Nav: Home

New approach to HIV management in Tanzania and Zambia reduces deaths by almost one-third

March 10, 2015

A new approach to care for patients with advanced HIV in Tanzania and Zambia, combining community support and screening for a type of meningitis, has reduced deaths by 28%.

The research, published in The Lancet, suggests that a simple low-cost intervention could be an effective approach to reducing HIV-related deaths in Africa.

Researchers from the National Institute of Medical Research Tanzania, the University Teaching Hospital in Zambia, St Georges University of London and the London School of Hygiene & Tropical Medicine conducted a randomised trial of 1,999 HIV patients in Tanzania and Zambia.

They enrolled patients beginning HIV treatment who had advanced HIV disease. Most of the deaths in African HIV programmes occur in this group at around the time or just shortly after HIV treatment is started. All patients were firstly screened for tuberculosis and started quickly on HIV treatment. Patients were then given either standard care from a clinic, or given additional care which consisted of screening for cryptococcal meningitis as well as weekly home visits for the first four weeks from lay workers to support them with antiretroviral therapy.

The trial, which was conducted between February 2012 and September 2014, found deaths among patients receiving the additional screening for cryptococcal meningitis and home visits were 28% lower than those receiving standard clinic care (134 deaths and 180 deaths respectively over a 12 month follow-up period).

Cryptococcal meningitis, which is caused by a fungus, mostly occurs in people who have HIV/AIDS. According to CDC there are nearly one million new cases of cryptococcal meningitis each year worldwide, resulting in 625,000 deaths, most of which occur in sub-Saharan Africa.*

Study senior author Shabbar Jaffar, Professor of Epidemiology at the London School of Hygiene & Tropical Medicine, said: "This large trial was the first of its kind and the results are very exciting. The combination of screening and community lay worker support reduced the death rate among patients with advanced HIV by almost a third. About 10 million people in Africa are on antiretroviral therapy, but there is a disparity in the number of people who die in the first year of treatment compared to wealthier regions like Europe. This new approach could begin closing that gap.

"The biggest challenge facing health care delivery in Africa is the severe shortage of clinically-qualified health care workers, particularly doctors". But our intervention involved trained lay-workers and did not add substantial burden onto doctors and nurses.

"The screening for cryptococcal meningitis was also a significant component in the success of our trial. We now know that screening combined with giving pre-emptive treatment for this type of fungal meningitis is an effective strategy in reducing the high number of HIV deaths associated with it in Africa.

"If this intervention were to be scaled-up by governments, the cost of the lay-workers plus the screening would be even lower than the $30-70 in our trial, meaning it should be even more highly cost-effective than what our study suggests."
-end-
The research was funded by the European and Developing Countries Clinical Trials Partnership (EDCTP).

Sayoki Mfinanga, Shabbar Jaffar et al. Cryptococcal meningitis screening and community-based early adherence support in people with advanced HIV infection starting antiretroviral therapy in Tanzania and Zambia: an open-label, randomised controlled trial. The Lancet. DOI: 10.1016/S0140-6736(15)60164-7

For more information or to request interviews, contact the London School of Hygiene & Tropical Medicine press office on press@lshtm.ac.uk or +44(0)2079272802.

Notes to Editors:

Figures from CDC http://www.cdc.gov/fungal/global/cryptococcal-meningitis.html

London School of Hygiene & Tropical Medicine

Related Antiretroviral Therapy Articles:

HIV may affect the brain despite ongoing antiretroviral therapy
HIV-positive patients are living longer thanks to combination antiretroviral therapy (cART), but the virus can remain in some tissues, preventing a total cure.
Being HIV positive and staying on antiretroviral therapy in Africa: A systematic review
An international team of researchers have carried out a review of the evidence examining what influences people who are HIV positive to go to health services and then stay on antiretroviral drugs in Africa.
Benefits of early antiretroviral therapy in HIV-infected children
The initial findings of the ANRS CLEAC study coordinated by Pierre Frange (Hôpital Necker -- AP-HP), help define the immunological and virological benefits of early antiretroviral therapy in HIV-infected children living in France.
Fauci: HIV remission free of antiretroviral therapy is a feasible goal
Long-lasting control of HIV infection without antiretroviral therapy (ART) is a feasible goal that deserves vigorous pursuit, Anthony S.
Lyndra announces publication of feasibility study of oral once-weekly drug delivery system for HIV antiretroviral therapy in Nature Communications
Lyndra Inc., an emerging biopharmaceutical company developing oral dosage forms designed to release drug for up to a week or longer, today announced the publication of a feasibility study of an oral, once-weekly drug delivery platform for HIV antiretroviral therapy in the peer-reviewed journal Nature Communications.
More Antiretroviral Therapy News and Antiretroviral Therapy Current Events

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Rethinking Anger
Anger is universal and complex: it can be quiet, festering, justified, vengeful, and destructive. This hour, TED speakers explore the many sides of anger, why we need it, and who's allowed to feel it. Guests include psychologists Ryan Martin and Russell Kolts, writer Soraya Chemaly, former talk radio host Lisa Fritsch, and business professor Dan Moshavi.
Now Playing: Science for the People

#537 Science Journalism, Hold the Hype
Everyone's seen a piece of science getting over-exaggerated in the media. Most people would be quick to blame journalists and big media for getting in wrong. In many cases, you'd be right. But there's other sources of hype in science journalism. and one of them can be found in the humble, and little-known press release. We're talking with Chris Chambers about doing science about science journalism, and where the hype creeps in. Related links: The association between exaggeration in health related science news and academic press releases: retrospective observational study Claims of causality in health news: a randomised trial This...