A5058695007- HIV/AIDS Research and Interventions
- HIV Research and Treatment
- HIV, Drug Use, Sexual Risk
- Adolescent Sexual and Reproductive Health
- HIV/AIDS drug development and treatment
- HIV/AIDS Impact and Responses
- Global Public Health Policies and Epidemiology
- Global Maternal and Child Health
- Mobile Health and mHealth Applications
- Blood Pressure and Hypertension Studies
- Diabetes Management and Education
- Health Promotion and Cardiovascular Prevention
- Digital Mental Health Interventions
- HIV/AIDS oral health manifestations
- Diabetes, Cardiovascular Risks, and Lipoproteins
- Energy and Environment Impacts
- Health Policy Implementation Science
- Hepatitis C virus research
- Chronic Disease Management Strategies
- Sex work and related issues
- Health Systems, Economic Evaluations, Quality of Life
- Vaccine Coverage and Hesitancy
- Obesity, Physical Activity, Diet
- Ethics in Clinical Research
- Mental Health Treatment and Access
University Hospital of Basel
2023-2024
University of Basel
2015-2024
University of KwaZulu-Natal
2023
Community Health Partnership
2020-2022
Swiss Tropical and Public Health Institute
2022
Stada Arzneimittel (United Kingdom)
2014-2019
Kantonsspital Baselland
2013
Home-based HIV testing is a frequently used strategy to increase awareness of status in sub-Saharan Africa. However, with referral health facilities, less than half those who test positive link care and initiate antiretroviral therapy (ART).To determine whether offering same-day home-based ART patients improves linkage viral suppression rural, high-prevalence setting Africa.Open-label, 2-group, randomized clinical trial (February 22, 2016-September 17, 2017), involving 6 facilities northern...
Nathan Ford and co-authors discuss global priorities in the provision of HIV prevention treatment services.
For HIV-positive individuals on antiretroviral therapy (ART), the World Health Organization (WHO) recommends routine viral load (VL) monitoring. We report cascade of care in with unsuppressed VL after introduction monitoring a district Lesotho.In Butha-Buthe 12 clinics (11 rural, 1 hospital) send samples for testing to laboratory. included data from patients aged ≥15 years Dec 1, 2015 November 2018. As per WHO guidelines <1000 copies/mL are considered suppressed, those ≥1000copies/mL...
The World Health Organization (WHO) guidelines on antiretroviral therapy (ART) define treatment failure as 2 consecutive viral loads (VLs) ≥1000 copies/mL. There is, however, little evidence supporting 1000 copies an optimal threshold to failure. Objective of this study was assess the correlation WHO definition with presence drug-resistance mutations in patients who present unsuppressed VL a resource-limited setting. In 10 nurse-led clinics rural Lesotho children and adults first-line ART...
There are no recent data on the prevalence of cardiovascular risk factors (CVDRFs) in Lesotho. This study aims to assess CVDRFs and their determinants. We conducted a household-based, cross-sectional survey among adults ≥18 y age 120 randomly sampled clusters two districts. Among 6061 participants, 52.2% were female median was 39 (interquartile range 27-58). The overall overweight, diabetes, elevated blood pressure (BP) tobacco use 39.9%, 5.3%, 21.6% 24.9%, respectively. 34.6% had none,...
Achievement of the UNAIDS 90-90-90 targets in Sub-Sahara Africa is challenged by a weak care-cascade with poor linkage to care and retention care. Community-based HIV testing counselling (HTC) widely used African countries. However, rates initiation antiretroviral therapy (ART) individuals who tested HIV-positive are often very low. A frequently cited reason for non-linkage time-consuming pre-ART assessment requiring several clinic visits before ART-initiation. This two-armed open-label...
