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Increased prevalence of pregnancy and comparative risk of program attrition among individuals starting HIV treatment in East Africa

: Constantin T. Yiannoutsos, Beverly S. Musick, Carolyn Williams, Kara K. Wools-Kaloustian. Funding acquisition: Craig Cohen. Investigation: Charles B. Holmes, Constantin T. Yiannoutsos, Batya Elul, Elizabeth ... Bukusi, John Ssali, Andrew Kambugu, Beverly S. Musick, Craig Cohen, Carolyn Williams, Lameck Diero, Nancy Padian, Kara K. Wools-Kaloustian. Methodology: Constantin T. Yiannoutsos, Batya Elul, Beverly S

Impact of and Correction for Outcome Misclassification in Cumulative Incidence Estimation

Cohort studies and clinical trials may involve multiple events. When occurrence of one of these events prevents the observance of another, the situation is called “competing risks”. A useful measure in such studies is the cumulative incidence of an event, which is useful in evaluating interventions or assessing disease prognosis. When outcomes in such studies are subject to ...

Facility-Level Factors Influencing Retention of Patients in HIV Care in East Africa

Losses to follow-up (LTFU) remain an important programmatic challenge. While numerous patient-level factors have been associated with LTFU, less is known about facility-level factors. Data from the East African International epidemiologic Databases to Evaluate AIDS (EA-IeDEA) Consortium was used to identify facility-level factors associated with LTFU in Kenya, Tanzania and Uganda. ...

Modeling AIDS survival after initiation of antiretroviral treatment by Weibull models with changepoints

Background Mortality of HIV-infected patients initiating antiretroviral therapy in the developing world is very high immediately after the start of ART therapy and drops sharply thereafter. It is necessary to use models of survival time that reflect this change. Methods In this endeavor, parametric models with changepoints such as Weibull models can be useful in order to explicitly ...

Cerebrospinal Fluid (CSF) Neuronal Biomarkers across the Spectrum of HIV Infection: Hierarchy of Injury and Detection

Zetterberg 2 7 Dietmar Fuchs 3 7 Barbara L. 7 Shacklett 4 7 Lars Hagberg 1 7 Constantin T. Yiannoutsos 5 7 Serena S. Spudich 6 7 0 Department of Neurology, University of California San Francisco , San

Comparison of Methods for Correction of Mortality Estimates for Loss to Follow-Up after ART Initiation: A Case of the Infectious Diseases Institute, Uganda

Background In sub-Saharan Africa, a large proportion of HIV positive patients on antiretroviral therapy (ART) are lost to follow-up, some of whom are dead. The objective of this study was to validate methods used to correct mortality estimates for loss-to-follow-up using a cohort with complete death ascertainment. Methods Routinely collected data from HIV patients initiating first ...

Active Tuberculosis Is Associated with Worse Clinical Outcomes in HIV-Infected African Patients on Antiretroviral Therapy

Objective This cohort study utilized data from a large HIV treatment program in western Kenya to describe the impact of active tuberculosis (TB) on clinical outcomes among African patients on antiretroviral therapy (ART). Design We included all patients initiating ART between March 2004 and November 2007. Clinical (signs and symptoms), radiological (chest radiographs) and ...

A Causal Framework for Understanding the Effect of Losses to Follow-up on Epidemiologic Analyses in Clinic-based Cohorts: The Case of HIV-infected Patients on Antiretroviral Therapy in Africa

Biostatistics, Department of Medicine, School of Medicine, Indiana University, Indianapolis, Indiana (Constantin T. Yiannoutsos); Department of Epidemiology and Biostatistics, School of Public Health, University

Alternative antiretroviral monitoring strategies for HIV-infected patients in east Africa: opportunities to save more lives?

Background Updated World Health Organization guidelines have amplified debate about how resource constraints should impact monitoring strategies for HIV-infected persons on combination antiretroviral therapy (cART). We estimated the incremental benefit and cost effectiveness of alternative monitoring strategies for east Africans with known HIV infection. Methods Using a validated ...

Chemokines in cerebrospinal fluid correlate with cerebral metabolite patterns in HIV-infected individuals

Chemokines influence HIV neuropathogenesis by affecting the HIV life cycle, trafficking of macrophages into the nervous system, glial activation, and neuronal signaling and repair processes; however, knowledge of their relationship to in vivo measures of cerebral injury is limited. The primary objective of this study was to determine the relationship between a panel of chemokines ...

Universal Definition of Loss to Follow-Up in HIV Treatment Programs: A Statistical Analysis of 111 Facilities in Africa, Asia, and Latin America

Based on a statistical analysis of 111 facilities in Africa, Asia, and Latin America, Benjamin Chi and colleagues develop a standard loss-to-follow-up (LTFU) definition that can be used by HIV antiretroviral programs worldwide.

Retention in Care and Connection to Care among HIV-Infected Patients on Antiretroviral Therapy in Africa: Estimation via a Sampling-Based Approach

Introduction Current estimates of retention among HIV-infected patients on antiretroviral therapy (ART) in Africa consider patients who are lost to follow-up (LTF) as well as those who die shortly after their last clinic visit to be no longer in care and to represent limitations in access to care. Yet many lost patients may have “silently” transferred and deaths shortly after the ...

Trends in the clinical characteristics of HIV-infected patients initiating antiretroviral therapy in Kenya, Uganda and Tanzania between 2002 and 2009

Background East Africa has experienced a rapid expansion in access to antiretroviral therapy (ART) for HIV-infected patients. Regionally representative socio-demographic, laboratory and clinical characteristics of patients accessing ART over time and across sites have not been well described. Methods We conducted a cross-sectional analysis of characteristics of HIV-infected adults ...

Sampling-Based Approaches to Improve Estimation of Mortality among Patient Dropouts: Experience from a Large PEPFAR-Funded Program in Western Kenya

Background Monitoring and evaluation (M p = 0.003), and younger than non-dropouts (35.3 versus 35.7 years old; p = 0.020), with lower median CD4 count at enrollment (160 versus 189 cells/ml; p<0.001) and WHO stage 3–4 disease (47.5% versus 41.1%; p<0.001). Urban clinic clients were 75.0% of non-dropouts but 70.3% of dropouts (p<0.001). Of the 3,624 dropouts, 1,143 were sought and ...

Safety of Discontinuation of Maintenance Therapy for Disseminated Histoplasmosis after Immunologic Response to Antiretroviral Therapy

We performed a prospective observational study to assess the safety of stopping maintenance therapy for disseminated histoplasmosis among human immunodeficiency virus–infected patients after response to antiretroviral therapy. All subjects received at least 12 months of antifungal therapy and 6 months of antiretroviral therapy before entry. Negative results of fungal blood ...

Paromomycin: No More Effective than Placebo for Treatment of Cryptosporidiosis in Patients with Advanced Human Immunodeficiency Virus Infection

Ross G. Hewitt () 3 Constantin T. Yiannoutsos 7 Elizabeth S. Higgs 6 John T. Carey 5 P. Jan Geiseler 9 Rosemary Soave 1 Richard Rosenberg 0 Guillermo J. Vazquez 10 L. Joseph Wheat 8 Robert J. Fass 4