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Huber, Amy, Kamban Hirasen, Alana T. Brennan, Bevis Phiri, Timothy Tcherini, Lloyd Mulenga, Prudence Haimbe, et al. "Uptake of same-day initiation of HIV treatment among adult men and women in Malawi, South Africa, and Zambia: the SPRINT retrospective cohort study." Gates Open Research 7 (February 14, 2023): 42. http://dx.doi.org/10.12688/gatesopenres.14424.1.
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Background: Since 2017 global guidelines have recommended “same-day initiation” (SDI) of antiretroviral treatment (ART) for patients considered ready for treatment on the day of HIV diagnosis. Many countries have incorporated a SDI option into national guidelines, but SDI uptake is not well documented. We estimated average time to ART initiation at 12 public healthcare facilities in Malawi, five in South Africa, and 12 in Zambia. Methods: We sequentially enrolled patients eligible to start ART between January 2018 and June 2019 and reviewed their medical records from the point of HIV diagnosis or first HIV-related interaction with the clinic to the earlier date of treatment initiation or 6 months. We estimated the proportion of patients initiating ART on the same day or within 7, 14, 30, or 180 days of baseline. Results: We enrolled 826 patients in Malawi, 534 in South Africa, and 1,984 in Zambia. Overall, 88% of patients in Malawi, 57% in South Africa, and 91% in Zambia were offered and accepted SDI. In Malawi, most who did not receive SDI had not initiated ART ≤6 months. In South Africa, an additional 13% initiated ≤1 week, but 21% had no record of initiation ≤6 months. Among those who did initiate within 6 months in Zambia, most started ≤1 week. There were no major differences by sex. WHO Stage III/IV and tuberculosis symptoms were associated with delays in ART initiation. Conclusions: As of 2020, SDI of ART was widespread, if not nearly universal, in Malawi and Zambia but considerably less common in South Africa. Limitations of the study include pre-COVID-19 data that do not reflect pandemic adaptations and potentially missing data for Zambia. South Africa may be able to increase overall ART coverage by reducing numbers of patients who do not initiate ≤6 months. Registration: Clinicaltrials.gov (NCT04468399; NCT04170374; NCT04470011).
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Umar, Eric, Judith A. Levy, Geri Donenberg, Mary Ellen Mackesy-Amiti, Hening Pujasari, and Robert C. Bailey. "THE INFLUENCE OF SELF-EFFICACY ON THE RELATIONSHIP BETWEEN DEPRESSION AND HIV-RELATED STIGMA WITH ART ADHERENCE AMONG THE YOUTH IN MALAWI." Jurnal Keperawatan Indonesia 22, no. 2 (July 28, 2019): 147–60. http://dx.doi.org/10.7454/jki.v22i2.952.
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Depression and HIV-related stigma, among other factors, have been inversely linked independently with adherence to antiretroviral therapy (ART) among the youth. However, the processes through which the various factors influence this relationship is not fully known. Guided by Social Action Theory, we examined the interactive mechanisms through which depression, HIV-related stigma, and self-efficacy influenced ART adherence and whether or not these relationships are moderated by gender. A total of 450 HIV-positive youth (13–24 years) in Malawi receiving ART participated in this cross-sectional study. Moderated mediation analyses were conducted using Hayes’ PROCESS macro 2.11 in SPSS. ART adherence was measured by pill count. Findings showed that self-efficacy mediated the effects of depression and stigma on ART adherence. The analyses also revealed that gender moderated both the direct and indirect influence of depression and stigma (via self-efficacy) on ART adherence. Furthermore, self-efficacy simultaneously mediated and moderated the relationship between stigma and ART adherence. The interactive mechanisms through which various factors influence ART nonadherence must be considered to design effective interventions. To reduce the impact of depression and stigma on ART adherence, medication self-efficacy should be bolstered while taking gender in consideration. Keywords: Adolescent, Antiretroviral adherence, Malawi, Moderated mediation, Social action theory, Youth Abstrak Pengaruh Efikasi Diri Terhadap Hubungan antara Depresi dan Stigma HIV dengan Kepatuhan Terapi ART pada Remaja di Malawi. Depresi dan stigma HIV, di antara faktor-faktor lain, berhubungan terbalik secara independen dengan kepatuhan terapi antiretroviral (ART) pada remaja. Akan tetapi, dalam prosesnya faktor yang memengaruhi hubungan ini belum sepenuhnya diketahui. Berdasarkan Teori Perilaku Sosial, penelitian ini dilakukan bertujuan untuk mengkaji mekanisme interaktif depresi, stigma HIV, dan efikasi diri yang memengaruhi kepatuhan ART, dan untuk mengetahui apakah hubungan ini dimoderasi oleh gender atau tidak. Sebanyak 450 remaja dengan HIV-positif (13–24 tahun) di Malawi yang menerima ART ikut berpartisipasi dalam penelitian potong lintang ini. Analisis mediasi moderated dilakukan dengan menggunakan Hayes 'PROCESS macro 2.11 pada SPSS. Kepatuhan ART diukur menggunakan jumlah pil. Hasil penelitian menunjukkan bahwa efikasi diri memediasi efek depresi dan stigma pada kepatuhan ART. Hasil analisis juga mengungkapkan bahwa jenis kelamin memoderasi pengaruh langsung dan tidak langsung dari depresi dan stigma (melalui efikasi diri) terhadap kepatuhan ART. Lebih lanjut,efikasi diri secara bersamaan mediasi dan moderasi hubungan antara stigma dan kepatuhan ART. Mekanisme interaktif dengan berbagai faktor yang memengaruhi ketidakpatuhan ART harus dipertimbangkan untuk merancang intervensi yang efektif. Untuk mengurangi dampak depresi dan stigma terhadap kepatuhan ART, efikasi diri pengobatan harus didukung saat mempertimbangkan jenis kelamin. Kata kunci: Kepatuhan antiretroviral, Malawi, Mediasi tingkat menengah, Teori Perilaku Sosial, Remaja
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Nicholson, Philip J., Deborah Dixon, Deepa Pullanikkatil, Boyson Moyo, Hazel Long, and Brian Barrett. "Malawi Stories: mapping an art-science collaborative process." Journal of Maps 15, no. 3 (March 24, 2019): 39–47. http://dx.doi.org/10.1080/17445647.2019.1582440.
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Kawiya, Harry Henry, Thandi Davies, Crick Lund, and Katherine Sorsdahl. "Missed opportunities to address common mental disorders and risky alcohol use among people living with HIV in Zomba, Malawi: A cross sectional clinic survey." PLOS ONE 18, no. 2 (February 6, 2023): e0278160. http://dx.doi.org/10.1371/journal.pone.0278160.
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Common mental disorders (CMDs) and risky alcohol use are highly prevalent among people living with HIV, yet many do not receive treatment for these mental health problems. In Malawi, despite a mental health policy aiming to include mental healthcare into primary health care, many clients with HIV go unscreened and untreated for mental illnesses, indicating missed opportunities to offer mental health care to people living with HIV. The aim of this study was to determine the numbers and types of missed opportunities for screening and treatment of CMDs and risky alcohol use amongst a sample of people living with HIV attending anti-retroviral (ART) clinics in Zomba Malawi. A descriptive cross-sectional clinic survey was used, at three ART clinics in the Zomba district. Random sampling was conducted for all clients attending their ART clinics on specific days. The study surveyed 382 participants living with HIV. Of these participants, the majority were women (N = 247, 64.7%), and 87 (22.8%) screened positive for CMDs and/or alcohol misuse using the self-reporting questionnaire 20 (SRQ-20) and alcohol use disorder identification test (AUDIT). Of these, only 47 (54%) had been screened by health workers for CMDs or risky alcohol use in the past 12 months, and 66 (76%) wanted to receive treatment. Of the total sample of 382 participants, only 92 (24%) and 89 (23%) had been screened for CMDs or risky alcohol use by health workers. Failures by clinical officers and nurses to screen or treat CMDs and risky alcohol use in ART clinics represent missed opportunities to address the mental health of people living with HIV. Providing psychoeducation for staff, guidelines for screening and managing CMDs and alcohol use, increasing human resources, and accelerating implementation of the mental health policy in Malawi may be a few ways of improving mental health service provision at ART clinics in Malawi.
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Makombe, Simon D., Anthony D. Harries, Joseph Kwong-Leung Yu, Mindy Hochgesang, Eustice Mhango, Ralf Weigel, Olesi Pasulani, Margaret Fitzgerald, Erik J. Schouten, and Edwin Libamba. "Outcomes of patients with Kaposi's sarcoma who start antiretroviral therapy under routine programme conditions in Malawi." Tropical Doctor 38, no. 1 (January 2008): 5–7. http://dx.doi.org/10.1258/td.2007.060023.
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AIDS-associated Kaposi's sarcoma (KS) is the most common AIDS-related malignancy in sub-Saharan Africa, with a generally unfavourable prognosis. We report on six-month and 12-month cohort treatment outcomes of human immunodeficiency virus (HIV)-positive KS patients and HIV-positive non-KS patients treated with antiretroviral therapy (ART) in public sector facilities in Malawi. Data were collected from standardized antiretroviral (ARV) patient master cards and ARV patient registers. Between July and September 2005, 7905 patients started ART-488 (6%) with a diagnosis of KS and 7417 with a non-KS diagnosis. Between January and March 2005, 4580 patients started ART-326 (7%) with a diagnosis of KS and 4254 with a non-KS diagnosis. At six-months and 12-months, significantly fewer KS patients were alive and significantly more had died or defaulted compared to non-KS patients. HIV-positive KS patients on ART in Malawi have worse outcomes than other patients on ART. Methods designed to improve these outcomes must be found.
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C. Wetzel, Elizabeth, Tapiwa Tembo, Elaine J. Abrams, Alick Mazenga, Mike J. Chitani, Saeed Ahmed, Xiaoying Yu, and Maria H. Kim. "The relationship between intimate partner violence and HIV outcomes among pregnant women living with HIV in Malawi." Malawi Medical Journal 33, no. 4 (December 22, 2021): 242–52. http://dx.doi.org/10.4314/mmj.v33i4.4.
