Titel Deelnemers "Korte inhoud" "Reasons for missing antiretroviral therapy" "Olivier Koole, J.A. Denison, Joris Menten, S. Tsui, F. Wabwire-Mangen, G. Kwesigabo, M. Mulenga, A. Auld, S. Agolory, Y.D. Mukadi, E Van Praag, K Torpey, S. Williams, J. Kaplan, A. Zee, D.R. Bangsberg, Robert Colebunders" "OBJECTIVES: To identify the reasons patients miss taking their antiretroviral therapy (ART) and the proportion who miss their ART because of symptoms; and to explore the association between symptoms and incomplete adherence. METHODS: Secondary analysis of data collected during a cross-sectional study that examined ART adherence among adults from 18 purposefully selected sites in Tanzania, Uganda, and Zambia. We interviewed 250 systematically selected patients per facility (>/=18 years) on reasons for missing ART and symptoms they had experienced (using the HIV Symptom Index). We abstracted clinical data from the patients' medical, pharmacy, and laboratory records. Incomplete adherence was defined as having missed ART for at least 48 consecutive hours during the past 3 months. RESULTS: Twenty-nine percent of participants reported at least one reason for having ever missed ART (1278/4425). The most frequent reason was simply forgetting (681/1278 or 53%), followed by ART-related hunger or not having enough food (30%), and symptoms (12%). The median number of symptoms reported by participants was 4 (IQR: 2-7). Every additional symptom increased the odds of incomplete adherence by 12% (OR: 1.1, 95% CI: 1.1-1.2). Female participants and participants initiated on a regimen containing stavudine were more likely to report greater numbers of symptoms. CONCLUSIONS: Symptoms were a common reason for missing ART, together with simply forgetting and food insecurity. A combination of ART regimens with fewer side effects, use of mobile phone text message reminders, and integration of food supplementation and livelihood programmes into HIV programmes, have the potential to decrease missed ART and hence to improve adherence and the outcomes of ART programmes." "Lower levels of antiretroviral therapy enrollment among men with HIV compared with women - 12 countries, 2002-2013" "A.F. Auld, R.W. Shiraishi, F Mbofana, A. Couto, E.B. Fetogang, S. El-Halabi, R. Lebelonyane, P.T. Pilatwe, N. Hamunime, V. Okello, T. Mutasa-Apollo, O Mugurungi, J. Murungu, J. Dzangare, G. Kwesigabo, F. Wabwire-Mangen, M. Mulenga, S Hachizovu, V. Ettiegne Traore, F. Mohamed, A. Bashorun, D.T. Nhan, N.H. Hai, T.H. Quang, J.D. Van Onacker, K. Francois, E.G. Robin, G. Desforges, M. Farahani, H. Kamiru, H. Nuwagaba-Biribonwoha, P. Ehrenkranz, J.A. Denison, Olivier Koole, S. Tsui, K Torpey, Y.D. Mukadi, E Van Praag, Joris Menten, T.D. Mastro, C.D. Hamilton, O.O. Abiri, M. Griswold, E. Pierre, C. Xavier, C. Alfredo, K. Jobarteh, M. Letebele, S. Agolory, A.L. Baughman, G. Mutandi, P. Preko, C. Ryan, T. Ao, E. Gonese, A. Herman-Roloff, K.A. Ekra, J.S. Kouakou, S. Odafe, D. Onotu, I. Dalhatu, H.H. Debem, D.B. Nguyen, L.N. Yen, A.S. Abdul-Quader, V. Pelletier, S.G. Williams, S. Behel, G. Bicego, M. Swaminathan, E.K. Dokubo, G Adjorlolo-Johnson, R. Marlink, D. Lowrance, T. Spira, Robert Colebunders, D. Bangsberg, A. Zee, J. Kaplan, T.V. Ellerbrock" "Equitable access to antiretroviral therapy (ART) for men and women with human immunodeficiency virus (HIV) infection is a principle endorsed by most countries and funding bodies, including the U.S. President's Emergency Plan for AIDS (acquired immunodeficiency syndrome) Relief (PEPFAR) (1). To evaluate gender equity in ART access among adults (defined for this report as persons aged >/=15 years), 765,087 adult ART patient medical records from 12 countries in five geographic regions* were analyzed to estimate the ratio of women to men among new ART enrollees for each calendar year during 2002-2013. This annual ratio was compared with estimates from the Joint United Nations Programme on HIV/AIDS (UNAIDS)dagger of the ratio of HIV-infected adult women to men in the general population. In all 10 African countries and Haiti, the most recent estimates of the ratio of adult women to men among new ART enrollees significantly exceeded the UNAIDS estimates for the female-to-male ratio among HIV-infected adults by 23%-83%. In six African countries and Haiti, the ratio of women to men among new adult ART enrollees increased more sharply over time than the estimated UNAIDS female-to-male