Browsing by Author "Lelo P"

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Global Trends in CD4 Measurement and Immunosuppression at ART Initiation Among Children With HIV.
(2025-Apr-04) Patten G; Malateste K; Bolton Moore C; Sipambo N; Mokone L; Anderegg N; Wools-Kaloustian K; Michael D; Odhiambo F; Kasozi C; Desmonde S; Amorissani-Folquet M; Leroy V; Kumara Wati D; Nallusamy R; Kinikar A; Quy DT; Yotebieng M; Ebasone PV; Lelo P; Pinto J; Rouzier V; Machado DM; Haw NJ; Ford N; Department of Pediatrics, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Udayana University, Bali, Indonesia.; School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.; Pediatric Department, Cocody University Hospital, Abidjan, Cote d'Ivoire.; Department of Medicine, Indiana University School of Medicine; Indianapolis, Indiana.; Department of Pediatrics, BJ Government Medical College and Sassoon General Hospital, Pune, India.; Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia.; Kalembe Lembe Pediatric Hospital, Kinshasa, Democratic Republic of the Congo.; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.; Clinical Research Education, Networking and Consultancy (CRENC), Yaoundé, Cameroon.; Department of Pediatrics, Escola Paulista de Medicina, Federal University of Sao Paulo (UNIFESP), São Paulo, Brazil.; Centres GHESKIO, Port-au-Prince, Haiti.; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.; SolidarMed, Maseru, Lesotho.; World Health Organization, Geneva, Switzerland.; Children's Hospital 1, Ho Chi Minh City, Vietnam.; 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.; Department of Paediatrics and Child Health, Harriet Shezi Children's Clinic, Chris Hani Baragwanath Academic Hospital, University of Witwatersrand, Johannesburg, South Africa.; From the Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa.; Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya.; Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York.; Centre d'Epidémiologie et de Recherche en santé des POPulations (CERPOP), French National Institute for Health and Medical Research (Inserm), University of Toulouse 3, UMR 1295, Toulouse, France.; Department of Pediatrics, Penang Hospital, Penang, Malaysia.; Masaka Regional Referral Hospital, Masaka City, Uganda.; Tanzanian National Institute of Medical Research, Mwanza, Tanzania.
Eligibility for antiretroviral therapy is no longer based on immune criteria. In a global cohort of 97,453 children, between 2005 and 2021, we observed large declines in CD4 measurement, from 51% to 12% among <5 seconds, and from 74% to 20% among those 5-14 years of age. Lack of CD4 testing may negatively affect clinical care and surveillance of severe immune suppression.
Gone But Not Lost: Implications for Estimating HIV Care Outcomes When Loss to Clinic Is Not Loss to Care.
(2020-Jul) Edwards JK; Lesko CR; Herce ME; Murenzi G; Twizere C; Lelo P; Anastos K; Tymejczyk O; Yotebieng M; Nash D; Adedimeji A; Edmonds A; From the Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC.; Kalembelembe Pediatric Hospital, Kinshasa, Democratic Republic of the Congo.; Departments of Medicine and Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY.; Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC.; Rwanda Military Hospital, Kigali, Rwanda.; Centre Hospitalo, Universitaire de Kamenge, Bujumbura, Burundi.; Institute for Implementation Science in Population Health, City University of New York, New York, NY.; Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY.; Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia.; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
BACKGROUND: In some time-to-event analyses, it is unclear whether loss to follow up should be treated as a censoring event or competing event. Such ambiguity is particularly common in HIV research that uses routinely collected clinical data to report the timing of key milestones along the HIV care continuum. In this setting, loss to follow up may be viewed as a censoring event, under the assumption that patients who are "lost" from a study clinic immediately enroll in care elsewhere, or a competing event, under the assumption that people "lost" are out of care all together. METHODS: We illustrate an approach to address this ambiguity when estimating the 2-year risk of antiretroviral treatment initiation among 19,506 people living with HIV who enrolled in the IeDEA Central Africa cohort between 2006 and 2017, along with published estimates from tracing studies in Africa. We also assessed the finite sample properties of the proposed approach using simulation experiments. RESULTS: The estimated 2-year risk of treatment initiation was 69% if patients were censored at loss to follow up or 59% if losses to follow up were treated as competing events. Using the proposed approach, we estimated that the 2-year risk of antiretroviral therapy initiation was 62% (95% confidence interval: 61, 62). The proposed approach had little bias and appropriate confidence interval coverage under scenarios examined in the simulation experiments. CONCLUSIONS: The proposed approach relaxes the assumptions inherent in treating loss to follow up as a censoring or competing event in clinical HIV cohort studies.
