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1.
Clin Infect Dis ; 2021 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-33912911

RESUMO

Large public-health training events may result in SARS-CoV-2 transmission. Universal SARS-CoV-2 testing during trainings for the Uganda Population-based HIV Impact Assessment identified 28/475 (5.9%) individuals with COVID-19 among attendees; most (89.3%) were asymptomatic. Effective COVID-19 mitigation measures, along with SARS-CoV-2 testing, are recommended for in-person trainings, particularly when trainees will have subsequent contact with survey participants.

2.
Artigo em Inglês | MEDLINE | ID: mdl-33765683

RESUMO

BACKGROUND: Male circumcision (MC) offers men lifelong partial protection from heterosexually-acquired HIV infection. The impact of MC on HIV incidence has not been quantified in nationally-representative samples. Data from the Population-based HIV Impact Assessments (PHIAs) were used to compare incidence by MC status in countries implementing voluntary medical MC (VMMC) programs. METHODS: Data were pooled from PHIAs conducted in Eswatini, Lesotho, Malawi, Namibia, Tanzania, Uganda, Zambia and Zimbabwe from 2015-2017. Incidence was measured using a recent infection testing algorithm, and analyzed by self-reported MC status distinguishing between medical and non-medical MC. Country, marital status, urban setting, sexual risk behaviors, and mean population HIV viral load among women as an indicator of treatment scale-up were included in a random effects logistic regression model using pooled survey weights. Analyses were age-stratified (15-34 and 35-59 years). Annualized incidence rates and 95% confidence intervals (CIs) and incidence differences were calculated between medically circumcised and uncircumcised men. RESULTS: Men 15-34 years reporting medical MC had lower HIV incidence than uncircumcised men (0.04% [95% CI: 0.00, 0.10%] versus 0.34% [95% CI: 0.10, 0.57%], respectively; p-value = 0.01); whereas among men 35-59 years, there was no significant incidence difference (1.36% [95% CI: 0.32, 2.39%] versus 0.55% [95% CI: 0.14, 0.67%], respectively; p-value = 0.14). DISCUSSION: Medical MC was associated with lower HIV incidence in men aged 15-34 years in nationally-representative surveys in Africa. These findings are consistent with the expected ongoing VMMC program impact and highlight the importance of VMMC for the HIV response in Africa.

3.
MMWR Morb Mortal Wkly Rep ; 69(19): 582-586, 2020 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-32407305

RESUMO

Although mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV) is preventable through antiretroviral treatment (ART) during pregnancy and postpartum, the Joint United Nations Programme on HIV/AIDS (UNAIDS) estimates that 160,000 new HIV infections occurred among children in 2018 (1). Child survival and HIV-free survival rates* are standard measures of progress toward eliminating MTCT† (2). Nationally representative Population-based HIV Impact Assessment (PHIA)§ survey data, pooled from eight sub-Saharan African countries¶ were used to calculate survival probability among children aged ≤3 years by maternal HIV status during pregnancy and HIV-free survival probability among children aged ≤3 years born to women with HIV infection, stratified by maternal ART** status during pregnancy. Survival probability was significantly lower among children born to women with HIV infection (94.7%) than among those born to women without HIV infection (97.6%). HIV-free survival probability of children born to women with HIV infection differed significantly by the timing of initiation of maternal ART: 93.0% among children whose mothers received ART before pregnancy, 87.8% among those whose mothers initiated ART during pregnancy, and 53.4% among children whose mothers did not receive ART during pregnancy. Focusing on prevention of HIV acquisition and, among women of reproductive age with HIV infection, on early diagnosis of HIV infection and ART initiation when applicable, especially before pregnancy, can improve child survival and HIV-free survival.


Assuntos
Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Taxa de Sobrevida/tendências , África ao Sul do Saara/epidemiologia , Fármacos Anti-HIV/uso terapêutico , Pré-Escolar , Feminino , Infecções por HIV/mortalidade , Infecções por HIV/transmissão , Humanos , Lactente , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Masculino , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/tratamento farmacológico
4.
PLoS One ; 15(4): e0230451, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32287264

