101
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Abiodun O, Jagun O, Sodeinde K, Bamidele F, Adekunle M, David A. Socioeconomic, clinical, and behavioral characteristics of adolescents living with HIV in Southwest Nigeria: implication for preparedness for transition to adult care. AIDS Care 2021; 34:315-323. [PMID: 33764812 DOI: 10.1080/09540121.2021.1906402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
There is a need to generate data that demonstrate preparedness (or a lack of it) of adolescents to crossover to adult care to inform policy and create appropriate models in LMICs. This cross-sectional survey of 252 adolescents (15-19 years) receiving HIV-care assessed sociodemographic characteristics, clinical and ART status, and HIV-related behaviors. Also, the study appraised HIV status awareness, and disclosure, and access to healthcare. The mean age of the participants was 16.41 (SD = 1.41) years, and 128 (50.8%) of them were female. The mean adherence level (by VAS) reported was 73.05 ± 16.75. The most frequently reported reasons for missing medications were forgetting (39.6%), falling asleep (37.7%), being away from home (33.8%), and being too busy with other endeavors (32.6%). Most (93.7%) of the participants paid for health care services out-of-pocket. Many (38.1%) of them did not know how they acquired HIV infection. About half (44.8%) of them had boy/girlfriends, but only 25 (9.9%) reported ever having sex. Only 4% disclosed their HIV status to their boy/girlfriends. Critical gaps exist in adolescents' preparedness for transition to adult HIV-care, necessitating the need for specific transition preparedness programs within the HIV-care cascade to address the peculiar needs of adolescents at this stage.Trial registration: ClinicalTrials.gov identifier: NCT03394391.
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Affiliation(s)
- Olumide Abiodun
- Department of Community Medicine, School of Clinical Sciences, Babcock University, Ilishan-Remo, Nigeria.,Centre for Epidemiology and Clinical Research, Sagamu, Nigeria
| | - Omodele Jagun
- Department of Ophthalmology, Benjamin Carson School of Medicine, Babcock University, Ilishan-Remo, Nigeria
| | - Kolawole Sodeinde
- Department of Community Medicine, School of Clinical Sciences, Babcock University, Ilishan-Remo, Nigeria
| | - Fikayo Bamidele
- Department of Community Medicine, Babcock University Teaching Hospital, Ilishan-Remo, Nigeria
| | - Motunrayo Adekunle
- Department of Pediatrics, Lagos State University College of Medicine, Ikeja, Nigeria
| | - Agatha David
- Clinical Sciences Department, Nigerian Institute Medical Research, Yaba, Lagos, Nigeria
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102
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Wogrin C, Willis N, Mutsinze A, Chinoda S, Verhey R, Chibanda D, Bernays S. It helps to talk: A guiding framework (TRUST) for peer support in delivering mental health care for adolescents living with HIV. PLoS One 2021; 16:e0248018. [PMID: 33657185 PMCID: PMC7928463 DOI: 10.1371/journal.pone.0248018] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 02/17/2021] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Adolescents living with HIV have poor treatment outcomes, including lower rates of viral suppression, than other age groups. Emerging evidence suggests a connection between improved mental health and increased adherence. Strengthening the focus on mental health could support increased rates of viral suppression. In sub-Saharan Africa clinical services for mental health care are extremely limited. Additional mechanisms are required to address the unmet mental health needs of this group. We consider the role that community-based peer supporters, a cadre operating at scale with adolescents, could play in the provision of lay-support for mental health. METHODS We conducted qualitative research to explore the experiences of peer supporters involved in delivering a peer-led mental health intervention in Zimbabwe as part of a randomized control trial (Zvandiri-Friendship Bench trial). We conducted 2 focus group discussions towards the end of the trial with 20 peer supporters (aged 18-24) from across 10 intervention districts and audio recorded 200 of the peer supporters' monthly case reviews. These data were thematically analysed to explore how peer supporters reflect on what was required of them given the problems that clients raised and what they themselves needed in delivering mental health support. RESULTS A primary strength of the peer support model, reflected across the datasets, is that it enables adolescents to openly discuss their problems with peer supporters, confident that there is reciprocal trust and understanding derived from the similarity in their lived experiences with HIV. There are potential risks for peer supporters, including being overwhelmed by engaging with and feeling responsible for resolving relationally and structurally complex problems, which warrant considerable supervision. To support this cadre critical elements are needed: a clearly defined scope for the manageable provision of mental health support; a strong triage and referral system for complex cases; mechanisms to support the inclusion of caregivers; and sustained investment in training and ongoing supervision. CONCLUSION Extending peer support to explicitly include a focus on mental health has enormous potential. From this empirical study we have developed a framework of core considerations and principles (the TRUST Framework) to guide the implementation of adequate supportive infrastructure in place to enhance the opportunities and mitigate risks.
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Affiliation(s)
| | | | | | | | - Ruth Verhey
- Friendship Bench, Avondale, Harare, Zimbabwe
| | - Dixon Chibanda
- Friendship Bench, Avondale, Harare, Zimbabwe
- Department of Psychiatry, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
- Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sarah Bernays
- Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
- School of Public Health, University of Sydney, Sydney, Australia
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103
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Factors Associated With Nonadherence to Antiretroviral Therapy Among Young People Living With Perinatally Acquired HIV in England. J Assoc Nurses AIDS Care 2021; 31:574-586. [PMID: 32467489 PMCID: PMC7497417 DOI: 10.1097/jnc.0000000000000171] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Young people living with perinatally acquired HIV may be at risk of poor adherence to antiretroviral therapy; identification of predictors, using a conceptual framework approach proposed previously by others, is important to identify those at higher risk. In 261 young people with perinatally acquired HIV in England, 70 (27%) reported 3-day nonadherence, 82 (31%) last month nonadherence, and 106 (41%) nonadherence on either measure. Of those reporting nonadherence on both measures, 52% (23/44) had viral load of <50 copies/ml, compared with 88% (127/145) of those reported being fully adherent. In multivariable analysis, young person and medication theme factors were associated with nonadherence. The main predictors of 3-day nonadherence were antiretroviral therapy containing a boosted protease inhibitor and poorer quality of life. Predictors of last month nonadherence were having told more people about one's HIV status, worse self-perception about having HIV, and boosted protease inhibitor-based regimens. The consistency of individual young person and medication factors in predicting nonadherence gives insight into where interventions may best be targeted to improve adherence.
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104
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Bongfen MC, Torpey K, Ganle J, Ankomah A. Level of adherence and associated factors among HIV-positive adolescents on antiretroviral therapy in Cameroon. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2021; 19:269-275. [PMID: 33337976 DOI: 10.2989/16085906.2020.1833055] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Aim: Globally, there were over 250 000 new HIV infections among adolescents in 2017, with a higher proportion of these in sub-Saharan Africa. In Cameroon, UNICEF estimated over 4 200 new HIV infections in adolescents in 2015; by 2016, there were over 40 000 adolescents who had HIV. Given that the number of adolescents living with HIV in Cameroon is on the increase, there is a need to better understand the factors influencing adherence to treatment. The objective of this study was to assess the factors associated with adherence among adolescents in Cameroon. Methods: A cross-sectional study was conducted. A total of 460 HIV+ adolescents who were receiving antiretroviral therapy were sampled randomly from nine health facilities. Questionnaires and data extraction forms were used to collect data. Descriptive (frequencies and proportions) and inferential (chi-square and multivariate logistic regression) statistical analyses methods were used to analyse the data. Statistical significance was set at p = 0.05 and 95% confidence level. Results: The level of adherence to antiretroviral therapy among the adolescents was 83%. Twelve out of 30 independent variables examined showed significant statistical association with adherence at the bivariate level. In the multivariable logistic regression analyses, however, only two variables significantly predicted adherence - experiencing side effects (AOR = 2.63; 95% CI = 1.14, 6.09; p = 0.02), and internalized stigma (AOR = 2.51; 95% CI = 1.04, 6.04; p = 0.04). Conclusion: Adherence to treatment among adolescents in Cameroon was found to be suboptimal. There is a need for more individualized, targeted medication counselling for adolescents and their guardians as well as strategies to reduce internalized stigma and improve adherence to antiretroviral treatment.
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Affiliation(s)
- Mbuwir Charlotte Bongfen
- Department of Population, Family and Reproductive Health, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Kwasi Torpey
- Department of Population, Family and Reproductive Health, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
| | - John Ganle
- Department of Population, Family and Reproductive Health, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
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105
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Minwagaw MT, Akenie BB, Tewabe DS, Tegegne AS, Beyene TB. Predictors of Poor Adherence to CART and Treatment Failure at Second-Line Regimens Among Adults in Public Hospitals of Amhara Region, North-Western Ethiopia: A Retrospective Cohort Study. Patient Prefer Adherence 2021; 15:2855-2864. [PMID: 34992354 PMCID: PMC8713999 DOI: 10.2147/ppa.s339108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 12/10/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Globally, HIV/AIDS has challenged the lives of 36.3 million people and resulted in 17 million orphans. The disease has neither a vaccine nor a cure and the only option currently is highly active antiretroviral therapy. This research was conducted to identify the predictors of poor adherence to CART and treatment failure at second-line regimen among adults living with HIV/AIDS in public hospitals of Amhara region, north-western Ethiopia. METHODS A retrospective cohort study design was conducted on 700 HIV-positive people who were receiving a second-line CART regimen. Participants on second-line regimens who followed their treatment between 2016 and 2019 were considered. Data were extracted from participants' clinical charts from June 18-July 7, 2020. RESULTS A multivariate regression analysis indicates that age of patients (OR = 1.025, 95% CI: 1.001-1.321; p = 0.005), follow-up visits (OR = 0.979, 95% CI: 0.873-0.998; p < 0.001), CD4 cell count change (OR = 0.9860; 95% CI: 0.835-0.998; p < 0.01), marital status (OR = 0.973, 95% CI: 0.789- 0.997; p = 0.006), female HIV-infected patients (OR = 0.990; 95% CI: 0.789-0.999; p <0.001), rural patients (OR = 1.151; 95% CI 1.065-1.398; p = 0.004), non-educated adult patients (OR = 1.026, 95% CI: 1.002-1.198; p = 0.003), existence of social violence (OR = 0.012, 95% CI: 0.008-0.134; p< 0.01), patients with opportunistic diseases (OR = 1.0345, 95% CI 1.002-1.142; p = 0.001), CD4 cell count (OR = 0.901, 95% CI: 0.843-0.995; p = 0.025) and malnutrition (OR = 0.883, 95% CI; 0.762-0.954; p = 0.001) significantly affected the two response variables. CONCLUSION Several variables affected both poor adherence to HAART and treatment failure at second-line regimens in the current investigation. Due attention should be given to aged patients, rural residents, non-educated patients, and patients with other morbidities to be successful with second-line treatment regimens.
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Affiliation(s)
| | | | - Desalew Salew Tewabe
- Department of Public Health, Amhara Public Health Institute, Bahir Dar, Ethiopia
| | - Awoke Seyoum Tegegne
- Department of Statistics, Bahir Dar University, Bahir Dar, Ethiopia
- Correspondence: Awoke Seyoum Tegegne Department of Statistics, Bahir Dar University, Po. Box 79, Bahir Dar, EthiopiaTel +251 918779451Fax + 251 2205927 Email
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106
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Gu LY, Zhang N, Mayer KH, McMahon JM, Nam S, Conserve DF, Moskow M, Brasch J, Adu-Sarkodie Y, Agyarko-Poku T, Boakye F, Nelson LE. Autonomy-Supportive Healthcare Climate and HIV-Related Stigma Predict Linkage to HIV Care in Men Who Have Sex With Men in Ghana, West Africa. J Int Assoc Provid AIDS Care 2021; 20:2325958220978113. [PMID: 33733909 PMCID: PMC7983411 DOI: 10.1177/2325958220978113] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
In Ghana, the HIV prevalence among MSM is more than 10 times greater than the general population of adults, and rates of engagement in HIV medical care are low among MSM diagnosed with HIV. Using structured surveys, we investigated the impact of HIV-related stigma, same-sex behavior stigma, and gender nonconformity stigma on linkage to HIV care (LTC) in MSM (N = 225) living with HIV in Ghana. Autonomy-supportive healthcare climate (OR = 1.63, p < .01), vicarious HIV stigma (OR = 2.73, p < .01), and age (OR = 1.06, p < .004) predicted LTC. Conversely, felt normative HIV stigma negatively predicted LTC (OR = 0.65, p < .05). Finally, we identified regional disparities, with MSM from Takoradi being 4 times and 5 times more likely to be LTC compared to Kumasi and Accra, respectively. Our findings highlight the nuanced roles of stigmas in shaping the HIV care continuum among MSM living with HIV, while revealing potential gaps in current measures of HIV-related stigma.
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Affiliation(s)
- Lily Y. Gu
- School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Nanhua Zhang
- Division of Biostatistics and Bioinformatics, Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | | | | | - Soohyun Nam
- School of Nursing, Yale University, New Haven, CT, USA
| | - Donaldson F. Conserve
- Milken Institute School of Public Health, George Washington University, Washington DC, USA
| | - Marian Moskow
- School of Nursing, University of Rochester, Rochester, NY, USA
| | - Judith Brasch
- School of Nursing, University of Rochester, Rochester, NY, USA
| | - Yaw Adu-Sarkodie
- School of Medical Sciences, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Thomas Agyarko-Poku
- School of Medical Sciences, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | | | - LaRon E. Nelson
- School of Nursing, Yale University, New Haven, CT, USA
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA
- Yale Institute of Global Health, Yale University, New Haven, CT, USA
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada
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107
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Ahonkhai AA, Pierce LJ, Mbugua S, Wasula B, Owino S, Nmoh A, Idigbe I, Ezechi O, Amaral S, David A, Okonkwo P, Dowshen N, Were MC. PEERNaija: A Gamified mHealth Behavioral Intervention to Improve Adherence to Antiretroviral Treatment Among Adolescents and Young Adults in Nigeria. FRONTIERS IN REPRODUCTIVE HEALTH 2021; 3. [PMID: 35237765 PMCID: PMC8887881 DOI: 10.3389/frph.2021.656507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: HIV is the leading cause of death for youth in Sub-Saharan Africa (SSA). The rapid proliferation of smart phones in SSA provides an opportunity to leverage novel approaches to promote adherence to life-saving antiretroviral therapy (ART) for adolescents and young adults living with HIV (AYA-HIV) that go beyond simple medication reminders. Methods: Guided by the Integrate, Design, Assess and Share (IDEAS) framework, our multidisciplinary team developed a peer-based mHealth ART adherence intervention—PEERNaija. Grounded in Social Cognitive Theory, and principles of contingency management and supportive accountability, PEERNaija delivers a multi-faceted behavioral intervention within a smartphone application to address important obstacles to adherence. Results:PEERNaija was developed as a gamified Android-based mHealth application to support the behavioral change goal of improving ART adherence among AYA-HIV within Nigeria, a low- and middle- income country (LMIC). Identified via foundational interviews with the target population and review of the literature, key individual (forgetfulness and poor executive functioning), environmental (poor social support) and structural (indirect cost of clinic-based interventions) barriers to ART adherence for AYA-HIV informed application features. Further informed by established behavioral theories and principles, the intervention aimed to improve self-efficacy and self-regulation of AYA-HIV, leverage peer relationships among AYA to incentivize medication adherence (via contingency management, social accountability), provide peer social support through an app-based chat group, and allow for outreach of the provider team through the incorporation of a provider application. Gamification mechanics incorporated within PEERNaija include: points, progress bar, leaderboard with levels, achievements, badges, avatars and targeted behavior change messages. PEERNaija was designed as a tethered mobile personal health record application, sharing data to the widely deployed OpenMRS electronic health record application. It also uses the secure opensource Nakama gamification platform, in line with Principles of Digital Development that emphasize use of opensource systems within LMICs. Conclusions: Theory-based gamified mHealth applications that incorporate social incentives have the potential to improve adherence to AYA-HIV. Ongoing evaluations of PEERNaija will provide important data for the potential role for a gamified, smartphones application to deliver multifaceted adherence interventions for vulnerable AYA-HIV in SSA.