HIV-infected individuals on first-line antiretroviral therapy (ART) in resource-limited settings who do not achieve the last "90" (viral suppression) enter a complex care cascade: enhanced adherence counselling (EAC), repetition of viral load (VL) and switch to second-line ART aiming resuppression. This study describes "failure cascade" patients Lesotho.Patients aged ≥16 years at 10 facilities rural Lesotho received first-time VL June 2014. Those with ≥80 copies/mL were included cohort. The...
Southern and Eastern Africa is home to more than 2.1 million young people aged 15 24 years living with HIV. As compared other age groups, this population group has poorer outcomes along the HIV care cascade. Young research team co-created PEBRA (Peer Educator-Based Refill of ART) model. In PEBRA, a peer educator (PE) delivered services as per regularly assessed patient preferences for medication pick-up, short message service (SMS) notifications, psychosocial support. The cluster-randomized...
Abstract We conducted a household survey among 6061 adults in Lesotho to (1) assess the prevalence of moderate/severe mental health (MH) and substance use (SU) problems (2) describe MH SU service cascades, (3) predictors problem awareness (i.e., having MH/SU that requires treatment). Moderate/severe or was reported between 0.7% for anxiety past 2 weeks 36.4% alcohol 3 months. The treatment gaps were high both (62% gap; 82% gap) (89% 95% gap). Individuals with higher than median wealth had...
Abstract Background Arterial hypertension (aHT) is a major cause for premature morbidity and mortality. Control rates remain poor, especially in low- middle-income countries. Task-shifting to lay village health workers (VHWs) the use of digital clinical decision support systems may help overcome current aHT care cascade gaps. However, evidence on effectiveness comprehensive VHW-led models, which VHWs provide antihypertensive drug treatment manage cardiovascular risk factors scarce. Methods...
Abstract Background Arterial hypertension (aHT) is the leading cardiovascular disease (CVD) risk factor in sub-Saharan Africa; it remains, however, underdiagnosed, and undertreated. Community-based care services could potentially expand access to aHT diagnosis treatment underserved communities. In this scoping review, we catalogued, described, appraised community-based models for Africa, considering their acceptability, engagement clinical outcomes. Additionally, developed a framework design...
Lesotho was among the first countries to adopt decentralization of care from hospitals nurse-led health centres (HCs) scale up provision antiretroviral therapy (ART). We compared outcomes between patients who started ART at HCs and in two rural catchment areas Lesotho.The comprise 12 HCs. Patients ≥16 years starting a hospital or HC 2008 2011 were included. Loss follow-up (LTFU) defined as not returning facility for ≥180 days after last visit, no (no FUP) ART, retention alive on facility....
Abstract Introduction Home‐based HIV testing fails to reach high coverage among adolescents and young adults (AYA), mainly because they are often absent during the day of home‐based testing. ADORE (ADolescent ORal tEsting) is a mixed‐method nested study AYA in rural Lesotho, measuring effect secondary distribution oral self‐tests (HIVST) on coverage, as well exploring how perceive this self‐testing model. Methods was cluster‐randomized trial. In intervention village‐clusters, HIVST were left...
Abstract Objective To compare virologic success between adult patients on tenofovir ( TDF ) and zidovudine AZT )‐containing first‐line antiretroviral ART regimens in 10 rural clinics Lesotho, Southern Africa. Methods Multicentre cross‐sectional study, ≥16 years, ≥6 months, receiving AZT/lamivudine (3TC) or TDF/3TC combined with efavirenz (EFV) nevirapine (NVP). Patient characteristics clinical/therapeutic history were collected the day of blood draw for viral load (VL). Analysis was...
Abstract Background The CASCADE trial showed that compared with usual care (UC), offering same-day (SD) antiretroviral therapy (ART) during home-based human immunodeficiency virus testing improved engagement in and viral suppression 12 months after diagnosis. However, questions remain regarding long-term outcomes the risk of propagating drug resistance. Methods After completion primary endpoint at months, participants not both arms were traced encouraged to access care. At 24 following...
