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Implementation of differentiated service delivery for paediatric HIV care and treatment:opportunities,challenges and experience from seven sub-Saharan African countries

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Family Medicine and Community Health 2020年第3期8卷 36-41页

作者： Rebecca Abelman Catharina Alons Jeni Stockman Ivan Teri Anna Grimsrud Maryanne Ombija Christopher Makwindi Justine Odionyi Esther Tumbare Barry Longwe Mahoudo Bonou Juma Songoro Lawrence Mugumya Jennifer Cohn Internal Medicine Massachusetts General HospitalBostonMassachusettsUSA University of Pennsylvania Perelman School of Medicine PhiladelphiaPennsylvaniaUSA Technical Leaderhip and Program Optimization Elizabeth Glaser Pediatric AIDS FoundationWashingtonDistrict of ColumbiaUSA Elizabeth glaser pediatric aids foundation WashingtonDistrict of ColumbiaUSA International aids Society Cape TownSouth Africa Elizabeth glaser pediatric aids foundation MbabaneSwaziland Elizabeth glaser pediatric aids foundation NairobiKenya Elizabeth glaser pediatric aids foundation MaseruLesotho Elizabeth glaser pediatric aids foundation LilongweMalawi Elizabeth glaser pediatric aids foundation MaputoMozambique Elizabeth glaser pediatric aids foundation Dar Es SalaamUnited Republic of Tanzania Elizabeth glaser pediatric aids foundation KampalaUganda Infectious Diseases University of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA Elizabeth glaser pediatric aids foundation GenevaSwitzerland

Differentiated service delivery(DSD)models for HIV often exclude children and *** that children and adolescents have lower rates of HIV diagnosis,treatment and viral load suppression,there is a need to use DSD to meet the needs of children and adolescents living with *** commentary reviews the concept of DSD,examines the application of DSD to the care of children and adolescents living with HIV,and describes national guidance on use of DSD for children and adolescents and implementation of DSD for HIV care and treatment in children and adolescents in Elizabeth glaser pediatric aids foundation(EGPAF)-supported programmes in seven sub-Saharan countries between 2017 and *** descriptions include eligibility criteria,location and frequency of care delivery,healthcare cadre delivering the care,as well as the number of EGPAF-supported facilities supporting each type of DSD model.A range of DSD models were *** facility-based models predominate,several countries support community-based *** significant uptake of various DSD models for children and adolescents,there was variable coverage within countries and variability in age criteria for each *** the recent uptake of DSD models for children and adolescents suggests feasibility,more can be done to optimise and extend the use of DSD models for children and adolescents living with *** to further DSD uptake are described and solutions *** models for children and adolescents are a critical tool that can be optimised to improve the quality of HIV care and outcomes for children and adolescents.

关键词： treatment service supporting

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Evaluation of Extracorporeal Shockwave Lithotripsy in the Management of Renal and Ureteral Calculi

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Open Journal of Urology 2021年第12期11卷 474-485页

作者： Cyril Kamadjou Calson Ambomatei Achille Mbassi Annie Kameni Dolly Bilonda Kolela Fru Angwafor Medical and Surgical Center of Urology Douala Cameroon Faculty of Medicine and Pharmaceutical Sciences Department of Surgery and Specialities University of Douala Douala Cameroon elisabeth glaser pediatric aids foundation Buea Cameroon Central Hospital Yaounde Cameroon Coordinator Urology Residency Program Faculty of Medicine and Biomedical Sciences University of Yaounde Yaounde Cameroon

