1 Predictors of Immunological Failure Among Adult Patients Receiving ART at an urban, HIV Clinic in Uganda Dr. Muhumuza Simon (M.D, MPH) Mulago-Mbarara.

Slides:

Advertisements

Similar presentations

Antiretroviral Therapy: An HIV Prevention Strategy? Wafaa El-Sadr, MD, MPH Columbia University Harlem Hospital New York.

Advertisements

Tuberculosis incidence and risk factors among adult patients receiving HAART in Senegal: a 7-year cohort study Assane DIOUF et al. IRD/UMR 145 CRCF, CHNU.

A Training Needs Analysis of Health Workforce Competencies in HIV Care and Treatment Services in Rwanda (L305) Presented by: Dr. Peter Memiah Presented.

Antiretroviral therapy eligibility at enrollment and time to treatment initiation in Ethiopia Chloe A. Teasdale 1, Chunhui Wang 1, Sileshi Lulseged 1,

Improving Retention, Adherence, and Psychosocial Support within PMTCT Services: Implementation Workshop for Health Workers All slide illustrations by Petra.

Fabio Mesquita, MD, PhD Director of the Brazilian Ministry of Health’s HIV/AIDS and Viral Hepatitis Department July 20th, 2014 Evidence.

INTRODUCTION Sometimes Data Managers need a simplified way of knowing the clinical status as well as HIV patients management in their District Hospitals.

Most deaths among children enrolled in two program settings in Cambodia occur within the first 6 months after enrolment. Early mortality rates were more.

THE CORE STUDY COMPARING TWO STRATEGIES FOR ENROLLING HIV-INFECTED PREGNANT WOMEN FROM ANTENATAL CARE TO CARE AND TREATMENT SERVICES IN CAMEROON: CONTINUUM.

Possible solution: Change testing & care for patients in TB treatment Old system TB patient treated at TB center Referred to VCT center for HIV testing.

HIV in Suriname Ministry of Health Suriname M.Sigrid Mac Donald – Ottevanger, MD Focal point HIV Treatment and Care, NAP.

PMTCT at Different Levels of Care: The Uganda Experience Dr. Saul Onyango National PMTCT Coordinator Ministry of Health 1 1.

Establishment of Routine HIV Counseling & Testing at Mulago & Mbarara Teaching Hospitals, Uganda: Acceptability & Lessons Learned IAS Conference Wednesday,

1 Treatment Failure HAIVN Harvard Medical School AIDS Initiative in Vietnam.

Translating the Vision Towards Universal Access Dr Zengani Chirwa.

Management and Development for Health (MDH)

Life expectancy of patients treated with ART in the UK: UK CHIC Study Margaret May University of Bristol, Department of Social Medicine, Bristol.

EARLY CHILDHOOD OUTCOMES AT THE BOTSWANA- BAYLOR CHILDREN’S CLINICAL CENTRE OF EXCELLENCE: A REPORT TO THE WHO TECHNICAL REFERENCE GROUP ON PEDIATRIC CARE.

Pioneering IMAI: Developing an integrated approach in Uganda Dr Elizabeth Madraa, Program Manager National STD/AIDS Control Program MOH - UGANDA 5 th Dec.

Press Briefing: Office of the Vice Chancellor MUK 6 th September 2010 The Infectious Diseases Institute Care and Research Initiatives Dr Alex G Coutinho.

Kuala Lumpur, Malaysia, 30 June - 3 July 2013 Outcomes of newly diagnosed HIV- infected patients referred to care after Provider Initiated.

The Effectiveness of generic Highly Active Antiretroviral Therapy for the treatment of HIV infected Ugandan children Presenter: Linda Barlow-Mosha MD,

Charles S. Kiptemas, MBChB, MPH Director South Rift Valley HIV Care & Treatment Program Kenya Medical Research Institute/Walter Reed Project Track 1 Partners.

Promoting Rational Use of ARVs in HIV/AIDS Clinics in Tanzania Presented by Salama Mwakisu -MSH.