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BackgroundIntimate partner violence (IPV) is a global public health concern particularly in pregnancy where IPV can have negative health implications for the mother and child. Data suggest IPV disproportionately affects pregnant women living with HIV (PWLWH) compared to those without HIV. HIV-related outcomes are worse among women experiencing IPV. Despite this knowledge, there is paucity of data concerning PWLWH and IPV in Malawi, where there is a high HIV prevalence (10.6%). ObjectivesWe aim to characterize IPV amongst PWLWH in Malawi and describe its relationship to demographic characteristics, psychosocial factors, and HIV-related outcomes. MethodsThis analysis used data from the VITAL Start pilot study, which is a video-based intervention targeting retention and ART adherence amongst PWLWH in Malawi. PWLWH not on ART were recruited at antenatal clinic and given study questionnaires to assess demographics, IPV, and psychosocial factors. Questionnaires were also administered at one-month follow-up to assess outcomes related to HIV. Descriptive statistics and logistic regression models were used to explore the risk factors associated with IPV.ResultsThirty-nine percent of participants reported ever experiencing IPV from their current partner. The majority (53%) reporting IPV experienced more than one type of violence. IPV was associated with being married (p=0.04) and depression (p<0.0001) in the univariable analysis. For women retained at one-month, IPV was associated with reporting a missed ART dose in the past month but not with adherence measured by pill count.ConclusionsA large proportion of PWLWH experienced IPV from their current partner and IPV was associated with worse self-reported ART adherence at one-month follow-up. Further evidence is needed to understand how IPV impacts PWLWH throughout postpartum and beyond. Given the detrimental impact on health outcomes among PWLWH in Malawi, additional focus on IPV is essential to identify mechanisms to prevent, screen, and manage IPV among this population.
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Chisati, Enock. "Physical activity levels among Malawian adults living with HIV and receiving anti-retroviral therapy." Malawi Medical Journal 32, no. 1 (March 31, 2020): 8–12. http://dx.doi.org/10.4314/mmj.v32i1.3.
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IntroductionDespite increasing life expectancy among people living with HIV (PLWHIV), anti-retroviral therapy (ART) side effects, HIV chronic inflammation and co-morbidities may limit functional abilities and reduced participation in exercises and physical activity (PA). PA improves wellbeing and overall quality of life of PLWHIV. In Malawi, there is paucity of information regarding PA levels among Malawians living with HIV and receiving ART. Therefore, this study aimed at determining PA levels among PLWHIV and receiving ART in Malawi.
MethodsA quantitative cross-sectional design was employed. Eligible participants were male and female adults aged 18–45 years living with HIV receiving ART for at least 1 year. The participants were recruited from Limbe Health Center, Gateway Health Center and Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi. The International Physical Activity Questionnaire (IPAQ) was used to assess the PA levels. A Stadiometer (HS-DBS00361, Model: 1127154) was used to measure weight (kg) and height (cm) of the participants.
ResultsA total of 213 participants were recruited. There were more females than male participants (n=132 females). Overall, the mean age of all participants was 37±6.5 years and they were within normal body weight (BMI=23±4.0). Many participants (n=85, 40%) had low PA levels followed by those who were moderately physically active (n=75, 36%). A larger proportion of the female participants (51%) had low PA levels compared to males (22%). Forty-two percent of participants with 1–3 years of ART had low PA whereas 39% with >3 years ART had low PA.
ConclusionMost PLWHIV and receiving ART in the sample have low PA levels. The study has also revealed that proportionally more females than males had low PA levels.
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Makombe, Simon D., Andreas Jahn, Hannock Tweya, Lameck Thambo, Joseph Kwong-Leung Yu, Bethany Hedt, Ralf Weigel, et al. "A national survey of prisoners on antiretroviral therapy in Malawi: access to treatment and outcomes on therapy." Journal of Infection in Developing Countries 1, no. 03 (December 1, 2007): 303–7. http://dx.doi.org/10.3855/jidc.368.
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Background: Malawi is making good progress scaling up antiretroviral therapy (ART), but we do not know the levels of access of high-risk, disadvantaged groups such as prisoners. The aim of this study was to measure access and treatment outcomes of prisoners on ART at the national level. Methodology: A retrospective cohort study was conducted examining patient follow-up records from all 103 public sector ART clinics in Malawi, and observations were censored on December 31, 2006. Results: By December 31, 2006, a total of 81,821 patients had been started on ART. Of these, 103 (0.13%) were prisoners. At ART initiation, 93% of prisoners were in World Health Organization (WHO) clinical stage 3 or 4 while 7% started in stage 1 or 2 with a CD4-lymphocyte count of ≤250/mm3. Treatment outcomes by the end of December 2006 were as follows: 66 (64%) alive and on ART at their registration facility; 9 (9%) dead; 8 (8%) lost to follow-up; and 20 (19%) transferred out to another facility. The probability of being alive and on ART at 6 and 12 months was 82.5% and 77.7%. Conclusions: In spite of the rapid scale-up of ART, only a small number of HIV-positive prisoners had accessed ART by the end of 2006. Treatment outcomes were good. Initiatives are now needed to improve access to HIV testing and ART in Malawi’s prisons.
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Chikwapulo, Bongani, Bagrey Ngwira, Jean Baptiste Sagno, and Rhys Evans. "Renal outcomes in patients initiated on tenofovir disoproxil fumarate-based antiretroviral therapy at a community health centre in Malawi." International Journal of STD & AIDS 29, no. 7 (January 16, 2018): 650–57. http://dx.doi.org/10.1177/0956462417749733.
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Tenofovir-based antiretroviral therapy (TDF ART) is the first-line regimen for human immunodeficiency virus (HIV) in Africa. However, contemporary data on nephrotoxicity are lacking. We determined the renal outcomes of patients commenced on TDF ART in Malawi. ART-naïve patients initiated on TDF ART at a community health centre between 1 July 2013 and 31 December 2015 were included. The estimated glomerular filtration rate (eGFR, Cockcroft-Gault) was recorded at the initiation of therapy and over 18 months thereafter. The prevalence of renal impairment at ART initiation (eGFR < 60 ml/min) and the incidence of nephrotoxicity (eGFR < 50 ml/min) were determined. A total of 439 patients (median age: 32 years; 317 [72.2%] female) were included. Twenty-one (4.8%) patients had renal impairment at ART initiation; eGFR improved in all during follow-up. Nephrotoxicity occurred in 17 (4.0%) patients with eGFR > 50 ml/min at baseline, predominantly within the first six months of therapy. Increasing age and diastolic hypertension (>100 mmHg) were independent risk factors for nephrotoxicity development. The prevalence of kidney disease at ART initiation was 4.8% and nephrotoxicity occurred in 4.0%. Some eGFR decline may have been due to weight gain. Targeted monitoring of kidney function six months after TDF initiation should be considered in Malawi.
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McGuire, Megan, Tamika Munyenyembe, Elisabeth Szumilin, Annette Heinzelmann, Mickael Le Paih, Nenette Bouithy, and Mar Pujades-Rodríguez. "Vital status of pre-ART and ART patients defaulting from care in rural Malawi." Tropical Medicine & International Health 15 (April 29, 2010): 55–62. http://dx.doi.org/10.1111/j.1365-3156.2010.02504.x.
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Koseki, Shunya, and Priscilla A. Mooney. "Influences of Lake Malawi on the spatial and diurnal variability of local precipitation." Hydrology and Earth System Sciences 23, no. 7 (July 5, 2019): 2795–812. http://dx.doi.org/10.5194/hess-23-2795-2019.
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Abstract. We investigate how the intensity and spatial distribution of precipitation vary around Lake Malawi on a diurnal timescale, which can be valuable information for water resource management in tropical south-eastern African nations. Using a state-of-the-art satellite product and regional atmospheric model, the well-defined diurnal cycle is detected around Lake Malawi with harmonic and principle component analyses: the precipitation is intense during midnight to morning over Lake Malawi and the precipitation peaks in the daytime over the surrounding area. This diurnal cycle in the precipitation around the lake is associated with the lake–land breeze circulation. Comparisons between the benchmark simulation and an idealized simulation in which Lake Malawi is removed reveal that the diurnal variations in precipitation are substantially amplified by the presence of Lake Malawi. This is most evident over the lake and surrounding coastal regions. Lake Malawi also enhances the lake–land breeze circulation; the nocturnal lakeward land breeze generates surface convergence effectively and precipitation intensifies over the lake. Conversely, the daytime landward lake breeze generates the intense divergence over the lake and precipitation is strongly depressed over the lake. The lake–land breeze and the background vapour enriched by Lake Malawi drive primarily a diurnal variation in the surface moisture flux divergence/convergence over the lake and surrounding area which contributes to the diurnal cycle of precipitation in this region.
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Heller, T., P. Ganesh, J. Gumulira, L. Nkhoma, C. Chipingu, C. Kanyama, T. Kalua, R. Nyrienda, S. Phiri, and A. Schooley. "Successful establishment of third-line antiretroviral therapy in Malawi: lessons learned." Public Health Action 9, no. 4 (December 21, 2019): 169–73. http://dx.doi.org/10.5588/pha.19.0043.
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Setting: Malawi has an extensive national antiretroviral treatment (ART) program, and although less than 2% of all patients receive second-line ART, there are increasingly more patients failing on these regimens.Objective: To establish a virtual ART committee using limited available local facilities and expertise to recommend third-line regimens based on genotype resistance of samples sent abroad.Design: A secretariat and a laboratory sample hub were established. The committee started work after locally organizing training courses. Decisions about ART regimens were mainly based on a relatively simple, previously described algorithm, which allowed decisions to be taken without extensive expert knowledge.Results: Of the 25 applications assessed, 23 samples were sent for resistance testing from June 2017 to April 2018. Major protease inhibitor (PI) resistance was detected in 65% of the samples. PI resistance was found even in patients exposed to PIs for short periods. In particular, patients who received co-administration of PIs and rifampicin frequently showed resistance mutations.Conclusion: Third-line ART using genotypic resistance testing and algorithm-based treatment regimens are feasible in low-resource settings. Our model can serve as a base for similar programs initiating programmatic third-line ART in other African countries.
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Nabity, Scott A., Laurence J. Gunde, Diya Surie, Ray W. Shiraishi, Hannah L. Kirking, Alice Maida, Andrew F. Auld, et al. "Early-phase scale-up of isoniazid preventive therapy for people living with HIV in two districts in Malawi (2017)." PLOS ONE 16, no. 4 (April 1, 2021): e0248115. http://dx.doi.org/10.1371/journal.pone.0248115.
