laboratory or EMR system were likely to be LTFU. Decentralization of laboratory services and scaling use of EMR systems could help to improve pediatric retention. |
Entomological monitoring data driving decision-making for appropriate and sustainable malaria vector control in Cte d'Ivoire
Kouassi BL , Edi C , Ouattara AF , Ekra AK , Bellai LG , Gouaméné J , Kacou YAK , Kouamé JKI , Béké AO , Yokoli FN , Gbalegba CGN , Tia E , Yapo RM , Konan LY , N'Tamon RN , Akré MA , Koffi AA , Tanoh AM , Zinzindohoué P , Kouadio B , Yepassis-Zembrou PL , Belemvire A , Irish SR , Cissé NG , Flatley C , Chabi J . Malar J 2023 22 (1) 14 BACKGROUND: Entomological surveillance provides critical information on vectors for appropriate malaria vector control and strategic decision-making. The widely documented insecticide resistance of malaria vectors in Côte d'Ivoire requires that any vector control intervention deployment be driven by entomological data to optimize its effectiveness and appropriate resource allocations. To achieve this goal, this study documents the results of monthly vector surveillance and insecticide susceptibility tests conducted in 2019 and a review of all previous entomological monitoring data used to guide vector control decision making. Furthermore, susceptibility to pirimiphos-methyl and clothianidin was assessed in addition to chlorfenapyr and pyrethroids (intensity and piperonyl butoxide (PBO) synergism) tests previously reported. Vector bionomic data were conducted monthly in four sites (Sakassou, Béoumi, Dabakala and Nassian) that were selected based on their reported high malaria incidence. Adult mosquitoes were collected using human landing catches (HLCs), pyrethrum spray catches (PSCs), and human-baited CDC light traps to assess vector density, behaviour, species composition and sporozoite infectivity. RESULTS: Pirimiphos-methyl and clothianidin susceptibility was observed in 8 and 10 sites, respectively, while previous data reported chlorfenapyr (200 µg/bottle) susceptibility in 13 of the sites, high pyrethroid resistance intensity and increased mortality with PBO pre-exposure at all 17 tested sites. Anopheles gambiae sensu lato was the predominant malaria vector collected in all four bionomic sites. Vector density was relatively higher in Sakassou throughout the year with mean biting rates of 278.2 bites per person per night (b/p/n) compared to Béoumi, Dabakala and Nassian (mean of 48.5, 81.4 and 26.6 b/p/n, respectively). The mean entomological inoculation rate (EIR) was 4.44 infective bites per person per night (ib/p/n) in Sakassou, 0.34 ib/p/n in Beoumi, 1.17 ib/p/n in Dabakala and 1.02 ib/p/n in Nassian. The highest EIRs were recorded in October in Béoumi (1.71 ib/p/n) and Nassian (3.22 ib/p/n), in July in Dabakala (4.46 ib/p/n) and in May in Sakassou (15.6 ib/p/n). CONCLUSION: Based on all results and data review, the National Malaria Control Programme developed and implemented a stratified insecticide-treated net (ITN) mass distribution in 2021 considering new generation ITNs. These results also supported the selection of clothianidin-based products and an optimal spraying time for the first indoor residual spraying (IRS) campaign in Sakassou and Nassian in 2020. |
Outcome of HIV testing among family members of index cases across 36 facilities in Abidjan, Cte d'Ivoire
Lasry A , Danho NK , Hulland EN , Diokouri AD , Kingbo MH , Doumatey NIL , Ekra AK , Ebah LG , Kouamé H , Hedje J , Jean-Baptiste AE . AIDS Behav 2020 25 (2) 554-561 In Côte d'Ivoire, the Family Approach to Counseling and Testing (FACT) program began in 2015 and provides facility-based HIV testing to the sexual partners, children and other household family members of HIV-positive index cases. We evaluated whether the FACT program is an effective approach to HIV case finding. We reviewed 1762 index patient charts to evaluate outcomes of the FACT program, held across 36 facilities in Abidjan. Index cases enumerated a total of 644 partners, 2301 children and 508 other family members including parents and siblings. Among the partners tested for HIV, the positivity rate was 21%; for children the positivity rate was 5% and for all other family members the positivity rate was 11%. Offering HIV testing services to the family members of HIV positive index cases is an effective approach to case finding in Côte d'Ivoire. Particularly, offering HIV testing to the partners of positive women index cases can be key to identifying previously undiagnosed men and linking them to treatment. |
