Medicine and Health Sciences Commons^™

Interventions To Promote Adherence To Antiretroviral Therapy In Africa: A Network Meta-Analysis, Edward J. Mills, Richard Lester, Kristian Thorlund, Maria Lorenzi, Katherine Muldoon, Steve Kanters, Sebastian Linnemayr, Robert Gross, Yvette Calderon, K Rivet Amico, Harsha Thirumurthy, Cynthia Pearson, Robert H. Remien, Lawrence Mbuagbaw, Lehana Thabane, Michael Chung, Ira B. Wilson, Albert Liu, Olalekan A. Uthman, Jane Simoni, David Bangsberg, Sanni Yaya, Till Bärnighausen, Nathan Ford, Jean B. Nachega

Internal Medicine, East Africa

Background: Adherence to antiretroviral therapy (ART) is necessary for the improvement of the health of patients and for public health. We sought to determine the comparative effectiveness of different interventions for improving ART adherence in HIV-infected people living in Africa.

Methods: We searched for randomised trials of interventions to promote antiretroviral adherence within adults in Africa. We searched AMED, CINAHL, Embase, Medline (via PubMed), and ClinicalTrials.gov from inception to Oct 31, 2014, with the terms “HIV”, “ART”, “adherence”, and “Africa”. We created a network of the interventions by pooling the published and individual patients' data for comparable treatments and comparing …

Emerging Antiretroviral Drug Resistance In Sub-Saharan Africa: Novel Affordable Technologies Are Needed To Provide Resistance Testing For Individual And Public Health Benefits, Gert U. Van Zyl, Lisa M. Frenkel, Michael Chung, Wolfgang Preiser, John W. Mellors, Jean B. Nachega

Internal Medicine, East Africa

In industrialized countries, viral load monitoring and genotypic antiretroviral drug resistance testing (GART) play an important role in the selection of initial and subsequent combination antiretroviral therapy (cART) regimens. In contrast, resource constraints in Africa limit access to assays that could detect virologic failure, transmitted drug resistance (TDR) and acquired drug resistance to cART. This has adverse consequences for both individual and public health. Although the further roll-out of antiretrovirals for prevention, including preexposure prophylaxis (PrEP) and universal test and treat (UTT) strategies, could reduce HIV-1 incidence, these strategies may increase TDR [1,2]. Here, we present arguments that the scale …

Oligonucleotide Ligation Assay Detects Hiv Drug Resistance Associated With Virologic Failure Among Antiretroviral-Naive Adults In Kenya, Michael Chung, Ingrid A. Beck, Sandra Dross, Kenneth Tapia, James N. Kiarie, Barbra A. Richardson, Julie Overbaugh, Samah R. Sakr, Grace C. John-Stewart, Lisa M. Frenkel

Internal Medicine, East Africa

Background: Transmitted drug resistance (TDR) is increasing in some areas of Africa. Detection of TDR may predict virologic failure of first-line non-nucleoside reverse-transcriptase inhibitor (NNRTI)-based antiretroviral therapy (ART). We evaluated the utility of a relatively inexpensive oligonucleotide ligation assay (OLA) to detect clinically relevant TDR at time of ART initiation.

Methods: Pre-ART plasmas from ART-naive Kenyans initiating an NNRTI-based fixed-dose combination ART in a randomized adherence trial conducted in 2006 were retrospectively analyzed by OLA for mutations conferring resistance to NNRTI (K103N, Y181C, and G190A) and lamivudine (M184V). Post-ART plasmas were analyzed for virologic failure (≥1,000 copies/mL) at 6 month …

The Government Of Kenya Cash Transfer For Orphaned And Vulnerable Children: Cross-Sectional Comparison Of Household And Individual Characteristics Of Those With And Without, Lukoye Atwoli, Lonnie Embleton, Julius Koech, Paula Braitstein, Allan Kamanda

Internal Medicine, East Africa

Background: The ‘Cash Transfer to Orphans and Vulnerable Children’ (CT-OVC) in Kenya is a government-supported program intended to provide regular and predictable cash transfers (CT) to poor households taking care of OVC. CT programs can be an effective means of alleviating poverty and facilitating the attainment of an adequate standard of living for people’s health and well-being and other international human rights. The objective of this analysis was to compare the household socioeconomic status, school enrolment, nutritional status, and future outlook of orphaned and separated children receiving the CT compared to those not receiving a CT.