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Background Isoniazid preventive therapy (IPT) against tuberculosis (TB) is a life-saving intervention for people living with HIV (PLHIV). In September 2017, Malawi began programmatic scale-up of IPT to eligible PLHIV in five districts with high HIV and TB burden. We measured the frequency and timeliness of early-phase IPT implementation to inform quality-improvement processes. Methods and findings We applied a two-stage cluster design with systematic, probability-proportional-to-size sampling of six U.S. Centers for Disease Control and Prevention (CDC)-affiliated antiretroviral therapy (ART) centers operating in the urban areas of Lilongwe and Blantyre, Malawi (November 2017). ART clinic patient volume determined cluster size. Within each cluster, we sequentially sampled approximately 50 PLHIV newly enrolled in ART care. We described a quality-of-care cascade for intensive TB case finding (ICF) and IPT in PLHIV. PLHIV newly enrolled in ART care were eligibility-screened for hepatitis and peripheral neuropathy, as well as for TB disease using a standardized four-symptom screening tool. Among eligible PLHIV, the overall weighted IPT initiation rate was 70% (95% CI: 46%–86%). Weighted IPT initiation among persons aged <15 years (30% [95% CI: 12%–55%]) was significantly lower than among persons aged ≥15 years (72% [95% CI: 47%–89%]; Rao-Scott chi-square P = 0.03). HIV-positive children aged <5 years had a weighted initiation rate of only 13% (95% CI: 1%–79%). For pregnant women, the weighted initiation rate was 67% (95% CI: 32%–90%), similar to non-pregnant women aged ≥15 years (72% [95% CI: 49%–87%]). Lastly, 95% (95% CI: 92%–97%) of eligible PLHIV started ART within one week of HIV diagnosis, and 92% (95% CI: 73%–98%) of patients receiving IPT began on the same day as ART. Conclusions Early-phase IPT uptake among adults at ART centers in Malawi was high. Child uptake needed improvement. National programs could adapt this framework to evaluate their ICF-IPT care cascades.
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Spielman, Kathryn L., Erica Soler-Hampejsek, Adamson S. Muula, Lyson Tenthani, and Paul C. Hewett. "Depressive symptoms, HIV-related stigma and ART adherence among caregivers of children in vulnerable households in rural southern Malawi." PLOS ONE 16, no. 3 (March 5, 2021): e0247974. http://dx.doi.org/10.1371/journal.pone.0247974.
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Background Few studies have explored the association between depressive symptoms, HIV infection and stigma in vulnerable populations. The objective of this study is to examine factors associated with depressive symptoms among caregivers living in vulnerable households in Malawi and assess how reported depressive symptoms and other factors affect ART adherence among caregivers who report testing positive for HIV and currently on ART. Methods We interviewed 818 adult caregivers of children aged 0–17 years living in vulnerable households in 24 health facility catchment areas in five districts in rural southern Malawi in 2016–2017. Vulnerable households had either economic and food insecurity, or chronic illness. Questions on five depressive symptoms were used. ART adherence was self-report of not forgetting to take ART medication in the last week. Perceived and anticipated measures of stigma were used. Multivariable linear and logistic regressions documented relationships between depressive symptoms, self-reported HIV status, HIV-related stigma, and ART adherence. Results Most caregivers were women (86.2%); about one third had no spouse or live-in partner. Fifty-seven percent of caregivers reported having three or more depressive symptoms. Forty-one percent of caregivers reported testing positive for HIV. Self-reported HIV positive status was associated with depressive symptoms (adjusted coeff = 0.355, p-value <0.001), which were in turn associated with poorer ART adherence among caregivers (aOR 0.639, p-value = 0.023). HIV-related stigma was also associated with depressive symptoms for caregivers who reported having HIV (coeff = 0.302, p-value = 0.028) and those who reported testing negative for HIV (coeff = 0.187, p-value <0.001). Having social support was associated with lower depressive symptoms (coeff = -0.115, p = 0.007). HIV-related stigma, having social support, and other socio-demographic characteristics were not found to be associated with ART adherence. Conclusions Addressing mental health among caregivers in vulnerable households may be an important step toward achieving viral suppression among vulnerable populations living with HIV in Malawi. Integrating depression screening into HIV care and treatment protocols could be a promising intervention to improve longer-term outcomes.
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McKinney, Ogbochi, Naomi N. Modeste, Jerry W. Lee, Peter C. Gleason, and Gisele Maynard-Tucker. "Determinants of Antiretroviral Therapy Adherence among Women in Southern Malawi: Healthcare Providers’ Perspectives." AIDS Research and Treatment 2014 (2014): 1–9. http://dx.doi.org/10.1155/2014/489370.
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Background. The purpose of this study was to explore healthcare providers’ perspectives on antiretroviral (ART) adherence in two ART clinics in southern Malawi. Nonadherence to ART is a significant hindrance to the success of HIV/AIDS treatment.Methods. A one-on-one semistructured interview was conducted with eight healthcare providers in two ART clinics in rural and urban southern Malawi. The interviews were focused on factors facilitating or hindering ART adherence and strategies to improve adherence. Interviews were audio-recorded, transcribed, and content-analyzed with the use of the constant comparison approach.Results. Of the eight participants, 63% were between the ages of 20 and 30 years and 37% were HIV counselors. Factors facilitating adherence include patients’ belief and knowledge, HIV/AIDS education, and a supportive network. Barriers to adherence include discrimination, nondisclosure of HIV status, food insecurity, medication side effects, religion, misinformation, and staff and drug shortages. Strategies to improve adherence were identified by participants to include nutritional/food supplementation for malnourished or undernourished patients and patient counseling.Conclusions. There is a need for collaborative efforts between healthcare providers, patients, and faith-based organizations to identify and address hindrances and facilitators to patients’ adherence. Further research is needed to develop strategies addressing religion, staff, and drug shortages.
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Muula, Adamson. "Herbal Medicine, Diabetes Care at Primary Care Facilities and Prevention of Vertical HIV Transmission." Malawi Medical Journal 33, no. 3 (September 27, 2021): 229–30. http://dx.doi.org/10.4314/mmj.v33i3.12.
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In this September 2021 issue of the Malawi Medical Journal, three articles which attracted my attention are those by Mbali et al, Zimba et al, and Pfaff et al. Perhaps as Editor-in-Chief of the Journal, I should endeavor to be impartial and “love” all the articles the same. This time however, I have selected these articles because they touch on important health issues in Malawi, with Mbali et al, reporting on the use of herbal medicines among individuals living with HIV and receiving life-saving antiretroviral therapy (ART).
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Gondwe, Yolanda, Evaristar Kudowa, Tamiwe Tomoka, Cara Randall, Amy Lilly, Edwards Kasonkanji, Bongani Kaimila, et al. "Clinical Characteristics of Incident Lymphoma in Malawi before and after Implementation of Universal Anti-Retroviral Therapy." Blood 138, Supplement 1 (November 5, 2021): 1445. http://dx.doi.org/10.1182/blood-2021-153538.
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Abstract Purpose: In 2016, Malawi implemented a universal test and treat (UTT) policy, expanding eligibility for antiretroviral therapy (ART) to anyone with confirmed HIV infection. Prior to 2016, Malawi restricted ART initiation to HIV-positive individuals with CD4 count ≤500 cells/µL, with WHO staging ≥III who were pregnant or breastfeeding, or who were younger than 5 years old. Here, we assess the impact on distribution of lymphoma presentation and baseline clinical characteristics at Kamuzu Central Hospital, Lilongwe, Malawi. Methods: Participants with newly diagnosed, pathologically confirmed lymphoproliferative disorders were enrolled from 2013 - 2020. We categorized participants as pre-universal ART (pre-UART) if enrolled during 2013-June 2016 or post-universal ART (post-UART) if enrolled during July 2016-2020 and evaluated clinical characteristics. Findings: Of 412 total participants, 156 were pre-UART and 256 were post-UART. The most common diagnoses were diffuse large B-cell lymphoma (DLBCL) (45%), low-grade lymphoma (11%), Burkitt lymphoma (10%), Hodgkin lymphoma (9%), and multicentric Castleman disease (7%) and there was no significant difference in distribution of diagnoses between pre-UART and post-UART periods (Figure 1). HIV prevalence was 50%, mean age 43, and 62% male. Sixty-six percent (48/73) of pre-UART HIV-positive participants knew their HIV status, for median 5 years (IQR 2-8) and 71% (41/58) were on ART for median 4 years (IQR 2-7). Eighty percent (94/117) of post-UART HIV positive participants knew their HIV status (p=0.02), for median 4 years (IQR 2-9) and 84% (89/106) were on ART (p=0.05) for median 4 years (IQR 2-8). HIV was suppressed <1000 copies/mL in 56% (33/59) pre-UART and 71% (73/103) post-UART (p=0.05). Among DLBCL participants, 61% (23/38) of pre-UART HIV-positive participants knew their HIV status, for median 5 years (IQR 2-9), 61% (19/31) were on ART for median 4 years (IQR 2-6). Eighty-two percent (n=51/63) of post-UART DLBCL HIV-positive participants knew their HIV status (p=0.02) for median 5 years (IQR 2-9) and 89% (47/53) were on ART (p < 0.01) for median 5 years (IQR 2-9). Post-UART DLBCL participants had median HIV viral load of 0 log copies/mL (IQR 0-10) compared to pre-UART (6.2; IQR 0-10) (p=0.09). CD4 count, age adjusted-IPI and Ki67 proliferation index were similar for DLBCL patients in the two groups. Interpretation: There were no significant differences in lymphoma subtypes diagnosed or in traditional DLBCL prognostic factors after implementation of universal ART in Malawi. However, HIV was better controlled in the post-UART period and differences in immunological status may have implications for therapy and prognosis. Strengths of this study include a deeply characterized cohort, both clinically and pathologically. As opposed to epidemiological data from the US and Europe, we did not see a major shift in diagnoses over this time period with increasing access to ART. However, possible explanations for the differences include that this is not a epidemiological survey as cancer registration data is not comprehensively collected in Malawi and that the roll out of ART across sub-Saharan Africa has been much more gradual than the abrupt increase in access that was seen in the US and Europe. Therefore, epidemiological chances may also be more gradual. In summary, this is some of the most comprehensive data on lymphoma presentation from sub-Saharan Africa across periods of increasing access to ART and despite improved HIV control among incident lymphoma cases, there was no change in the distribution of diagnoses in this time period. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.
