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Curbing the hepatitis C virus epidemic in Pakistan: the impact of scaling up treatment and prevention for achieving elimination

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INTERNATIONAL JOURNAL OF EPIDEMIOLOGY 2018年第2期47卷 550-560页

作者： Lim, Aaron G. Qureshi, Huma Mahmood, Hassan Hamid, Saeed Davies, Charlotte F. Trickey, Adam Glass, Nancy Saeed, Quaid Fraser, Hannah Walker, Josephine G. Mukandavire, Christinah Hickman, Matthew Martin, Natasha K. May, Margaret T. Averhoff, Francisco Vickerman, Peter Univ Bristol Bristol Med Sch Populat Hlth Sci Bristol Avon England Pakistan Hlth Res Council Islamabad Pakistan Ctr Dis Control & Prevent TEPHINET Atlanta GA USA Aga Khan Univ Karachi Pakistan Ctr Dis Control & Prevent Natl Ctr HIV AIDS Viral Hepatitis STD & TB Preven Atlanta GA USA Natl AIDS Control Programme Islamabad Pakistan Univ Calif San Diego Dept Med Div Global Publ Hlth San Diego CA 92103 USA

Background: The World Health Organization (WHO) has developed a global health strategy to eliminate viral hepatitis. We project the treatment and prevention requirements to achieve the WHO HCV elimination target of reducing HCV incidence by 80% and HCV-related mortality by 65% by 2030 in Pakistan, which has the second largest HCV burden worldwide. Methods: We developed an HCV transmission model for Pakistan, and calibrated it to epidemiological data from a national survey (2007), surveys among people who inject drugs (PWID), and blood donor data. Current treatment coverage data came from expert opinion and published reports. The model projected the HCV burden, including incidence, prevalence and deaths through 2030, and estimated the impact of varying prevention and direct-acting antiviral (DAA) treatment interventions necessary for achieving the WHO HCV elimination targets. Results: With no further treatment (currently similar to 150 000 treated annually) during 2016-30, chronic HCV prevalence will increase from 3.9% to 5.1%, estimated annual incident infections will increase from 700 000 to 1 100 000, and 1 400 000 HCV-associated deaths will occur. To reach the WHO HCV elimination targets by 2030, 880 000 annual DAA treatments are required if prevention is not scaled up and no treatment prioritization occurs. By targeting treatment toward persons with cirrhosis (80% treated annually) and PWIDs (double the treatment rate of non-PWIDs), the required annual treatment number decreases to 750 000. If prevention activities also halve transmission risk, this treatment number reduces to 525 000 annually. Conclusions: Substantial HCV prevention and treatment interventions are required to reach the WHO HCV elimination targets in Pakistan, without which Pakistan's HCV burden will increase markedly.

关键词： Mathematical model direct-acting antivirals prevention incidence mortality LMIC

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Human papillomavirus (HPV) associated oral cavity and oropharyngeal cancers: Cross-sectional follow-up study in South Asian country, Sri Lanka

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ANNALS OF ONCOLOGY 2018年 29卷 104-104页

作者： Alahakoon, P. K. D. P. P. Perera, K. A. Pannala, W. S. Natl Canc Inst Clin Oncol Colombo Sri Lanka Natl STD AIDS Control Programme Clin Res Colombo Sri Lanka

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Modelling the cost of hepatitis C virus transmission in Pakistan

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JOURNAL OF HEPATOLOGY 2020年 73卷 S791-S791页

作者： Lim, Aaron G. Walker, Josephine Mafirakureva, Nyashadzaishe Khalid, Gul Ghuttai Qureshi, Huma Mahmood, Hassan Trickey, Adam Fraser, Hannah Aslam, Khawar Falq, Gregoire Fortas, Camille Zahid, Hassaan Naveed, Ammara Auat, Rosa Saeed, Quaid Davies, Charlotte Mukandavire, Christinah Glass, Nancy Maman, David Martin, Natasha Hickman, Matthew May, Margaret Hamid, Saeed Sadiq Loarec, Anne Averhoff, Francisco Vickerman, Peter Univ Bristol Bristol Med Sch Populat Hlth Sci Bristol Avon England Univ Sheffield Hlth Econ & Decis Sci Sheffield S Yorkshire England Med San Frontieres Brussels Belgium Doctors Plaza Karachi Pakistan Pakistan Hlth Res Council Islamabad Pakistan World Hlth Org Islamabad Pakistan Med San Frontieres Epictr Paris France Inst Pasteur Paris France Pakistan Kidney & Liver Inst & Res Ctr Dept Gastroenterol & Hepatol Lahore Pakistan Natl AIDS Control Programme Islamabad Pakistan Imperial Coll London Dept Infect Dis Epidemiol London England US Ctr Dis Control & Prevent Div Viral Hepatitis Natl Ctr HIV AIDS Viral Hepatitis STD & TB Preven Atlanta GA USA Univ Calif San Diego Dept Med Div Infect Dis & Global Publ Hlth San Diego CA 92103 USA Aga Khan Univ Karachi Pakistan

