Location via proxy:   [ UP ]  
[Report a bug]   [Manage cookies]                
Skip to main content
  • A physician with postgraduate training in Pediatrics, Clinical Epidemiology and Evidence-based health care. Has vast ... moreedit
Background Detailed assessments of mortality patterns, particularly age-specific mortality, represent a crucial input that enables health systems to target interventions to specific populations. Understanding how all-cause mortality has... more
Background Detailed assessments of mortality patterns, particularly age-specific mortality, represent a crucial input that enables health systems to target interventions to specific populations. Understanding how all-cause mortality has changed with respect to development status can identify exemplars for best practice. To accomplish this, the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) estimated age-specific and sex-specific all-cause mortality between 1970 and 2016 for 195 countries and territories and at the subnational level for the five countries with a population greater than 200 million in 2016.
Research Interests:
Background The UN's Sustainable Development Goals (SDGs) are grounded in the global ambition of " leaving no one behind ". Understanding today's gains and gaps for the health-related SDGs is essential for decision makers as they aim to... more
Background The UN's Sustainable Development Goals (SDGs) are grounded in the global ambition of " leaving no one behind ". Understanding today's gains and gaps for the health-related SDGs is essential for decision makers as they aim to improve the health of populations. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016), we measured 37 of the 50 health-related SDG indicators over the period 1990–2016 for 188 countries, and then on the basis of these past trends, we projected indicators to 2030.
Research Interests:
Background As mortality rates decline, life expectancy increases, and populations age, non-fatal outcomes of diseases and injuries are becoming a larger component of the global burden of disease. The Global Burden of Diseases, Injuries,... more
Background As mortality rates decline, life expectancy increases, and populations age, non-fatal outcomes of diseases and injuries are becoming a larger component of the global burden of disease. The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of prevalence, incidence, and years lived with disability (YLDs) for 328 causes in 195 countries and territories from 1990 to 2016.
Research Interests:
Background Measurement of changes in health across locations is useful to compare and contrast changing epidemiological patterns against health system performance and identify specific needs for resource allocation in research, policy... more
Background Measurement of changes in health across locations is useful to compare and contrast changing epidemiological patterns against health system performance and identify specific needs for resource allocation in research, policy development, and programme decision making. Using the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we drew from two widely used summary measures to monitor such changes in population health: disability-adjusted life-years (DALYs) and healthy life expectancy (HALE). We used these measures to track trends and benchmark progress compared with expected trends on the basis of the Socio-demographic Index (SDI).
Little is known about the effect of community versus health facility-based interventions to improve and sustain antiretroviral therapy (ART) adherence, virologic suppression, and retention in care among HIV-infected individuals in low-and... more
Little is known about the effect of community versus health facility-based interventions to improve and sustain antiretroviral therapy (ART) adherence, virologic suppression, and retention in care among HIV-infected individuals in low-and middle-income countries (LMICs). We systematically searched four electronic databases for all available random-ized controlled trials (RCTs) and comparative cohort studies in LMICs comparing community versus health facility-based interventions. Relative risks (RRs) for pre-defined adherence, treatment engagement (linkage and retention in care), and relevant clinical outcomes were pooled using random effect models. Eleven cohort studies and eleven RCTs (N = 97,657) were included. Meta-analysis of the included RCTs comparing community-versus health facility-based interventions found comparable outcomes in terms of ART adherence (RR = 1.02, 95 % CI 0.99 to 1.04), virologic suppression (RR = 1.00, 95 % CI 0.98 to 1.03), and all-cause mortality (RR = 0.93, 95 % CI 0.73 to 1.18). The result of pooled analysis from the RCTs (RR = 1.03, 95 % CI 1.01 to 1.06) and cohort studies (RR = 1.09, 95 % CI 1.03 to 1.15) found that
Research Interests:
Research Interests:
Variations in the elimination of new HIV infections among children in Africa O. Adetokunboh Stellenbosch University, Cape Town, South Africa Background: Sub-Saharan Africa is responsible for the majority of new HIV infections among... more
Variations in the elimination of new HIV
infections among children in Africa
O. Adetokunboh
Stellenbosch University, Cape Town, South Africa
Background: Sub-Saharan Africa is responsible for the majority
of new HIV infections among children. An initiative was launched
in 2011 to rapidly eliminate new HIV infections among high burden
countries. This research evaluated the progress and challenges
of two indicators of Global Plan among 21 sub-Saharan priority
countries.
Methods & Materials: Data from Joint United Nations Programme
on HIV/AIDS 2014 Progress Report on Global Plan was used
to determine the differences among the Eastern/Southern African
(ESA) and Central/Western African (CWA) countries in terms of the
number of new paediatric infections and mother to child transmission
(MTCT) rate. Published literatures were systematically
reviewed from January 2011 to September 2015 using 3 databases;
Scopus, Pubmed and ISI Web of Science with respect to the challenges
faced by these countries in eliminating new HIV infections
among children.
