101 research outputs found
Service delivery challenges in HIV care during the first year of the COVID-19 pandemic: results from a site assessment survey across the global IeDEA consortium
No full textOnly Vanderbilt University affiliated authors are listed on VUIR. For a full list of authors, access the version of record at https://onlinelibrary.wiley.com/doi/10.1002/jia2.26036IntroductionInterruptions in treatment pose risks for people with HIV (PWH) and threaten progress in ending the HIV epidemic; however, the COVID-19 pandemic's impact on HIV service delivery across diverse settings is not broadly documented. MethodsFrom September 2020 to March 2021, the International epidemiology Databases to Evaluate AIDS (IeDEA) research consortium surveyed 238 HIV care sites across seven geographic regions to document constraints in HIV service delivery during the first year of the pandemic and strategies for ensuring care continuity for PWH. Descriptive statistics were stratified by national HIV prevalence (= 5%) and country income levels. ResultsQuestions about pandemic-related consequences for HIV care were completed by 225 (95%) sites in 42 countries with low (n = 82), medium (n = 86) and high (n = 57) HIV prevalence, including low- (n = 57), lower-middle (n = 79), upper-middle (n = 39) and high- (n = 50) income countries. Most sites reported being subject to pandemic-related restrictions on travel, service provision or other operations (75%), and experiencing negative impacts (76%) on clinic operations, including decreased hours/days, reduced provider availability, clinic reconfiguration for COVID-19 services, record-keeping interruptions and suspension of partner support. Almost all sites in low-prevalence and high-income countries reported increased use of telemedicine (85% and 100%, respectively), compared with less than half of sites in high-prevalence and lower-income settings. Few sites in high-prevalence settings (2%) reported suspending antiretroviral therapy (ART) clinic services, and many reported adopting mitigation strategies to support adherence, including multi-month dispensing of ART (95%) and designating community ART pick-up points (44%). While few sites (5%) reported stockouts of first-line ART regimens, 10-11% reported stockouts of second- and third-line regimens, respectively, primarily in high-prevalence and lower-income settings. Interruptions in HIV viral load (VL) testing included suspension of testing (22%), longer turnaround times (41%) and supply/reagent stockouts (22%), but did not differ across settings. ConclusionsWhile many sites in high HIV prevalence settings and lower-income countries reported introducing or expanding measures to support treatment adherence and continuity of care, the COVID-19 pandemic resulted in disruptions to VL testing and ART supply chains that may negatively affect the quality of HIV care in these settings
Corrigendum: Possible Involvement of Hsp90 in the Regulation of Telomere Length and Telomerase Activity During the Leishmania Amazonensis Developmental Cycle and Population Proliferation
No full textAn author name was incorrectly spelled as Stepany C. Paiva. The correct spelling is Stephany C. Paiva. The authors apologize for this error and state that this does not change the scientific conclusions of the article in any way. The original article has been updated.Department of Chemical and Biological Sciences Institute of Biosciences São Paulo State University (UNESP)Faculdade Brasileira MultivixHemocentro da Faculdade de Medicina de Ribeirão Preto Universidade of São PauloSão Carlos Institute of Chemistry University of São PauloDepartment of Chemical and Biological Sciences Institute of Biosciences São Paulo State University (UNESP
Service delivery challenges in HIV care during the first year of the COVID-19 pandemic: results from a site assessment survey across the global IeDEA consortium.
No full textINTRODUCTION
Interruptions in treatment pose risks for people with HIV (PWH) and threaten progress in ending the HIV epidemic; however, the COVID-19 pandemic's impact on HIV service delivery across diverse settings is not broadly documented.
METHODS
From September 2020 to March 2021, the International epidemiology Databases to Evaluate AIDS (IeDEA) research consortium surveyed 238 HIV care sites across seven geographic regions to document constraints in HIV service delivery during the first year of the pandemic and strategies for ensuring care continuity for PWH. Descriptive statistics were stratified by national HIV prevalence (<1%, 1-4.9% and ≥5%) and country income levels.
RESULTS
Questions about pandemic-related consequences for HIV care were completed by 225 (95%) sites in 42 countries with low (n = 82), medium (n = 86) and high (n = 57) HIV prevalence, including low- (n = 57), lower-middle (n = 79), upper-middle (n = 39) and high- (n = 50) income countries. Most sites reported being subject to pandemic-related restrictions on travel, service provision or other operations (75%), and experiencing negative impacts (76%) on clinic operations, including decreased hours/days, reduced provider availability, clinic reconfiguration for COVID-19 services, record-keeping interruptions and suspension of partner support. Almost all sites in low-prevalence and high-income countries reported increased use of telemedicine (85% and 100%, respectively), compared with less than half of sites in high-prevalence and lower-income settings. Few sites in high-prevalence settings (2%) reported suspending antiretroviral therapy (ART) clinic services, and many reported adopting mitigation strategies to support adherence, including multi-month dispensing of ART (95%) and designating community ART pick-up points (44%). While few sites (5%) reported stockouts of first-line ART regimens, 10-11% reported stockouts of second- and third-line regimens, respectively, primarily in high-prevalence and lower-income settings. Interruptions in HIV viral load (VL) testing included suspension of testing (22%), longer turnaround times (41%) and supply/reagent stockouts (22%), but did not differ across settings.