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Building the Framework for Standardized Clinical Laboratory Reporting of Next-generation Sequencing Data for Resistance-associated Mutations in Mycobacterium tuberculosis Complex

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CLINICAL INFECTIOUS DISEASES 2019年第9期69卷 1634-1640页

作者： Tornheim, Jeffrey A. Starks, Angela M. Rodwell, Timothy C. Gardy, Jennifer L. Walker, Timothy M. Cirillo, Daniela M. Jayashankar, Lakshmi Miotto, Paolo Zignol, Matteo Schito, Marco Johns Hopkins Univ Sch Med Div Infect Dis Baltimore MD 21205 USA Ctr Dis Control & Prevent Div TB Eliminat Natl Ctr HIV AIDS Viral Hepatitis STD & TB Preven Atlanta GA USA Fdn Innovat New Diagnost Geneva Switzerland Univ Calif San Diego Div Pulm Crit Care & Sleep Med La Jolla CA 92093 USA Univ British Columbia Sch Populat & Publ Hlth Vancouver BC Canada British Columbia Ctr Dis Control Clin Prevent Serv Vancouver BC Canada Univ Oxford Nuffield Dept Med Oxford England IRCCS San Raffaele Sci Inst Milan Italy NIAID Columbus Technol Inc US Natl Inst Hlth 9000 Rockville Pike Bethesda MD 20892 USA WHO Global TB Programme Geneva Switzerland Crit Path Inst Crit Path TB Drug Regimens Tucson AZ 85718 USA

Tuberculosis is the primary infectious disease killer worldwide, with a growing threat from multidrug-resistant cases. Unfortunately, classic growth-based phenotypic drug susceptibility testing (DST) remains difficult, costly, and time consuming, while current rapid molecular testing options are limited by the diversity of antimicrobial-resistant genotypes that can be detected at once. Next-generation sequencing (NGS) offers the opportunity for rapid, comprehensive DST without the time or cost burden of phenotypic tests and can provide useful information for global surveillance. As access to NGS expands, it will be important to ensure that results are communicated clearly, consistent, comparable between laboratories, and associated with clear guidance on clinical interpretation of results. In this viewpoint article, we summarize 2 expert workshops regarding a standardized report format, focusing on relevant variables, terminology, and required minimal elements for clinical and laboratory reports with a proposed standardized template for clinical reporting NGS results for Mycobacterium tuberculosis.

关键词： tuberculosis next-generation sequencing reporting standardization interpretation

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Genital inflammation undermines the effectiveness of tenofovir gel in preventing HIV acquisition in women

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NATURE MEDICINE 2018年第4期24卷 491-+页

作者： McKinnon, Lyle R. Liebenberg, Lenine J. Yende-Zuma, Nonhlanhla Archary, Derseree Ngcapu, Sinaye Sivro, Aida Nagelkerke, Nico Lerma, Jose Gerardo Garcia Kashuba, Angela D. Masson, Lindi Mansoor, Leila E. Karim, Quarraisha Abdool Karim, Salim S. Abdool Passmore, Jo-Ann S. Ctr AIDS Programme Res South Africa CAPRISA Durban South Africa Univ Manitoba Dept Med Microbiol Winnipeg MB Canada Univ KwaZulu Natal Dept Med Microbiol Durban South Africa Ctr Dis Control & Prevent Div HIV AIDS Prevent Natl Ctr HIV AIDS Viral Hepatitis STD & TB Preven Atlanta GA USA Univ North Carolina Chapel Hill Eschelman Sch Pharm Chapel Hill NC USA Univ Cape Town Inst Infect Dis & Mol Med IDM Cape Town South Africa Columbia Univ Dept Epidemiol New York NY USA Natl Hlth Lab Serv Cape Town South Africa