ratio among adults with HIV in the general population. Increased ART coverage among men is needed to decrease their morbidity and mortality and to reduce HIV incidence among their sexual partners. Reaching more men with HIV testing and linkage-to-care services and adoption of test-and-treat ART eligibility guidelines (i.e., regular testing of adults, and offering treatment to all infected persons with ART, regardless of CD4 cell test results) could reduce gender inequity in ART coverage." "Antiretroviral therapy enrollment characteristics and outcomes among HIV-infected adolescents and young adults compared with older adults - seven African countries, 2004-2013" "A.F. Auld, S.G. Agolory, R.W. Shiraishi, F. Wabwire-Mangen, G. Kwesigabo, M. Mulenga, S Hachizovu, E. Asadu, M.Z. Tuho, V. Ettiegne Traore, F Mbofana, V. Okello, C. Azih, J.A. Denison, S. Tsui, Olivier Koole, H. Kamiru, H. Nuwagaba-Biribonwoha, C. Alfredo, K. Jobarteh, S. Odafe, D. Onotu, K.A. Ekra, J.S. Kouakou, P. Ehrenkranz, G. Bicego, K Torpey, Y.D. Mukadi, E. Praag, Joris Menten, T. Mastro, C.D. Hamilton, M. Swaminathan, E.K. Dokubo, A.L. Baughman, T. Spira, Robert Colebunders, D. Bangsberg, R. Marlink, A. Zee, J. Kaplan, T.V. Ellerbrock" "Although scale-up of antiretroviral therapy (ART) since 2005 has contributed to declines of about 30% in the global annual number of human immunodeficiency (HIV)-related deaths and declines in global HIV incidence, estimated annual HIV-related deaths among adolescents have increased by about 50% and estimated adolescent HIV incidence has been relatively stable. In 2012, an estimated 2,500 (40%) of all 6,300 daily new HIV infections occurred among persons aged 15-24 years. Difficulty enrolling adolescents and young adults in ART and high rates of loss to follow-up (LTFU) after ART initiation might be contributing to mortality and HIV incidence in this age group, but data are limited. To evaluate age-related ART retention challenges, data from retrospective cohort studies conducted in seven African countries among 16,421 patients, aged >/=15 years at enrollment, who initiated ART during 2004-2012 were analyzed. ART enrollment and outcome data were compared among three groups defined by age at enrollment: adolescents and young adults (aged 15-24 years), middle-aged adults (aged 25-49 years), and older adults (aged >/=50 years). Enrollees aged 15-24 years were predominantly female (81%-92%), commonly pregnant (3%-32% of females), unmarried (54%-73%), and, in four countries with employment data, unemployed (53%-86%). In comparison, older adults were more likely to be male (p" "Paediatric pharmacovigilance" "D.K. Kajungu, Annette Erhart, A.O. Talisuna, Q. Bassat, C. Karema, C Nabasumba, M Nambozi, H. Tinto, P Kremsner, M. Meremikwu, D'Alessandro, Niko Speybroeck" "Birds of a feather: homophily and sexual network structure in sub-Saharan Africa" "Christopher Kenyon, Robert Colebunders" "Sexual partner homophily is the tendency of individuals to choose partners similar to themselves. The extent and nature of partner homophily influences the structure of sexual networks and hence the spread of sexually transmitted infections (STIs). In this paper, we compare homophily by ethnicity, age and educational status in representative populations from five African cities in Benin (Cotonou), Cameroon (Yaounde), Kenya (Kisumu), Zambia (Ndola) and South Africa (Carletonville). We find low rates of homophily by age and high rates for educational status throughout the region. There is a large variation in homophily by ethnicity between these five cities, with rates lowest in Ndola. In Carletonville, there is a gendered difference in homophily by ethnicity. We discuss the possible implications these variations in the extent and type of homophily may have for STI transmission in the region." "Equity in financing and use of health care in Ghana, South Africa, and Tanzania: implications for paths to universal coverage" "A Mills, J.E. Ataguba, J. Akazili, J. Borghi, B. Garshong, S. Makawia, G. Mtei, B. Harris, J. Macha, Filip Meheus, D. McIntyre" "A phase 3 trial of RTS,S/AS01 malaria vaccine in African infants" D'Alessandro "Attempting to explain heterogeneous HIV epidemics in sub-Saharan Africa: potential role of historical changes in risk behaviour and male circumcision" "KK Orroth, RG White, EE Freeman, R Bakker, Anne Buvé, JR Glynn, JDF Habbema, RJ Hayes" "Background: A key