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Article: Pre-exposure Prophylaxis: The Delivery Challenge.

Venter, Willem D F

2018 Volume 6, Page(s) 188

Abstract: HIV pre-exposure prophylaxis (PrEP), despite its efficacy, has been slow in uptake throughout the world. This article discusses the operational and service delivery complexity, based on early real-world experience, with some recommendations on how this ... ...

Abstract	HIV pre-exposure prophylaxis (PrEP), despite its efficacy, has been slow in uptake throughout the world. This article discusses the operational and service delivery complexity, based on early real-world experience, with some recommendations on how this promising intervention could be made more available. Currently, access to PrEP is made complex by restricting delivery to dedicated health facilities, as well as requirements around HIV testing and toxicity monitoring. Expanding to verticalized services that focus on well-defined populations where HIV testing and treatment programmes already exist, has proven relatively simple. Providing PrEP outside of this environment has yet to be demonstrated at any scale, and will likely require innovative thinking addressing the regulatory and clinical environment, so as to ensure easier access to this promising HIV prevention tool.
Language	English
Publishing date	2018-07-06
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2711781-9
ISSN	2296-2565
ISSN	2296-2565
DOI	10.3389/fpubh.2018.00188
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Article ; Online: Impact of rilpivirine cross-resistance on long-acting cabotegravir-rilpivirine in low and middle-income countries.

Steegen, Kim / Chandiwana, Nomathemba / Sokhela, Simiso / Venter, Willem D F / Hans, Lucia

AIDS (London, England)

2023 Volume 37, Issue 6, Page(s) 1009–1011

Abstract: Baseline rilpivirine drug resistance mutations (DRMs) are a risk factor for virological failure in patients treated with long-acting cabotegravir and rilpivirine (CAB/RPV LA). We investigated rilpivirine cross-resistance in treatment-naive and ... ...

Abstract	Baseline rilpivirine drug resistance mutations (DRMs) are a risk factor for virological failure in patients treated with long-acting cabotegravir and rilpivirine (CAB/RPV LA). We investigated rilpivirine cross-resistance in treatment-naive and experienced patients in South Africa. One in 10 treatment-naive patients and 74.5% of patients failing treatment presented with rilpivirine DRMs. Our data suggest targeted genotyping may be required for patients initiating CAB/RPV LA, which significantly complicates the currently used public health approach.
MeSH term(s)	Humans ; Rilpivirine/therapeutic use ; Anti-HIV Agents/adverse effects ; Developing Countries ; HIV Infections/drug therapy ; HIV-1/genetics ; Pyridones/therapeutic use ; Anti-Retroviral Agents/therapeutic use
Chemical Substances	Rilpivirine (FI96A8X663) ; cabotegravir (HMH0132Z1Q) ; Anti-HIV Agents ; Pyridones ; Anti-Retroviral Agents
Language	English
Publishing date	2023-02-04
Publishing country	England
Document type	Letter
ZDB-ID	639076-6
ISSN	1473-5571 ; 0269-9370 ; 1350-2840
ISSN (online)	1473-5571
ISSN	0269-9370 ; 1350-2840
DOI	10.1097/QAD.0000000000003505
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Article ; Online: From Evidence to Effectiveness: Implications of the Randomized Trial to Prevent Vascular Events in HIV Study for People With Human Immunodeficiency Virus in Low- and Middle-Income Settings.

Manne-Goehler, Jennifer / Ali, Mohammed K / Flood, David / Marconi, Vincent C / Venter, Willem D F / Siedner, Mark J

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

2023

Abstract: The Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE) study found a 35% reduction in major adverse cardiovascular events for people with human immunodeficiency virus who received daily pitavastatin. However, how this evidence will change ... ...

Abstract	The Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE) study found a 35% reduction in major adverse cardiovascular events for people with human immunodeficiency virus who received daily pitavastatin. However, how this evidence will change practice is far from certain. Here, we outline evidence gaps and political and healthcare delivery challenges that will need to be addressed for REPRIEVE to offer public health benefits in low- and middle-income countries.
Language	English
Publishing date	2023-12-08
Publishing country	United States
Document type	Journal Article
ZDB-ID	1099781-7
ISSN	1537-6591 ; 1058-4838
ISSN (online)	1537-6591
ISSN	1058-4838
DOI	10.1093/cid/ciad702
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Article ; Online: Profile of presentation of HIV-positive patients to an emergency department in Johannesburg, South Africa.

Laher, Abdullah E / Venter, Willem D F / Richards, Guy A / Paruk, Fathima

Southern African journal of HIV medicine

2021 Volume 22, Issue 1, Page(s) 1177

Abstract: Background: Despite improved availability and better access to antiretroviral therapy (ART), approximately 36% of human immunodeficiency virus (HIV)-positive South Africans are still not virally suppressed.: Objective: The aim of this study was to ... ...

