36 research outputs found
J Acquir Immune Defic Syndr
Get PDFObjectiveTo identify risk factors for loss to follow up (LTFU) in an HIV-infected pediatric population in Dar es Salaam, Tanzania between 2004 and 2011.DesignLongitudinal analysis of 6236 HIV-infected children.MethodsWe conducted a prospective cohort study of 6236 pediatric patients enrolled in care and treatment in Dar es Salaam from October 2004 to September 2011. LTFU was defined as missing a clinic visit for >90 days for patients on ART and for >180 days for patients in care and monitoring. The relationship of baseline and time-varying characteristics to risk of LTFU was examined using a Cox proportional hazards model.Results2130 children (34%) were LTFU over a median follow up of 16.7 months (IQR, 3.4\u201336.9). Factors independently associated with a higher risk of LTFU were age 2 years (RR=1.59, 95% CI 1.40\u20131.80), diarrhea at enrollment (RR=1.20, 95% CI 1.03\u20131.41), a low mid-upper arm circumference for age (RR=1.20, CI 1.05\u20131.37), eating protein 3 times a week (RR=1.39, 95% CI 1.05\u20131.90), taking cotrimoxazole (RR=1.39, 95% CI 1.06\u20131.81), initiating onto antiretrovirals (RR=1.37, 95% CI 1.17\u20131.61), receiving treatment at a hospital instead of a local facility (RR=1.39, 95% CI 1.06\u20131.41), and starting treatment in 2006 or later (RR=1.10, 95% CI 1.04\u20131.16).ConclusionsHealth workers should be aware of pediatric patients who are at greatest risk of LTFU, such as younger and undernourished patients, so that they can proactively counsel families about the importance of visit adherence. Findings support decentralization of HIV care to local facilities as opposed to hospitals.K24 HD058795/HD/NICHD NIH HHSUnited States/K24 DK104676/DK/NIDDK NIH HHSUnited States/R01 HD043688-01/HD/NICHD NIH HHSUnited States/U2G PS001966/PS/NCHHSTP CDC HHSUnited States/R01 HD043688/HD/NICHD NIH HHSUnited States/K24HD058795/HD/NICHD NIH HHSUnited States/5U2GPS001966-04/PHS HHSUnited States
Contemp Clin Trials Commun
Get PDFIntroductionResearchers planning cluster-randomized controlled trials (cRCTs) require estimates of the intra-cluster correlation coefficient (ICC) from previous studies for sample size calculations. This paper fills a persistent gap in the literature by providing estimates of ICCs for many key HIV-related clinical outcomes.MethodsData from HIV-positive patients from 47 HIV care and treatment clinics in Dar es Salaam, Tanzania were used to calculate ICCs by site of enrollment or site of ART initiation for various clinical outcomes using cross-sectional and longitudinal data. ICCs were estimated using linear mixed models where either clinic of enrollment or clinic of ART initiation served as the random effect.ResultsICCs ranged from 0 to 0.0706 (95% CI: 0.0447, 0.1098). For most outcomes, the ICCs were large enough to meaningfully affect sample size calculations. For binary outcomes, the ICCs for event prevalence at baseline tended to be larger than the ICCs for later cumulative incidences. For continuous outcomes, the ICCs for baseline values tended to be larger than the ICCs for the change in values from baseline.ConclusionThe ICCs for HIV-related outcomes cannot be ignored when calculating sample sizes for future cluster-randomized trials. The differences between ICCs calculated from baseline data alone and ICCs calculated using longitudinal data demonstrate the importance of selecting an ICC that reflects a study\u2019s intended design and duration for sample size calculations. While not generalizable to all contexts, these estimates provide guidance for future researchers seeking to design adequately powered cRCTs in Sub-Saharan African HIV treatment and care clinics.DP1 ES025459/ES/NIEHS NIH HHSUnited States/R01 AI112339/AI/NIAID NIH HHSUnited States/U2G PS001966/PS/NCHHSTP CDC HHSUnited States
AIDS
