scholarly journals The Effect of Monitoring Viral Load and Tracing Patients Lost to Follow-up on the Course of the HIV Epidemic in Malawi: A Mathematical Model

2018 ◽  
Vol 5 (5) ◽  
Author(s):  
Janne Estill ◽  
Cliff C Kerr ◽  
Nello Blaser ◽  
Luisa Salazar-Vizcaya ◽  
Lyson Tenthani ◽  
...  
Keyword(s):  
Mathematical Model ◽  
Viral Load ◽  
Hiv Transmission ◽  
Scale Up ◽  
Hiv Infections ◽  
Transmission Model ◽  
Speed Test ◽  
Treatment Interruptions ◽  
Lost To Follow Up

Abstract Background Antiretroviral therapy (ART) reduces HIV transmission, but treated patients may again become infectious. We used a mathematical model to determine whether ART as prevention is more effective if viral load (VL) is routinely monitored and patients lost to follow-up (LTFU) traced. Methods We simulated ART cohorts to parameterize a deterministic transmission model calibrated to Malawi. We investigated the following strategies for improving treatment and retention: monitoring VL every 12 or 24 months, tracing patients LTFU, or a generic strategy leading to uninterrupted treatment. We tested 3 scenarios, where ART scale-up continues at current (Universal ART), reduced (Failed scale-up), or accelerated speed (Test&Treat). Results In the Universal ART scenario, between 2017 and 2020 (2050), monitoring VL every 24 months prevented 0.5% (0.9%), monitoring every 12 months prevented 0.8% (1.4%), tracing prevented 0.3% (0.5%), and uninterrupted treatment prevented 5.5% (9.9%) of HIV infections. Failed scale-up resulted in 25% more infections than the Universal ART scenarios, whereas Test&Treat resulted in 7%–8% less. Conclusions Test&Treat reduces transmission of HIV, despite individual cases of treatment failure and ART interruption. Whereas viral load monitoring and tracing have only a minor impact on transmission, interventions that aim to minimize treatment interruptions can further increase the preventive effect of ART.

scholarly journals The impact of condom use on the HIV epidemic

2021 ◽  
Vol 5 ◽  
pp. 91
Author(s):  
John Stover ◽  
Yu Teng
Keyword(s):  
Condom Use ◽  
Hiv Transmission ◽  
New Technologies ◽  
Scale Up ◽  
Hiv Infections ◽  
Transmission Model ◽  
Middle Income ◽  
Sexually Transmitted ◽  
Hiv Programs ◽  
The Impact

Background: Condom promotion and supply was one the earliest interventions to be mobilized to address the HIV pandemic. Condoms are inexpensive and provide protection against transmission of HIV and other sexually transmitted diseases (STIs) as well as against unintended pregnancy. As many as 16 billion condoms may be used annually in all low- and middle-income countries (LMIC). In recent years the focus of HIV programs as been on testing and treatment and new technologies such as PrEP. Rates of condom use have stopped increasing short of UNAIDS targets and funding from donors is declining. Methods: We applied a mathematical HIV transmission model to 77 high HIV burden countries to estimate the number of HIV infections that would have occurred from 1990 to 2019 if condom use had remained at 1990 levels. Results: The results suggest that current levels of HIV would be five times higher without condom use and that the scale-up in condoms use averted about 117 million HIV infections. Conclusions: HIV programs should ensure that affordable condoms are consistently available and that the benefits of condom use are widely understood.

scholarly journals Loss to Followup in HIV-Infected Patients from Asia-Pacific Region: Results from TAHOD

2012 ◽  
Vol 2012 ◽  
pp. 1-10 ◽  
Author(s):  
Jialun Zhou ◽  
Junko Tanuma ◽  
Romanee Chaiwarith ◽  
Christopher K. C. Lee ◽  
Matthew G. Law ◽  
...  
Keyword(s):  
Viral Load ◽  
Drug Regimen ◽  
Clinic Visit ◽  
Asia Pacific ◽  
Pacific Region ◽  
Asia Pacific Region ◽  
Hiv Viral Load ◽  
History Of ◽  
Lost To Follow Up