RESUMO

INTRODUCTION: With the scale-up of antiretroviral therapy (ART) there is a need to monitor programme performance to maximize ART efficacy and to prevent emergence of HIV drug resistance (HIVDR). In keeping with the elements of the World Health Organisation (WHO) guidance we carried out a nationally representative assessment of early warning indicators (EWI) at 304 randomly selected ART service outlets in Uganda. METHODS: Retrospective patient data was extracted for the six EWIs for HIVDR including; on-time antiretroviral (ARV) drug pick-up, patient retention on ART at 12 months, ART dispensing practices, ARV drug stock-outs, viral load suppression (VLS) and viral load (VL) testing completion. Point prevalence for each clinic and national aggregate prevalence with 95% confidence intervals (CI) for all clinics were estimated and facility performances were computed and association between EWIs and programmatic factors assessed using Fisher's Exact Test. RESULTS: Facilities meeting the EWI targets: on-time pill pick-up was 9.5%, more facilities in the north met this target (p = 0.040). Retention on ART at 12 months was 24.1%, facilities in Kampala region (p<0.001) and Specialized ART clinics (p = 0.01) performed better in this indicator. Pharmacy stock-outs was 33.6%, with more facilities in Kampala (p<0.001), specialized ART clinics (p<0.001) and private-for-profit (p<0.001) meeting this target. Dispensing practices was met by 100% of the facilities. VLS was met by 49.2% and 50.8% of facilities met VL completion target with facilities in central region performing better (p<0.001). National prevalence for the EWIs was: on-time pill pick-up 63.3% (CI: 58.9-67.8); retention on ART at 12 months 69.9% (CI: 63.8-76.0); dispensing practices 100.0%; VLS 85.2% (CI: 81.8-88.5) and VL completion, 60.7% (CI: 56.9-64.6). CONCLUSION: Dispensing practices in all facilities were in line with the national guidelines however, there still remains a challenge to long-term ART programmatic success in monitoring patient response to treatment, and maintaining patients on ART without interruptions arising due to poor patient adherence and as a consequence of ARV supply interruption. It is therefore of high importance that the national ART program ensures intensified follow-up for patients, ensuring uninterrupted supply of ARV drugs and increasing VL monitoring at treatment centres, in order to improve patient outcomes and avert preventable HIVDR.


Assuntos
Antirretrovirais/provisão & distribução , Infecções por HIV/tratamento farmacológico , Cooperação do Paciente/estatística & dados numéricos , Adulto , Antirretrovirais/uso terapêutico , Farmacorresistência Viral , Feminino , Infecções por HIV/epidemiologia , Humanos , Masculino , Prevalência , Estudos Retrospectivos , Inquéritos e Questionários , Uganda , Carga Viral , Organização Mundial da Saúde
5.
J Antimicrob Chemother ; 75(5): 1280-1289, 2020 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-32025714

RESUMO

OBJECTIVES: We implemented the WHO cross-sectional survey protocol to determine rates of HIV viral load (VL) suppression (VLS), and weighted prevalence, predictors and patterns of acquired drug resistance (ADR) in individuals with virological failure (VF) defined as VL ≥1000 copies/mL. METHODS: We enrolled 547 and 1064 adult participants on first-line ART for 12 (±3) months (ADR12) and ≥48 months (ADR48), respectively. Dried blood spots and plasma specimens were collected for VL testing and genotyping among the VFs. RESULTS: VLS was 95.0% (95% CI 93.4%-96.5%) in the ADR12 group and 87.9% (95% CI 85.0%-90.9%) in the ADR48 group. The weighted prevalence of ADR was 96.1% (95% CI 72.9%-99.6%) in the ADR12 and 90.4% (95% CI 73.6-96.8%) in the ADR48 group, out of the 30 and 95 successful genotypes in the respective groups. Initiation on a zidovudine-based regimen compared with a tenofovir-based regimen was significantly associated with VF in the ADR48 group; adjusted OR (AOR) 1.96 (95% CI 1.13-3.39). Independent predictors of ADR in the ADR48 group were initiation on a zidovudine-based regimen compared with tenofovir-based regimens, AOR 3.16 (95% CI 1.34-7.46) and ART duration of ≥82 months compared with <82 months, AOR 1.92 (95% CI 1.03-3.59). CONCLUSIONS: While good VLS was observed, the high prevalence of ADR among the VFs before they underwent the recommended three intensive adherence counselling (IAC) sessions followed by repeat VL testing implies that IAC prior to treatment switching may be of limited benefit in improving VLS.

6.
J Acquir Immune Defic Syndr ; 78 Suppl 2: S134-S141, 2018 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-29994836

RESUMO

BACKGROUND: Remarkable success in the prevention and treatment of pediatric HIV infection has been achieved in the past decade. Large differences remain between the estimated number of children living with HIV (CLHIV) and those identified through national HIV programs. We evaluated the number of CLHIV and those on treatment in Lesotho, Malawi, Swaziland, Tanzania, Uganda, Zambia, and Zimbabwe. METHODS: We assessed the total number of CLHIV, CLHIV on antiretroviral treatment (ART), and national and regional ART coverage gaps using 3 data sources: (1) Joint United Nations Programme on HIV/AIDS model-based estimates and national program data used as input values in the models, (2) population-based HIV impact surveys (PHIA), and (3) program data from the President's Emergency Plan for AIDS Relief (PEPFAR)-supported clinics. RESULTS: Across the 7 countries, HIV prevalence among children aged 0-14 years ranged from 0.4% (Uncertainty Bounds (UB) 0.2%-0.6%) to 2.8% (UB: 2.2%-3.4%) according to the PHIA surveys, resulting in estimates of 520,000 (UB: 460,000-580,000) CLHIV in 2016-2017 in the 7 countries. This compared with Spectrum estimates of pediatric HIV prevalence ranging from 0.5% (UB: 0.5%-0.6%) to 3.5% (UB: 3.0%-4.0%) representing 480,000 (UB: 390,000-550,000) CLHIV. CLHIV not on treatment according to the PEPFAR, PHIA, and Spectrum for the countries stood at 48% (UB: 25%-60%), 49% (UB: 37%-50%), and 38% (UB: 24%-47%), respectively. Of 78 regions examined across 7 countries, 33% of regions (PHIA data) or 41% of regions (PEPFAR data) had met the ART coverage target of 81%. CONCLUSIONS: There are substantial gaps in the coverage of HIV treatment in CLHIV in the 7 countries studied according to all sources. There is continued need to identify, engage, and treat infants and children. Important inconsistencies in estimates across the 3 sources warrant in-depth investigation.


