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1. J Int AIDS Soc

Author

Larmarange, Joseph, Diallo, Mamadou, McGrath, Nuala, Iwuji, Collins, PLAZY, Mélanie, Thiébaut, Rodolphe, Tanser, Frank, Bärrnighausen, Till, Orne‐Gliemann, Joanna, Pillay, Deenan, Dabis, Francois, Herbst, Kobus, Makowa, Thembisa, Naidu, Kevi, Okesola, Nonhlanhla, Rochat, Tamsen, Viljoen, Johannes, Zuma, Thembelihle, Oliveira, Tulio, Karcher, Sophie, Prague, Mélanie, Tiendrebeogo, Thierry, Boyer, Sylvie, Donfouet, Hermann, Gosset, Andréa, March, Laura, Protopopescu, Camelia, Spire, Bruno, Calvez, Vincent, Derache, Anne, Marcelin, Anne‐Genevieve, Dray‐Spira, Rosemary, Lert, France, El Farouki, Kamal, Chaix, Marie‐Laure, Bazin, Brigitte, Rekacewicz, Claire, Imrie, John, Lessells, Richard, Newell, Colin, Newell, Marie‐Louise, Calmy, Alexandra, Freedberg, Kenneth, Hontelez, Jan, Centre population et développement (CEPED - UMR_D 196), Institut de Recherche pour le Développement (IRD)-Université de Paris (UP), London School of Hygiene and Tropical Medicine (LSHTM), Brighton and Sussex Medical School (BSMS), Institut de Santé Publique, d'Epidémiologie et de Développement (ISPED), Université Bordeaux Segalen - Bordeaux 2, Africa Health Research Institute [Durban/Mtubatuba] (AHRI), Harvard School of Public Health, University College of London [London] (UCL), Africa Centre for Health and Population Studies, University of KwaZulu-Natal (UKZN)-Medical Research Council of South Africa, Pathogénèse et contrôle des infections chroniques (PCCI), Centre Hospitalier Universitaire de Montpellier (CHU Montpellier )-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Epidémiologie et Biostatistique [Bordeaux], Université Bordeaux Segalen - Bordeaux 2-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U912 INSERM - Aix Marseille Univ - IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD), Sexual Health Unit, Institut National de la Santé et de la Recherche Médicale (Inserm)-Université de Bordeaux-Institut National de la Santé et de la Recherche Médicale (Inserm)-Université de Bordeaux, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre de recherche en épidémiologie et santé des populations (CESP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse, Agence Nationale de Recherches sur le Sida et les Hépatites Virales (ANRS), HIV Unit, Geneva University Hospital, Massachusetts General Hospital [Boston], International Initiative for Impact EvaluationDeutsche Gesellschaft für Internationale Zusammenarbeit. Grant Number: 81151938Wellcome TrustAgence Nationale de Recherches sur le Sida et les Hepatites Virales. Grant Number: 2011‐375Bill and Melinda Gates Foundation, Bordeaux population health (BPH), Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Université de Bordeaux (UB), Statistics In System biology and Translational Medicine (SISTM), Inria Bordeaux - Sud-Ouest, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria)-Epidémiologie et Biostatistique [Bordeaux], Université Bordeaux Segalen - Bordeaux 2-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Bordeaux Segalen - Bordeaux 2-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Agence Nationale de Recherches sur le Sida et les Hépatites Virales, Institut de Recherche pour le Développement (IRD)-Université Paris Descartes - Paris 5 (UPD5), Santé, vulnérabilités et relations de genre au sud (SAGESUD - ERL Inserm U1244), Institut de Recherche pour le Développement (IRD)-Université Paris Descartes - Paris 5 (UPD5)-Institut de Recherche pour le Développement (IRD)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut de Recherche pour le Développement (IRD)-Université Paris Cité (UPCité), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre population et développement (CEPED - UMR_D 196), Institut de Recherche pour le Développement (IRD)-Université Paris Cité (UPCité)-Institut de Recherche pour le Développement (IRD)-Université Paris Cité (UPCité), Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria)- Bordeaux population health (BPH), Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Universitaire de Montpellier (CHU Montpellier )-Université de Montpellier (UM), Epidémiologie, Systèmes d'Information, Modélisation, Université Pierre et Marie Curie - Paris 6 (UPMC)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Mode de vie, génétique et santé : études intégratives et transgénérationnelles (U1018 (Équipe 9)), Institut Gustave Roussy (IGR)-Centre de recherche en épidémiologie et santé des populations (CESP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris-Sud - Paris 11 (UP11)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris-Sud - Paris 11 (UP11)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris-Sud - Paris 11 (UP11)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), University of Southampton, Hôpital Universitaire de Genève, Heidelberg University, Public Health, HAL AMU, Administrateur, and Institut de Recherche pour le Développement (IRD)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Aix Marseille Université (AMU)

