Search

We monitored severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants in Haiti from 2020 to 2023. Despite Haitian coronavirus disease 2019 (COVID-19) travel restrictions and in the setting of a vaccination rate of 2.7%, the timing and lineage evolution of the Haiti epidemic mirrored what was occurring in the rest of the world. Sources for importation of lineages into Haiti were the United States, the Dominican Republic, Europe, and Brazil, with exportation of lineages to the United States, the Dominican Republic, Europe, and Asia. Viral loads in patients infected by the Delta and Omicron BA.1 variants were correlated along the phylogenies, suggesting that higher viral loads have facilitated strain transmission and evolution. [ABSTRACT FROM AUTHOR]

IntroductionLittle is known about outcomes after hospitalization for HIV-infected adults in sub-Saharan Africa. We determined 12-month, posthospital mortality rates in HIV-infected vs. uninfected adults and predictors of mortality.MethodsIn this prospective cohort study, we enrolled adults admitted to the medical wards of a public hospital in northwestern Tanzania. We conducted standardized questionnaires, physical examinations, and basic laboratory analyses including HIV testing. Participants or proxies were called at 1, 3, 6, and 12 months to determine outcomes. Predictors of in-hospital and posthospital mortality were determined using logistic regression. Cox regression models were used to analyze mortality incidence and associated factors. To confirm our findings, we studied adults admitted to another government hospital.ResultsWe enrolled 637 consecutive adult medical inpatients: 38/143 (26.6%) of the HIV-infected adults died in hospital vs. 104/494 (21.1%) of the HIV-uninfected adults. Twelve-month outcomes were determined for 98/105 (93.3%) vs. 352/390 (90.3%) discharged adults, respectively. Posthospital mortality was 53/105 (50.5%) for HIV-infected adults vs. 126/390 (32.3%) for HIV-uninfected adults (adjusted P = 0.006). The 66/105 (62.9%) HIV-infected adults who attended clinic within 1 month after discharge had significantly lower mortality than the other HIV-infected adults [adjusted hazards ratio = 0.17 (0.07-0.39), P < 0.001]. Adults admitted to a nearby government hospital had similar high rates of posthospital mortality.ConclusionsPosthospital mortality is disturbingly high among HIV-infected adult inpatients in Tanzania. The posthospital period may offer a window of opportunity to improve survival in this population. Interventions are urgently needed and should focus on increasing posthospital linkage to primary HIV care.

Background In 2018 the World Health Organization recommended a switch to an all oral bedaquiline-based second-line regimen for treatment of drug-resistant tuberculosis (DR-TB). How these new second-line regimens fare in comparison to first-line regimens for treatment of drug-sensitive tuberculosis (DS-TB) is not well known. Methods In this study, we contemporaneously enrolled subjects with DS-TB (n = 31) or DR-TB (n = 23) and assessed their response to therapy with first-line (rifampin, isoniazid, ethambutol, pyrazinamide) or second-line (bedaquiline, pyrazinamide, levofloxacin, linezolid, clofazimine) regimens, respectively. Results We found that the early bactericidal activity of first- and second-line regimens was similar during the first 2 weeks of therapy as determined by BACTEC MGIT, colony-forming units, and a liquid limiting dilution assay capable of detecting differentially detectable/culturable Mycobacterium tuberculosis. Furthermore, an identical percentage (77.8%) of subjects from the DS-TB and DR-TB cohorts converted to culture negative after 2 months of therapy. Conclusions Despite presenting with more advanced disease at time of treatment, subjects with DR-TB receiving an all oral bedaquiline-based second-line treatment regimen displayed a similar microbiological response to therapy as subjects with DS-TB receiving a first-line treatment regimen. [ABSTRACT FROM AUTHOR]