Assuntos
Antirretrovirais/uso terapêutico , Infecções por HIV/tratamento farmacológico , HIV/isolamento & purificação , Adolescente , África Oriental/epidemiologia , África Austral/epidemiologia , Criança , Pré-Escolar , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Humanos , Lactente , Masculino , Prevalência , Inquéritos e Questionários , Nações Unidas
7.
MMWR Morb Mortal Wkly Rep ; 67(1): 29-32, 2018 Jan 12.
Artigo em Inglês | MEDLINE | ID: mdl-29329280

RESUMO

In 2016, an estimated 1.5 million females aged 15-24 years were living with human immunodeficiency virus (HIV) infection in Eastern and Southern Africa, where the prevalence of HIV infection among adolescent girls and young women (3.4%) is more than double that for males in the same age range (1.6%) (1). Progress was assessed toward the Joint United Nations Programme on HIV/AIDS (UNAIDS) 2020 targets for adolescent girls and young women in sub-Saharan Africa (90% of those with HIV infection aware of their status, 90% of HIV-infected persons aware of their status on antiretroviral treatment [ART], and 90% of those on treatment virally suppressed [HIV viral load <1,000 HIV RNA copies/mL]) (2) using data from recent Population-based HIV Impact Assessment (PHIA) surveys in seven countries. The national prevalence of HIV infection in adolescent girls and young women aged 15-24 years, the percentage who were aware of their status, and among those persons who were aware, the percentage who had achieved viral suppression were calculated. The target for viral suppression among all persons with HIV infection is 73% (the product of 90% x 90% x 90%). Among all seven countries, the prevalence of HIV infection among adolescent girls and young women was 3.6%; among those in this group, 46.3% reported being aware of their HIV-positive status, and 45.0% were virally suppressed. Sustained efforts by national HIV and public health programs to diagnose HIV infection in adolescent girls and young women as early as possible to ensure rapid initiation of ART should help achieve epidemic control among adolescent girls and young women.


Assuntos
Epidemias/prevenção & controle , Infecções por HIV/prevenção & controle , Adolescente , África/epidemiologia , Fármacos Anti-HIV/uso terapêutico , Feminino , Infecções por HIV/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Prevalência , Avaliação de Programas e Projetos de Saúde , Carga Viral/estatística & dados numéricos , Adulto Jovem
8.
Glob Health Action ; 10(sup1): 1291169, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28532304

RESUMO

BACKGROUND: The development of global HIV estimates has been critical for understanding, advocating for and funding the HIV response. The process of generating HIV estimates has been cited as the gold standard for public health estimates. OBJECTIVE: This paper provides important lessons from an international scientific collaboration and provides a useful model for those producing public health estimates in other fields. DESIGN: Through the compilation and review of published journal articles, United Nations reports, other documents and personal experience we compiled historical information about the estimates and identified potential lessons for other public health estimation efforts. RESULTS: Through the development of core partnerships with country teams, implementers, demographers, mathematicians, epidemiologists and international organizations, UNAIDS has led a process to develop the capacity of country teams to produce internationally comparable HIV estimates. The guidance provided by these experts has led to refinements in the estimated numbers of people living with HIV, new HIV infections and AIDS-related deaths over the past 20 years. A number of important updates to the methods since 1997 resulted in fluctuations in the estimated levels, trends and impact of HIV. The largest correction occurred between the 2005 and 2007 rounds with the additions of household survey data into the models. In 2001 the UNAIDS models at that time estimated there were 40 million people living with HIV. In 2016, improved models estimate there were 30 million (27.6-32.7 million) people living with HIV in 2001. CONCLUSIONS: Country ownership of the estimation tools has allowed for additional uses of the results than had the results been produced by researchers or a team in Geneva. Guidance from a reference group and input from country teams have led to critical improvements in the models over time. Those changes have improved countries' and stakeholders' understanding of the HIV epidemic.


