Browsing by Author "Huwa J"

Now showing 1 - 4 of 4

Drug Resistance in People With Viremia on Dolutegravir-based Antiretroviral Therapy in Sub-Saharan Africa: The DTG RESIST Study.
(2025-May-20) Loosli T; Moore CB; Buzaalirwa L; Byakwaga H; Çelikağ İ; Chimbetete C; Ebasone PV; Giandhari J; Han N; Huwa J; Kasozi C; Mafoua A; Messou E; Minga A; Muula G; Muyindike W; Ndala ACM; Sauermann M; Semeere A; Singh L; Kouyos RD; Lessells R; Egger M; Center for AIDS Research, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.; Centre de Prise en Charge, de Recherche et de Formation, Abidjan, Côte d'Ivoire.; Centre de Traitement Ambulatoire, Brazzaville, Republic of the Congo.; Newlands Clinic, Harare, Zimbabwe.; Lighthouse Trust, Lilongwe, Malawi.; Infectious Diseases Institute, Makerere University, Kampala, Uganda.; Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.; Centre de Traitement Ambulatoire, Pointe Noire, Republic of the Congo.; KwaZulu-Natal Research Innovation and Sequencing Platform, University of KwaZulu-Natal, Durban, South Africa.; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.; Institute of Medical Virology, University of Zurich, Zurich, Switzerland.; AIDS Healthcare Foundation Uganda Cares, Masaka, Uganda.; Centre for Infectious Disease Epidemiology and Research, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom.; Public Health Department, Regional Referral Hospital, Masaka, Uganda.; Centre National de Transfusion Sanguine, Abidjan, Côte d'Ivoire.; Centre for the AIDS Programme of Research in South Africa, Durban, South Africa.; Hôpital Jamot, Yaoundé and Regional Hospital, Limbé, Cameroon.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
Dolutegravir resistance is an increasing concern. An analysis of the DTG RESIST study found that among 227 integrase sequences from 7 African countries (all non-B subtypes), 59 (26.0%) had at least 1 major drug resistance mutation (primarily G118R and E138A/K/T), with 49 (21.6%) predicted to have high-level resistance to dolutegravir.
Scale of differentiated service delivery implementation in HIV care facilities in low- and middle-income countries: a global facility survey.
(2025-Jul) Fernández Villalobos NV; Helfenstein F; Khol V; Twizere C; Secco M; Castelnuovo B; Huwa J; Tiendredbeogo T; Wester CW; Fong SM; Murenzi G; Caro-Vega Y; Lyamuya RE; Rafael I; Zannou DM; Petoumenos K; Nsonde DM; Pinto J; Wools-Kaloustian K; Moore CB; Takassi OE; Kiertiburanakul S; Awoh RA; Ali SM; Fatti G; Malateste K; Zaniewski E; Ballif M; Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.; National Center for HIV/AIDS, Dermatology & STDs, Phnom Penh, Cambodia.; Department of Clinical Research, University of Bern, Bern, Switzerland.; School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya.; Kheth'Impilo AIDS Free Living, Cape Town, South Africa.; Lighthouse Trust, Lilongwe, Malawi.; Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil.; University of Buea, Buea, Cameroon.; SolidarMed, Pemba, Mozambique.; Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda.; Department of Pediatrics, Hospital Likas, Kota Kinabalu, Malaysia.; Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center (VUMC), Nashville, Tennessee, USA.; Lome University, Lome, Togo.; Department of Infectious Diseases, Bern University Hospital and University of Bern, Bern, Switzerland.; Centre National de Référence en matière de VIH/SIDA (CNR), Bujumbura, Burundi.; Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.; Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia.; University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Research Centre, Bordeaux, France.; Einstein-Rwanda Research and Capacity Building Program, Research for Development and Rwanda Military Referral and Teaching Hospital, Kigali, Rwanda.; Morogoro Regional Hospital - CTC, Indiana University, Morogoro, Tanzania.; The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia.; Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México.; Centre national de référence pour la recherche et la prise en charge des PVVIH au Centre National Hospitalier Universitaire HK MAGA (CNHU-HKM), Cotonou, Bénin.; Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.; Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.; University of Alabama at Birmingham, Birmingham, Alabama, USA.; Centre de Traitement Ambulatoire of Brazzaville, Brazzaville, Congo.