Growth and CD4 patterns of adolescents living with perinatally acquired HIV worldwide, a CIPHER cohort collaboration analysis.
(2022-Mar) Jesson J; Crichton S; Quartagno M; Yotebieng M; Abrams EJ; Chokephaibulkit K; Le Coeur S; Aké-Assi MH; Patel K; Pinto J; Paul M; Vreeman R; Davies MA; Ben-Farhat J; Van Dyke R; Judd A; Mofenson L; Vicari M; Seage G; Bekker LG; Essajee S; Gibb D; Penazzato M; Collins IJ; Wools-Kaloustian K; Slogrove A; Powis K; Williams P; Matshaba M; Thahane L; Nyasulu P; Lukhele B; Mwita L; Kekitiinwa-Rukyalekere A; Wanless S; Goetghebuer T; Thorne C; Warszawski J; Galli L; van Rossum AMC; Giaquinto C; Marczynska M; Marques L; Prata F; Ene L; Okhonskaya L; Navarro M; Frick A; Naver L; Kahlert C; Volokha A; Chappell E; Pape JW; Rouzier V; Marcelin A; Succi R; Sohn AH; Kariminia A; Edmonds A; Lelo P; Lyamuya R; Ogalo EA; Odhiambo FA; Haas AD; Bolton C; Muhairwe J; Tweya H; Sylla M; D'Almeida M; Renner L; Abzug MJ; Oleske J; Purswani M; Teasdale C; Nuwagaba-Biribonwoha H; Goodall R; Leroy V; Baylor College of Medicine Children's Foundation, Mbabane, eSwatini.; University Hospital Yopougon, Abidjan, Côte d'Ivoire.; Siriraj Institute of Clinical Research, Faculty of Medicine Siriraj Hospital, Mahidol University, Salaya, Thailand.; Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden.; Pediatric Hospital Kalembe Lembe, Lingwala, Demogratic Republic of Congo.; Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA.; Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.; Department of Pediatrics, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.; CHU Gabriel Toure, Bamako, Mali.; Hospital de Santa Maria, Lisboa, Portugal.; Hospital Universitari Vall d' Hebron, Vall d' Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain.; Baylor College of Medicine Children's Foundation, Kampala, Uganda.; Baylor International Pediatric AIDS Initiative, Texas Children's Hospital-USA, Houston, Texas, USA.; Hospital St Pierre, Brussels, Belgium.; Centro Hospitalar do Porto, Porto, Portugal.; Baylor College of Medicine Children's Foundation, Lilongwe, Botswana.; Republican Hospital of Infectious Diseases, St Petersburg, Russian Federation.; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.; MRC Clinical Trials Unit, University College London, London, UK.; Moi Teaching and Referral Hospital, Eldoret, Kenya.; Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA.; Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, USA.; Medical University of Warsaw, Hospital of Infectious Diseases in Warsaw, Warsaw, Poland.; Korle Bu Teaching Hospital, Accra, Ghana.; Institut de Recherche pour le Developpement (IRD), UMI-174/PHPT, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand.; Epicentre, Médecins Sans Frontières, Paris, France.; Tulane University Health Sciences Center, New Orleans, Louisiana, USA.; Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya.; Institut National d'Etude Demographique (INED), Mortality, Health and Epidemiology Unit, Paris, France.; Department of Health Sciences, University of Florence, Florence, Italy.; CERPOP, Inserm, Université Paul Sabatier Toulouse 3, Toulouse, France.; Lighthouse Trust Clinic, Lilongwe, Malawi.; Padova University/PENTA Foundation, Padua, Italy.; University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado, USA.; Children's Hospital of Eastern Switzerland, Saint Gallen, Switzerland.; Shupyk National Medical Academy of Postgraduate Education, Kiev, Ukraine.; TREAT Asia/amfAR, Bangkok, Thailand.; Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.; Morogoro Regional Hospital, Morogoro, Tanzania.; SolidarMed, Lesotho, Zimbabwe.; Department