Scaling up testing for human immunodeficiency virus infection among contacts of index patients - 20 countries, 2016-2018
Lasry A , Medley A , Behel S , Mujawar MI , Cain M , Diekman ST , Rurangirwa J , Valverde E , Nelson R , Agolory S , Alebachew A , Auld AF , Balachandra S , Bunga S , Chidarikire T , Dao VQ , Dee J , Doumatey LEN , Dzinotyiweyi E , Dziuban EJ , Ekra KA , Fuller WB , Herman-Roloff A , Honwana NB , Khanyile N , Kim EJ , Kitenge SF , Lacson RS , Loeto P , Malamba SS , Mbayiha AH , Mekonnen A , Meselu MG , Miller LA , Mogomotsi GP , Mugambi MK , Mulenga L , Mwangi JW , Mwangi J , Nicoue AA , Nyangulu MK , Pietersen IC , Ramphalla P , Temesgen C , Vergara AE , Wei S . MMWR Morb Mortal Wkly Rep 2019 68 (21) 474-477 In 2017, the Joint United Nations Programme on HIV/AIDS (UNAIDS) estimated that worldwide, 36.9 million persons were living with human immunodeficiency virus (HIV) infection, the virus infection that causes acquired immunodeficiency syndrome (AIDS). Among persons with HIV infection, approximately 75% were aware of their HIV status, leaving 9.4 million persons with undiagnosed infection (1). Index testing, also known as partner notification or contact tracing, is an effective case-finding strategy that targets the exposed contacts of HIV-positive persons for HIV testing services. This report summarizes data from HIV tests using index testing in 20 countries supported by CDC through the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) during October 1, 2016-March 31, 2018. During this 18-month period, 1,700,998 HIV tests with 99,201 (5.8%) positive results were reported using index testing. The positivity rate for index testing was 9.8% among persons aged >/=15 years and 1.5% among persons aged <15 years. During the reporting period, HIV positivity increased 64% among persons aged >/=15 years (from 7.6% to 12.5%) and 67% among persons aged <15 years (from 1.2% to 2.0%). Expanding index testing services could help increase the number of persons with HIV infection who know their status, are initiated onto antiretroviral treatment, and consequently reduce the number of persons who can transmit the virus. |
Epidemiology of rubella infection and genotyping of rubella virus in Cote d'Ivoire, 2012-2016.
Kadjo HA , Waku-Kouomou D , Adagba M , Abernathy ES , Abdoulaye O , Adjogoua DE , Coulibaly-Traore F , Aboubacar S , Daniel E , Icenogle J , Dosso M . J Med Virol 2018 90 (11) 1687-1694 BACKGROUND: Rubella is a contagious disease cause by the rubella virus (RuV) that can lead to serious birth defects when women are infected in early pregnancy. This work aimed to describe the epidemiology and genetic diversity of rubella viruses in Cote d'Ivoire (CIV). MATERIAL AND METHODS: Blood or oral fluid samples collected from suspected measles cases were first tested for the presence of measles specific IgM antibodies by ELISA. All measles IgM negative or indeterminate samples were tested for rubella IgM antibody using ELISA. Rubella- IgM positive samples were tested by real-time reverse transcription PCR (RT-PCR) for the presence of rubella virus RNA. Real-time RT-PCR positive RNA samples were used as template to amplify the 739-nt region used for rubella genotyping. PCR positive samples were sequenced and phylogenetic analysis performed. RESULTS: Between 2012 and 2016, 4121 serums and 126 oral fluids were collected through the measles surveillance system. Of these, 3823 and 108 respectively were measles IgM negative or indeterminate. Subsequent testing for rubella found that 690/3823 (18%) serum samples and 25/108 (23%) oral fluid samples were rubella IgM positive. The 739-nt segment of the E1 glycoprotein gene was amplified and sequenced for 2 serums and 7 oral fluids samples. Phylogenetic analysis showed that the rubella viruses from CIV belonged to genotypes 1G (8 samples) and 2B (1 sample). CONCLUSION: Rubella virus genotype 2B was found in CIV for the first time. These data contribute to baseline information on rubella virus strains found in CIV prior to the introduction of rubella vaccine This article is protected by copyright. All rights reserved. |
