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Prevalence, predictors, and management of advanced HIV disease among individuals initiating ART in Senegal, West Africa

BACKGROUND: The WHO guidelines for the management of advanced HIV disease recommend a package of care consisting of rapid initiation of antiretroviral therapy (ART), enhanced screening and diagnosis of tuberculosis (TB) and cryptococcal meningitis, co-trimoxazole prophylaxis, isoniazid preventive th...

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Autores principales: Benzekri, Noelle A., Sambou, Jacques F., Ndong, Sanou, Tamba, Ibrahima Tito, Faye, Dominique, Diallo, Mouhamadou Baïla, Diatta, Jean Phillippe, Faye, Khadim, Sall, Ibrahima, Sall, Fatima, Manga, Noël Magloire, Malomar, Jean Jacques, Ndour, Cheikh T., Hawes, Stephen E., Seydi, Moussa, Gottlieb, Geoffrey S.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6420737/
https://www.ncbi.nlm.nih.gov/pubmed/30876400
http://dx.doi.org/10.1186/s12879-019-3826-5
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author Benzekri, Noelle A.
Sambou, Jacques F.
Ndong, Sanou
Tamba, Ibrahima Tito
Faye, Dominique
Diallo, Mouhamadou Baïla
Diatta, Jean Phillippe
Faye, Khadim
Sall, Ibrahima
Sall, Fatima
Manga, Noël Magloire
Malomar, Jean Jacques
Ndour, Cheikh T.
Hawes, Stephen E.
Seydi, Moussa
Gottlieb, Geoffrey S.
author_facet Benzekri, Noelle A.
Sambou, Jacques F.
Ndong, Sanou
Tamba, Ibrahima Tito
Faye, Dominique
Diallo, Mouhamadou Baïla
Diatta, Jean Phillippe
Faye, Khadim
Sall, Ibrahima
Sall, Fatima
Manga, Noël Magloire
Malomar, Jean Jacques
Ndour, Cheikh T.
Hawes, Stephen E.
Seydi, Moussa
Gottlieb, Geoffrey S.
author_sort Benzekri, Noelle A.
collection PubMed
description BACKGROUND: The WHO guidelines for the management of advanced HIV disease recommend a package of care consisting of rapid initiation of antiretroviral therapy (ART), enhanced screening and diagnosis of tuberculosis (TB) and cryptococcal meningitis, co-trimoxazole prophylaxis, isoniazid preventive therapy (IPT), fluconazole pre-emptive therapy, and adherence support. The goals of this study were to determine the prevalence of advanced HIV disease among individuals initiating ART in Senegal, to identify predictors of advanced disease, and to evaluate adherence to the WHO guidelines. METHODS: This study was conducted among HIV-positive individuals initiating ART in Dakar and Ziguinchor, Senegal. Clinical evaluations, laboratory analyses, questionnaires and chart review were conducted. Logistic regression was used to identify predictors of advanced disease. RESULTS: A total of 198 subjects were enrolled; 70% were female. The majority of subjects (71%) had advanced HIV disease, defined by the WHO as a CD4 count < 200 cells/mm(3) or clinical stage 3 or 4. The median CD4 count was 185 cells/mm(3). The strongest predictors of advanced disease were age ≥ 35 (OR 5.80, 95%CI 2.35–14.30) and having sought care from a traditional healer (OR 3.86, 95%CI 1.17–12.78). Approximately one third of subjects initiated ART within 7 days of diagnosis. Co-trimoxazole prophylaxis was provided to 65% of subjects with CD4 counts ≤350 cells/mm(3) or stage 3 or 4 disease. TB symptom screening was available for 166 subjects; 54% reported TB symptoms. Among those with TB symptoms, 39% underwent diagnostic evaluation. Among those eligible for IPT, one subject received isoniazid. No subjects underwent CrAg screening or received fluconazole to prevent cryptococcal meningitis. CONCLUSIONS: This is the first study to report an association between seeking care from a traditional healer and presentation with WHO defined advanced disease in sub-Saharan Africa. Given the widespread use of traditional healers in sub-Saharan Africa, future studies to further explore this finding are indicated. Although the majority of individuals in this study presented with advanced disease and warranted management according to WHO guidelines, there were numerous missed opportunities to prevent HIV-associated morbidity and mortality. Programmatic evaluation is needed to identify barriers to implementation of the WHO guidelines and enhanced funding for operational research is indicated.