Key Points: Question: Can a linkage case management intervention decrease mortality among people with HIV in Tanzania during the first year after hospital discharge? Finding: In this randomized clinical trial that involved 500 hospitalized people with HIV, a linkage case management intervention did not reduce 12-month mortality (17.2% with intervention vs 16.8% with standard care; hazard ratio, 1.01; 95% CI, 0.66-1.55; P =.96). Meaning: Among hospitalized people with HIV, linkage case management did not reduce 12-month mortality. Importance: Despite the widespread availability of antiretroviral therapy (ART), people with HIV still experience high mortality after hospital admission. Objective: To determine whether a linkage case management intervention (named "Daraja" ["bridge" in Kiswahili]) that was designed to address barriers to HIV care engagement could improve posthospital outcomes. Design, Setting, and Participants: Single-blind, individually randomized clinical trial to evaluate the effectiveness of the Daraja intervention. The study was conducted in 20 hospitals in Northwestern Tanzania. Five hundred people with HIV who were either not treated (ART-naive) or had discontinued ART and were hospitalized for any reason were enrolled between March 2019 and February 2022. Participants were randomly assigned 1:1 to receive either the Daraja intervention or enhanced standard care and were followed up for 12 months through March 2023. Intervention: The Daraja intervention group (n = 250) received up to 5 sessions conducted by a social worker at the hospital, in the home, and in the HIV clinic over a 3-month period. The enhanced standard care group (n = 250) received predischarge HIV counseling and assistance in scheduling an HIV clinic appointment. Main Outcomes and Measures: The primary outcome was all-cause mortality at 12 months after enrollment. Secondary outcomes related to HIV clinic attendance, ART use, and viral load suppression were extracted from HIV medical records. Antiretroviral therapy adherence was self-reported and pharmacy records confirmed perfect adherence. Results: The mean age was 37 (SD, 12) years, 76.8% were female, 35.0% had CD4 cell counts of less than 100/μL, and 80.4% were ART-naive. Intervention fidelity and uptake were high. A total of 85 participants (17.0%) died (43 in the intervention group; 42 in the enhanced standard care group); mortality did not differ by trial group (17.2% with intervention vs 16.8% with standard care; hazard ratio [HR], 1.01; 95% CI, 0.66-1.55; P =.96). The intervention, compared with enhanced standard care, reduced time to HIV clinic linkage (HR, 1.50; 95% CI, 1.24-1.82; P <.001) and ART initiation (HR, 1.56; 95% CI, 1.28-1.89; P <.001). Intervention participants also achieved higher rates of HIV clinic retention (87.4% vs 76.3%; P =.005), ART adherence (81.1% vs 67.6%; P =.002), and HIV viral load suppression (78.6% vs 67.1%; P =.01) at 12 months. The mean cost of the Daraja intervention was about US $22 per participant including startup costs. Conclusions and Relevance: Among hospitalized people with HIV, a linkage case management intervention did not reduce 12-month mortality outcomes. These findings may help inform decisions about the potential role of linkage case management among hospitalized people with HIV. Trial Registration: ClinicalTrials.gov Identifier: NCT03858998 This randomized trial assesses whether a linkage case management intervention reduces 12-month mortality compared with enhanced standard care among people with HIV not taking antiretroviral therapy (ART) who were hospitalized for any reason. [ABSTRACT FROM AUTHOR]

Despite their therapeutic benefits, antibiotics exert collateral damage on the microbiome and promote antimicrobial resistance. However, the mechanisms governing microbiome recovery from antibiotics are poorly understood. Treatment of Mycobacterium tuberculosis, the world's most common infection, represents the longest antimicrobial exposure in humans. Here, we investigate gut microbiome dynamics over 20 months of multidrug-resistant tuberculosis (TB) and 6 months of drug-sensitive TB treatment in humans. We find that gut microbiome dynamics and TB clearance are shared predictive cofactors of the resolution of TB-driven inflammation. The initial severe taxonomic and functional microbiome disruption, pathobiont domination, and enhancement of antibiotic resistance that initially accompanied long-term antibiotics were countered by later recovery of commensals. This resilience was driven by the competing evolution of antimicrobial resistance mutations in pathobionts and commensals, with commensal strains with resistance mutations reestablishing dominance. Fecal-microbiota transplantation of the antibiotic-resistant commensal microbiome in mice recapitulated resistance to further antibiotic disruption. These findings demonstrate that antimicrobial resistance mutations in commensals can have paradoxically beneficial effects by promoting microbiome resilience to antimicrobials and identify microbiome dynamics as a predictor of disease resolution in antibiotic therapy of a chronic infection. Editor's summary: Antibiotic exposure is well known to disrupt the microbiome, but how microbiota recovery occurs is less well studied. Examining a clinical cohort, Bhattarai et al. longitudinally investigated the long-term impact of multidrug-resistant (MDR) tuberculosis (TB) antibiotic treatment on the gut microbiota. Although treatment severely destabilized patient gut microbiota, repopulation by nonpathogenic bacteria occurred by treatment completion at 6 to 24 months, a process that was promoted by the emergence of antibiotic resistance in commensal species. This study sheds light on the treatment and resolution of the most common infection worldwide. —Catherine Charneski [ABSTRACT FROM AUTHOR]