INTRODUCTION: In 2016, the World Health Organization recommended differentiated service delivery (DSD) as a client-centred approach to simplify HIV care in frequency and intensity, thus reducing the clinic visit burden on individuals and HIV programmes. We describe the scale of DSD implementation among HIV facilities in low- and middle-income countries (LMICs) in Latin America, Africa and the Asia-Pacific before the COVID-19 pandemic. METHODS: We analysed facility-level survey data from HIV care facilities participating in the International epidemiology Databases to Evaluate AIDS consortium in 2019. We used descriptive statistics to summarise the availability of DSD, multi-month dispensing (MMD) and DSD for HIV treatment models. We explored factors associated with DSD implementation using multivariable models. RESULTS: We included 175 facilities in the Asia-Pacific (n = 30), Latin America (n = 8), Central Africa (n = 21), East Africa (n = 74), Southern Africa (n = 28) and West Africa (n = 14). Overall, 133 facilities (76%) reported implementing DSD. Of these, 91% offered DSD for HIV treatment, 61% for HIV testing and 59% for antiretroviral therapy (ART) initiation. The most common duration of ART refills for clinically stable clients was 3MMD, (70%), followed by monthly (14%) and 6MMD (10%). Facility-based individual models were the most frequently available DSD for the HIV treatment model (82%), followed by client-managed group models (60%). Out-of-facility individual models were available at 48% of facilities. Facility-based individual models were particularly common among facilities in East (92%) and Southern Africa (96%). Facilities in medium and high HIV prevalence countries, and those with 3MMD, were more likely to implement DSD. CONCLUSIONS: In 2019, DSD was available in most HIV care facilities globally but was not evenly implemented across regions and HIV services. Most offered facility-based DSD for HIV treatment models and 3MMD for clinically stable clients. Efforts to expand DSD for HIV testing and ART initiation and to offer longer MMD can improve long-term retention in care of people living with HIV in LMICs, while further alleviating the operational burden on healthcare services. These findings from the pre-COVID-19 era underline the need for strengthening DSD in HIV care, which remains at the centre of current efforts towards client-centred care.
The long-term impact of the COVID-19 pandemic on tuberculosis care and infection control measures in anti-retroviral therapy (ART) clinics in low- and middle-income countries: a multiregional site survey in Asia and Africa.
(2025-Mar-24) Ballif M; Banholzer N; Perrig L; Avihingsanon A; Nsonde DM; Obatsa S; Muula G; Komena E; Uemura H; Lelo P; Otaalo B; Huwa J; Gouéssé P; Kumarasamy N; Brazier E; Michael D; Rafael I; Ramdé R; Somia IKA; Yotebieng M; Diero L; Euvrard J; Ezechi O; Fenner L; Centre de Traitement Ambulatoire, Brazzaville, Republic of Congo.; Centre for Reproduction and Population Health Studies, Nigerian Institute of Medical Research, Lagos, Nigeria.; City University of New York, Institute for Implementation Science in Population Health, New York, NY, USA.; Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA.; CePReF, Abidjan, Côte d'Ivoire.; Lighthouse Trust, Lilongwe, Malawi.; Centre for Microbiology and Research, Kenya Medical Research Institute, Kisumu, Kenya.; AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan.; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland lukas.fenner@unibe.ch.; Faculty of Medicine, Udayana University, Ngoerah Hospital, Bali, Indonesia.; School of Public Health, University of Cape Town, Cape Town, South Africa.; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.; Pediatric Hospital of Kalembelembe, Kinshasa, Democratic Republic of the Congo.; CART Clinical Research Site, Voluntary Health Services, Chennai, India.; Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland.; Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda.; HIV-NAT / Thai Red Cross AIDS Research Centre and Center of Excellence in Tuberculosis, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.; SolidarMed, Chiure, Mozambique.; PAC-CI program, Abidjan, Côte d'Ivoire.; CHU Sourô Sanou, Bobo-Dioulasso, Burkina Faso.; Department of Medicine, Moi University, AMPATH Program / Moi Teaching and Referral Hospital, Eldoret, Kenya.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; Kisesa Observation Cohort study, National Institute for Medical Reseach, Mwanza, Tanzania.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