Assessment of poliovirus antibody seroprevalence in polio high risk areas of West Africa
Guindo O , Mach O , Doumbia S , Ekra DK , Beavogui AH , Weldon WC , Oberste MS , Sutter RW . Vaccine 2018 36 (8) 1027-1031 We conducted a serological survey of anti-polio antibodies in polio high-risk areas of Mali, Guinea and Cote d'Ivoire to assess risk of future poliovirus outbreaks. Random community sampling of children 6-11 and 36-48months-old was conducted; neutralizing antibodies against poliovirus were detected using microneutralization assay. We analysed 1059/1064 (99.5%) of enrolled children. Seroprevalence to poliovirus type 1 (PV1) across all age groups and locations ranged between 92 and 100%, for PV2 it was 77-100%, and 89-95% for PV3. PV2 seroprevalence in the younger age group in Guinea and Cote d'Ivoire was<80%. History of<4 polio vaccine doses and acute malnutrition were associated with seronegativity (OR=2.1 CI95%=1.5-3.1, OR=1.8 CI95%=1.1-3.3 respectively). The risk of poliovirus outbreak following importation is low because of high population immunity to PV1, however, due to large cohort of PV2 seronegative children any future detection of vaccine-derived poliovirus type 2 requires urgent response to arrest rapid spread. |
Task-sharing with nurses to enhance access to HIV treatment in Cote d'Ivoire
McNairy ML , Bashi JB , Chung H , Wemin L , Lorng MA , Brou H , Nioble C , Lokossue A , Abo K , Achi D , Ouattara K , Sess D , Sanogo PA , Ekra A , Ettiegne-Traore V , Diabate CJ , Abrams EJ , El-Sadr WM . Trop Med Int Health 2017 22 (4) 431-441 OBJECTIVE: We report the first national programme in Cote d'Ivoire to evaluate the feasibility of nurse-led HIV care as a model of task-sharing with nurses to increase coverage and decentralisation of HIV services. METHODS: Twenty-six public HIV facilities implemented either a nurse-with-onsite-physician or a nurse-with-visiting-physician model of HIV task-sharing. Routinely collected patient data were reviewed to analyse patient characteristics of those enrolling in care and initiating antiretroviral therapy (ART). Retention, loss to programme and death were compared across facility-level characteristics. RESULTS: A total of 1224 patients enrolled in HIV care, with 666 initiating ART, from January 2012 to May 2013 (median follow-up 13 months). The majority (94%) were adults ≥15 years. Fourteen facilities provided ART initiation for the first time during the pilot period; 20 facilities were primary level. Nurse-led care with a visiting physician was provided in 14 of the primary-level facilities. Nurse-led ART care with an onsite physician was provided in all secondary-level facilities and six of the primary-level facilities. During the pilot, 567 (85%) of patients were retained, 28 (4.2%) died, 47 (7.1%) were lost to follow-up, and 24 (3.6%) transferred. Five deaths (10.9%) were recorded among children as compared to 23 deaths (3.7%) among adults (P = 0.037). There were no differences in retention by model of nurse-led ART care. CONCLUSION: Task-sharing of HIV care and ART initiation with nurses in Cote d'Ivoire is feasible. This pilot illustrates two models of nurse-led HIV care and has informed national policy on nurse-led HIV care in Cote d'Ivoire. |
Effects of climatological parameters in modeling and forecasting seasonal influenza transmission in Abidjan, Cote d'Ivoire
N'Gattia A K , Coulibaly D , Nzussouo NT , Kadjo HA , Cherif D , Traore Y , Kouakou BK , Kouassi PD , Ekra KD , Dagnan NS , Williams T , Tiembre I . BMC Public Health 2016 16 (1) 972 BACKGROUND: In temperate regions, influenza epidemics occur in the winter and correlate with certain climatological parameters. In African tropical regions, the effects of climatological parameters on influenza epidemics are not well defined. This study aims to identify and model the effects of climatological parameters on seasonal influenza activity in Abidjan, Cote d'Ivoire. METHODS: We studied the effects of weekly rainfall, humidity, and temperature on laboratory-confirmed influenza cases in Abidjan from 2007 to 2010. We used the Box-Jenkins method with the autoregressive integrated moving average (ARIMA) process to create models using data from 2007-2010 and to assess the predictive