Cryptococcal meningitis screening and community-based early adherence support in people with advanced HIV infection starting antiretroviral therapy in Tanzania and Zambia: an open-label, randomised controlled trial

Lancet
Sayoki MfinangaREMSTART trial team

Abstract

Mortality in people in Africa with HIV infection starting antiretroviral therapy (ART) is high, particularly in those with advanced disease. We assessed the effect of a short period of community support to supplement clinic-based services combined with serum cryptococcal antigen screening. We did an open-label, randomised controlled trial in six urban clinics in Dar es Salaam, Tanzania, and Lusaka, Zambia. From February, 2012, we enrolled eligible individuals with HIV infection (age ≥18 years, CD4 count of <200 cells per μL, ART naive) and randomly assigned them to either the standard clinic-based care supplemented with community support or standard clinic-based care alone, stratified by country and clinic, in permuted block sizes of ten. Clinic plus community support consisted of screening for serum cryptococcal antigen combined with antifungal therapy for patients testing antigen positive, weekly home visits for the first 4 weeks on ART by lay workers to provide support, and in Tanzania alone, re-screening for tuberculosis at 6-8 weeks after ART initiation. The primary endpoint was all-cause mortality at 12 months, analysed by intention to treat. This trial is registered with the International Standard Randomised Controlled T...Continue Reading

References

Apr 16, 2002·AIDS·Neil FrenchCharles F Gilks
Feb 21, 2003·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Charles B HolmesKenneth A Freedberg
Sep 15, 2005·International Journal of Epidemiology·François DabisUNKNOWN Antiviral Therpapy in Lower Income Countries (ART-LINC) Study Group
Aug 19, 2007·Tropical Medicine & International Health : TM & IH·Cheryl A LiechtyJonathan Mermin
Jan 16, 2008·BMC Public Health·Dag Gundersen StorlaGunnar Aksel Bjune
Apr 25, 2008·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Andrew KambuguDavid R Boulware
Feb 19, 2009·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Joseph N JarvisThomas S Harrison
Jul 6, 2010·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·David B MeyaDavid R Boulware
Jun 10, 2011·Proceedings of the American Thoracic Society·Neil A MartinsonRichard E Chaisson
Mar 14, 2012·Journal of Acquired Immune Deficiency Syndromes : JAIDS·Radha RajasinghamDavid R Boulware
Nov 13, 2012·PloS One·Nicolas A MenziesJohn M Blandford
Feb 23, 2013·Current Opinion in Pulmonary Medicine·Matthew BatesAlimuddin Zumla
Nov 8, 2013·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Maria LahuertaUNKNOWN Identifying Optimal Models of HIV Care in sub-Saharan Africa Collaboration
Nov 23, 2013·Tropical Medicine & International Health : TM & IH·Victoria SimmsShabbar Jaffar
Dec 10, 2013·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Joseph N JarvisThomas Harrison
Jan 15, 2014·Journal of Acquired Immune Deficiency Syndromes : JAIDS·Dorita AvilaMatthias Egger
Apr 25, 2014·The Lancet Infectious Diseases·Angela LoyseUNKNOWN all authors
May 30, 2014·Clinical Epidemiology·Derek J Sloan, Victoria Parris
Aug 12, 2014·The Lancet Global Health·Giorgio ComettoTim Evans

❮ Previous
Next ❯

Citations

Nov 14, 2015·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Nicky LongleyThomas S Harrison
Dec 22, 2015·Nature Reviews. Microbiology·Robin C MayKirsten Nielsen
Jan 8, 2016·Infectious Disease Clinics of North America·Snigdha VallabhaneniTom Chiller
May 10, 2016·Current Fungal Infection Reports·Elizabeth NalintyaDavid Meya
Mar 15, 2015·Lancet·Radha Rajasingham, David R Boulware
Oct 14, 2016·BMC Infectious Diseases·Susannah L WooddSuzanne Filteau
Nov 26, 2016·Nature Reviews. Neurology·Peter R WilliamsonThomas S Harrison
Jan 24, 2017·Expert Review of Anti-infective Therapy·Sarah LofgrenDavid R Boulware
Jun 2, 2017·MMWR. Morbidity and Mortality Weekly Report·Andrew F AuldTedd V Ellerbrock
May 16, 2017·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Mark W TenfordeJoseph N Jarvis
Mar 2, 2018·Journal of Fungi·Patricia EscandónElizabeth Castañeda
Oct 14, 2017·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Rachel M WakeNelesh P Govender
Oct 12, 2017·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Tafese BeyeneDavid R Boulware
Mar 8, 2018·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Lisa FrigatiNathan Ford
Mar 8, 2018·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Nathan FordGraeme Meintjes
Mar 8, 2018·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Nathan FordUNKNOWN Guideline Development Group for Managing Advanced HIV Disease and Rapid Initiation of Antiretroviral Therapy
May 18, 2018·Journal of Acquired Immune Deficiency Syndromes : JAIDS·Rachel M WakeNelesh P Govender
Jul 26, 2018·The Cochrane Database of Systematic Reviews·Mark W TenfordeNathan Ford
Jun 4, 2016·Current Clinical Microbiology Reports·Mark W TenfordeJoseph N Jarvis
Aug 30, 2018·The Cochrane Database of Systematic Reviews·Ajibola A AwotiwonIngrid Eshun-Wilson
Sep 2, 2015·Antimicrobial Agents and Chemotherapy·Kyle D SmithUNKNOWN ASTRO-CM/COAT Team
Dec 7, 2018·The Cochrane Database of Systematic Reviews·Chantal MigoneIngrid Eshun-Wilson
Sep 28, 2018·Journal of Clinical Microbiology·Radha RajasinghamDavid R Boulware
Nov 14, 2018·Journal of Acquired Immune Deficiency Syndromes : JAIDS·Diana FainiEmilio Letang
Jan 31, 2019·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Joseph N Jarvis, Thomas S Harrison
Oct 28, 2016·Nature Reviews. Neurology·Lauren N BowenAvindra Nath
Jun 18, 2019·The Cochrane Database of Systematic Reviews·Alberto Mateo-UrdialesIngrid Eshun-Wilson
Jun 11, 2019·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Radha Rajasingham, David R Boulware

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Next ❯

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