Assuntos
Saúde Global/estatística & dados numéricos , Infecções por HIV/epidemiologia , Indicadores Básicos de Saúde , Saúde Pública/estatística & dados numéricos , Humanos
9.
PLoS One ; 10(12): e0145536, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26700639

RESUMO

BACKGROUND: With the scale-up of antiretroviral therapy (ART), monitoring programme performance is needed to maximize ART efficacy and limit HIV drug resistance (HIVDR). METHODS: We implemented a WHO HIVDR prospective survey protocol at three treatment centers between 2012 and 2013. Data were abstracted from patient records at ART start (T1) and after 12 months (T2). Genotyping was performed in the HIV pol region at the two time points. RESULTS: Of the 425 patients enrolled, at T2, 20 (4.7%) had died, 66 (15.5%) were lost to follow-up, 313 (73.6%) were still on first-line, 8 (1.9%) had switched to second-line, 17 (4.0%) had transferred out and 1 (0.2%) had stopped treatment. At T2, 272 out of 321 on first and second line (84.7%) suppressed below 1000 copies/ml and the HIV DR prevention rate was 70.1%, just within the WHO threshold of ≥ 70%. The proportion of participants with potential HIVDR was 20.9%, which is higher than the 18.8% based on pooled analyses from African studies. Of the 35 patients with mutations at T2, 80% had M184V/I, 65.7% Y181C, and 48.6% (54.8% excluding those not on Tenofovir) had K65R mutations. 22.9% had Thymidine Analogue Mutations (TAMs). Factors significantly associated with HIVDR prevention at T2 were: baseline viral load (VL) <100,000 copies/ml [Adjusted odds ratio (AOR) 3.13, 95% confidence interval (CI): 1.36-7.19] and facility. Independent baseline predictors for HIVDR mutations at T2 were: CD4 count < 250 cells/µl (AOR 2.80, 95% CI: 1.08-7.29) and viral load ≥ 100,000 copies/ml (AOR 2.48, 95% CI: 1.00-6.14). CONCLUSION: Strengthening defaulter tracing, intensified follow-up for patients with low CD4 counts and/or high VL at ART initiation together with early treatment initiation above 250 CD4 cells/ul and adequate patient counselling would improve ART efficacy and HIVDR prevention. The high rate of K65R and TAMs could compromise second line regimens including NRTIs.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Terapia Antirretroviral de Alta Atividade , Farmacorresistência Viral , Infecções por HIV/virologia , HIV-1/efeitos dos fármacos , Adulto , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Uganda/epidemiologia , Carga Viral
10.
J Public Health Policy ; 36(2): 153-69, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25811386

RESUMO

Uganda introduced an HIV Early Infant Diagnosis (EID) program in 2006, and then worked to improve the laboratory, transportation, and clinical elements. Reported here are the activities involved in setting up a prospective analysis in which the Ministry of Health, with its NGO partners, determined it would be more effective and efficient to consolidate the initial eight-laboratory system for EID testing of HIV dried blood samples offered by two nongovernmental partners operating research facilities into a single well-equipped and staffed laboratory within the Ministry. A retrospective analysis confirmed that redesign reduced overhead cost per PCR test of HIV dried blood samples from US$22.20 to an average of $5. Along with the revamped system of sample collection, transportation, and result communication, Uganda has been able to vastly increase the HIV diagnosis of babies and engagement of them and their mothers in clinical care, including antiretroviral therapy. Uganda reduced turnaround times for results reporting to clinicians from more than a month in 2006 to just 2 weeks by 2014, even as samples tested increased dramatically. The next challenge is overcoming loss of babies and mothers to follow up.


Assuntos
Diagnóstico Precoce , Infecções por HIV/diagnóstico , Laboratórios/organização & administração , Administração em Saúde Pública , Antirretrovirais/uso terapêutico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/transmissão , Humanos , Lactente , Recém-Nascido , Transmissão Vertical de Doença Infecciosa , Laboratórios/economia , Reação em Cadeia da Polimerase , Estudos Retrospectivos , Uganda
11.
J Acquir Immune Defic Syndr ; 69(1): 92-7, 2015 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-25622056

RESUMO

OBJECTIVE: We examine the extent to which Ugandans accurately know their HIV status and that of their partners. METHODS: The 2011 Uganda AIDS Indicator Survey (UAIS) was a nationally representative study of 15-59 year olds that tested 21,366 individuals for HIV. We compared self-reported HIV status with UAIS-determined HIV status for respondents. We were able to link 3285 couples in the survey, and in this group, we compared the reported HIV status of partners with that determined by UAIS. Multiple logistic regression analysis was used to identify factors associated with inaccurate knowledge of HIV status. RESULTS: An estimated 55.8% of adult Ugandans reported having had an HIV test. Of 1495 HIV-infected Ugandans, 59.1% were unaware of their HIV infection. Among 3285 linked couples in this analysis, 273 couples (8.3%) had at least 1 infected partner, with 96 couples (2.9%) having both members infected and the remaining 177 couples (5.4%) being HIV discordant. This meant that 369 persons in the linked couple group had an HIV-infected partner. One hundred ten (29.8%) of this group knew that their partner was HIV infected. In multiple logistic regression analysis, accurately knowing that ones partner was HIV infected was strongly associated with couple HIV testing [adjusted odds ratio (AOR): 4.3, 95% confidence interval (CI): 2.2 to 8.4] and reporting oneself to be HIV positive versus reporting HIV negative (AOR: 7.3, 95% CI: 3.8 to 14.3) or HIV status unknown (AOR: 30.6, 95% CI: 3.8 to 263.4). CONCLUSIONS: Respondents may be reporting the HIV status of their partners based on their own HIV status. Campaigns to inform people about the prevalence of serodiscordance in conjunction with further promotion of couple counseling may help increase the proportion of Ugandans who know their own HIV status and that of their partners.


