A Systematic Review of Pediatric Adherence to Antiretroviral Therapy in Sub-Saharan Africa

A Systematic Review of Pediatric Adherence to Antiretroviral Therapy in Sub-Saharan Africa


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AEP Vol. 19, No. 9 September 2009: 651–680

P40 SEASONAL FLU TRACKING WITHIN THE DUPONT COMPANY: INCREASING FLU AWARENESS AND PREPARING FOR A PANDEMIC CJ Sakr, HQ Le, JM Symons, KH Kreckmann, WM Lednar, DuPont Epidemiology Program, Integrated Health Services, Newark, DE 19711

PURPOSE: The DuPont Epidemiology Program conducted a pilot study in early 2008 to track cases of seasonal influenza at 3 sites in the US. For the 2008–2009 influenza season, we expanded the tracking activity to 17 U.S. sites. We combined this surveillance activity with regular communication updates of seasonal flu activity in the US. METHODS: We used a web-based ‘Flu Tracking Form’ as a tool to index cases of seasonal influenza. Access to the form was restricted to medical staff. The study was based on employee self-report to medical staff. RESULTS: The 17 sites include 14,617 employees. Eighteen cases of seasonal influenza were reported for an ‘incidence’ rate of 2.1 cases per 10,000 person-months for the 6-month tracking period. We provided updates on the cases of influenza reported within the company during occupational medicine monthly calls that included 80 U.S. medical department staff. In addition, we presented updates on seasonal influenza activity within the US. Information was acquired from reports prepared by the Centers for Disease Control and Prevention and included the geographic spread of the virus, mortality data, outpatient and inpatient surveillance networks data, and circulating strains and resistance patterns. CONCLUSION: A public health approach to track seasonal influenza within the company and provide external statistics about influenza activity in the U.S. strengthened awareness among the company medical staff. This program increased the company’s medical staff preparedness in face of the current novel H1N1 pandemic originating in late April 2009.

P41 USING A SYSTEMATIC REVIEW TO INFORM POLICIES ABOUT LIVESTOCK DISEASE CONTROL: AN INFLUENZA EXAMPLE CK Irwin, AM O’Connor, Department of Veterinary Diagnostic and Production Animal Medicine, Iowa State University, Ames, IA

PURPOSE: The survival of influenza virus in the environment influences decisions in regulatory livestock disease control. Avian and equine influenza viruses are World Organization for Animal Health (OIE) notifiable diseases with quarantine and depopulation requirements for highly pathogenic avian influenza. Primary research on influenza survival should inform policies about the length of depopulation periods.



METHODS: A systematic review was conducted on the survival of influenza in the environment, involving 5 search engines and a search string of terms which were comprehensive for influenza, environment and environmental conditions, and survival. Completeness was determined by investigating references from appropriate and current narrative review articles written about influenza. Relevance and quality assessment were determined by set parameters of the review. RESULTS: Only 19 articles described the minimal standards for quality assessment for determining influenza survival in environmental conditions. Most articles failed to report sufficient information to be considered valid. Replication of environmental conditions within studies and between studies was limited. There was considerable heterogeneity in designs, methods and measures used to assess survival. CONCLUSION: Estimates of influenza survival can only be based on the results of very few studies. A great deal of uncertainty remains about the length of time influenza survives in depopulated livestock facilities and consequently how long depopulation should be imposed is unclear.


PURPOSE: There has been no formal systematic review / meta-analysis on pediatric antiretroviral (ARV) adherence with a focus on sub-Saharan Africa. The objective of this study is to conduct a systematic review of pediatric ARV adherence in sub-Saharan Africa to inform ARV adherence monitoring. METHODS: We searched MEDLINE for studies published in the last ten years that assessed adherence cross-sectionally or longitudinally among HIV infected children on Highly Active Antiretroviral Therapy (HAART) in sub-Saharan Africa. The reference lists of identified articles and abstracts from HIV/AIDS related conferences were also searched for inclusion. Two reviewers independently assessed the quality and relevance of the data, which were analyzed using the MetaAnalyst software. RESULTS: The search yielded 543 related titles. From the initial list of studies 10 studies met the selection criteria, including 2935 children. Adherence measurement procedures included self or proxy report measures and/or pill counts with >95% adherence rates. Our analysis showed a pooled >95% adherence rate of 66% for the children included in this study, with a 95% Confidence Interval between 55% and 75%.



