Temporal changes in programme outcomes among adult patients initiating antiretroviral therapy across South Africa, 2002-2007

Little is known about the temporal impact of the rapid scale-up of large antiretroviral therapy (ART) services on programme outcomes. We describe patient outcomes [mortality, loss-to-follow-up (LTFU) and retention] over time in a network of South African ART cohorts.

Ärztliche Haltung zur Komplementärmedizin in der Region Burgdorf

Hintergrund: Komplementärmedizinische Methoden sind in der Schweiz seit langem sehr beliebt. Gemäss den Schweizerischen Gesundheitsbefragungen 2002/2007 lassen sich mehr als 30% der Bevölkerung über 15 Jahren innerhalb eines Jahres komplementärmedizinisch behandeln. Auf Lebensfrist steigt diese Zahl auf 63.4%. Eine aktuelle Untersuchung der KIKOM zeigt, dass ca. 30% der befragten Grundversorgern in der ganzen Schweiz mehr als einmal pro Woche von Patienten nach Komplementärmedizin gefragt werden. Dieselbe Studie zeigt, dass ein Grossteil der befragten Grundversorger selber Komplementärmedizin anbieten oder Patienten für komplementärmedizinische Behandlungen überweisen. Zur Einstellung von Ärzten gegenüber Komplementärmedizin existieren viele Studien. Kaum untersucht ist bisher, ob und wie sich die Haltung von Spitalärzten und zuweisenden Ärzten nach Einrichtung eines Ambulatoriums/Konsiliartätigkeit mit Komplementärmedizin ändert. Fragestellung Wie ist die Haltung gegenüber Komplementärmedizin bei den Ärzten in der Region Burgdorf (Spital Burgdorf, zuweisende Ärzte) vor der Einrichtung einer Sprechstunden-/Konsiliartätigkeit von drei komplementärmedizinischen Methoden (Akupunktur/TCM, Anthroposophische Medizin, Klassische Homöopathie) am Spital Burgdorf und wie ist die Haltung nach einem Jahr und nach zwei Jahren? Methode: Mittels eines Fragebogens werden Meinung und Entschiedenheit dieser Aussage gegenüber Komplementärmedizin und ganzheitlichem Heilungsverständnis erfasst. Der Fragebogen steht Online zur Verfügung und wird zusätzlich allen Ärzten per Post zugeschickt. Die erste Befragung Ende 2010/Anfangs 2011 dient der Erhebung der Ausgangsdaten vor der Aufnahme der Sprechstundentätigkeit. In jährlichen Abständen wird die Umfrage wiederholt. Ergebnis: Von 170 verschickten Fragebogen wurden 6 nicht zugestellt. Lediglich 5 Teilnehmer haben den Fragebogen online ausgefüllt. 43 Fragebogen kamen spontan zurück. Nach telefonischem und schriftlichem Reminder konnten nochmals 26 Fragebogen eingeholt werden. Die Rücklaufquote beträgt damit 45% (74 von 164). Die weiteren Resultate sind in der Auswertung und werden im August zur Verfügung stehen.

Risk attribution of Campylobacter infection by age group using exposure modelling

Knowledge on the relative importance of alternative sources of human campylobacteriosis is important in order to implement effective disease prevention measures. The objective of this study was to assess the relative importance of three key exposure pathways (travelling abroad, poultry meat, pet contact) for different patient age groups in Switzerland. With a stochastic exposure model data on Campylobacter incidence for the years 2002-2007 were linked with data for the three exposure pathways and the results of a case-control study. Mean values for the population attributable fractions (PAF) over all age groups and years were 27% (95% CI 17-39) for poultry consumption, 27% (95% CI 22-32) for travelling abroad, 8% (95% CI 6-9) for pet contact and 39% (95% CI 25-50) for other risk factors. This model provided robust results when using data available for Switzerland, but the uncertainties remained high. The output of the model could be improved if more accurate input data are available to estimate the infection rate per exposure. In particular, the relatively high proportion of cases attributed to 'other risk factors' requires further attention.