Assuntos
Transmissão de Doença Infecciosa/prevenção & controle , Infecções por HIV/epidemiologia , Infecções por HIV/transmissão , Parceiros Sexuais/psicologia , Adolescente , Adulto , Coleta de Dados , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/prevenção & controle , Humanos , Masculino , Pessoa de Meia-Idade , Uganda/epidemiologia , Adulto Jovem
12.
PLoS One ; 8(11): e78609, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24236026

RESUMO

INTRODUCTION: Uganda scaled-up Early HIV Infant Diagnosis (EID) when simplified methods for testing of infants using dried blood spots (DBS) were adopted in 2006 and sample transport and management was therefore made feasible in rural settings. Before this time only 35% of the facilities that were providing EID services were reached through the national postal courier system, Posta Uganda. The transportation of samples during this scale-up, therefore, quickly became a challenge and varied from facility to facility as different methods were used to transport the samples. This study evaluates a novel specimen transport network system for EID testing. METHODS: A retrospective study was done in mid-2012 on 19 pilot hubs serving 616 health facilities in Uganda. The effect on sample-result turnaround time (TAT) and the cost of DBS sample transport on 876 sample-results was analyzed. RESULTS: The HUB network system provided increased access to EID services ranging from 36% to 51%, drastically reduced transportation costs by 62%, reduced turn-around times by 46.9% and by a further 46.2% through introduction of SMS printers. CONCLUSIONS: The HUB model provides a functional, reliable and efficient national referral network against which other health system strengthening initiatives can be built to increase access to critical diagnostic and treatment monitoring services, improve the quality of laboratory and diagnostic services, with reduced turn-around times and improved quality of prevention and treatment programs thereby reducing long-term costs.


Assuntos
Assistência à Saúde/organização & administração , Infecções por HIV/diagnóstico , Programas de Rastreamento , Transportes/economia , Coleta de Amostras Sanguíneas , Teste em Amostras de Sangue Seco , Diagnóstico Precoce , Infecções por HIV/sangue , Humanos , Lactente , Estudos Retrospectivos , População Rural , Uganda
13.
AIDS ; 26 Suppl 2: S137-45, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-23303435

RESUMO

OBJECTIVES: The scale-up of delivery of antiretroviral therapy (ART) in low-income and middle-income countries has been coupled with the collection of data aimed at monitoring the welfare of the HIV-positive and treated populations in those countries. We aimed to compare the data items collected and reported and the degree of harmonization achieved following the publication of WHO tools for collection and reporting of these data in 2006, and of two United Nations General Assembly Special Session (UNGASS) indicators relating to the health of patients on ART in 2008. DESIGN: Retrospective examination of monitoring tools used in four countries in 2008 and 2010. METHODS: We examined and compared the type of information collected and reported from treatment and care programmes in Malawi, Uganda, Tanzania and Ukraine. We also assessed the effect of the publication of the WHO-recommended data capture and reporting tools and the UNGASS-recommended indicators on harmonizing data in these four countries 2 years following the publication of each of these tools and indicators. RESULTS: : Although the majority of WHO-recommended data items were included in patient record cards, clinic ART registers and in reports submitted to the ministries of health in the countries by 2010, there remains little concordance between the four countries examined on the specific items included in patient records and monitoring reports. Furthermore, numerous additional items, which differ by country, and which are not included in WHO recommendations, are still recorded and reported. CONCLUSION: The differences and diversity of data reported across countries continues to challenge our ability to make international comparisons and to assess programme performance.


