Introduction Monitoring HIV viral load (HVL) in people living with HIV (PLHIV) on antiretroviral therapy (ART) is recommended by the World Health Organization. Implementation of HVL testing programs have been affected by logistic and organizational challenges. Here we describe the HVL monitoring cascade in a rural setting in Tanzania and compare turnaround times (TAT) between an on-site and a referral laboratory. Methods In a nested study of the prospective Kilombero and Ulanga Antiretroviral Cohort (KIULARCO) we included PLHIV aged ≥ 15 years, on ART for ≥ 6 months after implementation of routine HVL monitoring in 2017. We assessed proportions of PLHIV with a blood sample taken for HVL, whose results came back, and who were virally suppressed (HVL < 1000 copies/mL) or unsuppressed (HVL ≥ 1000 copies/mL). We described the proportion of PLHIV with unsuppressed HVL and adequate measures taken as per national guidelines and outcomes among those with low-level viremia (LLV; 100–999 copies/mL). We compare TAT between on-site and referral laboratories by Wilcoxon rank sum tests. Results From 2017 to 2020, among 4,454 PLHIV, 4,238 (95%) had a blood sample taken and 4,177 (99%) of those had a result. Of those, 3,683 (88%) were virally suppressed. In the 494 (12%) unsuppressed PLHIV, 425 (86%) had a follow-up HVL (102 (24%) within 4 months and 158 (37%) had virologic failure. Of these, 103 (65%) were already on second-line ART and 32/55 (58%) switched from first- to second-line ART after a median of 7.7 months (IQR 4.7–12.7). In the 371 (9%) PLHIV with LLV, 327 (88%) had a follow-up HVL. Of these, 267 (82%) resuppressed to < 100 copies/ml, 41 (13%) had persistent LLV and 19 (6%) had unsuppressed HVL. The median TAT for return of HVL results was 21 days (IQR 13–39) at the on-site versus 59 days (IQR 27–99) at the referral laboratory (p < 0.001) with PLHIV receiving the HVL results after a median of 91 days (IQR 36–94; similar for both laboratories). Conclusion Robust HVL monitoring is achievable in remote resource-limited settings. More focus is needed on care models for PLHIV with high viral loads to timely address results from routine HVL monitoring.
Background: Globally there is a high burden of low serum vitamin D deficiency (VDD) with children being acknowledged at risk due to low vitamin D content in both breastmilk and available foods and inadequate cutaneous synthesis of vitamin D. Even in countries with abundant sunshine, vitamin D deficiency (VDD) remains a problem. There is little characterization of the status of vitamin D among infants in East Africa. This study aimed to determine the prevalence and factors associated with vitamin D deficiency among infants attending the Reproductive and Child Health (RCH) Clinic in Arusha, Tanzania. Methods: A cross-sectional study of 304 infants aged 6 weeks to 12 months was conducted at Arusha Lutheran Medical Centre (ALMC). Infants were enrolled during the warm season between November 2018 and January 2019. A pre-coded questionnaire was used to collect data on sociodemographic characteristics of the infant with consent from their caretakers. Physical examination was done for anthropometric measures and signs of rickets. Blood was drawn for assessment of serum 25-hydroxyvitamin D 25(OH)D, calcium, phosphorus and alkaline phosphate. Vitamin D deficiency was defined as 25(OH)D level below 20 ng/ml (<50 nmol/L) and Vitamin D insufficiency defined as a 25(OH)D level 20 -30 ng/ml (50 -75 nmol/L). Statistical analysis was performed using STATA 14 version and factors associated with VDD explored with multivariate analysis. Results: The mean serum 25(OH)D among infants was 34.51 ng/ml (±15.53). Vitamin D deficiency was found in 67/304 (22%) infants and Vitamin D insufficiency in 50 (16.5%
Background: Globally there is a high burden of low serum vitamin D levels, with children being more at risk, due to low intake in breastmilk, few available foods and inadequate cutaneous synthesis of vitamin D. Even in countries with abundant sunshine, Vitamin D deficiency (VDD) remains a problem. The classical clinical effect of severe vitamin D deficiency is rickets. VDD is common in developing countries and may affect developmental outcomes of children. This study aimed to determine the prevalence and factors associated with vitamin D deficiency among infants attending the Reproductive and Child Health Clinic (RCH), in Arusha, Tanzania.Methods: This was a cross-sectional study of infants aged 6 weeks to 12 months attending RCH clinic at Arusha Lutheran Medical Centre (ALMC). We enrolled 304 infants from November 2018 to January 2019 after consent. A pre-coded questionnaire was used to collect data on sociodemographic characteristics of the infants. Physical examination was done for anthropometric measures and signs of rickets. Serum was drawn for assessment of 25-hydroxyvitamin D (25(OH) D),calcium, phosphorus, alkaline phosphate was assessed. Vitamin D deficiency was defined as 25(OH)D less than 20ng/ml. Multivariate analysis was done to determine factors associated with VDD. Statistical analysis was performed using STATA 14 version. P- value < 0.05 was significant. Results: A total of 67/ 304 infants had vitamin D deficiency. Another 50(16.5%) were found to have insufficiency level of vitamin D. Only 187(61.5%) had adequate vitamin D. Signs of rickets were observed in 11(3.6%) and hypocalcemia in 33(10.9%) infants. Factors independently associated with VDD include age < 6 months Adjusted Odds Ratio (AOR) 1.56 (95% CI 1.19-4.0) p value < 0.026, presence of signs of rickets and hypocalcemia p value <0.001 and <0.002 respectively. Conclusion and Recommendation: A high prevalence of VDD (22%) was observed among infants attending RCH clinic in Arusha Tanzania. Age <6 months and the presence of the clinical sign of rickets were associated with VDD. Clinicians should actively assess for VDD and vitamin D supplementation with special emphasis infants <6 months should be implemented.
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