Background: Cryptococcal meningitis is a leading cause of death among HIV‐infected individuals in sub‐Saharan Africa. Recent developments include the availability of intravenous fluconazole, cryptococcal antigen assays and new data to support fluconazole pre‐emptive treatment. In this study, we describe the impact of screening HIV‐positive adult inpatients with serum cryptococcal antigen (CRAG) at a Tanzanian referral hospital. Methods: All adults admitted to the medical ward of Bugando Medical Centre are counseled and tested for HIV. In this prospective cohort study, we consecutively enrolled HIV‐positive patients admitted between September 2009 and January 2010. All patients were interviewed, examined and screened with serum CRAG. Patients with positive serum CRAG or signs of meningitis underwent lumbar puncture. Patients were managed according to standard World Health Organization treatment guidelines. Discharge diagnoses and in‐hospital mortality were recorded. Results: Of 333 HIV‐infected adults enrolled in our study, 15 (4.4%) had confirmed cryptococcal meningitis and 10 of these 15 (66%) died. All patients with cryptococcal meningitis had at least two of four classic symptoms and signs of meningitis: fever, headache, neck stiffness and altered mental status. Cryptococcal meningitis accounted for a quarter of all in‐hospital deaths. Conclusions: Despite screening of all HIV‐positive adult inpatients with the serum CRAG at the time of admission and prompt treatment with high‐dose intravenous fluconazole in those with confirmed cryptococcal meningitis, the in‐hospital mortality rate remained unacceptably high. Improved strategies for earlier diagnosis and treatment of HIV, implementation of fluconazole pre‐emptive treatment for high‐risk patients and acquisition of better resources for treatment of cryptococcal meningitis are needed., Background Cryptococcal meningitis is one of the most common and severe opportunistic infections among people infected with HIV: there are an estimated 720, 000 cases and 500, 000 deaths per [...]

A randomized clinical trial in Haiti was conducted determine if early initiation of antiretroviral therapy, as compared with the standard timing for the initiation of therapy improves survival. Early initiation of antiretroviral therapy was observed to decrease the rates of death and incident tuberculosis hence access to antiretroviral therapy should be expanded to include all HIV-infected adults who have CD4+ T-cell counts of less than 350 per cubic millimeter, including those who live in areas with limited resources.

Haiti is one of the most food-insecure (FIS) nations in the world, with increasing rates of overweight and obesity. This study aimed to characterize FIS among households in urban Haiti and assess the relationship between FIS and body mass index (BMI) using enrollment data from the Haiti Cardiovascular Disease Cohort Study. FIS was characterized as no/low, moderate/high, and extreme based on the Household Food Security Scale. Multinomial logistic generalized estimating equations were used to evaluate the association between FIS categories and BMI, with obesity defined as BMI ≥ 30 kg/m2. Among 2972 participants, the prevalence of moderate/high FIS was 40.1% and extreme FIS was 43.7%. Those with extreme FIS had higher median age (41 vs. 38 years) and were less educated (secondary education: 11.6% vs. 20.3%) compared to those with no/low FIS. Although all FIS categories had high obesity prevalence, those with extreme FIS compared to no/low FIS (15.3% vs. 21.6%) had the lowest prevalence. Multivariable models showed an inverse relationship between FIS and obesity: moderate/high FIS (OR: 0.77, 95% CI: 0.56, 1.08) and extreme FIS (OR: 0.58, 95% CI: 0.42, 0.81) versus no/low FIS were associated with lower adjusted odds of obesity. We found high prevalence of extreme FIS in urban Haiti in a transitioning nutrition setting. The inverse relationship between extreme FIS and obesity needs to be further studied to reduce both FIS and obesity in this population. [ABSTRACT FROM AUTHOR]

