Browsing by Subject "Nevirapine"
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Item Open Access Effects of the Pratt pouch model of dispensing nevirapine prophylaxis on HIV exposed infant completion of 6 weeks of prophylaxis in Uganda.(PloS one, 2021-01) Bitarakwate, Edward; Ashburn, Kim; Kazooba, Patrick; Khamasi, Ronald; Natumanya, Eliab; Herrera, Nicole; Owomugisha, Boaz; Malkin, Robert A; Kisaakye, LindaIntroduction
The innovative Pratt pouch could optimize dispensing nevirapine prophylaxis to HIV-exposed infants in pre-measured single dose pouches to increase completion of the full 6 week infant nevirapine regimen.Materials and methods
Nineteen health facilities with highest HIV positivity rates among pregnant women across 9 districts in southwest and central Uganda were assigned to control and intervention groups. HIV-positive women enrolled at intervention facilities received pouches filled with premeasured single doses of nevirapine using Uganda national guidelines, which were integrated into the existing drug distribution system. During antenatal care (ANC) women received 14 pouches to cover time until the 6 day postpartum visit, with an additional 8 pouches if women were delayed in returning to the facility, and 28 pouches after delivery. Women enrolled at control facilities received standard nevirapine syrup following delivery for postnatal infant prophylaxis. In a select number of intervention facilities, during ANC, women received all 42 pouches needed to complete the 6 weeks regimen. Medical record data from enrolled women were extracted; interviews with HIV-positive women during postnatal care visits were conducted. Data were collected January to August 2018 (control sites) and October 2019 to February 2020 (intervention sites). Unadjusted and adjusted logistic regression models were used to identify factors associated with facility delivery, postnatal care follow-up visit, and completion of the full 6 weeks infant nevirapine regimen.Results
Significantly more women in the intervention (n = 320) versus control (n = 340) group had facility delivery (292/316, 92.4% versus 169/340, 49.7%, p<0.0001), postnatal visits within 2 weeks postpartum (295/297, 99.3% versus 133/340, 39.1%, p<0.0001) and reported their infants completing the full 6 weeks infant prophylaxis regimen (299/313, 95.5% versus 210/242, 86.8%, p = 0.0002). Dispensing 42 versus 14 pouches during ANC did not have negative effects on these outcomes. Among out-of-facility deliveries, a higher proportion of infants received nevirapine within 72 hours of birth in the intervention versus control group, 95.8% versus 77.9%. In multivariate models, the intervention group was the only significant factor associated with facility delivery or completion of the full 6 weeks infant prophylaxis.Conclusions
Use of the Pratt pouch resulted in an increase in HIV-exposed infants completing the full 6weeks prophylaxis regimen and associated benefits including increasing facility delivery and women's adherence to postnatal care services.Item Open Access Initiation of antiretroviral therapy in HIV-infected adults with skin complaints in northern Tanzania.(Int J Dermatol, 2015-01) Mavura, Daudi R; Masenga, E John; Minja, Eli; Grossmann, Henning; Crump, John A; Bartlett, John AAbnormal skin findings are identified in over 90% of human immunodeficiency virus (HIV)-infected persons globally. A prospective cohort study of HIV-infected patients with skin complaints commencing antiretroviral therapy (ART) in northern Tanzania was undertaken. Consecutive HIV-infected subjects presenting with skin complaints, who met criteria for ART initiation, were recruited at a Tanzanian Regional Dermatology Training Center. A single dermatologist evaluated all subjects; baseline skin biopsies were performed, and CD4(+) cell counts and plasma HIV RNA levels were measured. All subjects received a fixed-dose combination of stavudine, lamivudine, and nevirapine. A total of 100 subjects were enrolled; 86 subjects completed six months of follow-up. Median baseline CD4(+) cell counts and plasma HIV RNA levels were 120 cells/μl and 5.2 log10 copies/ml. The most common dermatologic condition was papular pruritic eruption (47%). The median baseline score on the Burn Scale was 38%. After six months, 10 subjects had achieved the complete resolution of skin abnormalities. In those without complete resolution, the median Burn Scale score improved to 7%. Five patients developed new eruptions by month 3, which in two cases were attributed to drug reactions. In the 86 subjects remaining on ART after six months, the median CD4(+) cell count had increased to 474 cells/μl, and plasma HIV RNA levels were <400 copies/ml in 85 (99%) subjects. Patients with HIV infection with skin complaints experienced marked clinical improvements following ART initiation.Item Open Access Performance of PMTCT Among HIV Exposed Infants in Tanzania(2012) Dow, Dorothy ElizabethBackground: In Tanzania, 70% of the estimated 84,000 HIV-infected pregnant women who deliver annually receive some intervention to prevent mother to child transmission (PMTCT) of HIV. Few data exist concerning the effectiveness of various treatment approaches in a field setting across a large geographic area. Dried blood spot (DBS) HIV DNA PCR testing of HIV-exposed infants was first rolled out in Tanzania in 2008. Using data gathered for DBS testing, we evaluated the prevalence of perinatal HIV transmission based on PMTCT regimen across three regions of Tanzania.
