DOCSLIB.ORG

Eligibility for and Initiation of Antiviral Therapy in Chronic Hepatitis B Virus Infection in Zambia: a Prospective Cohort Study Michael J

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Eligibility for and Initiation of Antiviral Therapy in Chronic Hepatitis B Virus Infection in Zambia: a Prospective Cohort Study Michael J Abstract #38 Eligibility for and initiation of antiviral therapy in chronic hepatitis B virus infection in Zambia: a prospective cohort study Michael J. Vinikoor, Edford Sinkala, Bright Nsokolo, Annie Kanunga, Mutinta Muchimba, and Paul Kelly Tropical Gastroenterology and Nutrition Group, University of Zambia, Lusaka, Zambia; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia; University of Alabama at Birmingham, Birmingham, USA; University Teaching Hospital, Lusaka, Zambia; Levy Mwanawasa Medical University, Lusaka, Zambia; Queen Mary University of London, London, UK; *Presenting author: [email protected], +260974662483 Background Results: Baseline characteristics • After diagnosis, hepatitis B surface antigen (HBsAg)- Factor Median (IQR) or n (%) positive individuals must enroll in appropriate Median age (IQR) 33 (26-40) clinical care, be assessed for the need of antiviral Female sex 36 (27.7) therapy (AVT), and possible be re-assessed during longitudinal follow-up in order to access AVT Median ALT (IQR) 24 (17-35) • We characterized AVT eligibility at enrollment and ALT elevation 53 (41.7) during follow-up in a prospective cohort based at a APRI >2.0 6 (6.7) hospital in Zambia. Decompensated cirrhosis 9 (6.8) • We also described the percentage of those eligible HBV DNA >2,000 IU/ml 35 (31.8) who initiated AVT and some of the reasons for delays in initiation. Antiviral therapy criteria BL FU EASL Cirrhosis and detectable 15 4 Materials & Methods 2017 HBV DNA • At University Teaching Hospital in Lusaka, a cohort ALT elevation and HBV 3 8 was established for adults (18+ years) who were DNA >2,000 HBsAg-positive and HIV-negative. HBV DNA <2,000 and 11 8 • At baseline, 3, 6, 12, 18, and 24 months, we assessed normal ALT and age >30 ALT and AST. At baseline, 1, and 2 years we Subtotal (% of assessed) 29 (21.8) 20 (19.2) measured platelet count, HBV DNA and liver stiffness (LSM; Fibroscan 402, Echosens, France). HIV WHO Cirrhosis 18 6 testing was repeated yearly. Bus fare was provided. 2015 Persistently elevated ALT 0 25 • Acute HBV infection was suspected on the basis of Subtotal (% of assessed) 18 (13.5) 31 (31.3) symptoms and/or ALT >10 times the ULN. BL = at baseline, defined as enrollment in cohort • Normal ALT was <30 U/L for men <20 for women. FU = at follow-up among patients not eligible at baseline • Cirrhosis was defined as: decompensated cirrhosis, Note: we excluded from analysis patients with suspected acute AST-to-platelet ratio index >2.0, or LSM ³9.5 kPa. HBV and those who were AVT-experienced at enrollment. At baseline, 133 were assessed; Of these 104 EASL-ineligible and • AVT eligibility was assessed in AVT naïve patients 99 WHO-ineligible patients were re-assessed during follow-up. using EASL 2017 and WHO 2015 (see below) Results: Main reasons for delayed AVT Results Uncertainty or challenges in applying 9 • We enrolled 174 HBV patients. Of them, we criteria to start therapy excluded from further analysis 37 who were already Lost to follow-up 6 taking AVT and 4 with acute infection. Schistosomiasis coinfection with high 3 • We described baseline characteristics of the elastography remaining 133 (see adjacent table). • During 185.3 person-years of follow-up, we retained Patient declined AVT 1 104 patients (1.78 years per person on average). • The adjacent table shows the # and % who met EASL and WHO criteria at baseline and follow-up. Conclusions • So far, among the 32 who met baseline criteria • Longitudinal follow-up will be essential as HBV (either EASL or WHO), only 13 started AVT (40.6%). patients who are ineligible at diagnosis may later Delays in starting therapy are reported to the right. need therapy • Significant training and capacity building will be needed to correctly apply treatment criteria 2nd Conference on Liver Disease in Africa; September 6-8, 2019; Cairo, Egypt.
