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Browsing by Author "Chimbetete, Cleophas"
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Item Cervical cancer prevention and care in HIV clinics across sub-Saharan Africa: results of a facility-based survey(Wiley, 2024) Asangbeh-Kerman, Serra Lem; Davidović, Maša; Taghavi, Katayoun; Dhokotera, Tafadzwa; Manasyan, Albert; Sharma, Anjali; Jaquet, Antoine; Musick, Beverly; Twizere, Christella; Chimbetete, Cleophas; Murenzi, Gad; Tweya, Hannock; Muhairwe, Josephine; Wools-Kaloustian, Kara; Technau, Karl-Gunter; Anastos, Kathryn; Yotebieng, Marcel; Jousse, Marielle; Ezechi, Oliver; Orang’o, Omenge; Bosomprah, Samuel; Boni, Simon Pierre; Basu, Partha; Bohlius, Julia; IeDEA; Biostatistics and Health Data Science, Richard M. Fairbanks School of Public HealthIntroduction: To eliminate cervical cancer (CC), access to and quality of prevention and care services must be monitored, particularly for women living with HIV (WLHIV). We assessed implementation practices in HIV clinics across sub-Saharan Africa (SSA) to identify gaps in the care cascade and used aggregated patient data to populate cascades for WLHIV attending HIV clinics. Methods: Our facility-based survey was administered between November 2020 and July 2021 in 30 HIV clinics across SSA that participate in the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium. We performed a qualitative site-level assessment of CC prevention and care services and analysed data from routine care of WLHIV in SSA. Results: Human papillomavirus (HPV) vaccination was offered in 33% of sites. Referral for CC diagnosis (42%) and treatment (70%) was common, but not free at about 50% of sites. Most sites had electronic health information systems (90%), but data to inform indicators to monitor global targets for CC elimination in WLHIV were not routinely collected in these sites. Data were collected routinely in only 36% of sites that offered HPV vaccination, 33% of sites that offered cervical screening and 20% of sites that offered pre-cancer and CC treatment. Conclusions: Though CC prevention and care services have long been available in some HIV clinics across SSA, patient and programme monitoring need to be improved. Countries should consider leveraging their existing health information systems and use monitoring tools provided by the World Health Organization to improve CC prevention programmes and access, and to track their progress towards the goal of eliminating CC.Item Comorbidities and HIV-related factors associated with mental health symptoms and unhealthy substance use among older adults living with HIV in low- and middle-income countries: a cross-sectional study(Wiley, 2025) Ross, Jeremy L.; Rupasinghe, Dhanushi; Chanyachukul, Thida; Crabtree Ramírez, Brenda; Murenzi, Gad; Kwobah, Edith; Mureithi, Fiona; Minga, Albert; Marbaniang, Ivan; Perazzo, Hugo; Parcesepe, Angela; Goodrich, Suzanne; Chimbetete, Cleophas; Mensah, Ephrem; Maruri, Fernanda; Nguyen, Dung Thi Hoai; López-Iñiguez, Alvaro; Lancaster, Kathryn; Byakwaga, Helen; Tlali, Mpho; Plaisy, Marie K.; Nimkar, Smita; Moreira, Rodrigo; Anastos, Kathryn; Semeere, Aggrey; Wandeler, Gilles; Jaquet, Antoine; Sohn, Annette; Sentinel Research Network of the International epidemiology Databases to Evaluate AIDS; Medicine, School of MedicineIntroduction: People with HIV (PWH) are vulnerable to mental health and substance use disorders (MSDs), but the extent to which these are associated with other non-communicable diseases in ageing PWH populations remains poorly documented. We assessed comorbidities associated with symptoms of MSD among PWH ≥40 years in the Sentinel Research Network (SRN) of the International epidemiology Database to Evaluate AIDS (IeDEA). Methods: Baseline data collected between June 2020 and September 2022, from 10 HIV clinics in Asia, Latin America and Africa contributing to the SRN, were analysed. Symptoms of MSDs and comorbidities were assessed using standardized questionnaires, anthropometric and laboratory tests, including weight, height, blood pressure, glucose, lipids, chronic viral hepatitis and liver transient elastography. HIV viral load, CD4 count and additional routine clinical data were accessed from participant interview or medical records. HIV and non-HIV clinical associations of mental illness symptoms and unhealthy substance use were analysed using logistic regression. Mental illness symptoms were defined as moderate-to-severe depressive symptoms (PHQ-9 score >9), moderate-to-severe anxiety symptoms (GAD-7 >9) or probable post-traumatic stress disorder (PCL-5 >32). Unhealthy substance use was defined as ASSIST score >3, or AUDIT ≥7 for women (≥8 for men). Results: Of 2614 participants assessed at baseline study visits, 57% were female, median age was 50 years, median CD4 was 548 cells/mm3 and 86% had HIV viral load <1000 copies/ml. Overall, 19% had mental illness symptoms, 15% unhealthy substance use, 49% BMI >25 kg/m2, 38% hypertension, 15% type 2 diabetes, 35% dyslipidaemia, 34% liver disease and 23% history of tuberculosis. BMI >25 and dyslipidaemia were found in 54% and 40% of those with mental illness symptoms compared to 49% and 34% of those without. Mental illness symptoms were not significantly associated with the clinical factors assessed. Unhealthy substance use was more likely among those with dyslipidaemia (OR 1.55, CI 1.16-2.09, p = 0.003), and less likely in those with BMI >25 (OR 0.48, CI 0.30-0.77, p = 0.009). Conclusions: Improved integration of MSD and comorbidity services in HIV clinical settings, and further research on the association between MSD and comorbidities, and