Abstract	Background: Despite improved availability and better access to antiretroviral therapy (ART), approximately 36% of human immunodeficiency virus (HIV)-positive South Africans are still not virally suppressed. Objective: The aim of this study was to describe the patterns of presentation of HIV-positive patients to a major central hospital emergency department (ED). Methods: In this prospectively designed study, consecutive HIV-positive patients presenting to the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) adult ED were enrolled between 07 July 2017 and 18 October 2018. Results: A total of 1224 participants were enrolled. Human immunodeficiency virus was newly diagnosed in 212 (17.3%) patients, 761 (75.2%) were on ART, 245 (32.2%) reported ART non-adherence, 276 (22.5%) had bacterial pneumonia, 244 (19.9%) had tuberculosis (TB), 86 (7.0%) had gastroenteritis, 205 (16.7%) required intensive care unit admission, 381 (31.1%) were admitted for ≥ 7 days and 166 (13.6%) died. With regard to laboratory parameters, CD Conclusion: Human immunodeficiency virus-positive patients presenting to the CMJAH ED demonstrated a high prevalence of opportunistic infections, required a prolonged hospital stay and had high mortality rates. There is a need to improve the quality of ART services and accessibility to care.
Language	English
Publishing date	2021-01-29
Publishing country	South Africa
Document type	Journal Article
ZDB-ID	2259791-8
ISSN	2078-6751 ; 2078-6751
ISSN (online)	2078-6751
ISSN	2078-6751
DOI	10.4102/sajhivmed.v22i1.1177
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Article ; Online: What does preexposure prophylaxis mean for treatment; what does treatment mean for preexposure prophylaxis?

Venter, Willem D F

Current opinion in HIV and AIDS

2016 Volume 11, Issue 1, Page(s) 35–40

Abstract: Purpose of review: Both preexposure prophylaxis (PrEP) and treatment as prevention (TaP) have shown promise in contributing to HIV prevention, in models, observational cohorts and in real-world intervention studies. They share similarities, in that they ...

Abstract	Purpose of review: Both preexposure prophylaxis (PrEP) and treatment as prevention (TaP) have shown promise in contributing to HIV prevention, in models, observational cohorts and in real-world intervention studies. They share similarities, in that they use the same drugs, toxicity markers and may be focused on the same key populations. How to implement PrEP is still the source of much debate; effective coverage with TaP, with recent data on the positive impact of treatment at high CD4 counts, is still an ongoing challenge. Recent findings: Treatment has demonstrated individual benefit even at CD4 counts above 350 cells/μl; PrEP has shown the effectiveness in real-world use. Summary: This article discusses the intersection of the two interventions, some programmatic misconceptions and complexities, and argues that PrEP is a nuanced and useful adjunct to HIV programmes. PrEP can be rolled out in a way that complements treatment, possibly even within primary health clinics, and may be required for the many people in whom TaP currently fails. PrEP will need constant adaptation so as to maintain programmatic and cost-effectiveness, as the epidemiology of HIV changes with TaP rollout and expansion as CD4 restrictions are lifted. Finally, the article also argues that so-called ethical concerns around competing resources are relatively easily resolved.
MeSH term(s)	Anti-HIV Agents/administration & dosage ; Antiretroviral Therapy, Highly Active/methods ; Chemoprevention/methods ; Disease Transmission, Infectious/prevention & control ; HIV Infections/drug therapy ; HIV Infections/prevention & control ; HIV Infections/transmission ; Humans ; Pre-Exposure Prophylaxis/methods
Chemical Substances	Anti-HIV Agents
Language	English
Publishing date	2016-01
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	2502511-9
ISSN	1746-6318 ; 1746-630X
ISSN (online)	1746-6318
ISSN	1746-630X
DOI	10.1097/COH.0000000000000208
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Article ; Online: Predictors of prolonged hospital stay in HIV-positive patients presenting to the emergency department.

Laher, Abdullah E / Paruk, Fathima / Richards, Guy A / Venter, Willem D F

PloS one

2021 Volume 16, Issue 4, Page(s) e0249706

Abstract: Background: Prolonged hospitalization places a significant burden on healthcare resources. Compared to the general population, hospital length of stay (LOS) is generally longer in HIV-positive patients. We identified predictors of prolonged hospital ... ...

