ABSTRACT
Background: Stage at time of diagnosis and survival after diagnosis are critical parameters regarding the control of any cancer in any geographical setting. Unlike in resource-rich settings where publicly funded cancer surveillance routinely monitors these parameters, these data are non-existent through routine means in resource-limited areas. This is particularly relevant for Kaposi sarcoma (KS) in East Africa, for which recent changes in HIV treatment and chemotherapy guidelines as well as the COVID-19 pandemic dictate an update regarding stage and survival. Method(s): From October 2021 to August 2022, we evaluated HIV-infected adults (age >= 18 years) with a new diagnosis of KS made in 4 different primary care facilities (or their associated inpatient units) in Kenya and Uganda using a process of rapid case ascertainment. KS diagnosis was confirmed by pathology. Participants were examined, at time of biopsy, to document the extent of lesions and subsequently monitored longitudinally for vital status. Result(s): Among 180 HIV-infected adults identified with new onset KS, 31% were women, and the median (IQR) age was 35 (29-42) years. At time of KS diagnosis, 95% of the participants were taking ART, and the median (IQR) CD4+ T cell count was 197 (46-354) cells/mm3;46%, 20%, 11% and 23% had plasma HIV RNA of < 40, 40-1000, 1001-10,000 and >10,000 copies/ml, respectively. The median number of anatomic sites with KS lesions per participant was 7 (4-11);26% of participants had oral KS lesions that interfered with either eating or speaking, 74% had KS-associated edema, and 86% had ACTG stage T1 (advanced KS). Over a median follow-up of 2.6 months (IQR: 0.75 to 5.5), 56 participants died, and only 3 lost to follow-up. Cumulative incidence of death (95% CI), via Kaplan-Meier estimation, at 2 months, 6 months and 8 months following KS diagnosis was 24% (18%-31%), 33% (26%-42%), and 38% (29- 49%), respectively (Figure). Conclusion(s): In a recently assembled community-based sample of adults with newly-diagnosed HIV-related KS in East Africa, the majority have advanced KS at the time of KS diagnosis, and survival is poor. The findings are stark in absolute terms for the Treat-All era and unchanged from parameters obtained in the 5 years prior, indicating no improvement in these aspects of the control of KS in the region. Along with primary prevention of KS (i.e., reducing its incidence), novel approaches are needed for earlier detection, more efficient linkage to oncologic care, and more potent therapy. Survival Among Adults with HIV-Related Kaposi Sarcoma in East Africa.
ABSTRACT
Introduction: Information on non-healthcare setting Infection control measures, especially in the Context of the COVID-19 pandemic is scarce. The Ministry of Health Uganda instituted national lockdown to minimize the spread of the SARS CoV2 virus, which has progressively eased since July 2020. The Infectious Diseases Institute (IDI) established measures to ensure workplace safety for staff, visitors, and service providers. However, monitoring compliance is crucial for the standards to have an impact. Objectives: This survey aimed to monitor and improve staff compliance with the prescribed criteria for workplace safety for over two months. Methods: A baseline survey using a pretested tool was done in August 2020 to check staff compliance to the different IPC mitigation measures at IDI. This survey's feedback informed an enhancement of workplace safety measures, including encouraging working from home, reducing office occupancy to about 30% of the pre-pandemic capacity, and mandatory use of face coverings. The evaluation was followed by a second survey in October 2020 to assess changes in compliance following the enhancement of IPC mitigation measures. The metrics assessed include;Compliance with screening procedures at the entrance (Hand hygiene, face mask possession, Temperature measurement, and Registration). Assessment of proper face-covering use and number of staff carrying personal ABHR was done by directly observing and asking a convenient sample of staff on each of the building complex's six levels, respectively. Results: Over the two months, the overall staff compliance with screening efforts increased from 59 to 89%, with the most considerable improvements seen in mask possession and recording of contact details at the entrance. Correct mask use within the premises improved from 23 to 47% and ownership of personal ABHR from 39%-61%. Conclusion: Strengthened administrative controls lead to measurable improvement in compliance with IPC. Workplace settings should actively monitor for compliance, with constant reminders on best practices for occupational exposure to COVID-19 since changing behaviour takes time.
ABSTRACT
With the emergence of the COVID-19, the loss of the hard-won momentum towards HIV epidemic control has become a major concern globally. The containment measures associated with COVID-19, including lockdowns, travel restrictions and physical distancing, which result in restricted access to essential services, compounded by the diversion of human and other key resources to address the pandemic, have led to significant disruptions in HIV service delivery and demand. During the earlier phase of the COVID-19 outbreak, modeling studies estimated a 10% increase in deaths among persons living with HIV in low- and middle-income countries (LMICs) as a result of the health systems disruptions occasioned by the pandemic, with interruptions in antiretroviral supplies being the key driver of mortality. Emerging data from multi-country surveys indicate that almost 1 in 7 countries have had either high or very high disruptions in HIV service delivery. Specifically, COVID-19 has resulted in substantial disruptions in HIV testing services, resulting in significant reductions in HIV case-identification and treatment initiation across many age groups. There is also emerging evidence of reductions in patient retention and viral suppression. This talk will focus on the impact of COVID-19 on the HIV pandemic worldwide. It will highlight the drivers of the disruptions to the HIV care system, from containment measures including lockdowns and other restrictions, the diversion of substantial resources to address COVID-19, the high demand on the health systems, to COVID-19 stigma and other human rights concerns. The data suggest that the most vulnerable communities are bearing the brunt of the COVID-19-induced health systems disruptions. The talk will summarize insights from local and regional modeling studies on the impact of COVID-19 on HIV health systems as well as share emerging data on the direct and indirect impacts on services delivery across different regions. Finally, the talk will highlight proposals for and documented approaches to mitigating the effect of COVID-19 on the HIV pandemic.