Family Health International FHI360

Durham, NC, United States

Family Health International FHI360

Durham, NC, United States
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Negedu-Momoh O.R.,Family Health International FHI360 | Jegede F.E.,Family Health International FHI360 | Yakubu A.,Murtala Mohammed Specialist Hospital | Balogun O.,Family Health International FHI360 | And 7 more authors.
PLoS ONE | Year: 2017

Background: Despite the upsurge in support and intervention of donor agencies in HIV care and treatment programing in Sub-Sahara African, antiretroviral (ART) programs are still confronted with access and coverage challenges which influence enrolment of new patients. This study investigated the validity of point of care BD FACSPresto™ CD4 analyzer for CD4+ cell count, overall agreement, correlation, sensitivity, and specificity in comparison to a reference standard flow cytometry method. We also assessed the feasibility of use among nonlaboratorians. Methods Blood samples from 300 HIV infected individuals were analyzed for CD4+ T cell and CD4%, using finger prick capillary sample from 150 PMTCT clients and 150 ART clients at Murtala Mohammed Specialist Hospital, Kano, Nigeria. Their venous samples were compared on a flow cytometry reference method using BD FACSCount CD4+ count system. The accuracy of the BD FACSPresto machine in comparison to BD FACSCount was evaluated. Statistical analysis was carried out using STATA (version 12). Bland-Altman method and correlation analysis were used to analyze agreement between both measurements. In addition, sensitivity and specificity of both measurements were determined. Statistical significance was set at p-value <0.05. Results The mean bias and limit of agreement for CD4+ count between BD FACSPresto and BD FACS count machine were 7.49 (95% CI: 2.44 to 12.54) and -8.14 to 96.39 respectively. Further analysis revealed close agreement between BD FACSPresto and BD FACSCount with no significant difference between the two methods (p = .0.95). Using a threshold of 500 cells/μL, sensitivity and specificity of BD FACSPresto were 95.1% and 97.1% respectively, compared to BD FACSCount. There was no statistically significant difference in the misclassification between BD FACSPresto and BD FACSCount results (p = 0.23). Furthermore, sensitivity and specificity were similar when BD FACSPresto machine was operated by a nurse or laboratory scientist, there was no substantial difference in testing variability observed between laboratory and non-laboratory operators using the BD FACSPresto analyzer. Conclusions Overall, BD FACSPresto Point of Care CD4+ count finger stick capillary blood results is a reliable method in comparison to venous sample cytometry method and no significant difference variability observed between laboratory personnel and non-laboratory operators. The BD FACSPresto is simple, more robust and easy to use equipment without significant variability in reliability by non-laboratory health care workers hence will be a valuable instrument in increasing access and coverage of CD4 estimations in developing countries. The introduction of the BD FACSPresto POC analyzer has a high potential in reducing patients waiting time and improving the overall quality of ART service and clients' satisfaction especially in rural settings. © 2017 Negedu-Momoh et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Shankalala P.,University of Zambia | Jacobs C.,University of Zambia | Bosomprah S.,Center for Infectious Diseases Research in Zambia | Bosomprah S.,University of Ghana | And 4 more authors.
Journal of Diabetes and Metabolic Disorders | Year: 2017