Results: A total of 214,700 infants and children were newly
diagnosed with HIV infections in 2013, 135,800 (63%) children were
from ESA while CWA had 78,900 (37%). In 2013, the MTCT rate
among the ESA and CWA countries were 15% and 26% respectively;
p= 0.0051. TheMTCTrate decreased from 11% in 2009 to 6% in 2013;
p= 0.0434. A total of 16 peer reviewed articles were included in
this review after a comprehensive search of databases. Challenges
being encountered by these 21 countries included low HIV testing
rates during pregnancy, poor adherence to antiretroviral therapy,
poor linkage between mother—child pairs and post-natal healthcare
services, delayed and low early infant diagnosis coverage, low
paediatric ART uptake, and high unmet needs for family planning
service among the women living with HIV.
Conclusion: Both the final MTCT rate and the number of new
infections reduced progressively between 2009 and 2013 but the
performance are still below the expected milestone. The performance
of ESA countries was better when compared with the CWA
countries. There is need to put more effort in the bid to eliminate
new infections among the countries and the two regions to must
collaborate and share experiences.
http://dx.doi.org/10.1016/j.ijid.2016.02.561
Research Interests:
Introduction Human Immunodeficiency Virus / Acquired Immunodeficiency Syndrome (HIV/AIDS) and Tuberculosis (TB) are among the foremost diseases of poverty and leading causes of deaths globally. Patients with advanced HIV infection are... more
Introduction Human Immunodeficiency Virus / Acquired Immunodeficiency Syndrome (HIV/AIDS) and Tuberculosis (TB) are among the foremost diseases of poverty and leading causes of deaths globally. Patients with advanced HIV infection are vulnerable to opportunistic infections such as Pneumocystic jirovecii pneumonia but this particular infection can be prevented with the use of prophylactic cotrimoxazole. Monitoring the level of progress of treatment coverage is essential in attaining the Millennium Development Goal (MDG) 6. This study seeks to evaluate the progress made in the treatment and care of people living with HIV who are also co- infected with tuberculosis (TB) globally. Methods and Materials Data were obtained from the World Health Organization (WHO) Global Tuberculosis Report 2014. Percentages of HIV positive TB patients who are on antiretroviral therapy (ART) and those on cotrimoxazole prophylaxis therapy (CPT) in Africa, the Americas, Eastern Mediterranean, Europe, South- East Asia, Western Pacific regions and globally were analysed. The data obtained and analysed were that of 2005, 2010 and 2013 using a one-way independent analysis of variance (ANOVA). Results Globally, the percentages of HIV positive TB patients who are on ART increased from 35% (2005) to 46% (2010) and 70% (2013). However, the percentages of those on CPT increased progressive from 77% (2005) to 81% (2010) and 85% (2013). Among the six WHO regions evaluated, ART percentage use increased from 34% (2005) to 61% (2013); while CPT percentage use increased from 35% (2005) to 66% (2013). The data was analysed with a one-way independent ANOVA to compare the treatment coverage in 2005, 2010 and 2013. The ART coverage result was significant, F(2, 15) = 3.76, P = 0.0475. CPT coverage was also significant, F(2, 15) = 4.53, P = 0.0289. Conclusions There has been a progressive increase in the coverage of ART and CPT among HIV/TB co-infected individuals in the six WHO regions. This significant coverage will help in reducing progression to advanced stages of HIV/ AIDS, development of resistant TB, incidence of opportunistic infections such as Pneumocystic jirovecii pneumonia and subsequently lead to better quality of life. These progressive treatment coverages are very pivotal in achieving the global goals of WHO, the MDGs and the post- 2015 global development agenda. Disclosure Nothing to disclose.
Full-text · Article · Sep 2015 · Tropical Medicine & International Health
Research Interests:
Tuberculosis (TB) is a major global public health concern. It was estimated that about 8.6 million people had active TB and 1.3 million died from TB in 2012. TB remains the leading cause of death among the people living with HIV, causing... more
Tuberculosis (TB) is a major global public health concern. It was estimated that about 8.6 million people had active TB and 1.3 million died from TB in 2012. TB remains the leading cause of death among the people living with HIV, causing about one fifth of all deaths. There has been decline in the rate of new TB infections globally but the African region is not on track to achieve the mortality and prevalence targets. Sub-Saharan Africa has the highest new cases per population with more than 255 cases per 100 000 population in 2012. Nine countries from sub-Saharan Africa are part of the 22 countries with the highest burden of TB globally. The objective of this study is assess the trend in the burden of TB among the nine high burden African countries after launching of the directly observed treatment- short course. Design / Methods: Study data was obtained from the 2013 World Health Organisation (WHO) global TB database. We estimated trends in TB mortality rates, prevalence and incidence (1995-2012). The estimated TB mortality excludes TB deaths among HIV-positive people. The values used are the best estimates for the 9 countries. Paired data mean- comparison test was conducted to determine the mean difference (MD) of TB mortality rates, prevalence rates and incidence (in number and rates). The rates are per 100,000 population and numbers are in thousands. Results: Mortality rates reduced from 42.3 to 31.2, MD 11.1, 95%CI -29.1-6.9, p=0.1929 while the prevalence rates also reduced from 438.1 to 382.8, MD 54.3, 95%CI -240.9-132.2, p=0.5207. Incidence in number increased from 112.9 to 181.2, MD 68.3, 95%CI -31.9-168.6, p=0.1546 and incidence rates also increased from 344.4 to 379.1, MD 94.6, 95%CI -183.4-252.8, p=0.7235. Only four of the African countries had reduction in incidence rates with Uganda leading the pack with 67% while South Africa had an increase of 215% in the period under review. Conclusion: African countries with high burden of TB infections has made some progress in tackling the TB burden. TB mortality and prevalence rates has reduced from the mid-1990s level but this reduction is not significant. A big challenge to the control of TB is the increasing new infections in many of the African countries. There is need to check the increasing trend of new infections by changing in approaches to public health implementations in these countries. More research and prompt implementation are needed to achieve significant reduction.