Get PDFObjective:The objective of this study was to assess the effectiveness of a routine multivitamin supplementation program for adults living with HIV in Tanzania.Design:We conducted a retrospective cohort study of 67,707 adults enrolled in the Dar es Salaam HIV care and treatment program during 2004\u20132012.Methods:The Dar es Salaam HIV care and treatment program intended to provide all adult patients with multivitamin supplements (vitamins B-complex, C, and E) free of charge; however, intermittent stockouts and other implementation issues did not afford universal coverage. We use Cox proportional hazard models to assess the time-varying association of multivitamin supplementation with mortality and clinical outcomes.Results:The study cohort contributed 41,540 and 129,315 person-years of follow-up time to the ART-na\uefve and ART-experienced analyses, respectively. Among 48,207 ART-na\uefve adults, provision of multivitamins reduced the risk of mortality (adjusted hazard ratio (aHR): 0.69; 95% CI: 0.59\u20130.81), incident tuberculosis (TB) (aHR: 0.83; 0.76\u20130.91), and meeting ART eligibility criteria (aHR: 0.78; 95% CI: 0.73\u20130.83) after adjustment for time-varying confounding. Among 46,977 ART-experienced patients, multivitamins reduced mortality (HR: 0.86; 95% CI: 0.80\u20130.92), incident TB (aHR: 0.78; 95% CI: 0.73\u20130.84), and immunologic failure (aHR: 0.70; 95% CI: 0.67\u20130.73). The survival benefits associated with provision multivitamins appeared to be greatest during the first year of ART and declined over time (p-value <0.001).Conclusion:Multivitamin supplementation appears to be a simple, effective, safe, and scalable program to improve survival, reduce incidence of TB, and improve treatment outcomes for adult HIV patients in Tanzania.20192020-01-27T00:00:00ZD43 TW009775/TW/FIC NIH HHS/United StatesU2G PS001966/PS/NCHHSTP CDC HHS/United StatesPEPFAR/PEPFAR/United States30289815PMC6599688712
Impact of Dual Gauge Railway Tracks on Traffic Load Induced Permanent Deformation of Low Embankments
No full textAbstractThere is a growing interest in recent years of many African countries to revamp their neglected railways in order to promote regional trade and transportation integration. Investors are faced with problems of railway track gauge conversions to promote railway inter operability. The objective of the work documented here was to numerically evaluate the impact of track gauge conversions on traffic load induced permanent deformation (PD) of low embankment on soft sub-grade. A method to predict the traffic load induced settlement of low embankment on soft sub-grade is proposed. Using the user-defined material subroutines (UMAT) in ABAQUS, a 2-D finite element (FE) model was formulated. These models are converted into a numerical formulation for implementation in FE analysis and the traffic load induced dynamic stress in the sub grade are calculated by using the multi-layer elastic theory. Then the plastic vertical strain in the sub-grade is calculated by an empirical equation, whose constants are related to the physical and mechanical properties of the sub-grade soil. The method was applied to analyze a 700m long section of a low embankment on the soft black cotton soil of Nakuru plains in Kenya. Corresponding results showed that the application of traffic loads on alternate rail tracks due to gauge conversions have a significant effect on the permanent deformation of the sub grade soil. The depth significantly influenced by traffic loading was found to be close to 6 m below the base of the embankment. The analysis also shows that increasing the thickness and stiffness of the sub grade is a very effective way of reducing the traffic load induced permanent deformation of soft sub grade soil. The proposed method can be used for settlement analysis on low embankments as well as a useful tool for making decisions on railway track gauge conversions
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Equity of child and adolescent treatment, continuity of care and mortality, according to age and gender among enrollees in a large HIV programme in Tanzania
Get PDFAbstract Introduction: Global scale up of anti‐retroviral therapy (ART) has led to expansion of HIV treatment and prevention across sub‐Saharan Africa. However, age and gender‐specific disparities persist leading to failures in fulfillment of Sustainability Development Goals, including SDG3 (achieving healthy lives and wellbeing for all, at all ages) and SDG5 (gender equality). We assessed ART initiation and adherence, loss to follow‐up, all‐cause death and early death, according to SDG3 and SDG5 indicators among a cohort of HIV‐infected children and adolescents enrolled in care in Dar‐es‐Salaam, Tanzania Methods: SDG3 indicators included young (<5 years) and older paediatric children (5 to <10 years), early adolescent (10 to <15 years) and late adolescent (15 to <20 years) age group divisions and the SDG5 indicator was gender. Associations