Hodgkin lymphoma in the Swiss HIV Cohort Study

Hodgkin lymphoma (HL) risk is elevated among persons infected with HIV (PHIV) and has been suggested to have increased in the era of combined antiretroviral therapy (cART). Among 14,606 PHIV followed more than 20 years in the Swiss HIV Cohort Study (SHCS), determinants of HL were investigated using 2 different approaches, namely, a cohort and nested case-control study, estimating hazard ratios (HRs) and matched odds ratios, respectively. Forty-seven incident HL cases occurred during 84,611 person-years of SHCS follow-up. HL risk was significantly higher among men having sex with men (HR vs intravenous drug users = 2.44, 95% confidence interval [CI], 1.13-5.24) but did not vary by calendar period (HR for 2002-2007 vs 1995 or earlier = 0.65, 95% CI, 0.29-1.44) or cART use (HR vs nonusers = 1.02, 95% CI, 0.53-1.94). HL risk tended to increase with declining CD4(+) cell counts, but these differences were not significant. A lower CD4(+)/CD8(+) ratio at SHCS enrollment or 1 to 2 years before HL diagnosis, however, was significantly associated with increased HL risk. In conclusion, HL risk does not appear to be increasing in recent years or among PHIV using cART in Switzerland, and there was no evidence that HL risk should be increased in the setting of improved immunity.

Long-term trends of HIV type 1 drug resistance prevalence among antiretroviral treatment-experienced patients in Switzerland

BACKGROUND:Accurate quantification of the prevalence of human immunodeficiency virus type 1 (HIV-1) drug resistance in patients who are receiving antiretroviral therapy (ART) is difficult, and results from previous studies vary. We attempted to assess the prevalence and dynamics of resistance in a highly representative patient cohort from Switzerland. METHODS:On the basis of genotypic resistance test results and clinical data, we grouped patients according to their risk of harboring resistant viruses. Estimates of resistance prevalence were calculated on the basis of either the proportion of individuals with a virologic failure or confirmed drug resistance (lower estimate) or the frequency-weighted average of risk group-specific probabilities for the presence of drug resistance mutations (upper estimate). RESULTS:Lower and upper estimates of drug resistance prevalence in 8064 ART-exposed patients were 50% and 57% in 1999 and 37% and 45% in 2007, respectively. This decrease was driven by 2 mechanisms: loss to follow-up or death of high-risk patients exposed to mono- or dual-nucleoside reverse-transcriptase inhibitor therapy (lower estimates range from 72% to 75%) and continued enrollment of low-risk patients who were taking combination ART containing boosted protease inhibitors or nonnucleoside reverse-transcriptase inhibitors as first-line therapy (lower estimates range from 7% to 12%). A subset of 4184 participants (52%) had >or= 1 study visit per year during 2002-2007. In this subset, lower and upper estimates increased from 45% to 49% and from 52% to 55%, respectively. Yearly increases in prevalence were becoming smaller in later years. CONCLUSIONS:Contrary to earlier predictions, in situations of free access to drugs, close monitoring, and rapid introduction of new potent therapies, the emergence of drug-resistant viruses can be minimized at the population level. Moreover, this study demonstrates the necessity of interpreting time trends in the context of evolving cohort populations.

A different perspective on poverty in Lao PDR: Multidimensional poverty in Lao PDR for the years 2002/2003 and 2007/2008

This paper presents an indicator for measuring multidimensional poverty in the Lao People’s Democratic Republic applying the Alkire–Foster methodology to the Lao Expenditure and Consumption Survey 2002/2003 and 2007/2008. We calculated a multidimensional poverty index (MPI) that includes three dimensions: education, health, and standard of living. Making use of the MPI’s decomposability, we analyse how much each of the different dimensions and its respective indicators contribute to the overall MPI. We find a marked reduction in the multidimensional poverty headcount ratio over the study period, regardless of how the indicators are weighted or how the deprivation and poverty cut-offs are set. This reduction is based on improvements regarding all indicators except cooking fuel and nutrition. We observe no significant reduction in the intensity of poverty, however; there are wide disparities between the country’s regions and between urban and rural areas. The proportion of poor people in rural areas is more than twice as high as that in urban areas. By complementing the traditional income-based poverty measure, we hope to provide useful information that can support knowledge-based decision-making for poverty alleviation.