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Thom Chaweza

Bio: Thom Chaweza is an academic researcher from Kamuzu Central Hospital. The author has contributed to research in topics: Population & Family planning. The author has an hindex of 4, co-authored 8 publications receiving 103 citations.

Papers
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Journal ArticleDOI
TL;DR: Virological failure combined with drug resistance after resumption of first-line ART occurred in 24.1% of the patients with treatment interruption, requiring a switch to protease inhibitor-based second-line therapy.
Abstract: Background. Since 2004, Malawi has rapidly scaled up access to antiretroviral therapy (ART) in the national program following a public health approach with limited laboratory monitoring. We examined virological outcomes in patients with treatment interruption at 2 clinics of the Lighthouse Trust, Lilongwe, Malawi. Methods. We evaluated patients who resumed first-line ART after having at least 1 treatment interruption documented in the electronic data system in 2008–2009. Viral load (VL) was analyzed at least 2 months after resumption of ART. For VL ≥1000 copies/mL, drug-resistance genotype was characterized using the Stanford database. Results. Between June and November 2009, we enrolled 133 patients (58.7% female) with a mean age of 38.4 years. Mean duration of ART prior to treatment interruption was 14.3 months. After a minimum of 2 months following ART resumption, VL was undetectable in 81 (60.9%) patients, was 400–1000 copies/mL in 12 (9.0%) patients, and was ≥1000 copies/mL in 40 (30.1%) patients. Genotyping and drug-resistance testing were successfully performed for 36 of 40 patients, all carrying human immunodeficiency virus type 1 subtype C. Relevant mutations affecting nonnucleoside reverse transcriptase inhibitors were found in 32 of 133 (24.1%) patients and combined with relevant nucleoside reverse transcriptase mutations in 27 of 133 (20.3%) patients. Conclusions. Virological failure combined with drug resistance after resumption of first-line ART occurred in 24.1% of the patients with treatment interruption, requiring a switch to protease inhibitor–based second-line therapy. Patients with treatment interruption should receive VL assessment after resumption of ART to detect treatment failure and to reduce development and spread of drug resistance.

47 citations

Journal ArticleDOI
TL;DR: It is recommended that ART clinics integrate comprehensive family planning services to address reproductive health needs among women on ART and increasing age and advanced WHO clinical stage were associated with decreased probability of becoming pregnant while higher body mass index and longer time on ART were associatedWith increased probability of become pregnant.
Abstract: Although previous studies investigated pregnancy rates among women on antiretroviral therapy (ART), incidence of, and factors associated with pregnancy among these women remain poorly understood. We, therefore, conducted a retrospective cohort study at a large public HIV clinic in Lilongwe, Malawi, between July 2007 and December 2010. At each clinic visit, pregnancy status was assessed. Time to event analysis was conducted using Poisson regression. Among 4,738 women, 589 pregnancies were observed. Pregnancy incidence was 9.3/100 person-years. After 6 months on ART, women on ART had similar total fertility rates to women in the urban population. In multivariable analysis, increasing age and advanced WHO clinical stage were associated with decreased probability of becoming pregnant while higher body mass index and longer time on ART were associated with increased probability of becoming pregnant. We recommend that ART clinics integrate comprehensive family planning services to address reproductive health needs among women on ART.

