Suchergebnisse

Background: Ethiopian government launched free ART initiative in 2005, since then, there is an unprecedented effort to scale-up ART and access to HIV care. Following massive rollout of ART, large numbers of people are receiving first-line ART and as the cohort mature, the number of people living with HIV who will fail and switching will steadily increase. Identifying treatment failure in patients taking ART in order to propose early therapeutic switches to another available ART regimen is essential. In Ethiopia, there is no study on treatment outcome for the second line anti-retroviral therapy. Objective: The aim of this study is to assess the clinical, immunological and virological treatment outcomes of patients on second line antiretroviral therapy among adult HIV/AIDS patients in selected public health facilities in Addis Ababa, Ethiopia. Materials and Methods: A longitudinal study was conducted between July 2014 and June 2015.A total of 236 adult HIV patients who were on second line ART for more than six month were included. Clinical specimen were collected from each client during routine clinic visits. Viral load and CD4 cell count tests were done and basic clinical information were extracted from the medical record. Data analysis was performed using SPSS version 20 software. P values <0.05 was considered as statistically significant. Result: Among the total of 236 HIV infected individuals received second line ART, 111(47%)were male and 125(53 %)were female. The mean age was 40+ 10SD (18-78)years and the average time on second line treatment was 2.4+ 1.17SD(0.5-7.5) years. The average CD4 count at switch to second line ART was 133 cells/mm3(4-519)[95%CI:121.4-145] and there was significant increase in mean CD4 count to 338 cells/mm3 after switch to second line ART. About 204 (86.4% )the of the patients had undetectable viral load. Conclusion: In this study, we observed a significant improvement in clinical and immunological condition as well as good virological suppression in patients after starting second line therapy. Even though higher viral load suppression observed, 32(13.5% )of the study participants also have virological failure.

Abay Sisay,1,2 Abraham Tesfaye,2,3 Adino Desale,4 Israel Ataro,5 Zerihun Woldesenbet,6 Bisrat Nigusse,7 Adamu Tayachew,4,8 Adisu Kebede,4 Adey F Desta1 1Department of Microbial Cellular and Molecular Biology, College of Natural and Computational Sciences, Addis Ababa University, Addis Ababa, Ethiopia; 2Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; 3Diagnostic Unit, Center for Innovative Drug Development and Therapeutic Trials for Africa, CDT-Africa, Addis Ababa, Ethiopia; 4National Laboratories Capacity Building Directorate, Ethiopian Public Health Institutes, EPHI, Addis Ababa, Ethiopia; 5Health Extension Program and Primary Health Care Directorate, Federal Democratic Republic of Ethiopia, Ministry of Health, Addis Ababa, Ethiopia; 6Department of Medical Laboratory, Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia; 7Program Management Unit, Ethiopian Public Health Laboratory Association, Addis Ababa, Ethiopia; 8National Influenza and Arbovirus Reference Laboratory, Ethiopian Public Health Institutes, EPHI, Addis Ababa, EthiopiaCorrespondence: Abay Sisay Email abusis27@gmail.comPurpose: Rapid severe acute respiratory syndrome coronavirus 2 test kits are crucial for bridging diagnostic gaps in health facilities and community screening mainly in resource limited settings. However, there is no objective evidence on their diagnostic performance. Thus, the study aimed to evaluate comparative diagnostic performance of three selected SARS-CoV-2 IgG/IgM rapid test kits in Ethiopia.Methods: A cross-sectional study was conducted among 200 clients between May and July 2020 in Addis Ababa, Ethiopia. The performance of three SARS-CoV-2 rapid test kits EGENE, CTK BIOTECKs Onsite, and ACON Biotech were evaluated using blood specimens against RT-PCR on respiratory swabs. Sensitivity, specificity, and agreement with each other and to RT-PCR were computed using Vassarstats, MedCalc and SPSS version 23 statistical software.Results: Test kits showed a heterogeneous comparative diagnostic performance in their sensitivity and specificity. The sensitivity was 61.18% (95% CI: 49.96– 71.37%), 74.12% (95% CI: 63.28– 82.74%) and 83.53% (95% CI: 73.57– 90.38%) for kit A, B and C, respectively. Similarly, the specificity was 96.52% (90.81– 98.88%), 94.78% (88.52– 97.86%) and 94.78% (88.52– 97.86%) for test kit A, B and C, respectively. The test kits have an agreement with RT-PCR with kappa value of 0.60 (0.48– 0.83), 0.71 (0.65– 0.93), and 0.80 (0.76– 1.04) for A, B, and C, respectively. There was a significant difference on diagnostic performance among the three test kits and PCR with a p-value < 0.001 Cochran's Q test.Conclusion: The diagnostic performance of the test kits was promising and recommended for COVID-19 diagnostics in combination with RT-PCR to detect more infected patients. It allows determining the seroprevalence of the virus and true extent of SARS-COV-2 community spread in resource limited settings. We underline countries to evaluate rapid diagnostic test kits before diagnostic use.Keywords: COVID-19, diagnostic performance, Ethiopia, rapid test, sensitivity, specificity