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Affiliation(s)
- Aima A Ahonkhai
- Department of Medicine, Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, United States.,Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, United States.,Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Leslie J Pierce
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Samuel Mbugua
- Institute of Biomedical Informatics, Moi University, Kesses, Kenya
| | - Benjamin Wasula
- Institute of Biomedical Informatics, Moi University, Kesses, Kenya
| | - Samuel Owino
- Institute of Biomedical Informatics, Moi University, Kesses, Kenya
| | - Ashley Nmoh
- Department of Medicine Health and Society, Vanderbilt University, Nashville, TN, United States
| | - Ifeoma Idigbe
- Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Oliver Ezechi
- Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Sandra Amaral
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, United States
| | - Agatha David
- Nigerian Institute of Medical Research, Lagos, Nigeria
| | | | - Nadia Dowshen
- Craig-Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Martin C Were
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States.,Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
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108
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Nsibandze BS, Downing C, Poggenpoel M, Myburgh CP. “I have been rejected so many times” experiences of female adolescents living with HIV in rural Manzini, Eswatini: A case study. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2021. [DOI: 10.1016/j.ijans.2021.100307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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109
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Saberi P, McCuistian C, Agnew E, Wootton AR, Legnitto Packard DA, Dawson-Rose C, Johnson MO, Gruber VA, Neilands TB. Video-Counseling Intervention to Address HIV Care Engagement, Mental Health, and Substance Use Challenges: A Pilot Randomized Clinical Trial for Youth and Young Adults Living with HIV. TELEMEDICINE REPORTS 2021; 2:14-25. [PMID: 33575683 PMCID: PMC7869821 DOI: 10.1089/tmr.2020.0014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/01/2020] [Indexed: 05/04/2023]
Abstract
Background: Substance use and mental health are two barriers to engagement in care and antiretroviral therapy (ART) adherence among youth and young adults living with HIV (YLWH). The consequences of suboptimal adherence in YLWH are increased risk of HIV transmission and a future generation of immunodeficient adults with drug-resistant virus. Methods: The Youth to Telehealth and Texting for Engagement in Care (Y2TEC) study was a pilot randomized crossover trial that examined the feasibility and acceptability of a novel video-counseling series and accompanying text messages aimed at mental health, substance use, and HIV care engagement for YLWH. The intervention consisted of twelve 20-30-min weekly video-counseling sessions focused on identifying and addressing barriers to HIV care, mental health, and substance use challenges. Participants completed quantitative surveys at baseline, 4 months, and 8 months. Feasibility and acceptability were evaluated using prespecified benchmarks. Results: Fifty YLWH aged 18-29 years living in the San Francisco Bay Area were enrolled. Eighty-six percent and 75% of participants were retained at 4 and 8 months, respectively. A total of 455 (76%) video-counseling sessions were completed. In 82% of sessions, participants responded that they strongly agreed/agreed with this statement: "I felt heard, understood, and respected by the counselor." In 81% of sessions, participants responded that they strongly agreed/agreed with this statement: "Overall, today's session was right for me." At baseline, among participants reporting mental health challenges, only 10% noted having ever received mental health services, and among those who reported substance use challenges, ∼19% reported ever receiving substance use services. After 4 months of the Y2TEC intervention, participants reported slightly higher ART adherence and HIV knowledge, decreased depression and anxiety, and reduced stigma related to mental health and substance use. Conclusions: The Y2TEC intervention using video-counseling and text messaging was feasible and acceptable for YLWH. ClinicalTrials.gov ID: NCT03681145.
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Affiliation(s)
- Parya Saberi
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, California, USA
- Address correspondence to: Parya Saberi, PharmD, MAS, Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, UCSF Box 0886, 550 16th Street, 3rd Floor, San Francisco, CA 94143, USA
| | - Caravella McCuistian
- Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA
| | - Emily Agnew
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, California, USA
| | - Angie R. Wootton
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, California, USA
| | - Dominique A. Legnitto Packard
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, California, USA
| | - Carol Dawson-Rose
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, San Francisco, California, USA
| | - Mallory O. Johnson
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, California, USA
| | - Valerie A. Gruber
- Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA
| | - Torsten B. Neilands
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, California, USA
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Sabin LL, Nguyen VC, Harvey K, Bonawitz R, Hai LT, Van Lam N, Yen LT, Gifford AL, Haberer JE, Linh DT, DeSilva MB. Challenges to Antiretroviral Therapy Adherence and Coping Strategies to Overcome Them: Qualitative Investigations of Adolescents Living with HIV, their Caregivers, and Clinicians in Vietnam. Open AIDS J 2020. [DOI: 10.2174/1874613602014010114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
Adolescents living with HIV (ALHIV) in Vietnam are known to struggle with adherence to Antiretroviral Therapy (ART).
Objective:
To examine treatment challenges and facilitators experienced by ALHIV from the perspective of adolescents, their caregivers, and providers, and to inform an adherence intervention.
Methods:
In-depth Interviews (IDIs) of adolescent/caregiver dyads and Focus Group Discussions (FGDs) with adolescents, caregivers, and clinicians were conducted in Hanoi, Vietnam. We used semi-structured guides to encourage open-ended responses. We queried the challenges adolescents experience taking ART medications and being adherent, their awareness of disease status, and facilitators to support high adherence. Audio-recorded IDIs were translated into English, and coded and analyzed in NVivo using a thematic approach.
Results:
A total of 78 individuals participated in the study. Forty individuals participated in IDIs (20 adolescents and 20 caregivers). All adolescents had acquired HIV perinatally. We conducted six FGDs: four with adolescents, and one each with caregivers and clinicians. We identified major themes regarding awareness of HIV status (most caregivers reported they had disclosed to their child, while few adolescents revealed the knowledge of their status); perceived barriers to adherence (medication-related challenges, stigma, school-associated issues, financial obstacles, system challenges, awareness of HIV status); and adherence facilitators (development of dose-taking habits, reminder systems, social support). Differences between adolescents and caregivers related to key issues were evident.
Conclusion:
Further research is needed to elucidate discrepancies in adolescent-caregiver viewpoints and develop interventions tailored to both ALHIV and their caregivers.
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111
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Nursing Contributions to Ending the Global Adolescent and Young Adult HIV Pandemic. J Assoc Nurses AIDS Care 2020; 32:264-282. [DOI: 10.1097/jnc.0000000000000227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Muthelo L, Mgwenya JP, Malema RN, Mothiba T. How is becoming pregnant whilst HIV-positive? Voices of women at a selected rural clinic in Mpumalanga Province of South Africa. SAHARA J 2020; 17:1-8. [PMID: 33307995 PMCID: PMC7733978 DOI: 10.1080/17290376.2020.1857299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background Pregnancy decision-making is complicated for HIV-positive women because they have to contend with unpredictable symptoms, potential vertical transmission, and often a problematic life context including poverty, abuse, and stigma. Purpose The purpose of the study was to explore the views of HIV-positive women attending a support group at a clinic in the Mpumalanga Province, on becoming pregnant. Methods A qualitative, descriptive, and phenomenological research design was adopted to conduct one-on-one interviews using a semi-structured interview guide. Purposive sampling aided the selection of fifteen HIV-positive women who were members of the HIV/AIDS support group at the clinic. Data saturation was reached at participant number 15. Lincoln and Guba's four criteria for ensuring the trustworthiness of data were applied. Data were analysed using the open coding technique. Results The following categories emerged: Mitigating fears of becoming pregnant through the prevention of mother-to-child transmission (PMTCT) programme; relationship between becoming pregnant and stigma attached to HIV/AIDS; cultural and social norms about becoming pregnant and the relationship between support groups and becoming pregnant. Conclusion The study concluded that the desire to become pregnant amongst HIV-positive women is influenced by several aspects such as knowledge about the prevention of mother to child transmission, cultural values and social norms, and belonging to support groups where they were able to share experiences. Furthermore, becoming pregnant was viewed as an obligation to satisfy their partners/husbands and security to maintain marriages.
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Affiliation(s)
- Livhuwani Muthelo
- Department of Nursing Science, University of Limpopo, Sovenga, South Africa
| | | | | | - Tebogo Mothiba
- Department of Nursing Science, University of Limpopo, Sovenga, South Africa.,Faculty of Health Sciences Executive Dean's Office, University of Limpopo, Sovenga, South Africa
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Njuguna IN, Beima-Sofie K, Mburu CW, Mugo C, Neary J, Itindi J, Onyango A, Richardson BA, Rubin Means A, Sharma M, Weiner BJ, Wagner AD, Oyiengo L, Wamalwa D, John-Stewart G. Adolescent transition to adult care for HIV-infected adolescents in Kenya (ATTACH): study protocol for a hybrid effectiveness-implementation cluster randomised trial. BMJ Open 2020; 10:e039972. [PMID: 33268417 PMCID: PMC7713196 DOI: 10.1136/bmjopen-2020-039972] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 08/20/2020] [Accepted: 11/02/2020] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Successfully transitioning adolescents to adult HIV care is critical for optimising outcomes. Disclosure of HIV status, a prerequisite to transition, remains suboptimal in sub-Saharan Africa. Few interventions have addressed both disclosure and transition. An adolescent transition package (ATP) that combines disclosure and transition tools could support transition and improve outcomes. METHODS AND ANALYSIS In this hybrid type 1 effectiveness-implementation cluster randomised controlled trial, 10 HIV clinics with an estimated ≥100 adolescents and young adults age 10-24 living with HIV (ALWHIV) in Kenya will be randomised to implement the ATP and compared with 10 clinics receiving standard of care. The ATP includes provider tools to assist disclosure and transition. Healthcare providers at intervention clinics will receive training on ATP use and support to adapt it through continuous quality improvement cycles over the initial 6 months of the study, with continued implementation for 1 year. The primary outcome is transition readiness among ALWHIV ages 15-24 years, assessed 6 monthly using a 22-item readiness score. Secondary outcomes including retention and viral suppression among ALWHIV at the end of the intervention period (month 18), implementation outcomes (acceptability, feasibility, fidelity, coverage and penetration) and programme costs complement effectiveness outcomes. The primary analysis will be intent to treat, using mixed-effects linear regression models to compare transition readiness scores (overall and by domain (HIV literacy, self-management, communication, support)) over time in control and intervention sites with adjustment for multiple testing, accounting for clustering by clinic and repeated assessments. We will estimate the coefficients and 95% CIs with a two- sided α=0.05. ETHICS AND DISSEMINATION The study was approved by the University of Washington Institutional Review Board and the Kenyatta National Hospital Ethics and Research Committee. Study results will be shared with participating facilities, county and national policy-makers. TRIALS REGISTRATION NUMBER NCT03574129; Pre-results.
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Affiliation(s)
- Irene N Njuguna
- Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
- Global Health, University of Washington, Seattle, Washington, USA
| | | | - Caren W Mburu
- Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Cyrus Mugo
- Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
- Epidemiology, University of Washington, Seattle, Washington, United States
| | - Jillian Neary
- Global Health, University of Washington, Seattle, Washington, USA
| | - Janet Itindi
- Kenya Medical Research Institute, Nairobi, Kenya
| | | | - Barbra A Richardson
- Global Health, University of Washington, Seattle, Washington, USA
- Biostatistics, University of Washington, Seattle, Washington, United States
| | | | - Monisha Sharma
- Global Health, University of Washington, Seattle, Washington, USA
| | - Bryan J Weiner
- Global Health, University of Washington, Seattle, Washington, USA
- Department of Health Services, University of Washington, Seattle, Washington, USA
| | - Anjuli D Wagner
- Global Health, University of Washington, Seattle, Washington, USA
| | - Laura Oyiengo
- Neonatal and Child Health Services, Ministry of Health, Nairobi, Kenya
| | - Dalton Wamalwa
- Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Grace John-Stewart
- Global Health, University of Washington, Seattle, Washington, USA
- Epidemiology, University of Washington, Seattle, Washington, United States
- Pediatrics, University of Washington, Seattle, Washington, United States
- Medicine, University of Washington, Seattle, Washington, United States
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114
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Lin CJ, Cheng YI, Garvie PA, D’Angelo LJ, Wang J, Lyon ME. The Effect of FAmily-CEntered (FACE ®) Pediatric Advanced Care Planning Intervention on Family Anxiety: A Randomized Controlled Clinical Trial for Adolescents With HIV and Their Families. JOURNAL OF FAMILY NURSING 2020; 26:315-326. [PMID: 33283612 PMCID: PMC8015181 DOI: 10.1177/1074840720964093] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Clinicians fear pediatric advance care planning (pACP) for adolescents is too distressing for families. Multisite longitudinal randomized controlled trial of adolescents with HIV tested the effect of FAmily-CEntered (FACE®) pACP intervention on families' anxiety and depression. One hundred five adolescent/family dyads were randomized to FACE® (n = 54 dyads) or control (n = 51 dyads). Families were 90% African American, 37% HIV-positive, and 22% less than high school educated. Families reported lower anxiety 3 months post-FACE® intervention than control (β = -4.71, 95% confidence interval [CI] = [-8.20, -1.23], p = .008). Male family members were less anxious than female family members (β = -4.55, 95% CI = [-6.96, -2.138], p ≤ .001). Family members living with HIV reported greater depressive symptoms than HIV-uninfected families (β = 3.32, 95% CI = [0.254, 6.38], p = .034). Clinicians can be assured this structured, facilitated FACE® pACP model minimized family anxiety without increasing depressive symptoms. Adolescent/family dyads should be invited to have access to, and provision of, evidence-based pACP as part of patient-centered/family-supported care in the HIV continuum of care.
