Browsing by Author "Hardy Y"

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    Standard of care in advanced HIV disease: review of HIV treatment guidelines in sub-Saharan African countries-an extension study of eight countries.
    (2025-Mar-29) Scheier TC; Tufa TB; Feldt T; Hardy Y; Minga A; Moh R; Damasceno A; Chambal L; Ntoumi F; Kades C; Bitunguhari L; Sebatunzi OR; Missanga M; Njekwa K; Muyoyeta M; Rangarajan S; Meintjes G; Mertz D; Eikelboom JW; Wasserman S; Wellcome Discovery Research Platforms in Infection, Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory, Cape Town, Republic of South Africa.; Hirsch Institute of Tropical Medicine (HITM), Heinrich-Heine University, P.O. Box 04, Asella, Ethiopia.; Department of Medicine, University of Cape Town, Cape Town, South Africa.; Maputo Central Hospital, Maputo, Mozambique.; Wellcome Discovery Research Platforms in Infection, Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory, Cape Town, Republic of South Africa. swasserm@sgul.ac.uk.; Directorate of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana.; Department of Health Research Methodology, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.; Institute for Tropical Medicine, University of Tübingen, Tübingen, Germany.; Institute for Infection and Immunity, City St George's, University of London, London, UK. swasserm@sgul.ac.uk.; Fondation Congolaise pour la Recherche Médicale, Brazzaville, Republic of the Congo.; NIMR-Mbeya Medical Research Center, Mbeya, Tanzania.; Programme PAC-CI, Site ANRS de Côte d'Ivoire, Abidjan, Côte d'Ivoire.; Unité Pédagogique de Dermatologie et Infectiologie, Université Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire.; Division of Infectious Diseases, Department of Medicine, McMaster University, Hamilton, ON, Canada.; Blizard Institute, Queen Mary University of London, London, UK.; Asella Referral and Teaching Hospital, College of Health Sciences, Arsi University, P.O. Box 04, Asella, Ethiopia.; Department of Internal Medicine, University Teaching Hospital of Kigali, Kigali, Rwanda.; Department of Internal Medicine, School of Medicine and Pharmacy, University of Rwanda, Kigali, Rwanda.; Tuberculosis Programs-Director, Centre for Infectious Disease Research, P.O. Box 34681, 10101, Lusaka, Zambia.; Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital of Düsseldorf (UKD), 40225, Düsseldorf, Germany.; Center for Infectious Disease Research in Zambia (CIDRZ), P.O. Box 34681, 10101, Lusaka, Zambia.; Centre Médical de Suivi des Donneurs de Sang (CMSDS-CNTSCI), Abidjan, Côte d'Ivoire.; Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique.; Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada.
    INTRODUCTION: The World Health Organization (WHO) has published guidelines for the management of patients with advanced HIV disease (AHD) but mortality remains high. Adoption of WHO recommendations by national guidelines is poorly documented. We aimed to extend our prior review of six national management guidelines by including additional countries from sub-Saharan Africa. METHODS: We identified guidelines of eight additional countries participating in a multicountry trial of azithromycin prophylaxis for AHD. Data was extracted in five domains including definition of AHD (1 item), screening (6 items), prophylaxis (6 items), supportive care (1 items), and HIV treatment (4 items) and scored agreement of each national guideline with the WHO guidelines. RESULTS: Six of the eight national guidelines had a designated section for AHD. Compared with the WHO guideline, the agreement score for national guidelines was between 7 and 17 out of 18, whereby disagreement is mainly driven by missing information. None of the national guidelines had more than three items not in agreement with the WHO guidelines, and the maximum number of items not addressed by any one guideline was eight. Main areas of disagreement were the targeted population for start of ART in presence of tuberculosis meningitis (1/8 in agreement) and urine lipoarabinomannan screening (2/8 in agreement). The targeted population group for cotrimoxazole prophylaxis and its discontinuation was in line with the WHO recommendations in 3/8 national guidelines. Except one guideline, all documents showed similar overall agreement, irrespectively of publication date. CONCLUSION: National guidelines for the management of people with AHD are broadly in agreement with WHO guidelines. Main areas of disagreement are recommendations regarding urine lipoarabinomannan screening, cotrimoxazole prophylaxis and start of antiretroviral therapy in presence of tuberculosis.