Publications des membres du Ceped

2021



  • Diallo Alhassane, Carlos-Bolumbu Miguel, Cervantes-Gonzalez Minerva, Wozniak Veronika, Diallo Mamadou Hassimiou, Diallo Boubacar Djelo, Delamou Alexandre et Galtier Florence (2021) « Immunogenicity and safety of Ebola virus vaccines in healthy adults: a systematic review and network meta-analysis », Human Vaccines & Immunotherapeutics (juillet 16), p. 1-13. DOI : 10.1080/21645515.2021.1932214. https://www.tandfonline.com/doi/full/10.1080/21645515.2021.1932214.

2020



  • Diallo Alhassane, Diallo Boubacar Djelo, Camara Lansana Mady, Kounoudji Lucrèce Ahouéfa Nadège, Bah Boubacar, N’Zabintawali Fulgence, Carlos-Bolumbu Miguel, Diallo Mamadou Hassimiou et Sow Oumou Younoussa (2020) « Different profiles of body mass index variation among patients with multidrug-resistant tuberculosis: a retrospective cohort study », BMC Infectious Diseases, 20 (1). DOI : 10.1186/s12879-020-05028-0. https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-020-05028-0.
    Résumé : Contexte Malgré le rôle prédictif de la variation du poids corporel dans les résultats du traitement dans la tuberculose multirésistante (TB-MR), peu de données corroborantes sont disponibles. Nous avons étudié la variation de poids chez les patients atteints de TB-MR pour identifier les groupes de changement de poids et déterminer les facteurs qui influencent ces changements. Les méthodes Nous avons analysé les patients présentant une résistance à la rifampicine qui ont été traités par un schéma thérapeutique contre la TB-MR entre le 7 juin 2016 et le 22 juin 2018 dans trois grands centres de TB résistants aux médicaments en Guinée. Les patients ont été vus tous les mois jusqu'à la fin du traitement. Le résultat clinique était l'indice de masse corporelle (IMC). Nous avons utilisé un modèle mixte linéaire pour analyser les trajectoires de l'IMC et un modèle mixte de classe latente pour identifier les groupes de trajectoires de l'IMC. Résultats Sur 232 patients traités pour TB-MR au cours de la période d'étude, 165 ont été analysés. Ces patients ont eu un total de 1 387 visites, avec une médiane de 5 visites (intervalle interquartile, 3 à 8 visites). L'IMC mensuel était de 0,24 (SE 0,02) par kg / m 2 . Les facteurs associés à une progression plus rapide de l'IMC étaient le succès du traitement de la TB-MR (0,24 [SE 0,09] par kg / m 2 ; p  = 0,0205) et l'absence de cavités pulmonaires aux rayons X (0,18 [0,06] par kg / m 2 ; p  = 0,0068). Deux groupes de changement d'IMC ont été identifiés: augmentation rapide de l'IMC ( n  = 121; 85%) et augmentation lente de l'IMC ( n = 22; 15%). Les patients du groupe à augmentation lente de l'IMC étaient principalement des femmes (68%) n'avaient aucun antécédent de traitement antituberculeux (41%), avaient une infection par le VIH positive (59%) et avaient une condition clinique plus sévère au départ, caractérisée par une fréquence plus élevée des symptômes, dont la dépression (18%), la dyspnée (68%), une mauvaise observance du traitement contre la TB-MR (64%), une numération plaquettaire plus faible et un SGOT plus élevé. Ces patients ont également eu un temps de conversion de culture plus long (test du log-rank: p  = 0,0218). Conclusion Les données quantitatives de l'IMC sur les patients atteints de TB-MR traités avec un régime court ont permis d'identifier des sous-groupes de patients avec différentes trajectoires d'IMC et ont souligné l'utilité de l'IMC en tant que biomarqueur pour le suivi des résultats du traitement de la TB-MR.