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Affiliation(s)
| | - Yao I. Cheng
- Children’s National Hospital & Center for Translational Research, Washington, DC, USA
| | | | | | - Jichuan Wang
- Children’s National Hospital, Washington, DC, USA
- George Washington University School of Medicine and Health Sciences, DC, USA
| | - Maureen E. Lyon
- Children’s National Hospital & Center for Translational Research, Washington, DC, USA
- George Washington University School of Medicine and Health Sciences, DC, USA
- Children’s National Research Institute, Washington, DC, USA
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The Comparison of Teen Clubs vs. Standard Care on Treatment Outcomes for Adolescents on Antiretroviral Therapy in Windhoek, Namibia. AIDS Res Treat 2020; 2020:8604276. [PMID: 33178455 PMCID: PMC7609153 DOI: 10.1155/2020/8604276] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 10/07/2020] [Accepted: 10/12/2020] [Indexed: 12/13/2022] Open
Abstract
Background Adolescents living with HIV (ALHIV) are challenged to adhere to antiretroviral therapy (ART) and achieve and maintain virologic suppression. Group-based adherence support interventions, such as adherence clubs, have been shown to improve long-term adherence in ART patients. The teen club intervention was introduced in 2010 in Namibia to improve treatment outcomes for ALHIV by providing adherence support in a peer-group environment. Adolescents who have completed the full HIV disclosure process can voluntarily join the teen clubs. The current study compared treatment outcomes of ALHIV receiving ART at a specialized paediatric HIV clinic between 1 July 2015 and 30 June 2017 in Windhoek, Namibia. Methods A retrospective cohort analysis was conducted on routine patient data extracted from the electronic Patient Monitoring System, individual Patient Care Booklets, and teen club attendance registers. A sample of 385 adolescents were analysed: 78 in teen clubs and 307 in standard care. Virologic suppression was determined at 6, 12, and 18 months from study start date, and compared by model of care, age, sex, disclosure status, and ART regimen. Comparisons between adolescents in teen clubs and those receiving standard care were performed using the chi-square test, and risk ratios were calculated to analyze differences in ART adherence and virologic suppression. Results The average clinician-measured ART adherence was 89% good, 6% fair, and 5% poor amongst all adolescents, with no difference between teen club members and adolescents in standard care (p = 0.277) at 3 months. Virologic suppression over the 2-year observation period was 87% (68% fully suppressed <40 copies/ml and 19% suppressed between 40–999 copies/ml), with no difference between teen club members and those in standard care. However, there were statistically significant differences in virologic suppression levels between the younger (10–14 years) adolescents and older (15–19 years) adolescents at 6 months (p = 0.015) and at 12 months (p = 0.021) and between adolescents on first-line and second-line ART regimen at 6 months (p = 0.012), 12 months (p = 0.004), and 18 months (p = 0.005). Conclusion The teen club model delivering psychosocial support only did not improve adherence and virologic suppression levels for adolescents in a specialized paediatric ART clinic, neither were they inferior to standard care. Considering the limitations of this study, teen clubs may still hold potential for improving adherence and virologic suppression levels for older adolescents, and more robust research on adherence interventions for adolescents with higher methodological quality is required.
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116
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Burns R, Magalasi D, Blasco P, Szumilin E, Pasquier E, Schramm B, Wringe A. "We give them threatening advice…": expectations of adherence to antiretroviral therapy and their consequences among adolescents living with HIV in rural Malawi. J Int AIDS Soc 2020; 23:e25459. [PMID: 32124554 PMCID: PMC7052309 DOI: 10.1002/jia2.25459] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 01/16/2020] [Accepted: 01/27/2020] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Many adolescents living with HIV in sub-Saharan Africa struggle to achieve optimal adherence to antiretroviral therapy (ART), but few studies have investigated how their treatment-taking decisions are influenced by their social interactions with providers, caregivers and community leaders. This study aims to explore the narratives that define expectations of adherence to ART among adolescents living with HIV in a rural Malawian setting. METHODS Overall, 45 in-depth interviews were conducted in 2016 with adolescents living with HIV, caregivers, health workers and community leaders, and four group sessions using participatory tools were undertaken with adolescents. Interviews and group sessions were audio-recorded, transcribed and translated into English. Data were coded inductively and analysed thematically. RESULTS Adolescents were given strict behavioural codes around optimal treatment adherence, which were often enforced through encouragement, persuasian and threats. In HIV clinics, some staff supported adolescents with broader concerns relating to living with HIV, but other measures to address sub-optimal adherence in HIV clinics were perceived by patients as punitive, including pill-counts and increased frequency of clinic visits. Community leaders felt responsible for young peoples' health, sometimes attempting to influence their treatment-taking by threatening to withdraw services, or to publically "out" those deemed to be non-adherent. At home, discussions with adolescents about HIV were often limited to dose reminders, and some caretakers resorted to physical punishment to ensure adherence. While some adolescents complied with strictly-enforced adherence rules, others demonstrated resistance by hiding missed doses, secretly throwing away drugs, or openly refusing to take them. CONCLUSIONS The potential of young people to adhere to their ART may be undermined by restrictive messages and punitive approaches to enforce and control their engagement with treatment at home, in the clinic and in the wider community. Interventions should focus on creating safe spaces for adolescents to speak frankly about the adherence challenges that they face and support for caregivers including home-based interventions.
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Affiliation(s)
| | | | | | | | - Estelle Pasquier
- Epicentre, Paris, France.,Médecins Sans Frontières, Paris, France
| | | | - Alison Wringe
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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117
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Sher R, Dlamini S, Muloiwa R. Patterns of detectable viral load in a cohort of HIV-positive adolescents on antiretroviral therapy in South Africa. J Int AIDS Soc 2020; 23:e25474. [PMID: 32180367 PMCID: PMC7076279 DOI: 10.1002/jia2.25474] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 02/20/2020] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Despite improved treatment and access to care, adolescent AIDS deaths are decreasing more slowly than in any other age group. There is lack of longitudinal data around adolescent adherence and the dynamics of viraemia over time. We aimed to describe patterns of detectable viral load (VL) in a cohort of adolescents attending an ARV clinic in Cape Town, South Africa. METHODS We conducted a retrospective cohort study of all patients on antiretroviral therapy aged 10 to 19 years. Participants were included if they underwent at least two VL measurements and remained in care at the Groote Schuur Hospital HIV Clinic for at least 24 months between 2002 and 2016. The primary outcome was two consecutive HIV VL >100 copies/mL, in line with the lower limit of detection of assays in use over the follow-up period. RESULTS AND DISCUSSION Of the 482 screened participants, 327 met inclusion criteria. Most participants had perinatally acquired HIV (n = 314; 96%), and 170 (52%) were males. Overall, there were 203 episodes of confirmed detectable VL involving 159 (49% (95% CI 43% to 54%)) participants during the follow-up period. Six participants had genotyped resistance to protease inhibitors. Four of these never suppressed, while two suppressed on salvage regimens. Total follow-up time was 1723 person years (PY), of which 880 (51%) were contributed by the 159 participants who experienced detectable VL. Overall time with detectable VL was 370 PY. This comprised 22% of total follow-up time, and 42% of the follow-up time contributed by those who experienced detectable VL. The rate of detectable VL was 11.8 (95% CI 10.3 to 13.5) episodes per 100 PY. The risk increased by 24% for each year of increasing age (Relative Risk 1.24 (95% CI 1.17 to 1.31); p < 0.0001). There was no sex difference with respect to duration (p = 0.4), prevalence (p = 0.46) and rate (p = 0.608) of detectable VL. CONCLUSIONS Clinicians need to be alert to the high prevalence of detectable VL during adolescence so as to pre-empt it and act swiftly once it is diagnosed. This study helps to highlight the risk of detectable VL that is associated with increase in age as well the high proportion of time that poorly adherent adolescents spend in this state.
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Affiliation(s)
- Rebecca Sher
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.,Groote Schuur Hospital, Cape Town, South Africa
| | - Sipho Dlamini
- Groote Schuur Hospital, Cape Town, South Africa.,Division of Infectious Diseases, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Rudzani Muloiwa
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.,Groote Schuur Hospital, Cape Town, South Africa
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118
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Evangeli M, Foster C, Musiime V, Fidler S, Seeley J, Gnan G. A randomised feasibility trial of an intervention to support sharing of HIV status for 18-25-year olds living with perinatally acquired HIV compared with standard care: HIV Empowering Adults' Decisions to Share-UK/Uganda Project (HEADS-UP). Pilot Feasibility Stud 2020; 6:141. [PMID: 32999731 PMCID: PMC7517800 DOI: 10.1186/s40814-020-00688-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 09/17/2020] [Indexed: 11/10/2022] Open
Abstract
Abstract Background Young adults with perinatally acquired HIV (PAH) face several challenges, including adhering to antiretroviral therapy (ART), managing the risk of onward HIV transmission and maintaining positive well-being. Sharing one’s HIV status with others (onward HIV disclosure) may assist with these challenges by facilitating emotional and practical support. Rates of HIV status sharing are, however, low in this population. There are no existing interventions focused on sharing one’s HIV status for young adults living with PAH. The HEADS-UP study is designed to develop and test the feasibility of an intervention to help the sharing of HIV status for young adults with PAH. Methods The study is a 30-month multi-site randomised feasibility study across both a high-income/low-HIV prevalence country (UK) and a low-income/high-HIV prevalence country (Uganda). Phase 1 (12 months) will involve developing the intervention using qualitative interviews with 20 young people living with PAH (ten in the UK—18 to 29 years; ten in Uganda—18 to 25 years), 20 of their social network (friends, family, sexual partners as defined by the young person; ten in the UK, ten in Uganda) and ten professionals with experience working with young adults with PAH (five in the UK, five in Uganda). Phase 2 (18 months) involves conducting a randomised feasibility parallel group trial of the intervention alongside current standard of care condition in each country (main study) with 18- to 25-year olds with PAH. A sample size of 94 participants per condition (intervention or standard of care; 188 participants in total: 47 in each condition in each country) with data at both the baseline and 6-month follow-up time points, across UK and Ugandan sites will be recruited. Participants in the intervention condition will also complete measures immediately post-intervention. Face-to-face interviews will be conducted with ten participants in both countries immediately post-intervention and at 6-month follow-up (sub-study). Discussion This study will be the first trial that we are aware of to address important gaps in understanding acceptable and feasible ways of delivering HIV status sharing support for young people living with PAH. Trial registration ISRCTN Registry, ISRCTN31852047, Registered on 21 January, 2019. Study sponsor: Royal Holloway University of London. Sponsor contact: alicen.nickson@rhul.ac.uk. Date and version: April 2020. Protocol version 3.5.
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Affiliation(s)
| | | | - Victor Musiime
- Makerere University, Kampala, Uganda.,Joint Clinical Research Centre, Lubowa, Uganda
| | - Sarah Fidler
- Imperial College London, Department of Infectious Disease, London, UK.,Imperial College NIHR BRC, London, UK
| | - Janet Seeley
- London School of Hygiene and Tropical Medicine, London, UK
| | - Georgina Gnan
- Royal Holloway University of London, Egham, Surrey, UK
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119
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Broström S, Andersson A, Hallström IK, Jerene D. Transitioning from child to adult-oriented HIV clinical care for adolescents living with HIV in Ethiopia: results from a retrospective cohort study. Pan Afr Med J 2020; 37:13. [PMID: 33062116 PMCID: PMC7532856 DOI: 10.11604/pamj.2020.37.13.21407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 07/13/2020] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Ethiopia has one of the largest number of adolescents living with HIV (ALHIV). As these adolescents reach adulthood they need to transfer from pediatric to adult-oriented clinics. Clear implementation guidelines for transition are lacking and factors associated with successful transition are inadequately investigated. Our objective was to describe the rate and age of transition from child- to adult-oriented care and the factors associated with transition success among ALHIV in selected health facilities in Ethiopia. METHODS a retrospective cohort study of adolescents was conducted in eight health facilities in two regions of Ethiopia: Addis Ababa and the Southern Nations, Nationalities and Peoples´ Region (SNNPR). The study was embedded within a broader study originally aimed at studying clinical outcomes of adolescents. The proportion of adolescents who transitioned was calculated and the association between baseline characteristics and transition was assessed by bivariate and multivariate analysis. RESULTS of 1072 adolescents, 8.7% transitioned to adult care. The most frequent age of transition was 15 (range: 10-22). Multivariate analysis generated two significant findings: adolescents from Addis Ababa were more to likely transitioned than adolescents from SNNPR (aOR: 2.18; 95% CI=1.17-4.06; p<0.01), as well as disclosed adolescents compared to those not disclosed of their HIV-status (aOR: 4.19; 95% CI=1.57-11.98; p<0.01). CONCLUSION transition occurred in less than 10% of participants, in a wide range of age, indicating a lack of implementation policies regarding the transition process. Thereto, we found that adolescents from Addis Ababa and those disclosed of their disease, were more likely to transition. Further studies are needed to better understand factors associated with transition success.
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Affiliation(s)
- Sander Broström
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Axel Andersson
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | | | - Degu Jerene
- KNCV Tuberculosis Foundation, The Hague, Netherlands
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120
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Rojo P, Carpenter D, Venter F, Turkova A, Penazzato M. The HIV drug optimization agenda: promoting standards for earlier investigation and approvals of antiretroviral drugs for use in adolescents living with HIV. J Int AIDS Soc 2020; 23 Suppl 5:e25576. [PMID: 32869500 PMCID: PMC7459170 DOI: 10.1002/jia2.25576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 06/10/2020] [Accepted: 06/22/2020] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Most clinical trials for new antiretroviral (ARV) agents are conducted among narrowly defined adult populations. Only after safety and efficacy have been clearly demonstrated among adults living with HIV are trials including adolescents, children and infants conducted. This approach contributes to significant delays in the availability of optimal new ARV regimens for infants, children and adolescents. This commentary discusses issues related to the inclusion of adolescents aged 12 to 18 years in initial HIV clinical phase 3 trials of novel antiretrovirals (ARVs) or conducting parallel phase 3 clinical trials among adolescents. DISCUSSION The absorption, metabolic and excretion or elimination pathways for drugs do not significantly differ between adolescents and adults. In fact, dosing recommendations for ARVs are the same for adults and adolescents who meet the age and weight criteria. Although conducting clinical trials among adolescents present special challenges (e.g. consenting minors and concerns about trial completion and contraception), these challenges can be addressed to obtain high-quality trial results. Importantly, new agents and optimized combinations have more favourable dosing schedules and side-effect profiles and are more effective ARV agents with higher HIV drug resistance thresholds, which would be extremely beneficial to improve outcomes among HIV-positive adolescents. CONCLUSIONS Adolescents may not present with significantly different pharmacokinetic characteristics from those in adults. Including HIV-positive adolescents in phase 3 ARV clinical trials, either with adults or in specific adolescent studies conducted in parallel, would allow adolescents to access promising, more effective treatment for HIV years earlier than with the current stepwise approach.