value of best model on data from 2011 to 2012. RESULTS: The weekly number of influenza cases showed significant cross-correlation with certain prior weeks for both rainfall, and relative humidity. The best fitting multivariate model (ARIMAX (2,0,0) _RF) included the number of influenza cases during 1-week and 2-weeks prior, and the rainfall during the current week and 5-weeks prior. The performance of this model showed an increase of >3 % for Akaike Information Criterion (AIC) and 2.5 % for Bayesian Information Criterion (BIC) compared to the reference univariate ARIMA (2,0,0). The prediction of the weekly number of influenza cases during 2011-2012 with the best fitting multivariate model (ARIMAX (2,0,0) _RF), showed that the observed values were within the 95 % confidence interval of the predicted values during 97 of 104 weeks. CONCLUSION: Including rainfall increases the performances of fitted and predicted models. The timing of influenza in Abidjan can be partially explained by rainfall influence, in a setting with little change in temperature throughout the year. These findings can help clinicians to anticipate influenza cases during the rainy season by implementing preventive measures. |
Wide variations in compliance with tuberculosis screening guidelines and tuberculosis incidence between antiretroviral therapy facilities - Cote d'Ivoire
Auld AF , Blain M , Ekra KA , Kouakou JS , Ettiegne-Traore V , Tuho MZ , Mohamed F , Shiraishi RW , Sabatier J , Essombo J , Adjorlolo-Johnson G , Marlink R , Ellerbrock TV . PLoS One 2016 11 (6) e0157059 BACKGROUND: In Cote d'Ivoire, tuberculosis (TB) is a common cause of death among HIV-infected antiretroviral therapy (ART) enrollees. Ivorian guidelines recommend screening for TB and initiation of TB treatment before ART initiation. Compliance with these guidelines can help reduce TB-related mortality during ART and possibly nosocomial TB transmission. METHODS AND FINDINGS: In a retrospective cohort study among 3,682 randomly selected adults (≥15 years old) starting ART during 2004-2007 at 34 randomly selected facilities, documentation of TB screening completion, prevalence of active TB at ART initiation, and incidence of TB during ART were evaluated. At ART initiation, median age was 36 years, 67% were female, and median CD4 count was 135 cells/muL. Among all 3,682 enrollees, 73 (2%) were on TB treatment at the time of referral to the ART facility. Among the 3,609 not on TB treatment, 1,263 (36%) were documented to receive some TB screening before ART initiation; 21% were screened for cough, 21% for weight loss, 18% for fever, 18% for TB contacts, and 12% for night sweats. Among the 1,263 screened, 111 (11%) were diagnosed with TB and started TB treatment before ART. No associations between patient characteristics and probability of being screened were noted. However, documentation of TB screening completion before ART varied widely by ART facility from 0-100%. TB incidence during ART was 3.0 per 100 person-years but varied widely by ART facility from 0/100 person-year to 13.1/100 person-years. CONCLUSIONS: Screening for TB before ART initiation was poorly documented. Facility-level variations in TB screening documentation suggest facility-level factors, such as investment in training programs, might determine documentation practices. Targeting under-performing ART facilities with improvement activities is needed. Variations among facilities in TB incidence warrant further research. These incidence variations could reflect differences between facilities in TB screening, diagnostic tests, documentation practices, or TB risk possibly related to infection control practices or local community TB incidence. |
Lower levels of antiretroviral therapy enrollment among men with HIV compared with women - 12 countries, 2002-2013