of Global Health, Icahn School of Medicine at Mount Sinai, New York, USA.; Baylor College of Medicine Children's Foundation, Mwanza, Tanzania.; Victor Babes Hospital, Bucharest, Romania.; Bronx-Lebanon Hospital Center, Bronx, New York, USA.; UNICEF, New York, USA.; Department of Paediatrics & Child Health, Faculty of Medicine & Health Sciences, Stellenbosch University, Worcester, South Africa.; Centre National Hospitalier Universitaire Hubert K. Maga, Cotonou, Benin.; International AIDS Society, Geneva, Switzerland.; School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.; Rutgers - New Jersey Medical School, Newark, New Jersey, USA.; Infection Disease Unit, Meyer Children's University Hospital, Florence, Italy.; Inserm U1018, Centre de recherche en Epidémiologie et Santé des Populations, Paris, France.; Erasmus MC University Medical Center Rotterdam-Sophia Children's Hospital, Rotterdam, The Netherlands.; Universidade Federal de Sao Paulo, Sao Paulo, Brazil.; Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa.; HIV Department, World Health Organization, Geneva, Switzerland.; GHESKIO Center, Port-au-Prince, Haiti.; UCL Great Ormond Street Institute of Child Health, University College London, London, UK.; Baylor College of Medicine Children's Foundation, Maseru, Lesotho.; ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, USA.; Indiana University School of Medicine, Indianapolis, Indiana, USA.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; Hospital General Universitario "Gregorio Marañón", Madrid, Spain.; Baylor College of Medicine Children's Foundation, Lilongwe, Malawi.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
INTRODUCTION: Adolescents living with HIV are subject to multiple co-morbidities, including growth retardation and immunodeficiency. We describe growth and CD4 evolution during adolescence using data from the Collaborative Initiative for Paediatric HIV Education and Research (CIPHER) global project. METHODS: Data were collected between 1994 and 2015 from 11 CIPHER networks worldwide. Adolescents with perinatally acquired HIV infection (APH) who initiated antiretroviral therapy (ART) before age 10 years, with at least one height or CD4 count measurement while aged 10-17 years, were included. Growth was measured using height-for-age Z-scores (HAZ, stunting if <-2 SD, WHO growth charts). Linear mixed-effects models were used to study the evolution of each outcome between ages 10 and 17. For growth, sex-specific models with fractional polynomials were used to model non-linear relationships for age at ART initiation, HAZ at age 10 and time, defined as current age from 10 to 17 years of age. RESULTS: A total of 20,939 and 19,557 APH were included for the growth and CD4 analyses, respectively. Half were females, two-thirds lived in East and Southern Africa, and median age at ART initiation ranged from <3 years in North America and Europe to >7 years in sub-Saharan African regions. At age 10, stunting ranged from 6% in North America and Europe to 39% in the Asia-Pacific; 19% overall had CD4 counts <500 cells/mm CONCLUSIONS: Growth patterns during adolescence differed substantially by sex and region, while CD4 patterns were similar, with an observed CD4 decline that needs further investigation. Early diagnosis and timely initiation of treatment in early childhood to prevent growth retardation and immunodeficiency are critical to improving APH growth and CD4 outcomes by the time they reach adulthood.
Impact of Universal Antiretroviral Treatment Eligibility on Rapid Treatment Initiation Among Young Adolescents with Human Immunodeficiency Virus in Sub-Saharan Africa.