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Affiliation(s)
- Pablo Rojo
- Pediatric Infectious Diseases UnitDepartment of PediatricsHospital 12 de OctubreUniversidad ComplutenseMadridSpain
| | - Deborah Carpenter
- Maternal and Child Health BranchDivision of Global HIV and TuberculosisCenter for Global HealthUS Centers for Disease Control and PreventionAtlantaGAUSA
| | - François Venter
- Wits Reproductive Health and HIV InstituteUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Anna Turkova
- MRC Clinical Trials Unit at UCLInstitute of Clinical Trials & MethodologyLondonUnited Kingdom
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121
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Kaunda-Khangamwa BN, Maposa I, Dambe R, Malisita K, Mtagalume E, Chigaru L, Munthali A, Chipeta E, Phiri S, Manderson L. Validating a Child Youth Resilience Measurement (CYRM-28) for Adolescents Living With HIV (ALHIV) in Urban Malawi. Front Psychol 2020; 11:1896. [PMID: 32982826 PMCID: PMC7488208 DOI: 10.3389/fpsyg.2020.01896] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 07/09/2020] [Indexed: 11/13/2022] Open
Abstract
Resilience as a strength-based notion, measured across cultures, age groups, and sub-populations, contributes to understanding health and well-being. Yet, there is limited evidence of how the construct performs in resource-limited countries. We explored the psychometric properties of the CYRM-28 and validated the scale with adolescents living with HIV (ALHIV), a key sub-population. The participants included members of an advisory panel and 406 ALHIV, aged 15–19 years, attending an antiretroviral therapy and teen-club clinic in Blantyre, Malawi. This study employed a mixed-method study using an exploratory sequential design. The advisory panel discussed the CYRM-28, and select ALHIV then translated it into Chichewa, pilot-tested it using cognitive interviews, and back-translated it for clarity and appropriateness. The resultant CYRM-28 was tested using a survey with purposefully selected ALHIV. The overall median score was 123, with an interquartile range of 110–130. Minimum and maximum scores were 53 and 140. Cronbach’s alpha of 0.863 and Kaiser–Meyer–Olkin measure (0.866) confirmed internal consistency and the sample size adequacy, respectively. Bartlett’s tests of sphericity (p < 0.001) informed factor analysis. Exploratory factor analysis determined possible dimensions of resilience and the sub-scales. The confirmatory factor analysis (CFA) confirmed the construct validity and supported a three-factor model consistent with the conceptualization of resilience as a multi-dimensional construct. Structural equation modeling was applied to perform CFA to measure model of resilience. Multiple fit indices showed a good fit for the model. The CYRM-28 has good internal consistency, test and re-test reliability, and moderate convergent validity which render it useful as a self-report resilience measure to inform and evaluate interventions for the health and well-being of adolescents in Malawi.
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Affiliation(s)
- Blessings N Kaunda-Khangamwa
- School of Public Health, University of the Witwatersrand, Johannesburg, Johannesburg, South Africa.,School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi.,Malaria Alert Centre, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Innocent Maposa
- School of Public Health, University of the Witwatersrand, Johannesburg, Johannesburg, South Africa
| | | | | | | | | | - Alister Munthali
- Centre for Social Research, Chancellor College, University of Malawi, Zomba, Malawi
| | - Effie Chipeta
- Centre for Reproductive Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Sam Phiri
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi.,Lighthouse Trust, Lilongwe, Malawi
| | - Lenore Manderson
- School of Public Health, University of the Witwatersrand, Johannesburg, Johannesburg, South Africa.,School of Social Sciences, Monash University, Clayton, VIC, Australia.,Institute at Brown for Environment and Society, Brown University, Providence, RI, United States
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122
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Reif LK, Belizaire ME, Seo G, Rouzier V, Severe P, Joseph JM, Joseph B, Apollon S, Abrams EJ, Arpadi SM, Elul B, Pape JW, McNairy ML, Fitzgerald DW, Kuhn L. Point-of-care viral load testing among adolescents and youth living with HIV in Haiti: a protocol for a randomised trial to evaluate implementation and effect. BMJ Open 2020; 10:e036147. [PMID: 32868354 PMCID: PMC7462242 DOI: 10.1136/bmjopen-2019-036147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 07/25/2020] [Accepted: 07/27/2020] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Adolescents living with HIV have poor antiretroviral therapy (ART) adherence and viral suppression outcomes. Viral load (VL) monitoring could reinforce adherence but standard VL testing requires strong laboratory capacity often only available in large central laboratories. Thus, coordinated transport of samples and results between the clinic and laboratory is required, presenting opportunities for delayed or misplaced results. Newly available point-of-care (POC) VL testing systems return test results the same day and could simplify VL monitoring so that adolescents receive test results faster which could strengthen adherence counselling and improve ART adherence and viral suppression. METHODS AND ANALYSIS This non-blinded randomised clinical trial is designed to evaluate the implementation and effectiveness of POC VL testing compared with standard laboratory-based VL testing among adolescents and youth living with HIV in Haiti. A total of 150 participants ages 10-24 who have been on ART for >6 months are randomised 1:1 to intervention or standard arms. Intervention arm participants receive a POC VL test (Cepheid Xpert HIV-1 Viral Load system) with same-day result and immediate ART adherence counselling. Standard care participants receive a laboratory-based VL test (Abbott m2000sp/m2000rt) with the result available 1 month later, at which time they receive ART adherence counselling. VL testing is repeated 6 months later for both arms. The primary objective is to describe the implementation of POC VL testing compared with standard laboratory-based VL testing. The secondary objective is to evaluate the effect of POC VL testing on VL suppression at 6 months and participant comprehension of the correlation between VL and ART adherence. ETHICS AND DISSEMINATION This study is approved by GHESKIO, Weill Cornell Medicine and Columbia University ethics committees. This trial will provide critical data to understand if and how POC VL testing may impact adolescent ART adherence and viral suppression. If effective, POC VL testing could routinely supplement standard laboratory-based VL testing among high-risk populations living with HIV. TRIAL REGISTRATION NUMBER NCT03288246.
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Affiliation(s)
- Lindsey K Reif
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York, USA
| | | | - Grace Seo
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Vanessa Rouzier
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
- GHESKIO, Port-au-Prince, Ouest, Haiti
| | | | | | | | | | - Elaine J Abrams
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York, USA
- ICAP at Columbia University, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York, USA
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York, USA
| | - Stephen M Arpadi
- ICAP at Columbia University, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York, USA
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York, USA
- Gertrude H. Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York, USA
| | - Batya Elul
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York, USA
| | - Jean W Pape
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
- GHESKIO, Port-au-Prince, Ouest, Haiti
| | - Margaret L McNairy
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Daniel W Fitzgerald
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Louise Kuhn
- ICAP at Columbia University, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York, USA
- Gertrude H. Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York, USA
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Brooks RA, Nieto O, Swendeman D, Myers J, Lepe RM, Cabral A, Kao U, Donohoe T, Comulada WS. Qualitative Evaluation of Social Media and Mobile Technology Interventions Designed to Improve HIV Health Outcomes for Youth and Young Adults Living With HIV: A HRSA SPNS Initiative. Health Promot Pract 2020; 21:693-704. [PMID: 32757839 PMCID: PMC7646559 DOI: 10.1177/1524839920938704] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Youth and young adults living with HIV (YYALH) are less likely to be engaged in HIV care, adhere to their medications, and achieve viral suppression compared to older adult populations. In the United States, the majority of YYALH belong to racial/ethnic, sexual, and gender minority groups. HIV care interventions are needed that specifically target YYALH and that exploit the use of social media and mobile technology (SMMT) platforms, where youth and young adults have a ubiquitous presence. We conducted a qualitative evaluation of SMMT interventions included in a Health Resources and Services Administration Special Projects of National Significance initiative designed to improve medical care engagement, retention, and medication adherence to achieve viral suppression among YYALH. However, in this study, only young adults living with HIV (YALH) ages 18 to 34 years participated. A total of 48 YALH were interviewed. The data were analyzed using thematic analysis and revealed three main themes supporting the usefulness of the SMMT interventions, which included (1) acceptability of SMMT interventions in managing HIV care with subthemes of medical information accessibility, reminders, and self-efficacy; (2) feelings of support and personal connection afforded by SMMT interventions; and (3) SMMT interventions help to alleviate negative feelings about status and mitigate HIV-related stigma. A few participants identified problems with using their respective intervention, primarily related to the functionality of the technologies. Overall, findings from our qualitative evaluation suggest that SMMT-based interventions have the potential to increase engagement and retention in care, support YALH in adhering to medication, and help them adjust to their diagnosis.
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Affiliation(s)
| | - Omar Nieto
- University of California, Los Angeles, Los Angeles, CA, USA
| | | | - Janet Myers
- University of California, San Francisco, San Francisco, CA, USA
| | | | | | - Uyen Kao
- University of California, Los Angeles, Los Angeles, CA, USA
| | - Thomas Donohoe
- University of California, Los Angeles, Los Angeles, CA, USA
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Goossens AJM, Cheung KL, Sijstermans E, Conde R, Gonzalez JGR, Hiligsmann M. A discrete choice experiment to assess patients' preferences for HIV treatment in the rural population in Colombia. J Med Econ 2020; 23:803-811. [PMID: 32098539 DOI: 10.1080/13696998.2020.1735398] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Aim: To elicit patients' preferences for HIV treatment of the rural population in Colombia.Methods: A discrete choice experiment (DCE), conducted in a HIV clinic in Bogotá, was used to examine the trade-off between five HIV treatment attributes: effect on life expectancy, effect on physical activity, risk of moderate side-effects, accessibility to clinic, and economic costs to access controls. Attributes selection was based on literature review, expert consultation and a focus group with six patients. An efficient experimental design was used to define two versions of the questionnaire with each of 12 choice sets and a dominance task was added to check reliability. A mixed logit model was then used to analyse the data and sub-group analyses were conducted on the basis of age, gender, education, and sexual preference.Results: A total of 129 HIV patients were included for analysis. For all treatment attributes, significant differences between at least two levels were observed, meaning that all attributes were significant predictors of choice. Patients valued the effect on physical activity (conditional relative importance of 27.5%) and the effect on life expectancy (26.0%) the most. Sub-group analyses regard age and education showed significant differences: younger patients and high educated patients valued the effect on physical activity the most important, whereas older patients mostly valued the effect on life expectancy and low educated patients mostly valued the accessibility to clinic.Limitations: One potential limitation is selection bias, as only patients from one HIV clinic were reached. Additionally, questionnaires were partly administered in the waiting rooms, which potentially led to noise in the data.Conclusions: This study suggests that all HIV treatment characteristics included in this DCE were important and that HIV patients from rural Colombia valued short-term efficacy (i.e. effect on physical activity) and long-term efficacy (i.e. effect on life expectancy) the most.
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Affiliation(s)
- Anne J M Goossens
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Kei Long Cheung
- Department of Clinical Sciences, College of Health and Life Sciences, Brunel University London, London, United Kingdom
| | - Eric Sijstermans
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Rafael Conde
- Centro de Investigación Clínica ACISC, Asistencia Científica de Alta Complejida, Bogota, Colombia
| | - Javier G R Gonzalez
- Rosario Graduate School of Business, School of Business, Administración en Salud, Universidad del Rosario, Bogotá, Colombia
| | - Mickael Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
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125
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Benning L, Mantsios A, Kerrigan D, Coleman JS, Golub E, Blackstock O, Konkle-Parker D, Philbin M, Sheth A, Adimora AA, Cohen MH, Seidman D, Milam J, Kassaye SG, Taylor T, Murray M. Examining adherence barriers among women with HIV to tailor outreach for long-acting injectable antiretroviral therapy. BMC WOMENS HEALTH 2020; 20:152. [PMID: 32711509 PMCID: PMC7382076 DOI: 10.1186/s12905-020-01011-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 07/05/2020] [Indexed: 12/26/2022]
Abstract
Background Long-acting (LA) injectable antiretroviral therapy (ART) has been found non-inferior to daily oral ART in Phase 3 trials. LA ART may address key barriers to oral ART adherence and be preferable to daily pills for some people living with HIV. To date, women have been less represented than men in LA ART research. Using longitudinal data from the Women’s Interagency HIV Study (WIHS) cohort of women living with HIV in the United States, we examined barriers and facilitators of daily oral ART adherence that may be related to or addressed by LA ART. Methods We conducted a secondary analysis of WIHS cohort data from 1998 to 2017 among participants seen for at least 4 visits since 1998 who reported using ART at least once (n = 2601). Two dichotomous outcomes, patient-reported daily oral ART adherence and viral suppression were fit using generalized linear models, examining the role of socio-demographic and structural factors. Results At study enrollment, the median age was 40.5 years, 63% of participants were African American and 22% were Latina. The majority (82%) reported taking ART more than 75% of the time and 53% were virally suppressed. In multivariate analysis, several sub-groups of women had lower odds of reported adherence and viral suppression: 1) younger women (adherence aOR: 0.71; viral suppression aOR: 0.63); 2) women who inject drugs (adherence aOR: 0.38; viral suppression aOR: 0.50) and those with moderate (adherence aOR: 0.59; viral suppression aOR: 0.74) and heavy alcohol consumption (adherence aOR: 0.51; viral suppression aOR: 0.69); 3) those with depressive symptoms (adherence aOR: 0.61; viral suppression aOR: 0.76); and 4) those with a history of going on and off ART (adherence aOR: 0.62, viral suppression aOR: 0.38) or changing regimens (adherence aOR: 0.83, viral suppression aOR: 0.56). Conclusions Current injectable contraceptive users (vs. non-users) had greater odds of oral ART adherence (aOR: 1.87) and viral suppression (aOR: 1.28). Findings identify profiles of women who may benefit from and be interested in LA ART. Further research is warranted focused on the uptake and utility of LA ART for such key subpopulations of women at high need for innovative approaches to achieve sustained viral suppression.