Aim: To evaluate the efficacy of extracorporeal lithotripsy in the management of renal and ureteric calculi in a urology center in Douala, Cameroon. Materials and Methods: This is a retrospective study carried out over six years, between January 2014 and December 2020. All the patients were treated using a Direx Integra lithotripter, with the number of shockwaves ranging from 1200 to 3500, without anaesthesia and were discharged a few hours after the procedure on the same day. In a majority (63.75%) of the cases, the calculi were incidental findings. A Double-J stent was indicated in two patients and preceded extracorporeal lithotripsy because of renal colic and signs of urinary tract infection. Results: We recruited a total of 122 patients with a mean age of 42.19 ± 13.08. We had 65 (53.3%) males and all patients had at least one calculus confirmed by CT scan with a mean size of 13.84 ± 4.17 mm, 85 (69.7%) patients became completely stone-free after a maximum of four sessions of extracorporeal lithotripsy (ESWL). 21 (17.2%) patients had intermediate results, being asymptomatic and/or having less than three residual fragments that measured less than 4 mm. The failure rate was 13.9%, with 17 patients still having more than three fragments measuring more than 4 mm after 4 ESWL sessions. 1 (0.8%) had septic shock as a post ESWL complication while 6 (4.9%) benefitted from a complimentary medical and/or surgical treatment (double J stent placement). Conclusion: The management of renal and ureteral calculi through extracorporeal lithotripsy in adults seems to be particularly effective for renal calculi measuring less than 20 mm and ureteral calculi measuring less than 15 mm. Extracorporeal lithotripsy, which can be performed on an outpatient basis (and without anaesthesia) is associated with minimal complications, and remains the option of choice for most upper urinary tract calculi.

关键词： Renal and Ureteric Calculi Extracorporeal Lithotripsy Double-J Stent

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Effects of aids-related disability on workforce participation and earned income in Botswana: A quasi-experimental evaluation

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Health 2013年第3期5卷 409-416页

作者： Mansour Farahani Danae Roumis Ajay Mahal Marionette Holmes Gillian Moalosi Chris Molomo Richard Marlink aids Initiative Harvard School of Public Health Boston USA Botswana Harvard Partnership Gaborone Botswana Department of Economics Spelman College Atlanta USA Elizabeth glaser pediatric aids foundation Los Angeles USA National aids Coordinating Agency (NACA) Gaborone Botswana School of Public Health and Preventive Medicine Monash University Melbourne Australia

Background: Botswana is regarded as a leader of progressive HIV/aids policy, as the first country in sub-Saharan Africa to establish a free, national antiretroviral therapy program. In light of such programmatic successes, it is important to evaluate the potentially changing relationship of HIV/aids to the wellbeing of individuals, households, and institutions in the country. Methods: We evaluate the effects of HIV-related illness on absenteeism and earnings several years after the start of the national treatment program among a random sample of adults in Botswana using survey data from 3999 individuals aged 15 to 49, using quasi-experimental methods. We compare absenteeism between individuals with and without HIV-related illness, using a propensity score matching approach. We then estimate the effect of HIV-related illness on earnings using a Heckman selection model to account for selection into the workforce. We stratify our analyses by sex. Results: Men and women with HIV-related illness were absent by about 5.2 and 3.3 additional days, respectively, in the month prior to the survey compared to matched controls, and earned approximately 38% and 43% less, respectively, in the month prior to the survey compared to those without HIV-related illness. Conclusions: HIV-related illness appears to increase absenteeism in this sample and dramatically reduce earnings. The findings suggest a need for policies that confer greater financial security to individuals with HIV/aids in Botswana.

关键词： HIV/aids Botswana Absenteeism Earnings Propensity Score Matching Heckman Selection Model

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Long noncoding nuclear enriched abundant transcript 1_2 is a promising biomarker for childhood-onset systemic lupus erythematosus

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pediatric Investigation 2024年第2期8卷 101-107页

作者： Shipeng Li Xia Wang Xiaozhen Zhao Jianghong Deng Weiying Kuang Junmei Zhang Xiaohua Tan Chao Li Caifeng Li Department of Rheumatology Beijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina Center for Infectious Diseases Beijing Youan HospitalCapital Medical UniversityBeijing Key Laboratory for HIV/AIDS ResearchBeijingChina

