George Bicego - Profile on Academia.edu (original) (raw)

Papers by George Bicego

Antiretroviral therapy enrollment characteristics and outcomes among HIV-infected adolescents and young adults compared with older adults--seven African countries, 2004-2013

MMWR. Morbidity and mortality weekly report, Jan 28, 2014

Although scale-up of antiretroviral therapy (ART) since 2005 has contributed to declines of about... more Although scale-up of antiretroviral therapy (ART) since 2005 has contributed to declines of about 30% in the global annual number of human immunodeficiency (HIV)-related deaths and declines in global HIV incidence, estimated annual HIV-related deaths among adolescents have increased by about 50% and estimated adolescent HIV incidence has been relatively stable. In 2012, an estimated 2,500 (40%) of all 6,300 daily new HIV infections occurred among persons aged 15-24 years. Difficulty enrolling adolescents and young adults in ART and high rates of loss to follow-up (LTFU) after ART initiation might be contributing to mortality and HIV incidence in this age group, but data are limited. To evaluate age-related ART retention challenges, data from retrospective cohort studies conducted in seven African countries among 16,421 patients, aged ≥15 years at enrollment, who initiated ART during 2004-2012 were analyzed. ART enrollment and outcome data were compared among three groups defined by ...

Journal of the International AIDS Society, 2012

Background: Dual infection with HIV-1 and HIV-2, which is not uncommon in West Africa, has import... more Background: Dual infection with HIV-1 and HIV-2, which is not uncommon in West Africa, has important implications for transmission, progression, and antiretroviral therapy. Few studies have examined HIV viral dynamics in this setting. Methods: We compared HIV-1 and HIV-2 viral loads from 65 dually infected, antiretroviral therapy-naïve Senegalese subjects. Participants provided demographic information and blood, oral fluid, and cervicovaginal lavage (CVL) or semen samples for virologic and immunologic testing. Associations between HIV-1 and HIV-2 levels in plasma, PBMC, oral and genital samples were assessed using linear regression models with generalized estimating equations to account for subjects with multiple samples over time. Results: In analyses adjusting for CD4 count, age, sex, and commercial sex work, HIV-1 RNA levels were significantly higher than HIV-2 levels in semen (b02.05 log 10 copies/ml, 95% CI 0.44 to 3.66), CVL (b 01.37, 95% CI 0.83 to 1.91), and oral fluids (b 01.93, 95% CI 1.56 to 2.30). HIV-1 and HIV-2 PBMC viral DNA loads were similar in those with normal immune function (CD4 counts above 500 cells/ml) (b 00.17 log 10 copies/mg of PBMC DNA, 95% CIÁ0.58 to 0.24), but compared to those with high CD4 counts, subjects with CD4 counts below 500 cells/ml had higher HIV-1 and lower HIV-2 levels. In plasma, subjects with CD4 counts above 500 cells/ml had mean HIV-1 plasma RNA viral loads 0.87 log 10 copies/ml higher (95% CI 0.35 to 1.38) than HIV-2, while among subjects with CD4 counts between 200 and 500 cells/ml or below 200 cells/ml, this difference increased to 4.28 and 4.35 log 10 copies/ml (95% CIs 2.51 to 6.04 and 2.67 to 6.04), respectively. Conclusion: Our data are consistent with the hypothesis that with decreasing CD4 counts and HIV disease progression, HIV-1 may outcompete HIV-2 in dually-infected individuals. This finding may help explain the differences in epidemiology between HIV-1 and HIV-2.

Additional file 5 of Risk scores for predicting early antiretroviral therapy mortality in sub-Saharan Africa to inform who needs intensification of care: a derivation and external validation cohort study

Additional file 5. Figure showing association between 6-month ART mortality risk and (a) temperat... more Additional file 5. Figure showing association between 6-month ART mortality risk and (a) temperature and (b) heart rate, at ART initiation.

