Progressive phasing out of baseline CD4+ cell count testing for people living with HIV in Kinshasa, Democratic Republic of the Congo

Ngongo, Nadine Mayasi; Nani-Tuma, Hippolyte Situakibanza; Mambimbi, Marcel Mbula; Mashi, Murielle Longokolo; Izizag, Ben Bepouka; Maes, Nathalie; Moutschen, Michel; Darcis, Gilles

doi:10.1097/qad.0000000000002802

Cited by 5 publications

(9 citation statements)

References 7 publications

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“…The difference between definitions is slight because the numbers were mainly influenced by WHO stages. Indeed, CD4 cell counts at baseline were rarely performed in the DRC and have been totally abandoned in recent years [ 21 ].…”

Section: Resultsmentioning

confidence: 99%

“…It should be noted that the probability of being a late presenter increased when a CD4 cell count at baseline was performed. This could be an important confounding factor in our analysis, as CD4 cell count measurement at baseline has been abandoned in recent years [ 21 ]. However, the percentage of LP based on a pure clinical definition also significantly decreased over time (Fig.…”

Section: Resultsmentioning

confidence: 99%

“…The level of late presentation was high, approximately 45%, and comparable to percentages in other countries [ 14 , 19 , 23 ]. It should be noted that this number is likely underestimated, as CD4 cell count at baseline was rarely performed in the DRC, particularly during recent years [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

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Decrease in late presentation for HIV care in Kinshasa, DRC, 2006–2020

et al. 2021

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Introduction Late presentation for HIV care is a well-described issue for the success of ART outcomes and the cause of higher morbidity, mortality and further transmission. Monitoring the level of late presentation and understanding the factors associated with it would help to tailor screening and information strategies for better efficiency. We performed a retrospective cohort study in Kinshasa, the capital of the DRC. The studied population included HIV-positive adults newly enrolled in HIV care between January 2006 and June 2020 at 25 HIV urban care facilities. Patient information collected at presentation for HIV care included age, sex, WHO clinical stage and screening context. We used 2 definitions of late presentation: the WHO definition of advanced HIV disease (WHO stage 3/4 or CD4 cell count < 200 cells/mm3) and a more inclusive definition (WHO stage 3/4 or CD4 cell count < 350 cells/mm3). Results A total of 10,137 HIV-infected individuals were included in the analysis. The median age was 40 years; 68% were female. A total of 45.9% or 47.5% of the patients were late presenters, depending on the definition used. The percentage of patients with late presentation (defined as WHO stage 3/4 or CD4 cell count < 350 cells/mm3) decreased during recent years, from 70.7% in 2013 to 46.5% in 2017 and 23.4% in 2020. Age was associated with a significantly higher risk of LP (p < 0.0001). We did not observe any impact of sex. Conclusions The frequency of late presentation for care is decreasing in Kinshasa, DRC. Efforts have to be continued. In particular, the issue of late diagnosis in older individuals should be addressed.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Decrease in late presentation for HIV care in Kinshasa, DRC, 2006–2020

et al. 2021

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“…Additionally, due to the retrospective nature of the study and routine data collection, some variables were missing. In particular, the initial CD4 cell count may have underestimated the proportion of individuals with advanced-stage HIV infection [54]. Finally, our study was performed in the city of Kinshasa.…”

Section: Plos Global Public Healthmentioning

confidence: 95%

Retention in care and predictors of attrition among HIV-infected patients who started antiretroviral therapy in Kinshasa, DRC, before and after the implementation of the ‘treat-all’ strategy

Mayasi

Situakibanza

Mbula

et al. 2022

PLOS Glob Public Health

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The retention of patients in care is a key pillar of the continuum of HIV care. It has been suggested that the implementation of a “treat-all” strategy may favor attrition (death or lost to follow-up, as opposed to retention), specifically in the subgroup of asymptomatic people living with HIV (PLWH) with high CD4 counts. Attrition in HIV care could mitigate the success of universal antiretroviral therapy (ART) in resource-limited settings. We performed a retrospective study of PLWH at least 15 years old initiating ART in 85 HIV care centers in Kinshasa, Democratic Republic of Congo (DRC), between 2010 and 2019, with the objective of measuring attrition and to define factors associated with it. Sociodemographic and clinical characteristics recorded at ART initiation included sex, age, weight, height, WHO HIV stage, pregnancy, baseline CD4 cell count, start date of ART, and baseline and last ART regimen. Attrition was defined as death or loss to follow-up (LTFU). LTFU was defined as “not presenting to an HIV care center for at least 180 days after the date of a last missed visit, without a notification of death or transfer”. Kaplan–Meier curves were used to present attrition data, and mixed effects Cox regression models determined factors associated with attrition. The results compared were before and after the implementation of the “treat-all” strategy. A total of 15,762 PLWH were included in the study. Overall, retention in HIV care was 83% at twelve months and 77% after two years of follow-up. The risk of attrition increased with advanced HIV disease and the size of the HIV care center. Time to ART initiation greater than seven days after diagnosis and Cotrimoxazole prophylaxis was associated with a reduced risk of attrition. The implementation of the “treat-all” strategy modified the clinical characteristics of PLWH toward higher CD4 cell counts and a greater proportion of patients at WHO stages I and II at treatment initiation. Initiation of ART after the implementation of the ‘treat all” strategy was associated with higher attrition (p<0.0001) and higher LTFU (p<0.0001). Attrition has remained high in recent years. The implementation of the “treat-all” strategy was associated with higher attrition and LTFU in our study. Interventions to improve early and ongoing commitment to care are needed, with specific attention to high-risk groups to improve ART coverage and limit HIV transmission.

