Journal Article > Short ReportFull Text
Morbidity and Mortality Weekly Report. 2015 May 22
Browne L, Menkir Z, Kahi V, Maina G, Asnakew S, et al.
Morbidity and Mortality Weekly Report. 2015 May 22
In early April 2014, two South Sudanese refugees in the Gambella region of western Ethiopia experienced acute onset of jaundice, accompanied by fever. One patient was a pregnant woman aged 24 years evaluated at a routine prenatal clinic visit in Leitchour refugee camp. The second patient was a malnourished boy aged 1 year who resided in Tierkidi refugee camp. The boy died despite hospitalization. During the last 2 weeks of May, four more cases of acute jaundice syndrome (AJS), defined as yellow discoloration of the eyes, were detected in Leitchuor. By mid-June, an additional 50 AJS cases were reported across three large camps in the region, Kule, Leitchuor, and Tierkidi, with 45 (90%) of these cases reported in Leitchuor. Sera collected from a convenience sample of 21 AJS cases were sent to Addis Ababa and Nairobi for real-time polymerase chain reaction testing; 12 (57%) were positive for hepatitis E virus (HEV) RNA. By January 2015, a total of 1,117 suspected cases of hepatitis E meeting the case definition of AJS were reported among refugees in camps across Gambella.
Journal Article > ReviewFull Text
Curr Opin HIV AIDS. 2017 May 1; Volume 12 (Issue 3); DOI:10.1097/COH.0000000000000370
Easterbrook PJ, Roberts TR, Sands A, Peeling RW
Curr Opin HIV AIDS. 2017 May 1; Volume 12 (Issue 3); DOI:10.1097/COH.0000000000000370
Journal Article > CommentaryAbstract
Int J Drug Policy. 2015 May 18; Volume 26 (Issue 11); DOI:10.1016/j.drugpo.2015.05.004
Ford NP, Wiktor SZ, Kaplan K, Andrieux-Meyer I, Hill AM, et al.
Int J Drug Policy. 2015 May 18; Volume 26 (Issue 11); DOI:10.1016/j.drugpo.2015.05.004
Journal Article > Meta-AnalysisFull Text
Lancet Infect Dis. 2015 May 5; Volume 15 (Issue 7); DOI:10.1016/S1473-3099(15)00006-7
Rao VB, Johari N, du Cros PAK, Messina J, Ford NP, et al.
Lancet Infect Dis. 2015 May 5; Volume 15 (Issue 7); DOI:10.1016/S1473-3099(15)00006-7
An estimated 150 million people worldwide are infected with hepatitis C virus (HCV). HIV co-infection accelerates the progression of HCV and represents a major public health challenge. We aimed to determine the epidemiology of HCV and the prevalence of HIV co-infection in sub-Saharan Africa.
Journal Article > ResearchFull Text
BMC Infect Dis. 2018 April 11; Volume 18 (Issue 1); 172.; DOI:10.1186/s12879-018-3073-1
le Polain de Waroux O, Cohuet S, Ndazima D, Kucharski AJ, Juan-Giner A, et al.
BMC Infect Dis. 2018 April 11; Volume 18 (Issue 1); 172.; DOI:10.1186/s12879-018-3073-1
BACKGROUND
Quantification of human interactions relevant to infectious disease transmission through social contact is central to predict disease dynamics, yet data from low-resource settings remain scarce.
METHODS
We undertook a social contact survey in rural Uganda, whereby participants were asked to recall details about the frequency, type, and socio-demographic characteristics of any conversational encounter that lasted for ≥5 min (henceforth defined as 'contacts') during the previous day. An estimate of the number of 'casual contacts' (i.e. < 5 min) was also obtained.
RESULTS
In total, 566 individuals were included in the study. On average participants reported having routine contact with 7.2 individuals (range 1-25). Children aged 5-14 years had the highest frequency of contacts and the elderly (≥65 years) the fewest (P < 0.001). A strong age-assortative pattern was seen, particularly outside the household and increasingly so for contacts occurring further away from home. Adults aged 25-64 years tended to travel more often and further than others, and males travelled more frequently than females.
CONCLUSION
Our study provides detailed information on contact patterns and their spatial characteristics in an African setting. It therefore fills an important knowledge gap that will help more accurately predict transmission dynamics and the impact of control strategies in such areas.
Quantification of human interactions relevant to infectious disease transmission through social contact is central to predict disease dynamics, yet data from low-resource settings remain scarce.