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Affiliation(s)
- Lorie Benning
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Deanna Kerrigan
- Center for Health, Risk and Society, American University, Washington, DC, USA
| | - Jenell S Coleman
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Elizabeth Golub
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Oni Blackstock
- Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA
| | - Deborah Konkle-Parker
- Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, MS, USA
| | - Morgan Philbin
- Columbia University Mailman School of Public Health, Sociomedical Sciences, New York, USA
| | - Anandi Sheth
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
| | - Adaora A Adimora
- Department of Medicine, School of Medicine and Department of Epidemiology, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mardge H Cohen
- Department of Medicine, Stroger Hospital, Cook County Bureau of Health Services, Chicago, IL, USA
| | - Dominika Seidman
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, California, USA
| | - Joel Milam
- Institute for Health Promotion and Disease Prevention Research, University of Southern California, Los Angeles, CA, USA
| | - Seble G Kassaye
- Division of Infectious Diseases and Travel Medicine, Georgetown University, Washington, DC, USA
| | - Tonya Taylor
- SUNY Downstate Medical Center, Brooklyn, NY, USA
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Alcon S, Ahmed B, Sloane D, Lim YS, Cervia JS. Interventions to improve medication adherence in adolescents with HIV: a systematic review and meta-analysis. J Investig Med 2020; 68:1217-1222. [DOI: 10.1136/jim-2020-001295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2020] [Indexed: 11/04/2022]
Abstract
As of 2017, 1.8 million people living with HIV (PLWH) were adolescents between ages 10 and 19, accounting for 5% of all PLWH and 590,000 people between the ages 15 and 24 were newly infected with HIV. Between 2004 and 2011, AIDS-related deaths increased 50% among adolescents, and optimal adolescent adherence to antiretroviral treatment (ART) is estimated at only 62% of adolescents worldwide. While there have been great strides toward achieving the UNAIDS 90-90-90 goals, adolescents remain a group lacking appropriate resources and research to achieve these. This review analyzes current interventions aimed toward increasing adolescent ART adherence. Systematic searches of EMBASE, PubMed and PsycINFO were performed using the keywords ‘adolescent HIV medication adherence interventions’. The Gain Score effect size was calculated for studies reporting the Cohen’s d and variance to include both prestudy and poststudy values. A random-effects model analyzed intervention significance. Authors were contacted to obtain additional data values and study clarification. Twelve studies met inclusion criteria for meta-analysis. There were no significant differences seen between control and intervention groups in medication adherence (z=−1.4714, p<0.1412), viral load (z=−0.1946, p<0.8547) or CD4+ lymphocyte count (z=0.2650, p<0.7910). There was no significant difference between studies in increasing medication adherence. Results indicate that interventions did not improve medication adherence in adolescents with HIV. However, the paucity of quantitative research available speaks to a need for more quantitative intervention studies and standardization of measures of intervention efficacy.
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127
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Azmach NN, Hamza TA, Husen AA. Socioeconomic and Demographic Statuses as Determinants of Adherence to Antiretroviral Treatment in HIV Infected Patients: A Systematic Review of the Literature. Curr HIV Res 2020; 17:161-172. [PMID: 31538899 DOI: 10.2174/1570162x17666190919130229] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 08/24/2019] [Accepted: 09/04/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Socioeconomic and demographic statuses are associated with adherence to the treatment of patients with several chronic diseases. However, there is a controversy regarding their impact on adherence among HIV/AIDS patients. Thus, we performed a systematic review of the evidence regarding the association of socioeconomic and demographic statuses with adherence to antiretroviral therapy (ART) among HIV/AIDS patients. METHODS The PubMed database was used to search and identify studies concerning about socioeconomic and demographic statuses and HIV/AIDS patients. Data were collected on the association between adherence to ART and varies determinants factors of socioeconomic (income, education, and employment/occupation) and socio-demographic (sex and age). FINDINGS From 393 potentially-relevant articles initially identified, 35 original studies were reviewed in detail, which contained data that were helpful in evaluating the association between socioeconomic/ demographic statuses and adherence to ART among HIV patients. Two original research study has specifically focused on the possible association between socioeconomic status and adherence to ART. Income, level of education, and employment/occupational status were significantly and positively associated with the level of adherence in 7 studies (36.8%), 7 studies (28.0%), and 4 studies (23.5%) respectively out of 19, 25, and 17 studies reviewed. Sex (being male), and age (per year increasing) were significantly and positively associated with the level of adherence in 5 studies (14.3%), and 9 studies (25.7%) respectively out of 35 studies reviewed. However, the determinant of socioeconomic and demographic statuses was not found to be significantly associated with adherence in studies related to income 9(47.4%), education 17(68.0%), employment/ occupational 10(58.8%), sex 27(77.1%), and age 25(71.4%). CONCLUSION The majority of the reviewed studies reported that there is no association between socio- demographic and economic variables and adherence to therapy. Whereas, some studies show that age of HIV patients (per year increasing) and sex (being male) were positively associated with adherence to ART. Among socio-economic factors, the available evidence does not provide conclusive support for the existence of a clear association with adherence to ART among HIV patients. There seems to be a positive trend between socioeconomic factors and adherence to ART in some of the reviewed studies.
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Affiliation(s)
- Nuredin Nassir Azmach
- Department of Statistics, College of Natural Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Temam Abrar Hamza
- Department of Biotechnology, College of Natural Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Awel Abdella Husen
- Department of Physics, College of Natural Sciences, Arba Minch University, Arba Minch, Ethiopia
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The association between diagnosis disclosure and adherence to antiretroviral therapy among adolescents living with HIV in sub-Saharan Africa: a protocol for systematic review and meta-analysis. Syst Rev 2020; 9:160. [PMID: 32665026 PMCID: PMC7362460 DOI: 10.1186/s13643-020-01420-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 07/05/2020] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION More than eight in ten of the world's 1.65 million adolescents living with human immunodeficiency virus (ALHIV) live in sub-Saharan Africa (SSA). Suboptimal adherence to antiretroviral therapy (ART) and poor viral suppression are reported among ALHIV which may in turn compromise the gains achieved so far. The evidence on whether knowing one's own human immunodeficiency virus (HIV) status and self-disclosure to others benefit adherence to ART or not is inconclusive. This review aims to estimate the association between knowing one's HIV status and self-disclosure on adherence to ART among ALHIV in SSA. METHODS Comprehensive search strings will be used to identify relevant observational studies published in English up to May 2020 in major databases: Excerpta Medica database (EMBASE), PubMed, and Ovid/MEDLINE. To access African studies and also to freely access subscription-based articles, the African Index Medicus (AIM) and the WHO HINARI databases will be searched. The AfroLib database will be searched to access the gray literature of African studies. We will use the COVIDENCE software for title/abstract screening, full-text screening, quality assessment, and data extraction. Two authors will independently screen retrieved articles, and a third author authorized to resolve conflicts will handle disagreements. The Joanna Briggs Institute's (JBI) critical appraisal tools will be used to assess study quality. Appropriate statistical tests will be conducted to quantify the between studies heterogeneity and for the assessment of publication bias. We will check individual study influence analysis and also do subgroup analysis. The STATA version 14.2 will be used for statistical analysis. DISCUSSION A high-level adherence to ART is required to achieve adequate viral suppression and improve quality of life. Consequently, the evidence on how adherence to ART differs with knowledge of one's own HIV status and self-disclosure may help guide interventions aimed at improving adherence to ART.
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129
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Goma F, Papazisis G, Karakiulakis G. Adherence to antiretroviral therapy among HIV seropositive patients in northern Greece. Major factors of influence. Hippokratia 2020; 24:114-119. [PMID: 34239288 PMCID: PMC8256785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Adherence to HIV antiretroviral therapy (ART) is of great importance for reducing viral load and the eventual treatment of the patients and minimizing infectivity. This study aimed to investigate adherence to ART among people living with HIV in northern Greece and investigate the factors influencing adherence to ART. METHODS A correlational study was performed on a cohort of 112 seropositive individuals (100 men and 12 women) with a mean age of 37.14 years. The simplified medication adherence questionnaire (SMAQ) was used to assess adherence. In addition, the perceived available support questionnaire (PAS) for social support assessment was utilized to evaluate the perceived social support. RESULTS Approximately 60% of patients were found to be nonadherent to ART. Important factors affecting adherence are educational level, social support, and use of substances. CONCLUSIONS The results show that a significant proportion of the cohort of patients investigated from northern Greece does not show adherence to ART. Several factors were identified to be of significant influence, which should be taken into consideration by the Greek healthcare providers. HIPPOKRATIA 2020, 24(3): 114-119.
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Affiliation(s)
- F Goma
- National Public Health Organization, School of Medicine, Aristotle University of Thessaloniki Greece
- Department of Pharmacology, School of Medicine, Aristotle University of Thessaloniki Greece
| | - G Papazisis
- Department of Pharmacology, School of Medicine, Aristotle University of Thessaloniki Greece
| | - G Karakiulakis
- Department of Pharmacology, School of Medicine, Aristotle University of Thessaloniki Greece
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Grossoehme DH, Smith E, Standiford D, Morwessel N, Kichler J, Maahs DM, Driscoll K, Seid M. Understanding adolescent and parent acceptability and feasibility experience in a large Type 1 diabetes mellitus behavioural trial. Diabet Med 2020; 37:1134-1145. [PMID: 30701596 PMCID: PMC6667304 DOI: 10.1111/dme.13913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/28/2019] [Indexed: 11/29/2022]
Abstract
AIMS Using an 18-month, multisite randomized control trial as an exemplar, the aim of this study was to identify themes related to adolescent and parental feasibility and acceptability for participation in large behavioural trials designed to improve adolescents' Type 1 diabetes self-management. METHODS Thematic analysis methodology was used to develop themes describing factors related to acceptability and feasibility. RESULTS Based on a sample of interviews (N = 72), factors contributing to intervention acceptability and feasibility were identified. Aspects of acceptability included: a framework for goal-setting, the coach as a non-judgemental listener, perception of an ongoing benefit to participation and the delivery mode. Aspects of feasibility included: participants' altruism to help adolescents with Type 1 diabetes; pre-enrolment preparation for intervention content and duration; and the option of remote intervention delivery via telephone or video, which minimized travel time and costs. In addition, participants described positive outcomes including improvements in behaviour, Type 1 diabetes self-management behaviours and parent-adolescent communication, and emotion-attitude changes. Participants also described potential revisions that may inform future trials. CONCLUSIONS Acceptability and feasibility of behavioural interventions with adolescents with chronic illness have multifactorial dimensions. While empowering adolescent self-management, parental support is also an under-appreciated aspect to consider. Potential revisions were identified for subsequent behavioural trials.
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Affiliation(s)
- D H Grossoehme
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
- Divisions of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - E Smith
- Divisions of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - D Standiford
- Divisions of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - N Morwessel
- Divisions of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - J Kichler
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
- Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - D M Maahs
- Division of Pediatric Endocrinology, Stanford University, Stanford, CA
| | - K Driscoll
- Department of Pediatrics, Barbara Davis Center for Childhood Diabetes, The Children's Hospital of Colorado, Aurora, CO
| | - M Seid
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
- Divisions of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- James M. Anderson Center for Healthy System Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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131
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Govindasamy D, Seeley J, Olaru ID, Wiyeh A, Mathews C, Ferrari G. Informing the measurement of wellbeing among young people living with HIV in sub-Saharan Africa for policy evaluations: a mixed-methods systematic review. Health Qual Life Outcomes 2020; 18:120. [PMID: 32370772 PMCID: PMC7201613 DOI: 10.1186/s12955-020-01352-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 04/03/2020] [Indexed: 12/11/2022] Open
Abstract
Young people living with HIV (YPLHIV) in sub-Saharan Africa (SSA) are at high risk of having a poor quality of life. Addressing wellbeing explicitly within HIV/AIDS policies could assist mitigation efforts. However, guidance on wellbeing measures to evaluate policies for YPLHIV is scarce. The aims of this mixed-methods review were to identify: i) key dimensions of wellbeing and ii) wellbeing measures that align to these dimensions among YPLHIV (15-24 years) in SSA. We searched six social science and medical databases, including grey literature. We included studies that examined correlates and lived experiences of wellbeing, among YPLHIV in SSA, from January 2000 to May 2019. Two reviewers independently screened abstracts and full texts and assessed methodological quality of included articles. We analysed quantitative and qualitative data using descriptive and meta-ethnographic approaches, respectively. Thereafter, we integrated findings using a framework approach. We identified 6527 citations. Of these, 10 quantitative and 30 qualitative studies were included. Being male, higher educational status, less stigma and more social support were likely correlates of wellbeing. Themes that shaped experiences suggestive of wellbeing were: 1) acceptance and belonging- stigma, social support; 2) coping; 3) standard of living. Our final synthesis found that the following dimensions potentially characterise wellbeing: self-acceptance, belonging, autonomy; positive relations, environmental mastery, purpose in life. Wellbeing for YPLHIV is multi-dimensional and relational. Relevant measures include the Personal Wellbeing Index, Ryff's Psychological Wellbeing Scale and Mental Health Continuum Short Form. However, psychometric evaluations of these scales among YPLHIV in SSA are needed.
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Affiliation(s)
- Darshini Govindasamy
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
- Health Systems Research Unit, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, PO Box 19070, Tygerberg, 7501, South Africa.
- Adolescent Health Research Unit, Department of Child and Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa.
| | - Janet Seeley
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Ioana D Olaru
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Alison Wiyeh
- Cochrane South Africa, South African Medical Research Council, Tygerberg, South Africa
- Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington, USA
| | - Catherine Mathews
- Health Systems Research Unit, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, PO Box 19070, Tygerberg, 7501, South Africa
- Adolescent Health Research Unit, Department of Child and Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Giulia Ferrari
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Christodoulou J, Abdalian SE, Jones ASK, Christodoulou G, Pentoney SL, Rotheram-Borus MJ. Crystal Clear with Active Visualization: Understanding Medication Adherence Among Youth Living with HIV. AIDS Behav 2020; 24:1207-1211. [PMID: 31696369 DOI: 10.1007/s10461-019-02721-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Adherence to antiretroviral therapy (ART) among youth remains low. We piloted an adapted active visualization device that demonstrates how ART works in the body. Youth living with HIV were randomized to: (1) standard care (n = 14) or the (2) adapted active visualization intervention (n = 14) and 71% of the sample (n = 19) were re-assessed on viral load, adherence behaviors, and illness perceptions 2.5 months later. Intervention youth had lower viral loads, reported less difficulty in adhering to ART, and more motivation and control over their HIV than standard care at follow-up. Active visualization may be an acceptable tool to address ART adherence among youth.