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Baranov, Victoria, and Hans-Peter Kohler. "The Impact of AIDS Treatment on Savings and Human Capital Investment in Malawi." American Economic Journal: Applied Economics 10, no. 1 (January 1, 2018): 266–306. http://dx.doi.org/10.1257/app.20150369.
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Antiretroviral therapy (ART), a treatment for AIDS, is rapidly increasing life expectancy throughout sub-Saharan African countries affected by the AIDS epidemic. This change in life expectancy has potentially profound influences on life-cycle decisions. A longer life expectancy increases the value of human capital investment, while the effect on savings is theoretically ambiguous and life-cycle saving could increase or decrease. This paper uses spatial and temporal variation in ART availability to evaluate the impact of ART provision on savings and investment. We find that ART availability significantly increases savings, expenditures on education, and children's schooling, including among HIV-negative individuals who do not directly benefit from ART. These results are not driven by the direct health effects of treatment or reductions in caretaking responsibilities, but rather by reduced perceptions of mortality risk after ART has become available. (JEL D14, D15, I12, I15, J24, O12)
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Kamoto, Kelita, and John Aberle-Grasse. "Surveillance of transmitted HIV drug resistance with the World Health Organization threshold survey method in Lilongwe, Malawi." Antiviral Therapy 13, no. 2_suppl (February 1, 2007): 83–87. http://dx.doi.org/10.1177/135965350801302s02.
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Background Malawi started rapid scale-up of antiretroviral therapy (ART) in 2004 and by December 2006 had initiated 81,821 patients on treatment in the public sector. Owing to capacity constraints, standard patient care, treatment initiation and follow up are based on World Health Organization (WHO) clinical staging and do not provide laboratory monitoring to assess treatment failure. Methods To monitor possible transmission of HIV drug resistance (HIVDR) an HIVDR threshold surveillance based on the WHO guidelines was implemented in Malawi. Anonymous dried blood specimens were collected from routine blood samples of HIV-positive women attending primagravida antenatal care and aged <25 years. Results Of 59 samples tested, 54 were successfully amplified indicating good specimen quality and processing. The WHO protocol algorithm to classify the prevalence of transmitted drug resistance in the site sample only required the genotyping of 34 of the samples. None of the major drug resistance mutations on the WHO surveillance list were found in these 34 specimens. Conclusions Malawi HIVDR transmission can be classified as <5% for all relevant drugs and drug classes in this population. On the basis of the very positive experience of this survey, an expanded HIVDR surveillance system will be implemented to inform the ART program as it continues to scale-up.
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Maman, David, Judith R. Glynn, Amelia C. Crampin, Katharina Kranzer, Jacqueline Saul, Andreas Jahn, Venance Mwinuka, et al. "Very Early Anthropometric Changes After Antiretroviral Therapy Predict Subsequent Survival, in Karonga, Malawi." Open AIDS Journal 6, no. 1 (April 27, 2012): 36–44. http://dx.doi.org/10.2174/1874613601206010036.
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Background: Antiretroviral (ART) scale-up in Malawi has been achieved on a large scale based mainly on clinical criteria. Simple markers of prognosis are useful, and we investigated the value of very early anthropometric changes in predicting mortality. Methods: Principal findings: Adult patients who initiated ART in Karonga District, northern Malawi, between September 2005 and August 2006 were included in a prospective cohort study, and followed for up to one year. We used Cox regression to examine the association between anthropometric changes at 2 and 6 weeks and deaths within the first year. 573 patients were included, of whom 59% were women; the median age at initiation was 37 and 64% were in WHO stage 4. Both body mass index (BMI) and mid-upper arm circumference (MUAC) increased linearly with increased time on ART, and were closely correlated with each other. There were 118 deaths. After 2 weeks on ART, a BMI increase of <0.5 kg/m2 (HR 2.47, 95%CI 1.24-4.94, p=0.005) or a MUAC increase of <0.5cm (HR 2.79, 95%CI 1.19-6.55, p=0.008) were strong predictors of death, and these associations were stronger after adjusting for baseline charactertistics. Similar results were found after 6 weeks on ART. Conclusions: Very early anthropometric changes, after 2 and 6 weeks on ART, are strong predictors of survival, independent of baseline characteristics. This should help identify patients requiring more detailed assessment where facilities are limited. MUAC is particularly valuable, requiring the simplest equipment and being appropriate for patients who have problems standing.
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van Oosterhout, Joep J., Jane Mallewa, Symon Kaunda, Newton Chagoma, Yassin Njalale, Elizabeth Kampira, Mavuto Mukaka, and Robert S. Heyderman. "Stavudine Toxicity in Adult Longer-Term ART Patients in Blantyre, Malawi." PLoS ONE 7, no. 7 (July 26, 2012): e42029. http://dx.doi.org/10.1371/journal.pone.0042029.
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Sasse, Simone A., Bryna J. Harrington, Bethany L. DiPrete, Maganizo B. Chagomerana, Laura Limarzi Klyn, Shaphil D. Wallie, Madalitso Maliwichi, et al. "Factors associated with a history of treatment interruption among pregnant women living with HIV in Malawi: A cross-sectional study." PLOS ONE 17, no. 4 (April 19, 2022): e0267085. http://dx.doi.org/10.1371/journal.pone.0267085.
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Introduction Long-term care engagement of women on antiretroviral therapy (ART) is essential to effective HIV public health measures. We sought to explore factors associated with a history of HIV treatment interruption among pregnant women living with HIV presenting to an antenatal clinic in Lilongwe, Malawi. Methods We performed a cross-sectional study of pregnant women living with HIV who had a history of ART interruption presenting for antenatal care. Women were categorized as either retained in HIV treatment or reinitiating care after loss-to-follow up (LTFU). To understand factors associated with treatment interruption, we surveyed socio-demographic and partner relationship characteristics. Crude and adjusted prevalence ratios (aPR) for factors associated with ART interruption were estimated using modified Poisson regression with robust variance. We additionally present patients’ reasons for ART interruption. Results We enrolled 541 pregnant women living with HIV (391 retained and 150 reinitiating). The median age was 30 years (interquartile range (IQR): 25–34). Factors associated with a history of LTFU were age <30 years (aPR 1.46; 95% CI: 1.33–1.63), less than a primary school education (aPR 1.25; CI: 1.08–1.46), initiation of ART during pregnancy or breastfeeding (aPR 1.49, CI: 1.37–1.65), nondisclosure of HIV serostatus to their partner (aPR 1.39, CI: 1.24–1.58), lack of awareness of partner’s HIV status (aPR 1.41, CI: 1.27–1.60), and no contraception use at conception (aPR 1.60, CI 1.40–1.98). Access to care challenges were the most common reasons reported by women for treatment interruption (e.g., relocation, transport costs, or misplacing health documentation). Conclusions Interventions that simplify the ART clinic transfer process, facilitate partner disclosure, and provide counseling about the importance of lifelong ART beyond pregnancy and breastfeeding should be further evaluated for improving retention in ART treatment of women living with HIV in Malawi.
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Kim, Evelyn, Sasi Jonnalagadda, Juliana Cuervo-Rojas, Andreas Jahn, Danielle Payne, Christine West, Francis Ogollah, et al. "Toward elimination of mother-to-child transmission of HIV in Malawi: Findings from the Malawi Population-based HIV Impact Assessment (2015–2016)." PLOS ONE 17, no. 9 (September 1, 2022): e0273639. http://dx.doi.org/10.1371/journal.pone.0273639.
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Background Malawi spearheaded the development and implementation of Option B+ for prevention of mother-to-child transmission of HIV (PMTCT), providing life-long ART for all HIV-positive pregnant and breastfeeding women. We used data from the 2015–2016 Malawi Population-based HIV Impact Assessment (MPHIA) to estimate progress toward 90-90-90 targets (90% of those with HIV know their HIV-positive status; of these, 90% are receiving ART; and of these, 90% have viral load suppression [VLS]) for HIV-positive women reporting a live birth in the previous 3 years. Methods MPHIA was a nationally representative household survey; consenting eligible women aged 15–64 years were interviewed on pregnancies and outcomes, including HIV status during their most recent pregnancy, PMTCT uptake, and early infant diagnosis (EID) testing. Descriptive analyses were weighted to account for the complex survey design. Viral load (VL) results were categorized by VLS (<1,000 copies/mL) and undetectable VL (target not detected/below the limit of detection). Results Of the 3,153 women included in our analysis, 371 (10.1%, 95% confidence interval [CI]: 8.8%–11.3%) tested HIV positive in the survey. Most HIV-positive women (84.2%, 95% CI: 79.9%–88.6%) reported knowing their HIV-positive status; of these, 94.9% (95% CI: 91.7%–98.2%) were receiving ART; and of these, 91.2% (95% CI: 87.4%–95.0%) had VLS. Among the 371 HIV-positive women, 76.0% (95% CI: 70.4%–81.7%) had VLS and 66.5% (95% CI: 59.8%–73.2%) had undetectable VL. Among 262 HIV-exposed children, 50.8% (95% CI: 42.8%–58.8%) received EID testing within 2 months of birth, whereas 17.9% (95% CI: 11.9%–23.8%) did not receive EID testing. Of 190 HIV-exposed children with a reported HIV test result, 2.1% (95% CI: 0.0%–4.6%) had positive results. Conclusions MPHIA data demonstrate high PMTCT uptake at a population level. However, our results identify some gaps in VLS in postpartum women and EID testing.
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Loyse, Angela, Godfrey S. Mfinanga, Cecilia Kanyama, Charles Kounfack, Sokoine Lesikari, Chimwemwe Chawinga, Muirgen Stack, and Sile Molloy. "OC 8494 DRIVING REDUCED AIDS-ASSOCIATED MENINGO-ENCEPHALITIS MORTALITY." BMJ Global Health 4, Suppl 3 (April 2019): A10.2—A10. http://dx.doi.org/10.1136/bmjgh-2019-edc.24.