This study examined characteristics of HIV-infected patients in the TREAT Asia HIV Observational Database who were lost to follow-up (LTFU) from treatment and care. Time from last clinic visit to 31 March 2009 was analysed to determine the interval that best classified LTFU. Patients defined as LTFU were then categorised into permanently LTFU (never returned) and temporary LTFU (re-entered later), and these groups compared. A total of 3626 patients were included (71% male). No clinic visits for 180 days was the best-performing LTFU definition (sensitivity 90.6%, specificity 92.3%). During 7697 person-years of follow-up, 1648 episodes of LFTU were recorded (21.4 per 100-person-years). Patients LFTU were younger (P=0.002), had HIV viral load ≥500 copies/mL or missing (P=0.021), had shorter history of HIV infection (P=0.048), and received no, single- or double-antiretroviral therapy, or a triple-drug regimen containing a protease inhibitor (P<0.001). 48% of patients LTFU never returned. These patients were more likely to have low or missing haemoglobin (P<0.001), missing recent HIV viral load (P<0.001), negative hepatitis C test (P=0.025), and previous temporary LTFU episodes (P<0.001). Our analyses suggest that patients not seen at a clinic for 180 days are at high risk of permanent LTFU, and should be aggressively traced.

scholarly journals The impact of the program for medical male circumcision on HIV in South Africa: analysis using three epidemiological models

2021 ◽  
Vol 5 ◽  
pp. 15
Author(s):  
Eline L. Korenromp ◽  
Anna Bershteyn ◽  
Edina Mudimu ◽  
Renay Weiner ◽  
Collen Bonecwe ◽  
...  
Keyword(s):  
South Africa ◽  
Male Circumcision ◽  
Hiv Transmission ◽  
Scale Up ◽  
Household Survey ◽  
Hiv Infections ◽  
Treatment Needs ◽  
Medical Male Circumcision ◽  
Hiv Epidemic ◽  
The Impact

Background: South Africa began offering medical male circumcision (MMC) in 2010. We evaluated the current and future impact of this program to see if it is effective in preventing new HIV infections. Methods: The Thembisa, Goals and Epidemiological Modeling Software (EMOD) HIV transmission models were calibrated to South Africa’s HIV epidemic, fitting to household survey data on HIV prevalence, risk behaviors, and proportions of men circumcised, and to programmatic data on intervention roll-out including program-reported MMCs over 2009-2017. We compared the actual program accomplishments through 2017 and program targets through 2021 with a counterfactual scenario of no MMC program. Results: The MMC program averted 71,000-83,000 new HIV infections from 2010 to 2017. The future benefit of the circumcision already conducted will grow to 496,000-518,000 infections (6-7% of all new infections) by 2030. If program targets are met by 2021 the benefits will increase to 723,000-760,000 infections averted by 2030. The cost would be $1,070-1,220 per infection averted relative to no MMC. The savings from averted treatment needs would become larger than the costs of the MMC program around 2034-2039. In the Thembisa model, when modelling South Africa’s 9 provinces individually, the 9-provinces-aggregate results were similar to those of the single national model. Across provinces, projected long-term impacts were largest in Free State, KwaZulu-Natal and Mpumalanga (23-27% reduction over 2017-2030), reflecting these provinces’ greater MMC scale-up. Conclusions: MMC has already had a modest impact on HIV incidence in South Africa and can substantially impact South Africa’s HIV epidemic in the coming years.

scholarly journals 1319. Events of Disengagement from HIV care and Subsequent Reengagement in a Kenyan Pastoralist Community: Frequency, Determinants, and Patient Views