Several clinical trials have demonstrated that antiretroviral (ARV) drugs taken as pre-exposure prophylaxis (PrEP) can prevent HIV infection1, with the magnitude of protection ranging from -49 to 86% (refs. 2-11). Although these divergent outcomes are thought to be due primarily to differences in product adherence(12), biological factors likely contribute(13). Despite selective recruitment of higher-risk participants for prevention trials, HIV risk is heterogeneous even within higher-risk groups(14-16). To determine whether this heterogeneity could influence patient outcomes following PrEP, we undertook a post hoc prospective analysis of results from the CAPRISA 004 trial for 1% tenofovir gel (n = 774 patients), one of the first trials to demonstrate protection against HIV infection. Concentrations of nine proinflammatory cytokines were measured in cervicovaginal lavages at >2,000 visits, and a graduated cytokine score was used to define genital inflammation. In women without genital inflammation, tenofovir was 57% protective against HIV (95% confidence interval (CI): 7-80%) but was 3% protective (95% CI: -104-54%) if genital inflammation was present. Among women who highly adhered to the gel, tenofovir protection was 75% (95% CI: 25-92%) in women without inflammation compared to -10% (95% CI: -184-57%) in women with inflammation. Immunological predictors of HIV risk may modify the effectiveness of tools for HIV prevention;reducing genital inflammation in women may augment HIV prevention efforts.

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Assisted HIV partner services training in three sub-Saharan African countries: facilitators and barriers to sustainable approaches

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JOURNAL OF THE INTERNATIONAL aids SOCIETY 2019年第S3期22卷 e25307页

作者： Han, Hannah Myers, Serene Khan, Eveline Mboh Masyukoi, Sarah J. Paredes, Zulmira Chimoun, Francois T. Mudender, Florindo Wamuti, Beatrice M. Nambu, Winifred Kemunto, Emily Mugambi, Mary Kariithi, Edward Golden, Matthew R. Tih, Pius M. Welty, Thomas Farquhar, Carey Univ Washington Dept Global Hlth Seattle WA 98195 USA I TECH Seattle WA USA Cameroon Baptist Convent Hlth Serv AIDS Care & Prevent Program Bamenda Cameroon Minist Hlth Natl AIDS & STI Control Programme Nairobi Kenya I TECH Maputo Mozambique PATH Kisumu Kenya Univ Washington Dept Epidemiol Seattle WA 98195 USA Univ Washington Dept Med Seattle WA USA Publ Hlth Seattle & King Cty HIV STD Program Seattle WA USA

Introduction: Healthcare worker training is essential to successful implementation of assisted partner services (aPS), which aims to improve HIV testing and linkage-to-care outcomes for previously unidentified HIV-positive individuals. Cameroon, Kenya and Mozambique are three African countries that have implemented aPS programmes and are working to bring those programmes to scale. In this paper, we present and compare different aPS training strategies implemented by these three countries, and discuss facilitators and barriers associated with implementation of aPS training in sub-Saharan Africa. Discussion: aPS training programmes in Cameroon, Kenya and Mozambique share the following components: the development of comprehensive and interactive training curricula, recruitment of qualified trainees and trainers with intimate knowledge of the community served, continuous training, and rigorous monitoring and evaluation activities. Cameroon and Kenya were able to engage various stakeholders early on, establishing multilateral coalitions that facilitated attainment of long-term buy-in from the local governments. Ministries of Health and various implementing partners are often included in strategic planning and delivery of training curricula to ensure sustainability of the training programmes. Kenya and Mozambique have integrated aPS training into the national HTS guidelines, which are being rolled out nationwide by the Ministries of Health and implementing partners. Continual revision of training curricula to reflect the country context, as well as ongoing monitoring and evaluation, have also been identified as key facilitators to sustain aPS training programmes. Some of the barriers to scale-up and sustainability of aPS training include limited funding and resources for training and scale-up and shortage of aPS providers to facilitate on-the-job mentorship. Conclusions: These three programmes demonstrate that aPS training can be implemented and scaled up in sub-Saharan A