of age group and gender with ART initiation, loss to follow‐up and all‐cause death, were analysed using Cox proportional hazards regression and with adherence, using generalized estimating equations (GEE) with the Poisson distribution. Associations of age group and gender with early death were analysed, using log‐Poisson regression with empirical variance. Results: A total of 18,315 enrollees with at least one clinic visit were included in this cohort study. Of these 7238 (40%) were young paediatric , 4169 (23%) older paediatric, 2922 (16%) early adolescent and 3986 (22%) late adolescent patients at enrolment. Just over half of paediatric and early adolescents and around four fifths of the late adolescents were female. Young paediatric patients were at greater risk of early death, being almost twice as likely to die within 90 days. Males were at greater risk of early death once initiated on ART (HR 1.35, 95% CI 1.09, 1.66)), while females in late adolescence were at greatest risk of late death (HR 2.44 [1.60, 3.74] <0.01). Late adolescents demonstrated greater non‐engagement in care (RR 1.21 (95% CI 1.16, 1.26)). Among both males and females, early paediatric and late adolescent groups experienced significantly greater loss to follow‐up. Conclusion: These findings highlight equity concerns critical to the fulfillment of SDG3 and SDG5 within services for children and adolescents living with HIV in sub‐Saharan Africa. Young paediatric and late adolescent age groups were at increased risk of late diagnosis, early death, delayed treatment initiation and loss of continuity of care. Males were more likely to die earlier. Special attention to SDG3 and SDG5 disparities for children and adolescents living with HIV will be critical for fulfillment of the 2030 SDG agenda.Version of Recor
RETRACTED ARTICLE: Determinants of viral load suppression failure among HIV adults on ARV attending health care facilities: a retrospective study in Tanga region, Tanzania
No full textAbstract Background Availability and accessibility of Antiretroviral drugs (ARV’s) improve the lives of People living with HIV (PLHIV) by improving client’s immune system to overcome infections and prevent the development of AIDS and other HIV complications. Combination therapy, early initiation of ART, newer ART drugs, single dosage and drug affordability significantly contribute in the reduction of viral multiplication and suppression of HIV to undetectable plasma levels. Methods A retrospective longitudinal study design study was conducted from 1st October, 2018 to 30th June 2022 in all supported HIV care and treatment health facilities in Tanga region which were supported by Amref Health Africa, Tanzania. The participants were HIV adult patients aged 15 years and above on ART and attended the clinic at least once after ART initiation. Viral load suppression levels are defined with viral load 15 years whom were on ART were included in the analysis to determine the level of plasma Viral Load suppression after being on ART. Female 41,304 (69.4%) and male 18,199 (30.6%). Only four percent (2,290) were found to be unsuppressed i.e having plasma Viral Load >1,000cp/ml while 96% (57,213) were virally suppressed. Several factors were independently associated with virologic failure that included; age between 15 - <25 years (HR: 2.82, 95% CI 1.96 – 4.04), BMI <18.5 (HR: 1.69, 95% CI 1.23 – 2.30), advanced WHO stage IV (HR: 1.60, 95% CI 1.12 – 2.24), CD4 cell count <350 (HR: 2.61, 95% CI 2.12 – 3.23), poor adherence (HR: 1.98, 95% CI 1.80 – 2.18) and not using DTG based drug (HR: 11.8, 95% CI 9.74 – 14.3). Conclusion Virologic failure was observed in this study among clients with young age, advanced WHO stage IV, not using DTG based regimen, poor drug adherence and second line regime. To improve Viral Load Suppression among these clients; the existing HIV intervention strategies should be taken care by targeting the identified risk factors
Equity of child and adolescent treatment, continuity of care and mortality, according to age and gender among enrollees in a large HIV programme in Tanzania
Get PDFIncidence and Risk Factors for Overweight and Obesity after Initiation of Antiretroviral Therapy in Dar es Salaam, Tanzania