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S476-S477
Author(s):  
Paul Otieno Yonga ◽  
Stephen Kiplimo Kalya ◽  
Lutgarde Lynen ◽  
Tom Decroo
Keyword(s):  
Antiretroviral Therapy ◽  
Hiv Transmission ◽  
Hospital Admissions ◽  
Hiv Care ◽  
Engagement In Care ◽  
Work Related ◽  
Medication Side ◽  
Competing Priorities ◽  
Lost To Follow Up

Abstract Background Regular follow-up HIV-infected patients on antiretroviral therapy (ART) is vital to ensure viral suppression, thus reducing HIV transmission, and HIV-related morbidity and mortality. However, some patients have been reported to have events of disengagement from care with subsequent re-engagement in care, though knowledge on the magnitude and determinants of this phenomenon, particularly in pastoralist communities is scarce. Methods A mixed-methods study was carried out among HIV-infected patients on antiretroviral therapy (ART) follow-up between January 2014 and June 2017 at the Baringo County Referral Hospital, Kabarnet, Kenya. Records on their clinic attendance and laboratory follow-up were extracted, and those noted to have a recent event of disengagement from care who later re-engaged in care, were then purposively sampled for in-depth interviews. Results 342 patient records were analyzed, of which 48% (166/342) of the patients were noted to be active at the end of the study period, with 63.3% (105/166) of them noted to have one or more events of disengagement from care. Female patients, patients with baseline CD4 counts ≥200 cells/mm3, and patients with a low WHO stage category (I and II) were more likely to return to care after an experience of disengagement from HIV care (P < 0.05). Eight interviewee transcripts showed the following reported reasons for disengagement in care: long distances, stigma, work-related problems, medication side effects, competing priorities, perceived recovery of the health status, medication fatigue, and not being informed of their clinic return dates. Motivators for re-engagement in care included hospital admissions, fear of getting sick like their spouse, and phone reminders. Conclusion A vast majority of patients currently active in care experienced multiple events of disengagement from care. Thus, early identification of those who disengage from care is recommended, before they become lost to follow-up. Disclosures All authors: No reported disclosures.

scholarly journals Tracing of Patients Lost to Follow-up and HIV Transmission

2014 ◽  
Vol 65 (5) ◽  
pp. e179-e186 ◽  
Author(s):  
Janne Estill ◽  
Hannock Tweya ◽  
Matthias Egger ◽  
Gilles Wandeler ◽  
Caryl Feldacker ◽  
...  
Keyword(s):  
Hiv Transmission ◽  
Lost To Follow Up

Treatment for prevention of HIV transmission in a localised epidemic: the case for South Australia

Sexual Health ◽  
2011 ◽  
Vol 8 (3) ◽  
pp. 280 ◽  
Author(s):  
Kelly-Jean Heymer ◽  
David P. Wilson
Keyword(s):  
Hiv Transmission ◽  
South Australia ◽  
Hiv Infections ◽  
Small Population ◽  
Transmission Model ◽  
Minimal Impact ◽  
Gay Community ◽  
Epidemiological Impact ◽  
Sex With Men ◽  
Novel Model

Background Discussion is currently taking place among international HIV/AIDS groups around increasing HIV testing and initiating earlier use of antiretroviral therapy (ART) among people diagnosed with HIV as a method to reduce the spread of HIV. In this study, we explore the expected epidemiological impact of this strategy in a small population in which HIV transmission is predominantly confined to men who have sex with men (MSM). Methods: A deterministic mathematical transmission model was constructed to investigate the impacts of strategies that increase testing and treatment rates, and their likely potential to mitigate HIV epidemics among MSM. Our novel model distinguishes men in the population who are more easily accessible to prevention campaigns through engagement with the gay community from men who are not. This model is applied to the population of MSM in South Australia. Results: Our model-based findings suggest that increasing testing rates alone will have minimal impact on reducing the expected number of infections compared to current conditions. However, in combination with increases in treatment coverage, this strategy could lead to a 59–68% reduction in the number of HIV infections over the next 5 years. Targeting men who are socially engaged with the gay community would result in the majority of potential reductions in incidence, with only minor improvements possible by reaching all other MSM. Conclusions: Investing in strategies that will achieve higher coverage and earlier initiation of treatment to reduce infectiousness of HIV-infected individuals could be an effective strategy for reducing incidence in a population of MSM.