36 citations

Journal ArticleDOI
TL;DR: In this observational study, patients on TDF-containing second-line ART were less likely to develop treatment failure than patients on other regimens and seems to be an effective component of second- line ART in southern Africa.
Abstract: OBJECTIVES: Tenofovir (TDF) is increasingly used in second-line antiretroviral treatment (ART) in sub-Saharan Africa. We compared outcomes of second-line ART containing and not containing TDF in cohort studies from Zambia and the Republic of South Africa (RSA). METHODS: Patients aged 16 years and older starting protease-inhibitor-based second-line ART in Zambia (1 cohort) and RSA (5 cohorts) were included. We compared mortality immunological failure (all cohorts) and virological failure (RSA only) between patients receiving and not receiving TDF. Competing risk models and Cox models adjusted for age sex CD4 count time on first-line ART and calendar year were used to analyze mortality and treatment failure respectively. Hazard ratios (HRs) were combined in fixed-effects meta-analysis. FINDINGS: 1687 patients from Zambia and 1556 patients from RSA including 1350 (80.0%) and 206 (13.2%) patients starting TDF were followed over 4471 person-years. Patients on TDF were more likely to have started second-line ART in recent years and had slightly higher baseline CD4 counts than patients not on TDF. Overall 127 patients died 532 were lost to follow-up and 240 patients developed immunological failure. In RSA 94 patients had virologic failure. Combined HRs comparing TDF with other regimens were 0.60 (95% confidence interval [CI]: 0.41 to 0.87) for immunologic failure and 0.63 (0.38-1.05) for mortality. The HR for virologic failure in RSA was 0.28 (0.09-0.90). CONCLUSIONS: In this observational study patients on TDF-containing second-line ART were less likely to develop treatment failure than patients on other regimens. TDF seems to be an effective component of second-line ART in southern Africa.

15 citations

Journal ArticleDOI
TL;DR: The men and women in the study population differed in the factors associated with hormonal and intrauterine contraceptive use, and understanding these differences may help decrease unmet FP needs among HIV-infected men andWomen.
Abstract: Background. Understanding the factors associated with the use of hormonal and intrauterine contraception among HIV-infected men and women may lead to interventions that can help reduce high unintended pregnancy rates. Materials and Methods. This study is a subanalysis of a cross-sectional survey of 289 women and 241 men who were sexually active and HIV-infected and were attending HIV care visits in Lilongwe, Malawi. We estimated adjusted prevalence ratios (PRs) to evaluate factors associated with hormonal and intrauterine contraceptive use for men and women in separate models. Results and Discussion. 39.8% of women and 33.2% of men () reported that they were using hormonal or intrauterine contraception at last intercourse. Having greater than 3 children was the only factor associated with hormonal and intrauterine contraceptive use among men. Among women, younger age, not wanting a pregnancy in 2 years, being with their partner for more than 4 years, and being able to make family planning decisions by themselves were associated with hormonal and intrauterine contraceptive use. Conclusions. The men and women in our study population differed in the factors associated with hormonal and intrauterine contraceptive use. Understanding these differences may help decrease unmet FP needs among HIV-infected men and women.

6 citations

Journal ArticleDOI
TL;DR: The Lighthouse Trust (Lighthouse) as mentioned in this paper is a volunteer initiative for home-based care in Malawi that has developed considerably over a period of 15 years (2000 to 2015).
Abstract: The HIV epidemic has triggered the development of new health institutions with a special focus on HIV care. The role of these relatively new institutions within the health systems of low-income countries like Malawi is not clearly determined. We evaluate and describe the development of one example, the Lighthouse Trust (Lighthouse), over a period of 15 years (2000–2015). Data from multiple sources, including a document review, participatory observation and interviews were analysed, triangulated and synthesized. The institution’s development, function, cooperation, financing, research and training were analysed using institutional administrative documents, annual reviews, project reports. For the assessment of the research activities, all publications that the Lighthouse contributed to were retrieved and categorized. Participatory observation and interviews with key Lighthouse staff members and external stakeholders were conducted. Established in 1997 as a volunteer initiative for home-based care, the Lighthouse has developed considerably. Major steps include being registered as a trust, moving into their own buildings, expanding clinical services, becoming a centre for clinical service, training and research working with close to 300 employees. As an independent legal entity, Lighthouse Trust works in close cooperation with Malawian public health services and plays an important role in the government’s HIV programme. Funding comes from various sources with a lion’s share from the US Centers for Disease Control and Prevention. Throughout 2015, the Lighthouse performed 58,210 HIV testing and counselling encounters and by year’s end, 28,302 patients were alive and on ART. From 2000 to 2015 Lighthouse staff contributed to 94 peer-reviewed publications. Novel institutions like the Lighthouse have been developed in the response to HIV. The Lighthouse has demonstrated its capacity to deliver health services and contributed significantly to the current level of success in addressing the disease. However, this kind of institution’s position in local health care systems is still developing. The Lighthouse will need to continue to work on well-planned strategies that consider the changing landscape of health needs, health care provision and financing. Independent institutions like the Lighthouse can contribute to the development of health systems in countries like Malawi that improve health care responsiveness and quality for the entire population.

