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Clinical and socio-demographic predictors for virologic failure in rural Southern Africa: preliminary findings from CART-1.

ABSTRACT: In 2013, the World Health Organization (WHO) recommended scaling up of routine viral load (VL) monitoring for patients on antiretroviral therapy (ART) in resource-limited settings [1]. During the transition phase from no VL-testing at all to routine VL-monitoring, targeted VL for groups at particular risk of virologic failure (VF) may be an option [2]. We present socio-demographic and clinical risk factors for VF in a cohort in rural Lesotho with no access to VL prior to the study.Data derive from a cross-sectional study providing multi-disease screening as well as VL testing to adult patients (?16 years old) on first-line ART ?6 months [3]. VF was defined as VL?1000 copies/mL. Assessed potential predictors of VF were: (1) socio-demographic (sex, age, wealth-quintile, education, employment status, disclosure of HIV status to environment, travel-time to facility); (2) treatment history (history of treatment interruption >2 days, previous drug substitution within first-line ART, time on ART, ART-base and -backbone); (3) adherence (pill count) and (4) clinical (clinical or immunological failure as defined by WHO guidelines [1], presence of papular pruritic eruption (PPE)). All variables with association to VF in univariate analysis were included in a multivariate logistic regression reporting adjusted Odds ratios (aOR).Data from 1,488 patients were analyzed. Overall VF-prevalence was 6.9% (95% CI 5.7-8.3). In univariate analysis, the following were associated with VF: age <30, lower wealth-quintile, no primary education, history of treatment interruption, nevirapine-base, zidovudine-backbone, history of drug substitution, travel-time to clinic ?2 hours, disclosure of HIV status to <5 persons, clinical failure, presence of PPE and immunological failure. In multivariate analysis, 6 out of the above 12 variables were independent predictors: age <30 years (aOR: 2.4; 95% CI 1.1-5.3, p=0.029), history of treatment interruption (2.5; 1.3-4.7, p=0.005), PPE (6.9; 2.5-18.9, p<0.001), immunological failure (11.5; 5.7-23.2, p<0.001), history of drug substitution (1.9; 1.0-3.7, p=0.043), disclosure of HIV status to <5 persons (1.8; 1.1-3.1, p=0.03).In this cohort in rural Lesotho, several socio-demographic and clinical predictors were associated with VF. Particularly age <30 years, history of treatment interruption, PPE and immunological failure were strongly associated with VF. These patients may be prioritized for targeted VL-testing.

SUBMITTER: Labhardt ND

PROVIDER: S-EPMC4225252 | biostudies-other | 2014

REPOSITORIES: biostudies-other

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Clinical and socio-demographic predictors for virologic failure in rural Southern Africa: preliminary findings from CART-1.

Labhardt Niklaus Daniel ND Bader Joëlle J Ramoeletsi Mojakisane M Kamele Mashaete M Lejone Thabo Ismael TI Cheleboi Molisana M Motlatsi Mokete M MM Ehmer Jochen J Faturyiele Olatunbosun O Puga Daniel D Klimkait Thomas T

Journal of the International AIDS Society 20141102 4 Suppl 3

<h4>Introduction</h4>In 2013, the World Health Organization (WHO) recommended scaling up of routine viral load (VL) monitoring for patients on antiretroviral therapy (ART) in resource-limited settings [1]. During the transition phase from no VL-testing at all to routine VL-monitoring, targeted VL for groups at particular risk of virologic failure (VF) may be an option [2]. We present socio-demographic and clinical risk factors for VF in a cohort in rural Lesotho with no access to VL prior to the ...[more]

PMID: 25397416

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Project description:Reliable statistics on maternal morbidity and mortality are scarce in low and middle-income countries, especially in rural areas. This is the case in Mozambique where many births happen at home. Furthermore, a sizeable number of facility births have inadequate registration. Such information is crucial for developing effective national and global health policies for maternal and child health. The aim of this study was to generate reliable baseline socio-demographic information on women of reproductive age as well as to establish a demographic surveillance platform to support the planning and implementation of the Community Level Intervention for Pre-eclampsia (CLIP) study, a cluster randomized controlled trial. This study represents a census of all women of reproductive age (12-49 years) in twelve rural communities in Maputo and Gaza provinces of Mozambique. The data were collected through electronic forms implemented in Open Data Kit (ODK) (an app for android based tablets) and household and individual characteristics. Verbal autopsies were conducted on all reported maternal deaths to determine the underlying cause of death. Between March and October 2014, 50,493 households and 80,483 women of reproductive age (mean age 26.9 years) were surveyed. A total of 14,617 pregnancies were reported in the twelve months prior to the census, resulting in 9,029 completed pregnancies. Of completed pregnancies, 8,796 resulted in live births, 466 resulted in stillbirths and 288 resulted in miscarriages. The remaining pregnancies had not yet been completed during the time of the survey (5,588 pregnancies). The age specific fertility indicates that highest rate (188 live births per 1,000 women) occurs in the age 20-24 years old. The estimated stillbirth rate was 50.3/1,000 live and stillbirths; neonatal mortality rate was 13.3/1,000 live births and maternal mortality ratio was 204.6/100,000 live births. The most common direct cause of maternal death was eclampsia and tuberculosis was the most common indirect cause of death. This study found that fertility rate is high at age 20-24 years old. Pregnancy in the advanced age (>35 years of age) in this study was associated with higher poor outcomes such as miscarriage and stillbirth. The study also found high stillbirth rate indicating a need for increased attention to maternal health in southern Mozambique. Tuberculosis and HIV/AIDS are prominent indirect causes of maternal death, while eclampsia represents the number one direct obstetric cause of maternal deaths in these communities. Additional efforts to promote safe motherhood and improve child survival are crucial in these communities.

