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Results

162,977

Enrollees in Nigeria, Kenya and Tanzania


16,184,200

Total disbursed loan amount in USD


1,938,199


Number of patient visits to SafeCare facilities per month


1,954

Number of active clinics in the SafeCare program

Publications

HIV-1 drug resistance in antiretroviral-naive individuals in sub-Saharan Africa after rollout of antiretroviral therapy: a multicentre observational study

Oct 1, 2011


Background
There are few data on the epidemiology of primary HIV-1 drug resistance after the roll-out of antiretroviral treatment (ART) in sub-Saharan Africa. We aimed to assess the prevalence of primary resistance in six African countries after ART roll-out and if wider use of ART in sub-Saharan Africa is associated with rising prevalence of drug resistance.

Methods
We did a cross-sectional study in antiretroviral-naive adults infected with HIV-1 who had not started first-line ART, recruited between 2007 and 2009 from 11 regions in Kenya, Nigeria, South Africa, Uganda, Zambia, and Zimbabwe. We did population-based sequencing of the pol gene on plasma specimens with greater than 1000 copies per mL of HIV RNA. We identified drug-resistance mutations with the WHO list for transmitted resistance. The prevalence of sequences containing at least one drug-resistance mutation was calculated accounting for the sampling weights of the sites. We assessed the risk factors of resistance with multilevel logistic regression with random coefficients.

Findings
2436 (94.1%) of 2590 participants had a pretreatment genotypic resistance result. 1486 participants (57.4%) were women, 1575 (60.8%) had WHO clinical stage 3 or 4 disease, and the median CD4 count was 133 cells per μL (IQR 62—204). Overall sample-weighted drug-resistance prevalence was 5.6% (139 of 2436; 95% CI 4.6—6.7), ranging from 1.1% (two of 176; 0.0—2.7) in Pretoria, South Africa, to 12.3% (22 of 179; 7.5—17.1) in Kampala, Uganda. The pooled prevalence for all three Ugandan sites was 11.6% (66 of 570; 8.9—14.2), compared with 3.5% (73 of 1866; 2.5—4.5) for all other sites. Drug class-specific resistance prevalence was 2.5% (54 of 2436; 1.8—3.2) for nucleoside reverse-transcriptase inhibitors (NRTIs), 3.3% (83 of 2436; 2.5—4.2) for non-NRTIs (NNRTIs), 1.3% (31 of 2436; 0.8—1.8) for protease inhibitors, and 1.2% (25 of 2436; 0.7—1.7) for dual-class resistance to NRTIs and NNRTIs. The most common drug-resistance mutations were K103N (43 [1.8%] of 2436), thymidine analogue mutations (33 [1.6%] of 2436), M184V (25 [1.2%] of 2436), and Y181C/I (19 [0.7%] of 2436). The odds ratio for drug resistance associated with each additional year since the start of the ART roll-out in a region was 1.38 (95% CI 1.13—1.68; p=0.001).

Interpretation
The higher prevalence of primary drug resistance in Uganda than in other African countries is probably related to the earlier start of ART roll-out in Uganda. Resistance surveillance and prevention should be prioritised in settings where ART programmes are scaled up.

Funding
Ministry of Foreign Affairs of the Netherlands.

Authors: Dr Raph L Hamers MD, Carole L Wallis PhD, Cissy Kityo MD, Margaret Siwale MRCP, Kishor Mandaliya MBChB, Francesca Conradie MD, Mariette E Botes MD, Maureen Wellington MBChB, Prof Akin Osibogun MD, Kim C E Sigaloff MD, Immaculate Nankya PhD, Rob Schuurman PhD, Ferdinand W Wit MD, Prof Wendy S Stevens MMed, Michèle van Vugt MD, Prof Tobias F Rinke de Wit PhD, for PharmAccess African Studies to Evaluate Resistance (PASER)

Click here to read the full article.

Also, click here to read a reaction in the Lancet from Anthony Amoroso and colleagues, and here to read the authors' reply.

 

 

Author: Dr Raph L Hamers MD, Carole L Wallis PhD, Cissy Kityo MD, Margaret Siwale MRCP, Kishor Mandaliya MBChB, Francesca Conradie MD, Mariette E Botes MD, Maureen Wellington MBChB, Prof Akin Osibogun MD, Kim C E Sigaloff MD, Immaculate Nankya PhD, Rob Schuurman

Date: October 2011

News

On 12 September 2016, OPIC, Calvert Foundation and two private investors announce expansion
PharmAccess and its German consultancy partner GFA have won a 27.3 million Euros tender from the German development bank KfW to improve access to healthcare for low-income pregnant women in 5 regions of Tanzania.
President Felipe Nyuse of Mozambique officially opened the University Clinic

Publications

A population-based study
Date: September, 2015

Research findings on Health Insurance Fund supported programs

Date: February, 2015