Background: Africa has a high prevalence of both Human Immunodeficiency Virus and Non Communicable Diseases (NCDs) but in Zambia there are few data on co-morbid NCDs like Diabetes Mellitus (DM) among HIV-infected individuals. We aimed to identify risk factors for impaired fasting glucose or diabetes among HIV-infected Zambians on long-term Combined Antiretroviral Treatment (cART). Methods: This was a cross sectional study of adult HIV patients in five health facilities of Copperbelt Province in Zambia. HIV/AIDS patients aged 18 years and above, enrolled in care at those health facilities and had been on cART for more than 2 years were included. All patients known to have Diabetes mellitus were excluded from the study. Participants underwent assessment of random blood sugar levels at enrolment and returned the following morning for fasting glucose measured by glucometers. The primary outcome was proportion with impaired fasting glucose or DM. Multivariable logistic regression was used to examine if demographics, time on ART, type of ART regimen, body mass index and baseline CD4 count were predictors of impaired fasting glucose. Results: Overall (n = 270) there were 186 females (69%) and 84 males (31%). The prevalence of impaired fasting blood sugar or diabetes after 8 h of fasting was 15% (95%CI: 11.1, 20.0). Ten percent (26/270) had impaired fasting glucose and 5 % (14/270) had diabetes. Impaired fasting glucose was higher in males than females [AOR = 3.26, (95% CI: 1.15-9.25; p-value = 0.03)]; as well as among patients on second line treatment than those on first line [AOR = 3.87 (95% CI 1.16-12.9); p-value = 0.03]. In contrast those with less likelihood of impaired fasting glucose included patients with a normal BMI (18.5-24.9) than overweight or obese patients [AOR = 0.09 (95% CI 0.03-0.31; p-value < 0.001)]; and participants who had less than 4 diabetes symptoms than those with more than 4 diabetes symptoms [AOR = 0.04 (95% CI 0.02-0.12); p-value < 0.001]. Conclusion: We have found high levels of impaired fasting glucose or diabetes among ART patients compared to what is reported in the general population suggesting missed care and support opportunities associated with metabolic imbalance management. There is thus a need to re-package HIV programming to include integration of diabetes screening as part of the overall care and support strategy. © 2017 The Author(s).

Apps R.,Frederick National Laboratory for Cancer Research | Apps R.,Massachusetts General Hospital | Qi Y.,Frederick National Laboratory for Cancer Research | Qi Y.,Massachusetts General Hospital | And 44 more authors.
Science | Year: 2013

A variant upstream of human leukocyte antigen C (HLA-C) shows the most significant genome-wide effect on HIV control in European Americans and is also associated with the level of HLA-C expression. We characterized the differential cell surface expression levels of all common HLA-C allotypes and tested directly for effects of HLA-C expression on outcomes of HIV infection in 5243 individuals. Increasing HLA-C expression was associated with protection against multiple outcomes independently of individual HLA allelic effects in both African and European Americans, regardless of their distinct HLA-C frequencies and linkage relationships with HLA-B and HLA-A. Higher HLA-C expression was correlated with increased likelihood of cytotoxic T lymphocyte responses and frequency of viral escape mutation. In contrast, high HLA-C expression had a deleterious effect in Crohn's disease, suggesting a broader influence of HLA expression levels in human disease.

Biritwum N.-K.,Neglected Tropical Diseases Programme | Yikpotey P.,Family Health International FHI360 | Marfo B.K.,Neglected Tropical Diseases Programme | Odoom S.,Neglected Tropical Diseases Programme | And 11 more authors.
Transactions of the Royal Society of Tropical Medicine and Hygiene | Year: 2016

Background: Among the 216 districts in Ghana, 98 were declared endemic for lymphatic filariasis in 1999 after mapping. Pursuing the goal of elimination, WHO recommends annual treatment using mass drugs administration (MDA) for at least 5 years. MDA was started in the country in 2001 and reached national coverage in 2006. By 2014, 69 districts had 'stopped-MDA' (after passing the transmission assessment survey) while 29 others remained with persistent microfilaraemia (mf) prevalence (≥1%) despite more than 11 years of MDA and were classified as 'hotspots'. Methods: An ecological study was carried out to compare baseline mf prevalence and anti-microfilaria interventions between hotspot and stopped-MDA districts. Results: Baseline mf prevalence was significantly higher in hotspots than stopped-MDA districts (p < 0.001). After three years of MDA, there was a significant decrease in mf prevalence in hotspot districts, but it was still higher than in stopped-MDA districts. The number of MDA rounds was slightly higher in hotspot districts (p < 0.001), but there were no differences in coverage of MDA or long-lasting-insecticide-treated nets. Conclusions: The main difference in hotspots and stopped-MDA districts was a high baseline mf prevalence. This finding indicates that the recommended 5-6 rounds annual treatment may not achieve interruption of transmission. © The Author 2017.

