BACKGROUND To prevent mother to child transmission(MTCT)of human immunodeficiency virus(HIV),sustained maternal viral load suppression(VLS)and early HIV testing among HIV exposed infants(HEI)is critical.AIM To investi...BACKGROUND To prevent mother to child transmission(MTCT)of human immunodeficiency virus(HIV),sustained maternal viral load suppression(VLS)and early HIV testing among HIV exposed infants(HEI)is critical.AIM To investigate maternal viral load results and infant HIV testing uptake at 6-weeks,and 9-months and 18-months in Rwanda.METHODS Between 2015 and 2022,VLS(<200 copies/mL)was measured among pregnant women living with HIV(WLHIV)from 38-healthcare facilities.Viral loads(VL)were measured at 6-months,12-months and 24-months,respectively.For maternal VL,the unit of analysis was visit-pair,and the pairs were created to define those with VL<200 copies/mL at two consecutive visits as having sustained VLS,persistent viremia(VL≥200 copies/mL at two consecutive visits),viral rebound(VL<200 copies/mL at prior visit only)and newly suppressed(VL<200 copies/mL at subsequent visit only).HEI were considered to have persistent HIV testing if they had all three HIV tests.Poisson regression models with generalized estimating equations were used to estimate the adjusted incidence rate ratio(aIRR)and 95%CI for factors associated with sustained VLS and persistent HIV testing.RESULTS A total of 1145 mother-infant pairs were analyzed.Infant HIV testing uptake at 6-weeks,9-months and 18-months was 1145(100.0%),1089(95.1%),1006(87.9%)respectively.Nine hundred ninety-nine HEI(87.3%)tested for HIV persistently.At 18-months,the incidence of HIV among HEI was 8(0.7%).Of 1145 mothers,1076(94.0%)had≥2 VL results making a total of 2010 visit-pairs(142-single;934-double visit-pairs).The incidence rate of sustained VLS,persistent viremia,viral rebound and new suppression were 91.0%,1.3%,3.6%and 4.0%respectively.Maternal disclosure of HIV status(aIRR=1.08,95%CI:1.02-1.14)was associated with increased likelihood of sustained VLS.Having peer support(aIRR=1.0595%CI:1.01-1.10)was associated with persistent HIV testing among HEI.CONCLUSION Sustained VLS is high among pregnant WLHIV in Rwanda.The low incidence of HIV among HEI may be attributed to high VLS levels.Targeted interventions,including enhanced HIV disclosure and peer support,are crucial for improving sustained VLS and increasing infant HIV testing uptake to reduce MTCT.展开更多
Background:Anti-tuberculosis drug resistance is a major public health problem that threatens the progress made in tuberculosis care and control worldwide.Treatment success rates of multidrug-resistant tuberculosis(MDR...Background:Anti-tuberculosis drug resistance is a major public health problem that threatens the progress made in tuberculosis care and control worldwide.Treatment success rates of multidrug-resistant tuberculosis(MDR-TB)is a key issue that cannot be ignored.There is a paucity of evidence that assessed studies on the treatment of MDR-TB,which focus on the effectiveness of the directly observed treatment,short-course(DOTS)-Plus program.Therefore,it is crucial to assess and summarize the overall treatment outcomes for MDR-TB patients enrolled in the DOTS-Plus program in recent years.The purpose of this study was to thus assess and summarize the available evidence for MDR-TB treatment outcomes under DOTS-Plus.Methods:A systematic review and meta-analysis of published literature was conducted.Original studies were identified using the databases MEDLINE®/PubMed®,Hinari,and Google Scholar.Heterogeneity across studies was assessed using the Cochran’s Q test and I2 statistic.Pooled estimates of treatment outcomes were computed using the random effect model.Results:Based on the 14 observational studies included in the meta-analysis,it was determined that 5047 patients reported treatment outcomes.Of these,the pooled prevalence,63.5%(95%CI:58.4-68.5%)successfully completed full treatment(cured or treatment completed)with a pooled cure rate of 55.6%,whereas 12.6%(95%CI:9.0-16.2%)of the patients died,14.2%(95%CI:11.6-16.8%)defaulted from therapy,and 7.6%(95%CI:5.6-9.7%)failed therapy.Overall 35.4%(95%CI:30-40.8%)of patients had unsuccessful treatment outcomes.An unsatisfactorily high percentage 43%(95%CI:32-54%)of unsuccessful treatment outcomes was observed among patients who were enrolled in standardized treatment regimens.Conclusion:This study revealed that patients with MDR-TB exhibited a very low treatment success rate compared to the World Health Organization 2015 target of at least 75 to 90%.The high default rate observed by conducting this literature review could possibly explain the spread of the MDR-TB strain in various populations.A better treatment success rate was observed among patients in individualized treatment regimens than in standardized ones.Conducting further individual-based meta-analysis is recommended to identify potential factors for defaulting treatment using large-scale and multi-center studies.展开更多
