No abstract

The retention of patients in care is a key pillar of the continuum of HIV care. It has been suggested that the implementation of a “treat-all” strategy may favor attrition (death or lost to follow-up, as opposed to retention), specifically in the subgroup of asymptomatic people living with HIV (PLWH) with high CD4 counts. Attrition in HIV care could mitigate the success of universal antiretroviral therapy (ART) in resource-limited settings. We performed a retrospective study of PLWH at least 15 years old initiating ART in 85 HIV care centers in Kinshasa, Democratic Republic of Congo (DRC), between 2010 and 2019, with the objective of measuring attrition and to define factors associated with it. Sociodemographic and clinical characteristics recorded at ART initiation included sex, age, weight, height, WHO HIV stage, pregnancy, baseline CD4 cell count, start date of ART, and baseline and last ART regimen. Attrition was defined as death or loss to follow-up (LTFU). LTFU was defined as “not presenting to an HIV care center for at least 180 days after the date of a last missed visit, without a notification of death or transfer”. Kaplan–Meier curves were used to present attrition data, and mixed effects Cox regression models determined factors associated with attrition. The results compared were before and after the implementation of the “treat-all” strategy. A total of 15,762 PLWH were included in the study. Overall, retention in HIV care was 83% at twelve months and 77% after two years of follow-up. The risk of attrition increased with advanced HIV disease and the size of the HIV care center. Time to ART initiation greater than seven days after diagnosis and Cotrimoxazole prophylaxis was associated with a reduced risk of attrition. The implementation of the “treat-all” strategy modified the clinical characteristics of PLWH toward higher CD4 cell counts and a greater proportion of patients at WHO stages I and II at treatment initiation. Initiation of ART after the implementation of the ‘treat all” strategy was associated with higher attrition (p<0.0001) and higher LTFU (p<0.0001). Attrition has remained high in recent years. The implementation of the “treat-all” strategy was associated with higher attrition and LTFU in our study. Interventions to improve early and ongoing commitment to care are needed, with specific attention to high-risk groups to improve ART coverage and limit HIV transmission.

Aim Mortality rates of coronavirus-2019 (COVID-19) disease continue to increase worldwide and in Africa. In this study, we aimed to summarize the available results on the association between sociodemographic, clinical, biological, and comorbidity factors and the risk of mortality due to COVID-19 in sub-Saharan Africa. Methods We followed the PRISMA checklist (S1 Checklist). We searched PubMed, Google Scholar, and European PMC between January 1, 2020, and September 23, 2021. We included observational studies with Subjects had to be laboratory-confirmed COVID-19 patients; had to report risk factors or predictors of mortality in COVID-19 patients, Studies had to be published in English, include multivariate analysis, and be conducted in the sub-Saharan region. Exclusion criteria included case reports, review articles, commentaries, errata, protocols, abstracts, reports, letters to the editor, and repeat studies. The methodological quality of the studies included in this meta-analysis was assessed using the methodological items for nonrandomized studies (MINORS). Pooled hazard ratios (HR) or odds ratios (OR) and 95% confidence intervals (CI) were calculated separately to identify mortality risk. In addition, publication bias and subgroup analysis were assessed. Results and discussion Twelve studies with a total of 43598 patients met the inclusion criteria. The outcomes of interest were mortality. The results of the analysis showed that the pooled prevalence of mortality in COVID-19 patients was 4.8%. Older people showed an increased risk of mortality from SARS-Cov-2. The pooled hazard ratio (pHR) and odds ratio (pOR) were 9.01 (95% CI; 6.30–11.71) and 1.04 (95% CI; 1.02–1.06), respectively. A significant association was found between COVID-19 mortality and men (pOR = 1.52; 95% CI 1.04–2). In addition, the risk of mortality in patients hospitalized with COVID-19 infection was strongly influenced by chronic kidney disease (CKD), hypertension, severe or critical infection on admission, cough, and dyspnea. The major limitations of the present study are that the data in the meta-analysis came mainly from studies that were published, which may lead to publication bias, and that the causal relationship between risk factors and poor outcome in patients with COVID-19 cannot be confirmed because of the inherent limitations of the observational study. Conclusions Advanced age, male sex, CKD, hypertension, severe or critical condition on admission, cough, and dyspnea are clinical risk factors for fatal outcomes associated with coronavirus. These findings could be used for research, control, and prevention of the disease and could help providers take appropriate measures and improve clinical outcomes in these patients.

Hypertension is a common comorbidity in COVID‐19 patients. However, little data is available on mortality in COVID‐19 patients with hypertension in sub‐Saharan Africa (SSA). Herein, the authors conducted a systematic review of research articles published from January 1, 2020 to July 1, 2021. Our aim was to evaluate the magnitude of COVID‐19 mortality in patients with hypertension in SSA. Following the PRISMA guidelines, two independent investigators conducted the literature review to collect relevant data. The authors used a random effect model to estimate the odds ratio, or hazard ratio, with a 95% confidence interval (CI). Furthermore, the authors used Egger's tests to check for publication bias. For mortality analysis, the authors included data on 29 945 COVID‐19 patients from seven publications. The authors assessed the heterogeneity across studies with the I2 test. Finally, the pooled analysis revealed that hypertension was associated with an increased odds of mortality among COVID‐19 inpatients (OR 1.32; 95% CI, 1.13–1.50). Our analysis revealed neither substantial heterogeneity across studies nor a publication bias. Therefore, our prespecified results provided new evidence that hypertension could increase the risk of mortality from COVID‐19 in SSA.

Background: Happy hypoxia is a new feature found in COVID-19 patients. It consists of the presence of severe hypoxemia but normal breathing rate. Failure to identify this hypoxia may have negative consequences on the survival of the patient. The objective of the present study was to measure the frequency of patients with happy hypoxia and to evaluate their survival at the Kinshasa University Hospital (KUH). Methods: This was a historical cohort of 141 hospitalized patients with COVID-19 at KUH from March 23 to June 15, 2020. Happy hypoxia was defined as oxygen saturation below 90% without dyspnea. Socio-demographic data, co-morbidities, follow up time of hospitalization and outcomes were studied. Survival was assessed using the Kaplan Meier curve. Results: Out of 141 hospitalized patients with COVID-19, 79 (56%) patients were at the severe or critical stage and 9 (6.4%) had a happy hypoxia on admission.