CONCLUSION:The levels of adherence seen among children are lower than the impressive ARV adherence rates reported among adults in sub- Saharan Africa. Adherence to ARV may be more challenging in children than among adults. MEETING THEME P43 A SIMPLE METHOD TO EVALUATE THE PSYCHOLOGISTIC FALLACY IN INDIVIDUALLEVEL EPIDEMIOLOGIC STUDIES: APPROXIMATING EVIDENCE TO POLICY AJ Idrovo1, JA Ferna´ndez-Nin˜o2, 1Center for Health Systems Research, National Institute of Public Health. Cuernavaca, Morelos, Mexico, 2Public & Tropical Health Department, School of Medicine, National University of Colombia. Bogota, DC, Colombia

PURPOSE: Most of epidemiologic studies explore individual risk factors and individual outcomes. Even in internally valid studies is possible that psychologistic fallacy is present, and there isn’t standard methods to its evaluation. This fallacy occurs when inference based on individual-level studies is incorrect since the need to incorporate variables from populationlevel. In this abstract, we resume a simple method to evaluate the presence of psychologistic fallacy based on theoretical considerations about internal and external validity, and meta-analytic techniques. METHODS: We use an example with 22 studies on nicotine gum for smoking cessation recompiled in a published systematic review, and the global trade categories described by Moore et al (Soc Sci Med 2006; 63:165–78). RESULTS: It was possible to establish that efficacy of nicotine gum depends in the position of country where was carried-out the clinical trial within the network of global trade. The efficacy was higher in the Semi- Periphery (RR: 0.29, 95% CI: 0.14–0.77), intermediate in the Core 2 (RR: 0.29, 95% CI: 0.14–0.77), and lesser in the Core 1, or more developed countries (RR: 0.68, 95% CI: 0.57–0.80). CONCLUSION: In further meta-analyses is possible to incorporate this method to improve the knowledge of causal network between exposures and outcomes. It is a new simple method to approximate evidence to specific contexts. P44 SLEEP DURATION AND BIOMARKERS OF METABOLIC FUNCTION AMONG POLICE OFFICERS LE Charles, CM Burchfiel, JK Gu, ME Andrew, D Fekedulegn, JM Violanti, NIOSH, CDC, Morgantown, WV; School of Public Health and Health Professions, University at Buffalo, NY

PURPOSE: To investigate the cross-sectional association between sleep duration and two biomarkers of metabolic function, adiponectin and leptin.

AEP Vol. 19, No. 9 September 2009 : 651–680

METHODS: Participants were 113 randomly selected officers (26–61 years) from the Buffalo, New York Police Department. Metabolic markers were measured in 2008 from frozen fasting specimens stored at 80 C since 1999–2000. Mean levels of the metabolic markers were assessed across categories of sleep duration (0–5.9, 6.0–6.9, > 7.0 hours), using ANOVA and ANCOVA. RESULTS: Longer sleep duration was associated with higher mean levels of adiponectin (ageadjusted p Z 0.049) and slightly lower mean levels of leptin (age-adjusted p Z 0.176) among men only. Among officers with BMI > 25.0 Kg/m2, longer sleep duration was significantly associated with higher mean levels of adiponectin (age- and genderadjusted p Z 0.030); levels of leptin tended to decrease as duration of sleep increased (age- and gender-adjusted p Z 0.213). Similarly, longer sleep duration was directly associated with adiponectin (age- and genderadjusted p Z 0.016) and inversely associated with leptin (age- and gender-adjusted p Z 0.201) only among officers with larger abdominal height. BMI appreciably modified the association between sleep duration and leptin (interaction p Z 0.061). CONCLUSION: Based on previous research, adiponectin is cardio-protective while leptin is not; our results therefore appear to underscore the potential benefits of adequate sleep especially among persons with increased body weight and abdominal height.

P45 DEFINING ‘ORAL NEGLECT IN INSTITUTIONALIZED ELDERLY’ FOR PUBLIC POLICY USE: THE ONIIE PROJECT RV Katz1, BJ Smith2, D Berkey3, A Guset1, O’Connor MP1, 1 NYU College of Dentistry, 2American Dental Association, 3 University of Colorado at Denver School of Dental Medicine

PURPOSE: The primary purpose of this project was to develop an operational definition of oral neglect for institutionalized older adults in nursing homes in the U.S. by obtaining an expert consensus opinion using a Delphi Technique survey. Although the federal legislation that funds payments to nursing homes for the care and housing of their residents states that there shall be no oral neglect, the absence of a consensus definition of oral neglect means that there can be no systematic enforcement of this legislative expectation. METHODS: Two Delphi Technique Surveys, consisting of serial rounds of discussion via questionnaire by a panel of nationally recognized experts in geriatric dentistry, were conducted to obtain a consensus definition of Oral Neglect in Institutional Elderly (ONiIE). The key components of this operational definition of ONiIE were to include: 1) a list