Project description:Due to its side effects stavudine (D4T) has been replaced by zidovudine (AZT) and tenofovir (TDF) in most low- and middle-income countries (LMICs). In 2014 about 38% of adult first-line regimens contain AZT and 62% TDF [1]. Whereas the unfavourable metabolic outcomes of D4T in comparison to TDF have been described extensively, studies from LMICs comparing metabolic profiles between patients on AZT and TDF are scarce. Given the high number of patients in LMICs still taking AZT, data on their metabolic profile are needed. We present rates of metabolic syndrome (MS) in adult patients taking either AZT- or TDF-containing first-line, non-nucleoside reverse transcriptase (NNRTI)-based regimens.Data derived from a cross-sectional multi-disease screening conducted in ten facilities in two rural districts of Lesotho, Southern Africa [2]. Patients were eligible if aged ?25 years and on NNRTI-containing first-line ART ?6 months. The MS definition for Africa of the International Diabetes Federation was applied [3]. Assessed potential predictors for MS were age, time on ART, virologic suppression, body-mass index (BMI), alcohol consumption, wealth quintile, NNRTI (nevirapine (NVP) or Efavirenz (EFV)), history of previous D4T exposure and ART-backbone (AZT or TDF). Statistical analyses - stratified for sex - comprised univariate logistic regression for each predictor variable with subsequent construction of a multivariate model including all predictors with an association to MS at a significance level<0.1 in univariate analysis.Out of 1026 patients, 660 (64.3%) were female. MS prevalence was 9.8% (95% CI 6.9-13.4) in men and 22.9% (19.7-26.3) in women. In women, aged ?35 years, AZT-backbone, NVP-base, BMI ?25kg/m2 and taking ART for ?4.5 years were associated with MS in univariate analysis. In the multivariate model only AZT (adjusted odds-ratio: 2.2, 95% CI 1.4-3.6; p=0.001) and BMI ?25kg/m2 (9.8; 2.8-34.1, p<0.001) were associated with MS. For men, age, higher wealth quintile, history of D4T exposure and BMI were associated with MS in univariate analysis. In the multivariate model only a BMI ?25kg/m2 was associated with MS (8.9; 3.8-20.9, p<0.001).In rural Lesotho, Southern Africa, the use of AZT instead of TDF among women who are on ART for ?6 months predisposes to the development of metabolic syndrome. Given that, still 38% of first-line regimens in LMIC contain AZT, this finding needs to be verified in other settings in Sub-Saharan Africa.

Project description:BackgroundPertussis is a toxin-mediated respiratory illness caused by Bordetella pertussis that can result in severe complications and death, particularly in infants. Between 2008 and 2011, children less than 3 months old accounted for 83% of the pertussis deaths in the United States. Understanding the geographic disparities in the distribution of pertussis risk and identifying high risk geographic areas is necessary for guiding resource allocation and public health control strategies. Therefore, this study investigated geographic disparities and temporal changes in pertussis risk in Florida from 2010 to 2018. It also investigated socioeconomic and demographic predictors of the identified disparities.MethodsPertussis data covering the time period 2010-2018 were obtained from Florida HealthCHARTS web interface. Spatial patterns and temporal changes in geographic distribution of pertussis risk were assessed using county-level choropleth maps for the time periods 2010-2012, 2013-2015, 2016-2018 and 2010-2018. Tango's flexible spatial scan statistics were used to identify high-risk spatial clusters which were displayed in maps. Ordinary least squares (OLS) regression was used to identify significant predictors of county-level risk. Residuals of the OLS model were assessed for model assumptions including spatial autocorrelation.ResultsCounty-level pertussis risk varied from 0 to 116.31 cases per 100,000 people during the study period. A total of 11 significant (p < 0.05) spatial clusters were identified with risk ratios ranging from 1.5 to 5.8. Geographic distribution remained relatively consistent over time with areas of high risk persisting in the western panhandle, northeastern coast, and along the western coast. Although county level pertussis risks generally increased from 2010-2012 to 2013-2015, risk tended to be lower during the 2016-2018 time period. Significant predictors of county-level pertussis risk were rurality, percentage of females, and median income. Counties with high pertussis risk tended to be rural (p = 0.021), those with high median incomes (p = 0.039), and those with high percentages of females (p < 0.001).ConclusionThere is evidence that geographic disparities exist and have persisted over time in Florida. This study highlights the application and importance of Geographic Information Systems (GIS) technology and spatial statistical/epidemiological tools in identifying areas of highest disease risk so as to guide resource allocation to reduce health disparities and improve health for all.