2018


  • Larmarange Joseph, Diallo Mamadou Hassimiou, McGrath Nuala, Iwuji Collins, Plazy Mélanie, Thiébaut Rodolphe, Tanser Frank, Bärnighausen Till, Orne-Gliemann Joanna, Pillay Deenan, Dabis François et ANRS 12249 TasP Study Group (2018) « Temporal trends of population viral suppression in the context of Universal Test and Treat: results from the ANRS 12249 TasP trial in rural South Africa » (communication orale TUAC0103), présenté à 22nd International AIDS Conference, Amsterdam. http://programme.aids2018.org/Programme/Session/105.
    Résumé : Background: The universal test-and-treat strategy (UTT) aims to maximize the proportion of all people living with HIV (PLWHIV) on antiretroviral treatment (ART) and virally suppressed in a community, i.e. to reach population viral suppression (PVS). The ANRS 12249 TasP trial did not demonstrate an impact of universal ART on HIV incidence at population level (Lancet HIV 2017). Here, we investigated whether PVS improved during the course of the trial: differentially by arm, according to trial interventions or contextual changes. Methods: The TasP cluster-randomized trial (2012-2016) implemented six-monthly repeated home-based HIV counselling and testing (RHBCT) and referral of PLWHIV to local HIV clinics in 2×11 clusters opened sequentially. ART was initiated according to national guidelines in control clusters vs. regardless of CD4 count in intervention clusters. Test results, clinic visits, ART prescriptions, viral loads, CD4 counts, migrations and deaths were used to produce information on residency status, HIV status and HIV care status for each participant. PVS was computed daily and per cluster among all resident PLWHIV (≥16, including those not in care). We used a mixed linear model to explore the relation between PVS with calendar time, time since cluster opening, trial arm and interaction between arm and time since cluster opening, adjusting on sociodemographic changes at cluster level. Results: 8,646 PLWHIV were observed. Between January 1st, 2013 and January 1st, 2016, PVS increased significantly in both arms (intervention: 29.0% to 46.2%, +17.2, p< 0.001; control: 32.4% to 44.6%, +12.2, p < 0.001), but difference in temporal variation (+5.0%) was not significant (p=0.175). According to adjusted model (figure) this increase was mainly attributable to RHBCT (measured by time since cluster opening). They were also some effect due to contextual changes (measured by calendar time). The effect attributable to universal ART (interaction term) was limited. Conclusions: Although suboptimal, the UTT strategy implemented in TasP trial improved PVS over time. As it was mainly due to RHBCT rather than universal ART, it did not induce differences between arms, explaining the null effect observed on cumulative incidence, the main trial finding. Changes in ART initiation guidelines alone are not enough to significantly increase PVS.