Full-text · Article · Nov 2014 · The International Journal of Tuberculosis and Lung Disease
Research Interests:
Paediatric HIV-infected patients have higher risk of developing resistance to antiretroviral drugs, and from public health perspective, drug resistance remains a limiting factor for effective management of HIV infection in children. We... more
Paediatric HIV-infected patients have higher risk of developing resistance to antiretroviral drugs, and from public health perspective, drug resistance remains a limiting factor for effective management of HIV infection in children. We reviewed the current evidences available on the antiretroviral treatment and resistance patterns in HIV-infected children. Prevalence of HIV drug resistance varied among the three main classes of antiretroviral drugs, namely nucleoside reverse transcriptase inhibitors, non-nucleoside reverse tran-scriptase inhibitors and protease inhibitors in both treatment naïve and treatment-experienced children in different countries. Most of the patients with extensive triple-class drug-resistant mutations were found to be considerably exposed to the three main classes of antiretroviral agents. Identification of genetic factors linked with susceptibility to perinatal transmission of HIV may be key in understanding the development of resistance due to waning antiviral effectiveness. Children who were less likely to achieve viral re-suppression were more likely to have resistance mutations. Newer drugs such as etravirine can be used as alternatives in case of resistance to efavirenz while newly developed diagnostic method such as next-generation sequencing is a platform for improving quality of detections especially minor variant drug resistance mutations.
Research Interests:
Abstract Background: Abacavir is one of the recommended nucleoside reverse transcriptase inhibitors (NRTIs) for the treatment of HIV infections among children and adolescents. However, there are concerns that the antiviral efficacy of... more
Abstract
Background: Abacavir is one of the recommended nucleoside reverse transcriptase inhibitors (NRTIs) for the
treatment of HIV infections among children and adolescents. However, there are concerns that the antiviral
efficacy of abacavir might be low when compared to other NRTIs especially among children. There are also
concerns that abacavir use may lead to serious adverse events such as hypersensitivity reactions and has
potential predisposition to developing cardiovascular diseases
Methods: We searched four electronic databases, four conference proceedings and two clinical trial registries
in August 2014, without language restrictions. Experimental and observational studies with control groups that
examined the efficacy and safety of abacavir-containing regimens in comparison with other NRTIs as first-line
treatment for HIV-infected children and adolescents aged between one month and eighteen years were eligible. Two
authors independently screened search results, extracted data and assessed the risk of bias of included studies using a
pre-specified, standardised data extraction form and validated risk of bias tools. We also assessed the quality of
evidence per outcome with the GRADE tool.
Results: We included two randomised controlled trials (RCTs) and two analytical cohort studies with a total of
10,595 participants. Among the RCTs we detected no difference in virologic suppression after a mean duration
of 48 weeks between abacavir- and stavudine-containing regimens (2 trials; n = 326: RR 1.28; 95 % CI 0.67–2.42)
with significant heterogeneity (P = 0.02; I2 = 81 %). We also found no significant differences between the two groups
for adverse events and death. After five years of follow-up, virologic suppression improved with abacavir (1 trial; n = 69:
RR 1.96; 95 % CI 1.11–3.44). For cohort studies, we detected that the virologic suppression activity of abacavir
was less effective than stavudine in both the lopinavir/ritonavir (1 study, n = 2165: RR 0.79, 95 % CI 0.67–0.92)
and efavirenz sub-groups (1 study, n = 3204: RR 0.79, 95 % CI 0.67–0.92) respectively. The quality of evidence from
RCTs was moderate for virologic suppression but low for death and adverse events, while that of cohort studies
was low for all three these outcomes.
Conclusions: Available evidence showed little or no difference between abacavir-containing regimen and other
NRTIs regarding efficacy and safety when given to children and adolescents as a first-line antiretroviral therapy.