(2020-Aug-04) Tymejczyk O; Brazier E; Wools-Kaloustian K; Davies MA; Dilorenzo M; Edmonds A; Vreeman R; Bolton C; Twizere C; Okoko N; Phiri S; Nakigozi G; Lelo P; von Groote P; Sohn AH; Nash D; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.; Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA.; Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.; Kenya Medical Research Institute (KEMRI), Nairobi, Kenya.; Department of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.; Kalembelembe Pediatric Hospital, Kinshasa, Democratic Republic of the Congo.; TREAT Asia, amfAR-The Foundation for AIDS Research, Bangkok, Thailand.; Lighthouse Trust, Lilongwe, Malawi.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; Rakai Health Sciences Program, Kalisizo, Uganda.; Department of Epidemiology and Biostatistics, School of Public Health, City University of New York, New York, NY, USA.; Centre Hospitalo-Universitaire de Kamenge, Bujumbura, Burundi.; Indiana University School of Medicine, Indianapolis, Indiana, USA.; Boston Medical Center, Boston, Massachusetts, USA.; Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
BACKGROUND: Young adolescents with perinatally acquired human immunodeficiency virus (HIV) are at risk for poor care outcomes. We examined whether universal antiretroviral treatment (ART) eligibility policies (Treat All) improved rapid ART initiation after care enrollment among 10-14-year-olds in 7 sub-Saharan African countries. METHODS: Regression discontinuity analysis and data for 6912 patients aged 10-14-years were used to estimate changes in rapid ART initiation (within 30 days of care enrollment) after adoption of Treat All policies in 2 groups of countries: Uganda and Zambia (policy adopted in 2013) and Burundi, Democratic Republic of the Congo, Kenya, Malawi, and Rwanda (policy adopted in 2016). RESULTS: There were immediate increases in rapid ART initiation among young adolescents after national adoption of Treat All. Increases were greater in countries adopting the policy in 2016 than in those adopting it in 2013: 23.4 percentage points (pp) (95% confidence interval, 13.9-32.8) versus 11.2pp (2.5-19.9). However, the rate of increase in rapid ART initiation among 10-14-year-olds rose appreciably in countries with earlier treatment expansions, from 1.5pp per year before Treat All to 7.7pp per year afterward. CONCLUSIONS: Universal ART eligibility has increased rapid treatment initiation among young adolescents enrolling in HIV care. Further research should assess their retention in care and viral suppression under Treat All.
The epidemiology of adolescents living with perinatally acquired HIV: A cross-region global cohort analysis.
(2018-Mar) Slogrove AL; Schomaker M; Davies MA; Williams P; Balkan S; Ben-Farhat J; Calles N; Chokephaibulkit K; Duff C; Eboua TF; Kekitiinwa-Rukyalekere A; Maxwell N; Pinto J; Seage G; Teasdale CA; Wanless S; Warszawski J; Wools-Kaloustian K; Yotebieng M; Timmerman V; Collins IJ; Goodall R; Smith C; Patel K; Paul M; Gibb D; Vreeman R; Abrams EJ; Hazra R; Van Dyke R; Bekker LG; Mofenson L; Vicari M; Essajee S; Penazzato M; Anabwani G; Q Mohapi E; N Kazembe P; Hlatshwayo M; Lumumba M; Goetghebuer T; Thorne C; Galli L; van Rossum A; Giaquinto C; Marczynska M; Marques L; Prata F; Ene L; Okhonskaia L; Rojo P; Fortuny C; Naver L; Rudin C; Le Coeur S; Volokha A; Rouzier V; Succi R; Sohn A; Kariminia A; Edmonds A; Lelo P; Ayaya S; Ongwen P; Jefferys LF; Phiri S; Mubiana-Mbewe M; Sawry S; Renner L; Sylla M; Abzug MJ; Levin M; Oleske J; Chernoff M; Traite S; Purswani M; Chadwick EG; Judd A; Leroy V; Bronx-Lebanon Hospital Center (Icahn School of Medicine at Mount Sinai), Bronx, New York, United States of America.; National Institute of Child Health and Human Development (NICHD), US National Institutes of Health, Rockville, Maryland, United States of America.; Institute of Child Health, University College London, London, United Kingdom.; UNICEF, New York, New York, United States of America.; Inserm (French Institute of Health and Medical Research), CESP UMR Villejuif, France.; School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.; University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado, United States of America.; ICAP at Columbia University Mailman School of Public Health, New York, New York, United States of America.; Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America.; CHU Gabriel Touré, Bamako, Mali.; Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, United