Auld AF , Shiraishi RW , Mbofana F , Couto A , Fetogang EB , El-Halabi S , Lebelonyane R , Pilatwe PT , Hamunime N , Okello V , Mutasa-Apollo T , Mugurungi O , Murungu J , Dzangare J , Kwesigabo G , Wabwire-Mangen F , Mulenga M , Hachizovu S , Ettiegne-Traore V , Mohamed F , Bashorun A , Nhan do T , Hai NH , Quang TH , Van Onacker JD , Francois K , Robin EG , Desforges G , Farahani M , Kamiru H , Nuwagaba-Biribonwoha H , Ehrenkranz P , Denison JA , Koole O , Tsui S , Torpey K , Mukadi YD , van Praag E , Menten J , Mastro TD , Hamilton CD , Abiri OO , Griswold M , Pierre E , Xavier C , Alfredo C , Jobarteh K , Letebele M , Agolory S , Baughman AL , Mutandi G , Preko P , Ryan C , Ao T , Gonese E , Herman-Roloff A , Ekra KA , Kouakou JS , Odafe S , Onotu D , Dalhatu I , Debem HH , Nguyen DB , Yen le N , Abdul-Quader AS , Pelletier V , Williams SG , Behel S , Bicego G , Swaminathan M , Dokubo EK , Adjorlolo-Johnson G , Marlink R , Lowrance D , Spira T , Colebunders R , Bangsberg D , Zee A , Kaplan J , Ellerbrock TV . MMWR Morb Mortal Wkly Rep 2015 64 (46) 1281-6 Equitable access to antiretroviral therapy (ART) for men and women with human immunodeficiency virus (HIV) infection is a principle endorsed by most countries and funding bodies, including the U.S. President's Emergency Plan for AIDS (acquired immunodeficiency syndrome) Relief (PEPFAR) (1). To evaluate gender equity in ART access among adults (defined for this report as persons aged ≥15 years), 765,087 adult ART patient medical records from 12 countries in five geographic regions* were analyzed to estimate the ratio of women to men among new ART enrollees for each calendar year during 2002-2013. This annual ratio was compared with estimates from the Joint United Nations Programme on HIV/AIDS (UNAIDS)(dagger) of the ratio of HIV-infected adult women to men in the general population. In all 10 African countries and Haiti, the most recent estimates of the ratio of adult women to men among new ART enrollees significantly exceeded the UNAIDS estimates for the female-to-male ratio among HIV-infected adults by 23%-83%. In six African countries and Haiti, the ratio of women to men among new adult ART enrollees increased more sharply over time than the estimated UNAIDS female-to-male ratio among adults with HIV in the general population. Increased ART coverage among men is needed to decrease their morbidity and mortality and to reduce HIV incidence among their sexual partners. Reaching more men with HIV testing and linkage-to-care services and adoption of test-and-treat ART eligibility guidelines (i.e., regular testing of adults, and offering treatment to all infected persons with ART, regardless of CD4 cell test results) could reduce gender inequity in ART coverage. |
Antiretroviral therapy enrollment characteristics and outcomes among HIV-infected adolescents and young adults compared with older adults - seven African countries, 2004-2013
Auld AF , Agolory SG , Shiraishi RW , Wabwire-Mangen F , Kwesigabo G , Mulenga M , Hachizovu S , Asadu E , Tuho MZ , Ettiegne-Traore V , Mbofana F , Okello V , Azih C , Denison JA , Tsui S , Koole O , Kamiru H , Nuwagaba-Biribonwoha H , Alfredo C , Jobarteh K , Odafe S , Onotu D , Ekra KA , Kouakou JS , Ehrenkranz P , Bicego G , Torpey K , Mukadi YD , Praag Ev , Menten J , Mastro T , Hamilton CD , Swaminathan M , Dokubo EK , Baughman AL , Spira T , Colebunders R , Bangsberg D , Marlink R , Zee A , Kaplan J , Ellerbrock TV . MMWR Morb Mortal Wkly Rep 2014 63 (47) 1097-103 Although scale-up of antiretroviral therapy (ART) since 2005 has contributed to declines of about 30% in the global annual number of human immunodeficiency (HIV)-related deaths and declines in global HIV incidence, estimated annual HIV-related deaths among adolescents have increased by about 50% and estimated adolescent HIV incidence has been relatively stable. In 2012, an estimated 2,500 (40%) of all 6,300 daily new HIV infections occurred among persons aged 15-24 years. Difficulty enrolling adolescents and young adults in ART and high rates of loss to follow-up (LTFU) after ART initiation might be contributing to mortality and HIV incidence in this age group, but data are limited. To evaluate age-related ART retention challenges, data from retrospective cohort studies conducted in seven African countries among 16,421 patients, aged ≥15 years at enrollment, who initiated ART during 2004-2012 were analyzed. ART enrollment and outcome data were compared among three groups defined by age at enrollment: adolescents and young adults (aged 15-24 years), middle-aged adults (aged 25-49 years), and older adults (aged ≥50 years). Enrollees aged 15-24 years were predominantly female (81%-92%), commonly pregnant (3%-32% of females), unmarried (54%-73%), and, in four countries with employment data, unemployed (53%-86%). In comparison, older adults were more likely to be male (p<0.001), employed (p<0.001), and married, (p<0.05 in five countries). Compared with older adults, adolescents and young adults had higher LTFU rates in all seven countries, reaching statistical significance in three countries in crude and multivariable analyses. Evidence-based interventions to reduce LTFU for adolescent and young adult ART enrollees could help reduce mortality and HIV incidence in this age group. |