Subjects
Counseling, Male, Rural Population, Impact evaluation, Human immunodeficiency virus (HIV), HIV Infections, medicine.disease_cause, South Africa, 0302 clinical medicine, Mass Screening, 030212 general & internal medicine, Viral suppression, 050207 economics, Referral and Consultation, Research Articles, Randomized Controlled Trials as Topic, education.field_of_study, retention in care, 050208 finance, Incidence, 05 social sciences, 3. Good health, SISTM, Infectious Diseases, Female, 0305 other medical science, Research Article, Adult, medicine.medical_specialty, Referral, Anti-HIV Agents, Population, antiretroviral therapy, Context (language use), Population health, IDLIC, 03 medical and health sciences, Acquired immunodeficiency syndrome (AIDS), 0502 economics and business, medicine, Humans, sustained viral suppression, education, Research ethics, 030505 public health, business.industry, Public Health, Environmental and Occupational Health, HIV, medicine.disease, CD4 Lymphocyte Count, Clinical trial, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Family medicine, Test and treat, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, Delivery of Health Care, population health, Demography
Abstract

Background: The universal test-and-treat strategy (UTT) aims to maximize population viral suppression (PVS), i.e. the proportion of all people living with HIV (PLHIV) on antiretroviral treatment (ART) and virally suppressed in a community. We investigated whether PVS improved during the course of the ANRS 12249 TasP trial conducted in rural South Africa and investigating UTT impact on HIV incidence. Methods: The TasP cluster-randomized trial (2012-2016) implemented six-monthly repeat home-based HIV counselling and testing (RHBCT) and referral of PLHIV to local HIV clinics in 2×11 clusters opened sequentially. ART was initiated according to national guidelines in control clusters and regardless of CD 4 count in intervention clusters. We measured residency status, HIV status and HIV care status for each participant. PVS was computed per cluster among all resident PLHIV (≥16, including those not in care) at cluster opening and daily thereafter. We used a mixed linear model to explore time patterns in PVS, adjusting for sociodemographic changes at cluster level. Findings: 8 563 PLHIV were followed. Between cluster opening and January 1, 2016, PVS increased significantly in both arms (intervention: 23·5% to 46·2%, +22·8, p

Published
2019

2. Human resources needs for universal access to antiretroviral therapy in South Africa: a time and motion study

Author

Hontelez Jan AC, Newell Marie-Louise, Bland Ruth M, Munnelly Kristen, Lessells Richard J, and Bärnighausen Till

Subjects
Human resources for health, HIV, South Africa, Antiretroviral treatment, Medicine (General), R5-920, Public aspects of medicine, RA1-1270
Abstract

Abstract Background Although access to life-saving treatment for patients infected with HIV in South Africa has improved substantially since 2004, treating all eligible patients (universal access) remains elusive. As the prices of antiretroviral drugs have dropped over the past years, availability of human resources may now be the most important barrier to achieving universal access to HIV treatment in Africa. We quantify the number of HIV health workers (HHWs) required to be added to the current HIV workforce to achieve universal access to HIV treatment in South Africa, under different eligibility criteria. Methods We performed a time and motion study in three HIV clinics in a rural, primary care-based HIV treatment program in KwaZulu-Natal, South Africa, to estimate the average time per patient visit for doctors, nurses, and counselors. We estimated the additional number of HHWs needed to achieve universal access to HIV treatment within one year. Results For universal access to HIV treatment for all patients with a CD4 cell count of ≤350 cells/μl, an additional 2,200 nurses, 3,800 counselors, and 300 doctors would be required, at additional annual salary cost of 929 million South African rand (ZAR), equivalent to US$ 141 million. For universal treatment (‘treatment as prevention’), an additional 6,000 nurses, 11,000 counselors, and 800 doctors would be required, at an additional annual salary cost of ZAR 2.6 billion (US$ 400 million). Conclusions Universal access to HIV treatment for patients with a CD4 cell count of ≤350 cells/μl in South Africa may be affordable, but the number of HHWs available for HIV treatment will need to be substantially increased. Treatment as prevention strategies will require considerable additional financial and human resources commitments.