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BackgroundDREAMM is an implementation study aiming to reduce meningo-encephalitis related mortality. Delays in diagnosis and treatment through poor access to diagnostics and treatments are significant contributing factors to the ongoing high mortality of HIV-associated central nervous system (CNS) infections, causing up to 25% of all HIV-related deaths in sub-Saharan Africa.MethodsA before-after design is being implemented across 3 sites in Africa; Lilongwe, Malawi, Dar Es Salaam, Tanzania and Yaoundé, Cameroon. The study is composed of 3 phases: Observation, Training and Implementation.ResultsThe observation phase (audit of practice) happened between November 2016 – May 2017 in Malawi and Tanzania. Overall, 110 patients were included. Ten-week all-cause mortality was 64% (42/66) in Tanzania and 37% (13/35) in Malawi. Approximately 75% of patients were ART experienced. Across sites, 76.6% of patients presented with abnormal mental status, with a median baseline CD4 count of 50 cells/µL. Only 2/75 patients in Tanzania had a lumbar puncture ordered compared to 27/35 in Malawi. All patients in Tanzania received empirical Fluconazole monotherapy whereas almost 1/3 patients in Malawi (11/35) were treated with Amphotericin B which is not readily available in both countries.The training phase (completed in November 2017 for Malawi and Tanzania) used the train-the-trainer approach. Interactive workshops on using rapid diagnostic tests (RDTs), performing basic microbiological techniques and safe administration of medicines were chosen as the most pertinent to reducing mortality. Patient and laboratory pathways were optimised afterwards by increasing the routine laboratory capacity, performing CSF analysis, providing infectious diseases mentorship for clinicians and procuring RDTs and reagents not locally available.Implementation is underway in Malawi and Tanzania and the audit phase is scheduled for autumn in Cameroon. Upon completion, the project is expected to create a sustainable approach to reduce the high mortality of HIV-related meningo-encephalitis with the optimised patient and laboratory pathways embedded within routine care.
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WHITE, R. G., E. VYNNYCKY, J. R. GLYNN, A. C. CRAMPIN, A. JAHN, F. MWAUNGULU, O. MWANYONGO, et al. "HIV epidemic trend and antiretroviral treatment need in Karonga District, Malawi." Epidemiology and Infection 135, no. 6 (January 12, 2007): 922–32. http://dx.doi.org/10.1017/s0950268806007680.
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SUMMARYWe describe the development of the HIV epidemic in Karonga District, Malawi over 22 years using data from population surveys and community samples. These data are used to estimate the trend in HIV prevalence, incidence and need for antiretroviral treatment (ART) using a simple mathematical model. HIV prevalence rose quickly in the late 1980s and early 1990s, stabilizing at around 12% in the mid-1990s. Estimated annual HIV incidence rose quickly, peaking in the early 1990s at 2·2% among males and 3·1% among females, and then levelled off at 1·3% among males and 1·1% among females by the late 1990s. Assuming a 2-year eligibility period, both our model and the UNAIDS models predicted 2·1% of adults were in need of ART in 2005. This prediction was sensitive to the assumed eligibility period, ranging from 1·6% to 2·6% if the eligibility period was instead assumed to be 1·5 or 2·5 years, respectively.
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Kalf-Schoite, Sonja M., Willem E. Amerongen, Albert J. E. Smith, and Harry J. A. Haastrecht. "Atraumatic Restorative Treatment (ART): A Three-year Clinical Study in Malawi-Comparison of Conventional Amalgam and ART Restorations." Journal of Public Health Dentistry 63, no. 2 (May 1, 2007): 99–103. http://dx.doi.org/10.1111/j.1752-7325.2003.tb03482.x.
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Gondwe, Yolanda, Evaristar Kudowa, Tamiwe Tomoka, Edwards D. Kasonkanji, Bongani Kaimila, Takondwa Zuze, Noel Mumba, et al. "Comparison of baseline lymphoma and HIV characteristics in Malawi before and after implementation of universal antiretroviral therapy." PLOS ONE 17, no. 9 (September 1, 2022): e0273408. http://dx.doi.org/10.1371/journal.pone.0273408.
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Access to antiretroviral therapy (ART) led to epidemiological changes in human immunodeficiency virus (HIV) associated lymphoma in high-income countries such as reductions in diffuse large B-cell lymphoma (DLBCL) and stable or increased Hodgkin lymphoma (HL) and Burkitt lymphoma (BL). In 2016, Malawi implemented a universal ART (UART) policy, expanding ART eligibility to all persons living with HIV (PLWH). We compare the distribution of lymphoma subtypes and baseline HIV and prognostic characteristics for lymphoma patients in Malawi before and after implementation of UART. We enrolled patients with pathologically confirmed incident lymphoproliferative disorders into a observational clinical cohort. At diagnosis, a comprehensive clinicopathological evaluation was performed. Of 412 participants, 156 (38%) were pre-UART (2013-June 2016) and 256 (62%) post-UART (July 2016–2020). HIV prevalence was 50% in both groups. The most common pre-UART diagnoses were DLBCL [75 (48%)], low-grade non-Hodgkin lymphoma (NHL) [19 (12%)], HL [17 (11%)] and, BL [13 (8%)]. For post-UART they were DLBCL [111 (43%)], NHL [28 (11%)], BL [27 11%)] and, HL [20 (8%)]. Among PLWH, 44 (57%) pre-UART initiated ART prior to lymphoma diagnosis compared to 99 (78%) post-UART (p = 0.02). HIV-ribonucleic acid was suppressed <1000 copies/mL in 56% (33/59) pre-UART and 71% (73/103) post-UART (p = 0.05). CD4 T-cell counts were similar for both groups. We observed similar findings in the subset of participants with DLBCL. Overall, there were no significant changes in incident lymphoma subtypes (p = 0.61) after implementation of UART, but HIV was better controlled. Emerging trends bear monitoring and may have implications for prognosis and health system priority setting. Trial registration: ClinicalTrials.gov identifier: NCT02835911.
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Gopal, Satish, Yuri D. Fedoriw, Nathan Montgomery, Agnes Moses, Richard Nyasosela, Yohannie Mlombe, Carlos Varela, et al. "Antiretroviral Therapy Has Equalized Presentations and Short-Term Outcomes Between HIV+ and HIV- Lymphoma Patients in Lilongwe, Malawi." Blood 124, no. 21 (December 6, 2014): 2626. http://dx.doi.org/10.1182/blood.v124.21.2626.2626.
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Abstract Introduction. There are scarce prospective data for lymphoma patients in sub-Saharan Africa since antiretroviral therapy (ART) scale-up began. We report early data from the Kamuzu Central Hospital (KCH) Lymphoma Study in Lilongwe,Malawi. KCH is the cancer referral center for Malawi’s northern and central regions. Methods. The KCH Lymphoma Study is a prospective observational cohort study initiated in June 2013. All diagnoses are pathologically confirmed using core biopsies or cell blocks from fine needle aspirates, supported by immunohistochemistry and weekly telepathology consultation between pathologists in Malawi and the US. Adult patients with confirmed lymphoma receive a comprehensive baseline evaluation including standardized staging. Patients undergo longitudinal follow-up with active tracing and transportation reimbursement to promote adherence to care. Response is assessed using standardized criteria incorporating physical exam, chest x-ray, and abdominal ultrasound. For these analyses, we focused on adults ≥18 years enrolled from June 1, 2013 until May 31, 2014. Chemotherapy protocols are standardized, and HIV+ patients receive ART concurrently with chemotherapy. Results. Seventeen of 38 (45%) of patients with lymphoma were HIV+. Baseline characteristics for HIV+ and HIV- patients were similar although HIV- patients presented with bulkier disease (median 10 vs 6 cm, p=0.027, Table 1). Among HIV+ patients, 82% were on ART for a median 22.5 months before lymphoma diagnosis (range 0.2-98.8). Median CD4 was 178 cells/µL and 53% had suppressed HIV RNA <400 copies/mL. Thirty-one patients were treated with first-line CHOP (15 HIV+, 16 HIV-; 30 NHL, 1 HL). Five HL patients received first-line ABVD, 1 CLL patient did not require treatment for Rai Stage I disease, and 1 CLL patient received CVP. Patients treated with CHOP received a median 5 cycles (range 1-8). Among 14 of 31 patients receiving <6 CHOP cycles, reasons for stopping were death (n=8), progression (n=1), toxicity (n=3), and social (n=2). Overall survival 6 months after CHOP initiation was 61% (95% CI 38-78%), with no significant differences between HIV+ and HIV- patients (Figure 1). Conclusions. Early experience in Malawi suggests ART has had equalized presentations and outcomes between HIV+ and HIV- lymphoma patients. CHOP can be safe, effective, and feasible in our setting for HIV+ and HIV- patients in the ART era. Among HIV+ patients, ART use, CD4 count, and HIV RNA at lymphoma diagnosis are comparable to contemporary US HIV+ lymphoma cohorts. Outcomes can be further improved through community education, better supportive care, protocol-based treatment, and incorporation of newer agents. Table 1. Characteristics of adult lymphoma patients from June 2013-May 2014 in Lilongwe, Malawi. HIV- (n=21) HIV+ (n=17) P value Age (years), median (range) 45.6 (15.8-77.4) 47.2 (22.4-62.6) 0.51 Male, n (%) 16 (76.2%) 10 (58.8%) 0.31 Body mass index (kg/m2), median (range) 21.3 (16.2-28.0) 20.4 (16.0-31.2) 0.99 Histology 0.21 Aggressive B-cell lymphoma NK/T-cell lymphoma Plasmablastic lymphoma Chronic lymphocytic leukemia Non-Hodgkin lymphoma unspecified Hodgkin lymphoma 9 1 1 6 4 12 1 1 1 2 B symptoms, n (%) 18 (85.7%) 12 (70.6%) 0.69 Largest lymph node mass (cm), median (range) 10 (5-20) 6 (2-16) 0.027 Performance status ≥2 10 (47.6%) 4 (23.5%) 0.18 Stage III/IV, n (%) 12 (57.1%) 10 (58.8%) 1.00 White blood cells (103/µL), median (range) 6.8 (2.1-45.7) 5.7 (3.0-17.0) 0.23 Absolute neutrophil count (103/µL), median (range) 2.9 (0.5-29.9) 2.6 (1.0-5.1) 0.19 Hemoglobin (g/dL), median (range) 11.0 (4.4-14.3) 11.6 (5.7-15.1) 0.46 Platelets (103/µL), median (range) 290 (25-725) 190 (101-764) 0.15 Albumin (g/dL), median (range) 3.3 (1.1-4.2) 3.5 (2.1-4.8) 0.78 Lactate dehydrogenase (IU/L), median (range) 321 (134-1,080) 307 (177-2,939) 0.85 Bone marrow involvement, n (%) 2/18 (11.1%) 2/13 (15.4%) 1.00 ≥2 extranodal sites 5 (23.8%) 3 (17.6%) 0.71 Hepatitis B surface antigen positive, n (%) 1/15 (6.7%) 4/15 (26.7%) 0.33 Antiretroviral therapy at enrollment Duration (months), median (range) 14 (82.4%) 22.5 (0.2-98.8) CD4 (cells/µL), median (range) 178 (55-1,288) HIV RNA (log10copies/mL), median (range) 1.8 (ND->7.0) HIV RNA <400 copies/mL, n (%) 9 (52.9%) ND=not detected. Figure 1. Overall survival for 31 adult lymphoma patients treated with CHOP in Lilongwe, Malawi during the 6 months after treatment initiation. Figure 1. Overall survival for 31 adult lymphoma patients treated with CHOP in Lilongwe, Malawi during the 6 months after treatment initiation. Disclosures Shea: CALGB/Alliance: CALGB Board of Directors Other.