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spelling pubmed-64207372019-03-28 Prevalence, predictors, and management of advanced HIV disease among individuals initiating ART in Senegal, West Africa Benzekri, Noelle A. Sambou, Jacques F. Ndong, Sanou Tamba, Ibrahima Tito Faye, Dominique Diallo, Mouhamadou Baïla Diatta, Jean Phillippe Faye, Khadim Sall, Ibrahima Sall, Fatima Manga, Noël Magloire Malomar, Jean Jacques Ndour, Cheikh T. Hawes, Stephen E. Seydi, Moussa Gottlieb, Geoffrey S. BMC Infect Dis Research Article BACKGROUND: The WHO guidelines for the management of advanced HIV disease recommend a package of care consisting of rapid initiation of antiretroviral therapy (ART), enhanced screening and diagnosis of tuberculosis (TB) and cryptococcal meningitis, co-trimoxazole prophylaxis, isoniazid preventive therapy (IPT), fluconazole pre-emptive therapy, and adherence support. The goals of this study were to determine the prevalence of advanced HIV disease among individuals initiating ART in Senegal, to identify predictors of advanced disease, and to evaluate adherence to the WHO guidelines. METHODS: This study was conducted among HIV-positive individuals initiating ART in Dakar and Ziguinchor, Senegal. Clinical evaluations, laboratory analyses, questionnaires and chart review were conducted. Logistic regression was used to identify predictors of advanced disease. RESULTS: A total of 198 subjects were enrolled; 70% were female. The majority of subjects (71%) had advanced HIV disease, defined by the WHO as a CD4 count < 200 cells/mm(3) or clinical stage 3 or 4. The median CD4 count was 185 cells/mm(3). The strongest predictors of advanced disease were age ≥ 35 (OR 5.80, 95%CI 2.35–14.30) and having sought care from a traditional healer (OR 3.86, 95%CI 1.17–12.78). Approximately one third of subjects initiated ART within 7 days of diagnosis. Co-trimoxazole prophylaxis was provided to 65% of subjects with CD4 counts ≤350 cells/mm(3) or stage 3 or 4 disease. TB symptom screening was available for 166 subjects; 54% reported TB symptoms. Among those with TB symptoms, 39% underwent diagnostic evaluation. Among those eligible for IPT, one subject received isoniazid. No subjects underwent CrAg screening or received fluconazole to prevent cryptococcal meningitis. CONCLUSIONS: This is the first study to report an association between seeking care from a traditional healer and presentation with WHO defined advanced disease in sub-Saharan Africa. Given the widespread use of traditional healers in sub-Saharan Africa, future studies to further explore this finding are indicated. Although the majority of individuals in this study presented with advanced disease and warranted management according to WHO guidelines, there were numerous missed opportunities to prevent HIV-associated morbidity and mortality. Programmatic evaluation is needed to identify barriers to implementation of the WHO guidelines and enhanced funding for operational research is indicated. BioMed Central 2019-03-15 /pmc/articles/PMC6420737/ /pubmed/30876400 http://dx.doi.org/10.1186/s12879-019-3826-5 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Benzekri, Noelle A.
Sambou, Jacques F.
Ndong, Sanou
Tamba, Ibrahima Tito
Faye, Dominique
Diallo, Mouhamadou Baïla
Diatta, Jean Phillippe
Faye, Khadim
Sall, Ibrahima
Sall, Fatima
Manga, Noël Magloire
Malomar, Jean Jacques
Ndour, Cheikh T.
Hawes, Stephen E.
Seydi, Moussa
Gottlieb, Geoffrey S.
Prevalence, predictors, and management of advanced HIV disease among individuals initiating ART in Senegal, West Africa
title Prevalence, predictors, and management of advanced HIV disease among individuals initiating ART in Senegal, West Africa
title_full Prevalence, predictors, and management of advanced HIV disease among individuals initiating ART in Senegal, West Africa
title_fullStr Prevalence, predictors, and management of advanced HIV disease among individuals initiating ART in Senegal, West Africa
title_full_unstemmed Prevalence, predictors, and management of advanced HIV disease among individuals initiating ART in Senegal, West Africa
title_short Prevalence, predictors, and management of advanced HIV disease among individuals initiating ART in Senegal, West Africa
title_sort prevalence, predictors, and management of advanced hiv disease among individuals initiating art in senegal, west africa
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6420737/
https://www.ncbi.nlm.nih.gov/pubmed/30876400
http://dx.doi.org/10.1186/s12879-019-3826-5
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