关键词： partner services HIV/aids training strategies facilitators and barriers sustainability sub-Saharan Africa

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Global and regional molecular epidemiology of HIV-1, 1990-2015: a systematic review, global survey, and trend analysis

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LANCET INFECTIOUS DISEASES 2019年第2期19卷 143-155页

作者： Hemelaar, Joris Elangovan, Ramyiadarsini Yun, Jason Dickson-Tetteh, Leslie Fleminger, Isabella Kirtley, Shona Williams, Brian Gouws-Williams, Eleanor Ghys, Peter D. Abimiku, Alash'le G. Agwale, Simon Archibald, Chris Avidor, Boaz Gabriela Barbas, Maria Barre-Sinoussi, Francoise Barugahare, Banson Belabbes, El Hadj Bertagnolio, Silvia Birx, Deborah Bobkov, Aleksei F. Brandful, James Bredell, Helba Brennan, Catherine A. Brooks, James Bruckova, Marie Buonaguro, Luigi Buonaguro, Franco Butto, Stefano Buve, Anne Campbell, Mary Carr, Jean Carrera, Alex Gomez Carrillo, Manuel Celum, Connie Chaplin, Beth Charles, Macarthur Chatzidimitriou, Dimitrios Chen, Zhiwei Chijiwa, Katsumi Cooper, David Cunningham, Philip Dagnra, Anoumou de Gascun, Cillian F. Del Amo, Julia Delgado, Elena Dietrich, Ursula Dwyer, Dominic Ellenberger, Dennis Ensoli, Barbara Essex, Max Fleury, Herve Fonjungo, Peter N. Foulongne, Vincent Gadkari, Deepak A. Gao, Feng Garcia, Federico Garsia, Roger Gershy-Damet, Guy Michel Glynn, Judith R. Goodall, Ruth Grossman, Zehava Guimaraes, Monick Lindenmeyer Hahn, Beatrice Hamers, Raph L. Hamouda, Osamah Handema, Ray He, Xiang Herbeck, Joshua Ho, David D. Holguin, Africa Hosseinipour, Mina Hunt, Gillian Ito, Masahiko Kacem, Mohamed Ali Bel Hadj Kahle, Erin Kaleebu, Pontiano Kalish, Marcia Kamarulzaman, Adeeba Kang, Chun Kanki, Phyllis Karamov, Edward Karasi, Jean-Claude Kayitenkore, Kayitesi Kelleher, Tony Kitayaporn, Dwip Kostrikis, Leondios G. Kucherer, Claudia Lara, Claudia Leitner, Thomas Liitsola, Kirsi Lingappa, Jai Linka, Marek Lorenzana de Rivera, Ivette Lukashov, Vladimir Maayan, Shlomo Mayr, Luzia McCutchan, Francine Meda, Nicolas Menu, Elisabeth Mhalu, Fred Mloka, Doreen Mokili, John L. Montes, Brigitte Mor, Orna Morgado, Mariza Mosha, Fausta Moussi, Awatef Mullins, James Najera, Rafael Nasr, Mejda Ndembi, Nicaise Neilson, Joel R. Nerurkar, Vivek R. Neuhann, Florian Nolte, Claudine Novitsky, Vlad Nyambi, Philippe Ofner, Marianna Paladin, Fem J. Papa, Anna Pape, Jean Parkin, Neil Parry, Chris Peeters, M Univ Oxford John Radcliffe Hosp Womens Ctr Nuffield Dept Womens & Reprod Hlth Oxford OX3 9DU England Univ Oxford Botnar Res Ctr Nuffield Dept Orthopaed Rheumatol & Musculoskelet Ctr Stat Med Oxford England Stellenbosch Univ South African Ctr Epidemiol Modelling & Anal Stellenbosch South Africa UNAIDS Fast Track Implementat Dept Geneva Switzerland UNAIDS Strateg Informat Dept Geneva Switzerland Univ Maryland Inst Human Virol Baltimore MD 21201 USA Gede Fdn Abuja Nigeria Publ Hlth Agcy Canada Ottawa ON Canada Tel Aviv Sourasky Med Ctr Tel Aviv Israel Minist Salud Cordoba Argentina Inst Pasteur Paris France Minist Hlth Entebbe Uganda Inst Pasteur Natl Reference Lab HIV AIDS Algiers Algeria WHO Geneva Switzerland Off Global AIDS Coordinator Washington DC USA DI Ivanovskii Inst Virol Moscow Russia Univ Ghana Noguchi Mem Inst Med Res Accra Ghana Univ Cape Town Cape Town South Africa Abbott Labs Chicago IL USA Natl Inst Publ Hlth Prague Czech Republic Natl Canc Inst Fdn G Pascale AIDS Reference Ctr Naples Italy Ist Super Sanita Natl AIDS Ctr Rome Italy Inst Trop Med Antwerp Belgium Univ Washington Sch Med Seattle WA USA St Vincents Hosp Sydney NSW Australia Univ Buenos Aires Buenos Aires DF Argentina Harvard TH Chan Sch Publ Hlth Boston MA USA Gheskio Ctr Port Au Prince Haiti Aristotle Univ Thessaloniki Thessaloniki Greece Chinese Acad Med Sci Peking Union Med Sch Beijing Peoples R China Kyushu Univ Hosp Fukuoka Inst Hlth & Environm Sci Dazaifu Japan Kirby Inst Sydney NSW Australia Univ Lome Fac Sci Sante Lome Togo Univ Coll Dublin Dublin Ireland Inst Salud Carlos III Madrid Spain Georg Speyer Haus Chemotherapeut Forschungsinstitut Frankfurt Germany Westmead Hosp Pathol West Westmead NSW Australia Ctr Dis Control & Prevent Atlanta GA USA Harvard Sch Publ Hlth Boston MA USA Duke Univ Med Ctr Durham NC USA Univ Bordeaux Bordeaux France Montpellier Univ Hosp Montpellier France Natl AIDS Res Inst Pune Maharashtra

