MSUIR Collection:
https://cris.library.msu.ac.zw//handle/11408/3308
2024-03-28T15:49:46ZA mathematical model of HIV/AIDS population dynamics with treatment failure and treatment dropouts in the era of universal test and treat approach
https://cris.library.msu.ac.zw//handle/11408/3856
Title: A mathematical model of HIV/AIDS population dynamics with treatment failure and treatment dropouts in the era of universal test and treat approach
Authors: Nhendo, Calvin
Abstract: Antiretroviral therapy is currently the major intervention against HIV infection.However, with increased access to treatment through the universal test and treat approach, potential barriers to the overall success of this strategy such as treatment dropouts and treatment failure arise. We constructed a deterministic mathematical model of HIV/AIDS to study the possible effects of treatment failure and treatment dropouts on the population dynamics of the infection. The model incorporated a universal test and treat scenario and a separate sub population of treatment dropouts. The disease free and endemic equilibria is computed and the basic reproduction number R0 of the model, is determined using the next generation matrix method. Numerical simulations are presented to investigate the effect of treatment failure and treatment dropouts on the dynamics of the model and on the R0. From the expression of R0 it is shown that the treatment dropout class contributes to the overall model reproduction number. Results of the numerical simulations show that an increase in treatment dropouts leads to an increased transimission of the HIV infection in a population. Also, the results indicate that even in the absence of treatment dropouts and treatment failure the basic reproduction number remains above unit, highlighting the need for several control measures to end the epidemic. Treatment failure is shown to increase the maximum size of the AIDS class. The results from this study demonstrate the need to focus on increasing efforts of reducing treatment dropouts in combination with other intervention strategies, through monitoring adherence and identifying and enrolling back to antiretroviral therapy(ART) of treatment dropouts. Also there is need to improve on early diagnosis of treatment failure such that those on treatment do not progress to AIDS before they are put on second or third line ART.2019-01-01T00:00:00ZNhendo, CalvinLongitudinal analysis to assess the contribution of the multi-month scripting (mms) regime on art outcomes among adult persons living with HIV in Zimbabwe
https://cris.library.msu.ac.zw//handle/11408/3309
Title: Longitudinal analysis to assess the contribution of the multi-month scripting (mms) regime on art outcomes among adult persons living with HIV in Zimbabwe
Authors: Sanhokwe, Hamfrey
Abstract: Zimbabwe has a generalized HIV epidemic. Since 2015, the national ART program has been rolling out a suite of differentiated models of care in line with the 2013 WHO guidelines. One of the common models adopted by the country is Multi-Month Scripting (MMS) for stable ART patients. Insufficient evidence exists in the country around the contribution of MMS to patient level ART outcomes, almost two years after it was rolled nationally. A retrospective cohort study was conducted at the five ART clinics in Chitungwiza. Secondary sources of data were used in the research. Longitudinal data analysis techniques were applied, including survival analysis.
Among the 305 ART patients with HIV/AIDS who initiated ART, there were five AIDS-related deaths; two within the first 6 months, two between the 42-48-month period and one in the 54-60-month period. Overall, the median survival time (53 months) was the same among MMS and non-MMS clients. The retention rates at 12, 24, 36, 48 and 60 months were 98%, 97%, 96% 91% and 87% respectively, and were not statistically different between MMS and non MMS clients. There was a statistically significant change in the CD4 counts (initial vs. follow up) for non-MMS clients. There were significant gains in weight among both MMS and nonMMS clients.
The outcomes of interest (weight, survival, retention and changes in CD4 cell count) were primarily associated with sex, age, WHO stage at initiation, receipt of Cotrimoxazole and level of education, among other factors, albeit at varying degrees of significance. Two years into the roll out of MMS, this study suggests that there are no statistically significant differences in observed outcomes between clients on MMS and those not on MMS. More research is necessary to conclusively determine the contribution of each of the models of differentiated care to observed outcomes. However, the contribution of MMS to observed ART
outcomes could as well be clinically significant. The factors associated with the clinical outcomes look similar to prior studies, albeit at varying levels of statistical significance.2017-01-01T00:00:00ZSanhokwe, Hamfrey