Abstract	Background: Prolonged hospitalization places a significant burden on healthcare resources. Compared to the general population, hospital length of stay (LOS) is generally longer in HIV-positive patients. We identified predictors of prolonged hospital length of stay (LOS) in HIV-positive patients presenting to an emergency department (ED). Methods: In this cross-sectional study, HIV-positive patients presenting to the Charlotte Maxeke Johannesburg Academic Hospital adult ED were prospectively enrolled between 07 July 2017 and 18 October 2018. Data was subjected to univariate and multivariate logistic regression to determine parameters associated with a higher likelihood of prolonged hospital LOS, defined as ≥7 days. Results: Among the 1224 participants that were enrolled, the median (IQR) LOS was 4.6 (2.6-8.2) days, while the mean (SD) LOS was 6.9 (8.2) days. On multivariate analysis of the data, hemoglobin <11 g/dL (OR 1.37, p = 0.032), Glasgow coma scale (GCS) <15 (OR 1.80, p = 0.001), creatinine >120 μmol/L (OR 1.85, p = 0.000), cryptococcal meningitis (OR 2.45, p = 0.015) and bacterial meningitis (OR 4.83, p = 0.002) were significantly associated with a higher likelihood of LOS ≥7 days, while bacterial pneumonia (OR 0.35, p = 0.000) and acute gastroenteritis (OR 0.40, p = 0.025) were significantly associated with a lower likelihood of LOS ≥7 days. Conclusion: Various clinical and laboratory parameters are useful in predicting prolonged hospitalization among HIV-positive patients presenting to the ED. These parameters may be useful in guiding clinical decision making and directing the allocation of resources.
MeSH term(s)	Adult ; Clinical Decision-Making/methods ; Cross-Sectional Studies ; Emergency Service, Hospital/statistics & numerical data ; Female ; HIV Infections/drug therapy ; HIV Infections/pathology ; HIV Infections/virology ; HIV-1/isolation & purification ; Hospitalization/statistics & numerical data ; Humans ; Length of Stay/statistics & numerical data ; Male ; Prognosis ; Retrospective Studies ; South Africa
Language	English
Publishing date	2021-04-21
Publishing country	United States
Document type	Journal Article
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0249706
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Article ; Online: Pre-exposure Prophylaxis

Willem D. F. Venter

Frontiers in Public Health, Vol

The Delivery Challenge

2018 Volume 6

Abstract	HIV pre-exposure prophylaxis (PrEP), despite its efficacy, has been slow in uptake throughout the world. This article discusses the operational and service delivery complexity, based on early real-world experience, with some recommendations on how this promising intervention could be made more available. Currently, access to PrEP is made complex by restricting delivery to dedicated health facilities, as well as requirements around HIV testing and toxicity monitoring. Expanding to verticalized services that focus on well-defined populations where HIV testing and treatment programmes already exist, has proven relatively simple. Providing PrEP outside of this environment has yet to be demonstrated at any scale, and will likely require innovative thinking addressing the regulatory and clinical environment, so as to ensure easier access to this promising HIV prevention tool.
Keywords	pre-exposure prophylaxis ; PrEP ; HIV ; prevention ; operational ; service delivery ; Public aspects of medicine ; RA1-1270
Subject code	360
Language	English
Publishing date	2018-07-01T00:00:00Z
Publisher	Frontiers Media S.A.
Document type	Article ; Online
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Article ; Online: Does Engagement in HIV Care Affect Screening, Diagnosis, and Control of Noncommunicable Diseases in Sub-Saharan Africa? A Systematic Review and Meta-analysis.

Kileel, Emma M / Zheng, Amy / Bor, Jacob / Fox, Matthew P / Crowther, Nigel J / George, Jaya A / Khoza, Siyabonga / Rosen, Sydney / Venter, Willem D F / Raal, Frederick / Hibberd, Patricia / Brennan, Alana T

AIDS and behavior

2024 Volume 28, Issue 2, Page(s) 591–608

Abstract: Low- and middle-income countries are facing a growing burden of noncommunicable diseases (NCDs). Providing HIV treatment may provide opportunities to increase access to NCD services in under-resourced environments. We conducted a systematic review and ... ...