Hughes J.P.,University of Washington | Hughes J.P.,Fred Hutchinson Cancer Research Center | Haley D.F.,Emory University | Haley D.F.,Family Health International FHI360 | And 8 more authors.
Annals of Epidemiology | Year: 2015

Purpose: Reductions in risk behaviors are common following enrollment in human immunodeficiency virus (HIV) prevention studies. We develop methods to quantify the proportion of change in risk behaviors that can be attributed to regression to the mean versus study participation and other factors. Methods: A novel model that incorporates both regression to the mean and study participation effects is developed for binary measures. The model is used to estimate the proportion of change in the prevalence of "unprotected sex in the past 6months" that can be attributed to study participation versus regression to the mean in a longitudinal cohort of women at risk for HIV infection who were recruited from ten U.S. communities with high rates of HIV and poverty. HIV risk behaviors were evaluated using audio computer-assisted self-interviews at baseline and every 6months for up to 12months. Results: The prevalence of "unprotected sex in the past 6months" declined from 96% at baseline to 77% at 12months. However, this change could be almost completely explained by regression to the mean. Conclusions: Analyses that examine changes over time in cohorts selected for high- or low- risk behaviors should account for regression to the mean effects. © 2015 Elsevier Inc.

PubMed | Family Health International FHI360, Ministry of Health and German Leprosy and TB Relief Association
Type: Journal Article | Journal: International journal of mycobacteriology | Year: 2016

Tuberculosis (TB) remains one of the deadliest infectious diseases worldwide, with a disproportionate number of those affected living in slum areas. We assessed the magnitude of pulmonary cases among tuberculosis patients in an urban slum in southeast Nigeria, their demographic and clinical characteristics and any associations with treatment outcomes.A retrospective cohort study of patients registered under the National TB Programme (NTP) from 1 January to 31 December 2012 was carried out. Data were extracted from TB treatment cards and registers.Of 647 new TB patients registered, 555 (85.8%) were pulmonary TB (PTB) with a mean age of 34.5years, and a male/female ratio of 1.3. Among these, 468 (84.3%) were smear-positive, while 87 (15.7%) were smear-negative cases. Twenty-one (3.8%) were children younger than 15years old. TB/HIV co-infection rate was 16.9%; 57.4% received antiretroviral therapy (ART) and 88.3% received cotrimoxazole preventive therapy (CPT). Female patients were significantly younger compared to male patients (p=0.003), had higher proportions of smear-negative TB (p=0.001) and HIV-positive status (p0.001). Treatment success rate was 88.5% among smear-positive patients and 79.3% among smear-negative patients. More patients with smear-negative TB were lost to follow up compared with smear-positive TB patients (p<0.02). HIV co-infection was associated with unfavourable treatment outcomes (OR 0.2, CI 0.1-0.4, p0.001). Among them, those who received ART had better outcomes.The study revealed high proportion of PTB, mostly smear-positive TB with HIV-associated outcomes and underlines the need to ensure early TB diagnosis and improved access to HIV care for HIV co-infected patients in this setting.

Mbah H.,Family Health International FHI360 | Ojo E.,Family Health International FHI360 | Ameh J.,Family Health International FHI360 | Musuluma H.,Family Health International FHI360 | And 9 more authors.
PLoS ONE | Year: 2014

Background: Achieving accreditation in laboratories is a challenge in Nigeria like in most African countries. Nigeria adopted the World Health Organization Regional Office for Africa Stepwise Laboratory (Quality) Improvement Process Towards Accreditation (WHO/AFRO-SLIPTA) in 2010. We report on FHI360 effort and progress in piloting WHO-AFRO recognition and accreditation preparedness in six health facility laboratories in five different states of Nigeria. Method: Laboratory assessments were conducted at baseline, follow up and exit using the WHO/AFRO-SLIPTA checklist. From the total percentage score obtained, the quality status of laboratories were classified using a zero to five star rating, based on the WHO/AFRO quality improvement stepwise approach. Major interventions include advocacy, capacity building, mentorship and quality improvement projects. Results: At baseline audit, two of the laboratories attained 1- star while the remaining four were at 0- star. At follow up audit one lab was at 1- star, two at 3-star and three at 4-star. At exit audit, four labs were at 4- star, one at 3-star and one at 2-star rating. One laboratory dropped a 'star' at exit audit, while others consistently improved. The two weakest elements at baseline; internal audit (4%) and occurrence/incidence management (15%) improved significantly, with an exit score of 76% and 81% respectively. The elements facility and safety was the major strength across board throughout the audit exercise. Conclusion: This effort resulted in measurable and positive impact on the laboratories. We recommend further improvement towards a formal international accreditation status and scale up of WHO/AFRO-SLIPTA implementation in Nigeria. © 2014 Mbah et al.

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