AbstractIntroductionPoint‐of‐care (POC) early infant diagnosis (EID) testing has been shown to dramatically decrease turnaround times from sample collection to caregiver result receipt and time to ART initiation for HIV‐positive infants compared to centralized laboratory testing. As governments in sub‐Saharan Africa implement POC EID technologies, we report on the feasibility and effectiveness of POC EID testing and the impact of same‐day result delivery on rapid ART initiation within national programmes across six countries.MethodsThis pre‐/post‐evaluation compared centralized laboratory‐based (pre) with POC (post) EID testing in 52 facilities across Cameroon, Democratic Republic of Congo, Ethiopia, Kenya, Senegal and Zimbabwe between April 2017 and October 2019 (country‐dependent). Data were collected retrospectively from routine records at health facilities for all infants tested under two years of age. Hazard ratios and 95% confidence intervals were calculated to compare time‐to‐event outcomes, visualized with Kaplan–Meier curves, and the Somers' D test was used to compare continuous outcomes.ResultsData were collected for 2892 EID tests conducted on centralized laboratory‐based platforms and 4610 EID tests on POC devices with 127 (4%) and 192 (4%) HIV‐positive infants identified, respectively. POC EID significantly reduced the time from sample collection to caregiver result receipt (POC median: 0 days, IQR: 0 to 0 vs. centralized: 35 days, IQR: 26 to 56) and time from sample collection to ART initiation for HIV‐positive infants (POC median: 1 day, IQR: 0 to 7 vs. centralized: 39 days, IQR: 26 to 57). With POC testing, 72% of infants received results on the same day as sample collection; HIV‐positive infants with a same‐day diagnosis had six times the rate of ART initiation compared to those diagnosed one or more days after sample collection (HR: 6.39; 95% CI: 3.44 to 11.85).ConclusionsSame‐day diagnosis and treatment initiation for infants is possible with POC EID within routine government‐led and ‐supported public sector healthcare facilities in resource‐limited settings. Given that POC EID allows for rapid ART initiation, aligning to the World Health Organization's recommendation of ART initiation within seven days, its use in public sector programmes has the potential to reduce overall mortality for infants with HIV through early treatment initiation.

INTRODUCTION: Point‐of‐care (POC) early infant diagnosis (EID) testing has been shown to dramatically decrease turnaround times from sample collection to caregiver result receipt and time to ART initiation for HIV‐positive infants compared to centralized laboratory testing. As governments in sub‐Saharan Africa implement POC EID technologies, we report on the feasibility and effectiveness of POC EID testing and the impact of same‐day result delivery on rapid ART initiation within national programmes across six countries. METHODS: This pre‐/post‐evaluation compared centralized laboratory‐based (pre) with POC (post) EID testing in 52 facilities across Cameroon, Democratic Republic of Congo, Ethiopia, Kenya, Senegal and Zimbabwe between April 2017 and October 2019 (country‐dependent). Data were collected retrospectively from routine records at health facilities for all infants tested under two years of age. Hazard ratios and 95% confidence intervals were calculated to compare time‐to‐event outcomes, visualized with Kaplan–Meier curves, and the Somers' D test was used to compare continuous outcomes. RESULTS: Data were collected for 2892 EID tests conducted on centralized laboratory‐based platforms and 4610 EID tests on POC devices with 127 (4%) and 192 (4%) HIV‐positive infants identified, respectively. POC EID significantly reduced the time from sample collection to caregiver result receipt (POC median: 0 days, IQR: 0 to 0 vs. centralized: 35 days, IQR: 26 to 56) and time from sample collection to ART initiation for HIV‐positive infants (POC median: 1 day, IQR: 0 to 7 vs. centralized: 39 days, IQR: 26 to 57). With POC testing, 72% of infants received results on the same day as sample collection; HIV‐positive infants with a same‐day diagnosis had six times the rate of ART initiation compared to those diagnosed one or more days after sample collection (HR: 6.39; 95% CI: 3.44 to 11.85). CONCLUSIONS: Same‐day diagnosis and treatment initiation for infants is possible with POC EID within routine government‐led and ...