BackgroundVisceral leishmaniasis (VL) in human immunodeficiency virus (HIV) co-infected patients requires special case management. AmBisome monotherapy at 40 mg/kg is recommended by the World Health Organization. The objective of the study was to assess if a combination of a lower dose of AmBisome with miltefosine would show acceptable efficacy at the end of treatment.Methodology/Principal findingsAn open-label, non-comparative randomized trial of AmBisome (30 mg/kg) with miltefosine (100 mg/day for 28 days), and AmBisome monotherapy (40 mg/kg) was conducted in Ethiopian VL patients co-infected with HIV (NCT02011958). A sequential design was used with a triangular continuation region. The primary outcome was parasite clearance at day 29, after the first round of treatment. Patients with clinical improvement but without parasite clearance at day 29 received a second round of the allocated treatment. Efficacy was evaluated again at day 58, after completion of treatment.Recruitment was stopped after inclusion of 19 and 39 patients in monotherapy and combination arms respectively, as per pre-specified stopping rules. At D29, intention-to-treat efficacy in the AmBisome arm was 70% (95% CI 45–87%) in the unadjusted analysis, and 50% (95% CI 27–73%) in the adjusted analysis, while in the combination arm, it was 81% (95% CI 67–90%) and 67% (95% CI 48–82%) respectively. At D58, the adjusted efficacy was 55% (95% CI 32–78%) in the monotherapy arm, and 88% (95% CI 79–98%) in the combination arm.No major safety concerns related to the study medication were identified. Ten SAEs were observed within the treatment period, and 4 deaths unrelated to the study medication.Conclusions/SignificanceThe extended treatment strategy with the combination regimen showed the highest documented efficacy in HIV-VL patients; these results support a recommendation of this regimen as first-line treatment strategy for HIV-VL patients in eastern Africa.Trial registration numberwww.clinicaltrials.gov
NCT02011958.
Purpose
Trachoma is endemic in Southern Nations, Nationalities and Peoples’ (SNNP) and Sidama regions of Ethiopia. We aimed to measure the prevalence of trachomatous inflammation – follicular (TF) among children aged 1 − 9 years and the prevalence of trachomatous trichiasis (TT) unknown to the health system among people aged ≥15 years following interventions for trachoma in 52 woredas of SNNP and Sidama regions.
Methods
From 2017 − 2019, 66 two-stage cluster sampling cross-sectional population-based surveys were carried out in 52 woredas (third-level administrative divisions) using a standardized World Health Organization-recommended survey methodology. This included one impact survey in 40 woredas, two consecutive impact surveys in 10 woredas and three consecutive impact surveys in two woredas. Water, sanitation and Hygiene (WASH) access was assessed using a modified version of the United Nations Children’s Fund/WHO Joint Monitoring Programme questionnaire.
Results
By the end of this survey series, 15 (23%) of the woredas had met the active trachoma elimination threshold (TF prevalence <5%) and 12 (18%) had met the TT threshold (TT ≤ 0.2%). Regarding WASH coverage, 20% of households had access to an improved drinking water source within a 30-min journey and 3% had an improved latrine. There was strong evidence that TF was less common in 4 − 6-year-olds and 7 − 9-year-olds than 1 − 3-year-olds.
Conclusion
Based on the findings, further antibiotic mass drug administration is required in 37 woredas and active TT case finding is needed in 40 woredas. In these surveys, access to WASH facilities was very low; WASH improvements are required.
Background
Trachoma is a serious health problem in the world's poorest countries, such as Ethiopia. The WHO aims to eliminate trachoma by 2030 through implementation of annual mass drug administration and other strategies. With almost eight years left, is Ethiopia on track to reach the goal? This research article attempts to model the time to stop MDA in one of the nations with the highest prevalence oftrachoma in the world.
Objectives
Evaluation of predictive analytic models (Cox proportional-hazards model and the random survival forest) to model the time to stop trachoma mass drug administration in persistence districts of Ethiopia and identify factors that accelerate or decelerate time to stop trachoma mass drug administration
Materials and Methods
We propose survival and machine learning models to predict the time needed to stop trachoma MDA in Ethiopia using secondary data from the Tropical Data Platform and the Trachoma Elimination Monitor Form. The impact of average mass drug administration coverage, improved latrine coverage, access to improved water, delay in MDA intervention, TF prevalence in thefirst Trachoma Impact Survey (TIS1),and MDA omission were also assessed.
Results
The result shows that the probability of districts reaching the 5% threshold varies by region, and there are also discrepancies between districts that have delayed MDA and those that have not. We also note the significant effects of MDA coverage, latrine coverage, access to water supply, initial TIS score, and MDAomission on current TF score. Ourmodel also predicts that under the existing scenarios, there are districts that will not meet the 2030 goal of eliminating trachoma.
Conclusions
In order to stop trachoma MDA or eliminate the infection efficiently and effectively, it is crucial to identify the appropriate efficacy of drug, quality of MDA coverage, frequency, timing and number of rounds of MDA. Additionally, increase environmental and hygienic conditions may accelerate progress towards 2030 goals.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.