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. 2019 Mar 15;19(1):261.
doi: 10.1186/s12879-019-3826-5.

Prevalence, predictors, and management of advanced HIV disease among individuals initiating ART in Senegal, West Africa

Noelle A Benzekri  1 , Jacques F Sambou  2 , Sanou Ndong  3 , Ibrahima Tito Tamba  4 , Dominique Faye  2 , Mouhamadou Baïla Diallo  3 , Jean Phillippe Diatta  2 , Khadim Faye  3 , Ibrahima Sall  2 , Fatima Sall  3 , Noël Magloire Manga  5 , Jean Jacques Malomar  2 , Cheikh T Ndour  6 , Stephen E Hawes  7   8 , Moussa Seydi  3 , Geoffrey S Gottlieb  9   8
Affiliations

Prevalence, predictors, and management of advanced HIV disease among individuals initiating ART in Senegal, West Africa

Noelle A Benzekri et al. BMC Infect Dis. .

Abstract

Background: The WHO guidelines for the management of advanced HIV disease recommend a package of care consisting of rapid initiation of antiretroviral therapy (ART), enhanced screening and diagnosis of tuberculosis (TB) and cryptococcal meningitis, co-trimoxazole prophylaxis, isoniazid preventive therapy (IPT), fluconazole pre-emptive therapy, and adherence support. The goals of this study were to determine the prevalence of advanced HIV disease among individuals initiating ART in Senegal, to identify predictors of advanced disease, and to evaluate adherence to the WHO guidelines.

Methods: This study was conducted among HIV-positive individuals initiating ART in Dakar and Ziguinchor, Senegal. Clinical evaluations, laboratory analyses, questionnaires and chart review were conducted. Logistic regression was used to identify predictors of advanced disease.

Results: A total of 198 subjects were enrolled; 70% were female. The majority of subjects (71%) had advanced HIV disease, defined by the WHO as a CD4 count < 200 cells/mm3 or clinical stage 3 or 4. The median CD4 count was 185 cells/mm3. The strongest predictors of advanced disease were age ≥ 35 (OR 5.80, 95%CI 2.35-14.30) and having sought care from a traditional healer (OR 3.86, 95%CI 1.17-12.78). Approximately one third of subjects initiated ART within 7 days of diagnosis. Co-trimoxazole prophylaxis was provided to 65% of subjects with CD4 counts ≤350 cells/mm3 or stage 3 or 4 disease. TB symptom screening was available for 166 subjects; 54% reported TB symptoms. Among those with TB symptoms, 39% underwent diagnostic evaluation. Among those eligible for IPT, one subject received isoniazid. No subjects underwent CrAg screening or received fluconazole to prevent cryptococcal meningitis.

Conclusions: This is the first study to report an association between seeking care from a traditional healer and presentation with WHO defined advanced disease in sub-Saharan Africa. Given the widespread use of traditional healers in sub-Saharan Africa, future studies to further explore this finding are indicated. Although the majority of individuals in this study presented with advanced disease and warranted management according to WHO guidelines, there were numerous missed opportunities to prevent HIV-associated morbidity and mortality. Programmatic evaluation is needed to identify barriers to implementation of the WHO guidelines and enhanced funding for operational research is indicated.

Keywords: Advanced disease; Antiretroviral therapy (ART); Co-trimoxazole; Cryptococcal meningitis; Fluconazole; HIV/AIDS; Implementation; Isoniazid preventive therapy (IPT); Preventive therapy; Prophylaxis; Senegal; Traditional healer; Tuberculosis (TB); West Africa; World Health Organization (WHO).

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Conflict of interest statement

Ethics approval and consent to participate

Study procedures were approved by the University of Washington Institutional Review Board and the Senegal Comité National d’Ethique pour la Recherche en Santé (CNERS). Written informed consent was required for participation in this study. For subjects < 18 years of age, consent to participate was obtained from their legal guardian.

Consent for publication

Not applicable

Competing interests

GSG has received research grants and support from the US National Institutes of Health, University of Washington, Bill & Melinda Gates Foundation, Gilead Sciences, Alere Technologies, Merck & Co, Inc, Janssen Pharmaceutica, Cerus Corporation, ViiV Healthcare, Bristol-Myers Squibb, and Abbott Molecular Diagnostics. All other authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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