Assuntos
Antirretrovirais/uso terapêutico , Coleta de Dados/métodos , Infecções por HIV/tratamento farmacológico , Acesso aos Serviços de Saúde/estatística & dados numéricos , Indicadores Básicos de Saúde , Coleta de Dados/normas , Países em Desenvolvimento , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Humanos , Programas Nacionais de Saúde/estatística & dados numéricos , Pobreza , Estudos Retrospectivos , Organização Mundial da Saúde
14.
AIDS ; 24(17): 2603-7, 2010 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-20683315

RESUMO

Monitoring the progress of HIV programmes is vital, as services are scaled up to include increasing numbers in need of care. Globally, the presence of multiple donors at all levels of HIV care has produced vast monitoring systems. Within HIV-treatment programmes in low and middle-income countries, directly assessing long-term outcomes such as survival is problematic, so indicators are used to monitor the progress of the treated population. However, the internal, external, construct validity and predictive value of current indicators have never been evaluated. Although the burden on facility staff compiling routine monitoring reports is vast, there is uncertainty as to which indicators best monitor patient progress. This burden will grow as increasing numbers of life-cohorts are created for monitoring purposes leading to data inaccuracies and compromising the internal validity of reported indicators. Furthermore, a number of fundamental indicators, including survival and retention, may not capture the construct they intend to measure, compromising the ability of programme managers to obtain reliable estimates regarding the welfare of their population in care. It is not known which indicators can predict the longer-term outcome of the patient population, and as such, can enable managers to respond to predictors of failure early. An evaluation of current indicators is urgently needed to ensure that reported facility-level data accurately reflect the welfare of the treated population and comparisons of programme performance are meaningful.


Assuntos
Países em Desenvolvimento/estatística & dados numéricos , Infecções por HIV/epidemiologia , HIV-1 , Terapia Antirretroviral de Alta Atividade , Infecções por HIV/tratamento farmacológico , Indicadores Básicos de Saúde , Humanos
15.
J Acquir Immune Defic Syndr ; 51(1): 78-84, 2009 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-19325495

RESUMO

OBJECTIVE: HIV programs in generalized epidemics have traditionally relied on antenatal clinic (ANC) sentinel surveillance data to guide prevention and to model epidemic trends. ANC data, however, come from a subset of the population, and their representativeness of the population has been debated. METHODS: Data from a national population-based Uganda HIV/AIDS Sero-Behavioral Survey (UHSBS) were compared with those from ANC sentinel surveillance. Using geographic information system, UHSBS clusters within a 30 km radius of the ANC sites were mapped. Estimates of HIV prevalence from ANC surveillance were compared with those from UHSBS. RESULTS: The ANC-based HIV prevalence, 6.0% [confidence interval (CI) 5.5% to 6.5%], was similar to that from UHSBS, 5.9% (CI 5.4% to 6.4%). The ANC-based estimate correlated with that of UHSBS catchment area women who were pregnant and those who had given birth in the 2 years preceding the survey. ANC data overestimated prevalence in the 15-year to 19-year age group, were similar to UHSBS for ages 20-29 years, and underestimated prevalence in older respondents. ANC data underestimated HIV prevalence among women (6.0% vs. 7.4%; CI 6.6% to 8.2%) and urban women (7.6% vs. 12.7%) but was similar for rural women (5.3% vs. 4.9%). CONCLUSIONS: ANC-based surveillance remains an important tool for monitoring HIV/AIDS programs. ANC and UHSBS data were similar overall and for 15-year to 29-year olds, women who were pregnant, and women who had a birth in the 2 years before the survey. ANC estimates were lower in those > or = 30 years and in urban areas. Periodic serosurveys to adjust ANC-based estimates are needed.


Assuntos
Infecções por HIV/epidemiologia , Soroprevalência de HIV , Adolescente , Adulto , Coleta de Dados/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Vigilância de Evento Sentinela , Uganda/epidemiologia , Adulto Jovem
16.
J Acquir Immune Defic Syndr ; 49(3): 320-6, 2008 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-18845955

RESUMO

OBJECTIVE(S): To describe recent trends in HIV-related behaviors and knowledge in Uganda between 1989 and 2005. DESIGN: Population-based, cross-sectional national surveys of adult women and men. METHODS: Trend analysis of selected HIV-related behavior and knowledge indicators, using data from the 2004-2005 Uganda HIV/AIDS Sero-Behavioral Survey and the 2000-2001, 1995, and 1988-1989 Uganda Demographic and Health Surveys. Responses to similar questions across the different surveys were compared to determine trends in indicators. RESULTS: HIV/AIDS knowledge increased to a high level by 2001 and remained stable thereafter. Some self-reported risk behaviors improved, whereas others deteriorated. Among 15- to 24-year-old women and men, primary abstinence increased, from 23% in 1989 to 32% in 2005 and from 32% in 1995 to 42% in 2005, respectively. In men, there were increases in sex with multiple partners and sex with nonspousal partners, although reported condom use during nonspousal sex declined. Of men aged 15-49 years, self-reported multiple sex partnership increased from 24% in 2001 to 29% in 2005 and nonspousal sex increased from 28% in 2001 to 37% in 2005. Between 2001 and 2005, condom use during last nonspousal sex declined from 65% to 55% in men aged 15-24 years. CONCLUSIONS: Although substantial improvements in HIV-related risk behaviors and knowledge occurred since 1989, recent increases in some HIV-related risk behaviors were observed, indicating a shift toward more risk-taking behaviors. Prevention efforts should be reinvigorated to address this, otherwise the past success in the HIV fight will be reversed. Monitoring of HIV-related indicators should be continued.