Additional file 6 of Risk scores for predicting early antiretroviral therapy mortality in sub-Saharan Africa to inform who needs intensification of care: a derivation and external validation cohort study

Additional file 6 Table showing multivariable model and clinical score generation from the deriva... more Additional file 6 Table showing multivariable model and clinical score generation from the derivation dataset with heart rate replacing the measured temperature variable (N = 2838).

Additional file 3 of Risk scores for predicting early antiretroviral therapy mortality in sub-Saharan Africa to inform who needs intensification of care: a derivation and external validation cohort study

Additional file 3. Tripod checklist for prediction model development and validation.

Additional file 1 of Risk scores for predicting early antiretroviral therapy mortality in sub-Saharan Africa to inform who needs intensification of care: a derivation and external validation cohort study

Additional file 1. Table showing HIV care clinical follow-up of clients in the Botswana XPRES coh... more Additional file 1. Table showing HIV care clinical follow-up of clients in the Botswana XPRES cohort (2010–2015).

Additional file 2 of Risk scores for predicting early antiretroviral therapy mortality in sub-Saharan Africa to inform who needs intensification of care: a derivation and external validation cohort study

Additional file 2. Text showing XPRES enrollment and follow-up procedures.

This report was made possible by support from the U.S.

Additional file 9 of Risk scores for predicting early antiretroviral therapy mortality in sub-Saharan Africa to inform who needs intensification of care: a derivation and external validation cohort study

Additional file 9. Figure showing area under the receiver operating characteristic curve for clin... more Additional file 9. Figure showing area under the receiver operating characteristic curve for clinical score performance in combined XPRES dataset (N = 5553) and external validation TB Fast Track Dataset (N = 1077) for Models A (excluding CD4) and B (including CD4).

Additional file 4 of Risk scores for predicting early antiretroviral therapy mortality in sub-Saharan Africa to inform who needs intensification of care: a derivation and external validation cohort study

Additional file 4. Table showing Hosmer-Lemeshow tests for calibration of final models A (CD4 exc... more Additional file 4. Table showing Hosmer-Lemeshow tests for calibration of final models A (CD4 excluded) and B (CD4 included).

Additional file 7 of Risk scores for predicting early antiretroviral therapy mortality in sub-Saharan Africa to inform who needs intensification of care: a derivation and external validation cohort study

Additional file 7. Tables showing performance of clinical score in derivation and validation data... more Additional file 7. Tables showing performance of clinical score in derivation and validation datasets for Models A (excluding CD4) and B (including CD4).

BMC Public Health, 2014

Background: Voluntary medical male circumcision (VMMC) reduces HIV acquisition among heterosexual... more Background: Voluntary medical male circumcision (VMMC) reduces HIV acquisition among heterosexual men by approximately 60%. VMMC is a surgical procedure and some adverse events (AEs) are expected. Swaziland's Ministry of Health established a toll-free hotline to provide general information about VMMC and to manage post-operative clinical AEs through telephone triage. Methods: We retrospectively analyzed a dataset of telephone calls logged by the VMMC hotline during a VMMC campaign. The objectives were to determine reasons clients called the VMMC hotline and to ascertain the accuracy of telephone-based triage for VMMC AEs. We then analyzed VMMC service delivery data that included date of surgery, AE type and severity, as diagnosed by a VMMC clinician as part of routine post-operative follow-up. Both datasets were de-identified and did not contain any personal identifiers. Proportions of AEs were calculated from the call data and from VMMC service delivery data recorded by health facilities. Sensitivity analyses were performed to assess the accuracy of phone-based triage compared to clinically confirmed AEs. Results: A total of 17,059 calls were registered by the triage nurses from April to December 2011. Calls requesting VMMC education and counseling totaled 12,492 (73.2%) and were most common. Triage nurses diagnosed 384 clients with 420 (2.5%) AEs. According to the predefined clinical algorithms, all moderate and severe AEs (153) diagnosed through telephone-triage were referred for clinical management at a health facility. Clinicians at the VMMC sites diagnosed 341 (4.1%) total clients as having a mild (46.0%), moderate (47.8%), or severe (6.2%) AE. Eighty-nine (26%) of the 341 clients who were diagnosed with AEs by clinicians at a VMMC site had initially called the VMMC hotline. The telephone-based triage system had a sensitivity of 69%, a positive predictive value of 83%, and a negative predictive value of 48% for screening moderate or severe AEs of all the AEs. Conclusions: The use of a telephone-based triage system may be an appropriate first step to identify life-threatening and urgent complications following VMMC surgery.

