Monitoring viral load for the last mile: what will it cost?

Introduction: Routine viral load testing is the WHO-recommended method for monitoring HIV-infected patients on ART, and many countries are rapidly scaling up testing capacity at centralized laboratories. Providing testing access to the most remote populations and facilities (the "last mile") is especially challenging. Using a geospatial optimization model, we estimated the incremental costs of accessing the most remote 20% of patients in Zambia by expanding the transportation network required to bring blood samples from ART clinics to centralized laboratories and return results to clinics.

Impact of a borderless sample transport network for scaling up viral load monitoring: results of a geospatial optimization model for Zambia.

Introduction: The World Health Organization recommends viral load (VL) monitoring at six and twelve months and then annually after initiating antiretroviral treatment for HIV. In many African countries, expansion of VL testing has been slow due to a lack of efficient blood sample transportation networks (STN). To assist Zambia in scaling up testing capacity, we modelled an optimal STN to minimize the cost of a national VL STN.

Cocaine effects on pulsatile secretion of ACTH in men.

The effects of cocaine on pulsatile secretion of adrenocorticotropic hormone (ACTH) in men were studied under controlled clinical research ward conditions. Eight men with a Diagnostic and Statistical Manual of the American Psychiatric Association Version III, revised, diagnosis of concurrent cocaine and opioid dependence provided their informed consent for participation in this study. After an overnight fast, a challenge dose of cocaine (30 mg i.

Buprenorphine effects on morphine- and cocaine-induced subjective responses by drug-dependent men.

The effects of daily buprenorphine treatment (4 or 8 mg/day, sublingual) on reports of subjective effects after single intravenous doses of morphine (10 mg), cocaine (30 mg), and saline placebo were studied on an inpatient clinical research ward in 26 men concurrently dependent on opioids and cocaine (DSM-III-R). Latency to detection and certainty of a drug effect, as well as drug quality (intensity, euphoria, and dysphoria), were studied before and after 10 to 12 days of buprenorphine maintenance. Saline was accurately identified by all 26 patients during the drugfree baseline and by 25 patients during buprenorphine maintenance conditions.

Acute interactions of buprenorphine with intravenous cocaine and morphine: an investigational new drug phase I safety evaluation.

Recent preclinical and clinical studies suggest that buprenorphine, an opioid mixed agonist-antagonist, may be useful for the treatment of dual dependence on cocaine and opiates. This report describes an inpatient clinical evaluation of the safety of buprenorphine alone and in combination with single doses of cocaine and morphine. Twenty subjects with a DSM-III-R diagnosis of concurrent cocaine and opioid dependence were randomly assigned to maintenance treatment with single daily doses of 4 or 8 mg of sublingual buprenorphine for 21 days.

Parallel increases in sister-chromatid exchanges at base level and with UV treatment in human opiate users.

The SCE base level frequency and SCE levels induced by far-UV (254 nm) treatment of cells in early G1 and early S phases of the cell cycle were significantly higher in leukocytes from heroin addicts as compared to controls. The increased SCE levels in addicts was greatest at base level and smallest after UV irradiation of cells in S phase. These results corroborate and extend our previous findings of increased chromosome damage and reduced DNA-repair synthesis in heroin users.

Effect of endogenous opioid blockade on the amplitude and frequency of pulsatile luteinizing hormone secretion in normal men.

The role of endogenous opiates in the neuroendocrine regulation of episodic LH secretion in normal men was examined in seven adult males before and after the administration of a potent and specific opiate receptor antagonist, naltrexone. The quantitative pattern of pulsatile LH secretion was analyzed in serum derived by continuous exfusion of blood in 20-min samples over 8-h period. The administration of naltrexone markedly increased the following: 1) total area under the continuous LH secretion curve [22,725 +/- 2,026 (control) vs.

Buprenorphine effects on plasma luteinizing hormone and prolactin in male heroin addicts.

Buprenorphine, a mixed opiate agonist-antagonist, suppressed plasma luteinizing hormone (LH) and increased prolactin levels after 12 consecutive days of ascending dose administration (0.5-8 mg/day s.c.

Operant analysis of human heroin self-administration and the effects of naltrexone.

The effects of maintenance on a narcotic antagonist, naltrexone (50 mg/day p.o.), or placebo on patterns of operant acquisition and use of heroin were studied under double-blind conditions.

Alteration of T and null lymphocyte frequencies in the peripheral blood of human opiate addicts: in vivo evidence for opiate receptor sites on T lymphocytes.

Street opiate addiction produces a significant depression in the absolute number of total T lymphocytes in peripheral blood as measured by the ability of the lymphocytes to rosette sheep red blood cells (SRBC). Associated with the decrease in T cells, there is an increase in the absolute number of null lymphocytes but no significant changes in B lymphocytes or total white blood cell count. The T cell values for 2 different populations of addicts (n = 12 and 32) are 31.

Heroin and naltrexone effects on pituitary-gonadal hormones in man: interaction of steroid feedback effects, tolerance and supersensitivity.

The acute and chronic effects of heroin, and the opiate antagonist naltrexone, on integrated plasma samples analyzed for luteinizing hormone (LH) and testosterone (T) levels were studied in six adult males with a history of heroin addiction. Acute doses of heroin (10 mg i.v.

Effect of acute ethanol ingestion on integrated plasma prolactin levels in normal men.

Healthy male subjects ingested 1.0 g ethanol/kg (Alcohol Day) and caloric equivalents of sucrose (Control Day). Plasma prolactin was determined on samples collected at 20-min intervals by serial constant blood exfusion, from 2 hr before to 4 hr after the drink.

Effect of alcohol and marihuana on tobacco smoking.

Tobacco smoking covaried with alcohol consumption in male social drinkers over 15 days of unrestricted alcohol availability. Increased tobacco smoking was associated with alcohol consumption in occasional, moderate, and heavy smokers. Tobacco smoking was not systematically related to marihuana smoking even though both drugs were often smoked at the same time.

Effects of heroin and naltrexone on plasma prolactin levels in man.

Plasma levels of prolactin were increased following intravenous self-administration of heroin by young men with a history of heroin addiction. Following 10 days of controlled heroin usage, tolerance could be demonstrated to the acute prolactin-releasing effect of heroin. There was no evidence that a single dose of naltrexone affected basal prolactin levels.

Effects of heroin self-administration on cigarette smoking.

Cigarette smoking increased during heroin self-administration in comparison to drug-free and methadone detoxification conditions in eight heroin addicts given naltrexone placebo (P less than 0.01) and three heroin addicts given buprenorphine placebo. Cigarette smoking was stable across conditions for one subject who did not use heroin during naltrexone blockade of heroin effects.