BACKGROUND: The COVID-19 pandemic challenged healthcare systems, particularly in settings with high infectious disease burden. We examined the postpandemic long-term impacts of COVID-19 on tuberculosis (TB) services at anti-retroviral therapy (ART) clinics in lower-income countries. METHODS: Using standardised online questionnaires, we conducted a cross-sectional site survey among ART clinics providing TB services in Africa and Asia from July to September 2023 (site-level information and number of TB diagnoses and tests). RESULTS: Of 45 participating ART clinics, 32 (71%) were in Africa and 13 (29%) in Asia. During the COVID-19 pandemic (2020-2022), 43 (96%) clinics reported implementing social distancing or separation measures, 39 (87%) personal protections for staff members and 32 (71%) protections for patients. Infection control measures were in place in 45% of the clinics before the pandemic (until 2019), 23% introduced measures during the pandemic and 15% maintained them after the pandemic (after 2022). Service provision was affected during the pandemic in 33 (73%) clinics, including TB services in 22 (49%) clinics. TB service restrictions were addressed by introducing changes in directly observed therapy provision in 8 (18%) clinics, multimonth TB drug dispensing in 23 (51%), telehealth services in 25 (56%) and differentiated service delivery in 19 (42%). These changes were sustained after the pandemic at 4 (9%), 11 (24%), 17 (38%) and 12 (27%) clinics, respectively. Compared with 2018-2019, the number of TB diagnoses decreased sharply in 2020-2021 and improved after the pandemic. CONCLUSIONS: COVID-19 affected TB care services in ART clinics in Africa and Asia. This was paralleled by a reduction in TB diagnoses, which partly resumed after the pandemic. Infection control measures and alternative modes of service delivery were adopted during the pandemic and only partially maintained. Efforts should be made to sustain the lessons learnt during the COVID-19 pandemic, particularly approaches that reduce the risk of transmission of infectious diseases, including TB, in ART clinics.
Virologic Failure and Drug Resistance After Programmatic Switching to Dolutegravir-based First-line Antiretroviral Therapy in Malawi and Zambia.
(2025-Feb-05) Skrivankova VW; Huwa J; Muula G; Chiwaya GD; Banda E; Buleya S; Chihota B; Chintedza J; Bolton C; Tweya H; Kalua T; Hossmann S; Kouyos R; Wandeler G; Egger M; Lessells RJ; Lighthouse Trust, Lilongwe, Malawi.; Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland.; Center for International Health, Education, and Biosecurity (Ciheb) at University of Maryland, Baltimore School of Medicine (UMB), Lilongwe, Malawi.; Diabetes Center Berne, Bern, Switzerland.; Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.; Centre for Infectious Disease Epidemiology and Research, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.; Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa.; KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), School of Laboratory Medicine & Medical Sciences, University of KwaZulu-Natal, Durban, South Africa.; International Training and Education Center for Health (I-TECH), Lilongwe, Malawi.; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.; Institute of Medical Virology, University of Zurich, Zurich, Switzerland.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
BACKGROUND: People with human immunodeficiency virus (PWH) on first-line, nonnucleoside reverse-transcriptase inhibitor-based antiretroviral therapy (ART) were routinely switched to tenofovir-lamivudine-dolutegravir. We examined virologic outcomes and drug resistance in ART programs in Malawi, where switching was irrespective of viral load, and Zambia, where switching depended on a viral load <1000 copies/mL in the past year. METHODS: We compared the risk of viremia (≥400 copies/mL) at 1 and 2 years by viral load at switch and between countries using exact methods and logistic regression adjusted for age and sex. We performed HIV-1 pol Sanger sequencing on plasma samples with viral load ≥1000 copies/mL. RESULTS: A total of 2832 PWH were eligible (Malawi 1422, Zambia 1410); the median age was 37 years, and 2578 (91.0%) were women. At switch, 77 (5.4%) were viremic in Malawi and 42 (3.0%) in Zambia (P = .001). Viremia at switch was associated with viremia at 1 year (adjusted odds ratio (OR), 6.15; 95% confidence interval [CI], 3.13-11.4) and 2 years (7.0; 95% CI, 3.73-12.6). Viremia was less likely in Zambia than in Malawi at 1 year (OR, 0.55; 0.32-0.94) and 2 years (OR, 0.33; 0.18-0.57). Integrase sequencing was successful for 79 of 113 eligible samples. Drug resistance mutations were found in 5 PWH (Malawi 4, Zambia 1); 2 had major mutations (G118R, E138K, T66A and G118R, E138K) leading to high-level dolutegravir resistance. CONCLUSIONS: Restricting switching to dolutegravir-based ART to PWH with a viral load <1000 copies/mL may reduce subsequent viremia and, consequently, the emergence of dolutegravir drug resistance mutations. CLINICAL TRIALS REGISTRATION: Clinicaltrials.gov (NCT04612452).