6 citations


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Journal ArticleDOI
TL;DR: The advantages and disadvantages of various approaches to measuring the latent reservoir of HIV-1 in resting memory CD4(+) T cells are described.

191 citations

Journal ArticleDOI
TL;DR: Resistance of HIV to first-line therapy is predictable at 12 months when evaluated by means of HIV RNA monitoring and, when detected, largely preserves second-line Therapy options, critical for long-term prevention of drug resistance.
Abstract: In the past decade, the marked expansion of human immunodeficiency virus (HIV) treatment programs in resource-limited settings has resulted in the receipt of life-saving therapy by >8 million individuals [1, 2]. In line with World Health Organization (WHO) guidelines, most countries have adopted similar approaches for initial antiretroviral treatment, with the overwhelming majority of programs choosing first-line regimens based on nonnucleoside reverse transcriptase inhibitors (NNRTIs) and 2 nucleoside reverse-transcriptase inhibitors (NRTIs). Countries are moving to phase out stavudine (d4T), used initially because of its low cost and twice-daily fixed-dose formulation with lamivudine (3TC) and nevirapine (NVP) [3], and are adopting tenofovir (TDF)–based therapy because of its more favorable long-term safety profile and once-daily fixed-dose combination with either 3TC or emtricitabine (FTC) plus efavirenz (EFV) or with zidovudine (ZDV)–based therapy [4]. Second-line therapy has consisted of a protease inhibitor (PI) with 2 NRTIs; most programs have not yet adopted third-line regimens. As a component of antiretroviral therapy (ART) roll out, surveillance for HIV drug resistance has been a critical to WHO recommendations and includes monitoring for early indicators of poor program performance, surveillance of transmitted drug resistance, and evaluation of drug resistance acquired during therapy [5]. Alongside WHO activities, treatment programs and research groups have evaluated the emergence of drug resistance among treated populations to better inform new treatment guidelines. To date, emergence of drugs resistance varies according to initial regimen choice, treatment monitoring strategies, and individual patient adherence and program factors. For this scientific overview, we review WHO publications, systematic reviews, and relevant abstracts and manuscripts on the topic of drug resistance and summarize presentations and expert discussions conducted at the Collaborative HIV and Drug Resistance Network workshop in Geneva, Switzerland, on 10 and 11 October 2012. Specifically, we summarize the emergence of first-line drug resistance mutations after 12 months of ART and, on the basis of monitoring strategies, describe the outcomes to second-line therapy and summarize HIV resistance among patients in whom second-line therapies have failed.

127 citations

Journal ArticleDOI
TL;DR: Pharmacy refill adherence emerged as the best method for predicting virological failure and to identify patients to be considered for viral load monitoring and HIVDR testing in RLS.
Abstract: Optimal adherence to antiretroviral therapy is critical to prevent HIV drug resistance (HIVDR) epidemic. The objective of the study was to investigate the best performing adherence assessment method for predicting virological failure in resource-limited settings (RLS). This study was a single-centre prospective cohort, enrolling 220 HIV-infected adult patients attending an HIV/AIDS Care and Treatment Centre in Dar es Salaam, Tanzania, in 2010. Pharmacy refill, self-report (via visual analog scale [VAS] and the Swiss HIV Cohort study-adherence questionnaire), pill count, and appointment keeping adherence measurements were taken. Univariate logistic regression (LR) was done to explore a cut-off that gives a better trade-off between sensitivity and specificity, and a higher area under the curve (AUC) based on receiver operating characteristic curve in predicting virological failure. Additionally, the adherence models were evaluated by fitting multivariate LR with stepwise functions, decision trees, and random forests models, assessing 10-fold multiple cross validation (MCV). Patient factors associated with virological failure were determined using LR. Viral load measurements at baseline and one year after recruitment were available for 162 patients, of whom 55 (34%) had detectable viral load and 17 (10.5%) had immunological failure at one year after recruitment. The optimal cut-off points significantly predictive of virological failure were 95%, 80%, 95% and 90% for VAS, appointment keeping, pharmacy refill, and pill count adherence respectively. The AUC for these methods ranged from 0.52 to 0.61, with pharmacy refill giving the best performance at AUC 0.61. Multivariate logistic regression with boost stepwise MCV had higher AUC (0.64) compared to all univariate adherence models, except pharmacy refill adherence univariate model, which was comparable to the multivariate model (AUC = 0.64). Decision trees and random forests models were inferior to boost stepwise model. Pharmacy refill adherence (<95%) emerged as the best method for predicting virological failure. Other significant predictors in multivariate LR were having a baseline CD4 T lymphocytes count < 200 cells/μl, being unable to recall the diagnosis date, and a higher weight. Pharmacy refill has the potential to predict virological failure and to identify patients to be considered for viral load monitoring and HIVDR testing in RLS.