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“…Our results must be interpreted with the integration of certain limits. First, several data were missing in the analyses, in particular, to some extent, the CD4 count both at diagnosis and at the initiation of treatment [67]. Missing data on several variables studied among the determinants significantly reduced the sample size in logistic regression.…”

Section: Plos Onementioning

confidence: 99%

Longitudinal analysis of sociodemographic, clinical and therapeutic factors of HIV-infected individuals in Kinshasa at antiretroviral therapy initiation during 2006-2017

Ngongo

Darcis²,

Nanituna

et al. 2021

PLoS ONE

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Background The benefits of antiretroviral therapy (ART) underpin the recommendations for the early detection of HIV infection and ART initiation. Late initiation (LI) of antiretroviral therapy compromises the benefits of ART both individually and in the community. Indeed, it promotes the transmission of infection and higher HIV-related morbidity and mortality with complicated and costly clinical management. This study aims to analyze the evolutionary trends in the median CD4 count, the median time to initiation of ART, the proportion of patients with advanced HIV disease at the initiation of ART between 2006 and 2017 and their factors. Methods and findings HIV-positive adults (≥ 16 years old) who initiated ART between January 1, 2006 and December 31, 2017 in 25 HIV care facilities in Kinshasa, the capital of DRC, were eligible. The data were processed anonymously. LI is defined as CD4≤350 cells/μl and/or WHO clinical stage III or IV and advanced HIV disease (AHD), as CD4≤200 cells/μl and/or stage WHO clinic IV. Factors associated with advanced HIV disease at ART initiation were analyzed, irrespective of year of enrollment in HIV care, using logistic regression models. A total of 7278 patients (55% admitted after 2013) with an average age of 40.9 years were included. The majority were composed of women (71%), highly educated women (68%) and married or widowed women (61%). The median CD4 was 213 cells/μl, 76.7% of patients had CD4≤350 cells/μl, 46.1% had CD4≤200 cells/μl, and 59% of patients were at WHO clinical stages 3 or 4. Men had a more advanced clinical stage (p <0.046) and immunosuppression (p<0.0007) than women. Overall, 70% of patients started ART late, and 25% had AHD. Between 2006 and 2017, the median CD4 count increased from 190 cells/μl to 331 cells/μl (p<0.0001), and the proportions of patients with LI and AHD decreased from 76% to 47% (p< 0.0001) and from 18.7% to 8.9% (p<0.0001), respectively. The median time to initiation of ART after screening for HIV infection decreased from 40 to zero months (p<0.0001), and the proportion of time to initiation of ART in the month increased from 39 to 93.3% (p<0.0001) in the same period. The probability of LI of ART was higher in married couples (OR: 1.7; 95% CI: 1.3–2.3) (p<0.0007) and lower in patients with higher education (OR: 0.74; 95% CI: 0.64–0.86) (p<0.0001). Conclusion Despite increasingly rapid treatment, the proportions of LI and AHD remain high. New approaches to early detection, the first condition for early ART and a key to ending the HIV epidemic, such as home and work HIV testing, HIV self-testing and screening at the point of service, must be implemented.

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Progressive phasing out of baseline CD4+ cell count testing for people living with HIV in Kinshasa, Democratic Republic of the Congo

Abstract: Fig. 1. (a) Trends in baseline CD4 R cell count assessment in people living with HIV during 2006-2020. (b) Percentage of people living with HIV (WHO stage 1 or 2) with CD4 R count above or below 200 cells/ml.

Cited by 5 publications

References 7 publications

Decrease in late presentation for HIV care in Kinshasa, DRC, 2006–2020

Decrease in late presentation for HIV care in Kinshasa, DRC, 2006–2020

Retention in care and predictors of attrition among HIV-infected patients who started antiretroviral therapy in Kinshasa, DRC, before and after the implementation of the ‘treat-all’ strategy

Longitudinal analysis of sociodemographic, clinical and therapeutic factors of HIV-infected individuals in Kinshasa at antiretroviral therapy initiation during 2006-2017

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