Published
2012
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3. Using the Emanuel Framework to Explore the Ethical Issues Raised in a Participatory Visual Research Project in Rural South Africa.

Author

Treffry-Goatley, Astrid, Moletsane, Relebohile, de Oliveira, Tulio, Seeley, Janet, and Lessells, Richard

Subjects
PARTICIPANT observation, DIGITAL storytelling, SOCIAL adjustment, PATIENT compliance, RESEARCH ethics, CRITICAL realism
Abstract

Participatory visual research can offer critical insight into the experiences of those most affected by health issues. As these methods are increasingly used to research sensitive topics, there is a need for a clear ethical framework to guide best practice on the part of researchers and research ethics committees. Here we reflect on a project where we used digital storytelling as a participatory visual methodology to explore HIV treatment adherence in rural South Africa, with a focus on the ethical issues we encountered during the lifetime of the project. To ground our reflections, we use the framework for ethical research developed by Emanuel et al., and the adaptation of this framework for social science proposed by Wassenaar and Mamotte. We suggest that fellow PVM practitioners and REC members draw on this holistic framework to support the optimal application of PVM in health research. [ABSTRACT FROM AUTHOR]

Published
2021
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4. Tuberculosis mortality and the male survival deficit in rural South Africa: an observational community cohort study

Author

Reniers, Georges, Blom, Sylvia, Lieber, Judith, Herbst, Abraham J, Calvert, Clara, Bor, Jacob, Barnighausen, Till, Zaba, Basia, Li, Zehang R, Clark, Samuel J, Grant, Alison D, Lessells, Richard, Eaton, Jeffrey W, and Hosegood, Victoria

Subjects
Male, Rural Population, RNA viruses, Bacterial Diseases, Epidemiology, lcsh:Medicine, HIV Infections, Rural Health, Pathology and Laboratory Medicine, Cohort Studies, South Africa, Immunodeficiency Viruses, Risk Factors, Medicine and Health Sciences, Public and Occupational Health, lcsh:Science, Middle Aged, Infectious Diseases, Medical Microbiology, HIV epidemiology, Viral Pathogens, Viruses, Female, Pathogens, Research Article, Adult, Death Rates, General Science & Technology, Microbiology, Adult Cohort Studies Female HIV Infections/complications/*epidemiology/mortality Humans Life Expectancy/*trends Male Middle Aged Risk Factors Rural Health Rural Population/*statistics & numerical data Sex Factors South Africa/epidemiology Survival Analysis Tuberculosis, Pulmonary/complications/*epidemiology/mortality Wounds and Injuries/complications/*epidemiology/mortality, Life Expectancy, Sex Factors, Population Metrics, Retroviruses, MD Multidisciplinary, Humans, Adults, Tuberculosis, Tuberculosis, Pulmonary, Microbial Pathogens, Population Biology, Lentivirus, lcsh:R, Organisms, Biology and Life Sciences, HIV, Tropical Diseases, Survival Analysis, Age Groups, People and Places, Wounds and Injuries, Population Groupings, lcsh:Q
Abstract

Background: Women live on average five years longer than men, and the sex difference in longevity is typically lower in populations with high mortality. South Africa – a high mortality population with a large sex disparity – is an exception, but the causes of death that contribute to this difference are not well understood. Methods: Using data from a demographic surveillance system in rural KwaZulu-Natal (2000-2014), we estimate differences between male and female adult life expectancy by HIV status. The contribution of causes of death to these life expectancy differences are computed with demographic decomposition techniques. Cause of death information comes from verbal autopsy interviews that are interpreted with the InSilicoVA tool.Results: Adult women lived an average of 10.4 years (95% confidence Interval 9.0-11.6) longer than men. Sex differences in adult life expectancy were even larger when disaggregated by HIV status: 13.1 (95% confidence interval 10.7-15.3) and 11.2 (95% confidence interval 7.5-14.8) years among known HIV negatives and positives, respectively. Elevated male mortality from pulmonary tuberculosis (TB) and external injuries were responsible for 43% and 31% of the sex difference in life expectancy among the HIV negative population, and 81% and 16% of the difference among people living with HIV.Conclusions: The sex differences in adult life expectancy in rural KwaZulu-Natal are exceptionally large, atypical for an African population, and largely driven by high male mortality from pulmonary TB and injuries. This is the case for both HIV positive and HIV negative men and women, signalling a need to improve the engagement of men with health services, irrespective of their HIV status.