  • Larmarange Joseph, Diallo Mamadou Hassimiou, McGrath Nuala, Iwuji Collins, Plazy Mélanie, Thiébaut Rodolphe, Tanser Frank, Bärnighausen Till, Pillay Deenan, Dabis François et Orne‐Gliemann Joanna (2018) « The impact of population dynamics on the population HIV care cascade: results from the ANRS 12249 Treatment as Prevention trial in rural KwaZulu-Natal (South Africa) », Journal of the International AIDS Society, 21 (S4) (juillet 20), p. e25128. DOI : 10.1002/jia2.25128. https://onlinelibrary.wiley.com/doi/abs/10.1002/jia2.25128.
    Résumé : Introduction The universal test and treat strategy (UTT) was developed to maximize the proportion of all HIV-positive individuals on antiretroviral treatment (ART) and virally suppressed, assuming that it will lead to a reduction in HIV incidence at the population level. The evolution over time of the cross-sectional HIV care cascade is determined by individual longitudinal trajectories through the HIV care continuum and underlying population dynamics. The purpose of this paper is to quantify the contribution of each component of population change (in- and out-migration, HIV seroconversion, ageing into the cohort and definitive exit such as death) on the HIV care cascade in the context of the ANRS 12249 Treatment as Prevention (TasP) cluster-randomized trial, investigating UTT in rural KwaZulu-Natal, South Africa, between 2012 and 2016. Methods HIV test results and information on clinic visits, ART prescriptions, viral load and CD4 count, migration and deaths were used to calculate residency status, HIV status and HIV care status for each individual on a daily basis. Position within the HIV care continuum was considered as a score ranging from 0 (undiagnosed) to 4 (virally suppressed). We compared the cascade score of each individual joining or leaving the population of resident adults living with HIV with the average score of their cluster at the time of entry or exit. Then, we computed the contribution of each entry or exit on the average cascade score and their annualized total contribution, by component of change. Results While the average cascade score increased over time in all clusters, that increase was constrained by population dynamics. Permanent exits and ageing into the people living with HIV cohort had a marginal effect. Both in-migrants and out-migrants were less likely to be retained at each step of the HIV care continuum. However, their overall impact on the cross-sectional cascade was limited as the effect of in- and out-migration balanced each other. The contribution of HIV seroconversions was negative in all clusters. Conclusions In a context of high HIV incidence, the continuous flow of newly infected individuals slows down the efforts to increase ART coverage and population viral suppression, ultimately attenuating any population-level impact on HIV incidence. Clinical Trial Number NCT01509508 (clinicalTrials.gov)/DOH-27-0512-3974 (South African National Clinical Trials Register).
    Mots-clés : Cross-sectional cascade, HIV care continuum, Migration, Population dynamics, Public health, Rural South Africa, Structural drivers.
  • Larmarange Joseph, Diallo Mamadou Hassimiou, McGrath Nuala, Iwuji Collins, Thiébaut Rodolphe, Tanser Frank, Bärnighausen Till, Pillay Deenan, Dabis François, Orne-Gliemann Joanna et ANRS 12249 TasP Study Group (2018) « From individual care trajectories to HIV care cascade at population level in rural KwaZulu-Natal (South Africa): the impact of population dynamics » (communication orale), présenté à Life History Research Society Conference, Paris.
    Résumé : Introduction The universal test-and-treat strategy (UTT) was developed to maximize the proportion of all HIV-positive individuals on antiretroviral and virally suppressed, assuming that it leads to reduction in HIV incidence. The evolution over time of the cross-sectional population HIV care cascade is determined by longitudinal individual trajectories through the HIV care continuum and the underlying HIV population dynamics. This structural effect could dilute the impact observed at population level of a UTT strategy RT: either add impact on what (incidence) or delete sentence. The purpose of this paper is to quantify the contribution of each component of population change on the population HIV care cascade in the context of UTT. Sample We used prospective individual-level longitudinal data from the ANRS 12249 cluster-randomized trial which was implemented in rural KwaZulu-Natal, South Africa between 2012 and 2016 to test such an approach. Methods HIV tests results and information on clinic visits, ART prescription, viral load and CD4 count, migration and deaths were used to calculate residency status, HIV status and HIV care status for each individual on a daily basis. Position within the HIV care continuum was considered as a score ranging from 0 (undiagnosed) to 4 (virally suppressed). We compared the cascade score of each individual joining or leaving the HIV population with the average score of their cluster at the time of entry or exit. Then, we computed the contribution of each event on the average cascade score and the annualised total contribution of all events, considering 5 components of HIV population change: aging into the cohort, HIV seroconversions, in-migrations, out-migrations, and permanent exits (including deaths). Results While the average cascade score increased over time in all clusters, that increase was limited due to population dynamics, the total contribution of all population entries and exits being negative. Permanent exits and individuals already infected when reaching the age of 16 had a marginal effect. Although migrants had a lower position than the rest of the population, their overall impact on the cross-sectional population cascade remained limited as in- and out-migration compensated each other. Conclusions In a context of high HIV incidence, the continuous flow of newly infected individuals slows down the efforts to increase ART coverage and population viral suppression.
  • Perriat Delphine, Diallo Mamadou Hassimiou, Dabis François, Pillay Deenan, Orne-Gliemann Joanna, Larmarange Joseph et ANRS 12249 TasP Study Group (2018) « From home-based HIV testing to viral suppression : HIV care trajectories in the context of Universal Test-and-Treat in rural South Africa » (communication orale), présenté à Life History Research Society Conference, Paris.
    Résumé : Background : In order for people living with HIV to achieve an undetectable viral load, and thus live longer and healthier, they need access to a continuum of services. There are numerous reports of “leaks” at all steps of the HIV care cascade. We described the timing and sequencing of individual HIV care statuses from care referral to viral suppression, by identifying groups of individuals with similar trajectories and factors associated. Sample : We used prospective individual-level longitudinal data from the ANRS 12249 TasP cluster-randomized trial, which investigated the impact of universal antiretroviral treatment (ART) on HIV incidence in rural South Africa (2012-2016). We included trial participants >16 years, identified HIV+, not in care at referral and followed-up for ≥18 months. Method : The care status of all study participants was classified for each calendar day as : not in care, in care but not on ART, on ART but not virally suppressed, virally suppressed. We used state sequence data analysis to identify homogeneous care trajectories groups. A multinomial logistic regression was used to identify the profile of each group in terms of individual and cluster characteristics. Results : 1,816 participants were included. Median age was 34 years [IQR 27-45], 74% were female. We identified four care trajectories groups : (i) participants who mostly did not enter care (55%), (ii) participants with inconstant care, visiting a clinic occasionally but leaving care thereafter (median time to exit care : 10 m. [5.2-13]) (12%), (iii) participants who took extensive time at each step of the care continuum (median time between referral and ART : 8.0 m. [6.4-9.7]) (12%) and (iv) participants who rapidly progressed towards continuous care (median time between referral and ART : 1.2 m. [0.6-2.7]) (21%). Participants younger than 50 years, newly diagnosed at referral, living further than a kilometre from a trial clinic, and living in a cluster were immediate ART was not offered, were more likely to present with incomplete, inconstant and slow care trajectories. Conclusions : A longitudinal and person-specific approach to the study of HIV care patterns contributed to highlight the heterogeneity in care trajectories, in terms of speed and care utilization behaviours. Differentiated and personalised care and support should be scaled-up, especially between diagnosis and ART initiation, which constitutes the main bottleneck of HIV programs in this South African rural study area.