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Affiliation(s)
- Joan Christodoulou
- Department of Psychiatry & Biobehavioral Sciences, Semel Institute, University of California Los Angeles, 10920, Wilshire Blvd., Suite 350, Los Angeles, CA, 90024, USA.
| | - Sue Ellen Abdalian
- School of Medicine, Tulane University, 1430 Tulane Ave, New Orleans, LA, 70112, USA
| | - Annie S K Jones
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Georgia Christodoulou
- Keck School of Medicine, University of Southern California, 1975 Zonal Ave, Los Angeles, CA, 90033, USA
| | | | - Mary Jane Rotheram-Borus
- Department of Psychiatry & Biobehavioral Sciences, Semel Institute, University of California Los Angeles, 10920, Wilshire Blvd., Suite 350, Los Angeles, CA, 90024, USA
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Murray J, Whitehouse K, Ousley J, Bermudez E, Soe TT, Hilbig A, Soe KP, Mon PE, Tun KT, Ei WLSS, Cyr J, Deglise C, Ciglenecki I. High levels of viral repression, malnutrition and second-line ART use in adolescents living with HIV: a mixed methods study from Myanmar. BMC Infect Dis 2020; 20:241. [PMID: 32197588 PMCID: PMC7085147 DOI: 10.1186/s12879-020-04968-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 03/12/2020] [Indexed: 11/30/2022] Open
Abstract
Background Adolescents living with HIV/AIDS (ALHIV) are a particularly vulnerable but often overlooked group in the HIV response despite additional disease management challenges. Methods All ALHIV (10–19 years), on ART for ≥6 months, presenting to care at a Médecins Sans Frontières (MSF) clinic in Myanmar from January–April 2016 were eligible for the quantitative study component (clinical history, medical examination, laboratory investigation). A subset of these respondents were invited to participate in qualitative interviews. Interviews and focus groups were also conducted with other key informants (care givers, clinicians). Results Of 177 ALHIV, 56% (100) were aged 9–13 years and 77 (44%) were 14–19. 49% (86) had been orphaned by one parent, and 19% (33) by both. 59% (104) were severely underweight (BMI < 16). 47% presented with advanced HIV (WHO stage III/IV). 93% were virally supressed (< 250 copies/mL). 38 (21%) of ALHIV were on a second-line ART after first-line virological failure. Qualitative interviewing highlighted factors limiting adherence and the central role that HIV counsellors play for both ALHIV patients and caregivers. Conclusions Our study shows good clinical, immunological, and virological outcomes for a cohort of Myanmar adolescents living with HIV, despite a majority being severely underweight, presenting with Stage III or IV illness, and the prevalence of comorbid infections (TB). Many treatment and adherence challenges were articulated in qualitative interviewing but emphasized the importance of actively engaging adolescents in their treatment. Comprehensive HIV care for this population must include routine viral load testing and social support programs.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Kyaw Tint Tun
- Myanmar Ministry of Health, National AIDS Program, Naypyitaw, Myanmar
| | | | - Joanne Cyr
- Médecins Sans Frontières, Geneva, Switzerland
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Moyo S, Ncube RT, Shewade HD, Ngwenya S, Ndebele W, Takarinda KC, Dzangare J, Goverwa-Sibanda TP, Apollo T. Children and adolescents on anti-retroviral therapy in Bulawayo, Zimbabwe: How many are virally suppressed by month six? F1000Res 2020; 9:191. [PMID: 32399206 PMCID: PMC7194453 DOI: 10.12688/f1000research.22744.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/12/2020] [Indexed: 11/20/2022] Open
Abstract
Background: Zimbabwe is one of the countries in sub-Saharan Africa disproportionately affected by human immunodeficiency virus. In the "treat all" era, we assessed the gaps in routine viral load (VL) monitoring at six months for children (0-9 years) and adolescents (10-19 years) newly initiated on anti-retroviral therapy (ART) from January 2017 to September 2018 at a large tertiary hospital in Bulawayo. Methods: In this cohort study using secondary data, we considered first VL done within six to nine months of starting therapy as 'undergoing VL test at six months'. We classified repeat VL≥1000 copies/ml despite enhanced adherence counselling as virally unsuppressed. Results: Of 295 patients initiated on ART, 196 (66%) were children and 99 (34%) adolescents. A total 244 (83%) underwent VL test at six months, with 161 (54%) virally suppressed, 52 (18%) unsuppressed and 82 (28%) with unknown status (due to losses in the cascade). Switch to second line was seen in 35% (18/52). When compared to children, adolescents were less likely to undergo a VL test at six months (73% versus 88%, p=0.002) and more likely to have an unknown VL status (40% versus 22%, p=0.001). Conclusion: At six months of ART, viral suppression was low and losses in the cascade high.
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Affiliation(s)
| | | | - Hemant Deepak Shewade
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France.,The Union South East Asia Office, New Delhi, India
| | | | | | - Kudakwashe Collin Takarinda
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France.,AIDS and TB Directorate, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Janet Dzangare
- AIDS and TB Directorate, Ministry of Health and Child Care, Harare, Zimbabwe
| | | | - Tsitsi Apollo
- AIDS and TB Directorate, Ministry of Health and Child Care, Harare, Zimbabwe
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135
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Dinaj-Koci V, Wang B, Naar-King S, MacDonell KK. A Multi-Site Study of Social Cognitive Factors Related to Adherence Among Youth Living With HIV in the New Era of Antiretroviral Medication. J Pediatr Psychol 2020; 44:98-109. [PMID: 30272202 DOI: 10.1093/jpepsy/jsy076] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 08/27/2018] [Indexed: 01/06/2023] Open
Abstract
Objective The goal of the current study was to determine how a set of social cognitive factors predict antiretroviral therapy (ART) medication adherence in youth living with HIV in an era of newer highly active ART medications using a conceptual model. Methods Behaviorally infected youth living with HIV ages 13-24 (N = 822) from 14 sites within the Adolescent Medicine Trials Unit (AMTU) were included in the study. Structural equation modeling was used to explore predictors of ART medication adherence. Results Results found that motivational readiness for ART was related to higher ART medication adherence, which was associated with lower viral load. Higher social support and higher self-efficacy had an indirect relationship with higher adherence through increased motivational readiness. Fewer psychological symptoms were associated with higher social support and higher self-efficacy. Lower substance use was directly associated with lower adherence. Conclusions The results provide insight into factors that may be related to adherence in youth living with HIV. Findings suggest focusing on motivational readiness to increase adherence. Improving the patients' ART self-efficacy and strengthening their social support networks during treatment can increase motivational readiness for ART treatment. Furthermore, programs maybe more effective with the inclusion of risk reduction components especially those related to substance use.
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Affiliation(s)
- Veronica Dinaj-Koci
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine
| | - Bo Wang
- Department of Quantitative Health Sciences, University of Massachusetts Medical School
| | - Sylvie Naar-King
- Behavioral Sciences and Social Medicine, Florida State University College of Medicine
| | - Karen Kolmodin MacDonell
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine
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136
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A Longitudinal Study of Behavioral Risk, Adherence, and Virologic Control in Adolescents Living With HIV in Asia. J Acquir Immune Defic Syndr 2020; 81:e28-e38. [PMID: 30865173 DOI: 10.1097/qai.0000000000002008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Adolescents living with HIV (ALHIV) have poorer adherence and clinical outcomes than adults. We conducted a study to assess behavioral risks and antiretroviral therapy outcomes among ALHIV in Asia. METHODS A prospective cohort study among ALHIV and matched HIV-uninfected controls aged 12-18 years was conducted at 9 sites in Malaysia, Thailand, and Vietnam from July 2013 to March 2017. Participants completed an audio computer-assisted self-interview at weeks 0, 48, 96, and 144. Virologic failure (VF) was defined as ≥1 viral load (VL) measurement >1000 copies/mL. Generalized estimating equations were used to identify predictors for VF. RESULTS Of 250 ALHIV and 59 HIV-uninfected controls, 58% were Thai and 51% females. The median age was 14 years at enrollment; 93% of ALHIV were perinatally infected. At week 144, 66% of ALHIV were orphans vs. 28% of controls (P < 0.01); similar proportions of ALHIV and controls drank alcohol (58% vs. 65%), used inhalants (1% vs. 2%), had been sexually active (31% vs. 21%), and consistently used condoms (42% vs. 44%). Of the 73% of ALHIV with week 144 VL testing, median log VL was 1.60 (interquartile range 1.30-1.70) and 19% had VF. Over 70% of ALHIV had not disclosed their HIV status. Self-reported adherence ≥95% was 60% at week 144. Smoking cigarettes, >1 sexual partner, and living with nonparent relatives, a partner or alone, were associated with VF at any time. CONCLUSIONS The subset of ALHIV with poorer adherence and VF require comprehensive interventions that address sexual risk, substance use, and HIV-status disclosure.
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Njuguna I, Beima-Sofie K, Mburu C, Black D, Evans Y, Guthrie B, Wagner AD, Mugo C, Neary J, Itindi J, Onyango A, Wamalwa D, John-Stewart G. What happens at adolescent and young adult HIV clinics? A national survey of models of care, transition and disclosure practices in Kenya. Trop Med Int Health 2020; 25:558-565. [PMID: 31984597 DOI: 10.1111/tmi.13374] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Tailored services for adolescents and young adults (AYA) living with HIV may improve treatment outcomes. We surveyed HIV clinics throughout Kenya to determine AYA clinic practices, disclosure and transition services. METHODS We deployed a mobile team to conduct surveys in a random sample of 102 public HIV clinics with> 300 total clients. Data were collected from healthcare workers offering AYA services who had >6 months of experience delivering AYA care. RESULTS Of 102 surveyed HIV clinics, almost all (101/102) had the same staff to provide services to all age groups. AYA-specific services included dedicated clinic days (91%), the majority being on weekends (57%) and designated clinic spaces (20%). Activities to support AYA retention and adherence were common (support groups [97%] and HIV literacy meetings [93%]). Fewer clinics offered more holistic care, including psychosocial support (16%) and career education (2%), posted additional staff during the AYA day (17%), provided food (17%) or had sporting activities (10%) as incentives. Tracking of disclosure of HIV status to AYA was common (87%). In 40% of clinics, disclosure discussions with caregivers or AYA occurred a median of 2 years later in practice than stated in clinic policy. Transition was not routinely tracked, and definitions were heterogeneous. Median age at transition was reported as 20 years (range: 14-30 years). CONCLUSION HIV programmes have implemented varied approaches to enhance AYA services that could be leveraged to support transition to adult services. Research on the impact of these services on health outcomes is needed.
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Affiliation(s)
- Irene Njuguna
- Kenyatta National Hospital, Nairobi, Kenya.,Department of Epidemiology, University of Washington, Seattle, WA, USA
| | | | - Caren Mburu
- Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Danae Black
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | | | - Brandon Guthrie
- Department of Epidemiology, University of Washington, Seattle, WA, USA.,Department of Global Health, University of Washington, Seattle, WA, USA
| | - Anjuli D Wagner
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Cyrus Mugo
- Kenyatta National Hospital, Nairobi, Kenya.,Department of Global Health, University of Washington, Seattle, WA, USA
| | - Jillian Neary
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Janet Itindi
- Kenya Medical Research Institute, Nairobi, Kenya
| | - Alvin Onyango
- Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Dalton Wamalwa
- Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Grace John-Stewart
- Department of Epidemiology, University of Washington, Seattle, WA, USA.,Department of Global Health, University of Washington, Seattle, WA, USA.,Department of Medicine, University of Washington, Seattle, WA, USA.,Department of Pediatrics, University of Washington, Seattle, WA, USA
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138
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Munyayi FK, van Wyk B. The effects of Teen Clubs on retention in HIV care among adolescents in Windhoek, Namibia. South Afr J HIV Med 2020; 21:1031. [PMID: 32158557 PMCID: PMC7059250 DOI: 10.4102/sajhivmed.v21i1.1031] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 10/30/2019] [Indexed: 11/12/2022] Open
Abstract
Background Adolescents living with HIV (ALHIV) are notably underserved by the national HIV programmes globally because of their unique needs. Of particular concern is limited access to and availability of adolescent-friendly antiretroviral therapy (ART) services, which contribute to poor retention in care in many sub-Saharan African countries. A Teen Club intervention was introduced in 2010 in Windhoek, Namibia, to improve retention in care among ALHIV through psychosocial support in a peer-group environment. Objectives To compare the effects of the Teen Club intervention against standard care on retention in HIV care amongst adolescents at a Paediatric ART clinic. Method A retrospective cohort analysis of adolescents aged 10–19 years receiving ART between July 2015 and June 2017 was conducted. Routine patient data were extracted from an electronic database and patient registers. A sample of 385 participants was analysed: 78 in the Teen Club and 307 in standard care. Retention was measured by assessing attendance to prescribed clinic visits up to 24 months. Comparisons were assessed with the Chi-square test, and Kaplan–Meier survival analysis was conducted to analyse differences in retention rates. Results The overall retention rate at 24 months among all adolescents was 90.1%, with no statistically significant difference between those in Teen Club (91%) and those in standard care (89%) (p = 0.956). Younger adolescents (10–14 years) had better retention rates at 24 months compared to older adolescents (15–19 years) (94% vs. 86%; p = 0.016). Retention rates were significantly higher for adolescents on first-line ART regimen (vs. second line: hazard ratio [HR] = 0.333; 95% confidence interval [CI] = 0.125–0.889); on ART ≥ 12 months (vs. < 12 months: HR =0.988; 95% CI = 0.977–0.999); and those to whom their HIV status was disclosed (HR = 0.131; 95% CI = 0.025–0.686). Conclusion Group-based adherence support interventions did not improve retention rates for younger adolescents in specialised paediatric ART clinics but may still hold the potential for improving retention rates of older adolescents.
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Affiliation(s)
- Farai K Munyayi
- School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa.,International Training and Education Center for Health, Windhoek, Namibia
| | - Brian van Wyk
- School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
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Khalifa A, Stover J, Mahy M, Idele P, Porth T, Lwamba C. Demographic change and HIV epidemic projections to 2050 for adolescents and young people aged 15-24. Glob Health Action 2020; 12:1662685. [PMID: 31510887 PMCID: PMC6746261 DOI: 10.1080/16549716.2019.1662685] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Ending AIDS as a public health threat by 2030 is a significant
challenge, as new HIV infections among adolescents and young people have not decreased
fast enough to curb the epidemic. The combination of slow HIV response and increasing
youth populations 15–24 could affect progress towards 2030 goals. Objective: This analysis aimed to describe global and regional trends from
2010–2050 in the HIV epidemic among adolescents and young people by accounting for
demographic projections and recent trends in HIV interventions. Methods: 148 national HIV estimates files were used to project the HIV
epidemic to 2050. Numbers of people living with HIV and new HIV infections were projected
by sex and five-year age group. Along with demographic data, projections were based on
three key assumptions: future trends in HIV incidence, antiretroviral treatment coverage,
and coverage of antiretrovirals for prevention of mother-to-child transmission. Results
represent nine geographic regions. Results: While the number of adolescents and young people is projected to
increase by 10% from 2010–2050, those living with HIV is projected to decrease by 61%. In
Eastern and Southern Africa, which hosts the largest HIV epidemic, new HIV infections
among adolescents and young people are projected to decline by 84% from 2010–2050. In West
and Central Africa, which hosts the second-largest HIV epidemic, new infections are
projected to decline by 35%. Conclusions: While adolescents and young people living with HIV are living
longer and ageing into adulthood, if current trends continue, the number of new HIV
infections is not projected to decline fast enough to end AIDS as a health threat in this
age group. Regional variations suggest that while progress in Eastern and Southern Africa
could reduce the size of the epidemic by 2050, other regions exhibit slower rates of
decline among adolescents and young people.