States of America.; Feinberg School of Medicine, Northwestern University, Evanston, Illinois, United States of America.; University Children's Hospital, Basel, Switzerland.; MRC Clinical Trials Unit at University College London, London, United Kingdom.; Centro Hospitalar do Porto, Porto, Portugal.; Republican Hospital of Infectious Diseases, St Petersburg, Russian Federation.; Rutgers New Jersey Medical School, Newark, New Jersey, United States of America.; Tulane University, New Orleans, Louisiana, United States of America.; Medical University of Warsaw, Hospital of Infectious Diseases in Warsaw, Warsaw, Poland.; Karolinska University Hospital, Stockholm, Sweden.; Yopougon University Hospital, University Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire.; Baylor International Pediatric AIDS Initiative, Kampala, Uganda.; Epicentre, Médecins Sans Frontières, Paris, France.; Indiana University School of Medicine, Indianapolis, Indiana, United States of America.; Center for Infectious Diseases Epidemiology and Research, University of Cape Town, Cape Town, South Africa.; College of Public Health, Ohio State University, Columbus, Ohio, United States of America.; Department of Health Sciences, University of Florence, Florence, Italy.; Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.; Lighthouse Trust Clinic, Lilongwe, Malawi.; World Health Organization, Geneva, Switzerland.; Inserm (French Institute of Health and Medical Research), UMR 1027 Université Toulouse 3, Toulouse, France.; Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.; Shupyk National Medical Academy of Postgraduate Education, Kiev, Ukraine.; TREAT Asia/amfAR, Bangkok, Thailand.; Baylor International Pediatric AIDS Initiative, Mbeya, Tanzania.; Hospital Doce de Octubre, Madrid, Spain.; Hospital de Santa Maria/CHLN, Lisbon, Portugal.; Baylor International Pediatric AIDS Initiative, Lilongwe, Malawi.; Baylor International Pediatric AIDS Initiative, Texas Children's Hospital-USA, Houston, Texas, United States of America.; Baylor International Pediatric AIDS Initiative, Mbabane, Swaziland.; Universidade Federal de São Paulo, São Paulo, Brazil.; Pediatric Hospital Kalembe Lembe, Lingwala, Kinshasa, Democratic Republic of Congo.; Family AIDS Care and Education Services, Kenya Medical Research Institute, Kisumu, Kenya.; Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.; International AIDS Society, Geneva, Switzerland.; Baylor International Pediatric AIDS Initiative, Maseru, Lesotho.; PENTA Foundation, Padova, Italy.; Center for Infectious Disease Research in Zambia, Lusaka, Zambia.; Hospital St Pierre Cohort, Bruxelles, Belgium.; Erasmus MC University Medical Center Rotterdam-Sophia Children's Hospital, Rotterdam, the Netherlands.; Institut National d'Etudes Démograhiques (Ined), F-75020 Paris, France.; Institut de Recherche pour le Développement (IRD) 174/PHPT, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand.; Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain.; SolidarMed Lesotho, Mozambique and Zimbabwe, Lucerne, Switzerland.; Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.; Harriet Shezi Children's Clinic, Chris Hani Baragwanath Hospital, Johannesburg, South Africa.; Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa.; GHESKIO Center, Port-au-Prince, Haiti.; Kirby Institute, UNSW, Sydney, Australia.; Victor Babes Hospital, Bucharest, Romania.; Baylor International Pediatric AIDS Initiative, Gaborone, Botswana.; University of Ghana School of Medicine and Dentistry, Accra, Ghana.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
BACKGROUND: Globally, the population of adolescents living with perinatally acquired HIV (APHs) continues to expand. In this study, we pooled data from observational pediatric HIV cohorts and cohort networks, allowing comparisons of adolescents with perinatally acquired HIV in "real-life" settings across multiple regions. We describe the geographic and temporal characteristics and mortality outcomes of APHs across multiple regions, including South America and the Caribbean, North America, Europe, sub-Saharan Africa, and South and Southeast Asia. METHODS AND FINDINGS: Through the Collaborative Initiative for Paediatric HIV Education and Research (CIPHER), individual retrospective longitudinal data from 12 cohort networks were pooled. All children infected with HIV who entered care before age 10 years, were not known to have horizontally acquired HIV, and were followed up beyond age 10 years were included