2017


  • Larmarange Joseph, Diallo Mamadou Hassimiou, Iwuji Collins, Orne-Gliemann Joanna, McGrath Nuala, Plazy Mélanie, Tanser Frank, Thiebaut Rodolphe, Pillay Deenan et Dabis François (2017) « Cascade of Care of HIV Seroconverters in the Context of Universal "Test and Treat" » (communication orale et poster 1018), présenté à Conference on Retroviruses and Opportunistic Infections (CROI) 2017, Seattle. http://www.croiconference.org/sessions/cascade-care-hiv-seroconverters-context-universal-%E2%80%9Ctest-and-treat%E2%80%9D-0.
    Résumé : The ANRS 12249 TasP cluster-randomized trial aimed at evaluating the impact of a Universal Test and Treat (UTT) approach on population-based HIV incidence in rural KwaZulu Natal, South Africa. Previous results showed low rates of early linkage to HIV care and treatment and did not identify any incidence reduction. To optimize the impact of UTT, time to ART initiation and viral suppression must be shorten significantly, in particular among newly infected individuals. We describe here the longitudinal cascade of care for those seroconverting during the course of the TasP trial. Every six months between March 2012 and June 2016, resident members aged ≥16 years old were offered rapid HIV testing at home and asked independently to provide dried blood spot (DBS) samples. Those testing positive or who self-reported their positive status were referred to local trial clinics for ART initiation, regardless of their CD4 count (intervention) or according to national guidelines (control). Cases of HIV seroconversion were identified using multiple sources: repeat DBS, repeat rapid tests, HIV+ self-reports and clinic visits. Date of seroconversion was estimated using a random point approach. The HIV care status, for each day following seroconversion (M0), was computed using additional data collected on CD4 count, ART prescription, viral load and migration out of the trial area. Follow-up was right-censored by dates of death or trial closure if alive. We observed 565 individuals acquiring HIV (244 in intervention arm; 321 in control arm). Among them, one year after seroconversion (M12), 22% out-migrated from the trial area. 57% were diagnosed (aware of their HIV status), 27% were actively in HIV care, 12% were on ART, and were 10% virally suppressed. The cascade was comparable in both trial arms, except for ART coverage, higher in the intervention arm (15%) than in the control arm (9%). The observed cascade of care was suboptimal in seroconverters despite the introduction of UTT services and a trial environment. This poor outcome was aggravated in this rural setting by out-migration considered here as loss to the cascade. Newly HIV-infected individuals need time to (re)test, initiate ART and reach viral suppression. This is one of the plausible explanations of the lack of effect of the UTT strategy on HIV incidence in our setting. For a UTT approach to be effective, innovative strategies to identify seroconverters and support them to engage in ART care promptly are required.
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