Research Interests:
This review was carried out to provide a comprehensive overview ofefforts toward elimination of mother-to-child transmission (MTCT) of human immu-nodeficiency virus (HIV) with respect to progress, challenges, and recommendationsin 21... more
This review was carried out to provide a comprehensive overview ofefforts toward elimination of mother-to-child transmission (MTCT) of human immu-nodeficiency virus (HIV) with respect to progress, challenges, and recommendationsin 21 sub-Saharan African priority countries. We reviewed literature published from2011 to April 2015 using 3 databases; PubMed, Scopus, and Web of Science, as well asthe 2014 Global Plan Progress Report. A total of 39 studies were included. Between2009 and 2013, there was a 43% reduction in new HIV infections, the final MTCT ratewas reduced from 28% to 18%, and antiretroviral therapy (ART) coverage increasedfrom 11% to 24%. Challenges included poor adherence to antiretroviral therapy,poor linkage between mother—child pairs and post-natal healthcare services lowearly infant diagnosis coverage, low pediatric ART coverage, and high unmet needsfor contraceptive services. Future recommendations include identification of keybarriers, health system strengthening, strengthening community involvement, andinternational collaboration. There has been significant progress toward eliminatingMTCT of HIV, but more effort is still needed
Research Interests:
Abstract Background: Abacavir is one of the recommended nucleoside reverse transcriptase inhibitors (NRTIs) for the treatment of HIV infections among children and adolescents. However, there are concerns that the antiviral efficacy of... more
Abstract
Background: Abacavir is one of the recommended nucleoside reverse transcriptase inhibitors (NRTIs) for the
treatment of HIV infections among children and adolescents. However, there are concerns that the antiviral efficacy
of abacavir might be low when compared to other NRTIs especially among children. There are also concerns that
abacavir use may lead to serious adverse events such as hypersensitivity reactions and has potential predisposition
to developing cardiovascular diseases.
Methods: We plan to do a systematic review to evaluate the antiviral efficacy and safety of abacavir-containing
combination antiretroviral therapy as first-line treatment of HIV-infected children aged between 3 months and 18 years,
compared with other NRTIs. We will search Scopus, Cochrane Central Register of Controlled Trials, MEDLINE, and Web
of Science databases for eligible studies regardless of language or publication status. We will check the reference lists
of included studies, search relevant conference proceedings, email the authors of included studies and also look for
unpublished and ongoing trials in prospective clinical trial registries. Two authors will independently screen search
outputs, select studies, extract data and assess the risk of bias in included studies. All disagreements will be resolved by
discussion and consensus. Where data allow, we will conduct meta-analysis for similar types of participants, study
designs, interventions, and outcome measures. If the results are statistically homogeneous, we will use the fixed-effect
model; otherwise, we will use the random-effects model and explore the reasons for heterogeneity using subgroup
analyses. Heterogeneity will be assessed with the Chi-squared test and quantified with the I-squared statistic.
Discussion: The findings will be useful to policy makers and programme managers to inform treatment and
management of HIV in children and adolescents and to point out research gaps for future research.
Trial registration: This review is registered with PROSPERO, registration number CRD42014009157.
Keywords: Abacavir, Children, Adolescents, Antiretroviral therapy, HIV, Efficacy, Safety
Research Interests:
Newcastle â Ottawa Quality Assessment Scale for included Cohort Studies. (PDF 240Â kb)
Search strategies. (PDF 347Â kb)
Additional file 2. Infant death record review form.
Additional file 3. Summary of community-linked death review components.
Additional file 1. Maternal death record review form.
A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding... more
A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016. Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers ...
ObjectivesLay people or non-pharmacy health workers with training could dispense antiretroviral therapy (ART) in resource-constrained countries, freeing up time for pharmacists to focus on more technical tasks. We assessed the... more
ObjectivesLay people or non-pharmacy health workers with training could dispense antiretroviral therapy (ART) in resource-constrained countries, freeing up time for pharmacists to focus on more technical tasks. We assessed the effectiveness of such task-shifting in low-income and middle-income countries.MethodWe conducted comprehensive searches of peer-reviewed and grey literature. Two authors independently screened search outputs, selected controlled trials, extracted data and resolved discrepancies by consensus. We performed random-effects meta-analysis and assessed certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.ResultsThree studies with 1993 participants met the inclusion criteria, including two cluster trials conducted in Kenya and Uganda and an individually randomised trial conducted in Brazil. We found very low certainty evidence regarding mortality due to the low number of events. Therefore, we are uncertain...
The UN's Sustainable Development Goals (SDGs) are grounded in the global ambition of "leaving no one behind". Understanding today's gains and gaps for the health-related SDGs is essential for decision makers as they aim... more
The UN's Sustainable Development Goals (SDGs) are grounded in the global ambition of "leaving no one behind". Understanding today's gains and gaps for the health-related SDGs is essential for decision makers as they aim to improve the health of populations. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016), we measured 37 of the 50 health-related SDG indicators over the period 1990-2016 for 188 countries, and then on the basis of these past trends, we projected indicators to 2030. We used standardised GBD 2016 methods to measure 37 health-related indicators from 1990 to 2016, an increase of four indicators since GBD 2015. We substantially revised the universal health coverage (UHC) measure, which focuses on coverage of essential health services, to also represent personal health-care access and quality for several non-communicable diseases. We transformed each indicator on a scale of 0-100, with 0 as the 2·5th percentile est...