care integration among older PWH in low-middle-income countries, are required.Item High Unreported Mortality in Children and Youth (<25 Years) Living With HIV Who Were Lost to Care From Antiretroviral Therapy Programs in Southern Africa: Results From a Multicountry Tracing Study(Wolters Kluwer, 2022-12-15) Nyakato, Patience; Christ, Benedikt; Anderegg, Nanina; Muhairwe, Josephine; Jefferys, Laura; van Dijk, Janneke; Vinikoor, Michael J.; van Lettow, Monique; Chimbetete, Cleophas; Phiri, Sam J.; Egger, Matthias; Ballif, Marie; Yiannoutsos, Constantin T.; Schomaker, Michael; Kassanjee, Reshma; Davies, Mary-Ann; Cornell, Morna; International epidemiology Databases to Evaluate AIDS Southern Africa (IeDEA-SA); Biostatistics and Health Data Science, Richard M. Fairbanks School of Public HealthBackground: Antiretroviral therapy program mortality maybe underestimated if deceased patients are misclassified as lost. Methods: We used two-stage inverse probability weighting to account for probability of being: sampled for tracing and found by the tracer. Results: Among 680 children and youth aged <25 years on antiretroviral therapy who were lost and traced in Southern Africa between October 2017 and November 2019, estimated mortality was high at 9.1% (62/680). After adjusting for measured covariates and within-site clustering, mortality remained lower for young adults aged 20–24 years compared with infants aged <2 years [adjusted hazard ratio: 0.40 (95% confidence interval: 0.31 to 0.51)]. Conclusions: Our study confirms high unreported mortality in children and youth who are lost and the need for tracing to assess vital status among those who are lost to accurately report on program mortality.Item Real-world use and outcomes of dolutegravir-containing antiretroviral therapy in HIV and tuberculosis co-infection: a site survey and cohort study in sub-Saharan Africa(Wiley, 2022) Romo, Matthew L.; Brazier, Ellen; Mahambou-Nsondé, Dominique; De Waal, Reneé; Sekaggya-Wiltshire, Christine; Chimbetete, Cleophas; Muyindike, Winnie R.; Murenzi, Gad; Kunzekwenyika, Cordelia; Tiendrebeogo, Thierry; Muhairwe, Josephine A.; Lelo, Patricia; Dzudie, Anastase; Twizere, Christelle; Rafael, Idiovino; Ezechi, Oliver C.; Diero, Lameck; Yotebieng, Marcel; Fenner, Lukas; Wools-Kaloustian, Kara K.; Shah, N. Sarita; Nash, Denis; International epidemiology Databases to Evaluate AIDS (IeDEA); Medicine, School of MedicineIntroduction: Dolutegravir is being scaled up globally as part of antiretroviral therapy (ART), but for people with HIV and tuberculosis co-infection, its use is complicated by a drug-drug interaction with rifampicin requiring an additional daily dose of dolutegravir. This represents a disadvantage over efavirenz, which does not have a major drug-drug interaction with rifampicin. We sought to describe HIV clinic practices for prescribing concomitant dolutegravir and rifampicin, and characterize virologic outcomes among patients with tuberculosis co-infection receiving dolutegravir or efavirenz. Methods: Within the four sub-Saharan Africa regions of the International epidemiology Databases to Evaluate AIDS consortium, we conducted a site survey (2021) and a cohort study (2015-2021). The cohort study used routine clinical data and included patients newly initiating or already receiving dolutegravir or efavirenz at the time of tuberculosis diagnosis. Patients were followed from tuberculosis diagnosis until viral suppression (<1000 copies/ml), a competing event (switching ART regimen; loss to program/death) or administrative censoring at 12 months. Results: In the survey, 86 of 90 (96%) HIV clinics in 18 countries reported prescribing dolutegravir to patients who were receiving rifampicin as part of tuberculosis treatment, with 77 (90%) reporting that they use twice-daily dosing of dolutegravir, of which 74 (96%) reported having 50 mg tablets available to accommodate twice-daily dosing. The cohort study included 3563 patients in 11 countries, with 67% newly or recently initiating ART. Among patients receiving dolutegravir (n = 465), the cumulative incidence of viral suppression was 58.9% (95% confidence interval [CI]: 54.3-63.3%), switching ART regimen was 4.1% (95% CI: 2.6-6.2%) and loss to program/death was 23.4% (95% CI: 19.7-27.4%). Patients receiving dolutegravir had improved viral suppression compared with patients receiving efavirenz who had a tuberculosis diagnosis before site dolutegravir availability (adjusted subdistribution hazard ratio [aSHR]: 1.47, 95% CI: 1.28-1.68) and after site dolutegravir availability (aSHR 1.28, 95% CI: 1.08-1.51). Conclusions: At a programmatic level, dolutegravir was being widely prescribed in sub-Saharan Africa for people with HIV and tuberculosis co-infection with a dose adjustment for the drug-drug interaction with rifampicin. Despite this more complex regimen, our cohort study revealed that dolutegravir did not negatively impact viral suppression.Item Response to Doherty et al: Early initiation of antiretroviral therapy amongst young children: a long way to go(Wolters Kluwer, 2015-10-01) Koller, Manuel; Patel, Kunjal; Chi, Benjamin H.; Wools-Kaloustian, Kara; Dicko, Fatoumata; Chokephaibulkit, Kulkanya; Chimbetete, Cleophas; Hazra, Rohan; Ayaya, Samual; Leroy, Valeriane; Trong, Huu Khanh; Egger, Huu Khanh; Davies, Mary-Ann; Department of Medicine, IU School of MedicineComment on Early Initiation of Antiretroviral Therapy Among Young Children: A Long Way to Go. [J Acquir Immune Defic Syndr. 2015] Immunodeficiency in children starting antiretroviral therapy in low-, middle-, and high-income countries. [J Acquir Immune Defic Syndr. 2015]