Browsing by Author "Michael D"

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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; Masaka Regional Referral Hospital, Masaka City, Uganda.; Pediatric Department, Cocody University Hospital, Abidjan, Cote d'Ivoire.; Children's Hospital 1, Ho Chi Minh City, Vietnam.; 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, BJ Government Medical College and Sassoon General Hospital, Pune, India.; Clinical Research Education, Networking and Consultancy (CRENC), Yaoundé, Cameroon.; SolidarMed, Maseru, Lesotho.; Department of Pediatrics, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Udayana University, Bali, Indonesia.; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.; Department of Paediatrics and Child Health, Harriet Shezi Children's Clinic, Chris Hani Baragwanath Academic Hospital, University of Witwatersrand, Johannesburg, South Africa.; Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York.; 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.; World Health Organization, Geneva, Switzerland.; Department of Pediatrics, Escola Paulista de Medicina, Federal University of Sao Paulo (UNIFESP), São Paulo, Brazil.; Tanzanian National Institute of Medical Research, Mwanza, Tanzania.; From the Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa.; Centres GHESKIO, Port-au-Prince, Haiti.; School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.; Kalembe Lembe Pediatric Hospital, Kinshasa, Democratic Republic of the Congo.; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.; Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya.; Department of Pediatrics, Penang Hospital, Penang, Malaysia.; Department of Medicine, Indiana University School of Medicine; Indianapolis, Indiana.
    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.
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    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.