Results of Baseline Assessments of Two Viral Load and Early Infant Diagnosis Laboratories in Gaza Province, Mozambique

2019 ◽  
Vol 152 (Supplement_1) ◽  
pp. S79-S79
Author(s):  
Augusto Nhabomba ◽  
Mariamo Assane ◽  
Noorbebi Adamo ◽  
Octavia Benzane ◽  
Isabel Pinto ◽  
...  
Keyword(s):  
Viral Load ◽  
Scale Up ◽  
Hiv Prevalence ◽  
Internal Quality ◽  
Early Infant Diagnosis ◽  
Hiv Viral Load ◽  
Early Infant ◽  
Sample Management ◽  
Basic Infrastructure

Abstract Following the WHO 2013 recommendations for routine HIV viral load (VL) testing as the tool to monitor antiretroviral therapy, countries have prepared for massive testing scale-up. However, developing countries that also bear the highest HIV prevalence often lack qualified human resources and basic infrastructure. Mozambique has established 13 VL laboratories, including 2 in the province with the highest overall HIV prevalence, Gaza. The challenges to VL testing implementation and this rapid scale-up demand an urgent investment toward laboratory accreditation to ensure accurate and reliable VL results. To identify gaps and areas for improvement where additional resources may be needed to provide high-quality VL testing services, the CDC developed a VL and Early Infant Diagnosis (EID) scorecard (106 points; 5 levels). The scorecard evaluates 9 key areas, including (1) Personnel, (2) Facility/Environment, (3) Safety, (4) Procurement/Inventory, (5) Sample Management, (6) Equipment, (7) Process Control, (8) M&E Documents and Records, and (9) Internal Quality Audits/Quality Indicators. These 9 essential areas cover the pretesting, testing, and posttesting phases along the continuum of care for HIV patients. Baseline assessments in the two VL and EID laboratories in Gaza Province, Carmelo Molecular Laboratory and Xai-Xai Molecular Laboratory, were recently conducted. Personnel standards and M&E documentation represented strengths across both laboratories, with over 70% of the master list of M&E documents having been developed and in use. The overall gaps identified included poor segregation and prioritization of higher VL results (>1,000 cp/mL), lack of internal audits, and no follow-up of nonconformities. Both laboratories scored in the level 2 range, with a total of 68 points (Carmelo) and 78 points (Xai-Xai). Considering this is a baseline assessment, we conclude that both labs are on an excellent path toward accreditation; however, additional laboratory quality mentorship is needed in order to reach accreditation standards.

scholarly journals Using patient–centered approach for improving adherence to treatment in DS/DR–TB patients in Ukraine

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
E Geliukh ◽  
V Tabunshchyk ◽  
N Kamenska ◽  
Z Islam
Keyword(s):  
Treatment Outcomes ◽  
Successful Treatment ◽  
Cohort Analysis ◽  
Scale Up ◽  
Adherence To Treatment ◽  
Patient Centered ◽  
Number Of Patients ◽  
Mdr Tb ◽  
Lost To Follow Up