Temporal trends in mortality and loss to follow-up among children enrolled in Cote d'Ivoire's national antiretroviral therapy program
Auld AF , Tuho MZ , Ekra KA , Shiraishi RW , Mohamed F , Kouakou JS , Ettiegne-Traore V , Sabatier J , Essombo J , Rivadeneira ED , Adjorlolo-Johnson G , Marlink R , Ellerbrock TV . Pediatr Infect Dis J 2014 33 (11) 1134-40 BACKGROUND: During 2004-2008, >2,000 children (<15 years old) initiated antiretroviral therapy (ART) in Cote d'Ivoire. Nationally representative outcomes, temporal trends in outcomes during 2004-2008, and site-level outcome determinants have not been investigated. METHODS: Incidence rates of death, loss to follow-up (LTFU), and attrition (death or LTFU) were evaluated in a nationally representative, retrospective cohort study among 2,110 children, who initiated ART at 29 facilities in Cote d'Ivoire during 2004-2008. RESULTS: At ART initiation, 54% were male, 1% were HIV-2-infected, and median age was 5.1 years. Median CD4% was 11%, and 61% had weight-for-age z-score (WAZ) ≤-2. Vaccination completion was documented for 9% of children. Eleven of 29 facilities had an integrated nutrition program. Over 4,585 person-years of ART, 237 children died and 427 became LTFU. Twelve-month attrition was 22% overall, but increased from 4-34% during 2004-2008, due to increases in 12-month mortality (from 3-11%) and 12-month LTFU (from 2-23%). In adjusted analysis, compared with enrollees in 2004, enrollees in 2008 had nearly four-fold higher mortality and eight-fold higher LTFU. World Health Organization stage III/IV, CD4% <10%, WAZ ≤2, and hemoglobin <8g/dL, were predictive of mortality. Incomplete vaccination was predictive of mortality and LTFU. Facilities with nutrition programs had lower LTFU and mortality rates. Clinics reporting nurse dissatisfaction with working conditions had higher LTFU rates. CONCLUSION: Investigation of causes of increasing mortality and LTFU is needed. Ensuring earlier ART initiation, vaccination completion, scale-up of site-level nutrition programs, and nurse work-environment satisfaction, could improve pediatric ART program outcomes. |
Investigation of an outbreak of acute respiratory disease in Cote d'Ivoire in April 2007
Ekaza E , Kadjo HA , Coulibaly D , Koutouan GGM , Coulibaly-N'Golo GMD , Kouakou B , Talla Nzussouo N , Olsen SJ , Ekra DK , Akoua-Koffi CG , Gilbernair EA , Bretin-Dosso MC . Afr J Infect Dis 2014 8 (2) 31-35 BACKGROUND: This study aim was to investigate an outbreak of human cases of unexplained influenza-like illness and fatal acute respiratory infection (ARI), with simultaneous poultry illness and high mortality raising concerns of possible influenza A (H5N1), virus in Cote d'Ivoire in February and March 2007. MATERIALS AND METHODS: To investigate the outbreak, we conducted active surveillance in the community and reviewed health registries. Persons meeting the case definition were asked to provide nasopharyngeal specimens. On the basis of clinical and epidemiological information, specimens were tested using conventional RT-PCR for the M gene of the influenza viruses and hemagglutinin H5 of avian influenza A (H5N1), virus; negative samples were tested for other respiratory viruses. Specimens from healthy animals were also collected. RESULTS: Between October 2006, and February 2007, 104 suspected cases of Acute Respiratory Disease that included; 31 deaths recorded. We collected and tested 73 nasopharyngeal specimens; of which, 2, were positive for human Coronavirus OC43 and 1 for influenza C virus. No pathogens were identified in animal specimens. CONCLUSION:The investigation quickly ruled out influenza A (H5N1), virus as the cause and found laboratory-confirmed cases of influenza C virus and human Coronavirus OC 43 for the first time in both Cote d'Ivoire and in a Sub-Saharan African country. However we were not able to show that these viruses caused the outbreak. Monitoring of influenza viruses must be a priority but other respiratory viruses and non-viral causes may be of interest too. |