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Affiliation(s)
- Aleya Khalifa
- Division of Data, Research and Policy, United Nations Children's Fund , New York , NY , USA
| | - John Stover
- Center for Modeling, Planning and Policy Analysis, Avenir Health, Avenir Health , Glastonbury , CT , USA
| | - Mary Mahy
- Department of Strategic Information and Evaluation, Joint United Nations Programme for HIV/AIDS , Geneva , Switzerland
| | - Priscilla Idele
- Division of Data, Research and Policy, United Nations Children's Fund , New York , NY , USA
| | - Tyler Porth
- Division of Data, Research and Policy, United Nations Children's Fund , New York , NY , USA
| | - Chibwe Lwamba
- Division of Data, Research and Policy, United Nations Children's Fund , New York , NY , USA
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Cea-Calvo L, Marín-Jiménez I, de Toro J, Fuster-RuizdeApodaca MJ, Fernández G, Sánchez-Vega N, Orozco-Beltrán D. Different Associations of Intentional and Non-Intentional Non-Adherence Behaviors with Patient Experience with Healthcare and Patient Beliefs in Medications: A Survey of Patients with Chronic Conditions. Patient Prefer Adherence 2020; 14:2439-2450. [PMID: 33363360 PMCID: PMC7754618 DOI: 10.2147/ppa.s281985] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 11/26/2020] [Indexed: 12/17/2022] Open
Abstract
PURPOSE To investigate relationships between intentional and non-intentional non-adherence behaviors and patient experience with healthcare and beliefs in medications. PATIENTS AND METHODS This is a post hoc analysis of a cross-sectional anonymous survey distributed between May and September 2017 to patients with rheumatic disease, inflammatory bowel disease, HIV infection or diabetes mellitus from outpatient and primary care clinics in Spain. Patients answered five questions about non-adherence behaviors and completed questionnaires on their experience with healthcare (IEXPAC: Instrument to Evaluate the EXperience of PAtients with Chronic diseases) and beliefs about medicines (BMQ: Beliefs About Medicines Questionnaire). RESULTS Among 1530 respondents, 53% showed ≥1 non-adherence behavior; 35% had ≥1 non-intentional non-adherence behavior, and 33% had ≥1 intentional non-adherence behavior. Patients with HIV infection had the lowest frequency of intentional non-adherence behaviors. Non-intentional non-adherence was associated with patient beliefs (inversely with BMQ overall score) and patient experiences (inversely with IEXPAC Factor 3 sub-score, self-management). Intentional non-adherence was strongly associated with beliefs scores (directly with BMQ concerns and inversely with BMQ necessity sub-score) and inversely associated with HIV infection. CONCLUSION The different associations of intentional and non-intentional non-adherence behaviors found in this study help to understand how patient experiences and beliefs influence medical non-adherence, and in the development of strategies for reducing non-adherence.
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Affiliation(s)
- Luis Cea-Calvo
- Medical Affairs Department, MSD Spain, Madrid, Spain
- Correspondence: Luis Cea-Calvo Medical Affairs Department, MSD Spain, Josefa Valcárcel 38, Madrid28027, SpainTel +34 913210740 Email
| | - Ignacio Marín-Jiménez
- IBD Unit, Gastroenterology Department, Clinical Research Institute Gregorio Marañón (IiSGM), Gregorio Marañón University Hospital, Madrid, Spain
| | - Javier de Toro
- Rheumatology Department, A Coruña University Hospital, A Coruña, Spain
| | - María J Fuster-RuizdeApodaca
- SEISIDA (Spanish AIDS Multidisciplinary Society), Madrid, Spain
- Department of Social and Organizational Psychology, Universidad Nacional de Educación a Distancia (UNED), Madrid, Spain
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141
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Lifetime Changes in CD4 T-cell count, Viral Load Suppression and Adherence Among Adolescents Living With HIV in Urban Peru. Pediatr Infect Dis J 2020; 39:54-56. [PMID: 31738325 DOI: 10.1097/inf.0000000000002501] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We quantified longitudinal changes in CD4 T-cell count, viral load suppression and combined antiretroviral therapy adherence from childhood to adolescence among patients living with HIV in urban Peru. Mean CD4 count and viral load suppression decreased dramatically in early adolescence (13 years of age) in tandem with increases in nonadherence.
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142
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Tapera T, Willis N, Madzeke K, Napei T, Mawodzeke M, Chamoko S, Mutsinze A, Zvirawa T, Dupwa B, Mangombe A, Chimwaza A, Makoni TM, Mandewo W, Senkoro M, Owiti P, Tripathy JP, Kumar AMV. Effects of a Peer-Led Intervention on HIV Care Continuum Outcomes Among Contacts of Children, Adolescents, and Young Adults Living With HIV in Zimbabwe. GLOBAL HEALTH: SCIENCE AND PRACTICE 2019; 7:575-584. [PMID: 31852741 PMCID: PMC6927836 DOI: 10.9745/ghsp-d-19-00210] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 10/15/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Africaid Zvandiri, in partnership with the Ministry of Health and Child Care (MOHCC) in Zimbabwe, implemented a comprehensive, peer-led program, focused on children, adolescents, and young adults living with HIV aged 0-24 years. The peers, known as community adolescent treatment supporters (CATS), are people living with HIV (PLHIV) aged 18-24 years who are trained and mentored to support their peers throughout the HIV care continuum through support groups, home visits, phone call reminders, and messages. We report the HIV care continuum outcomes (HIV testing uptake, antiretroviral therapy [ART] uptake, retention, and viral suppression) in a cohort of household contacts and sexual partners (aged younger than 25 years) of index children, adolescents, and young adults living with HIV identified by CATS from October 2017 to September 2018 in 24 districts of Zimbabwe. METHODS This was a retrospective cohort study involving analysis of routine program data, extracted from electronic databases consisting of data on contacts of index PLHIV and ART outcomes. We used April 30, 2019, as the censor date for all analyses. RESULTS A total of 15,223 household contacts and sexual partners with unknown HIV status (linked to 9,353 index PLHIV) were identified and referred for HIV testing. Of these, 12,114 (79.6%) were tested and 1,193 (9.8%) were HIV-positive. Of the latter, 1,153 (96.6%) were initiated on ART with 99% starting on the day of diagnosis. Of those on ART, 1,151 (99.8%) were alive on ART at 6 months and 2 (0.2%) died. A total of 1,044 (91%) children, adolescents, and young people living with HIV underwent viral load testing at 6 months or later, of whom 1,037 (99.3%) were virally suppressed (<1000 copies/ml). CONCLUSION These findings add to the global evidence demonstrating the effectiveness of peer-led interventions in children, adolescents, and young adults living with HIV and justify the decision of the MOHCC in Zimbabwe to scale-up the model nationally. Future research should aim to understand the reasons for the gaps in HIV testing and viral load testing using qualitative research.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Winnie Mandewo
- Elizabeth Glaser Pediatric AIDS Foundation, Harare, Zimbabwe
| | - Mbazi Senkoro
- National Institute for Medical Research, Muhimbili Centre, Dar es Salaam, Tanzania
| | - Philip Owiti
- International Union Against Tuberculosis and Lung Disease, Paris, France.,National Tuberculosis, Leprosy and Lung Disease Program, Nairobi, Kenya
| | - Jaya Prasad Tripathy
- International Union Against Tuberculosis and Lung Disease, Paris, France.,International Union Against Tuberculosis and Lung Disease, South-East Asia Office, New Delhi, India.,All India Institute of Medical Sciences, Nagpur, India
| | - Ajay M V Kumar
- International Union Against Tuberculosis and Lung Disease, Paris, France.,International Union Against Tuberculosis and Lung Disease, South-East Asia Office, New Delhi, India.,Yenepoya Medical College, Yenepoya, Mangaluru, India
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Adeagbo OA, Mthiyane N, Herbst C, Mee P, Neuman M, Dreyer J, Chimbindi N, Smit T, Okesola N, Johnson C, Hatzold K, Seeley J, Cowan F, Corbett L, Shahmanesh M. Cluster randomised controlled trial to determine the effect of peer delivery HIV self-testing to support linkage to HIV prevention among young women in rural KwaZulu-Natal, South Africa: a study protocol. BMJ Open 2019; 9:e033435. [PMID: 31874891 PMCID: PMC7008432 DOI: 10.1136/bmjopen-2019-033435] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION A cluster randomised controlled trial (cRCT) to determine whether HIV self-testing (HIVST) delivered by peers either directly or through incentivised peer-networks, could increase the uptake of antiretroviral therapy and pre-exposure prophylaxis (PrEP) among young women (18 to 24 years) is being undertaken in an HIV hyperendemic area in KwaZulu-Natal, South Africa. METHODS AND ANALYSIS A three-arm cRCT started mid-March 2019, in 24 areas in rural KwaZulu-Natal. Twenty-four pairs of peer navigators working with ~12 000 young people aged 18 to 30 years over a period of 6 months were randomised to: (1) incentivised-peer-networks: peer-navigators recruited participants 'seeds' to distribute up to five HIVST packs and HIV prevention information to peers within their social networks. Seeds receive an incentive (20 Rand = US$1.5) for each respondent who contacts a peer-navigator for additional HIVST packs to distribute; (2) peer-navigator-distribution: peer-navigators distribute HIVST packs and information directly to young people; (3) standard of care: peer-navigators distribute referral slips and information. All arms promote sexual health information and provide barcoded clinic referral slips to facilitate linkage to HIV testing, prevention and care services. The primary outcome is the difference in linkage rate between arms, defined as the number of women (18 to 24 years) per peer-navigators month of outreach work (/pnm) who linked to clinic-based PrEP eligibility screening or started antiretroviral, based on HIV-status, within 90 days of receiving the clinic referral slip. ETHICS AND DISSEMINATION This study was approved by the Institutional Review Boards at the WHO, Switzerland (Protocol ID: STAR CRT, South Africa), London School of Hygiene and Tropical Medicine, UK (Reference: 15 990-1), University of KwaZulu-Natal (BFC311/18) and the KwaZulu-Natal Department of Health (Reference: KZ_201901_012), South Africa. The findings of this trial will be disseminated at local, regional and international meetings and through peer-reviewed publications. TRIAL REGISTRATION NUMBER NCT03751826; Pre-results.
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Affiliation(s)
- Oluwafemi Atanda Adeagbo
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa
- Sociology, University of Johannesburg, Auckland Park, Gauteng, South Africa
| | - Nondumiso Mthiyane
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa
| | - Carina Herbst
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa
| | - Paul Mee
- Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Melissa Neuman
- Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Jaco Dreyer
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa
| | - Natsayi Chimbindi
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa
| | - Theresa Smit
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa
| | - Nonhlanhla Okesola
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa
| | - Cheryl Johnson
- Department of HIV/AIDS, World Health Organization, Geneva, Switzerland
| | | | - Janet Seeley
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa
- Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Frances Cowan
- International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
- CeSHHAR Zimbabwe, Harare, Zimbabwe
| | - Liz Corbett
- Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Maryam Shahmanesh
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa
- Institute for Global Health, University College London, London, UK
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144
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Njuguna I, Beima-Sofie K, Mburu C, Mugo C, Black DA, Neary J, Itindi J, Onyango A, Slyker J, Oyiengo L, John-Stewart G, Wamalwa D. Managing the transition from paediatric to adult care for HIV, Kenya. Bull World Health Organ 2019; 97:837-845. [PMID: 31819292 PMCID: PMC6883269 DOI: 10.2471/blt.19.232702] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 07/19/2019] [Accepted: 07/22/2019] [Indexed: 01/29/2023] Open
Abstract
Expansion of access to diagnosis and treatment for human immunodeficiency virus (HIV) and a high incidence of HIV infection in adolescence has resulted in a growing population of adolescents and young adults living with HIV. The prevalence of poor retention in care, insufficient viral suppression and loss to follow-up are higher among adolescents and young adults compared with other age groups. Poor outcomes could be attributed to psychosocial changes during adolescence, but also to poor transitional care from paediatric to adult HIV services. In many countries, transition processes remain poorly defined and unstructured, which may jeopardize treatment adherence and retention. We describe existing definitions of transition and transition frameworks, and key elements of transition as proposed by key national stakeholders in Kenya. Our consensus definition of transition is "a planned process by which adolescents and young adults living with HIV, and their caregivers, are empowered with knowledge and skills to enable them to independently manage their health." Transition should begin soon after disclosure of HIV status until an adolescent gains the necessary knowledge and skills and is willing to move to adult services, or by 25 years of age. Proposed key elements of transition are: target ages for milestone achievement; readiness assessment; caregiver involvement and communication with adult clinics; flexibility to return to adolescent or paediatric clinics; group transition; and considerations for adolescents with special needs. Retention in care, linkage to care and viral suppression are important markers of transition success. Proposed definitions and key elements could provide a framework for structuring transition programmes in other countries.