Abstract	Low- and middle-income countries are facing a growing burden of noncommunicable diseases (NCDs). Providing HIV treatment may provide opportunities to increase access to NCD services in under-resourced environments. We conducted a systematic review and meta-analysis to evaluate whether use of antiretroviral therapy (ART) was associated with increased screening, diagnosis, treatment, and control of diabetes, hypertension, chronic kidney disease, or cardiovascular disease among people living with HIV in sub-Saharan Africa (SSA). A comprehensive search of electronic literature databases for studies published between 01 January 2011 and 31 December 2022 yielded 26 studies, describing 13,570 PLWH in SSA, 61% of whom were receiving ART. Random effects models were used to calculate summary odds ratios (ORs) of the risk of diagnosis by ART status and corresponding 95% confidence intervals (95% CIs), where appropriate. ART use was associated with a small but imprecise increase in the odds of diabetes diagnosis (OR 1.07; 95% CI 0.71, 1.60) and an increase in the odds of hypertension diagnosis (OR 2.10, 95% CI 1.42, 3.09). We found minimal data on the association between ART use and screening, treatment, or control of NCDs. Despite a potentially higher NCD risk among PLWH and regional efforts to integrate NCD and HIV care, evidence to support effective care integration models is lacking.
MeSH term(s)	Humans ; HIV Infections/diagnosis ; HIV Infections/drug therapy ; HIV Infections/epidemiology ; Noncommunicable Diseases/epidemiology ; Noncommunicable Diseases/therapy ; Hypertension/diagnosis ; Hypertension/drug therapy ; Hypertension/epidemiology ; Diabetes Mellitus/diagnosis ; Diabetes Mellitus/drug therapy ; Diabetes Mellitus/epidemiology ; Africa South of the Sahara/epidemiology
Language	English
Publishing date	2024-02-01
Publishing country	United States
Document type	Meta-Analysis ; Systematic Review ; Journal Article
ZDB-ID	1339885-4
ISSN	1573-3254 ; 1090-7165
ISSN (online)	1573-3254
ISSN	1090-7165
DOI	10.1007/s10461-023-04248-0
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Article ; Online: Change in body weight and risk of hypertension after switching from efavirenz to dolutegravir in adults living with HIV: evidence from routine care in Johannesburg, South Africa.

Brennan, Alana T / Nattey, Cornelius / Kileel, Emma M / Rosen, Sydney / Maskew, Mhairi / Stokes, Andrew C / Fox, Matthew P / Venter, Willem D F

EClinicalMedicine

2023 Volume 57, Page(s) 101836

Abstract: Background: The integrase strand transfer inhibitor (INSTI) dolutegravir is recommended in World Health Organization guidelines, but is associated with weight gain. We evaluated weight change in patients switching from efavirenz to dolutegravir in first- ...

Abstract	Background: The integrase strand transfer inhibitor (INSTI) dolutegravir is recommended in World Health Organization guidelines, but is associated with weight gain. We evaluated weight change in patients switching from efavirenz to dolutegravir in first-line antiretroviral therapy (ART) in Johannesburg, South Africa. Methods: We conducted a prospective cohort study of adults (≥16 years) of black African ancestry with HIV who initiated ART between January 2010-December 2020. Patients were propensity score-matched 1:1 (unexposed i.e. remaining on efavirenz: exposed i.e. switched from efavirenz to dolutegravir) on sex, age, months on ART, first ART regimen, haemoglobin, body mass index (BMI), blood pressure, viral load and CD4 count. We used linear regression to assess the effect of switching from efavirenz to dolutegravir on weight change and hypertension 12 months after exposure. Findings: We matched 794 patients switching to dolutegravir to 794 remaining on efavirenz. Exposed patients had a higher mean change in weight (1.78 kg; 95% confidence interval (CI):1.04,2.52 kg) from start of follow-up to 12 months vs. unexposed. We also found a 14.2 percentage point increase (95% CI: 10.6,17.7) in the risk of hypertension in those exposed to dolutegravir vs those that remained on efavirenz. Interpretation: In a real-world population, patients gained more weight and were at higher risk of hypertension after switching from efavirenz to dolutegravir than those remaining on efavirenz. Longer follow-up is needed, however, to determine if INSTI-associated weight gain is associated with changes in non-communicable disease risk over the long-term, or whether weight gain is sustained, as seen in clinical trials. Funding: This study has been made possible by the generous support of the American People and the President's Emergency Plan for AIDS Relief (PEPFAR) through the United States Agency for International Development (USAID), under the terms of cooperative agreement cooperative Agreement 72067419CA00004. In addition to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) 1K01MH105320-01A1.
Language	English
Publishing date	2023-02-06
Publishing country	England
Document type	Journal Article
ISSN	2589-5370
ISSN (online)	2589-5370
DOI	10.1016/j.eclinm.2023.101836
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Article ; Online: Southern African HIV Clinicians Society 2023 Guideline for post-exposure prophylaxis: Updated recommendations.

Horak, Jaco / Venter, Willem D F / Wattrus, Camilla / Papavarnavas, Nectarios / Howell, Pauline / Sorour, Gillian / Wallis, Carole / Gill, Katherine / Conradie, Francesca / Bekker, Linda-Gail

Southern African journal of HIV medicine

2023 Volume 24, Issue 1, Page(s) 1522

Language	English
Publishing date	2023-09-28
Publishing country	South Africa
Document type	Journal Article
ZDB-ID	2259791-8
ISSN	2078-6751 ; 2078-6751
ISSN (online)	2078-6751
ISSN	2078-6751
DOI	10.4102/sajhivmed.v24i1.1522
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