Background Global genetic diversity of HIV-1 is a major challenge to the development of HIV vaccines. We aimed to estimate the regional and global distribution of HIV-1 subtypes and recombinants during 1990-2015. Methods We searched PubMed, EMBASE (Ovid), CINAHL (Ebscohost), and Global Health (Ovid) for HIV-1 subtyping studies published between Jan 1, 1990, and Dec 31, 2015. We collected additional unpublished HIV-1 subtyping data through a global survey. We included prevalence studies with HIV-1 subtyping data collected during 1990-2015. We grouped countries into 14 regions and analysed data for four time periods (1990-99, 2000-04, 2005-09, and 2010-15). The distribution of HIV-1 subtypes, circulating recombinant forms (CRFs), and unique recombinant forms (URFs) in individual countries was weighted according to the UNaids estimates of the number of people living with HIV (PLHIV) in each country to generate regional and global estimates of HIV-1 diversity in each time period. The primary outcome was the number of samples designated as HIV-1 subtypes A, B, C, D, F, G, H, J, K, CRFs, and URFs. The systematic review is registered with PROSPERO, number CRD42017067164. Findings This systematic review and global survey yielded 2203 datasets with 383 519 samples from 116 countries in 1990-2015. Globally, subtype C accounted for 46 . 6% (16 280 897/34 921 639 of PLHIV) of all HIV-1 infections in 2010-15. Subtype B was responsible for 12 . 1% (4 235 299/34 921 639) of infections, followed by subtype A (10 . 3%;3 587 003/34 921 639), CRF02_AG (7 . 7%;2 705 110/34 921 639), CRF01_AE (5 . 3%;1 840 982/34 921 639), subtype G (4 . 6%;1 591 276/34 921 639), and subtype D (2 . 7%;926 255/34 921 639). Subtypes F, H, J, and K combined accounted for 0 . 9% (311 332/34 921 639) of infections. Other CRFs accounted for 3 . 7% (1 309 082/34 921 639), bringing the proportion of all CRFs to 16 . 7% (5 844 113/34 921 639). URFs constituted 6 . 1% (2 134 405/34 921 639), resulting in recombin

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HIV misdiagnosis in sub-Saharan Africa: performance of diagnostic algorithms at six testing sites

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JOURNAL OF THE INTERNATIONAL aids SOCIETY 2017年第1期20卷 21419页

