UNAIDS 90-90-90 targets; resource-limited setting; antiretroviral therapy; HIV; Sub-Sahara Africa; Southern Africa; Lesotho
Amstutz Alain, Nsakala Bienvenu Lengo, Vanobberghen Fiona, Muhairwe Josephine, Glass Tracy Renée, Achieng Beatrice, Sepeka Mamorena, Tlali Katleho, Sao Lebohang, Thin Kyaw, Klimkait Thomas, Battegay Manuel, Labhardt Niklaus Daniel (2018), SESOTHO trial ("Switch Either near Suppression Or THOusand") - switch to second-line versus WHO-guided standard of care for unsuppressed patients on first-line ART with viremia below 1000 copies/mL: protocol of a multicenter, parallel-group, open-label, randomized clinical trial in Lesotho, Southern Africa., in BMC infectious diseases
, 18(1), 76-76.
Labhardt Niklaus D, Ringera Isaac, Lejone Thabo I, Klimkait Thomas, Muhairwe Josephine, Amstutz Alain, Glass Tracy R (2018), Effect of Offering Same-Day ART vs Usual Health Facility Referral During Home-Based HIV Testing on Linkage to Care and Viral Suppression Among Adults With HIV in Lesotho: The CASCADE Randomized Clinical Trial., in JAMA
Lejone Thabo Ishmael, Ringera Isaac, Cheleboi Molisana, Wagner Sarah, Muhairwe Josephine, Klimkait Thomas, Labhardt Niklaus D. (2018), The Treatment Cascade in Children With Unsuppressed Viral Load—A Reality Check in Rural Lesotho, Southern Africa, in JAIDS Journal of Acquired Immune Deficiency Syndromes
, 77(3), 250-256.
N Bachmann, von Braun A, ND Labhardt, C Kadelka, HF Günthard, C Sekaggya-Wiltshire, B Castelnuovo, A Kambugu, TI Lejone, J Böni, S Yerly, M Perreau, Study Swiss HIV Cohort (2018), Importance of routine viral load monitoring: higher levels of resistance at ART failure in Uganda and Lesotho compared with Switzerland., in The Journal of antimicrobial chemotherapy
Labhardt Niklaus Daniel, Ringera Isaac, Lejone Thabo Ishmael, Cheleboi Molisana, Wagner Sarah, Muhairwe Josephine, Klimkait Thomas (2017), When patients fail UNAIDS’ last 90 - the “failure cascade” beyond 90-90-90 in rural Lesotho, Southern Africa: a prospective cohort study, in Journal of the International AIDS Society
, 20(1), 21803-21803.
Labhardt ND, Müller UF, Ringera I, Ehmer J, Motlatsi MM, Pfeiffer K, Hobbins MA, Muhairwe JA, Muser J, Hatz C (2017), Metabolic syndrome in patients on first-line antiretroviral therapy containing zidovudine or tenofovir in rural Lesotho, Southern Africa., in Trop Med Int Health
Labhardt N.D. Ringera I. Lejone T.I. Muhairwe J. Fritz C. Klimkait T. & Glass T.R. (2016), "The first 90": how close can we get with home-based HIV testing? First results from recruitment for the CASCADE trial in rural Lesotho, in HIV Congress Glasgow
, GlasgowAbstracts of the HIV Glasgow supplement, Journal of the International AIDS Society, 19 (Suppl 7), Switzerland.
Labhardt Niklaus Daniel, Ringera Isaac, Lejone Thabo Ishmael, Masethothi Phofu, Thaanyane T'sepang, Kamele Mashaete, Gupta Ravi Shankar, Thin Kyaw, Cerutti Bernard, Klimkait Thomas, Fritz Christiane, Glass Tracy Renée (2016), Same day ART initiation versus clinic-based pre-ART assessment and counselling for individuals newly tested HIV-positive during community-based HIV testing in rural Lesotho - a randomized controlled trial (CASCADE trial)., in BMC public health
, 16, 329-329.