Methods: This project analyzes …

Dsm‐5 And Icd‐11 Definitions Of Posttraumatic Stress Disorder: Investigating “Narrow” And “Broad” Approaches, Dan J. Stein, Katie A. Mclaughlin, Karestan C. Koenen, Lukoye Atwoli, Matthew J. Friedman, Eric D. Hill, Andreas Maercker, Maria Petukhova, Victoria Shahly, Mark Van Ommeren

Internal Medicine, East Africa

Background: The development of the Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5) and ICD-11 has led to reconsideration of diagnostic criteria for posttraumatic stress disorder (PTSD). The World Mental Health (WMH) Surveys allow investigation of the implications of the changing criteria compared to DSM-IV and ICD-10.

Methods: WMH Surveys in 13 countries asked respondents to enumerate all their lifetime traumatic events (TEs) and randomly selected one TE per respondent for PTSD assessment. DSM-IV and ICD-10 PTSD were assessed for the 23,936 respondents who reported lifetime TEs in these surveys with the fully structured Composite International Diagnostic Interview …

Clinical Features, Proximate Causes, And Consequences Of Active Convulsive Epilepsy In Africa, Symon M. Kariuki, William Matuja, Albert Akpalu, Angelina Kakooza-Mwesige, Martin Chabi, Ryan G. Wagner, Myles Connor, Eddie Chengo, Anthony K. Ngugi, Rachael Odhiambo, Christian Bottomley, Steven White, Josemir W. Sander, Brian G. R. Neville, Charles R. J. C. Newton

Internal Medicine, East Africa

Purpose: Epilepsy is common in sub-Saharan Africa (SSA), but the clinical features and consequences are poorly characterized. Most studies are hospital-based, and few studies have compared different ecological sites in SSA. We described active convulsive epilepsy (ACE) identified in cross-sectional community-based surveys in SSA, to understand the proximate causes, features, and consequences.

Methods: We performed a detailed clinical and neurophysiologic description of ACE cases identified from a community survey of 584,586 people using medical history, neurologic examination, and electroencephalography (EEG) data from five sites in Africa: South Africa; Tanzania; Uganda; Kenya; and Ghana. The cases were examined by clinicians to …

Acute Management Of St-Elevation Myocardial Infarction In A Tertiary Hospital In Kenya: Are We Complying With Practice Guidelines?, Benjamin Wachira, Andrew Owuor, Harun Otieno

Internal Medicine, East Africa

Introduction: Current practice guidelines emphasize the importance of rapid reperfusion of patients with ST-elevation myocardial infarction (STEMI). The aim of this study was to evaluate the current rate of compliance with evidence-based practice guidelines for the management of STEMI patients at a tertiary hospital in Kenya.

Methods: This was a retrospective chart review. Data on patient characteristics, emergency treatment, and outcomes were collected on adults admitted with a diagnosis of STEMI from January 2012 to February 2013.

Results: Data were collected for 45 patient presentations. There were 37 male patients (82%). The mean age was 59.7 ± 3.8 years. Of …

Association Between Parental Psychopathology And Suicidal Behavior Among Adult Offspring: Results From The Cross-Sectional South African Stress And Health Survey, Lukoye Atwoli, Matthew K. Nock, David R. Williams, Dan J. Stein

Internal Medicine, East Africa

Background: Prior studies have demonstrated a link between parental psychopathology and offspring suicidal behavior. However, it remains unclear what aspects of suicidal behavior among adult offspring are predicted by specific parental mental disorders, especially in Africa. This study set out to investigate the association between parental psychopathology and suicidal behavior among their adult offspring in a South African general population sample.

Method: Parental psychopathology and suicidal behavior in offspring were assessed using structured interviews among 4,315 respondents from across South Africa. The WHO CIDI was used to collect data on suicidal behavior, while the Family History Research Diagnostic Criteria Interview …