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Browsing by Author "Phiri, Sam"
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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 Impact of Universal Antiretroviral Treatment Eligibility on Rapid Treatment Initiation Among Young Adolescents with Human Immunodeficiency Virus in Sub-Saharan Africa(Oxford Academic, 2020-08) Tymejczyk, Olga; Brazier, Ellen; Wools-Kaloustian, Kara; Davies, Mary-Ann; Dilorenzo, Madeline; Edmonds, Andrew; Vreeman, Rachel; Bolton, Carolyn; Twizere, Christella; Okoko, Nicollate; Phiri, Sam; Nakigozi, Gertrude; Lelo, Patricia; von Groote, Per; Sohn, Annette H.; Nash, Denis; Pediatrics, School of MedicineBackground Young adolescents with perinatally acquired human immunodeficiency virus (HIV) are at risk for poor care outcomes. We examined whether universal antiretroviral treatment (ART) eligibility policies (Treat All) improved rapid ART initiation after care enrollment among 10–14-year-olds in 7 sub-Saharan African countries. Methods Regression discontinuity analysis and data for 6912 patients aged 10–14-years were used to estimate changes in rapid ART initiation (within 30 days of care enrollment) after adoption of Treat All policies in 2 groups of countries: Uganda and Zambia (policy adopted in 2013) and Burundi, Democratic Republic of the Congo, Kenya, Malawi, and Rwanda (policy adopted in 2016). Results There were immediate increases in rapid ART initiation among young adolescents after national adoption of Treat All. Increases were greater in countries adopting the policy in 2016 than in those adopting it in 2013: 23.4 percentage points (pp) (95% confidence interval, 13.9–32.8) versus 11.2pp (2.5–19.9). However, the rate of increase in rapid ART initiation among 10–14-year-olds rose appreciably in countries with earlier treatment expansions, from 1.5pp per year before Treat All to 7.7pp per year afterward. Conclusions Universal ART eligibility has increased rapid treatment initiation among young adolescents enrolling in HIV care. Further research should assess their retention in care and viral suppression under Treat All.Item Pitfalls of practicing cancer epidemiology in resource-limited settings: the case of survival and loss to follow-up after a diagnosis of Kaposi’s sarcoma in five countries across sub-Saharan Africa.(BMC, 2016) Freeman, Esther; Semeere, Aggrey; Wenger, Megan; Bwana, Mwebesa; Asirwa, F. Chite; Busakhala, Naftali; Oga, Emmanuel; Jedy-Agba, Elima; Kwaghe, Vivian; Iregbu, Kenneth; Jaquet, Antoine; Dabis, Francois; Yumo, Habakkuk Azinyui; Dusingize, Jean Claude; Bangsberg, David; Anastos, Kathryn; Phiri, Sam; Bohlius, Julia; Egger, Matthias; Yiannoutsos, Constantin; Wools-Kaloustian, Kara; Martin, Jeffrey; Department of Biostatistics, Fairbanks School of Public HealthSurvival after diagnosis is a fundamental concern in cancer epidemiology. In resource-rich settings, ambient clinical databases, municipal data and cancer registries make survival estimation in real-world populations relatively straightforward. In resource-poor settings, given the deficiencies in a variety of health-related data systems, it is less clear how well we can determine cancer survival from ambient data.