No full textObjective:To describe the incidence of and risk factors for overweight and obesity following antiretroviral therapy (ART) initiation.Methods:We used Cox proportional hazards models to investigate risk factors for incident overweight and obesity in 79 074 individuals aged 15 years or older who initiated ART in Dar es Salaam, Tanzania.Results:Twenty-five percent of the patients became overweight and 10% became obese. The incidence rate of obesity was 3.2 per 100 person-years (95% confidence interval [CI]: 3.1-3.3) in patients who were of normal weight before starting ART and 22.6 per 100 person-years (95% CI: 21.9-23.3) in those who were overweight. Lower CD4 count was associated with a higher risk of overweight and obesity ( P value for trend < .0001).Conclusion:There is a high burden of overweight and obesity after starting ART, leading to proportions of these 2 conditions that are similar to those in the general population.</jats:sec
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Risk Factors of Loss to Follow up Among HIV Positive Pediatric Patients in Dar es Salaam, Tanzania
No full textObjective: o identify risk factors for loss to follow-up (LTFU) in an HIV-infected pediatric population in Dar es Salaam, Tanzania, between 2004 and 2011. Design:Longitudinal analysis of 6236 HIV-infected children. Methods:We conducted a prospective cohort study of 6236 pediatric patients enrolled in care and treatment in Dar es Salaam from October 2004 to September 2011. LTFU was defined as missing a clinic visit for >90 days for patients on ART and for >180 days for patients in care and monitoring. The relationship of baseline and time-varying characteristics to the risk of LTFU was examined using a Cox proportional hazards model. Results: total of 2130 children (34%) were LTFU over a median follow-up of 16.7 months (interquartile range, 3.4-36.9). Factors independently associated with a higher risk of LTFU were age 2 years (relative risk [RR] = 1.59, 95% CI: 1.40 to 1.80), diarrhea at enrollment (RR = 1.20, 95% CI: 1.03 to 1.41), a low mid-upper arm circumference for age (RR = 1.20, CI: 1.05 to 1.37), eating protein-rich foods 3 times a week (RR = 1.39, 95% CI: 1.05 to 1.90), taking cotrimoxazole (RR = 1.39, 95% CI: 1.06 to 1.81), initiating onto antiretrovirals (RR = 1.37, 95% CI: 1.17 to 1.61), receiving treatment at a hospital instead of a local facility (RR = 1.39, 95% CI: 1.06 to 1.41), and starting treatment in 2006 or later (RR = 1.10, 95% CI: 1.04 to 1.16). Conclusions:Health workers should be aware of pediatric patients who are at a greatest risk of LTFU, such as younger and undernourished patients, so that they can proactively counsel families about the importance of visit adherence. Findings support decentralization of HIV care to local facilities as opposed to hospitals.Accepted Manuscrip
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Incident tuberculosis and risk factors among HIV-infected children in Tanzania
No full textObjective
To describe the burden of pediatric tuberculosis (TB) in a human immunodeficiency virus (HIV)-infected population and explore the demographic and clinical factors associated with the occurrence of pediatric TB.
Design
Longitudinal analysis of a cohort of HIV-infected children.
Methods
The endpoint of the study was clinically diagnosed TB. Cox proportional hazard regression was used to explore the predictors of incident TB among HIV-infected children under age 15 years after enrollment into the HIV program.
Results
The cohort comprised of 5040 children [median age: 5 years, interquartile range (IQR): 1–9 years]. During a median follow-up of 0.8 (IQR: 0.1–2.5) years, 376 out of 5040 children met the case definition for TB. The overall incidence of TB was 5.2/100 person-years. In multivariate analyses, older age at enrollment [relative risk (RR): 1.7, 95%, confidence interval (CI): 1.5–1.8], severe wasting (RR: 1.8, 95% CI: 1.3 –2.5), severe immune-suppression (RR: 2.6, 95% CI: 1.8–3.8), anemia (RR: 1.4, 95% CI: 1.0–1.9) and World Health Organization (WHO) stage IV (RR: 4.5, 95% CI: 2.4–8.5) were all independently associated with a higher risk of TB. In addition, the use of antiretroviral drugs for more than 180 days reduced the risk of TB by 70% (RR: 0.3, 95% CI: 0.2–0.4).
Conclusions
ART use is strongly associated with a reduced risk of tuberculosis among HIV-infected children, and should therefore be included in HIV care and treatment programs. Trials of interventions designed to improve the nutritional and hematologic status of these children should also be performed.Accepted Manuscrip