Load more

Recommended publications
  • African Democratic Transitions Tracker Technical Appendix
    African Democratic Transitions Tracker Technical Appendix Contents Definitions ..................................................................................................................................................... 2 Notes ............................................................................................................................................................. 3 Data Sources for Individual Countries .......................................................................................................... 4 1 Definitions Multi‐party election ‐ two or more political parties have affiliated candidates participating in an election. Single party election ‐ only one political party has an affiliated candidate participating in an election. Other transitions ‐ assumption of power via: Appointment by parliament, presidential council, military junta, clan leaders, etc Appointment as an interim or “acting” head of state A plebiscite, national referendum, change to the constitution, etc. Conflicting claims for leadership or no recognized government Coups or assassination ‐ a segment of the state apparatus takes over the rest of the government and/or the current leader is assassinated . Deaths in office ‐ a leader dies of causes, unrelated to a coup or assassination. Resignation from office ‐ a ruler leaves power on his or her own accord. Total elections ‐ either a single‐ or multi‐party election. Note: Coups/assassinations, deaths and resignations are considered to be discrete events; distinct from how a following
    [Show full text]
  • The Power of Persistence: Education System Reform and Aid Effectiveness
    SPINE The Power of Persistence | Education System Reform and Aid Effectiveness Reform System Education The Power of Persistence Education System Reform and Aid Effectiveness 1875 Connecticut Ave., NW Case Studies in Long-Term Education Reform Washington, DC 20009 [email protected] www.equip123.net EQUIP 2 Publication_Cover F2.indd 1 1/4/11 10:48 AM The Power of Persistence Education System Reform and Aid Effectiveness Case Studies in Long-Term Education Reform November 2010 John Gillies EQUIP2 Project Director Case sTudy Teams: El SAlvADoR I Jessica Jester Quijada, John Gillies, Antonieta Harwood EGyPt I Mark Ginsburg, Nagwa Megahed, Mohammed Elmeski, Nobuyuki tanaka NAMIbIA I Donna Kay leCzel, Muhamed liman, Sifiso Nyathi, Michael tjivikua, Godfrey tubaundule NICARAGUA I John Gillies, Kirsten Galisson, Anita Sanyal, bridget Drury ZAMbIA I David balwanz, Arnold Chengo table of Contents Acknowledgments v Foreword viii Executive Summary 1 Section 1: Introduction 11 Challenges in Education System Reform 14 Evaluating Aid Effectiveness in Education Reform: Exploring Concepts 17 A Systems Approach to Education Reform: What constitutes meaningful change in education systems? 27 Section 2: Lessons from Country Case Studies 43 Summary of Country Case Studies 45 Egypt 49 El Salvador 67 Namibia 85 Nicaragua 99 Zambia 111 Section 3: Summary Findings and Conclusions 131 Findings 133 Conclusions 148 Implications for USAID Policy and Programming. 156 Bibliography 158 Acknowledgments This study is the result of a two-year inquiry into the dynamics of improving the performance of education systems on a sustainable basis, and the role that donor assistance can play in achieving such improvement. The study was focused on the forces that influence how complex policy and institutional changes are introduced, adopted, and sustained in a society over a 20 year period, rather than on the impact of specific policy prescriptions or programs.
    [Show full text]
  • The Chair of the African Union
    Th e Chair of the African Union What prospect for institutionalisation? THE EVOLVING PHENOMENA of the Pan-African organisation to react timeously to OF THE CHAIR continental and international events. Th e Moroccan delegation asserted that when an event occurred on the Th e chair of the Pan-African organisation is one position international scene, member states could fail to react as that can be scrutinised and defi ned with diffi culty. Its they would give priority to their national concerns, or real political and institutional signifi cance can only be would make a diff erent assessment of such continental appraised through a historical analysis because it is an and international events, the reason being that, con- institution that has evolved and acquired its current trary to the United Nations, the OAU did not have any shape and weight through practical engagements. Th e permanent representatives that could be convened at any expansion of the powers of the chairperson is the result time to make a timely decision on a given situation.2 of a process dating back to the era of the Organisation of Th e delegation from Sierra Leone, a former member African Unity (OAU) and continuing under the African of the Monrovia group, considered the hypothesis of Union (AU). the loss of powers of the chairperson3 by alluding to the Indeed, the desirability or otherwise of creating eff ect of the possible political fragility of the continent on a chair position had been debated among members the so-called chair function. since the creation of the Pan-African organisation.