Introduction AIDS is the leading cause of death in adolescents and youth aged 13-25 years in sub-Saharan Africa and Caribbean countries that have generalized epidemics of infection with HIV-1. (1-3) [...], Objective To assess outcomes after antiretroviral therapy (ART) in adolescents and youth in Haiti, a country with a generalized epidemic of infection with HIV-1. Methods An assessment was made of survival, plasma HIV-1 ribonucleic acid (RNA) concentrations and HIV-1 drug resistance patterns after 12 months of ART in patients aged 13-25 years who presented to a clinic in Port-au-Prince, Haiti, with AIDS between 1 March 2003 and 31 December 2005. Participants received ART in accordance with WHO guidelines. Kaplan-Meier analysis was used to estimate survival probabilities and their 95% confidence intervals (Cl) for the period from ART initiation to death. Findings Of a total of 146 patients, 96 (66%) were female; the median CD4+ T-cell count at baseline was 129 cells/ml. By Kaplan-Meier analysis, 13% of the patients had died at 12 months, 17% at 24 months and 20% at 36 months. A plasma HIV-1 RNA concentration ≥ 50 copies/ml was seen in 40 (51%) of 79 patients 12 months after treatment initiation and was associated. with poor ART adherence. Among 29 patients with > 1000 copies/ml at 12 months, resistance mutations to non-nucleoside reverse transcriptase inhibitors (NNRTIs) were detected in 23 cases (79%); to both NNRTIs and lamivudine in 21 (72%) cases; and to NNRTIs, lamivudine and other nucleoside reverse transcriptase inhibitors in 10 (35%) cases. One hundred and six participants (73%) reported sexual intercourse without condoms, and 35 of the 96 women (36%) were pregnant during follow-up. Conclusion Adolescents and youth with AIDS receiving ART are at risk of virologic failure and disease progression and can therefore transmit HIV-1 to sexual partners and infants. Strategies to target the special needs of this age group are urgently needed. Objectif Evaluer les issues du traitement antiretroviral (ART) chez des adolescents et des jeunes vivant en Haiti, pays victime d'une epidemie generalisee de VIH-1. Methodes On a effectue une evaluation de la survie, du taux d'acide ribonucleique (ARN) VIH-1 plasmatique et des schemas de pharmacoresistance du VIH-1 apres 12 mois de traitement ART chez des jeunes individus de 13 a 25 ans atteints de sida, accueillis dans un dispensaire de Port-au-Prince entre le ler mars 2003 et le 31 decembre 2005. Les sujets de l'etude ont recu des antiretroviraux conformement aux recommandations de I'OMS. On a utilise une analyse de Kaplan-Meier pour estimer les probabilites de survie et les intervalles de confiance a 95 % (IC) correspondants pour la periode allant du debut du traitement ART au deces des sujets. Resultats Sur les 146 malades, 96 (66 %) etaient des femmes ; la valeur mediane de reference pour la numeration des lymphocytes CD4+ etait de 129 cellules/ml. L'analyse de Kaplan-Meier a montre que 13 % des malades etaient decedes au bout de 12 mois, 17 % au bout de 24 mois et 20 % au bout de 36 mois. On a releve une concentration d'ARN VIH-1 plasmatique ≥ 50 copies/ml chez 40 malades sur 79 (51%), 12 mois apres le debut du traitement, en association avec une mauvaise observance therapeutique. Chez 29 malades presentant plus de 1000 copies/mi au bout de 12 mois, on a detecte des mutations de resistance aux inhibiteurs non-nucleosidiques de la transcriptase inverse (NNRTI) dans 23 cas (79 %) ; a la fois aux NNRTI et a la lamivudine dans 21 cas (72 %) ; et aux NNRTI, a la lamivudine et a des inhibiteurs nucleosidiques de la transcriptase inverse dans 10 cas (35 %). Cent six participants ont rapporte avoir eu des rapports sexuels non proteges et 35 des 96 femmes (36 %) etaient enceintes pendant le suivi. Conclusion Les adolescents et les jeunes atteints de sida qui recoivent un traitement ART courent un risque d'echec virologique et de progression de la maladie et peuvent donc transmettre le VIH-1 a leurs partenaires sexuels et le cas echeant a leur enfant a natre. Il est urgent de disposer de strategies permettant de cibler les besoins specifiques de cette tranche d'ages. Objetivo Evaluar los resultados dei tratamiento antirretroviral (TAR) en adolescentes y adultos jovenes en Haiti, pais que sufre una epidemia generalizada de infeccion por VIH-1. Metodos Se hizo una evaluacion de la supervivencia, las concentraciones plasmaticas de acido ribonucleico (ARN) de VIH-1 y el perfil de farmacorresistencia del VIH-1 a los 12 meses de iniciada la TAR en pacientes de 13 a 25 anos que acudieron a un consultorio de Puerto Principe, Haiti, con SIDA entre el 1 de marzo de 2003 y el 31 de diciembre de 2005. Los participantes recibieron TAR con arreglo a las directrices de la OMS. Se utilizo el metodo de Kaplan-Meier para estimar las probabilidades de supervivencia y sus intervalos de confianza (IC) dei 95% para el periodo transcurrido entre el inicio dei TAR y la defuncion. Resultados De un total de 146 pacientes, 96 (66%) eran mujeres; la mediana dei recuento de linfocitos T CD4+ al comienzo dei estudio fue de 129 celulas/ml. Segun el analisis de KaplanMeier, el 13% de los pacientes habian muerto a los 12 meses, el 17% a los 24 meses, y el 20% a los 36 meses. En 40 de 79 pacientes (51%) se detecto una concentracion plasmatica de ARN de VIH-1 ≥ 50 copias/ml a los 12 meses de iniciado el tratamiento, asociada a un escaso cumplimiento dei TAR. Entre los 29 pacientes con mas de 1000 copias/ml a los 12 meses, se detectaron mutaciones de resistencia a los inhibidores no nucleosidos de la transcriptasa inversa (NNRTI) en 23 casos (79%); tanto a los NNRTI como a la lamivudina en 21 casos (72%); y a los NNRTI, la lamivudina y otros inhibidores nucleosidos de la transcriptasa inversa en 10 casos (35%). En total, 106 participantes (73%) declararon que habian mantenido relaciones sexuales sin preservativo, y 35 de las 96 mujeres (36%) se encontraban embarazadas durante el seguimiento. Conclusion Los adolescentes y adultos jovenes con SIDA sometidos a TAR presentan un riesgo especial de fracaso virologico y de progresion de la enfermedad y pueden por consiguiente transmitir el VIH-1 a su pareja y a los lactantes. Se requieren urgentemente estrategias que aborden las necesidades especiales de ese grupo de edad.

