Correction: Evaluation of a community-based HIV test and start program in a conflict affected rural area of Yambio County, South Sudan.

[This corrects the article DOI: 10.1371/journal.pone.0254331.].

Evaluation of a community-based HIV test and start program in a conflict affected rural area of Yambio County, South Sudan.

BACKGROUND: Antiretroviral therapy (ART) coverage in South Sudan is around 10%. Access to HIV care in settings with low ART coverage or conflict affected is still low; innovative strategies are needed to increase access and ensure continuation of ART during instability. A pilot HIV test and start project was implemented in a conflict-affected area of South Sudan. In a retrospective analysis, we determined the feasibility and outcomes of this intervention. METHODS: Programme data from July 2015 to June 2018 was analysed. The project involved five mobile teams offering HIV counselling and testing (HCT) and same day ART initiation at community level. Baseline and follow-up information on clinical, immunological and viral load (VL) was routinely recorded, as well as treatment outcomes. A semi-qualitative study was conducted to assess acceptability of the program among beneficiaries and community members. RESULTS: By June 2018, 14824 people received counselling and testing for HIV and 498 (3.4%) tested positive. Out of those 395 (79.3%) started ART. A total of 72 ART patients were organized in 26 Community ART Groups (CAGs) and contingency plan was activated 9 times for 101 patients. Kaplan-Meier estimated retention in care (RIC) at 12 and 18 months was 80.6% [95% CI: 75.9-84.5%] and 69.9% [95% CI: 64.4-74.8%] respectively. RIC was significantly higher at 18 months in patients under community ART groups (CAGs) (90.9% versus 63.4% p<0.001) when compared to patients on regular follow up. VL suppression at 12 months was 90.3% and overall virological suppression reached 91.2%. A total of 279 persons were interviewed about the MSF program perception and acceptance: 98% had heard about the programme and 84% found it beneficial for the community, 98% accepted to be tested and only 4% found disadvantages to the programme. CONCLUSIONS: Our study shows that HCT and early ART initiation in conflict affected populations can be provided with good program outcomes. RIC and virological suppression are comparable with facility-based HIV programs and to those in stable contexts. This model could be extrapolated to other similar contexts with low access to ART and where security situation is a concern.

Increasing prevalence of type 2 diabetes mellitus and impact of ethnicity in north Sudan.

BACKGROUND: Diabetes mellitus constitutes a global health threat, with increasing burden of disease in low and middle-income countries witnessing ongoing epidemiological transition including Sudan. AIMS: To study the prevalence of type 2 diabetes mellitus (T2DM) and prediabetes and determine the relationship to gender, age, waist circumference, body mass index, residence and ethnicity among the adult population in north Sudan. METHODS: A cross-sectional, population-based study in Northern State and River Nile State using random multi-stage cluster sampling targeting 5376 participants from 14 localities divided into 60 urban and 40 rural clusters. In each cluster, 60 households were studied. Blood glucose level and anthropometric measurements were recorded and a questionnaire containing demographic data was obtained from each participant. RESULTS: The prevalence of T2DM among participants was 18.7% and prediabetes was 12.9%. Among people living with T2DM, 694(71.0%) were known cases of T2DM, whereas 284(29.0%) were newly diagnosed cases. The significant associated risk factors for T2DM included urban residence (AOR 1.23, 95%CI 1.09-1.41), age above 60 years (AOR 4.77, 95%CI 4.04-5.63), obese BMI (AOR 1.26, 95%CI 1.03-1.55) and central obesity (AOR 1.39, 95%CI 1.14-1.68). Compared to indigenous population, individuals of Egyptian descents (AOR 1.28, 95%CI 1.04-1.57) and mixed origin (AOR 1.24, 95%CI 1.04-1.48) had increased risk of T2DM. CONCLUSION: The prevalence of T2DM and prediabetes in north Sudan have increased significantly since 1996 with variations between ethnicities which showed to be an independent risk factor for T2DM. Health authorities are recommended to set plans to meet the health needs of these communities.