Importance:Systemic lupus erythematosus(SLE)is a diffuse connective tissue disease with complex clinical manifestations and prolonged *** early diagnosis and condition monitoring of SLE are crucial to disease ***:To assess the diagnostic value of long noncoding RNA(lncRNA)nuclear enriched abundant transcript 1(NEAT1)in childhood-onset SLE(cSLE).Methods:Fifty-seven children diagnosed with SLE,40 children diagnosed with juvenile idiopathic arthritis(JIA),and 40 healthy children were *** blood samples from each patient were collected.A quantitative polymerase chain reaction was used to confirm the expression of lncNEAT1_1 and lncNEAT1_2 in peripheral *** among parameters were analyzed using the Mann-Whitney U test or independent sample ***:The expression of both lncNEAT1_1 and lncNEAT1_2 in patients with cSLE were significantly higher than that of healthy control and patients with *** operating characteristic curves revealed an area under the curve(AUC)of 0.633(95%confidence interval[CI],0.524-0.742;P=0.024)for lncNEAT1_*** AUC of lncNEAT1_2 was 0.812(95%CI,0.727-0.897;P<0.0001)to discriminate individuals with cSLE from health control and children with JIA with a sensitivity of 0.622 and a specificity of ***,lncNEAT1_2 expression was higher in patients with cSLE presenting with fever,lupus nephritis,elevated erythrocyte sedimentation rate,active disease activity,and decreased C3 level,compared with those without these ***,no similar correlation was observed for lncNEAT1_***:The expression of lncNEAT1_2 was significantly elevated in children with SLE,especially those with fever,renal involvement,and low C3 *** findings suggest that lncNEAT1_2 may represent a potential biomarker for cSLE.

关键词： Biomarker Children LncRNA SLE NEAT1

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Outcome Evaluation of Early Implementation of Option B+ in Cameroon: A Prospective Cohort Observational Survey in the Northwest and Southwest Regions

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World Journal of aids 2018年第3期8卷 90-104页

作者： Pius Tih Muffih Edouard Katayi Tshimwanga Andrew Abutu Lem Edith Abongwa Jacques Chirac Awa Pascal Nji Atanga Felix Desembuin Eveline Mboh Khan Kuni Esther Bonje Nshom Emmanuel Ebeny Francois Temgbait Chimoun Thomas Welty Gladys Tayong Fosah Jennifer Lim Dana Duncan Leah Petit Gilbert Tene Jembia Mosoko Omotayo Bolu aids Care and Prevention Program Cameroon Baptist Convention Health Services Bamenda Cameroon United States Centers for Disease Control and Prevention (CDC) Atlanta USA Ministry of Public Health National AIDs Control Committee Northwest Region Technical Group Bamenda Cameroon Association of Schools and Programs of Public Health/Allan Rosenfield Global Health Fellowship Washington DC USA United States Centers for Disease Control and Prevention (CDC) Yaoundé Cameroon Elizabeth Glazer pediatric aids foundation (EGPAF) Washington DC USA QED Group LLC Washington DC USA

Background: Mother to child transmission (MTCT) of HIV constitutes a major source of new pediatric infections in Cameroon. Objective: The aim of this implementation research was to assess outcomes and effectiveness of providing life-long antiretroviral therapy (ART) for HIV-positive pregnant and breastfeeding women (Option B+). Methods: From October 2013 to July 2014, HIV-positive pregnant and breastfeeding women, not on antiretroviral (ARV) prophylaxis and ART, were recruited from 22 purposefully selected health facilities in the Northwest and Southwest regions for a prospective, observational cohort evaluation. Option B+ was offered to participants and outcome indicators were measured. Results: Out of 680 women eligible for this assessment, 669 (98%) were initiated on Option B+. Retention-in-care was 90% (95% CI, 87.85 - 92.61) and 79% (95% CI, 75.20 - 81.88), and loss to follow up (LTFU) was 7% (95% CI: 4.95 - 8.90) and 15% (95% CI: 12.06 - 17.56) at 6 and 12 months respectively. Maternal mortality at 12 months after ART initiation was 2% (13). As of March 2015, 538 HIV exposed infants (HEIs) were enrolled and received postpartum nevirapine prophylaxis within 72 hours of birth and 84% (454) were on cotrimoxazole at 6 to 8 weeks. By 8 weeks of age, 498 (93%) infants had HIV DNA PCR test with 486 (97.6%) negative and 12 (2.4%) positive. Conclusion: In Cameroon, successful implementation of Option B+ increased retention-in-care to 79% at one year for pregnant and breastfeeding women and reduced MTCT rate below 5% for HEIs at 8 weeks of age. Long term retention, maternal and infant mortality and final MTCT rate after cessation of breastfeeding require further evaluation.

