Browsing by Author "Cesar, Carina"

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Global Trends in CD4 Count Measurement and Distribution at First Antiretroviral Treatment Initiation.
(2025-Jul-18) de Waal, Renee; Wools-Kaloustian, Kara; Brazier, Ellen; Althoff, Keri N.; Jaquet, Antoine; Duda, Stephany N.; Kumarasamy, Nagalingeswaran; Savory, Theodora; Byakwaga, Helen; Murenzi, Gad; Justice, Amy; Ekouevi, Didier K.; Cesar, Carina; Pasayan, Mark K. U.; Thawani, Agness; Kasozi, Charles; Babakazo, Pelagie; Karris, Maile; Messou, Eugene; Cortes, Claudia P.; Kunzekwenyika, Cordelia; Choi, Jun Y.; Owarwo, Noela C.; Niyongabo, Annabelle; Marconi, Vincent C.; Ezechi, Oliver; Castilho, Jessica L.; Petoumenos, Kathy; Johnson, Leigh F.; Ford, Nathan; Kassanjee, Reshma
BACKGROUND: While people with human immunodeficiency virus (PWH) start antiretroviral treatment (ART) regardless of CD4 count, CD4 measurement remains crucial for detecting advanced human immunodeficiency virus (HIV) disease and evaluating ART programs. We explored CD4 measurement (proportion of PWH with a CD4 result available) and prevalence of CD4 <200 cells/µL (hereafter "CD4 <200") at ART initiation within the International epidemiology Databases to Evaluate AIDS (IeDEA) global collaboration. METHODS: We included PWH at participating ART programs who first initiated ART at age 15-80 years during 2005-2019. We described proportions of PWH with a CD4 result (measured within 6 months before to 2 weeks after ART initiation) and, among those with a CD4 result, with CD4 <200, by year of ART initiation and region. RESULTS: We included 1 355 104 PWH from 42 countries in 7 regions; 63% were female. The median (interquartile range) age at ART initiation was 37 (3144) years in males and 32 (26-39) years in females. CD4 measurement initially increased, or remained stable over time until around 2013, but then declined to low levels in some regions (Southern Africa, except South Africa: from 54% to 13%; East Africa: 85% to 31%; Central Africa: 72% to 20%; West Africa: 91% to 53%; and Latin America: 87% to 56%). Prevalence of CD4 <200 declined over time in all regions, but plateaued after 2015 at ≥30%. CONCLUSIONS: CD4 measurement has declined sharply in recent years, especially in sub-Saharan Africa. Among those with a CD4 measurement, the prevalence of CD4 <200 remains concerningly high. Scaling up CD4 testing and securing adequate funding are urgent priorities.
Universal definition of loss to follow-up in HIV treatment programs: a statistical analysis of 111 facilities in Africa, Asia, and Latin America.
(2011-Oct) Chi, Benjamin H.; Yiannoutsos, Constantin T.; Westfall, Andrew O.; Newman, Jamie E.; Zhou, Jialun; Cesar, Carina; Brinkhof, Martin W.; Mwango, Albert; Balestre, Eric; Carriquiry, Gabriela; Sirisanthana, Thira; Mukumbi, Henri; Martin, Jeffrey N.; Grimsrud, Anna; Bacon, Melanie; Thiebaut, Rodolphe
BACKGROUND: Although patient attrition is recognized as a threat to the long-term success of antiretroviral therapy programs worldwide, there is no universal definition for classifying patients as lost to follow-up (LTFU). We analyzed data from health facilities across Africa, Asia, and Latin America to empirically determine a standard LTFU definition. METHODS AND FINDINGS: At a set "status classification" date, patients were categorized as either "active" or "LTFU" according to different intervals from time of last clinic encounter. For each threshold, we looked forward 365 d to assess the performance and accuracy of this initial classification. The best-performing definition for LTFU had the lowest proportion of patients misclassified as active or LTFU. Observational data from 111 health facilities-representing 180,718 patients from 19 countries-were included in this study. In the primary analysis, for which data from all facilities were pooled, an interval of 180 d (95% confidence interval [CI]: 173-181 d) since last patient encounter resulted in the fewest misclassifications (7.7%, 95% CI: 7.6%-7.8%). A secondary analysis that gave equal weight to cohorts and to regions generated a similar result (175 d); however, an alternate approach that used inverse weighting for cohorts based on variance and equal weighting for regions produced a slightly lower summary measure (150 d). When examined at the facility level, the best-performing definition varied from 58 to 383 d (mean=150 d), but when a standard definition of 180 d was applied to each facility, only slight increases in misclassification (mean=1.2%, 95% CI: 1.0%-1.5%) were observed. Using this definition, the proportion of patients classified as LTFU by facility ranged from 3.1% to 45.1% (mean=19.9%, 95% CI: 19.1%-21.7%). CONCLUSIONS: Based on this evaluation, we recommend the adoption of ≥180 d since the last clinic visit as a standard LTFU definition. Such standardization is an important step to understanding the reasons that underlie patient attrition and establishing more reliable and comparable program evaluation worldwide. Please see later in the article for the Editors' Summary.