Detailed assessments of mortality patterns, particularly age-specific mortality, represent a crucial input that enables health systems to target interventions to specific populations. Understanding how all-cause mortality has changed with... more
Detailed assessments of mortality patterns, particularly age-specific mortality, represent a crucial input that enables health systems to target interventions to specific populations. Understanding how all-cause mortality has changed with respect to development status can identify exemplars for best practice. To accomplish this, the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) estimated age-specific and sex-specific all-cause mortality between 1970 and 2016 for 195 countries and territories and at the subnational level for the five countries with a population greater than 200 million in 2016. We have evaluated how well civil registration systems captured deaths using a set of demographic methods called death distribution methods for adults and from consideration of survey and census data for children younger than 5 years. We generated an overall assessment of completeness of registration of deaths by dividing registered deaths in each location-year by ...
Little is known about the effect of community versus health facility-based interventions to improve and sustain antiretroviral therapy (ART) adherence, virologic suppression, and retention in care among HIV-infected individuals in low-... more
Little is known about the effect of community versus health facility-based interventions to improve and sustain antiretroviral therapy (ART) adherence, virologic suppression, and retention in care among HIV-infected individuals in low- and middle-income countries (LMICs). We systematically searched four electronic databases for all available randomized controlled trials (RCTs) and comparative cohort studies in LMICs comparing community versus health facility-based interventions. Relative risks (RRs) for pre-defined adherence, treatment engagement (linkage and retention in care), and relevant clinical outcomes were pooled using random effect models. Eleven cohort studies and eleven RCTs (N = 97,657) were included. Meta-analysis of the included RCTs comparing community- versus health facility-based interventions found comparable outcomes in terms of ART adherence (RR = 1.02, 95 % CI 0.99 to 1.04), virologic suppression (RR = 1.00, 95 % CI 0.98 to 1.03), and all-cause mortality (RR = 0...
The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the first of a series of annual updates of the GBD. Risk factor quantification, particularly of modifiable risk factors, can help to identify emerging... more
The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the first of a series of annual updates of the GBD. Risk factor quantification, particularly of modifiable risk factors, can help to identify emerging threats to population health and opportunities for prevention. The GBD 2013 provides a timely opportunity to update the comparative risk assessment with new data for exposure, relative risks, and evidence on the appropriate counterfactual risk distribution. Attributable deaths, years of life lost, years lived with disability, and disability-adjusted life-years (DALYs) have been estimated for 79 risks or clusters of risks using the GBD 2010 methods. Risk-outcome pairs meeting explicit evidence criteria were assessed for 188 countries for the period 1990-2013 by age and sex using three inputs: risk exposure, relative risks, and the theoretical minimum risk exposure level (TMREL). Risks are organised into a hierarchy with blocks of behavioural, environmental...
Tuberculosis (TB) is a major global public health concern. It was estimated that about 8.6 million people had active TB and 1.3 million died from TB in 2012. TB remains the leading cause of death among the people living with HIV, causing... more
Tuberculosis (TB) is a major global public health concern. It was estimated that about 8.6 million people had active TB and 1.3 million died from TB in 2012. TB remains the leading cause of death among the people living with HIV, causing about one fifth of all deaths. There has been decline in the rate of new TB infections globally but the African region is not on track to achieve the mortality and prevalence targets. Sub-Saharan Africa has the highest new cases per population with more than 255 cases per 100 000 population in 2012. Nine countries from sub-Saharan Africa are part of the 22 countries with the highest burden of TB globally. The objective of this study is assess the trend in the burden of TB among the nine high burden African countries after launching of the directly observed treatment- short course. Design / Methods: Study data was obtained from the 2013 World Health Organisation (WHO) global TB database. We estimated trends in TB mortality rates, prevalence and incid...
Background World Health Organisation (WHO) recommended antiretroviral therapy (ART) for all people living with HIV who are co-infected with Tuberculosis (TB). Cotrimoxazole prophylaxis therapy (CPT) was also recommended for the same set... more
Background World Health Organisation (WHO) recommended antiretroviral therapy (ART) for all people living with HIV who are co-infected with Tuberculosis (TB). Cotrimoxazole prophylaxis therapy (CPT) was also recommended for the same set of people. CPT in people living with advanced HIV disease prevents opportunistic infections such as Pneumocystis jiroveci pneumonia (PCP) and toxoplasmosis. Studies have shown that ART and cotrimoxazole prophylaxis will help prevent infections and prolongs life in these patients. African region has the highest HIV positive incidence TB cases among the WHO global regions with 30 African countries classified as the high TB/HIV burden countries. This study evaluates the trend of ART and CPT coverage among the individuals with TB/HIV co-infections in the high TB/HIV burden countries in Africa. Design / Methods We analysed the secondary data from the WHO global TB database (October 2013 data). Paired data mean- comparison test was conducted to determine t...