Assuntos
Infecções por HIV/etiologia , Conhecimento , Assunção de Riscos , Comportamento Sexual , Adolescente , Adulto , Preservativos , Feminino , Infecções por HIV/prevenção & controle , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Uganda
17.
J Acquir Immune Defic Syndr ; 49(2): 183-9, 2008 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-18769350

RESUMO

OBJECTIVES: To compare HIV prevalence from routine voluntary counseling and testing (VCT) data with a population-based serosurvey in Uganda and to assess the utility of VCT data as a supplemental data source for HIV surveillance. METHODS: We analyzed HIV testing data from 75,640 unique VCT clients aged 15-59 years collected from August 2004 to January 2005 at 160 VCT sites. We excluded clients who reported illness as the reason for testing. During the same time period, 18,525 adults aged 15-59 years were tested for HIV in the Uganda HIV/AIDS Sero-Behavioral Survey (UHSBS). We compared UHSBS HIV prevalence with age-standardized VCT prevalence, overall and among stand-alone and facility-based VCT sites. RESULTS: HIV prevalence in urban areas was similar overall [UHSBS: 9.7%, 95% confidence interval (CI) 8.6 to 10.7; VCT: 10.1%, CI 9.8 to 10.5] and for both men (UHSBS: 6.3%, CI 4.9 to 7.6; VCT: 7.1, CI 6.6 to 7.5) and women (UHSBS: 12.2%, CI 10.6 to 13.7; VCT: 12.9%, CI 12.3 to 13.4). Urban prevalence from UHSBS (9.7%, CI 8.6 to 10.7), VCT stand-alone sites (10.3% CI 9.8 to 10.8), and VCT sites in health facility settings (10.0%, CI 9.5 to 10.4) was similar. However, in rural areas where VCT coverage is much lower than in urban areas (10% versus 31%), HIV prevalence was much higher among rural VCT clients (8.2%, CI 7.9% to 8.4%) than among rural UHSBS participants (5.2%, CI 4.8% to 5.5%). This resulted in overall higher HIV prevalence among all VCT clients (8.8%, CI 8.7 to 9.1) compared with all survey participants (5.9%, CI 5.6 to 6.2). CONCLUSIONS: After excluding clients who give illness as a reason for testing, VCT data may be used without further adjustment to monitor the HIV epidemic among urban Ugandans using either VCT data from stand-alone or health facility-based sites. However, monitoring rural and overall HIV prevalence using VCT data may not be appropriate until the uptake of VCT in rural areas is significantly improved or an adjustment factor is applied.


Assuntos
Infecções por HIV/epidemiologia , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , População Rural , Estudos Soroepidemiológicos , Uganda/epidemiologia , População Urbana
18.
JAMA ; 300(5): 540-9, 2008 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-18677026

RESUMO

CONTEXT: Studies of factors associated with acquiring human immunodeficiency virus (HIV) are often based on prevalence data that might not reflect recent infections. OBJECTIVE: To determine demographic, biological, and behavioral factors for recent HIV infection in Uganda. DESIGN AND SETTING: Nationally representative household survey of cross-sectional design conducted in Uganda from August 2004 through January 2005; data were analyzed until November 2007. PARTICIPANTS: There were 11,454 women and 9905 men aged 15 to 59 years who were eligible. Questionnaires were completed for 10,826 women (95%) and 8830 men (89%); of those interviewed, blood specimens were collected for 10,227 women (94%) and 8298 men (94%). MAIN OUTCOME MEASURE: Specimens seropositive for HIV were tested with the BED IgG capture-based enzyme immunosorbent assay to identify recent seroconversions (median, 155 days) using normalized optical density of 0.8 and adjustments. RESULTS: Of the 1023 HIV infections with BED results, 172 (17%) tested as recent. In multivariate analysis, risk factors associated with recent HIV infection included female sex (adjusted odds ratio [aOR], 2.4; 95% confidence interval [CI], 1.1-5.2); current marital status (widowed vs never married, aOR, 6.1; 95% CI, 2.8-13.3; divorced vs never married, aOR, 3.0; 95% CI, 1.5-6.1); geographic region (north central Uganda vs central Uganda/Kampala, aOR, 2.6; 95% CI, 1.7-4.1); number of sex partners in past year (> or = 2 compared with none; aOR, 2.9; 95% CI, 1.6-5.5); herpes simplex virus type 2 infection (aOR, 3.9; 95% CI, 2.6-5.8); report of a sexually transmitted disease in the past year (aOR, 1.7; 95% CI, 1.2-2.4); and being an uncircumcised man (aOR, 2.5; 95% CI, 1.1-5.3). Among married participants, recent HIV infection was associated with never using condoms with partners outside of marriage (aOR, 3.2; 95% CI, 1.7-6.1) compared with individuals having no outside partners. The risk of incident HIV infection for married individuals who used condoms with at least 1 outside partner was similar to that of those who did not have any partners outside of marriage (aOR, 1.0; 95% CI, 0.3-2.7). CONCLUSION: A survey of individuals in Uganda who were tested with an HIV assay used to establish recent infection identified risk factors, which offers opportunities for prevention initiatives.