Challenges in adapting chronic HIV/TB services to high mobile populations in Southern Africa Eric Goemaere, MD Médecins Sans Frontières IAS Washington,

Are Patients on HAART in Uganda experiencing less treatment failure than earlier anticipated? A case study of Mbarara JCRC HAART Clinic.

Evaluation of the WHO immunologic criteria for treatment failure among adults on first-line HAART in south India Snigdha Vallabhaneni 1, Sara Chandy 2,

Integration of TB and HIV Screening, Care and Treatment in Mulago Hospital, Uganda Rhoda Wanyenze, Doris Mwesigire, Henry Luzze, Violet Gwokyalya, Julius.

N ORTHWEST A IDS E DUCATION AND T RAINING C ENTER Treatment-Experienced Patients in Resource- Limited Settings Susan M. Graham Assistant Professor, Medicine.

Antiretroviral treatment programme in Thyolo district, Malawi Southern Region. MSF Luxembourg & Thyolo District Health Services - Strategic information.

N ORTHWEST A IDS E DUCATION AND T RAINING C ENTER ART Initiation in Resource-Limited Settings Susan M. Graham Assistant Professor, Medicine and Global.

Treatment Failure HAIVN Harvard Medical School AIDS Initiative in Vietnam.

1 Scaling-up ARV Therapy in Vietnam HAIVN Harvard Medical School AIDS Initiative in Vietnam.

Figure 2: Trends in currently prescribed antiretroviral therapy % prescribed HAART increased from 74% to 83% Trends in ART use, HIV viral load, and CD4.

HIV and STI Department, Health Protection Agency - Colindale HIV and AIDS Reporting System Predictors for high viraemia among the treatment naïve population.

WAD SYMPOSIUM 2014 ART Adherence and Retention: MDH Experience Eric Aris Management and Development for Health 29 th November 2014 NJOMBE.

A Call to Action Children – The missing face of AIDS.

Response to Antiretroviral Treatment In an Ethiopian Hospital Samuel Hailemariam, MD, MPH; J Allen McCutchan, MD, MSc Meaza Demissie, MD, PMH, PHD; Alemayehu.

More Than Just a Cut: Voluntary Medical Male Circumcision Programs Can Address Low HIV Testing and Counseling Usage and ART Enrollment among Young Men:

Public-Private Partnership to Scale Up and Sustain TB and HIV Care in Ethiopia Tesfai Gabre-Kidan, MD Country Director, Private Health Sector Abt Associates.

Expert Patients and AIDS Ministry of HealthMSF-OCB Mozambique CDC From Field Operational Research to National Roll Out of CASG in Mozambique.

Use of improved tracking of exposed infants during early infant diagnosis (EID) to reinforce PMTCT outcomes in a low resource setting. Lessons from East-central.

1 Predictors of virological failure in a Cambodian setting Sokkab An, M.D Sihanouk Hospital Center of HOPE (SHCH), Phnom Penh, Cambodia.

Retention in an antiretroviral program in the Democratic Republic of Congo Kalenga Lucien Koole Olivier Menten Joris Kiumbu Modeste Robin Ryder Mukumbi.

Home Based HIV Counseling and testing to optimize HIV identification, Kampala, Uganda Cecilia Nawavvu Co-authors Rhoda Wanyenze,

PRESENTED AT THE 9TH IAS CONFERENCE ON HIV SCIENCE - PARIS, FRANCE

Justine Mirembe MD, MPH ICASA, 5th December 2011

Number of people receiving antiretroviral therapy in

Daniel Meressa, M.D. Global Health Committee St. Peter’s Hospital

Facility Community Linkages

Palliative Care, an Integral Component of HIV/AIDS Management

ART and toxicities: CNS

Providing ARVs to children in resource limited settings

Validating Definitions of Antiretroviral Treatment Failure in Malawi

Berket Yemane, Melaku Umeta, Fikre Enquselassie, Wondwossen Amogne

Cross-sectional assessment of patient outcomes using a systematic file review process: Results from 12,987 patient files Ambereen Jaffer, Gesine Meyer-Rath,

Better Retention Rates Observed in Patients on Lopinavir than Atazanavir in Uganda

Closing the Treatment Gap of Children Living with HIV

Time to Focus: Doing Things Better and Differently for Transgender People Rena Janamnuaysook Thai Red Cross AIDS Research Centre, USAID LINKAGES, Thailand.