Up-to-date evidence about levels and trends in disease and injury incidence, prevalence, and years lived with disability (YLDs) is an essential input into global, regional, and national health policies. In the Global Burden of Disease... more
Up-to-date evidence about levels and trends in disease and injury incidence, prevalence, and years lived with disability (YLDs) is an essential input into global, regional, and national health policies. In the Global Burden of Disease Study 2013 (GBD 2013), we estimated these quantities for acute and chronic diseases and injuries for 188 countries between 1990 and 2013. Estimates were calculated for disease and injury incidence, prevalence, and YLDs using GBD 2010 methods with some important refinements. Results for incidence of acute disorders and prevalence of chronic disorders are new additions to the analysis. Key improvements include expansion to the cause and sequelae list, updated systematic reviews, use of detailed injury codes, improvements to the Bayesian meta-regression method (DisMod-MR), and use of severity splits for various causes. An index of data representativeness, showing data availability, was calculated for each cause and impairment during three periods globally...
during primary infection (Meier et al. 2009 Nat Med, Sterling et al. 2001 NEJM, Farzadegan et al. 1998 Lancet). It has been suggested that this is mainly due to Toll-like receptor (TLR)mediated responses of plasmacytoid dendritic cells... more
during primary infection (Meier et al. 2009 Nat Med, Sterling et al. 2001 NEJM, Farzadegan et al. 1998 Lancet). It has been suggested that this is mainly due to Toll-like receptor (TLR)mediated responses of plasmacytoid dendritic cells (pDCs), the main producers of IFN-a. We investigated the role of the TNF-a induced protein (TNFAIP) 3 (A20), an estrogen-regulated early NF-jB-responsive gene that encodes a ubiquitin-editing protein involved in negative feedback regulation of NF-jB signaling. Thus, TNFAIP3 is known to be a potent anti-inflammatory signaling molecule that restricts multiple intracellular signaling cascades including TLR signaling. Methods: 100 pDC were sorted and stimulated for 2h with a TLR7 ligand. Using fluidigm technology the expression level of TNFAIP3 mRNA was determined. Results: We detected a significant difference in TNFAIP3 mRNA upregulation in pDCs after 2h TLR7 stimulation between males and females (p < 0.05). pDCs from males showed a 2-log higher expression level of TNFAIP3 mRNA compared to females, associated with lower production of IFN-a in pDCs from males in response to HIV-1-derived TLR7 ligands and HIV-1. Conclusions: Taken together, these data demonstrate that sex differences described in response to HIV-1 are associated with the enhanced expression of the sex hormone-dependent inhibitory regulator of TLR signaling TNFAIP3 in pDCs of men compared to women, providing a novel target to modulate the inflammatory IFN-a response to HIV-1.
Introduction: Rubella vaccines have been used to prevent rubella and congenital rubella syndrome (CRS) in several World Health Organization (WHO) regions. Mathematical modelling studies have simulated introduction of rubella-containing... more
Introduction: Rubella vaccines have been used to prevent rubella and congenital rubella syndrome (CRS) in several World Health Organization (WHO) regions. Mathematical modelling studies have simulated introduction of rubella-containing vaccines (RCVs), and their results have been used to inform rubella introduction strategies in several countries. This systematic review aimed to synthesize the evidence from mathematical models regarding the impact of introducing RCVs. Methods: We registered the review in the international prospective register of systematic reviews (PROSPERO) with registration number CRD42020192638. Systematic review methods for classical epidemiological studies and reporting guidelines were followed as far as possible. A comprehensive search strategy was used to identify published and unpublished studies with no language restrictions. We included deterministic and stochastic models that simulated RCV introduction into the public sector vaccination schedule, with a t...
Background Engaging community health workers in a formalised death review process through verbal and social autopsy has been utilised in different settings to estimate the burden and causes of mortality, where civil registration and vital... more
Background Engaging community health workers in a formalised death review process through verbal and social autopsy has been utilised in different settings to estimate the burden and causes of mortality, where civil registration and vital statistics systems are weak. This method has not been widely adopted. We piloted the use of trained community health workers (CHW) to investigate the extent of unreported maternal and infant deaths in Khayelitsha and explored requirements of such a programme and the role of CHWs in bridging gaps. Methods This was a mixed methods study, incorporating both qualitative and quantitative methods. Case identification and data collection were done by ten trained CHWs. Quantitative data were collected using a structured questionnaire. Qualitative data were collected using semi-structured interview guides for key informant interviews, focus group discussions and informal conversations. Qualitative data were analysed thematically using a content analysis app...
Background Female sex workers are extremely vulnerable and highly susceptible to being infected with human immunodeficiency virus. As a result, community-based targeted interventions have been recommended as one of the models of care to... more
Background Female sex workers are extremely vulnerable and highly susceptible to being infected with human immunodeficiency virus. As a result, community-based targeted interventions have been recommended as one of the models of care to improve access to HIV services and continued engagement in care. We conducted a systematic review to (1) assess the effect of FSW-targeted community interventions on the improvement of HIV services access along the treatment cascade and (2) describe community-based interventions that positively affect continuation in HIV care across the HIV treatment cascade for FSWs in sub-Saharan Africa. Methods We defined the 5 steps that make up the HIV care cascade and categorized them as outcomes, namely, HIV testing and diagnosis, linkage to care, receipt of ART, and achievement of viral suppression. We conducted a systematic search of randomized controlled trials, cohort, and cross-sectional studies done in sub-Saharan African countries and published from 200...