CONCLUSIONS
While many sites in high HIV prevalence settings and lower-income countries reported introducing or expanding measures to support treatment adherence and continuity of care, the COVID-19 pandemic resulted in disruptions to VL testing and ART supply chains that may negatively affect the quality of HIV care in these settings
J Acquir Immune Defic Syndr
No full textBackground:Of women with cervical cancer (CC) and HIV, 85% live in sub-Saharan Africa, where 21% of all CC cases are attributable to HIV infection. We aimed to generate internationally acceptable facility-based indicators to monitor and guide scale up of CC prevention and care services offered on-site or off-site by HIV clinics.Methods:We reviewed the literature and extracted relevant indicators, grouping them into domains along the CC control continuum. From February 2021 to March 2022, we conducted a three-round, online Delphi process to reach consensus on indicators. We invited 106 experts to participate. Through an anonymous, iterative process, participants adapted the indicators to their context (round 1), then rated them for 5 criteria on a 5-point Likert-type scale (rounds 2 and 3) and then ranked their importance (round 3).Results:We reviewed 39 policies from 21 African countries and 7 from international organizations; 72 experts from 15 sub-Saharan Africa countries or international organizations participated in our Delphi process. Response rates were 34% in round 1, 40% in round 2, and 44% in round 3. Experts reached consensus for 17 indicators in the following domains: primary prevention (human papillomavirus prevention, n = 2), secondary prevention (screening, triage, treatment of precancerous lesions, n = 11), tertiary prevention (CC diagnosis and care, n = 2), and long-term impact of the program and linkage to HIV service (n = 2).Conclusion:We recommend that HIV clinics that offer CC control services in sub-Saharan Africa implement the 17 indicators stepwise and adapt them to context to improve monitoring along the CC control cascade
Acanthoctenus lamarrei Arizala & Labarque & Polotow 2021, sp. nov.
No full textAcanthoctenus lamarrei sp. nov. Figs 10A, 42–43 Type material: male holotype from Playa Corona, near San Carlos [8°25’59.0”N, 80°00’21.7”W], Panama Province, Panama, 08.VIII.1983. H. & L. Levi coll., deposited in MCZ. Etymology. The specific name is a patronym in honor of the entomologist Greg P. A. Lamarre, in recognition of many contributions to the knowledge on Panamanian spiders and friendship to the first author. Diagnosis. Males of Acanthoctenus lamarrei sp. nov. (Figs 42 D–E, 43) resemble those of A. spinipes (Figs 15 D–E, 16A–B) by the median apophysis massive, the apex at least five times wider than the base, and RTA elongated, longer than wide. It can be distinguished by the embolus short, the apex ending at 12 o’clock and the base swollen at least four times the apex width, and RTA curved distally. A. spinipes presents an elongated embolus, the base slightly swollen starting at 9 o’clock and the apex ending at 2 o’clock, and RTA straight distally. Description. Male (holotype MCZ). Total length 9.37. Carapace 4.93 long and 4.33 wide. Clypeus 0.26 high. Eye diameters: AME 0.26, ALE 0.19, PME 0.36, PLE 0.49. Leg measurements: I: femur 6.75/ patella 2.53/ tibia 8.55/ metatarsus 8.25/ tarsus 2.29/ total 28.37; II: 6.65/ 2.54/ 6.38/ 6.59/ 1.97/ 24.13; III: 5.18/ 1.91/ 4.50/ 5.33/ 1.63/ 18.55; IV: 6.70/ 1.96/ 6.10/ 8.46/ 2.71/ 25.93. Leg formula 1423. Leg spination: tibia I and II v-2-2-2-2-2-2-2-2-2, p-1-0-1-1, r-1-0-1-1-1, III v-2-2-2, p-1-1-1, r-0-0-1 and IV v-2-2-2, p-1-1-1, r-1-0-1-1; metatarsus I, II v2-2-2-2-2, p-1-0-1, r-1, III v-2-2-2, p-1-0-1, r-1-1, IV v2-0-1-1-1, p1-1-1, r-1-0-1-1. Palp (Figs 42 D–E, 43): tibia shorter than cymbium, slightly curved; RTA elongated and sinuous; cymbium elongated and with retrobasal projection; embolus elongated but shorter than in most Acanthoctenus spp., cylindrical, and curved; conductor hyaline and following the tip of embolus; median apophysis laminar, elongated, narrow at the base and wider at the top, with a proapical hook. Female. Unknown. Distribution. Panama (Fig. 10A).Published as part of Arizala, Stephany, Labarque, Facundo Martín & Polotow, Daniele, 2021, Revision of the Neotropical spider genus Acanthoctenus (Araneae: Ctenidae Acanthocteninae), pp. 1-55 in Zootaxa 4920 (1) on pages 44-46, DOI: 10.11646/zootaxa.4920.1.1, http://zenodo.org/record/447145
Screening and management of mental health and substance use disorders in HIV treatment settings in low- and middle-income countries within the global IeDEA consortium.