关键词： Option B+ Implementation Research Prevention of Mother to Child HIV Transmission HIV Exposed Infants

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Simultaneous cotargeting of ATR and RNA Polymerase I transcription demonstrates synergistic antileukemic effects on acute myeloid leukemia

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Signal Transduction and Targeted Therapy 2019年第1期4卷 240-242页

作者： Tingting Wang Margaret Shatara Fangbing Liu Tristan Knight Holly Edwards Guan Wang Hai Lin Yue Wang Jeffrey W.Taub Yubin Ge National Engineering Laboratory for aids Vaccine Key Laboratory for Molecular Enzymology and Engineeringthe Ministry of EducationSchool of Life SciencesJilin University130021 ChangchunPeople’s Republic of China Division of pediatric Hematology/Oncology Department of PediatricsChildren’s Hospital of MichiganDetroitMI 48201USA Department of pediatrics Wayne State University School of MedicineDetroitMI 48201USA Department of Oncology Wayne State University School of MedicineDetroitMI 48201USA Molecular Therapeutics Program Barbara Ann Karmanos Cancer InstituteWayne State University School of MedicineDetroitMI 48201USA Department of Hematology and Oncology The First Hospital of Jilin University130021 ChangchunPeople’s Republic of China Department of pediatric Hematology and Oncology The First Hospital of Jilin University130021 ChangchunPeople’s Republic of China

Dear Editor,Continued development of novel therapeutic agents is critical to improve the survival of patients with acute myeloid leukemia(AML).RNA Polymerase I(Pol I)-mediated transcription and ribosomal biogenesis become dysregulated,thereby allowing synthesis of necessary substrates to support uncontrolled cancer cell proliferation *** Pol I transcription rate is higher in AML cells than nonleukemic myeloid precursors 2,suggesting Pol I transcrip-tion as a therapeutic target for ***-5461 is a potent Pol I transcription inhibitor and stabilizer of the DNA G-quadruplex structure,which causes G2/M-phase arrest via the ATR(ataxia telangiectasia and Rad3-related protein)-mediated DNA damage response(DDR)3–5.

关键词： myeloid acute leukemic

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Growth and Associated Factors in Children and Adolescents Living with HIV/aids Followed at the Mother and Child Centre of the Chantal Biya foundation, Yaoundé-Cameroon: A Case Control Study

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Open Journal of pediatrics 2020年第1期10卷 194-205页

作者： David Chelo Eulalie Landrine Moguon Fondjo Pierre Fotsing Kwetche Séraphin Nguefack Félicitée Nguefack Suzanne Ngo Um Georges Nguefack Tsague Mother and Child Centre Chantal BIYA Foundation Yaoundé Cameroon Department of pediatrics Faculty of Medicine and Biomedical Sciences University of Yaoundé 1 Yaoundé Cameroon Faculty of Health Sciences Banganté Cameroon Gyneco-Obstetric and pediatric Hospital Yaoundé Cameroon Department of Public Health Faculty of Medicine and Biomedical Sciences University of Yaoundé 1 Yaoundé Cameroon

Background: HIV/aids has a negative impact on child growth. Assessing the growth of infected children is an important part of the overall care of these children which in turn improves the monitoring and prognosis of the disease. The purpose of the study was to describe and compare the growth of children living with HIV with those not infected and to identify the associated factors. Method: This was an analytical case control study conducted in a pediatric hospital, Yaoundé from January 25th to June 20th 2019. Our study population consisted of 164 children with an age range from 06 weeks to 19 years old of which we had 41 HIV-infected cases and 123 uninfected controls matched by sex and age plus or minus 02 months. Anthropometric parameters were measured according to the standards described by the WHO. The data was entered and analyzed using Epi info 3.5.4, WHO Anthro and WHO Anthropoplus softwares. The chi-square and the Fisher’s exact tests were used to compare qualitative variables, with a significance threshold set at P less than 5%. Results: Of the 41 cases, 15 (36.6%) had at least one anthropometric index (weight for age, height for age, weight for height) -2 Z score versus 05 for controls (4.1%). 36.6% of cases had growth retardation (Height for age -2 Z score) compared to 4.1% in controls with a significant difference (p = 0.000). In 18.2% of cases, underweight was found (Weight for age -2 Z score) with a significant difference compared to controls (p = 0.000). Wasting was present in 10% of infected children (P = 0.240). We found 7.3% obesity/overweight in cases and 25.2% in controls (P = 0.003). We did not find any associated factor with growth disorders in our study. Conclusion: Infected children are smaller in weight and size. After multivariate analysis, there remained a significant difference between cases and controls regarding stunting, obesity and overweight. No factors studied were associated with the growth disorders detected, which suggests that gr