conclusion of the Four Cities Study, carried out to explore reasons for heterogeneity in the HIV epidemic between two cities in sub-Saharan Africa with relatively low prevalence (Cotonou and Yaounde) and two with high prevalence (Kisumu and Ndola), was that differences in biological cofactors outweighed differences in sexual risk behaviours. The authors explore an alternative hypothesis, that risk behaviours were historically higher in the high-prevalence cities. They also investigate the effects of different prevalence of male circumcision on the HIV epidemics in the four cities.MethodsA transmission model was fitted to data from the Four Cities Study. Default scenarios included biological cofactor effects on HIV transmission. Counter-factual scenarios were simulated without biological cofactors, with and without higher historical sexual behaviours, and with various rates of male circumcision. Results: Simulated adult HIV prevalence in 1997 for the default scenarios was 3.1%, 7.8%, 28.9% and 27.1% in Cotonou, Yaounde, Kisumu and Ndola, respectively, in line with data. Without biological cofactors, even implausibly high historical levels of risk behaviour in East Africa could not reproduce the observed heterogeneity in the late 1990s. Increasing the proportion of men circumcised in Ndola from 10% to 100% reduced HIV prevalence in 1997 to 7%. Decreasing the proportion circumcised in Yaounde from 100% to 10% increased HIV prevalence to 26%. Conclusions: Differences in male circumcision rates are likely to have played a key role in the heterogeneous spread of HIV across Africa. The effect of circumcision interventions can vary depending on the epidemic setting, with a larger effect in more generalised epidemics." "Removing user fees in the health sector: a review of policy processes in six sub-Saharan African countries" "Bruno Meessen, David Hercot, M. Noirhomme, V. Ridde, A Tibouti, C Kirunga Tashobya, L Gilson" "A head-to-head comparison of four artemisinin-based combinations for treating uncomplicated malaria in African children: a randomized trial" "D'Alessandro, Joris Menten, Raffaella Ravinetto, Harry van Loen" "BACKGROUND: Artemisinin-based combination therapies (ACTs) are the mainstay for the management of uncomplicated malaria cases. However, up-to-date data able to assist sub-Saharan African countries formulating appropriate antimalarial drug policies are scarce. METHODS AND FINDINGS: Between 9 July 2007 and 19 June 2009, a randomized, non-inferiority (10% difference threshold in efficacy at day 28) clinical trial was carried out at 12 sites in seven sub-Saharan African countries. Each site compared three of four ACTs, namely amodiaquine-artesunate (ASAQ), dihydroartemisinin-piperaquine (DHAPQ), artemether-lumefantrine (AL), or chlorproguanil-dapsone-artesunate (CD+A). Overall, 4,116 children 6-59 mo old with uncomplicated Plasmodium falciparum malaria were treated (1,226 with AL, 1,002 with ASAQ, 413 with CD+A, and 1,475 with DHAPQ), actively followed up until day 28, and then passively followed up for the next 6 mo. At day 28, for the PCR-adjusted efficacy, non-inferiority was established for three pair-wise comparisons: DHAPQ (97.3%) versus AL (95.5%) (odds ratio [OR]: 0.59, 95% CI: 0.37-0.94); DHAPQ (97.6%) versus ASAQ (96.8%) (OR: 0.74, 95% CI: 0.41-1.34), and ASAQ (97.1%) versus AL (94.4%) (OR: 0.50, 95% CI: 0.28-0.92). For the PCR-unadjusted efficacy, AL was significantly less efficacious than DHAPQ (72.7% versus 89.5%) (OR: 0.27, 95% CI: 0.21-0.34) and ASAQ (66.2% versus 80.4%) (OR: 0.40, 95% CI: 0.30-0.53), while DHAPQ (92.2%) had higher efficacy than ASAQ (80.8%) but non-inferiority could not be excluded (OR: 0.35, 95% CI: 0.26-0.48). CD+A was significantly less efficacious than the other three treatments. Day 63 results were similar to those observed at day 28. CONCLUSIONS: This large head-to-head comparison of most currently available ACTs in sub-Saharan Africa showed that AL, ASAQ, and DHAPQ had excellent efficacy, up to day 63 post-treatment. The risk of recurrent infections was significantly lower for DHAPQ, followed by ASAQ and then AL, supporting the recent recommendation of considering DHAPQ as a valid option for the treatment of uncomplicated P. falciparum malaria. TRIAL REGISTRATION: ClinicalTrials.gov NCT00393679; Pan African Clinical Trials Registry PACTR2009010000911750 Please see later in the article for the Editors' Summary."