Economic and social impact of diabetes mellitus in a low-income country: A case-control study in Sudan.

BACKGROUND: Diabetes mellitus accounts for 11% of total health expenditure worldwide, and most people with diabetes live in low- and middle-income countries. The present study examined the economic and social effects attributed to diabetes in Sudan by calculating out-of-pocket medical expenses and the health and social effects of the disease for people with diabetes (n = 375) and their families compared with a non-diabetic control group (n = 375), matched for age, sex, and residence area. METHODS: Data were obtained in 2013 in four states within the Sudan, via structured interviews, using instruments from the International Diabetes Federation. Descriptive statistics were used to analyze differences between case and control participants. RESULTS: The median total annual medical expenditure was fourfold higher for people with than without diabetes (US$579 vs US$148, respectively). Annual mean expenditure was 85% higher for those with diabetes (US$1004 vs US$544). People with diabetes were also significantly more likely to suffer from serious comorbidities, such as cardiovascular disorders and foot ulcers, compared with control participants. Moreover, those with diabetes reported a higher proportion of personal adverse social effects, such as being prevented from doing paid work or participating in education, both for themselves and their families. CONCLUSIONS: The high economic burden and adverse social effects on people with diabetes and their families in Sudan call for the development of evidence-based policy and program strategies for the prevention and management of diabetes, with an emphasis on low-resource communities.

Health related quality of life and sense of coherence in Sudanese diabetic subjects with lower limb amputation.

Quality of life is an important outcome measure in diabetic patients with lower limb amputation (LLA). The aim of this study was to investigate the influence of lower limb amputation on health-related quality of life (HRQOL) in Sudanese diabetic subjects. Additionally the Sense of Coherence scale (SOC-13) and a symptom check list was used in subjects with LLA. A total of 60 (M/F; 40/20) diabetic subjects with LLA and 60 (M/F; 23/37) diabetic reference subjects without LLA, were studied. For both groups HRQOL was measured using The Medical Outcomes Study questionnaire (MOS). Subjects with LLA had significantly poorer HRQOL compared to the reference group in most HRQOL domains (p < 0.0001). Duration of diabetes had the greatest negative impact on HRQOL in both groups, those with LLA (p < 0.0001), and in those without LLA (p < 0.0001), although subjects who were amputated earlier had poorer HRQOL than recently amputated (p < 0.0001). Higher SOC scores were recorded in LLA patients who have greater ratings of positive feelings, family satisfaction and sleep in the HRQOL examination (p < 0.0001). In conclusion, Sudanese diabetic subjects with LLA have a poor quality of life. The triad of diabetes duration, symptoms and amputations, has turned to be important risk factor for poorer HRQOL. Functional and mobility status were suggested to be an important determinant of HRQOL among this population. As the Sudanese population has coherent social relationships, this poor performance of the diabetic subjects will certainly increase the burden on the whole family, in both integrity and economical status. Nevertheless, these deep-rooted social interrelations together with increasing diabetes awareness have substantially improved the family satisfaction among our patients.

Economic burden on families of childhood type 1 diabetes in urban Sudan.

The aims of this study were to estimate the direct costs of childhood diabetes in a low income country, Sudan, and to assess the effectiveness of care paid for by the families. For this purpose, socio-economic and demographic data on families were obtained from the parents of 147 children with type 1 diabetes, attending public or private clinics in Khartoum State, Sudan. The median annual income of the families of diabetic children was US dollars (US$) 1222 (range 0-14,338) of which 16% was received as financial help from relatives and friends. The median annual expenditure of diabetes care was US$ 283 per diabetic child of which 36% was spent on insulin. Of the family expenditure on health, 65% was used for the diabetic child. Families of diabetic children who were attending private clinics had a significantly higher total expenditure on health and home blood glucose monitoring than those who were attending the public clinics. However, there was no difference in total income between the two groups and glycaemic control was poor in 86% of the patients, regardless of whether care was being given by private or public clinics. The occurrence of the disease and its poor control appeared to exert a negative impact on the school performance of the diabetic child. In conclusion, the low direct costs reflect the minimal care given to the diabetic patients. Under the present economic conditions, families pay a considerable part of their income to sponsor the health of their diabetic children and receive little support other than that from relatives and friends. The present organization of diabetes care does not provide the patient with empowerment, knowledge and self-care ability. Well-trained diabetic teams and education programs may improve this situation.