Assuntos
Infecções por HIV/epidemiologia , Sorodiagnóstico da AIDS , Adolescente , Adulto , Estudos Transversais , Feminino , Infecções por HIV/diagnóstico , Soroprevalência de HIV , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Uganda/epidemiologia
19.
AIDS ; 22(5): 617-24, 2008 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-18317003

RESUMO

OBJECTIVE: Evaluate factors associated with HIV transmission risk behavior among HIV-infected adults in Uganda. DESIGN: Cross-sectional and nationally representative study (2004-2005 Uganda HIV/AIDS Sero-Behavioral Survey) tested 18,525 adults (15-59 years old) for HIV and herpes simplex virus type 2 (HSV-2). METHODS: Data were weighted to obtain nationally representative results. Sexual-risk behavior by HIV-infected individuals was defined as unprotected sex at last encounter. Using multivariate analysis, we identified factors associated with being sexually active, knowing HIV status, and using contraception and condoms. RESULTS: Of 1092 HIV-infected respondents, 64% were female (median age was 33 years), 84% had HSV-2, and 13% reported one lifetime partner (1% of men and 23% of women). Twenty-one percent of adults knew their HIV status and 9% knew their partners'. Seventy-seven percent were sexually active, of whom 27% reported condom use at last sex. Of last unprotected sexual encounters, 84% were with spouses and 13% with steady partners. Of cohabitating persons, 40% had an HIV-negative spouse. Those who knew their HIV status were three times more likely to use a condom at last sex encounter [adjusted odds ratio (AOR), 3.0; 95% confidence intervals (CI), 1.9-4.7] and those who knew their partners' HIV status were 2.3 times more likely to use condoms (AOR, 2.3; 95% CI, 1.2-4.3). CONCLUSIONS: A minority of HIV-infected adults in Uganda knew they had HIV infection; nearly half were in an HIV-discordant relationship, and few used condoms. Knowledge of HIV status, both one's own and one's partner's, was associated with increased condom use. Interventions to support HIV-infected persons and their partners to be tested are urgently needed.


Assuntos
Infecções por HIV/transmissão , HIV-1 , Herpes Simples/transmissão , Herpesvirus Humano 2 , Comportamento Sexual , Adolescente , Adulto , Preservativos , Estudos Transversais , Transmissão de Doença Infecciosa , Feminino , Infecções por HIV/psicologia , Infecções por HIV/virologia , Conhecimentos, Atitudes e Prática em Saúde , Inquéritos Epidemiológicos , Herpes Simples/psicologia , Herpes Simples/virologia , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prevalência , Assunção de Riscos , Parceiros Sexuais , Uganda , Sexo sem Proteção
20.
AIDS ; 22(4): 503-10, 2008 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-18301063

RESUMO

OBJECTIVES: To estimate the burden of HIV disease in Uganda and the effect of HIV/AIDS control programmes to mitigate it. DESIGN: Mathematical modelling and projecting using surveillance and census data. METHODS: Using antenatal clinic surveillance (1986-2002) and a recent population-based survey (2004-2005) data, we modelled the adult national HIV prevalence over time (1981-2004), and kept prevalence constant at 6.4% for the years 2004-2010. Using Spectrum software and census data, we estimated the national burden of HIV disease and the effect of selected HIV-related prevention and treatment programmes. RESULTS: In 2005, we estimated that there were 135,300 new HIV infections (adult HIV incidence 0.96%), 691,900 asymptomatic prevalent infections, 88 100 AIDS cases, and 76 400 AIDS deaths. An estimated 647,000 (80%) HIV-infected adults were unaware of their infection; one third of all adult deaths were HIV related. As a result of population growth, by 2008 a similar number of people will be HIV infected (1.1 million) as during the peak of the epidemic in 1994. Although antiretroviral therapy (ART) coverage is expected to rise from 67,000 (2005) to 160,000 (2010), the number of persons needing but not receiving ART will decrease only slightly from 127,600 (2005) to 111,100 (2010). The use of single-dose in 2005 nevirapine probably averted only 4% of the estimated 20 400 vertical infections. CONCLUSION: HIV/AIDS continues to be a leading cause of adult disease and death in Uganda. Universal ART access is probably unachievable. With the absolute burden of HIV disease approaching the historic peak in the early 1990s, more effective prevention programmes are of paramount importance.


Assuntos
Infecções por HIV/epidemiologia , Adolescente , Adulto , Anti-Infecciosos/uso terapêutico , Terapia Antirretroviral de Alta Atividade , Criança , Efeitos Psicossociais da Doença , Feminino , Infecções por HIV/tratamento farmacológico , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Uganda/epidemiologia
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