82 citations

Journal ArticleDOI
26 Sep 2013-PLOS ONE
TL;DR: The extent to which patients considered LTFU are misclassified as true disengagement from care when they are still alive on antiretroviral therapy is described and reasons for ART discontinuation are explained using the authors' active tracing program to further improve ART retention programs and policies.
Abstract: INTRODUCTION Patients who are lost to follow-up (LTFU) while on antiretroviral therapy (ART) pose challenges to the long-term success of ART programs. We describe the extent to which patients considered LTFU are misclassified as true disengagement from care when they are still alive on ART and explain reasons for ART discontinuation using our active tracing program to further improve ART retention programs and policies. METHODS We identified adult ART patients who missed clinic appointment by more than 3 weeks between January 2006 and December 2010, assuming that such patients would miss their doses of antiretroviral drugs. Patients considered LTFU who consented during ART registration were traced by phone or home visits; true ART status after tracing was documented. Reasons for ART discontinuation were also recorded for those who stopped ART. RESULTS Of the 4,560 suspected LTFU cases, 1,384 (30%) could not be traced. Of the 3,176 successfully traced patients, 952 (30%) were dead and 2,224 (70%) were alive, of which 2,183 (99.5%) started ART according to phone-based self-reports or physical verification during in-person interviews. Of those who started ART, 957 (44%) stopped ART and 1,226 (56%) reported still taking ART at the time of interview by sourcing drugs from another clinic, using alternative ART sources or making brief ART interruptions. Among 940 cases with reasons for ART discontinuations, failure to remember (17%), too weak/sick (12%), travel (46%), and lack of transport to the clinic (16%) were frequently cited; reasons differed by gender. CONCLUSION The LTFU category comprises sizeable proportions of patients still taking ART that may potentially bias retention estimates and misdirect resources at the clinic and national levels if not properly accounted for. Clinics should consider further decentralization efforts, increasing drug allocations for frequent travels, and improving communication on patient transfers between clinics to increase retention and adherence.

76 citations

Journal ArticleDOI
TL;DR: It is found that food insecurity was a common and an important barrier to ART adherence among patients in the DRC, and food insecurity should be appropriately addressed and incorporated into ARV treatment programs to ensure patient adherence and ultimately the long-term success of HIV treatment in the region.
Abstract: The global response to the HIV/AIDS epidemic has improved access to antiretroviral therapy (ART) and has contributed to decreased HIV/AIDS morbidity and mortality in sub-Saharan Africa. Patient adherence to ART is crucial to the success of HIV/AIDS treatment. However, little is known about the determinants of adherence to ART among people living with HIV/AIDS (PLWHA) in the Democratic Republic of Congo (DRC). This qualitative study used in-depth semi-structured patient interviews, a purposive sampling strategy and thematic analysis scheme to identify barriers and facilitators of adherence to ART in the DRC. We recruited three categories of participants from the Centre Hospitalier Monkole and the NGO ACS/Amo-Congo including participants on antiretroviral (ARV) treatment (n=19), on ARV re-treatment (n=13) and lost to follow-up (n=6). Among 38 participants interviewed, 24 were female and the median age was 41 years. Food insecurity as a barrier to adherence emerged as a dominant theme across the three catego...

74 citations