The purpose of this review is to assess the extent of missed opportunities for vaccination (MOV) in Africa, determine the associated factors, and provide recommendations that countries could adopt in reducing MOV. Two databases were... more
The purpose of this review is to assess the extent of missed opportunities for vaccination (MOV) in Africa, determine the associated factors, and provide recommendations that countries could adopt in reducing MOV. Two databases were searched for multinational studies and systematic reviews reporting MOV and involving African countries. A total of 288 records were identified and 12 studies included for synthesis. The prevalence ranged from 47.0% to 62.1%, with a weighted mean of 27.3%. This review highlighted caregiver utilization, health service delivery, and healthcare worker' factors associated with MOV. Understanding the extent of MOV in Africa presents an opportunity for multiple approaches to resolve the differential factors that contribute to MOV, and to bridge the gap in vaccination coverage in the continent.
IntroductionFemale sex workers (FSWs) are a known high-risk group that are at increased risk of HIV transmission due to exposure to multiple sexual partners and inability to negotiate safe sex attributed to challenging economic... more
IntroductionFemale sex workers (FSWs) are a known high-risk group that are at increased risk of HIV transmission due to exposure to multiple sexual partners and inability to negotiate safe sex attributed to challenging economic circumstances. Previous systematic reviews have examined the effectiveness of HIV interventions prioritising FSWs and have shown that targeted interventions improve access to HIV prevention and treatment services. Interventions that increase FSWs’ uptake of services are well documented; however, evidence on specific interventions aimed at improving FSWs’ continuity in HIV care along the treatment cascade is lacking. This systematic review aims to document the performance of community-based interventions along the HIV treatment cascade.Methods and analysisWe will use a sensitive search strategy for electronic bibliographic databases, bibliographies of included articles and grey literature sources. In addition, the Joint United Nations Programme on HIV/AIDS and...
IntroductionSub-Saharan Africa remains the epicentre of the HIV pandemic, yet enormous knowledge gaps still exist to elicit a comprehensive portrait of multimorbidity and HIV linkage. This study aims to conduct a systematic meta-analysis... more
IntroductionSub-Saharan Africa remains the epicentre of the HIV pandemic, yet enormous knowledge gaps still exist to elicit a comprehensive portrait of multimorbidity and HIV linkage. This study aims to conduct a systematic meta-analysis of peer-reviewed literature to investigate the current status of multimorbidity epidemiology among people living with HIV (PLHIV) in sub-Saharan Africa.Methods and analysisOur review will assess observational studies (ie, cohort, case–control and cross-sectional) on multimorbidity associated with HIV/AIDS between 1 January 2005 and 31 October 2020 from sub-Saharan Africa. Databases to be searched include PubMed/MEDLINE, Scopus, Web of Science, Cochrane library, African Index Medicus and African Journals Online. We will also search the WHO clinical trial registry and databases for systematic reviews. The search strategy will involve the use of medical subject headings and key terms to obtain studies on the phenomena of HIV and multimorbidity at high ...
Background The triple burden of COVID-19, tuberculosis and human immunodeficiency virus is one of the major global health challenges of the 21st century and in the future. In high burden HIV/TB countries, the spread of COVID-19 among... more
Background The triple burden of COVID-19, tuberculosis and human immunodeficiency virus is one of the major global health challenges of the 21st century and in the future. In high burden HIV/TB countries, the spread of COVID-19 among people living with HIV is a well-founded concern. A thorough understanding of HIV/TB and COVID-19 pandemics is important as the three diseases interact. This may clarify HIV/TB/COVID-19 as a newly related field and play an important role in the present and future management of the co-infections. However, several gaps are remaining in the knowledge of the burden of COVID-19 on patients with TB and HIV, the diagnosis, and management of these patients. The study was conducted to review different studies on SARS-CoV, MERS-CoV or COVID-19 associated with HIV/TB co-infection or only TB and to understand the interactions between HIV, TB and COVID-19 and its implications on the burden of the COVID-19 among HIV/TB co-infected or TB patients, screening algorithm ...
Background: Female Sex Workers are extremely vulnerable and highly susceptibility to being infected with human immunodeficiency virus. As a result, community based targeted interventions have been recommended as one of the models of care... more
Background: Female Sex Workers are extremely vulnerable and highly susceptibility to being infected with human immunodeficiency virus. As a result, community based targeted interventions have been recommended as one of the models of care to improve access to HIV services and continued engagement in care. However little is known about the specific community intervention packages that have optimal effect on FSWs access and retention in HIV care. This paper synthesized evidence on the effectiveness of community-based interventions that provided HIV services to FSWs across all stages of HIV care cascade.Methods: We defined the 5 steps that make up the HIV care cascade and categorized them as outcomes, namely HIV testing, HIV diagnosis, linkage to care, ART use and viral suppression. We conducted a systematic search of randomized controlled trials, cohort and cross sectional studies done in sub-Saharan African countries and published from 2004 to 2020. We reviewed studies with data on th...