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Wroe, Emily B., Elizabeth L. Dunbar, Noel Kalanga, Luckson Dullie, Chiyembekezo Kachimanga, Andrew Mganga, Michael Herce, et al. "Delivering comprehensive HIV services across the HIV care continuum: a comparative analysis of survival and progress towards 90-90-90 in rural Malawi." BMJ Global Health 3, no. 1 (January 2018): e000552. http://dx.doi.org/10.1136/bmjgh-2017-000552.
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IntroductionPartners In Health and the Malawi Ministry of Health collaborate on comprehensive HIV services in Neno, Malawi, featuring community health workers, interventions addressing social determinants of health and health systems strengthening. We conducted an observational study to describe the HIV care continuum in Neno and to compare facility-level HIV outcomes against health facilities nationally.MethodsWe compared facility-level outcomes in Neno (n=13) with all other districts (n=682) from 2013 to 2015 using mixed-effects linear regression modelling. We selected four outcomes that are practically useful and roughly mapped on to the 90-90-90 targets: facility-based HIV screenings relative to population, new antiretroviral therapy (ART)enrolments relative to population, 1-year survival rates and per cent retained in care at 1 year.ResultsIn 2013, the average number of HIV tests performed, as a per cent of the adult population, was 11.75%, while the average newly enrolled patients was 10.03%. Percent receiving testing increased by 4.23% over 3 years (P<0.001, 95% CI 2.98% to 5.49%), while percent enrolled did not change (P=0.28). These results did not differ between Neno and other districts (P=0.52), despite Neno having a higher proportion of expected patients enrolled. In 2013, the average ART 1-year survival was 80.41% nationally and 91.51% in Neno, which is 11.10% higher (P=0.002, 95% CI 4.13% to 18.07%). One-year survival declined by 1.75% from 2013 to 2015 (P<0.001, 95% CI −2.61% to −0.89%); this was similar in Neno (P=0.83). Facility-level 1-year retention was 85.43% nationally in 2013 (P<0.001, 95% CI 84.2% to 86.62%) and 12.07% higher at 97.50% in Neno (P=0.001, 95% CI 5.08% to19.05%). Retention declined by 2.92% (P<0.001, 95% CI −3.69% to −2.14%) between 2013 and 2015, both nationally and in Neno.ConclusionThe Neno HIV programme demonstrated significantly higher survival and retention rates compared with all other districts in Malawi. Incorporating community health workers, strengthening health systems and addressing social determinants of health within the HIV programme may help Malawi and other countries accelerate progress towards 90-90-90.
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Schouten, Erik J., Andreas Jahn, Anne Ben-Smith, Simon D. Makombe, Anthony D. Harries, Francis Aboagye-Nyame, and Frank Chimbwandira. "Antiretroviral drug supply challenges in the era of scaling up ART in Malawi." Journal of the International AIDS Society 14 (July 2011): S4. http://dx.doi.org/10.1186/1758-2652-14-s1-s4.
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Orlando, Stefano, Samantha Diamond, Leonardo Palombi, Maaya Sundaram, Lauren Shear Zimmer, Maria Cristina Marazzi, Sandro Mancinelli, and Giuseppe Liotta. "Cost-Effectiveness and Quality of Care of a Comprehensive ART Program in Malawi." Medicine 95, no. 21 (May 2016): e3610. http://dx.doi.org/10.1097/md.0000000000003610.
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Landis Lewis, Zach, Claudia Mello-Thoms, Oliver J. Gadabu, E. Miranda Gillespie, Gerald P. Douglas, and Rebecca S. Crowley. "The feasibility of automating audit and feedback for ART guideline adherence in Malawi." Journal of the American Medical Informatics Association 18, no. 6 (November 2011): 868–74. http://dx.doi.org/10.1136/amiajnl-2011-000097.
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Rachlis, Beth, Donald C. Cole, Monique van Lettow, Michael Escobar, Adamson S. Muula, Farah Ahmad, James Orbinski, and Adrienne K. Chan. "Follow-Up Visit Patterns in an Antiretroviral Therapy (ART) Programme in Zomba, Malawi." PLoS ONE 9, no. 7 (July 17, 2014): e101875. http://dx.doi.org/10.1371/journal.pone.0101875.
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Mbichila, Tinkhani H., Maganizo Chagomerana, Jennifer H. Tang, Lisa B. Haddad, Mina C. Hosseinipour, Hannock Tweya, and Samuel Phiri. "Partnership duration and HIV serodisclosure among people living with HIV/AIDS in Lilongwe, Malawi." International Journal of STD & AIDS 29, no. 10 (May 10, 2018): 987–93. http://dx.doi.org/10.1177/0956462418769730.
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HIV serodisclosure to sexual partners is an important aspect of HIV prevention, treatment, and care. We investigated the association between partnership duration and serodisclosure among HIV-infected individuals in Lilongwe, Malawi. We analyzed data from a cross-sectional study of individuals attending one of two antiretroviral therapy (ART) clinics in Lilongwe. Clients aged 18–45 years and sexually active within the past six months were eligible. Logistic regression was used to estimate the odds ratio (OR) and 95% confidence interval (CI) for the association between partnership duration ≤1 year and serodisclosure. Five hundred and sixty-two participants completed the survey: 308 (55%) women and 254 (45%) men. Median age was 35 years (IQR 30–40), 90% were married, 88% were on ART, and 95% had serodisclosed to their partner. Marital status, knowledge of partner serostatus, and ART use were significantly associated with serodisclosure. Participants in a relationship for ≤1 year were significantly less likely to disclose their serostatus to their partners compared to those in a relationship for >1 year (OR = 0.18, 95% CI: 0.06, 0.58). Couple-based interventions that encourage serodisclosure among partners within their first year of relationship should be developed to decrease HIV transmission, encourage treatment and support.
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Phillips, Tamsin K., Halli Olsen, Chloe A. Teasdale, Amanda Geller, Mamorapeli Ts’oeu, Nicole Buono, Dumbani Kayira, Bernadette Ngeno, Surbhi Modi, and Elaine J. Abrams. "Uninterrupted HIV treatment for women: Policies and practices for care transitions during pregnancy and breastfeeding in Côte d’Ivoire, Lesotho and Malawi." PLOS ONE 16, no. 12 (December 2, 2021): e0260530. http://dx.doi.org/10.1371/journal.pone.0260530.
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Transitions between services for continued antiretroviral treatment (ART) during and after pregnancy are a commonly overlooked aspect of the HIV care cascade, but ineffective transitions can lead to poor health outcomes for women and their children. In this qualitative study, we conducted interviews with 15 key stakeholders from Ministries of Health along with PEPFAR-supported and other in-country non-governmental organizations actively engaged in national programming for adult HIV care and prevention of mother-to-child-transmission of HIV (PMTCT) services in Côte d’Ivoire, Lesotho and Malawi. We aimed to understand perspectives regarding transitions into and out of PMTCT services for continued ART. Thematic analysis revealed that, although transitions of care are necessary and a potential point of loss from ART care in all three countries, there is a lack of clear guidance on transition approach and no formal way of monitoring transition between services. Several opportunities were identified to monitor and strengthen transitions of care for continued ART along the PMTCT cascade.
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Lewis, Samuel, Misheck Mphande, Florence Chibwana, Temwa Gumbo, Ben Allan Banda, Hitler Sigauke, Agnes Moses, Sundeep Gupta, Risa M. Hoffman, and Corrina Moucheraud. "Association of HIV status and treatment characteristics with VIA screening outcomes in Malawi: A retrospective analysis." PLOS ONE 17, no. 1 (January 25, 2022): e0262904. http://dx.doi.org/10.1371/journal.pone.0262904.
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Background Although evidence from high-resource settings indicates that women with HIV are at higher risk of acquiring high-risk HPV and developing cervical cancer, data from cervical cancer “screen and treat” programs using visual inspection with acetic acid (VIA) in lower-income countries have found mixed evidence about the association between HIV status and screening outcomes. Moreover, there is limited evidence regarding the effect of HIV-related characteristics (e.g., viral suppression, treatment factors) on screening outcomes in these high HIV burden settings. Methods This study aimed to evaluate the relationship between HIV status, HIV treatment, and viral suppression with cervical cancer screening outcomes. Data from a “screen and treat” program based at a large, free antiretroviral therapy (ART) clinic in Lilongwe, Malawi was retrospectively analyzed to determine rates of abnormal VIA results and suspected cancer, and coverage of same-day treatment. Multivariate logistic regression assessed associations between screening outcomes and HIV status, and among women living with HIV, viremia, ART treatment duration and BMI. Results Of 1405 women receiving first-time VIA screening between 2017–2019, 13 (0.9%) had suspected cancer and 68 (4.8%) had pre-cancerous lesions, of whom 50 (73.5%) received same-day lesion treatment. There was no significant association found between HIV status and screening outcomes. Among HIV+ women, abnormal VIA was positively associated with viral load ≥ 1000 copies/mL (aOR 3.02, 95% CI: 1.22, 7.49) and negatively associated with ART treatment duration (aOR 0.88 per additional year, 95% CI: 0.80, 0.98). Conclusion In this population of women living with HIV with high rates of ART coverage and viral suppression, HIV status was not significantly associated with abnormal cervical cancer screening results. We hypothesize that ART treatment and viral suppression may mitigate the elevated risk of cervical cancer for women living with HIV, and we encourage further study on this relationship in high HIV burden settings.