    [Show full text]
  • Ethnolinguistic Favoritism in African Politics ONLINE APPENDIX
    Ethnolinguistic Favoritism in African Politics ONLINE APPENDIX Andrew Dickensy For publication in the American Economic Journal: Applied Economics yBrock University, Department of Economics, 1812 Sir Issac Brock Way, L2S 3A2, St. Catharines, ON, Canada (email: [email protected]). 1 A Data Descriptions, Sources and Summary Statistics A.1 Regional-Level Data Description and Sources Country-language groups: Geo-referenced country-language group data comes from the World Language Mapping System (WLMS). These data map information from each language in the Ethnologue to the corresponding polygon. When calculating averages within these language group polygons, I use the Africa Albers Equal Area Conic projection. Source: http://www.worldgeodatasets.com/language/ Linguistic similarity: I construct two measures of linguistic similarity: lexicostatistical similarity from the Automatic Similarity Judgement Program (ASJP), and cladistic similar- ity using Ethnologue data from the WLMS. I use these to measure the similarity between each language group and the ethnolinguistic identity of that country's national leader. I discuss how I assign a leader's ethnolinguistic identity in Section 1 of the paper. Source: http://asjp.clld.org and http://www.worldgeodatasets.com/language/ Night lights: Night light intensity comes from the Defense Meteorological Satellite Program (DMSP). My measure of night lights is calculated by averaging across pixels that fall within each WLMS country-language group polygon for each year the night light data is available (1992-2013). To minimize area distortions I use the Africa Albers Equal Area Conic pro- jection. In some years data is available for two separate satellites, and in all such cases the correlation between the two is greater than 99% in my sample.
    [Show full text]
  • VII. Southern Africa
    VII. Southern Africa In several countries, the year was dominated by elections, which differed in terms of their legitimacy. Due to the death of Zambian President Mwanawasa in offi ce and the subse- quent ousting of South Africa’s President Thabo Mbeki, SADC had three different chair- persons during the year. The sub-regional body, which welcomed back the Seychelles as its 15th member state during its annual summit, was kept busy with a number of meetings in the reluctant search for a political solution in Zimbabwe, but failed to contribute in a meaningful way to a lasting improvement there. The country remained mired in violence and confl ict, while the situation for the majority of the population deteriorated further. The general stability of SADC and cooperation among its member states was tested by the differences in view over the handling of the Zimbabwe crisis, but the sub-regional bloc avoided a split over these political matters. Swaziland and Angola, next to Zimbabwe, 400 • Southern Africa remained among the worst performers with regard to democracy and human rights, while elections in all three countries testifi ed further to the authoritarian nature of the dominant political culture. Intra-regional economic integration went ahead with the implementation of a FTA, though multiple affi nities among member states with different preferential trade organisations, and the differences over the interim EPAs remained a challenge. The gen- eral economic performance declined considerably towards the end of the year as a result of the global economic crisis, and rising food prices had severe impacts on many people, forcing governments to take relief measures for the poorest.
    [Show full text]
  • African Studies Keyword: Democracy Nic Cheeseman and Sishuwa Sishuwa
    African Studies Keyword: Democracy Nic Cheeseman and Sishuwa Sishuwa Abstract: Democracy is one of the most contested words in the English language. In Africa, these complexities are compounded by the question of whether democracy is a colonial imposition. Cheeseman and Sishuwa provide a historiography of debates around democracy, track how these narratives have developed over time, and argue that there is widespread public support for a form of what they call “consensual democracy.” This is not to say that democracy is universally loved, but despite the controversy it remains one of the most compelling ideals in political life, even in countries in which it is has yet to be realized. Résumé: Le terme démocratie est l’un des mots les plus contestés de la langue anglaise. En Afrique, ces complexités sont aggravées par la question de savoir si la démocratie est une imposition coloniale. Cheeseman et Sishuwa présentent une historiographie des débats autour de la démocratie, suivent l’évolution de ces récits au fil du temps et argumentent qu’il existe un large soutien public pour une forme qu’ils appellent la “démocratie consensuelle.” Cela ne veut pas dire que la démocratie est universellement aimée, mais malgré la polémique elle reste l’un des idéaux les plus convaincants de la vie politique, même dans les pays où elle est encore à réaliser. Resumo: A palavra democracia é uma das mais polémicas na língua inglesa. Em África, estas complexidades são agravadas pela questão de saber se a democracia é uma imposição colonial. Cheeseman e Sishuwa apresentam uma historiografia dos debates em torno da democracia, e registam a evolução que estas narrativas sofreram ao longo African Studies Review, Volume 0, Number 0 (2021), pp.