作者： Kosack, Cara S. Shanks, Leslie Beelaert, Greet Benson, Tumwesigye Savane, Aboubacar Ng'ang'a, Anne Andre, Bita Zahinda, Jean-Paul B. N. Fransen, Katrien Page, Anne-Laure Med Sans Frontieres Diagnost Network Amsterdam Netherlands Med Sans Frontieres Publ Hlth Dept Amsterdam Netherlands Inst Trop Med AIDS Reference Lab Antwerp Belgium Minist Hlth Uganda STD AIDS Control Program Kampala Uganda Lab Natl Reference Conakry Guinea Natl AIDS & Sexually Transmitted Infect Control P Nairobi Kenya Reg Delegat Publ Hlth Littoral Reg Yaounde Cameroon Programme Natl Lutte Sida & IST PNLS Bukavu DEM REP CONGO Epictr Epidemiol & Populat Hlth Dept Paris France

Introduction: We evaluated the diagnostic accuracy of HIV testing algorithms at six programmes in five sub-Saharan African countries. Methods: In this prospective multisite diagnostic evaluation study (Conakry, Guinea;Kitgum, Uganda;Arua, Uganda;Homa Bay, Kenya;Doula, Cameroun and Baraka, Democratic Republic of Congo), samples from clients (greater than equal to five years of age) testing for HIV were collected and compared to a state-of-the-art algorithm from the aids reference laboratory at the Institute of Tropical Medicine, Belgium. The reference algorithm consisted of an enzyme-linked immuno-sorbent assay, a line-immunoassay, a single antigen-enzyme immunoassay and a DNA polymerase chain reaction test. Results: Between August 2011 and January 2015, over 14,000 clients were tested for HIV at 6 HIV counselling and testing sites. Of those, 2786 (median age: 30;38.1% males) were included in the study. Sensitivity of the testing algorithms ranged from 89.5% in Arua to 100% in Douala and Conakry, while specificity ranged from 98.3% in Doula to 100% in Conakry. Overall, 24 (0.9%) clients, and as many as 8 per site (1.7%), were misdiagnosed, with 16 false-positive and 8 false-negative results. Six false-negative specimens were retested with the on-site algorithm on the same sample and were found to be positive. Conversely, 13 false-positive specimens were retested: 8 remained false-positive with the on-site algorithm. Conclusions: The performance of algorithms at several sites failed to meet expectations and thresholds set by the World Health Organization, with unacceptably high rates of false results. Alongside the careful selection of rapid diagnostic tests and the validation of algorithms, strictly observing correct procedures can reduce the risk of false results. In the meantime, to identify false-positive diagnoses at initial testing, patients should be retested upon initiating antiretroviral therapy.

关键词： HIV diagnostic test RDT misdiagnosis algorithm

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Towards more accurate HIV testing in sub-Saharan Africa: a multi-site evaluation of HIV RDTs and risk factors for false positives

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JOURNAL OF THE INTERNATIONAL aids SOCIETY 2017年第1期20卷 21345页

作者： Kosack, Cara S. Page, Anne-Laure Beelaert, Greet Benson, Tumwesigye Savane, Aboubacar Ng'ang'a, Anne Andre, Bita Zahinda, Jean-Paul B. N. Shanks, Leslie Fransen, Katrien Med Sans Frontieres Diagnost Network Amsterdam Netherlands Epicentre Epidemiol & Populat Hlth Dept Paris France Inst Trop Med AIDS Reference Lab Antwerp Belgium Minist Hlth Uganda STD AIDS Control Program Kampala Uganda Minist Hlth Guinea Lab Natl Reference Conakry Guinea Minist Hlth Kenya Natl AIDS & Sexually Transmitted Infect Control P Nairobi Kenya Minist Hlth Cameroon Reg Delegat Publ Hlth Littoral Reg Yaounde Cameroon Minist Hlth Democrat Republ Congo Programme Natl Lutte Sida & IST PNLS Bukavu DEM REP CONGO Med Sans Frontieres Dept Publ Hlth Amsterdam Netherlands