Project description:INTRODUCTION:Globally, sub-Saharan Africa (SSA) bears the highest proportion of women with unmet need for contraception as nearly 25% of women of reproductive age in the sub-region have unmet need for contraception. Unmet need for contraception is predominant among young women. We examined the association between socio-economic and demographic factors and unmet need for contraception among young women in SSA. METHODS:Data for this study obtained from current Demographic and Health Surveys (DHS) conducted between January 1, 2010 and December 31, 2018 in 30 sub-Saharan African countries. The sample size consisted of young women (aged 15-24), who were either married or cohabiting and had complete cases on all the variables of interest (N?=?59,864). Both bivariate and multivariable binary logistic regression analyses were performed using STATA version 14.0. RESULTS:The overall prevalence of unmet need for contraception among young women was 26.90% [95% CI: 23.82-29.921], ranging from 11.30% [95% CI: 5.1-17.49] in Zimbabwe to 46.7% [95% CI: 36.92-56.48] in Comoros. Results on socio-economic status and unmet need for contraception showed that young women who had primary [aOR?=?1.18; CI?=?1.12-1.25, p?<?0.001] and secondary/higher levels of formal education [aOR?=?1.27; CI?=?1.20-1.35, p?<?0.001] had higher odds of unmet need for contraception compared to those with no formal education. With wealth status, young women in the richest wealth quintile had lower odds of unmet need for contraception compared with those in the poorest wealth quintile [aOR?=?0.89; CI?=?0.81-0.97, p?<?0.01]. With the demographic factors, the odds of unmet need for contraception was lower among young women aged 20-24 [aOR?=?0.74; CI?=?0.70-0.77, p?<?0.001], compared with 15-19 aged young women. Also, young women who were cohabiting had higher odds of unmet need for contraception compared to those who were married [aOR?=?1.35; CI?=?1.28-1.43, p?<?0.001]. CONCLUSION:Our study has demonstrated that unmet need for contraception is relatively high among young women in SSA and this is associated with socio-economic status. Age, marital status, parity, occupation, sex of household head, and access to mass media (newspaper) are also associated with unmet need for contraception. It is therefore, prudent that organisations such as UNICEF and UNFPA and the Bill & Melinda Gates Foundation who have implemented policies and programmes on contraception meant towards reducing unmet need for contraception among women take these factors into consideration when designing interventions in sub-Saharan African countries to address the problem of high unmet need for contraception among young women.

Project description:BackgroundHousehold food insecurity is a potent social determinant of health and health care costs in Canada, but understanding of the social and economic conditions that underlie households' vulnerability to food insecurity is limited.MethodsData from the 2011-12 Canadian Community Health Survey were used to determine predictors of household food insecurity among a nationally-representative sample of 120,909 households. Household food insecurity over the past 12 months was assessed using the 18-item Household Food Security Survey Module. Households were classified as food secure or marginally, moderately, or severely food insecure based on the number of affirmative responses. Multivariable binary and multinomial logistic regression analyses were used to determine geographic and socio-demographic predictors of presence and severity of household food insecurity.ResultsThe prevalence of household food insecurity ranged from 11.8% in Ontario to 41.0% in Nunavut. After adjusting for socio-demographic factors, households' odds of food insecurity were lower in Quebec and higher in the Maritimes, territories, and Alberta, compared to Ontario. The adjusted odds of food insecurity were also higher among households reliant on social assistance, Employment Insurance or workers' compensation, those without a university degree, those with children under 18, unattached individuals, renters, and those with an Aboriginal respondent. Higher income, immigration, and reliance on seniors' income sources were protective against food insecurity. Living in Nunavut and relying on social assistance were the strongest predictors of severe food insecurity, but severity was also associated with income, education, household composition, Aboriginal status, immigration status, and place of residence. The relation between income and food insecurity status was graded, with every $1000 increase in income associated with 2% lower odds of marginal food insecurity, 4% lower odds of moderate food insecurity, and 5% lower odds of severe food insecurity.ConclusionsThe probability of household food insecurity in Canada and the severity of the experience depends on a household's province or territory of residence, income, main source of income, housing tenure, education, Aboriginal status, and household structure. Our findings highlight the intersection of household food insecurity with public policy decisions in Canada and the disproportionate burden of food insecurity among Indigenous peoples.

Dataset Information

Clinical and socio-demographic predictors for virologic failure in rural Southern Africa: preliminary findings from CART-1.

Publications

Clinical and socio-demographic predictors for virologic failure in rural Southern Africa: preliminary findings from CART-1.

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