Faculty of Health Sciences (ETDs)
Permanent URI for this communityhttps://hdl.handle.net/10539/37925
Browse
Search Results
Item Trend of Pre-antiretroviral Therapy HIV-1 Drug Resistance in Kilombero and Ulanga Antiretroviral Cohort, South-Western Tanzania, for over 15 years (2005-2020)(University of the Witwatersrand, Johannesburg, 2024) Ntamatungiro, Alex; Kagura, JulianaIntroduction Pre-treatment HIV drug-resistance (PDR) may result in increased risk of virological failure and subsequently acquisition of new HIV drug resistant mutations. With recent increase in antiretroviral therapy (ART) coverage and periodic modifications of the guidelines for HIV treatment, monitoring changes in levels of PDR is critical, particularly in under-sampled areas, such as rural Tanzania. This PhD project aimed to determine the trend and patterns of PDR in the Kilombero and Ulanga antiretroviral cohort (KIULARCO), analyse the impact of recent HIV-1 infection, and dolutegravir rollout in rural Tanzania. Methods The study comprised a systematic review and meta-analysis of primary studies about prevalence of PDR among ART-naive people living with HIV (PLHIV) (³15 years old), published between 2017 and 2022. The data had to be in one or several of the countries of Eastern Africa, namely, Ethiopia, Kenya, Malawi, Rwanda, Mozambique, Tanzania, and Uganda. Thereafter, cross- sectional analyses of data on newly HIV-1-diagnosed ART-naïve adults (aged ≥ 15 years), enrolled in the on-going prospective clinic-based observational rural antiretroviral cohort- KIULARCO focusing on various aspects of PDR. Multivariate logistic regressions were used to determine the factors associated with recent HIV-1 infection, and viral suppression at 12-months in patients initiating dolutegravir-based ART in the KIULARCO. Results Overall, the pooled prevalence estimate of any PDR was 10.0% (95% CI: 7.9%–12.0%, I2 =88.9%) among 22 studies in the general adults’ population, which was higher than the previously reported prevalence of 8.7% using data available until 2016 in the Eastern Africa region. PDR was mainly driven by non-nucleoside reverse transcriptase inhibitors (NNRTI); whereas the pooled prevalence of PDR to nucleoside reverse transcriptase inhibitors (NRTI) was 2.6% (95% CI: 1.8%–3.4%, I2=69.2%). Remarkably, PDR to NRTIs in a sub-population of recently HIV-1 infected PLHIV in the KIULARCO was high at 12.5%. Also, there was a notable tendency to an increasing prevalence of PDR to NRTI, with the overall prevalence of 2.1% in the first five-year period (2005-2009) of the ART program in Tanzania, and 3.4 % in the most recent period (2019-2022). Moreover, there was no PDR to the dolutegravir co-administered NRTI in those with viremia ≥50 copies/mL, at one year, in patients initiating dolutegravir-based ART in the KIULARCO 2 years after dolutegravir roll. Notably, dolutegravir-based ART was associated with >2 times the odds of viral suppression compared to NNRTI-based ART with an adjusted odds ratio (aOR) of 2.10 (95% CI 1.12-3.94). Conclusions There is notable level of PDR to NRTI among general adults’ population in Eastern Africa region, that was high among recently HIV-1 infected PLHIV in a representative rural Sub-Saharan Africa setting. Hence, routine surveillance of pre-existing resistance to the DTG co-administered NRTI remains particularly important, in resource-limited settings, to prevent risk of failure of newer antiretroviral agents such as dolutegravir, which would be detrimental to Tanzania and other low- and middle-income countries for the aim to “end AIDS by 2030”. Our results underline the benefit of programmatic uptake of dolutegravir -based ART in low- and middle-income countries.Item The practice of patient blood management among South African anaesthetic providers(University of the Witwatersrand, Johannesburg, 2024) Eddey, CreaghanPatient Blood Management (PBM) is a multidisciplinary and evidence-based approach aimed at optimising patient outcomes by effectively managing and preserving a patient's own blood, minimising unnecessary transfusions, and promoting overall blood conservation strategies. Thus far, perioperative PBM practices of South African anaesthetic providers have not been described. Methods This study prospectively evaluated perioperative PBM practices in South Africa utilising an online survey. In addition, we described the extent to which practices align to the national guidelines, the 2020 South African Society of Anaesthesiologists (SASA) guidelines, and 2014 South African National Blood Service (SANBS) guidelines. Results The information letter was opened 573 times. We received 403 surveys that were more than 50% complete and were included in this study. Most respondents were specialists (54.6%) or specialist trainees (25.1%) within their first five years of practice (54.6%). Most providers (89.3%) often or always record a preoperative haemoglobin. Only 1% of providers would defer elective surgery, other than caesarean section, if the haemoglobin (Hb) was <13 g/dL. Appropriate treatment of preoperative anaemia was rarely or never seen by 65.5% of respondents. Access to point of care (POC) coagulation testing was good with only 25.6% having no access to any POC test. Freeze-dried plasma (FDP) is commonly (89.3%) accepted as a substitute for fresh frozen plasma (FFP). A majority (63.9%) of respondents use a transfusion threshold of 57 g/dL for red cell concentrates (RCC) in non-cardiac patients. Few respondents often or always use cell salvage in non-obstetric surgery where >500 ml of blood loss is anticipated (21.2%), or in obstetric major haemorrhage (21.2%). In major haemorrhage, most respondents often or always monitor for, treat, and prevent hypothermia (97.5%), acidosis (96.0%), hypocalcaemia (90.0%), and hyperkalaemia (91.6%). Tranexamic acid is often or always used commonly in severe trauma (70.7%) and major obstetric haemorrhage (72.1%). Conclusions Overall, PBM practices were poor, and not in keeping with South African guidelines. The management of preoperative anaemia stands out as the most notable deficiency. Key points: Research question: What are the perioperative patient blood management (PBM) practices among South African anaesthetic providers? How do these practices align with the SASA and SANBS guidelines? Findings: Overall, PBM practices were poor, and not in keeping with South African guidelines. Meaning: Important context is provided for PBM in low- and middle-income countries