Evolving failures in the delivery of human immunodeficiency virus care: Lessons from a Ugandan meningitis cohort 2006-2016

Andrew G. Flynn, David B. Meya, Katherine Huppler Hullsiek, Joshua Rhein, Darlisha A. Williams, Abdu Musubire, Bozena M. Morawski, Kabanda Taseera, Alisat Sadiq, Liberica Ndyatunga, Mollie Roediger, Radha Rajasingham, Paul R. Bohjanen, Conrad Muzoora, David R. Boulware

Research output: Contribution to journalArticlepeer-review

7 Scopus citations

Abstract

Background. Because of investments in human immunodeficiency virus (HIV) care in sub-Saharan Africa, the number of people aware of their status and receiving antiretroviral therapy (ART) has increased; however, HIV/acquired immune deficiency syndrome (AIDS) mortality still remains high. Methods. We performed retrospective analysis of 3 sequential prospective cohorts of HIV-infected Ugandan adults presenting with AIDS and meningitis from 2006 to 2009, 2010 to 2012, and 2013 to 2016. Participants were categorized as follows: (1) unknown HIV status; (2) known HIV+ without ART; (3) known HIV+ with previous ART. We further categorized 2006 and 2013 cohort participants by duration of HIV-status knowledge and of ART receipt. Results. We screened 1353 persons with suspected meningitis. Cryptococcus was the most common pathogen (63%). Over the decade, we observed an absolute increase of 37% in HIV status knowledge and 59% in antecedent ART receipt at screening. The 2006 cohort participants were new/recent HIV diagnoses (65%) or known HIV+ but not receiving ART (35%). Many 2013 cohort participants were new/recent HIV diagnoses (34%) and known HIV+ with < 1 month ART (20%), but a significant proportion were receiving ART 1-4 months (11%) and > 4 months (30%). Four percent of participants discontinued ART. From 2010 to 2016, meningitis cases per month increased by 33%. Conclusions. Although improved HIV screening and ART access remain much-needed interventions in resource-limited settings, greater investment in viral suppression and opportunistic infection care among the growing HIV-infected population receiving ART is essential to reducing ongoing AIDS mortality.

Original languageEnglish (US)
Article numberofx077
JournalOpen Forum Infectious Diseases
Volume4
Issue number2
DOIs
StatePublished - Mar 1 2017

Bibliographical note

Funding Information:
Financial support. This research was funded by the National Institute of Neurologic Diseases and Stroke (NINDS) and the Fogarty International Center (R01NS086312, R25TW009345, K01TW010268), Grand Challenges Canada (S4-0296-01), and National Institute of Allergy and Infectious Diseases (U01AI089244, T32AI055433, K24AI096925). This work was also funded in part by the Minnesota Medical Foundation, the Tibotec REACH Initiative, the HIV Medicine Association, and the Doris Duke Charitable Foundation through a grant supporting the Doris Duke International Clinical Research Fellows Program at the University of Minnesota. A. G. F. is a Doris Duke International Clinical Research Fellow and received an HIV Medicine Association Medical Student Award.

Keywords

  • Antiretroviral therapy
  • Cryptococcal meningitis
  • HIV care continuum
  • HIV/AIDS
  • Sub-Saharan Africa

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