关键词： Growth HIV/aids Child Adolescent Yaoundé

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HIV infection among new synthetic drug abusers： a pilot study in Beijing

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Chinese Medical Journal 2013年第8期126卷 1517-1521页

作者： LI Ping CHEN Xiao XIE Pei-yan CHU Ping LI Dong-liang LI Qian-qian SHAO Yi-ming JIA Zhong-wei School of Public Health Guangxi Medical University NanningGuangxi 530021 China State Key Laboratory for Infectious Disease Prevention andControl National Center for AIDS/STD Control and PreventionChinese Center for Disease Control and Prevention Beijing102206 China Zaozhuang Center for Disease Control and Prevention ZaozhuangShandong 277101 China College of Mathematical Science Ocean University of ChinaQingdao Shangdong 266003 China Beijing pediatric Research Institute Beijing Children's HospitalCapital Medical University Beijing 100045 China Chaoyang District Center for Disease Control and Prevention Beijing 10021 China National Institution on Drug Dependence Peking UniversityBeijing 100191 China Takemi Program in International Health Department of GlobalHealth and Population Harvard School of Public Health BostonMA USA

Background Following the increased human immunodeficiency virus （HIV） notification （infection） rates via sexual transmission and increased abuse of new synthetic drugs instead of heroin in China, a study on HIV infections and risk factors among synthetic drugs and heroin users in Beijing was conducted to provide a cue for further development of targets and strategies of HIV/aids control and prevention for different drug populations. Methods A total of 428 subjects including 224 heroin users and 204 new synthetic drug users was recruited from communities in Beijing by convenience sampling. A X2 test was used to compare HIV and syphilis infections between the two subpopulations. Logistic regression models were used to evaluate factors related to HIV, syphilis infections and abuse of synthetic drugs. Results Unbalanced distributions of demographics were detected between the two subpopulations. Compared with heroin users, most users of synthetic drugs were migrants, single and of younger age （age 〈30 years）. Ten HIV infections and twenty-four syphilis infections were confirmed among 428 subjects. No significant difference in HIV infection was found between the two subpopulations （crude odds ratio （OR） =0.46, 95% confidence interval （CI）： 0.07-15.80 and adjusted odds ratio （AOR） =1.26, 95% Ch 0.09-18.28） while four times as many syphilis infections were identified among users of synthetics drugs （AOR=3.92, 95% CI： 1.06-14.56）. HIV and syphilis infections appeared to work *** migrants who were of Han ethnicity, single and who had stayed in Beijing for more than six months were more likely to abuse synthetics drugs. Conclusions The new synthetic drug users and heroin users are different subpopulations. We optimistically speculate that HIV has not yet been introduced into the former in Beijing, but considering higher syphilis infections in synthetic drug users and the role of syphilis in HIV infection, synthetic drug users, as a possible and important driver

关键词： human immunodeficiency virus syphilis new synthetic drugs heroin drug

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Inhibition of Mcl-1 enhances cell death induced by the Bcl-2-selective inhibitor ABT-199 in acute myeloid leukemia cells

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Signal Transduction and Targeted Therapy 2017年第1期2卷 242-250页

