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Cluver LD, Shenderovich Y, Seslija M, Zhou S, Toska E, Armstrong A, Gulaid LA, Ameyan W, Cassolato M, Kuo CC, Laurenzi C, Sherr L. Identifying Adolescents at Highest Risk of ART Non-adherence, Using the World Health Organization-Endorsed HEADSS and HEADSS+ Checklists. AIDS Behav 2024; 28:141-153. [PMID: 37589806 PMCID: PMC10803572 DOI: 10.1007/s10461-023-04137-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2023] [Indexed: 08/18/2023]
Abstract
Brief tools are necessary to identify adolescents at greatest risk for ART non-adherence. From the WHO's HEADSS/HEADSS+ adolescent wellbeing checklists, we identify constructs strongly associated with non-adherence (validated with viral load). We conducted interviews and collected clinical records from a 3-year cohort of 1046 adolescents living with HIV from 52 South African government facilities. We used least absolute shrinkage and selection operator variable selection approach with a generalized linear mixed model. HEADSS constructs most predictive were: violence exposure (aOR 1.97, CI 1.61; 2.42, p < 0.001), depression (aOR 1.71, CI 1.42; 2.07, p < 0.001) and being sexually active (aOR 1.80, CI 1.41; 2.28, p < 0.001). Risk of non-adherence rose from 20.4% with none, to 55.6% with all three. HEADSS+ constructs were: medication side effects (aOR 2.27, CI 1.82; 2.81, p < 0.001), low social support (aOR 1.97, CI 1.60; 2.43, p < 0.001) and non-disclosure to parents (aOR 2.53, CI 1.91; 3.53, p < 0.001). Risk of non-adherence rose from 21.6% with none, to 71.8% with all three. Screening within established checklists can improve identification of adolescents needing increased support. Adolescent HIV services need to include side-effect management, violence prevention, mental health and sexual and reproductive health.
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Affiliation(s)
- Lucie D Cluver
- Centre for Evidence-Based Intervention, Department of Social Policy & Intervention, University of Oxford, Barnett House, 32 Wellington Square, Oxford, OX1 2ER, UK.
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
| | - Yulia Shenderovich
- Wolfson Centre for Young People's Mental Health, Cardiff University, Cardiff, UK
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, Cardiff, UK
| | - Marko Seslija
- Centre for Evidence-Based Intervention, Department of Social Policy & Intervention, University of Oxford, Barnett House, 32 Wellington Square, Oxford, OX1 2ER, UK
| | - Siyanai Zhou
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
- Division of Social and Behavioural Sciences, School of Public Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Elona Toska
- Centre for Evidence-Based Intervention, Department of Social Policy & Intervention, University of Oxford, Barnett House, 32 Wellington Square, Oxford, OX1 2ER, UK
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
| | - Alice Armstrong
- UNICEF Eastern and Southern Africa Regional Office, Nairobi, Kenya
| | - Laurie A Gulaid
- UNICEF Eastern and Southern Africa Regional Office, Nairobi, Kenya
| | - Wole Ameyan
- Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland
| | | | - Caroline C Kuo
- Department of Health Studies, American University, Washington, DC, USA
| | - Christina Laurenzi
- Department of Global Health, Institute for Life Course Health Research, Stellenbosch University, Stellenbosch, South Africa
| | - Lorraine Sherr
- Health Psychology Unit, Institute of Global Health, University College London, London, UK
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Djiyou ABD, Penda CI, Madec Y, Ngondi GD, Moukoko A, Eboumbou CE, Aghokeng AF. Prevalence of HIV drug resistance among adolescents receiving ART in Cameroon with low- or high-level viraemia. J Antimicrob Chemother 2023; 78:2938-2942. [PMID: 37921335 DOI: 10.1093/jac/dkad334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 10/11/2023] [Indexed: 11/04/2023] Open
Abstract
OBJECTIVES To characterize HIV drug resistance (HIVDR) below and above the WHO threshold of 1000 copies/mL, considered for the definition of HIV ART failure in resource-limited settings. METHODS From a cohort of 280 adolescents (aged 10-19 years) receiving ART for at least 6 months, genotypic resistance testing (GRT) was attempted for two groups of participants: participants with low-level viraemia [LLV; viral load (VL) 200-999 copies/mL] and those in virological failure (VF; confirmed VL ≥1000 copies/mL) using an in-house method. The Stanford HIValg Program was used to identify relevant HIVDR mutations and predict the efficacy of the newly introduced tenofovir-lamivudine-dolutegravir combination. RESULTS GRT was successfully performed in 54/58 (93.1%) eligible participants, of which 28/31 (90.3%) were in VF and 26/27 (96.3%) had LLV. A high level of resistance was found both in adolescents with LLV and those in VF, with respectively 84.6% (22/26) and 75.0% (21/28) of participants harbouring at least one HIVDR mutation. NRTIs and NNRTIs were the most affected drug classes in both population groups. In contrast, PIs were not significantly affected and dolutegravir was expected to be active for all participants tested. However, for the newly introduced dolutegravir-based combination, functional monotherapy (dolutegravir only) was potentially possible for 22.7% (5/22) of the participants with LLV. CONCLUSIONS Our findings show that the 1000 copies/mL threshold is not an indicator of virological success and we call for a revision of the current WHO definition of VF in resource-limited countries.