PLoS ONE, 2013

The 2011 Swaziland HIV Incidence Measurement Survey (SHIMS) was conducted as part of a national s... more The 2011 Swaziland HIV Incidence Measurement Survey (SHIMS) was conducted as part of a national study to evaluate the scale up of key HIV prevention programs. Methods: From a randomly selected sample of all Swazi households, all women and men aged 18-49 were considered eligible, and all consenting adults were enrolled and received HIV testing and counseling. In this analysis, population-based measures of HIV prevalence were produced and compared against similarly measured HIV prevalence estimates from the 2006-7 Swaziland Demographic and Health. Also, measures of HIV service utilization in both HIV infected and uninfected populations were documented and discussed. Results: HIV prevalence among adults aged 18-49 has remained unchanged between 2006-2011 at 31-32%, with substantial differences in current prevalence between women (39%) and men (24%). In both men and women, between since 2006-7 and 2011, prevalence has fallen in the young age groups and risen in the older age groups. Over a third (38%) of the HIV-infected population was unaware of their infection status, and this differed markedly between men (50%) and women (31%). Of those aware of their HIV-positive status, a higher percentage of men (63%) than women (49%) reported ART use. While overall HIV prevalence remains roughly constant, age-specific changes strongly suggest both improved survival of the HIV-infected and a reduction in new HIV infections. Awareness of HIV status and entry into ART services has improved in recent years but remains too low. This study identifies opportunities to improve both HIV preventive and care services in Swaziland.

Bottle Use for Infant Feeding in Developing Countries: Data from the Demographic and Health Surveys: Has the bottle battle been lost?

Journal of Tropical Pediatrics, 1991

This paper uses data from 22 national surveys in developing countries to estimate the use of bott... more This paper uses data from 22 national surveys in developing countries to estimate the use of bottles for feeding of infants under 6 months of age. These data were collected in the context of the Demographic and Health Surveys programme (DHS) between 1986 and 1989. Bottle use appears to be very common in most countries. Only six of the 22 countries had levels of bottle use of less than 20 per cent, and all these countries are in sub-Saharan Africa. The policy implications are discussed briefly.

Accuracy and Completeness of Mothers' Recall of Diarrhoea Occurrence in Pre-School Children in Demographic and Health Surveys

International Journal of Epidemiology, 1991

In the context of the Demographic and Health Surveys program (DHS), data were collected on diarrh... more In the context of the Demographic and Health Surveys program (DHS), data were collected on diarrhoeal diseases in childhood and related treatment patterns. In this paper we assess the accuracy and completeness of mothers' recall of diarrhoea in 19 national DHS surveys and discuss the implications for health interview surveys in developing countries. It is concluded that there is under-reporting of diarrhoea if the recall period is longer than 2-3 days, whereas there may be over-reporting of very recent or current diarrhoea in most DHS surveys. Reporting errors appear to vary considerably between countries, which affects the comparability of survey results. A second and related issue, that is addressed in this paper, is the reporting of treatment practices by duration of diarrhoeal episode. There were no major differences in reported treatment patterns between children with diarrhoea that terminated in the last two weeks and children with current diarrhoea of at least two days' duration. The implications of the findings for retrospective surveys on childhood morbidity and treatment patterns are discussed.