作者： Daniel A Luedtke Xiaojia Niu Yihang Pan Jianyun Zhao Shuang Liu Holly Edwards Kang Chen Hai Lin Jeffrey W Taub Yubin Ge Cancer Biology Graduate Program Wayne State University School of MedicineDetroitMichiganUSA National Engineering Laboratory for aids Vaccine School of Life SciencesJilin UniversityChangchunChina Department of Pathology and Laboratory Medicine Weill Cornell MedicineNew YorkNew YorkUSA Department of pediatrics Wayne State University School of MedicineDetroitMichiganUSA Department of Oncology Wayne State University School of MedicineDetroitMichiganUSA Molecular Therapeutics Program Karmanos Cancer InstituteWayne State University School of MedicineDetroitMichiganUSA Department of Obstetrics and Gynecology Wayne State University School of MedicineDetroitMichiganUSA Mucosal Immunology Studies Team National Institute of Allergy and Infectious DiseasesNational Institutes of HealthBethesdaMarylandUSA Department of Hematology and Oncology The First Hospital of Jilin UniversityChangchunChina Division of pediatric Hematology and Oncology Children’s Hospital of MichiganDetroitMichiganUSA.

Acute myeloid leukemia(AML)is a serious *** 5-year survival rates remain frustratingly low(65%for children and 26%for adults).Resistance to frontline chemotherapy(usually cytarabine)often develops;therefore a new treatment modality is ***-2 family proteins play an important role in balancing cell survival and *** antiapoptotic Bcl-2 family proteins have been found to be dysregulated in ***-199,a BH3 mimetic,was developed to target antiapoptotic protein *** ABT-199 has demonstrated promising results,resistance *** studies in AML show that ABT-199 alone decreases the association of proapoptotic protein Bim with Bcl-2,but this is compensated by increased association of Bim with prosurvival protein Mcl-1,stabilizing Mcl-1,resulting in resistance to *** this study,we investigated the antileukemic activity of the Mcl-1-selective inhibitor A-1210477 in combination with ABT-199 in AML *** found that A-1210477 synergistically induced apoptosis with ABT-199 in AML cell lines and primary patient *** synergistic induction of apoptosis was decreased upon Bak,Bax and Bim *** A-1210477 treatment alone also increased Mcl-1 protein levels,combination with ABT-199 reduced binding of Bim to *** results demonstrate that sequestration of Bim by Mcl-1,a mechanism of ABT-199 resistance,can be abrogated by combined treatment with the Mcl-1 inhibitor A-1201477.

关键词： chemotherapy alone treatment

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Survival of HIV Infected Children Born to Mothers Enrolled in a PMTCT Program in a Resource Poor Setting

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World Journal of aids 2013年第2期3卷 119-123页

作者： F. Z. Gumbo G. Q. Kandawasvika E. N. Kurewa K. Duri P. Chandiwana M. P. Mapingure M. Z. Chirenje B. Stray-Pedersen Department of Immunology University of Zimbabwe Harare Zimbabwe Department of Obstetrics and Gynecology University of Zimbabwe Harare Zimbabwe Department of pediatrics and Child Health University of Zimbabwe Harare Zimbabwe Division of Obstetrics and Gynecology Faculty of Medicine University of Oslo and Rikshospitalet Oslo Norway Letten foundation Research Centre Harare Zimbabwe

Background: pediatric HIV is a leading cause of morbidity and mortality worldwide. The substantial expansion in PMTCT has generated information on rates of transmission and associated factors, but there are limited studies on disease progression and mortality in vertically infected children, especially from resource poor settings. Methods: A birth cohort study was initiated in 2002 to focus on the role of a single dose of nevirapine in HIV transmission before Highly Active Antiretroviral Therapy (HAART) was readily available. The enrolment of women and subsequent follow up of the children occurred at 3 peri urban clinics around Harare. Findings: 479 women were HIV infected. From these, 93 (19%) children became HIV infected, 182 (38.0%) uninfected and 204 (43%) lost to follow up before HIV diagnosis. Of the HIV infected children, 40 (43%) died before the fifth birthday, 26 (28%) were lost to follow up and 27 (29%) were alive five years after maternal enrolment prior to availability of cART. Conclusion: In this setting, there was unacceptable high mortality from HIV infected children and loss to follow up prior to availability of HAART. A small proportion of HIV vertically infected children is surviving in resource poor settings without antiretroviral therapy.

关键词： HIV Infected Children Outcome Mortality Loss to Follow Up

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