Background New rapid syphilis tests permit simple and immediate diagnosis and treatment at a single clinic visit. We compared the cost-effectiveness, projected health outcomes, and annual cost of screening pregnant [...]

The use of an educational video during the informed consent process for an HIV vaccine preparedness study conducted in Port-au-Prince, Haiti, is described. The results reveal that the informed consent using an educational video has ensured good comprehension in most of the volunteers.

The efficacy of antiretroviral therapy in the first 1004 consecutive patients with AIDS and without previous antiretroviral therapy who were treated beginning in March 2003 in Port-au-Prince, Haiti are studied. This report documents the feasibility of effective antiretroviral therapy in a large number of patients in an impoverished country.

The current study was conducted in Port au Prince, Haiti, to determine if information collected at HIV notification during voluntary counseling and testing (VCT) can predict patients' future adherence with risk reduction counseling and medical referral. Case histories describe HIV-infected patients with signs of depression during counseling who do not return for medical care, and women afraid of economic ruin and domestic violence who do not notify their sexual partners. Quantitative predictors of seeking medical care include: denial at the announcement of HIV test results (odds ratio [OR] 0.3, 95% confidence interval [CI] 0.1-0.6), belief that HIV can be transmitted by magic (OR 0.6, 95% CI 0.3-0.9), and having symptoms at the time of HIV testing (OR 1.9, 95% CI 1.6-2.3). Predictors of refusal to notify sexual partner of HIV status include: being poor (OR 1.8, 95% CI 1.1-2.5), female (OR 2.1, 95% CI 1.7-2.5), and belief that HIV can be transmitted by magic (OR 2.3, 95% CI 1.9-2.6) In conclusion, information collected during HIV counseling and testing can predict patients' future adherence with counseling and medical referral. Counselors can use information such as signs of severe depression, economic hardship, and denial of HIV disease to identify patients at risk for nonadherence and to provide them with specialized counseling and care.