Last data update: Dec 09, 2024. (Total: 48320 publications since 2009)
Records 1-7 (of 7 Records) |
Query Trace: Ekra KA[original query] |
---|
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. |
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. |
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. |
- Page last reviewed:Feb 1, 2024
- Page last updated:Dec 09, 2024
- Content source:
- Powered by CDC PHGKB Infrastructure