Juan Gonzalez Perez AIDS Healthcare Foundation

HIV Quality Improvement (QI) and the Treatment Cascade: How QI has Impacted Reach, Recruitment, Testing, Treatment, and Retention Efforts in Thailand?

Effect of POC CD4 testing at HIV diagnosis on attrition prior to ART initiation among youth in Khayelitsha, South Africa Pre-treatment losses to care remains.

Adele Schwartz Benzaken

Towards the last 90% of the 90:90:90 strategy: A review of viral suppression rates in a HIV program in Central and Eastern Kenya Dr Moses Kitheka,

Management and Development for Health (MDH)

Anthony D Harries Ministry of Health, Malawi

Incidence and risk factors of first line antiretroviral treatment failure among HIV infected children in Amhara Regional State, Ethiopia. Department of.

Alemseged Beyene Addis Ababa University , Ethiopia.

Treatment Outcome among patients on ART in Southern Tanzania: Does Time of ART initiation Matter?

Public Health Implications

Presentation transcript:

1 Predictors of Immunological Failure Among Adult Patients Receiving ART at an urban, HIV Clinic in Uganda Dr. Muhumuza Simon (M.D, MPH) Mulago-Mbarara Teaching Hospitals’ Joint AIDS Program [MJAP] 16 th International Conference on AIDS & STIs in Africa (ICASA 2011) Addis Ababa, Ethiopia, December 4-8, 2011

 In recent years, there has been a rapid scale up of HAART in resource limited settings  In Uganda, ART coverage is ~ 50% (290,000)  Monitoring patients on ART remains a challenge  Most ART centers use immunological criteria (CD4 cell count) to monitor HIV treatment success 2

 Established in November 2004 with funding from CDC-PEPFAR  Supports provision of comprehensive HIV/AIDS services in 2 National Referral Hospitals and 11 HIV clinics  Currently, the program supports > 29,000 patients on ART (~ 10% of the national ART coverage)  ~ 97% of ART patients are on first line treatment 3

4 One of the MJAP supported HIV clinic in Mulago National Referral Hospital

5 To determine factors associated with immunological failure among adult patients receiving HAART

 Retrospective cohort analysis of data of 5,306 patients at Mulago ISS clinic between , on 1 st line treatment for 1 year  Immunological failure was defined as having a CD4 cell count < pre-therapy value after 1 year on HAART  This was compared to the patients demographics, pre- therapy CD4 count, WHO stage, HAART regimen, mean adherence levels and incidence of OIs 6

7

8  Females 3,508 (66%); Males 1,798 (34%)  Median age was 33 yrs (28-39 IQ Range)  Median pre-therapy CD4 =169 cells/mm3 ( IQ Range)  Immunological failure observed in 336 (6.3%)

9

VariableAOR (95% CI)P Value 1. Gender Male2.35 ( ) Age < 35 years1.84 ( ) Regimen category NVP based1.44 ( ) Adherence level < 95%1.90 ( ) Pre-therapy CD4 count <100 cells/mm32.58 ( )

6. WHO StageCasesControlsOdds95% CI I II – 0.07 III – 0.08 IV – 0.14  Score test for trend of odds: Pr>Chi2 =

Immunological failure is significantly associated with: * Male gender * Age < 35 years * ARV regimen (NVP based) * Adherence level (<95%) * Pre-therapy CD4 count * WHO stage 12

 HIV care and treatment programs should emphasize adherence during each patient encounter - Male gender -Young patients  EFV should be preferred against NVP as a 1 st line drug  Early HIV testing and linkage to care before severe immunosuppression develops is critical 13

 PEPFAR/CDC  Ministry of Health, Uganda  MJAP Staff  Patients 14