in this analysis conducted from May 2016 to January 2017. Our primary analysis describes patient and treatment characteristics of APHs at key time points, including first HIV-associated clinic visit, antiretroviral therapy (ART) start, age 10 years, and last visit, and compares these characteristics by geographic region, country income group (CIG), and birth period. Our secondary analysis describes mortality, transfer out, and lost to follow-up (LTFU) as outcomes at age 15 years, using competing risk analysis. Among the 38,187 APHs included, 51% were female, 79% were from sub-Saharan Africa and 65% lived in low-income countries. APHs from 51 countries were included (Europe: 14 countries and 3,054 APHs; North America: 1 country and 1,032 APHs; South America and the Caribbean: 4 countries and 903 APHs; South and Southeast Asia: 7 countries and 2,902 APHs; sub-Saharan Africa, 25 countries and 30,296 APHs). Observation started as early as 1982 in Europe and 1996 in sub-Saharan Africa, and continued until at least 2014 in all regions. The median (interquartile range [IQR]) duration of adolescent follow-up was 3.1 (1.5-5.2) years for the total cohort and 6.4 (3.6-8.0) years in Europe, 3.7 (2.0-5.4) years in North America, 2.5 (1.2-4.4) years in South and Southeast Asia, 5.0 (2.7-7.5) years in South America and the Caribbean, and 2.1 (0.9-3.8) years in sub-Saharan Africa. Median (IQR) age at first visit differed substantially by region, ranging from 0.7 (0.3-2.1) years in North America to 7.1 (5.3-8.6) years in sub-Saharan Africa. The median age at ART start varied from 0.9 (0.4-2.6) years in North America to 7.9 (6.0-9.3) years in sub-Saharan Africa. The cumulative incidence estimates (95% confidence interval [CI]) at age 15 years for mortality, transfers out, and LTFU for all APHs were 2.6% (2.4%-2.8%), 15.6% (15.1%-16.0%), and 11.3% (10.9%-11.8%), respectively. Mortality was lowest in Europe (0.8% [0.5%-1.1%]) and highest in South America and the Caribbean (4.4% [3.1%-6.1%]). However, LTFU was lowest in South America and the Caribbean (4.8% [3.4%-6.7%]) and highest in sub-Saharan Africa (13.2% [12.6%-13.7%]). Study limitations include the high LTFU rate in sub-Saharan Africa, which could have affected the comparison of mortality across regions; inclusion of data only for APHs receiving ART from some countries; and unavailability of data from high-burden countries such as Nigeria. CONCLUSION: To our knowledge, our study represents the largest multiregional epidemiological analysis of APHs. Despite probable under-ascertained mortality, mortality in APHs remains substantially higher in sub-Saharan Africa, South and Southeast Asia, and South America and the Caribbean than in Europe. Collaborations such as CIPHER enable us to monitor current global temporal trends in outcomes over time to inform appropriate policy responses.
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; City University of New York, Institute for Implementation Science in Population Health, New York, NY, USA.; Pediatric Hospital of Kalembelembe, Kinshasa, Democratic Republic of the Congo.; Centre for Reproduction and Population Health Studies, Nigerian Institute of Medical Research, Lagos, Nigeria.; HIV-NAT / Thai Red Cross AIDS Research Centre and Center of Excellence in Tuberculosis, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.; Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda.; Centre for Microbiology and Research, Kenya Medical Research Institute, Kisumu, Kenya.; School of Public Health, University of Cape Town, Cape Town, South Africa.; Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA.; CHU Sourô Sanou, Bobo-Dioulasso, Burkina Faso.; PAC-CI program, Abidjan, Côte d'Ivoire.; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland lukas.fenner@unibe.ch.; Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland.; CART Clinical Research Site, Voluntary Health Services, Chennai, India.; SolidarMed, Chiure, Mozambique.; Lighthouse Trust, Lilongwe, Malawi.; Kisesa Observation Cohort study, National Institute for Medical Reseach, Mwanza, Tanzania.; Faculty of Medicine, Udayana University, Ngoerah Hospital, Bali, Indonesia.; Centre de Traitement Ambulatoire, Brazzaville, Republic of Congo.; Department of Medicine, Moi University, AMPATH Program / Moi Teaching and Referral Hospital, Eldoret, Kenya.; CePReF, Abidjan, Côte d'Ivoire.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan.; 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.