METHODS
We undertook a social contact survey in rural Uganda, whereby participants were asked to recall details about the frequency, type, and socio-demographic characteristics of any conversational encounter that lasted for ≥5 min (henceforth defined as 'contacts') during the previous day. An estimate of the number of 'casual contacts' (i.e. < 5 min) was also obtained.
RESULTS
In total, 566 individuals were included in the study. On average participants reported having routine contact with 7.2 individuals (range 1-25). Children aged 5-14 years had the highest frequency of contacts and the elderly (≥65 years) the fewest (P < 0.001). A strong age-assortative pattern was seen, particularly outside the household and increasingly so for contacts occurring further away from home. Adults aged 25-64 years tended to travel more often and further than others, and males travelled more frequently than females.
CONCLUSION
Our study provides detailed information on contact patterns and their spatial characteristics in an African setting. It therefore fills an important knowledge gap that will help more accurately predict transmission dynamics and the impact of control strategies in such areas.
Journal Article > ResearchFull Text
PLOS One. 2015 November 10; Volume 10 (Issue 11); e0142873.; DOI:10.1371/journal.pone.0142873
Daniels J, Khogali MA, Mohr E, Cox V, Moyo S, et al.
PLOS One. 2015 November 10; Volume 10 (Issue 11); e0142873.; DOI:10.1371/journal.pone.0142873
SETTING
Khayelitsha, South Africa, with high burdens of rifampicin-resistant tuberculosis (RR-TB) and HIV co-infection.
OBJECTIVE
To describe time to antiretroviral treatment (ART) initiation among HIV-infected RR-TB patients initiating RR-TB treatment and to assess the association between time to ART initiation and treatment outcomes.
DESIGN
A retrospective cohort study of patients with RR-TB and HIV co-infection not on ART at RR-TB treatment initiation.
RESULTS
Of the 696 RR-TB and HIV-infected patients initiated on RR-TB treatment between 2009 and 2013, 303 (44%) were not on ART when RR-TB treatment was initiated. The median CD4 cell count was 126 cells/mm3. Overall 257 (85%) patients started ART during RR-TB treatment, 33 (11%) within 2 weeks, 152 (50%) between 2-8 weeks and 72 (24%) after 8 weeks. Of the 46 (15%) who never started ART, 10 (21%) died or stopped RR-TB treatment within 4 weeks and 16 (37%) had at least 4 months of RR-TB treatment. Treatment success and mortality during treatment did not vary by time to ART initiation: treatment success was 41%, 43%, and 50% among patients who started ART within 2 weeks, between 2-8 weeks, and after 8 weeks (p = 0.62), while mortality was 21%, 13% and 15% respectively (p = 0.57). Mortality was associated with never receiving ART (adjusted hazard ratio (aHR) 6.0, CI 2.1-18.1), CD4 count ≤100 (aHR 2.1, CI 1.0-4.5), and multidrug-resistant tuberculosis (MDR-TB) with second-line resistance (aHR 2.5, CI 1.1-5.4).
CONCLUSIONS
Despite wide variation in time to ART initiation among RR-TB patients, no differences in mortality or treatment success were observed. However, a significant proportion of patients did not initiate ART despite receiving >4 months of RR-TB treatment. Programmatic priorities should focus on ensuring all patients with RR-TB/HIV co-infection initiate ART regardless of CD4 count, with special attention for patients with CD4 counts ≤ 100 to initiate ART as soon as possible after RR-TB treatment initiation.
Khayelitsha, South Africa, with high burdens of rifampicin-resistant tuberculosis (RR-TB) and HIV co-infection.
OBJECTIVE
To describe time to antiretroviral treatment (ART) initiation among HIV-infected RR-TB patients initiating RR-TB treatment and to assess the association between time to ART initiation and treatment outcomes.
DESIGN
A retrospective cohort study of patients with RR-TB and HIV co-infection not on ART at RR-TB treatment initiation.
RESULTS
Of the 696 RR-TB and HIV-infected patients initiated on RR-TB treatment between 2009 and 2013, 303 (44%) were not on ART when RR-TB treatment was initiated. The median CD4 cell count was 126 cells/mm3. Overall 257 (85%) patients started ART during RR-TB treatment, 33 (11%) within 2 weeks, 152 (50%) between 2-8 weeks and 72 (24%) after 8 weeks. Of the 46 (15%) who never started ART, 10 (21%) died or stopped RR-TB treatment within 4 weeks and 16 (37%) had at least 4 months of RR-TB treatment. Treatment success and mortality during treatment did not vary by time to ART initiation: treatment success was 41%, 43%, and 50% among patients who started ART within 2 weeks, between 2-8 weeks, and after 8 weeks (p = 0.62), while mortality was 21%, 13% and 15% respectively (p = 0.57). Mortality was associated with never receiving ART (adjusted hazard ratio (aHR) 6.0, CI 2.1-18.1), CD4 count ≤100 (aHR 2.1, CI 1.0-4.5), and multidrug-resistant tuberculosis (MDR-TB) with second-line resistance (aHR 2.5, CI 1.1-5.4).
