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Browsing by Author "Kamanga, Gift"
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Item Blood and genital fluid viral load trajectories among treated and untreated persons with acute HIV infection in Malawi(Wolters Kluwer, 2022) Chen, Jane S.; Pettifor, Audrey E.; Nelson, Julie A. E.; Phiri, Sam; Pasquale, Dana K.; Kumwenda, Wiza; Kamanga, Gift; Cottrell, Mackenzie L.; Sykes, Craig; Kashuba, Angela D. M.; Tegha, Gerald; Krysiak, Robert; Thengolose, Isaac; Cohen, Myron S.; Hoffman, Irving F.; Miller, William C.; Rutstein, Sarah E.; Global Health, School of Public HealthBackground: Persons with acute HIV infection (AHI) are highly infectious and responsible for a disproportionate share of incident infections. Immediate antiretroviral therapy (ART) rapidly reduces blood viral loads (VLs), but genital VLs after ART initiation during AHI are less well described. Setting: Lilongwe, Malawi, 2012-2014. Methods: HIV-seronegative and HIV-serodiscordant persons aged ≥18 years were screened for AHI (RNA positive) and randomized to standard of care, behavioral intervention, or behavioral intervention plus short-term ART (raltegravir/emtricitabine/tenofovir) (1:2:2). Persons who were ART eligible under Malawi guidelines could receive first-line therapy. Blood and genital VLs were assessed at weeks 1, 4, 8, and 12. Fisher's Exact test was used to compare viral suppression by ART status. Results: Overall, 46 persons with AHI were enrolled; of whom, 17 started ART within 12 weeks. Median blood VL at AHI diagnosis was 836,115 copies/mL. At week 12, 7% (1/14) of those who initiated ART had a blood VL of ≥400 copies/mL, compared with 100% (23/23; P < 0.0001) of those who did not initiate ART (median VL: 61,605 copies/mL). Median genital VL at week 1 was 772 copies/mL, with 13 of 22 (59%) having VL of ≥400 copies/mL. At week 12, 0 of 10 (0%) of those who initiated ART had genital VL of ≥400 copies/mL, compared with 7 of 15 (47%) of those who did not initiate ART (P = 0.02). Conclusion: Although highly correlated, VLs in blood and genital fluids occupy discrete biological compartments with distinct virologic dynamics. Our results corroborate the dramatic reduction in both compartments after ART initiation. Increasing AHI screening and rapidly initiating treatment is key to interrupting transmission.Item Towards Achieving the 95% Treatment Coverage for Hard-to-Reach Populations Living with HIV and AIDS in Lusaka, Zambia Using Community Retail Pharmacies to Improve Access to Antiretroviral Therapy(2023-08) Magomana, Trymore; Tierney, William M.; Yego, Faith; Kamanga, Gift; Pastakia, Sonak D.Objective: The HIV and AIDS epidemic still contributes to high mortality and morbidity in Zambia. Antiretroviral (ART) is the backbone of HIV epidemic control. Current ART delivery models have multiple barriers to access and availability. This study explored the feasibility of implementing ART delivery through private retail community pharmacies in Zambia's urban settings based on key stakeholders' perceptions. Methods: This qualitative study utilized a mix of focus group discussions and key informant interviews. Three focus group discussions were conducted with pharmacists practicing in Zambia. Three key informant interviews were conducted with NGO representatives whose primary work is in HIV and AIDS treatment, testing, and prevention. Two key informant interviews were conducted with government representatives from the Zambia MOH involved in HIV and AIDS treatment, testing, and prevention. Deductive theme generation based on research questions was used to analyze the data collected from key informant interviews and focus group discussions. Results: Implementation of ART delivery through private retail community pharmacies in urban settings in Zambia is feasible. Participant perceptions focused on mechanisms, policies, and considerations that must be addressed to implement ART delivery through private retail community pharmacies successfully. Participants indicated that implementing ART delivery through private retail pharmacies requires funding continuing education for participating pharmacists, capacity building for pharmacy infrastructure, and linkage of ART delivery to other HIV and AIDS services like counseling, dieting and nutrition, and viral load monitoring. Conclusion: This study generated new information on the attitudes and perspectives of stakeholders about implementing ART delivery through private retail community pharmacies in Zambia. Implementing ART distribution in private retail community pharmacies in Zambia is feasible, provided key implementation determinants are addressed. The implementation of ART delivery through private retail community pharmacies will help address challenges associated with Zambia's current ART delivery models and improve ART access and coverage.