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Price, A., M. Chihana, N. Kayuni, J. R. Glynn, T. Mzembe, E. Slaymaker, B. Zaba, N. French, F. Kalobekamo, and A. C. Crampin. "The Population Effect of ART on Mortality during an Eight year Period of Decentralised ART Care in Malawi; Rates in those Accessing ART and those not Accessing ART." International Journal of Epidemiology 44, suppl_1 (September 23, 2015): i28. http://dx.doi.org/10.1093/ije/dyv097.092.
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Phiri, Sam, Joe Gumulira, Hannock Tweya, Lameck Chinula, Agnes Moses, Bongani Kaimila, Christopher Stanley, et al. "The Malawi Cancer Consortium – Catalyzing Cancer Care and Research in Southern Africa." Journal of Global Oncology 2, no. 3_suppl (June 2016): 3s—4s. http://dx.doi.org/10.1200/jgo.2016.003780.
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Abstract 68 Background: Cancer burden is increasing in Malawi, particularly for HIV-associated malignancies. Methods: With support from the National Cancer Institute, the Malawi Cancer Consortium (MCC) was initiated in September 2014. Partners include the UNC Lineberger Comprehensive Cancer Center, Malawi Ministry of Health, University of Malawi College of Medicine, and Lighthouse Trust. Spanning Malawi’s two major cities, Lilongwe and Blantyre, MCC includes three support cores (administration, analysis, mentoring) and three multi-institution research projects: (1) a national HIV-cancer match study to assess cancer incidence in the ART era; (2) a longitudinal cohort to identify clinical and molecular correlates of KS chemotherapy response; and (3) a longitudinal cohort to elucidate lymphoma biology and develop better treatments for HIV-associated lymphoma. Results: For project 1, 65,500 records from the Malawi National Cancer Registry and Malawi HIV cohorts have been abstracted, and initial data harmonization completed. Record linkage is planned for February 2016, will be updated at regular intervals, and will contribute to regional analyses through the IeDEA- Southern Africa network. For project 2, KS studies through MCC have led to descriptions of KS biologic subtypes defined by viral gene expression profiling, and detailed characterization of multicentric Castleman disease. Malawi has also led enrollment into multinational phase III KS clinical trials implemented by the AIDS Clinical Trials Group and AIDS Malignancy Consortium. For project 3, more than 300 adults and children with lymphoma have been enrolled since June 2014, with approximately 2/3 of adults being HIV-infected. Patients receive standardized treatment and supportive care, and standardized clinical and laboratory evaluations. Specimen-based correlative studies (virologic, genomic, biomarker studies) are ongoing. Finally, the consortium provides a platform for pilot studies in breast and esophageal cancer, and facilitates career development for Malawian cancer investigators. Conclusions: MCC has initiated a national coalition to address cancer in Malawi, and continued progress is anticipated. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: Sam Phiri No relationship to disclose Joe Gumulira No relationship to disclose Hannock Tweya No relationship to disclose Lameck Chinula No relationship to disclose Agnes Moses No relationship to disclose Bongani Kaimila No relationship to disclose Christopher Stanley No relationship to disclose Edwards Kasonkanji No relationship to disclose Steady Chasimpha No relationship to disclose Richard Nyasosela No relationship to disclose Leo Masamba No relationship to disclose Tamiwe Tomoka No relationship to disclose Steve Kamiza No relationship to disclose Mina Hosseinipour No relationship to disclose Nora Rosenberg Research Funding: NIH/NCI Ron Mataya No relationship to disclose Charles Dzamalala No relationship to disclose George Liomba No relationship to disclose Irving Hoffman No relationship to disclose Dirk Dittmer No relationship to disclose Yuri Fedoriw Honoraria: Alexion Pharmaceuticals Blossom Damania No relationship to disclose Satish Gopal No relationship to disclose
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Horner, Marie-Josèphe, Steady Chasimpha, Adrian Spoerri, Jessie Edwards, Julia Bohlius, Hannock Tweya, Petros Tembo, et al. "High Cancer Burden Among Antiretroviral Therapy Users in Malawi: A Record Linkage Study of Observational Human Immunodeficiency Virus Cohorts and Cancer Registry Data." Clinical Infectious Diseases 69, no. 5 (November 17, 2018): 829–35. http://dx.doi.org/10.1093/cid/ciy960.
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Abstract Background With antiretroviral therapy (ART), AIDS-defining cancer incidence has declined and non-AIDS–defining cancers (NADCs) are now more frequent among human immunodeficiency virus (HIV)–infected populations in high-income countries. In sub-Saharan Africa, limited epidemiological data describe cancer burden among ART users. Methods We used probabilistic algorithms to link cases from the population-based cancer registry with electronic medical records supporting ART delivery in Malawi’s 2 largest HIV cohorts from 2000–2010. Age-adjusted cancer incidence rates (IRs) and 95% confidence intervals were estimated by cancer site, early vs late incidence periods (4–24 and >24 months after ART start), and World Health Organization (WHO) stage among naive ART initiators enrolled for at least 90 days. Results We identified 4346 cancers among 28 576 persons. Most people initiated ART at advanced WHO stages 3 or 4 (60%); 12% of patients had prevalent malignancies at ART initiation, which were predominantly AIDS-defining eligibility criteria for initiating ART. Kaposi sarcoma (KS) had the highest IR (634.7 per 100 000 person-years) followed by cervical cancer (36.6). KS incidence was highest during the early period 4–24 months after ART initiation. NADCs accounted for 6% of new cancers. Conclusions Under historical ART guidelines, NADCs were observed at low rates and were eclipsed by high KS and cervical cancer burden. Cancer burden among Malawian ART users does not yet mirror that in high-income countries. Integrated cancer screening and management in HIV clinics, especially for KS and cervical cancer, remain important priorities in the current Malawi context.
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Garver, Sarah, Jenny Trinitapoli, and Sara Yeatman. "Changing Childbearing Norms During an Era of ART Expansion in Malawi, 2009 to 2015." AIDS and Behavior 24, no. 6 (October 14, 2019): 1676–86. http://dx.doi.org/10.1007/s10461-019-02685-4.
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Hedt, Bethany L., Nellie Wadonda-Kabondo, Simon Makombe, Anthony D. Harries, Erik J. Schouten, Eddie Limbambala, Mindy Hochgesang, John Aberle-Grasse, and Kelita Kamoto. "Early warning indicators for HIV drug resistance in Malawi." Antiviral Therapy 13, no. 2_suppl (February 2008): 69–75. http://dx.doi.org/10.1177/135965350801302s06.
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Background Malawi started rapid scale-up of antiretroviral therapy (ART) in 2004 and by December 2006 had initiated over 85,000 patients on treatment. Early warning indicator (EWI) reports can help to minimize the risk of emerging drug resistance. Methods Data collected during the routine quarterly supervision of 103 public sector sites was used to compile the first EWI report for HIV drug resistance (HIVDR) in Malawi, reflecting outcomes for October to December 2006. Results All sites reach the World Health Organization (WHO) targets for prescribing practices and drug supply continuity. The target for adherence was achieved by 85% of sites and 84% achieved the target for minimizing treatment defaults; however, less than half of all sites reach the WHO target for patient retention. Conclusions These results emphasize the importance of defaulter tracing and initiating treatment earlier in the course of HIV infection. As part of a comprehensive HIVDR monitoring programme, the Ministry of Health plans for on-going tracking of these indicators, as well as special data collection from the private sector. Plans are also underway to gather information on other recommended indicators that are not collected during routine supervision.
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Peterson, Ingrid, Ntobeko Ntusi, Kondwani Jambo, Christine Kelly, Jacqueline Huwa, Louise Afran, Joseph Kamtchum Tatuene, et al. "Evaluating the reactivation of herpesviruses and inflammation as cardiovascular and cerebrovascular risk factors in antiretroviral therapy initiators in an African HIV-infected population (RHICCA): a protocol for a longitudinal cohort study." BMJ Open 9, no. 9 (September 2019): e025576. http://dx.doi.org/10.1136/bmjopen-2018-025576.
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IntroductionIn Sub-Saharan Africa, the rising rates of cerebrovascular and cardiovascular diseases (CBD/CVD) are intersecting with an ageing HIV-infected population. The widespread use of antiretroviral therapy (ART) may confer an additive risk and may not completely suppress the risk associated with HIV infection. High-quality prospective studies are needed to determine if HIV-infected patients in Africa are at increased risk of CBD/CVD and to identify factors associated with this risk. This study will test the hypothesis that immune activation and dysfunction, driven by HIV and reactivation of latent herpesvirus infections, lead to increased CBD/CVD risk in Malawian adults aged ≥35 years.Methods and analysisWe will conduct a single-centre, 36-month, prospective cohort study in 800 HIV-infected patients initiating ART and 190 HIV-uninfected controls in Blantyre, Malawi. Patients and controls will be recruited from government ART clinics and the community, respectively, and will be frequency-matched by 5-year age band and sex. At baseline and follow-up visits, we will measure carotid intima-media thickness and pulse wave velocity as surrogate markers of vasculopathy, and will be used to estimate CBD/CVD risk. Our primary exposures of interest are cytomegalovirus and varicella zoster reactivation, changes in HIV plasma viral load, and markers of systemic inflammation and endothelial function. Multivariable regression models will be developed to assess the study’s primary hypothesis. The occurrence of clinical CBD/CVD will be assessed as secondary study endpoints.Ethics and disseminationThe University of Malawi College of Medicine and Liverpool School of Tropical Medicine research ethics committees approved this work. Our goal is to understand the pathogenesis of CBD/CVD among HIV cohorts on ART, in Sub-Saharan Africa, and provide data to inform future interventional clinical trials. This study runs between May 2017 and August 2020. Results of the main trial will be submitted for publication in a peer-reviewed journal.Trial registration numberISRCTN42862937.
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Hoffman, Risa M., Florence Chibwana, Ben Allan Banda, Daniel Kahn, Khumbo Gama, Zachary P. Boas, Mayamiko Chimombo, et al. "High rate of left ventricular hypertrophy on screening echocardiography among adults living with HIV in Malawi." Open Heart 9, no. 1 (May 2022): e002026. http://dx.doi.org/10.1136/openhrt-2022-002026.