CONCLUSIONS
Despite wide variation in time to ART initiation among RR-TB patients, no differences in mortality or treatment success were observed. However, a significant proportion of patients did not initiate ART despite receiving >4 months of RR-TB treatment. Programmatic priorities should focus on ensuring all patients with RR-TB/HIV co-infection initiate ART regardless of CD4 count, with special attention for patients with CD4 counts ≤ 100 to initiate ART as soon as possible after RR-TB treatment initiation.
Journal Article > ResearchFull Text
BMC Infect Dis. 2011 November 24; Volume 11 (Issue 1); DOI:10.1186/1471-2334-11-327
Heiden D, Saranchuk P
BMC Infect Dis. 2011 November 24; Volume 11 (Issue 1); DOI:10.1186/1471-2334-11-327
AIDS-related CMV retinitis is a common clinical problem in patients with advanced HIV/AIDS in China and Southeast Asia. The disease is causing blindness, and current clinical management, commonly characterized by delayed diagnosis and inadequate treatment, results in poor clinical outcomes: 21% - 36% of eyes with CMV retinitis are already blind at the time the diagnosis is first established by an ophthalmologist. CMV retinitis also identifies a group of patients at extraordinary risk of mortality, and the direct or indirect contribution of extraocular CMV disease to AIDS-related morbidity and mortality is currently unmeasured and clinically often overlooked. The obvious way to improve clinical management of CMV retinitis is to screen all patients with CD4 counts < 100 cells/μL with indirect ophthalmoscopy at the time they first present for care, and to provide systemic treatment with oral valganciclovir when active CMV retinitis is detected. Treatment of opportunistic infections is an integral part of HIV management, and, with appropriate training and support, CMV retinitis screening and treatment can be managed by the HIV clinicians, like all other opportunistic infections. Access to ophthalmologist has been problematic for HIV patients in China, and although non-ophthalmologists can perform screening, sophisticated ophthalmological skills are required for the management of retinal detachment and immune recovery uveitis, the major complications of CMV retinitis. CMV retinitis has been clinically ignored, in part, because of the perceived complexity and expense of treatment, and this obstacle can be removed by making valganciclovir affordable and widely available. Valganciclovir is an essential drug for developing successful programs for management of CMV retinitis in China and throughout SE Asia.
Journal Article > ResearchFull Text
Trop Med Int Health. 2015 January 7; Volume 20 (Issue 4); DOI:10.1111/tmi.12454
Dallatomasinas S, Crestani R, Squire JS, Declerck H, Caleo GNC, et al.
Trop Med Int Health. 2015 January 7; Volume 20 (Issue 4); DOI:10.1111/tmi.12454
To describe Ebola cases in the district Ebola Management Centre of in Kailahun, a remote rural district of Sierra Leone, in terms of geographic origin, patient and hospitalization characteristics, treatment outcomes and time from symptom onset to admission.
Journal Article > CommentaryFull Text
Clin Infect Dis. 2012 March 19; Volume 54 (Issue 10); DOI:10.1093/cid/cis227
Ford NP, Singh K, Cooke GS, Mills EJ, von Schoen-Angerer T, et al.
Clin Infect Dis. 2012 March 19; Volume 54 (Issue 10); DOI:10.1093/cid/cis227
Journal Article > ResearchFull Text
J Clin Microbiol. 2009 June 1; Volume 47 (Issue 6); 1931-3.; DOI:10.1128/JCM.02245-08.
Merens A, Guerin PJ, Guthmann JP, Nicand E
J Clin Microbiol. 2009 June 1; Volume 47 (Issue 6); 1931-3.; DOI:10.1128/JCM.02245-08.
Biological samples collected in refugee camps during an outbreak of hepatitis E were used to compare the accuracy of hepatitis E virus RNA amplification by real-time reverse transcription-PCR (RT-PCR) for sera and dried blood spots (concordance of 90.6%). Biological profiles (RT-PCR and serology) of asymptomatic individuals were also analyzed.