    [Show full text]
  • Zambia Country Report BTI 2016
    BTI 2016 | Zambia Country Report Status Index 1-10 5.70 # 61 of 129 Political Transformation 1-10 6.25 # 57 of 129 Economic Transformation 1-10 5.14 # 77 of 129 Management Index 1-10 5.19 # 58 of 129 scale score rank trend This report is part of the Bertelsmann Stiftung’s Transformation Index (BTI) 2016. It covers the period from 1 February 2013 to 31 January 2015. The BTI assesses the transformation toward democracy and a market economy as well as the quality of political management in 129 countries. More on the BTI at http://www.bti-project.org. Please cite as follows: Bertelsmann Stiftung, BTI 2016 — Zambia Country Report. Gütersloh: Bertelsmann Stiftung, 2016. This work is licensed under a Creative Commons Attribution 4.0 International License. BTI 2016 | Zambia 2 Key Indicators Population M 15.7 HDI 0.561 GDP p.c., PPP $ 3904.0 Pop. growth1 % p.a. 3.1 HDI rank of 187 141 Gini Index 55.6 Life expectancy years 58.1 UN Education Index 0.591 Poverty3 % 78.9 Urban population % 40.5 Gender inequality2 0.617 Aid per capita $ 74.9 Sources (as of October 2015): The World Bank, World Development Indicators 2015 | UNDP, Human Development Report 2014. Footnotes: (1) Average annual growth rate. (2) Gender Inequality Index (GII). (3) Percentage of population living on less than $3.10 a day at 2011 international prices. Executive Summary Zambia remains one of the least developed countries in Africa, with 75% of the population living on less than $1.25 a day and a life expectancy of 57.
    [Show full text]
  • Checks and Balances
    Constitutions are the bedrock of multiparty democracies. Tension between the principles of democracy – rule by the people – and constitutionalism, as a predominantly elite driven process, have increased across the African continent as constitutional reforms have become regular occurrences in many states since the early 1990s. Some of these reforms have strengthened democratic ideals, while others have opened states up to greater abuses of power. As many African states continue to grapple with the consolidation of democratic norms and institutions into their legal frameworks, they have simultaneously been constrained by the remnants of colonial era constitutions. Colonial era states were deliberately CHECKS AND BALANCES: constructed to propagate elites in the governance of the colony, a system which has in many modern African states been reinforced by African political elites in furthering narrow interests. When political leaders, elites and other interest groups African constitutions and democracy undermine and weaken the constitution they weaken the very fabric of the society they claim to serve. When they weaken and abuse state institutions they weaken in the 21st century the very mechanisms created to give life to a constitution's ambitions. In this edited volume, some of Africa's leading academics seek to answer questions such as: “If constitutional changes continue to be elite driven processes – excluding citizens – can constitutions ever truly be 'living documents' providing the foundations to build and consolidate democratic norms
    [Show full text]
  • Zimbabwe: the Transitional Government and Implications for US
    Zimbabwe: The Transitional Government and Implications for U.S. Policy Lauren Ploch Analyst in African Affairs October 27, 2011 Congressional Research Service 7-5700 www.crs.gov RL34509 CRS Report for Congress Prepared for Members and Committees of Congress Zimbabwe: The Transitional Government and Implications for U.S. Policy Summary The U.S. government, which has expressed concerns regarding the rule of law in Zimbabwe for over a decade and which has long been critical of President Robert Mugabe, has been cautious in its engagement with the country’s three-year-old power-sharing government. That government, which includes members of the former opposition, has improved economic and humanitarian conditions during its ongoing transitional rule. However, significant concerns about the country’s political future remain. Zimbabwe’s March 2008 elections resulted in the party of long-serving President Mugabe losing its parliamentary majority for the first time since independence. Opposition leader Morgan Tsvangirai received more votes than Mugabe in the presidential race, but fell short of the needed margin for victory. Tsvangirai later withdrew his name from the ballot days before the required runoff, amid widespread political violence. Mugabe was thus declared the winner. In September 2008, after weeks of negotiations, Tsvangirai and Mugabe reached an agreement to form a unity government, with Mugabe remaining head of state. Tsvangirai became prime minister and cabinet and gubernatorial positions were divided among the parties. Disputes delayed implementation of the agreement until February 2009, when members of the opposition were sworn in alongside former rivals as ministers in a new government. The parties to the power-sharing agreement have faced significant challenges in working together to promote political reconciliation and in addressing serious economic and humanitarian needs.