Background The triple burden of COVID-19, tuberculosis and human immunodeficiency virus is one of the major global health challenges of the 21 st century. In high burden HIV/TB countries, the spread of COVID-19 among people living with... more
Background The triple burden of COVID-19, tuberculosis and human immunodeficiency virus is one of the major global health challenges of the 21 st century. In high burden HIV/TB countries, the spread of COVID-19 among people living with HIV is a well-founded concern. A thorough understanding of HIV/TB and COVID-19 pandemics is important as the three diseases interact. This may clarify HIV/TB/COVID-19 as a newly related field and play an important role in the present and future management of the co-infections. However, several gaps are remaining in the knowledge of the burden of COVID-19 on patients with TB and HIV, the diagnosis, and management of these patients. Objectives The study was conducted to review different studies on SARS-CoV, MERS-CoV or COVID-19 associated with HIV/TB co-infection or only TB and to understand the interactions between HIV, TB and COVID-19 and its implications on the burden of the COVID-19 among HIV/TB co-infected or TB patients, screening algorithm and cl...
BackgroundThere is mixed evidence and lack of consensus on the impact of economic development on stunting, and likewise there is a dearth of empirical studies on this relationship in the case of sub-Saharan Africa. Thus, this paper... more
BackgroundThere is mixed evidence and lack of consensus on the impact of economic development on stunting, and likewise there is a dearth of empirical studies on this relationship in the case of sub-Saharan Africa. Thus, this paper examines whether economic growth is associated with childhood stunting in low-income and middle-income sub-Saharan African countries.MethodsWe analysed data from 89 Demographic and Health Surveys conducted between 1987 and 2016 available as of October 2018 using multivariable multilevel logistic regression models to show the association between gross domestic product (GDP) per capita and stunting. We adjusted the models for child’s age, survey year, child’s sex, birth order and country random effect, and presented adjusted and unadjusted ORs.ResultsWe included data from 490 526 children. We found that the prevalence of stunting decreased with increasing GDP per capita (correlation coefficient=−0.606, p<0.0001). In the unadjusted model for full sample, ...
1st African Conference on Key Populations in the HIV Epidemic Dar es Salaam, 19 - 21 August, 2013 Prevention and harm reduction 1 Adetokunboh Olatunji Cape Town South Africa Stellenbosch University Sexually Transmitted Infections... more
1st African Conference on Key Populations in the HIV Epidemic Dar es Salaam, 19 - 21 August, 2013 Prevention and harm reduction 1 Adetokunboh Olatunji Cape Town South Africa Stellenbosch University Sexually Transmitted Infections Knowlegde and Self Reporting Among Brothel Based Female Sex Workers in Nigeria 1. Adetokunboh, Olatunji O., 2. Atibioke Oluyemi P. BACKGROUND: Identification and treatment of Sexually Transmitted Infections (STI) can help prevent the transmission of HIV from one person to another. AIM: The objective of our study was to examine changes in HIV /STI knowledge and self reporting behaviour among brothel based female sex workers living in Nigeria in order to guide prevention measures. METHODS: Two consecutive rounds of integrated biological and behavioural surveillance surveys (IBBSS) were undertaken in 2007 and 2010. HIV comprehensive knowledge and self reporting behaviour data on brothel-based (BB) FSWs from the IBBSS were evaluated in 6 Nigerian states. FINDIN...
1st African Conference on Key Populations in the HIV Epidemic Dar es Salaam, 19 - 21 August, 2013 h arm reduction 3 Adetokunboh Olatunji Cape Town South Africa Stellenbosch University HIV Prevention Services Coverage Among Brothel Based... more
1st African Conference on Key Populations in the HIV Epidemic Dar es Salaam, 19 - 21 August, 2013 h arm reduction 3 Adetokunboh Olatunji Cape Town South Africa Stellenbosch University HIV Prevention Services Coverage Among Brothel Based Female Sex Workers in Nine States of Nigeria 1. Adetokunboh , Olatunji O. Division of Community Health, Stellenbosch University, South Africa 2. Oluwasaanu, Mojisola Faculty of Public Health , University of Ibadan, Nigeria 3. Atibioke Oluyemi P. Association for Reproductive and Family Health University of Ibadan BACKGROUND: HIV prevention services are to facilitate risk reduction among the population that are at risk for HIV and other sexually transmitted infections. The objective of this study was to assess effective coverage level for HIV prevention services in 9 Nigerian States among the brothel based female sex workers. METHODS: The 2010 Integrated Biological and Behavioural Surveillance Survey (IBBSS) in the Nine States of Nigeria was used. The ...

And 13 more