Auld, Andrew F.; Agizew, Tefera; Mathoma, Anikie; Boyd, Rosanna; Date, Anand; Pals, Sherri L.; Serumola, Christopher; Mathebula, Unami; Alexander, Heather; Ellerbrock, Tedd V.; Rankgoane-Pono, Goabaone; Pono, Pontsho; Shepherd, James C.; Fielding, Katherine; Grant, Alison D.; Finlay, Alyssa published the artcile< Effect of tuberculosis screening and retention interventions on early antiretroviral therapy mortality in Botswana: a stepped-wedge cluster randomized trial>, Recommanded Product: (9Z,12Z)-Methyl octadeca-9,12-dienoate, the main research area is efavirenz emtricitabine nevirapine ritonavir antiretroviral agent tuberculosis; Intensified tuberculosis case finding; Mortality; Tuberculosis; Xpert MTB/RIF.
Undiagnosed tuberculosis (TB) remains the most common cause of HIV-related mortality. Xpert MTB/RIF (Xpert) is being rolled out globally to improve TB diagnostic capacity. However, previous Xpert impact trials have reported that health system weaknesses blunted impact of this improved diagnostic tool. During phased Xpert rollout in Botswana, we evaluated the impact of a package of interventions comprising (1) addnl. support for intensified TB case finding (ICF), (2) active tracing for patients missing clinic appointments to support retention, and (3) Xpert replacing sputum-smear microscopy, on early (6-mo) antiretroviral therapy (ART) mortality. At 22 clinics, ART enrollees > 12 years old were eligible for inclusion in three phases: a retrospective standard of care (SOC), prospective enhanced care (EC), and prospective EC plus Xpert (EC+X) phase. EC and EC+X phases were implemented as a stepped-wedge trial. Participants in the EC phase received SOC plus components 1 (strengthened ICF) and 2 (active tracing) of the intervention package, and participants in the EC+X phase received SOC plus all three intervention package components. Primary and secondary objectives were to compare all-cause 6-mo ART mortality between SOC and EC+X and between EC and EC+X phases, resp. We used adjusted analyses, appropriate for study design, to control for baseline differences in individual-level factors and intra-facility correlation. We enrolled 14,963 eligible patients: 8980 in SOC, 1768 in EC, and 4215 in EC+X phases. Median age of ART enrollees was 35 and 64% were female. Median CD4 cell count was lower in SOC than subsequent phases (184/μL in SOC, 246/μL in EC, and 241/μL in EC+X). By 6 mo of ART, 461 (5.3%) of SOC, 54 (3.2%) of EC, and 121 (3.0%) of EC+X enrollees had died. Compared with SOC, 6-mo mortality was lower in the EC+X phase (adjusted hazard ratio, 0.77; 95% confidence interval, 0.61-0.97, p = 0.029). Compared with EC enrollees, 6-mo mortality was similar among EC+X enrollees. Interventions to strengthen ICF and retention were associated with lower early ART mortality. This new evidence highlights the need to strengthen ICF and retention in many similar settings. Similar to other trials, no addnl. mortality benefit of replacing sputum-smear microscopy with Xpert was observed
BMC Medicine published new progress about Antiviral agents. 112-63-0 belongs to class esters-buliding-blocks, and the molecular formula is C19H34O2, Recommanded Product: (9Z,12Z)-Methyl octadeca-9,12-dienoate.
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