Transmission of human herpesvirus 8 by sexual activity among adults in Lagos, Nigeria.

BACKGROUND: Human herpesvirus 8 (HHV-8) infection is common in Africa, but prevalence varies geographically. Studies in Europe and America suggest spread through homosexual contact, but evidence of heterosexual spread is inconsistent. We examined the association between HHV-8 and markers of risky sexual activity in Nigeria. METHODS: The study subjects included an adult referent population at relatively low risk of HIV infection, patients attending a sexually transmitted disease (STD) clinic, and female commercial sex workers (CSW). Sera were collected between 1991 and 1994 to study the epidemiology of retroviruses and STD in Lagos, Nigeria. Residual samples were tested for HHV-8 antibodies using a K8.1 enzyme immunoassay and for antibodies to syphilis, chancroid, herpes simplex virus 2, HIV-1/2, and HTLV-1. Associations were sought using chi square tests and logistic regression. RESULTS: Overall, HHV-8 prevalence was 26.5% in 2002 study subjects, being higher among CSW and STD patients (31% in each) than in the referent population (19%). HHV-8 prevalence in women was approximately half that in men in both the referent and the STD populations. Increasing age and STD were each associated with HHV-8-seropositivity in men and women, and among women being a CSW was also a risk factor. HHV-8 antibodies were more frequently detected in those with laboratory evidence of STD in each group. Having at least one STD was associated with having HHV-8 antibodies. CONCLUSION: The higher prevalence of HHV-8 antibody in groups with multiple sexual partners and the association with STD among individuals both support the sexual transmission of HHV-8 in African adults.

Trends in Kaposi's sarcoma and non-Hodgkin's lymphoma incidence in the United States from 1973 through 1998.

BACKGROUND: The incidence of Kaposi's sarcoma (KS) and non-Hodgkin's lymphoma (NHL) in the general population has markedly increased since the onset of the AIDS epidemic in 1981. However, during the 1990s, the dynamics of the AIDS epidemic changed, as human immunodeficiency virus (HIV) infection rates slowed and effective antiretroviral therapies were introduced. We examined the impact of these changes on the general population incidence of KS and NHL. METHODS: Age-standardized incidences for KS and NHL from 1973 through 1998 were obtained from nine population-based cancer registries that participate in the Surveillance, Epidemiology and End Results (SEER) program. RESULTS: During the mid-1990s, KS incidence declined sharply in all nine registries. Decreases in KS incidence were most evident in San Francisco, where KS rates among white men had risen from 0.5 per 100 000 people per year in 1973 to between 31.1 and 33.3 from 1987 through 1991 and then declined to 2.8 in 1998. With background NHL incidence in the general population being much higher than that for KS, changes in incidence related to the AIDS epidemic were most evident in subgroups at high risk of AIDS. In San Francisco, NHL rates among white men rose from 10.7 in 1973 to a peak of 31.4 in 1995 and then declined to 21.6 in 1998. NHL types that were most highly AIDS-associated declined most steeply, whereas the incidence of NHL types not associated with AIDS was either stable or increasing. CONCLUSION: Changes in KS and NHL incidence since the mid 1990s may reflect declines in the number of individuals with AIDS and improved immune function in such individuals following the introduction of effective antiretroviral therapies in the 1990s. Notably, non-AIDS-associated NHL incidence has continued to increase steadily through 1998.