Introduction: Although individual HIV rapid diagnostic tests (RDTs) show good performance in evaluations conducted by WHO, reports from several African countries highlight potentially significant performance issues. Despite widespread use of RDTs for HIV diagnosis in resource-constrained settings, there has been no systematic, head-to-head evaluation of their accuracy with specimens from diverse settings across sub-Saharan Africa. We conducted a standardized, centralized evaluation of eight HIV RDTs and two simple confirmatory assays at a WHO collaborating centre for evaluation of HIV diagnostics using specimens from six sites in five sub-Saharan African countries. Methods: Specimens were transported to the Institute of Tropical Medicine (ITM), Antwerp, Belgium for testing. The tests were evaluated by comparing their results to a state-of-the-art reference algorithm to estimate sensitivity, specificity and predictive values. Results: 2785 samples collected from August 2011 to January 2015 were tested at ITM. All RDTs showed very high sensitivity, from 98.8% for First Response HIV Card Test 1-2.0 to 100% for Determine HIV 1/2, Genie Fast, SD Bioline HIV 1/2 3.0 and INSTI HIV-1/HIV-2 Antibody Test kit. Specificity ranged from 90.4% for First Response to 99.7% for HIV 1/2 STAT-PAK with wide variation based on the geographical origin of specimens. Multivariate analysis showed several factors were associated with false-positive results, including gender, provider-initiated testing and the geographical origin of specimens. For simple confirmatory assays, the total sensitivity and specificity was 100% and 98.8% for ImmunoComb II HIV 12 CombFirm (ImmunoComb) and 99.7% and 98.4% for Geenius HIV 1/2 with indeterminate rates of 8.9% and 9.4%. Conclusions: In this first systematic head-to-head evaluation of the most widely used RDTs, individual RDTs performed more poorly than in the WHO evaluations: only one test met the recommended thresholds for RDTs of >= 99% sensitivity and

关键词： HIV diagnostic test RDT false positive

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Delivering Prevention Interventions to People Living with HIV in Clinical Care Settings: Results of a Cluster Randomized Trial in Kenya, Namibia, and Tanzania

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aids AND BEHAVIOR 2016年第9期20卷 2110-2118页

作者： Bachanas, Pamela Kidder, Daniel Medley, Amy Pals, Sherri L. Carpenter, Deborah Howard, Andrea Antelman, Gretchen DeLuca, Nicolas Muhenje, Odylia Sheriff, Muhsin Somi, Geoffrey Katuta, Frieda Cherutich, Peter Moore, Janet US Ctr Dis Control & Prevent Div Global HIV AIDS 1600 Clifton RdMS E04 Atlanta GA 30333 USA US Ctr Dis Control & Prevent Div Global HIV AIDS Dar Es Salaam Tanzania Columbia Univ ICAP New York NY USA Columbia Univ ICAP Tanzania Dar Es Salaam Tanzania US Ctr Dis Control & Prevent Div Global HIV AIDS Windhoek Namibia US Ctr Dis Control & Prevent Div Global HIV AIDS Nairobi Kenya Columbia Univ ICAP Kenya Nairobi Kenya Minist Hlth & Social Welf Dar Es Salaam Tanzania Minist Hlth & Social Serv Windhoek Namibia Natl AIDS STD Control Programme NASCOP Nairobi Kenya

We conducted a group randomized trial to assess the feasibility and effectiveness of a multi-component, clinic-based HIV prevention intervention for HIV-positive patients attending clinical care in Namibia, Kenya, and Tanzania. Eighteen HIV care and treatment clinics (six per country) were randomly assigned to intervention or control arms. Approximately 200 sexually active clients from each clinic were enrolled and interviewed at baseline and 6- and 12-months post-intervention. Mixed model logistic regression with random effects for clinic and participant was used to assess the effectiveness of the intervention. Of 3522 HIV-positive patients enrolled, 3034 (86 %) completed a 12-month follow-up interview. Intervention participants were significantly more likely to report receiving provider-delivered messages on disclosure, partner testing, family planning, alcohol reduction, and consistent condom use compared to participants in comparison clinics. Participants in intervention clinics were less likely to report unprotected sex in the past 2 weeks (OR = 0.56, 95 % CI 0.32, 0.99) compared to participants in comparison clinics. In Tanzania, a higher percentage of participants in intervention clinics (17 %) reported using a highly effective method of contraception compared to participants in comparison clinics (10 %, OR = 2.25, 95 % CI 1.24, 4.10). This effect was not observed in Kenya or Namibia. HIV prevention services are feasible to implement as part of routine care and are associated with a self-reported decrease in unprotected sex. Further operational research is needed to identify strategies to address common operational challenges including staff turnover and large patient volumes.

关键词： HIV/aids Sub-Saharan Africa HIV prevention People living with HIV

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