Outcomes of a Remote, Decentralized Health Center-Based HIV/AIDS Antiretroviral Program in Zambia, 2003 to 2007

Elema, Riekje; Mills, Clair; Yun, Oliver; Lokuge, Kamalini; Ssonko, Charles; Nyirongo, Nashiola; Mtonga, Velepi; Zulu, Henry; Tu, David; Verputten, Meggy; O’Brien, D. P.

doi:10.1177/1545109709331472

Cited by 9 publications

(7 citation statements)

References 13 publications

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“…Our study population appears to be representative of the adult population on ART in Malawi, in that the demographic features and the clinical and immunological baseline indicators signifying advanced HIV disease were comparable to national data. 42 Baseline characteristics and overall oneyear virological and immunological outcomes are also comparable to other ART cohorts in sub-Saharan Africa, 25,27,43 supporting the external validity of our data for guidance of policy in ART scale-up programmes in the region.…”

Section: Discussionsupporting

confidence: 78%

Favourable one-year ART outcomes in adult Malawians with hepatitis B and C co-infection

Moore

Beadsworth

Chaponda

et al. 2010

Journal of Infection

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Section: Discussionsupporting

confidence: 78%

Favourable one-year ART outcomes in adult Malawians with hepatitis B and C co-infection

Moore

Beadsworth

Chaponda

et al. 2010

Journal of Infection

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“…The treatment outcomes of both ART programmes confirm the feasibility to provide ART care with no inferior outcomes in health centres, using lower health cadres and standardised treatment schemes [15,31-35]. This rationalisation of ART care delivery allowed a significant increase in patients on ART in both settings, as ART care became more accessible.…”

Section: Discussionmentioning

confidence: 64%

Short and long term retention in antiretroviral care in health facilities in rural Malawi and Zimbabwe

Rasschaert

Koole

Zachariah

et al. 2012

BMC Health Serv Res

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BackgroundDespite the successful scale-up of ART services over the past years, long term retention in ART care remains a major challenge, especially in high HIV prevalence and resource-limited settings. This study analysed the short (<12 months) and long (>12 months) term retention on ART in two ART programmes in Malawi (Thyolo district) and Zimbabwe (Buhera district).MethodsRetention rates at six-month intervals are reported separately among (1) patients since ART initiation and (2) patients who had been on ART for at least 12 months, according to the site of ART initiation and follow-up, using the Kaplan Meier method. ‘Retention’ was defined as being alive on ART or transferred out, while ‘attrition’ was defined as dead, lost to follow-up or stopped ART.ResultsIn Thyolo and Buhera, a total of 12,004 and 9,721 patients respectively were included in the analysis. The overall retention among the patients since ART initiation was 84%, 80% and 77% in Thyolo and 88%, 84% and 82% in Buhera at 6, 12 and 18 months, respectively. In both programmes the largest drop in ART retention was found during the initial 12 months on ART, mainly related to a high mortality rate in the health centres in Thyolo and a high loss to follow-up rate in the hospital in Buhera. Among the patients who had been on ART for at least 12 months, the retention rates leveled out, with 97%, 95% and 94% in both Thyolo and Buhera, at 18, 24 and 30 months respectively. Loss to follow-up was identified as the main contributor to attrition after 12 months on treatment in both programmes.ConclusionsTo better understand the reasons of attrition and adapt the ART delivery care models accordingly, it is advisable to analyse short and long term retention separately, in order to adapt intervention strategies accordingly. During the initial months on ART more medical follow-up, especially for symptomatic patients, is required to reduce mortality. Once stable on ART, however, the ART care delivery should focus on regular drug refill and adherence support to reduce loss to follow up. Hence, innovative life-long retention strategies, including use of new communication technologies, community based interventions and drug refill outside the health facilities are required.

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“…These data suggest GUIs contribute a substantial proportion of new HIV infections in ART-naïve serodiscordant couples after CVCT. In Zambia, virological failure, transmitted resistance 21 , 67 , 68 and GUI-associated transmission of multiple HIV-variants 66 , 69 , 70 have been noted.…”

Section: Discussionmentioning

confidence: 99%

Risk of heterosexual HIV transmission attributable to sexually transmitted infections and non-specific genital inflammation in Zambian discordant couples, 1994–2012

Wall

Kilembe

Vwalika

et al. 2017

International Journal of Epidemiology

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BackgroundStudies have demonstrated the role of ulcerative and non-ulcerative sexually transmitted infections (STI) in HIV transmission/acquisition risk; less is understood about the role of non-specific inflammatory genital abnormalities.MethodsHIV-discordant heterosexual Zambian couples were enrolled into longitudinal follow-up (1994–2012). Multivariable models estimated the effect of genital ulcers and inflammation in both partners on time-to-HIV transmission within the couple. Population-attributable fractions (PAFs) were calculated.ResultsA total of 207 linked infections in women occurred over 2756 couple-years (7.5/100 CY) and 171 in men over 3216 CY (5.3/100 CY). Incident HIV among women was associated with a woman’s non-STI genital inflammation (adjusted hazard ratio (aHR) = 1.55; PAF = 8%), bilateral inguinal adenopathy (BIA; aHR = 2.33; PAF = 8%), genital ulceration (aHR = 2.08; PAF = 7%) and the man’s STI genital inflammation (aHR = 3.33; PAF = 5%), BIA (aHR = 3.35; PAF = 33%) and genital ulceration (aHR = 1.49; PAF = 9%). Infection among men was associated with a man’s BIA (aHR = 4.11; PAF = 22%) and genital ulceration (aHR = 3.44; PAF = 15%) as well as with the woman’s non-STI genital inflammation (aHR = 1.92; PAF = 13%) and BIA (aHR = 2.76; PAF = 14%). In HIV-M+F- couples, the man being uncircumcised. with foreskin smegma. was associated with the woman’s seroconversion (aHR = 3.16) relative to being circumcised. In F+M- couples, uncircumcised men with BIA had an increased hazard of seroconversion (aHR = 13.03 with smegma and 4.95 without) relative to being circumcised. Self-reporting of symptoms was low for ulcerative and non-ulcerative STIs.ConclusionsOur findings confirm the role of STIs and highlight the contribution of non-specific genital inflammation to both male-to-female and female-to-male HIV transmission/acquisition risk. Studies are needed to characterize pathogenesis of non-specific inflammation including inguinal adenopathy. A better understanding of genital practices could inform interventions.

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Outcomes of a Remote, Decentralized Health Center-Based HIV/AIDS Antiretroviral Program in Zambia, 2003 to 2007

Cited by 9 publications

References 13 publications

Favourable one-year ART outcomes in adult Malawians with hepatitis B and C co-infection

Favourable one-year ART outcomes in adult Malawians with hepatitis B and C co-infection

Short and long term retention in antiretroviral care in health facilities in rural Malawi and Zimbabwe

Risk of heterosexual HIV transmission attributable to sexually transmitted infections and non-specific genital inflammation in Zambian discordant couples, 1994–2012

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