Abstract Issue/problem Ukraine is among 30 high MDR-TB burden countries with about 6500 laboratory confirmed MDR-TB cases annually. Ukraine provides full coverage for first- and second-line TB drugs from the state budget. Nevertheless, successful treatment outcomes are one of the lowest in EECA region - 49% in MDR/RR-TB cases and 37% in XDR-TB. High rates of lost to follow-up (15.8%), treatment failed (18%) and died (15.9%) among MDR-TB cases contribute to unsuccessful treatment outcomes. Description of the problem A new intervention was introduced aimed at improving patients' adherence to treatment. Medical-psycho-social services (MPSS) provision based on patient-centered approach is provided to all patients. In 2018, project funded by GFATM was launched in 8 oblasts of Ukraine. All patients are assessed on treatment adherence before discharge from hospitals. Those with low adherence are referred to NGOs. MPSS starts from the patient's needs assessment followed by development of individual plan of support. MPSS is provided during the whole period of outpatient treatment and may include DOT/VOT, social workers' permanent support, food kits, psychologist counselling, transport and/or cell reimbursement, housing, documents restore, legal services and other services as per patients' needs. Electronic depersonalized database SyrEx is used for the project related notes. Results Total amount of TB/DR-TB patients treated in 2018-2019 is 8640 and 4246 accordingly. Cohort analysis is used for treatment outcomes assessment. Intervention allowed reducing the number of patients lost to follow up in DS/DR-TB (to 1.2% and 2.5% accordingly), treatment failed (to 5.4% and 10.9%) and number of died (to 2.1% and 3.2%) Lessons MPSS based on patient-centered approach improved successful treatment outcomes: to 91% in DS-TB patients and 82.3% in DR-TB. Further initiative scale-up is required as well as transition of MPSS services from donor funding to domestic.

scholarly journals High rates of culture conversion and low loss to follow-up in MDR-TB patients managed at Regional Referral Hospitals in Uganda

2019 ◽  
Author(s):  
Martin Kayitale Mbonye ◽  
John-Paul Otuba ◽  
Sara Riese ◽  
Hilary Alima ◽  
Frank Mugabe ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Treatment Initiation ◽  
Scale Up ◽  
Health Concern ◽  
Cross Sectional ◽  
Tb Treatment ◽  
Referral Hospitals ◽  
Mdr Tb ◽  
Lost To Follow Up

Abstract Background: Multi-drug resistant – tuberculosis (MDR-TB) is an emerging public health concern in Uganda. Prior to 2013, MDR-TB treatment in Uganda was only provided at the national referral hospital and two private-not-for profit clinics. From 2013, it was scaled up to seven regional referral hospitals (RRH). The aim of this study was to measure interim (six months) treatment outcomes among the first cohort of patients started on MDR-TB treatment at the RRH in Uganda. Methods: This was a cross-sectional study in which a retrospective descriptive analysis of data on a cohort of 69 patients started on MDR-TB treatment at 7 RRH between 1st April 2013 and 30th June 2014 and had been on treatment for at least nine months was conducted. Results: Of the 69 patients, 21 (30.4%) were female, 39 (56.5%) HIV-negative, 30 (43.5%) resistant to both isoniazid and rifampicin and 57 (82.6%) category 1 or 2 drug susceptible TB treatment failures. Median age at start of treatment was 35 years (Interquartile range (IQR): 27-45), median time-to-treatment initiation was 27.5 (IQR:6-89) days and of the 30 HIV-positive patients, 27 (90.0%) were on anti-retroviral treatment with a median CD4 count of 206 cells/microliter of blood (IQR: 113-364.5). Within six months of treatment, 59 (86.0%) patients culture converted, of which 45 (65.2%) converted by the second month and the other 14 (20.3%) by the sixth month; one (1.5%) did not culture convert; three (4.4%) died; and six (8.8%) were lost-to-follow up. Fifty (76.8%) patients experienced at least one drug adverse event, while 40 (67.8%) gained weight. Mean weight gained was 4.7 (standard deviation:3.2) kilograms. Conclusions: Despite MDR-TB treatment initiation delays, most patients had favourable interim treatment outcomes with majority culture converting early and very few getting lost to follow-up. These encouraging interim outcomes indicate a successful scale-up of MDR-TB treatment to RRH.

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