Background Community-based antiretroviral therapy (ART) dispensing by lay workers is an important differentiated service delivery model in sub-Sahara Africa. However, patients new care are generally excluded from such models. Home-based same-day ART initiation becoming widespread practice, but linkage to the clinic challenging. The pragmatic VIBRA (Village-Based Refill of ART) trial compared refill existing village health (VHWs) versus clinic-based after home-based initiation. Methods and...
Objective To assess the positive predictive value (PPV) of a clinical score for viral failure among patients fulfilling WHO-criteria anti-retroviral treatment (ART) in rural Lesotho. Methods Patients and/or immunological WHO failure-criteria were enrolled. The includes following predictors: Prior ART exposure (1 point), CD4-count below baseline (1), 25% and 50% drop from peak 2), hemoglobin drop≥1 g/dL CD4 count<100/µl after 12 months new onset papular pruritic eruption adherence<95% (3). A...
Abstract Objective In 2007, Lesotho launched new national antiretroviral treatment (ART) guidelines, prioritising tenofovir and zidovudine over stavudine as a backbone together with lamivudine. We compared the rate of adoption these guidelines substitution first‐line drugs by health centers (HC) hospitals in two catchment areas rural Lesotho. Methods Retrospective cohort analysis. Patients aged ≥16 years were stratified into HC‐ hospital‐group. Main outcome variables: Type at ART‐initiation...
Introduction In 2013, the World Health Organization (WHO) recommended scaling up of routine viral load (VL) monitoring for patients on antiretroviral therapy (ART) in resource‐limited settings [ 1 ]. During transition phase from no VL‐testing at all to VL‐monitoring, targeted VL groups particular risk virologic failure (VF) may be an option 2 We present socio‐demographic and clinical factors VF a cohort rural Lesotho with access prior study. Materials Methods Data derive cross‐sectional...
Multi-month dispensing (MMD) of antiretroviral therapy (ART) represents one approach differentiated service delivery (DSD) aiming to improve quality and cost-effectiveness for HIV services in resource-limited settings. However, reduction clinic visits people living with (PLWH) should go along out-of-clinic care tailored PLWH`s preferences comorbidities maintain care. eHealth supported MMD offers a potential solution.
Emerging resistance to antiretroviral drugs may jeopardize the achievements of improved access ART. We compared prevalence different mutations in HIV-infected adults with virological failure a cohort regular routine viral load (VL) monitoring (Switzerland) and cohorts limited VL testing (Uganda Lesotho).We considered individuals who had genotypic (GRT) upon (≥1000 copies/mL) were on ART consisting at least one NNRTI two NRTIs. From Lesotho, subsequent VLs ≥1000 copies/mL despite enhanced...
Despite tremendous progress in controlling the HIV epidemic sub-Saharan Africa, HIV-related mortality continues to increase among adolescents and young people living with (AYPLHIV). Globally, Africa accounts for 85% of AYPLHIV. Overall outcomes along care cascade are worse AYPLHIV as compared all other age groups due various challenges accessing adhering antiretroviral therapy (ART). New, innovative multicomponent packages differentiated service delivery (DSD) models, required address...
Abstract Background Type 2 diabetes (T2D) poses a growing public health burden, especially in low- and middle-income countries (LMICs). Task-shifting to lay village workers (VHWs) the use of digital clinical decision support systems (CDSS) are promising approaches tackle current T2D care gap LMICs. However, evidence on effectiveness worker-led models, which VHWs initiate monitor drug treatment addition community-based screening referral services, is lacking. Methods We conducting...
There is a need for evaluating community-based antiretroviral therapy (ART) delivery models to improve overall performance of HIV programs, specifically in populations that may have difficulties access continuous care. This cluster-randomized clinical trial aims evaluate the effectiveness multicomponent differentiated ART model (VIBRA model) after home-based same-day initiation remote villages Lesotho, southern Africa.The VIBRA (VIllage-Based Refill ART) parallel-group superiority conducted...