iedea west africa wada: west africa database on antiretroviral therapy charlotte lewden médecin...

IeDEA West AfricaWADA: West Africa database on

antiretroviral therapy

Charlotte LewdenMédecin épidémiologiste,

ISPED, Inserm U897, Université de Bordeaux, France

IeDEA West Africa, 5 June 2013 2

IeDEA International Epidemiologic Databases

to Evaluate AIDS

• International research consortium established in 2005 by the US National Institute of Allergy and Infectious Diseases (NIH)

• Resource for globally diverse HIV/AIDS data• To address research questions in HIV/AIDS

unanswerable by single cohorts• First round 2006-2011;

Second round 2011-2016: currently year 7: July 2012 to June 2013


IeDEA Regions


• WADA: 16 adult and 11 pediatric centres in 9 countries: Benin, Burkina Faso, Côte d’Ivoire, Ghana, Guinea-Bissau, Mali, Nigeria, Senegal, Togo

• Coordinating Center: ISPED, Univ Bordeaux Segalen, France• Regional Office: PAC-CI, CHU Treichville, Abidjan Côte d’Ivoire

IeDEA West Africa (WADA)


WADA Objectives for 2011-2016

• To measure the effectiveness of ART in HIV-infected individuals in West Africa in the long-term, and to assess factors that influence program and treatment outcomes

• To increase the capacity for delivering ART durably in West Africa by increasing the capacity for monitoring clinical outcomes at the individual and population levels in adults and children

• To document the morbidity burden in HIV-infected individuals in care in HIV programs throughout West Africa.


WADA study design

• Observational prospective multicenter study

• Pooled database of HIV-infected adults and children data followed in reference clinics in West Africa


WADA SitesCountry Adults Children

Benin 1 1 urban

Burkina Faso 2 1 urban

Cote d’Ivoire 6 5 urban,

2 semi-rural

Ghana 1 urban

Guinea Bissau 1 urban

Guinee Conakry future semi-rural

Mali 2 1 urban

Nigeria 2 urban

Senegal 1 1 urban

Togo 1 1 urban


WADA Inclusion criteria

• 2006-2011– HIV-1 or HIV-2 infected– Treatment with ART (antiretroviral combinations)

• 2011-2016– HIV-infected individuals who initiated ART– HIV-2 or HIV-1/HIV-2 infected individuals >18

years, whatever they receive ART or not– HIV-exposed children born to HIV-infected mothers

until their early infant HIV diagnosis– Children with a confirmed HIV-infection whatever

the time of ART initiation


WADA scientific update and perspectives

• Response to ART in adults • Morbidity• Hepatitis• Cancer• Quality of life• HIV-2 and HIV-1/HIV-2• Pediatrics and adolescents• Women and mothers• (Linkage to care and in care)


IeDEA West Africa

Observational cohort

• HIV-infected adults with ART N= 58,611• HIV-2 or (HIV-2 and HIV-1) positive N= 1,933• HIV-exposed children N= 4,079• HIV-infected children without ART N= 526• HIV-infected children with ART N= 4,808


TablesTables

Description Pediatrics Adults

Socio-demographic and clinical characteristics at ART initiation /baseline

TAB_BAS TAB_BAS

Biological data (baseline and follow-up) TAB_LAB TAB_LAB

TCD4+ lymphocytes measurements (baseline and follow-up)

TAB_LAB_CD4 TAB_LABCD4

Viral load measurements (baseline and follow-up) TAB_LAB_RNA TAB_LABCV

Antiretroviral treatments (ART) TAB_ART TAB_MISEART

TAB_SUIART

Follow-up TAB_VIS TAB_SUIVI

Vital status, date of last contact TAB_OUTCOME TAB_STATUT

MTCT TAB_PMTCT_INT TAB_PTME

Opportunistic infections - TAB_IO

Prophylaxies of opportunistic infections - TAB_PROPHYIO

Parental health TAB_PAR_HEALTH -


Apport des bases de données pour le suivi des PVVIH

• Formalisation du recueil de données : fiche standard (pas toujours)

• Édition de liste de patients en retard de visite pour la relance active des patients perdus de vue

• Edition d’historiques à partir du dossier du patient (pas toujours) ou visualisation du dossier informatisé pendant la consultation

• Aide à la décision• Gestion de l’approvisionnement en tests et médicaments• Rapports aux financeurs• Suivi des pratiques, respect des recommandations• Recherche

Forster_Bul_WHO2008 (Art-Linc); Braitstein_jaids2009 (Kenya); Nash_jaids2009; Douglas_plosmed2010 (Malawi); Ekouevi_curr_opinin_hiv_aids2011


Sine qua non

• Personnels compétents et en nombre suffisant

• Maintenance du matériel

• Sauvegardes

• Complétude de la base

• Contrôle de la qualité


Inconvénients possibles

• Base de données incomplète donc inutilisable

• Redondance des fiches et des tables par ajouts successifs entrainant un surcroit de travail

iedea west africa wada: west africa database on antiretroviral therapy charlotte lewden médecin...

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