Published
2017

5. Neurocognitive functioning in MDR-TB patients with and without HIV in KwaZulu-Natal, South Africa.

Author

Ramlall, Suvira, Lessells, Richard J., Naidu, Thirusha, Sandra Mthembu, Sbusisiwe, Padayatchi, Nesri, Burns, Jonathan K., and Tomita, Andrew

Subjects
*SUBSTANCE-induced disorders, *PATIENT compliance, *MULTIDRUG-resistant tuberculosis, *HIV-positive persons, *POISSON regression
Abstract

Objectives: Optimising medication adherence is one of the essential factors in reversing the tide of a TB-HIV syndemic in sub-Saharan Africa, especially South Africa. Impairment in key neurocognitive domains may impair patients' ability to maintain adherence to treatment, but the level of cognition and its relationship to HIV status has not been examined in individuals with drug-resistant TB. We therefore investigated performance on several key neurocognitive domains in relationship to HIV status in a multidrug-resistant tuberculosis patients (MDR-TB) sample.Methods: We enrolled microbiologically confirmed MDR-TB inpatients at a TB-specialist referral hospital in KwaZulu-Natal province, South Africa. We collected cross-sectional data on sociodemographic, clinical and neurocognitive function (e.g. attention, memory, executive functioning, language fluency, visual-spatial, eye-hand coordination). For the primary analysis, we excluded participants with major depressive episode/substance use disorder (MDE/SUD). We fitted adjusted Poisson regression models to explore the association between HIV and neurocognitive function.Results: We enrolled 200 people with MDR-TB; 33 had MDE/SUD, and data of 167 were analysed (151 HIV+, 16 HIV-). The mean age of participants was 34.2 years; the majority were female (83%), and 53% had not completed secondary school. There was evidence of impaired neurocognitive functioning across all domains in both HIV+/- study participants. Based on the regression analyses, individuals with co-infection (MDR-TB/HIV+), as well as those who had longer duration of hospital stays experienced significantly lower cognitive performance in several domains. Poor cognitive performance was significantly related to older age and lower educational attainment. The presence of major depression or substance use disorders did not influence the significance of the findings.Conclusions: Adults with MDR-TB have significant neurocognitive impairment, especially if HIV positive. An integrated approach is necessary in the management of MDR-TB as cognitive health influences the ability to adhere to chronic treatment, clinical outcomes and functionality. [ABSTRACT FROM AUTHOR]

Published
2020
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6. Moderate-to-High Levels of Pretreatment HIV Drug Resistance in KwaZulu-Natal Province, South Africa.

Author

Chimukangara, Benjamin, Kharsany, Ayesha B.M., Lessells, Richard J., Naidoo, Kogieleum, Rhee, Soo-Yon, Manasa, Justen, Gräf, Tiago, Lewis, Lara, Cawood, Cherie, Khanyile, David, Diallo, Karidia, Ayalew, Kassahun A., Shafer, Robert W., Hunt, Gillian, Pillay, Deenan, Abdool, Salim Karim, and de Oliveira, Tulio

Abstract

There is evidence of increasing levels of pretreatment HIV drug resistance (PDR) in Southern Africa. We used data from two large population-based HIV surveillance studies to estimate prevalence of PDR in KwaZulu-Natal, the province with the highest HIV prevalence in South Africa. Sanger sequencing was performed on samples obtained from a longitudinal HIV surveillance program (study A, 2013–2014) and the HIV Incidence Provincial Surveillance System (study B, 2014–2015). Sequences were included for adult HIV positive participants (age ≥15 years for study A, age 15–49 years for study B) with no documented prior exposure to antiretroviral therapy (ART). Overall and drug class-specific PDR was estimated using the World Health Organization 2009 surveillance drug resistance mutation (SDRM) list, and phylogenetic analysis was performed to establish evidence of drug resistance transmission linkage. A total of 1,845 sequences were analyzed (611 study A; 1,234 study B). An overall PDR prevalence of 9.2% [95% confidence interval (CI) 7.0–11.7] was observed for study A and 11.0% (95% CI 8.9–13.2) for study B. In study B, the prevalence of non-nucleoside reverse-transcriptase inhibitor (NNRTI) PDR exceeded 10% for sequences collected in 2014 (10.2%, 95% CI 7.5–12.9). The most prevalent SDRMs were K103NS (7.5%), M184VI (2.4%), and V106AM (1.4%). There was no evidence of large transmission chains of drug-resistant virus. High level NNRTI PDR (>10%) suggests a need to modify the standard first-line ART regimen and to focus attention on improving the quality of HIV prevention, treatment, and care. [ABSTRACT FROM AUTHOR]

Published
2019
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