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Affiliation(s)
- Irene Njuguna
- Kenyatta National Hospital, Research and Programs, P.O. Box 20723-00202, Nairobi, Kenya
| | - Kristin Beima-Sofie
- Department of Global Health, University of Washington, Seattle, United States of America (USA)
| | - Caren Mburu
- Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Cyrus Mugo
- Kenyatta National Hospital, Research and Programs, P.O. Box 20723-00202, Nairobi, Kenya
| | - Danae A Black
- Department of Epidemiology, University of Washington, Seattle, USA
| | - Jillian Neary
- Department of Global Health, University of Washington, Seattle, United States of America (USA)
| | | | - Alvin Onyango
- Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Jennifer Slyker
- Department of Global Health, University of Washington, Seattle, United States of America (USA)
| | - Laura Oyiengo
- National AIDS and STI Control Program, Ministry of Health, Nairobi, Kenya
| | - Grace John-Stewart
- Department of Global Health, University of Washington, Seattle, United States of America (USA)
| | - Dalton Wamalwa
- Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
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145
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Thin K, Frederix K, McCracken S, Letsie M, Low A, Patel H, Parekh B, Motsoane T, Ahmed N, Justman J, Callaghan L, Tembo S, Schwitters A. Progress toward HIV epidemic control in Lesotho. AIDS 2019; 33:2393-2401. [PMID: 31764104 PMCID: PMC8064033 DOI: 10.1097/qad.0000000000002351] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The Lesotho Population-based HIV Impact Assessment survey was conducted nationally and designed to measure HIV prevalence, incidence, and viral load suppression (VLS). DESIGN A nationally representative sample of 9403 eligible households was surveyed between November 2016 and May 2017; analyses account for study design. Consenting participants provided blood samples, socio-demographic, and behavioral information. METHODS Blood samples were tested using the national rapid HIV testing algorithm. HIV-seropositive results were confirmed with Geenius supplemental assay. Screening for detectable concentrations of antiretroviral analytes was conducted on dried blood specimens from all HIV-positive adults using high-resolution liquid chromatography coupled with tandem mass spectrometry. Self-reported and/or antiretroviral biomarker data were used to classify individuals as HIV-positive and on treatment. Viral load testing was performed on all HIV-positive samples at central labs. VLS was defined as HIV RNA below 1000 copies/ml. RESULTS Overall, 25.6% of adults aged 15-59 years were HIV-positive. Among seropositive adults, 81.0% (male 76.6%, female 84.0%) reported knowing their HIV status, 91.8% of people living with HIV (male 91.6%, female 92.0%) who reported knowing their status reporting taking antiretrovirals, and 87.7% (male and female 87.7%) of these had VLS. Younger age was significantly associated with being less likely to be aware of HIV status for both sexes. CONCLUSIONS Findings from this population-based survey provide encouraging data in terms of HIV testing and treatment uptake and coverage. Specific attention to reaching youth to engage them in HIV-related interventions are critical to achieving epidemic control.
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Affiliation(s)
- Kyaw Thin
- Lesotho Ministry of Health, Maseru, Lesotho
| | - Koen Frederix
- ICAP at Columbia University in Lesotho, Maseru, Lesotho
| | | | | | - Andrea Low
- ICAP at Columbia University, New York, USA
| | - Hetal Patel
- Centers for Disease Control and Prevention, Atlanta
| | | | | | | | | | | | - Susan Tembo
- World Health Organization in Lesotho, Maseru, Lesotho
| | - Amee Schwitters
- Centers for Disease Control and Prevention in Lesotho, Maseru, Lesotho
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146
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Abstract
Supplemental Digital Content is Available in the Text. Background: Despite growing interest in undertaking research in adolescent HIV, the current pace of interventional research in particular remains very low compared with the needs of adolescents living with HIV (ALHIV). More robust evidence is needed to inform innovative and targeted interventions that bridge research gaps, inform policy, and improve outcomes for adolescents. A global research prioritization exercise was undertaken by WHO and CIPHER to focus efforts on priority research in the context of diminishing resources. Methods: The Child Health and Nutrition Research Initiative (CHNRI) methodology was adapted and used. Outcomes were reviewed by an expert group and 5 priority themes identified for testing, treatment, and service delivery, accounting for existing policies, published literature, and ongoing research. Results: A total of 986 research questions were submitted by 323 individuals from 67 countries. For HIV testing, priority themes included strategies and interventions to improve access, uptake, and linkage to care, and self-testing, particularly for key populations. For treatment, priorities included strategies to monitor and improve adherence, novel drug delivery systems, preventions and management of coinfections, optimal drug sequencing, and short- and long-term outcomes. For service delivery, priorities included service delivery models across the cascade, strategies to improve retention in care and sexual and reproductive health, support for pregnant ALHIV, and the provision of psychosocial support. Conclusions: This prioritized research agenda assists in focusing future research in ALHIV and will help to fill critical knowledge gaps. Key stakeholders, donors, program managers, and researchers should all support these priority questions and themes to collaboratively drive the adolescent HIV research agenda forward.
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147
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Factors Associated With Early Virological Response in HIV-Infected Individuals Starting Antiretroviral Therapy in Brazil (2014-2015): Results From a Large HIV Surveillance Cohort. J Acquir Immune Defic Syndr 2019; 78:e19-e27. [PMID: 29557856 PMCID: PMC6023593 DOI: 10.1097/qai.0000000000001684] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Objective: To identify clinical, sociodemographic, and treatment-related factors associated with early virological response in HIV-infected adults starting antiretroviral treatment (ART) in Brazil in 2014–2015. Methods: Data from 4 information systems from the Brazilian AIDS Program were combined to create a historical cohort. Unconditional logistic regression models were used to assess the likelihood of not achieving viral load suppression (VLS), defined as having either a viral load (VL) count >200 copies per milliliter or an aids-related death recorded within 180 ± 90 days after treatment initiation. Results: Among 76,950 individuals, 64.8% were men; median age, CD4+, and VL counts were 34 years, 378 cells per micro liter, and 38,131 copies per milliliter, respectively, and 85.2% achieved VLS. In the multivariate analysis, some factors which increased the odds of non-VLS were as follows: lower CD4+ and higher VL counts, younger age, heterosexual or injection drug use groups (relative to men who have sex with men), lower educational level, black/brown race, higher pill burden, and higher dosing frequency. Regimens containing boosted protease inhibitors were similar to those containing nonnucleoside reverse transcriptase inhibitors and superior to those containing unboosted protease inhibitors (all P values <0.001). No difference was observed between patients with CD4+ counts 350–499 and 500+ cells per micro liter. Conclusions: Our findings support the decision made in Brazil in 2013 to recommend immediate initiation of ART regardless of clinical stage or CD4+. Several factors were found to be associated with poorer virologic outcomes and should be addressed to maximize ART adherence and success rates.
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148
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Goswami R, Nelson AN, Tu JJ, Dennis M, Feng L, Kumar A, Mangold J, Mangan RJ, Mattingly C, Curtis AD, Obregon-Perko V, Mavigner M, Pollara J, Shaw GM, Bar KJ, Chahroudi A, De Paris K, Chan C, Van Rompay KKA, Permar SR. Analytical Treatment Interruption after Short-Term Antiretroviral Therapy in a Postnatally Simian-Human Immunodeficiency Virus-Infected Infant Rhesus Macaque Model. mBio 2019; 10:e01971-19. [PMID: 31488511 PMCID: PMC6945967 DOI: 10.1128/mbio.01971-19] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 08/05/2019] [Indexed: 12/27/2022] Open
Abstract
To achieve long-term viral remission in human immunodeficiency virus (HIV)-infected children, novel strategies beyond early antiretroviral therapy (ART) will be necessary. Identifying clinical predictors of the time to viral rebound upon ART interruption will streamline the development of novel therapeutic strategies and accelerate their evaluation in clinical trials. However, identification of these biomarkers is logistically challenging in infants, due to sampling limitations and the potential risks of treatment interruption. To facilitate the identification of biomarkers predicting viral rebound, we have developed an infant rhesus macaque (RM) model of oral simian-human immunodeficiency virus (SHIV) SHIV.CH505.375H.dCT challenge and analytical treatment interruption (ATI) after short-term ART. We used this model to characterize SHIV replication kinetics and virus-specific immune responses during short-term ART or after ATI and demonstrated plasma viral rebound in 5 out of 6 (83%) infants. We observed a decline in humoral immune responses and partial dampening of systemic immune activation upon initiation of ART in these infants. Furthermore, we monitored SHIV replication and rebound kinetics in infant and adult RMs and found that both infants and adults demonstrated equally potent virus-specific humoral immune responses. Finally, we validated our models by confirming a well-established correlate of the time to viral rebound, namely, the pre-ART plasma viral load, as well as identified additional potential humoral immune correlates. Thus, this model of infant ART and viral rebound can be used and further optimized to define biomarkers of viral rebound following long-term ART as well as to preclinically assess novel therapies to achieve a pediatric HIV functional cure.IMPORTANCE Novel interventions that do not rely on daily adherence to ART are needed to achieve sustained viral remission for perinatally infected children, who currently rely on lifelong ART. Considering the risks and expense associated with ART interruption trials, the identification of biomarkers of viral rebound will prioritize promising therapeutic intervention strategies, including anti-HIV Env protein therapeutics. However, comprehensive studies to identify those biomarkers are logistically challenging in human infants, demanding the need for relevant nonhuman primate models of HIV rebound. In this study, we developed an infant RM model of oral infection with simian-human immunodeficiency virus expressing clade C HIV Env and short-term ART followed by ATI, longitudinally characterizing the immune responses to viral infection during ART and after ATI. Additionally, we compared this infant RM model to an analogous adult RM rebound model and identified virologic and immunologic correlates of the time to viral rebound after ATI.
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Affiliation(s)
- Ria Goswami
- Duke Human Vaccine Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Ashley N Nelson
- Duke Human Vaccine Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Joshua J Tu
- Duke Human Vaccine Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Maria Dennis
- Duke Human Vaccine Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Liqi Feng
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Amit Kumar
- Duke Human Vaccine Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Jesse Mangold
- Duke Human Vaccine Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Riley J Mangan
- Duke Human Vaccine Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Cameron Mattingly
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Alan D Curtis
- Department of Microbiology and Immunology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Center for AIDS Research, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Maud Mavigner
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Justin Pollara
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - George M Shaw
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Katharine J Bar
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ann Chahroudi
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Emory+Children's Center for Childhood Infections and Vaccines, Atlanta, Georgia, USA
| | - Kristina De Paris
- Department of Microbiology and Immunology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Center for AIDS Research, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Cliburn Chan
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina, USA
| | - Koen K A Van Rompay
- California National Primate Research Center, University of California, Davis, California, USA
| | - Sallie R Permar
- Duke Human Vaccine Institute, Duke University Medical Center, Durham, North Carolina, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
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149
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Chappell E, Lyall H, Riordan A, Thorne C, Foster C, Butler K, Prime K, Bamford A, Peters H, Judd A, Collins IJ. The cascade of care for children and adolescents with HIV in the UK and Ireland, 2010 to 2016. J Int AIDS Soc 2019; 22:e25379. [PMID: 31498566 PMCID: PMC6733246 DOI: 10.1002/jia2.25379] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 07/31/2019] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION The UNAIDS 90-90-90 targets for the cascade of care are widely used to monitor the success of HIV care programmes but there are few studies in children. We assessed the cascade for children and adolescents living with HIV in the national Collaborative HIV Paediatric Study (CHIPS) in the UK and Ireland. METHODS Utilizing longitudinal data from CHIPS we compared the cascade of care for 2010, 2013 and 2016. Among children diagnosed with HIV and not known to be lost to follow-up at the start of each calendar year, we summarized the proportion in active paediatric care during that year (defined as having ≥1 clinic visit, CD4 or viral load measurement, or change to antiretroviral therapy (ART) regimen), and of these, the proportion on ART at last visit in that year. Among those on ART, the proportion with viral suppression (<200 copies/mL) and good immune status (WHO immunological stage none-/mild-for-age) at last visit in the year were summarized. Among those in care in 2016, outcomes were compared by current age, place of birth (born abroad vs. UK/Ireland) and sex. RESULTS Of children in paediatric HIV care at the start of 2010, 2013 and 2016 (n = 1249, 1157, 905 respectively), the proportion in active care during that calendar year was high throughout at 97 to 99%. Of those in active care, the proportion on ART increased from 79% to 85% and 92% respectively (p < 0.001). Among those on ART, the proportion with viral suppression and good immune status was stable at 83% to 86% and 85% to 88%, respectively, across the years. Among children in care in 2016, those aged ≥15 years were less likely to be virally suppressed (79% vs. 91%, p < 0.001) or to have good immune status (78% vs. 94%, p < 0.001) compared to younger children; there were no differences by place of birth or sex. CONCLUSIONS Children and adolescents in the UK and Ireland national cohort had high retention in care. The proportion on ART increased significantly over time although there was no change in viral suppression or good immune status. Poorer outcomes among adolescents highlight the need for targeted support for this population.
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Affiliation(s)
| | - Hermione Lyall
- St Mary's HospitalImperial College NHS Healthcare TrustLondonUK
| | | | - Claire Thorne
- UCL Great Ormond Street Institute of Child HealthLondonUK
| | - Caroline Foster
- St Mary's HospitalImperial College NHS Healthcare TrustLondonUK
| | - Karina Butler
- Paediatric DepartmentOur Lady's Children's HospitalCrumlinIreland
| | - Katia Prime
- St George's University Hospitals NHS TrustLondonUK
| | - Alasdair Bamford
- MRC Clinical Trials Unit at UCLLondonUK
- UCL Great Ormond Street Institute of Child HealthLondonUK
- Great Ormond Street Hospital for ChildrenNHS Foundation TrustLondonUK
| | - Helen Peters
- UCL Great Ormond Street Institute of Child HealthLondonUK
| | - Ali Judd
- MRC Clinical Trials Unit at UCLLondonUK
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Mesic A, Halim N, MacLeod W, Haker C, Mwansa M, Biemba G. Facilitators and Barriers to Adherence to Antiretroviral Therapy and Retention in Care Among Adolescents Living with HIV/AIDS in Zambia: A Mixed Methods Study. AIDS Behav 2019; 23:2618-2628. [PMID: 31093820 DOI: 10.1007/s10461-019-02533-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Little is known about the factors that contribute to the losses during stages of the HIV continuum of care (CoC) and specifically during the latter stages of antiretroviral (ART) adherence and retention in HIV care among adolescents living with HIV/AIDS (ALHA) in sub-Saharan Africa. We conducted a mixed-methods study: six focus group discussions with 43 ALHA (age 17-19); in-depth interviews with four (age 18-19): and survey-based interviews with 330 ALHA (age 18-19) to identify, understand, and describe factors contributing to the losses in the latter stages of the CoC among ALHA in Zambia. Through focus group discussions and in-depth interviews, ALHA identified barriers at the intrapersonal level (e.g., poverty; lack of adequate nutrition; fear of stigma), interpersonal level (e.g., stigma; disrespectful treatment by providers), institutional/facility level (e.g., lack of adolescent specific services), and community level (e.g., lack of collaboration among organizations; social norms). In quantitative interviews, we found that 46% (101/220) of ALHA reported missing any clinic appointments in the past three months, and about 19% (41/221) reporting missing one or more doses of ART in the last week. Logistic regressions indicate that walking to the site of appointment and being currently employed were predictive of missed visits. Findings highlight the complexity of the multiple factors that are unique to ALHA in Zambia, which should be addressed to improve adherence to ART and retention in HIV.
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