文摘BACKGROUND To prevent mother to child transmission(MTCT)of human immunodeficiency virus(HIV),sustained maternal viral load suppression(VLS)and early HIV testing among HIV exposed infants(HEI)is critical.AIM To investigate maternal viral load results and infant HIV testing uptake at 6-weeks,and 9-months and 18-months in Rwanda.METHODS Between 2015 and 2022,VLS(<200 copies/mL)was measured among pregnant women living with HIV(WLHIV)from 38-healthcare facilities.Viral loads(VL)were measured at 6-months,12-months and 24-months,respectively.For maternal VL,the unit of analysis was visit-pair,and the pairs were created to define those with VL<200 copies/mL at two consecutive visits as having sustained VLS,persistent viremia(VL≥200 copies/mL at two consecutive visits),viral rebound(VL<200 copies/mL at prior visit only)and newly suppressed(VL<200 copies/mL at subsequent visit only).HEI were considered to have persistent HIV testing if they had all three HIV tests.Poisson regression models with generalized estimating equations were used to estimate the adjusted incidence rate ratio(aIRR)and 95%CI for factors associated with sustained VLS and persistent HIV testing.RESULTS A total of 1145 mother-infant pairs were analyzed.Infant HIV testing uptake at 6-weeks,9-months and 18-months was 1145(100.0%),1089(95.1%),1006(87.9%)respectively.Nine hundred ninety-nine HEI(87.3%)tested for HIV persistently.At 18-months,the incidence of HIV among HEI was 8(0.7%).Of 1145 mothers,1076(94.0%)had≥2 VL results making a total of 2010 visit-pairs(142-single;934-double visit-pairs).The incidence rate of sustained VLS,persistent viremia,viral rebound and new suppression were 91.0%,1.3%,3.6%and 4.0%respectively.Maternal disclosure of HIV status(aIRR=1.08,95%CI:1.02-1.14)was associated with increased likelihood of sustained VLS.Having peer support(aIRR=1.0595%CI:1.01-1.10)was associated with persistent HIV testing among HEI.CONCLUSION Sustained VLS is high among pregnant WLHIV in Rwanda.The low incidence of HIV among HEI may be attributed to high VLS levels.Targeted interventions,including enhanced HIV disclosure and peer support,are crucial for improving sustained VLS and increasing infant HIV testing uptake to reduce MTCT.
基金The authors declare that they did not receive funding for this research from any source.
文摘Background:Anti-tuberculosis drug resistance is a major public health problem that threatens the progress made in tuberculosis care and control worldwide.Treatment success rates of multidrug-resistant tuberculosis(MDR-TB)is a key issue that cannot be ignored.There is a paucity of evidence that assessed studies on the treatment of MDR-TB,which focus on the effectiveness of the directly observed treatment,short-course(DOTS)-Plus program.Therefore,it is crucial to assess and summarize the overall treatment outcomes for MDR-TB patients enrolled in the DOTS-Plus program in recent years.The purpose of this study was to thus assess and summarize the available evidence for MDR-TB treatment outcomes under DOTS-Plus.Methods:A systematic review and meta-analysis of published literature was conducted.Original studies were identified using the databases MEDLINE®/PubMed®,Hinari,and Google Scholar.Heterogeneity across studies was assessed using the Cochran’s Q test and I2 statistic.Pooled estimates of treatment outcomes were computed using the random effect model.Results:Based on the 14 observational studies included in the meta-analysis,it was determined that 5047 patients reported treatment outcomes.Of these,the pooled prevalence,63.5%(95%CI:58.4-68.5%)successfully completed full treatment(cured or treatment completed)with a pooled cure rate of 55.6%,whereas 12.6%(95%CI:9.0-16.2%)of the patients died,14.2%(95%CI:11.6-16.8%)defaulted from therapy,and 7.6%(95%CI:5.6-9.7%)failed therapy.Overall 35.4%(95%CI:30-40.8%)of patients had unsuccessful treatment outcomes.An unsatisfactorily high percentage 43%(95%CI:32-54%)of unsuccessful treatment outcomes was observed among patients who were enrolled in standardized treatment regimens.Conclusion:This study revealed that patients with MDR-TB exhibited a very low treatment success rate compared to the World Health Organization 2015 target of at least 75 to 90%.The high default rate observed by conducting this literature review could possibly explain the spread of the MDR-TB strain in various populations.A better treatment success rate was observed among patients in individualized treatment regimens than in standardized ones.Conducting further individual-based meta-analysis is recommended to identify potential factors for defaulting treatment using large-scale and multi-center studies.