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BackgroundThere are limited data on structural heart disease among people living with HIV in southern Africa, where the success of antiretroviral therapy (ART) has drastically improved life expectancy and where risk factors for cardiovascular disease are prevalent.MethodsWe performed a cross-sectional study of screening echocardiography among adults (≥18 years) with HIV in Malawi presenting for routine ART care. We used univariable and multivariable logistic regression to evaluate correlates of abnormal echocardiogram.ResultsA total of 202 individuals were enrolled with a median age of 45 years (IQR 39–52); 52% were female, and 27.7% were on antihypertensive medication. The most common clinically significant abnormality was left ventricular hypertrophy (LVH) (12.9%, n=26), and other serious structural heart lesions were rare (<2% with ejection fraction less than 40%, moderate-severe valve lesions or moderate-severe pericardial effusion). Characteristics associated with abnormal echocardiogram included older age (OR 1.04, 95% CI 1.01 to 1.08), higher body mass index (OR 1.09, 95% CI 1.02 to 1.17), higher mean systolic blood pressure (OR 1.03, 95% CI 1.02 to 1.05) and higher mean diastolic blood pressure (OR 1.03, 95% CI 1.01 to 1.05). In a multivariable model including age, duration on ART, body mass index, and systolic and diastolic blood pressure, only mean body mass index (adjusted OR 1.10, 95% CI 1.02 to 1.19), systolic blood pressure (aOR 1.05, 95% CI 1.03 to 1.08) and diastolic blood pressure (aOR 0.96, 95% CI 0.92 to 1.00) remained associated with abnormal echocardiogram.ConclusionsLVH was common in this population of adults on ART presenting for routine care and was associated with elevated blood pressure. Further research is needed to characterise the relationship between chronic hypertension, LVH and downstream consequences, such as diastolic dysfunction and heart failure in people living with HIV.
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Blunt, Peter, and Merrick Jones. "Managerial Motivation in Kenya and Malawi: a Cross-Cultural Comparison." Journal of Modern African Studies 24, no. 1 (March 1986): 165–75. http://dx.doi.org/10.1017/s0022278x00006790.
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Managers are increasingly seen as having a critically important rôle to play in development and nation-building,1and doubts concerning the appropriateness of transferring western ideas and practices to third-world countries are assuming urgent significance. Questions are posed about the impact of social and cultural factors on the management of organisations, and about relationships, between managerial thinking and behaviour and the national stage of economic growth. For example, A. Gladstone asserts that management is a key determinant in development in Africa's new nations, and notes that there has been little research and analysis concerning the evolving state of the managerial art in Africa, both in terms of what exists and what is needed … while management training for Africans has developed considerably, is this training the most appropriate? To what extent should traditional African management be discarded… are the various modern Western approaches relevant and effective in the setting up of African enterprises?2
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Kelly, Christine, Rijan Gurung, Raphael Kamng'ona, Irene Sheha, Mishek Chammudzi, Kondwani Jambo, Jane Mallewa, et al. "Circulating microparticles are increased amongst people presenting with HIV and advanced immune suppression in Malawi and correlate closely with arterial stiffness: a nested case control study." Wellcome Open Research 6 (October 13, 2021): 264. http://dx.doi.org/10.12688/wellcomeopenres.17044.1.
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Background: We aimed to investigate whether circulating microparticle (CMPs) subsets were raised amongst people presenting with human immunodeficiency virus (HIV) and advanced immune suppression in Malawi, and whether they associated with arterial stiffness. Methods: Antiretroviral therapy (ART)-naïve adults with a new HIV diagnosis and CD4 <100 cells/µL had microparticle characterisation and carotid femoral Pulse Wave Velocity (cfPWV) at 2 weeks post ART initiation. HIV uninfected controls were matched on age, systolic blood pressure (BP) and diastolic BP in a 1:1 ratio. Circulating microparticles were identified from platelet poor plasma and stained for endothelial, leucocyte, monocyte and platelet markers. Results: The median (IQ) total CMP count for 71 participants was 1 log higher in HIV compared to those without (p<0.0001) and was associated with arterial stiffness (spearman rho 0.47, p<0.001). In adjusted analysis, every log increase in circulating particles showed a 20% increase in cfPWV (95% confidence interval [CI] 4 – 40%, p=0.02). In terms of subsets, endothelial and platelet derived microparticles were most strongly associated with HIV. Endothelial derived E-selectin+ CMPs were 1.3log-fold higher and platelet derived CD42a+ CMPs were 1.4log-fold higher (both p<0.0001). Endothelial and platelet derived CMPs also correlated most closely with arterial stiffness (spearman rho: E-selectin+ 0.57 and CD42a 0.56, both p<0.0001). Conclusions: Circulating microparticles associate strongly with arterial stiffness among people living with HIV in Malawi. Endothelial damage and platelet microparticles are the predominant cell origin types and future translational studies could consider prioritising these pathways.
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McLean, Estelle, Alison Price, Menard Chihana, Ndoliwe Kayuni, Milly Marston, Olivier Koole, Basia Zaba, and Amelia Crampin. "Changes in Fertility at the Population Level in the Era of ART in Rural Malawi." JAIDS Journal of Acquired Immune Deficiency Syndromes 75, no. 4 (August 2017): 391–98. http://dx.doi.org/10.1097/qai.0000000000001395.
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Chan, A. K., E. Singogo, R. Changamire, Y. E. C. Ratsma, J.-M. Tassie, and A. D. Harries. "Simplified methods of determining treatment retention in Malawi: ART cohort reports vs. pharmacy stock cards." Public Health Action 2, no. 2 (June 21, 2012): 32–37. http://dx.doi.org/10.5588/pha.11.0028.
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Masiano, Steven, Edwin Machine, Mtisunge Mphande, Christine Markham, Tapiwa Tembo, Mike Chitani, Angella Mkandawire, Alick Mazenga, Saeed Ahmed, and Maria Kim. "Video-Based Intervention for Improving Maternal Retention and Adherence to HIV Treatment: Patient Perspectives and Experiences." International Journal of Environmental Research and Public Health 18, no. 4 (February 10, 2021): 1737. http://dx.doi.org/10.3390/ijerph18041737.
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VITAL Start is a video-based intervention aimed to improve maternal retention in HIV care and adherence to antiretroviral therapy (ART) in Malawi. We explored the experiences of pregnant women living with HIV (PWLHIV) not yet on ART who received VITAL Start before ART initiation to assess the intervention’s acceptability, feasibility, fidelity of delivery, and perceived impact. Between February and September 2019, we conducted semi-structured interviews with a convenience sample of 34 PWLHIV within one month of receiving VITAL Start. The participants reported that VITAL Start was acceptable and feasible and had good fidelity of delivery. They also reported that the video had a positive impact on their lives, encouraging them to disclose their HIV status to their sexual partners who, in turn, supported them to adhere to ART. The participants suggested using a similar intervention to provide health-related education/counseling to people with long term conditions. Our findings suggest that video-based interventions may be an acceptable, feasible approach to optimizing ART retention and adherence amongst PWLHIV, and they can be delivered with high fidelity. Further exploration of the utility of low cost, scalable, video-based interventions to address health counseling gaps in sub-Saharan Africa is warranted.
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Mbali, Hawah, Jessie Jane Khaki Sithole, and Alinane Linda Nyondo-Mipando. "Prevalence and correlates of herbal medicine use among Anti-Retroviral Therapy (ART) clients at Queen Elizabeth Central Hospital (QECH), Blantyre Malawi: a cross-sectional study." Malawi Medical Journal 33, no. 3 (September 27, 2021): 153–58. http://dx.doi.org/10.4314/mmj.v33i3.2.
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Background There has been an unprecedented explosion in the popularity of herbal preparations during the last few decades. Herbal medicines are commonly used by HIV/AIDs clients. There is limited data on the prevalence of herbal medicine and correlating factors of herbal medicine use in Malawi. This study establishes prevalence and factors contributing to the use of herbal medicine among HIV/AIDS clients attending the ART clinic at QECH, Blantyre Malawi.Methods A cross-sectional study design was used to interview 211 conveniently sampled clients at QECH ART clinic. The questionnaire addressed socio-demographic, clinical characteristics, NCD-HIV comorbidity, and herbal medicine utilization. The main outcome of the study was herbal medicine use since the initiation of ART. Logistic regression analysis was done in Stata version 16. Both unadjusted and adjusted models were fitted for potential confounders. ResultsThe prevalence of use of herbal medicine was reported in 17.5% (n=37) of the ART clients. The adjusted logistic regression analysis showed that urban residence was statistically associated with reduced use of herbal medicine (adjusted Odds Ratio –AOR: 0.04, 95% CI: 0.169, 0.976).ConclusionThere is a high prevalence of use of herbal medicine among clients taking ART. Herbal Medicine has the potential to cover the gaps in health coverage in rural communities.
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Tymejczyk, Olga, Ellen Brazier, Kara Wools-Kaloustian, Mary-Ann Davies, Madeline Dilorenzo, Andrew Edmonds, Rachel Vreeman, et al. "Impact of Universal Antiretroviral Treatment Eligibility on Rapid Treatment Initiation Among Young Adolescents with Human Immunodeficiency Virus in Sub-Saharan Africa." Journal of Infectious Diseases 222, no. 5 (November 4, 2019): 755–64. http://dx.doi.org/10.1093/infdis/jiz547.
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Abstract Background Young adolescents with perinatally acquired human immunodeficiency virus (HIV) are at risk for poor care outcomes. We examined whether universal antiretroviral treatment (ART) eligibility policies (Treat All) improved rapid ART initiation after care enrollment among 10–14-year-olds in 7 sub-Saharan African countries. Methods Regression discontinuity analysis and data for 6912 patients aged 10–14-years were used to estimate changes in rapid ART initiation (within 30 days of care enrollment) after adoption of Treat All policies in 2 groups of countries: Uganda and Zambia (policy adopted in 2013) and Burundi, Democratic Republic of the Congo, Kenya, Malawi, and Rwanda (policy adopted in 2016). Results There were immediate increases in rapid ART initiation among young adolescents after national adoption of Treat All. Increases were greater in countries adopting the policy in 2016 than in those adopting it in 2013: 23.4 percentage points (pp) (95% confidence interval, 13.9–32.8) versus 11.2pp (2.5–19.9). However, the rate of increase in rapid ART initiation among 10–14-year-olds rose appreciably in countries with earlier treatment expansions, from 1.5pp per year before Treat All to 7.7pp per year afterward. Conclusions Universal ART eligibility has increased rapid treatment initiation among young adolescents enrolling in HIV care. Further research should assess their retention in care and viral suppression under Treat All.