Methods: This was a retrospective review of all mother/infant pairs enrolled in the National PMTCT program in the Kilimanjaro, Arusha, and Tanga Regions of Tanzania from January 1, 2008 to September 30, 2010. Enrollment registries at health facilities that submit DBS PCR were reviewed to document infant date of birth, weight, feeding practice, maternal and infant PMTCT regimen, and date and result of first DBS PCR. The present analysis included mother/infant pairs for whom DBS PCR was performed at infant age < 75 days. Maternal ARV regimens included: 1) none; 2) single-dose nevirapine (sdNVP); 3) sdNVP + zidovudine (combination prophylaxis); or 4) highly active antiretroviral therapy (HAART).
Results: In this field setting PMTCT is working better than hypothesized based on clinical trial results. Overall seroprevalence was 6.4% HIV transmission in the first 75 days of life. Women on HAART had the lowest transmission (2.1%), followed by those receiving combination prophylaxis (3.9%), sdNVP (8.9%), and no treatment having the highest rates (15.8%).
Conclusion: PMTCT regimens in resource-limited settings are effective and transmission rates are less than demonstrated by clinical trials data. Use of DBS for diagnosis of HIV provides an opportunity to evaluate use and effectiveness of PMTCT regimens.
Item Open Access Predicting virologic failure among HIV-1-infected children receiving antiretroviral therapy in Tanzania: a cross-sectional study.(J Acquir Immune Defic Syndr, 2010-08) Emmett, Susan D; Cunningham, Coleen K; Mmbaga, Blandina T; Kinabo, Grace D; Schimana, Werner; Swai, Mark E; Bartlett, John A; Crump, John A; Reddy, Elizabeth ABACKGROUND: Many HIV care and treatment programs in resource-limited settings rely on clinical and immunologic monitoring of antiretroviral therapy (ART), but accuracy of this strategy to detect virologic failure (VF) among children has not been evaluated. METHODS: A cross-sectional sample of HIV-infected children aged 1-16 years on ART >or=6 months receiving care at a Tanzanian referral center underwent clinical staging, CD4 lymphocyte measurement, plasma HIV-1 RNA level, and complete blood count. Associations with VF (HIV-1 RNA >or=400 copies/mL) were determined utilizing bivariable and multivariate analyses; accuracy of current clinical and immunologic guidelines in identifying children with VF was assessed. FINDINGS: Of 206 children (median age 8.7 years, ART duration 2.4 years), 65 (31.6%) demonstrated VF at enrollment. Clinical and immunological criteria identified 2 (3.5%) of 57 children with VF on first-line therapy, exhibiting 3.5% sensitivity and 100% specificity. VF was associated with younger age, receipt of nevirapine vs. efavirenz-based regimen, CD4% < 25%, and physician documentation of maladherence (P < 0.05 on bivariable analysis); the latter 2 factors remained significant on multivariate logistic regression. INTERPRETATION: This study demonstrates poor performance of clinical and immunologic criteria in identifying children with virologic failure. Affordable techniques for measuring HIV-1 RNA level applicable in resource-limited settings are urgently needed.