Cerutti B, Broers B, Masetsibi M, Faturiyele O, Toti-Mokoteli L, Motlatsi M, Bader J, Klimkait T, Labhardt ND (2016), Alcohol use and depression: link with adherence and viral suppression in adult patients on antiretroviral therapy in rural Lesotho, Southern Africa: a cross-sectional study., in BMC Public Health
Labhardt ND, Bader J, Lejone TI, Ringera I, Hobbins MA, Fritz C, Ehmer J, Cerutti B, Puga D, Klimkait T (2016), Should viral load thresholds be lowered?: Revisiting the WHO definition for virologic failure in patients on antiretroviral therapy in resource-limited settings., in Medicine (Baltimore)
Background: Despite enormous progress in the last decade, HIV/AIDS remains the most important cause of morbidity and mortality in most countries of Southern Africa and a central contributor to economic underdevelopment and poverty in many societies. The 2014 UNAIDS “90-90-90” targets for 2020 represent an important step towards an AIDS-free generation by 2030. The targets emphasize the importance of antiretroviral therapy (ART) to prolong the life of people living with HIV and as the most effective preventative measure for reducing the spread of new infections through better virus control. The three key targets of “90-90-90” are:-90% of all people living with HIV will know their HIV status. -90% of all people with diagnosed HIV infection receive treatment. -90% of all people receiving therapy will have their virus suppressedThis project represents a collaboration between the Research Coordination Unit (RCU) of the Ministry of Health (MoH) of Lesotho, the District Health Management Team (DHMT) of Butha-Buthe, SolidarMed (Lesotho-based Swiss organization for health in Africa), the Swiss Tropical and Public Health Institute (SwissTPH) and the Molecular Virology unit at the Department of Biomedicine (DBM) of the University of Basel. The project combines epidemiological, operational and clinical research to address key questions related to reaching 90-90-90 targets in rural Lesotho, a country with the second-highest HIV prevalence in the world, high transmission rates and low ART coverage. Methods:The proposed project is planned in Butha-Buthe district, Northern Lesotho, involving 2 hospitals and 10 health centers. As a crucial first step, the project has established the technical basis for the intended studies. As part of Lesotho’s national viral load (VL) roll-out plan, the country’s first decentralized VL monitoring platform was installed in the district laboratory of Butha-Buthe by the end of October 2015. Local laboratory personnel was trained and audited to roll out routine VL monitoring in the district of Butha-Buthe from 2016 onwards. Two randomized controlled trials (RCTs) and additional observational studies are planned within the proposed project.RCT-1 (CASCADE-trial; NCT02692027, www.visibleimpact.org/projects/1197-cascade-trial) addresses the care-cascade from HIV-test to linkage to care to retention in care and achievement of viral suppression in the era of test-and-treat. Individuals who are newly tested HIV-positive during home-based HIV testing and counseling (HTC) are randomized into 2 groups. The control group provides standard of care with post-test counseling and a referral letter for enrolment in pre-ART care at the nearest facility. In the intervention-group, baseline laboratory testing and adherence counseling is provided after a positive HIV test at the participant’s home with the option to start ART on the same day. The first primary endpoint is linkage to care at the facility within 3 months. The secondary endpoint is retention in care and viral suppression 12 months after HIV diagnosis. This trial has two nested observational studies. The first examines HTC-coverage achieved through home-based HTC while recruiting trial-participants. The second examines glucose- and lipid-profiles pre-ART and after ART initiation. This trial has started on 22nd of February 2016 (https://visibleimpact.org/projects/1197-cascade-trial).RCT-2 (SAVIR-trial): A culturally adapted, short, standardized adherence intervention for patients on ART with unsuppressed VL will be rolled out to the facilities in the district using a step-wedged design with the primary endpoint of VL re-suppression at follow-up determination.Establishing routine viral load monitoring will be linked to a database, a plasma-bank and introduction of genotypic sequencing in the district. This will allow observational studies on roll-out of viral load monitoring, treatment failure, switch to second-line ART and HIV resistance. Based on these observational data, a protocol for a third RCT will be elaborated by end of 2016. This RCT will address challenges identified in the field of treatment failure and switch to second-line ART.The projects aims at an impact at the following levels 1) Sustainable improvement of HIV care in the district; 2) Capacity building and strengthening among health professionals at district and national level; 3) Generation of evidence for future national and international guidelines and policies