Temporal trends in treatment outcomes for HIV-1 and HIV-2-infected adults enrolled in Cote d'Ivoire's national antiretroviral therapy program
Auld AF , Ekra KA , Shiraishi RW , Tuho MZ , Kouakou JS , Mohamed F , Ettiegne-Traore V , Sabatier J , Essombo J , Adjorlolo-Johnson G , Marlink R , Ellerbrock TV . PLoS One 2014 9 (5) e98183 BACKGROUND: In Cote d'Ivoire during 2004-2007, numbers of ART enrollees increased from <5,000 to 36,943. Trends in nationally representative ART program outcomes have not yet been reported. METHODOLOGY/PRINCIPAL FINDINGS: We conducted a retrospective chart review to assess trends in patient characteristics and attrition [death or loss to follow-up (LTFU)] over time, among a nationally representative sample of 3,682 adults (≥15 years) initiating ART during 2004-2007 at 34 health facilities. Among ART enrollees during 2004-2007, median age was 36, the proportion female was 67%, the proportion HIV-2-infected or dually HIV-1&2 reactive was 5%, and median baseline CD4+ T-cell (CD4) count was 135 cells/microL. Comparing cohorts initiating ART in 2004 with cohorts initiating ART in 2007, median baseline weight declined from 55 kg to 52 kg (p = 0.008) and the proportion weighing <45 kg increased from 17% to 22% (p = 0.014). During 2004-2007, pharmacy-based estimates of the percentage of new ART enrollees ≥95% adherent to ART declined from 74% to 60% (p = 0.026), and twelve-month retention declined from 86% to 69%, due to increases in 12-month mortality from 2%-4% and LTFU from 12%-28%. In univariate analysis, year of ART initiation was associated with increasing rates of both LTFU and mortality. Controlling for baseline CD4, weight, adherence, and other risk factors, year of ART initiation was still strongly associated with LTFU but not mortality. In multivariate analysis, weight <45 kg and adherence <95% remained strong predictors of LTFU and mortality. CONCLUSIONS: During 2004-2007, increasing prevalence among ART enrollees of measured mortality risk factors, including weight <45 kg and ART adherence <95%, might explain increases in mortality over time. However, the association between later calendar year and increasing LTFU is not explained by risk factors evaluated in this analysis. Undocumented transfers, political instability, and patient dissatisfaction with crowded facilities might explain increasing LTFU. |
Tuberculosis in human immunodeficiency virus-infected children starting antiretroviral therapy in Cote d'Ivoire
Auld AF , Tuho MZ , Ekra KA , Kouakou J , Shiraishi RW , Adjorlolo-Johnson G , Marlink R , Ellerbrock TV . Int J Tuberc Lung Dis 2014 18 (4) 381-7 SETTING: In Cote d'Ivoire, more than 2000 human immunodeficiency virus (HIV) infected children aged <15 years were started on antiretroviral therapy (ART) during 2004-2008. OBJECTIVES: To estimate tuberculosis (TB) incidence and determinants among ART enrollees. DESIGN: A nationally representative retrospective cohort study among 2110 children starting ART during 2004-2008 at 29 facilities. RESULTS: At ART initiation, the median age was 5.1 years; 82% had World Health Organization Stage III/IV, median CD4% was 11%, 42% were severely undernourished (weight-for-age Z-score [WAZ] <-3), and 150 (7%) were taking anti-tuberculosis treatment. Documentation of TB screening before ART declined from 63% to 46% during 2004-2008. Children taking anti-tuberculosis treatment at ART enrollment had a lower median CD4% (9.0% vs. 11.0%, P = 0.037) and a higher prevalence of WAZ <-3 (59% vs. 40%, P < 0.001). Among children considered TB-free at ART enrollment, TB incidence was 6.28/100 child-years during days 0-90 of ART, declining to 0.56/100 child-years after 180 days. Children with one unit higher WAZ at ART enrollment had 13% lower TB incidence (adjusted HR 0.87, 95%CI 0.77-1.00, P= 0.047). CONCLUSIONS: Ensuring clinician compliance with TB screening before ART and ensuring earlier ART initiation before children suffer from advanced HIV disease and nutritional compromise might reduce TB morbidity during ART. |