International Journal of Epidemiology, 1989

Social Science & Medicine, 2003

This study uses recent Demographic and Health Survey (DHS) data to examine levels, trends, and di... more This study uses recent Demographic and Health Survey (DHS) data to examine levels, trends, and differentials in orphan prevalence in sub-Saharan Africa. The first part of the analysis presents direct estimates of orphan prevalence in 17 countries during the period 1995-2000. We find a strong correlation between orphanhood prevalence and national adult HIV prevalence estimates lending support to the interpretation of the orphan crisis as, in large part, AIDS-related. The second part of the analysis consists of an in-depth study of trends and age-patterns in orphan prevalence and welfare in the 1990s for five countries that have had widely divergent HIV prevalence levels (Zimbabwe, Kenya, Tanzania, Ghana, and Niger). The vulnerability of orphans with respect to their situation in households and educational opportunities is evaluated in relation to non-orphans' experience. The results of the analysis indicate that losing one or both parents is significantly associated with diminished chances of being at the appropriate grade level for age. Our results are interpreted in the context of societal responses to the crisis, and potential recommendations for intervention.

Fourth-generation HIV rapid tests (RTs) claim to detect both p24 antigen (Ag) and HIV antibodies ... more Fourth-generation HIV rapid tests (RTs) claim to detect both p24 antigen (Ag) and HIV antibodies (Ab) for early identification of acute infections, important for targeting prevention and reducing HIV transmission. In a nationally representative household survey in Swaziland, 18,172 adults, age 18 to 49 years, received home-based HIV rapid testing in 2010 and 2011. Of the 18,172 individuals, 5,822 (32.0%) were Ab positive (Ab) by the Determine HIV-1/2 Ab/Ab combo test, and 5,789 (99.4%) of those were confirmed to be reactive in the Uni-Gold test. Determine combo identified 12 individuals as having acute infections (Ag/Ab negative [Ab]); however, none had detectable HIV-1 RNA and 8 of 12 remained HIV negative at their 6-week follow-up visit (4 were lost to follow-up). All RT-nonreactive samples were pooled and tested by nucleic acid amplification testing (NAAT) to iden-tify acute infections. NAAT identified 13 (0.1%) of the 12,338 HIV antibody-negative specimens as HIV RNA positive, w...

Adult and Maternal Mortality

Chapter 11 of the Kenya Demographic Health Survey (KDHS) report presents data on adult and matern... more Chapter 11 of the Kenya Demographic Health Survey (KDHS) report presents data on adult and maternal mortality. Sibling history data allowed for direct estimation of overall adult mortality by sex as well as maternal mortality in particular. Results showed that among surviving siblings current age (used to estimate death exposure) was not reported for less than 1% of siblings while among the deceased siblings complete reporting of age at death and years were recorded. The net effect of these opposing sex-specific age patterns was that the female and male mortality rates for ages 15-49 were equal (4.7 deaths/1000 years of exposure); though female mortality was higher than male mortality. Maternal deaths represented 27% of all deaths in women aged 15-49. Thus the maternal mortality ratio was estimated to be 590 maternal deaths per 100000 live births. However the sparseness of KDHS sibling history data makes it statistically reliable across the relevant calendar periods.

This report presents the findings of the May-October 1995 in-depth Sumve Survey on Adult and Chil... more This report presents the findings of the May-October 1995 in-depth Sumve Survey on Adult and Childhood Mortality (SACM) in the Mwanza Region of northwestern Tanzania. The aim was to determine whether data collection by proxy from mothers sisters could be used to estimate childhood mortality rates and to describe the demographic situation and use of maternity services in order to improve local programs. The sample was drawn from the Kwimba District of Mwanza Region and south of Lake Victoria. The area is largely subsistence-farmed with low modernization and educational levels. The Sukuma group is the dominant ethnic group. The study population resided mostly within the primary health care program service area which includes a large hospital for tertiary care needs. Phase I involved a representative sample of 1488 households and 2130 women aged 15-50 years. Data collection included full birth histories of own respondent and sibling histories. Phase II was conducted one month after Pha...