No full textINTRODUCTION
Integration of services to screen and manage mental health and substance use disorders (MSDs) into HIV care settings has been identified as a promising strategy to improve mental health and HIV treatment outcomes among people living with HIV/AIDS (PLWHA) in low- and middle-income countries (LMICs). Data on the extent to which HIV treatment sites in LMICs screen and manage MSDs are limited. The objective of this study was to assess practices for screening and treatment of MSDs at HIV clinics in LMICs participating in the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium.
METHODS
We surveyed a stratified random sample of 95 HIV clinics in 29 LMICs in the Caribbean, Central and South America, Asia-Pacific and sub-Saharan Africa. The survey captured information onsite characteristics and screening and treatment practices for depression, post-traumatic stress disorder (PTSD), substance use disorders (SUDs) and other mental health disorders.
RESULTS
Most sites (n = 76, 80%) were in urban areas. Mental health screening varied by disorder: 57% of sites surveyed screened for depression, 19% for PTSD, 55% for SUDs and 29% for other mental health disorders. Depression, PTSD, SUDs and other mental health disorders were reported as managed on site (having services provided at the HIV clinic or same health facility) at 70%, 51%, 41% and 47% of sites respectively. Combined availability of screening and on-site management of depression, PTSD, and SUDs, and other mental health disorders was reported by 42%, 14%, 26% and 19% of sites, respectively. On-site management of depression and PTSD was reported significantly less often in rural as compared to urban settings (depression: 33% and 78% respectively; PTSD: 24% and 58% respectively). Screening for depression and SUDs was least commonly reported by HIV programmes that treated only children as compared to HIV programmes that treated only adults or treated both adults and children.
CONCLUSIONS
Significant gaps exist in the management of MSDs in HIV care settings in LMICs, particularly in rural settings. Identification and evaluation of optimal implementation strategies to scale and sustain integrated MSDs and HIV care is needed
The IeDEA Harmonist Data Toolkit: A Data Quality and Data Sharing Solution for a Global HIV Research Consortium.
No full textWe describe the design, implementation, and impact of a data harmonization, data quality checking, and dynamic report generation application in an international observational HIV research network. The IeDEA Harmonist Data Toolkit is a web-based application written in the open source programming language R, employs the R/Shiny and RMarkdown packages, and leverages the REDCap data collection platform for data model definition and user authentication. The Toolkit performs data quality checks on uploaded datasets, checks for conformance with the network's common data model, displays the results both interactively and in downloadable reports, and stores approved datasets in secure cloud storage for retrieval by the requesting investigator. Including stakeholders and users in the design process was key to the successful adoption of the application. A survey of regional data managers as well as initial usage metrics indicate that the Toolkit saves time and results in improved data quality, with a 61% mean reduction in number of error records in a dataset. The generalized application design allows the Toolkit to be easily adapted to other research networks
Global disparities in skin cancer services at HIV treatment centers across 29 countries
No full textInternational audienc
International epidemiology databases to evaluate AIDS (IeDEA) in sub-Saharan Africa, 2012-2019.
No full textPURPOSE
The objectives of the International epidemiology databases to evaluate AIDS (IeDEA) are to (i) evaluate the delivery of combination antiretroviral therapy (ART) in children, adolescents and adults in sub-Saharan Africa, (ii) to describe ART regimen effectiveness, durability and tolerability, (iii) to examine HIV-related comorbidities and coinfections and (iv) to examine the pregnancy-related and HIV-related outcomes of women on ART and their infants exposed to HIV or ART in utero or via breast milk.
PARTICIPANTS
IeDEA is organised in four regions (Central, East, Southern and West Africa), with 240 treatment and care sites, six data centres at African, European and US universities, and almost 1.4 million children, adolescents and adult people living with HIV (PLWHIV) enrolled.
FINDINGS TO DATE
The data include socio-demographic characteristics, clinical outcomes, opportunistic events, treatment regimens, clinic visits and laboratory measurements. They have been used to analyse outcomes in PLWHIV-1 or PLWHIV-2 who initiate ART, including determinants of mortality, of switching to second-line and third-line ART, drug resistance, loss to follow-up and the immunological and virological response to different ART regimens. Programme-level estimates of mortality have been corrected for loss to follow-up. We examined the impact of coinfection with hepatitis B and C, and the epidemiology of different cancers and of (multidrug resistant) tuberculosis, renal disease and of mental illness. The adoption of 'Treat All', making ART available to all PLWHIV regardless of CD4+ cell count or clinical stage was another important research topic.
FUTURE PLANS
IeDEA has formulated several research priorities for the 'Treat All' era in sub-Saharan Africa. It recently obtained funding to set up sentinel sites where additional data are prospectively collected on cardiometabolic risks factors as well as mental health and liver diseases, and is planning to create a drug resistance database
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