Pandemic influenza A(H1N1) in Cote d'Ivoire: health-care providers' knowledge of influenza and attitudes towards vaccination
Coulibaly D , Nzussouo NT , Kadjo HA , Traore Y , Ekra DK , Cherif D , Kouassi PD , N'Gattia A K , Dagnan SN . J Infect Dev Ctries 2013 7 (7) 499-506 INTRODUCTION: During the 2009 influenza A(H1N1) pandemic (pH1N1), different methods were promoted to reduce the spread of influenza, including respiratory etiquette and vaccination. To identify knowledge gaps about influenza and to plan the vaccination campaign against the pandemic in Cote d'Ivoire, a survey was conducted among health-care providers (HCPs) to assess their knowledge about influenza and their willingness to be vaccinated. METHODOLOGY: A cross-sectional survey was performed in the city of Abidjan on 16-18 February 2010, in the three university teaching hospitals, a randomly selected general hospital, and two randomly selected private clinics. In face-to-face interviews, 383 health-care professionals were asked questions about their knowledge of influenza, means of influenza prevention, and their willingness to be vaccinated. Data analysis, both univariate and multivariate, was performed using SPSS. RESULTS: Willingness to be vaccinated against pH1N1 was 80% (n = 284), and 83% of the HCPs would recommend the vaccine to others. The respiratory mode of transmission of influenza was known by 85% (n = 295) of the participants and 50% (n = 174) believed that seasonal influenza virus and pH1N1 virus were different. In a multivariate model, the factors significantly associated with willingness to receive pH1N1vaccine were fear of pH1N1 disease (OR = 2.1; IC = 1.02-4.35), having only a high school education (OR = 8.28; IC = 2.04-33.60), and feeling at risk to contract pH1N1 (OR = 11.43; IC = 4.77-27.38). CONCLUSION: The willingness to be vaccinated against influenza A (H1N1) by health professionals is real. |
Evaluating the BED capture enzyme immunoassay to estimate HIV incidence among adults in three countries in Sub-Saharan Africa
Kim AA , McDougal JS , Hargrove J , Rehle T , Pillay-Van Wyk V , Puren A , Ekra A , Borget-Alloue MY , Adje-Toure C , Abdullahi AS , Odawo L , Marum L , Parekh BS . AIDS Res Hum Retroviruses 2010 26 (10) 1051-61 Serological assays for estimating HIV-1 incidence are prone to misclassification, limiting the accuracy of the incidence estimate. Adjustment factors have been developed and recommended for estimating assay-based HIV-1 incidence in cross-sectional settings. We evaluated the performance of the recommended adjustment factors for estimating incidence in national HIV surveys in three countries in sub-Saharan Africa. The BED-capture enzyme immunoassay was applied to stored blood specimens from (1) pregnant women aged 15-49 years attending antenatal clinics in Cote d'Ivoire (1998-2004), (2) adults aged 15-49 years participating in a demographic health survey in Kenya (2003), and (3) adults aged 15-49 years participating in a national household serosurvey in South Africa (2005). Assay-derived incidence estimates were corrected for misclassification using recommended adjustment factors and, where possible, were compared to mathematically modeled incidence in the same populations. Trends in HIV prevalence were compared to trends in assay-derived incidence to assess plausibility in the assay-derived trends. Unadjusted incidence was 3.8% [95% confidence interval (CI) 3.3-4.5] in Cote d'Ivoire, 3.5% (2.7-4.3) in Kenya, and 4.4% (CI 2.3-6.5]) in South Africa. Adjusted incidence was 2.9% (CI 2.1-3.7) in Cote d'Ivoire, 2.6% (CI 2.0-3.2) in Kenya, and 2.4% (CI 1.7-3.1) in South Africa. After adjustment, peak incidence shifted from older to younger age groups in Cote d'Ivoire and South Africa. Modeled HIV incidence was 1.0% (CI 1.02-1.08) in Kenya and 2.0% (CI 1.7-2.4) in South Africa. After applying the recommended adjustments factors, adjusted assay-derived estimates remained implausibly high in two of three populations evaluated. For more accurate measures of assay-derived population incidence, adjustment factors must be locally derived and validated. Until improved assays are available, caution should be applied in the use and interpretation of data from incidence assays. |
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