    [Show full text]
  • Torture in Police Custody of Opposition MP Job Sikhala
    Zimbabwe RIGHTS UNDER SIEGE: Torture in police custody of opposition MP Job Sikhala Members of Parliament (MPs) of the opposition party, Movement for Democratic Change (MDC) face escalating attacks, arbitrary arrests and violations of their rights to freedom of expression, association and assembly. The start of 2003, has witnessed an upsurge in attacks. Job Sikhala the MDC MP for St Mary’s constituency in Harare was arrested in January 2003, marking his fourth arrest in the last two years. Job Sikhala’s constituency of St Mary’s is a tense area where politically motivated violence by government supporters reached new levels in the run up to the parliamentary by-elections in March 2003. On 15 January, 2003, Job Sikhala was arrested along with Gabriel Shumba a lawyer with the Zimbabwe Human Rights NGO forum, and MDC supporters Bishop Shumba, Taurai Magaya and Charles Mutama. At about 11pm, riot police and plain clothes policemen reportedly arrested all five men and accused them of burning a state- owned bus. They were subsequently charged under Section 5 of the Public Order and Security Act (POSA) for allegedly planning to overthrow the government through unconstitutional means. All five were tortured while in police custody, and medical examinations revealed that both Job Sikhala and Gabriel Shumba had electric shocks applied to their genitals, mouth and feet. Both were also forced to drink urine. The charges against the five were subsequently dismissed due to lack of evidence. On 6 February 2001, Job Sikhala was assaulted by two truckloads of army personnel at 4 am, while at his home.
    [Show full text]
  • AC Vol 43 No 15
    www.africa-confidential.com 26 July 2002 Vol 43 No 15 AFRICA CONFIDENTIAL ZIMBABWE 3 SUDAN After the phoney war The economic crisis may just force Calling the shots at Machakos President Robert Mugabe to stand Arch manipulation of American and British peacemakers buys the down at the ruling ZANU-PF’s NIF another six and a half years’ time annual conference in December. ‘Breakthrough on peace!’ shout the headlines. ‘It’s a sham, it won’t work!’ protest the National Islamic Rival factions are lining up behind Parliament’s Speaker, Emmerson Front’s opponents. Five weeks of closed-door discussions at Machakos, Kenya, between the NIF Mnangagwa, and a smaller group government and the Sudan People’s Liberation Army/Movement, ended on 20 July. The talks, under the of ZANU-PF reformers behind auspices of the Inter-Governmental Authority on Development (IGAD), produced a protocol of Finance Minister Simba Makoni. understanding and an agreement to reconvene at the Machakos Garden Hotel on 12 August. The enthusiasm came almost entirely from the government side. Its team, led by presidential Peace KENYA 4Advisor Ghazi Salah el Din el Atabani, a core NIF man, talked as if peace already reigned. The SPLA/M delegation, led by Colonel John Garang de Mabior’s deputy, Commander Salva Kiir Uhuru now! Mayardit, was far less effusive, with good reason. Chaired by Kenya, overseen by Eritrea, Ethiopia and Uganda and driven (in top gear) by Britain and the United States, the talks were heavily weighted Uhuru Kenyatta has a lot of supporters for his bid for the in the Sudan government’s favour.
    [Show full text]
  • Zambia: Forty-Four Soldiers to Be Executed
    AMNESTY INTERNATIONAL PRESS RELEASE Zambia: Forty-four soldiers to be executed Amnesty International is strongly urging President Levy Mwanawasa of Zambia to use his constitutional prerogative to immediately commute the death sentences confirmed by the Supreme Court of Zambia on 44 soldiers for their role in a failed 1997 coup. While Amnesty International recognizes the right of states to bring to justice all those suspected of involvement in criminal acts, the organization believes that executing the soldiers will be a violation of their fundamental human rights. "These men have not been convicted of any offence which caused the death or injury of another and consequently international standards would prohibit the use of the death penalty against them," Amnesty International said. ‘Furthermore, it appears that several of the accused were tortured and that evidence obtained as a result of torture was subsequently used against them during their trials. To execute these men would be a violation of international law.’ Amnesty International opposes the death penalty in all circumstances, considering it to be a violation of the right to life and the right not to be subjected to cruel, inhuman or degrading treatment or punishment. ‘The evidence in support of abolition of the death penalty becomes more compelling with each passing year,’ the organization said. ‘Everywhere experience shows that executions brutalize those involved in the process. Nowhere has it been shown that the death penalty has resulted in a reduction in crime.’ There have been important steps towards abolition of the death penalty across Southern Africa in recent years. Angola, Mauritius, Mozambique, Namibia, Seychelles and South Africa have all abolished the death penalty.
    [Show full text]