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Affiliation(s)
- Armando B D Djiyou
- Department of Biological Sciences, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
- MIVEGEC, Université de Montpellier, CNRS, IRD, Montpellier, France
| | - Calixte I Penda
- Department of Clinical Sciences, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
- Department of Pediatrics and Child Health, General Hospital of Douala, Douala, Cameroon
| | - Yoann Madec
- Institut Pasteur, Université de Paris, Epidemiology of Emerging Diseases, F-75015 Paris, France
| | - Grace D Ngondi
- Department of Virology, Hôpital Laquintinie, Douala, Cameroon
| | - Astrid Moukoko
- Department of Virology, Hôpital Laquintinie, Douala, Cameroon
| | - Carole E Eboumbou
- Department of Biological Sciences, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
- Department of Parasitology, Centre Pasteur du Cameroun, Yaoundé, Cameroon
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PABO WILLYLEROITOGNA, NJUME DEBIMEH, NDIP ROLANDNDIP, TAKOU DÉSIRÉ, SANTORO MARIAMERCEDES, CHENWI COLLINS, BELOUMOU GRACE, SEMENGUE EZECHIELNGOUFACKJAGNI, NKA ALEXDURAND, KA'E AUDECHRISTELLE, TETO GEORGES, DAMBAYA BEATRICE, DJUPSA SANDRINE, NYASA RAYMONDBABILA, ANGUECHIA DAVYHYACINTHEGOUISSI, KAMTA CEDRIC, BALA LIONEL, LAMBO VIRGINIE, SOSSO SAMUELMARTIN, COLIZZI VITTORIO, PERNO CARLOFEDERICO, FOKAM JOSEPH, NDJOLO ALEXIS. Genotypic resistance testing improves antiretroviral treatment outcomes in a cohort of adolescents in Cameroon: Implications in the dolutegravir-era. J Public Health Afr 2023; 14:2612. [PMID: 38020274 PMCID: PMC10658463 DOI: 10.4081/jphia.2023.2612] [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: 03/22/2023] [Accepted: 06/01/2023] [Indexed: 12/01/2023] Open
Abstract
Acquired drug resistance (ADR) is common among adolescents living with perinatal HIV (APHI) in sub-Saharan Africa (SSA). Personalized management has the potential to improve pediatric antiretroviral therapy (ART), even in the presence of long-term treatment and HIV-1 subtype diversity. We sought to evaluate the effect of HIV-1 mutational profiling on immuno-virological response and ADR among APHI. A cohort-study was conducted from 2018-2020 among 311 APHI receiving ART in Cameroon. Clinical, immunological and virological responses were measured at enrolment (T1), 6-months (T2) and 12-months (T3). Immunological failure (IF: CD4 #x003C;250 cells/mm3), VF (viremia ≥1,000 copies/ml), and ADR were analyzed, with P#x003C;0.05 considered significant. Mean age was 15(±3) years; male-female ratio was 1:1; median [IQR] ART-duration was 36[21-81] months. At T1, T2, and T3 respectively, adherence-level was 66.4, 58.3 and 66.5%; 14 viral clades were found, driven by CRF02_AG (58.6%); ADR-mutations favored increased switch to second-line ART (16.1, 31.2, and 41.9%, P#x003C;0.0001). From T1-T3 respectively, there were declining rates of IF (25.5, 18.9, and 9.83%, P#x003C;0.0001), VF (39.7, 39.9, and 28.2%, P=0.007), and HIVDR (96.4, 91.7, and 85.0%, P=0.099). Predictors of ADR were being on first-line ART (P=0.045), high viremia at enrolment (AOR=12.56, P=0.059), and IF (AOR=5.86, P=0.010). Of note, optimized ART guided by mutational profile (AOR=0.05, P=0.002) was protective. Moreover, full Tenofovir+Lamivudine+Dolutegravir efficacy was predicted in 77 and 62% of APHI respectively after first- and second-line failure. Among APHI in this SSA setting, viral mutational profiling prompts the use of optimized Dolutegravir-based ART regimens, leading to improved immuno-virological response and declining ADR burdens. Thus, implementing personalized HIV medicine in this vulnerable population would substantially improve ART response and the achievement of the 95-95-95 goals in these underserved populations.
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Affiliation(s)
- WILLY LE ROI TOGNA PABO
- Virology Laboratory, Chantal Biya International Reference Center for Research on HIV/AIDS Prevention and Management, Messa, Yaoundé, P.O Box: 3077, Cameroon
| | - DEBIMEH NJUME
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management, Yaoundé
- Faculty of Medicine and Biomedical Sciences, Yaoundé
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | | | - DÉSIRÉ TAKOU
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management, Yaoundé
| | | | - COLLINS CHENWI
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management, Yaoundé
- Faculty of Medicine and Biomedical Sciences, Yaoundé
| | - GRACE BELOUMOU
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management, Yaoundé
| | - EZECHIEL NGOUFACK JAGNI SEMENGUE
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management, Yaoundé
- University of Rome Tor Vergata, Rome, Italy
- Evangelic University of Cameroon, Bandjoun
| | - ALEX DURAND NKA
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management, Yaoundé
- University of Rome Tor Vergata, Rome, Italy
- Evangelic University of Cameroon, Bandjoun
| | - AUDE CHRISTELLE KA'E
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management, Yaoundé
- University of Rome Tor Vergata, Rome, Italy
| | - GEORGES TETO
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management, Yaoundé
| | - BEATRICE DAMBAYA
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management, Yaoundé
| | - SANDRINE DJUPSA
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management, Yaoundé
| | | | - DAVY HYACINTHE GOUISSI ANGUECHIA
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management, Yaoundé
- Faculty of Medicine and Biomedical Sciences, Yaoundé
| | | | | | | | - SAMUEL MARTIN SOSSO
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management, Yaoundé
| | - VITTORIO COLIZZI
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management, Yaoundé
- University of Rome Tor Vergata, Rome, Italy
- Evangelic University of Cameroon, Bandjoun
| | - CARLO FEDERICO PERNO
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management, Yaoundé
- University of Rome Tor Vergata, Rome, Italy
- Bambino Gesu Pediatric Hospital, Rome, Italy
| | - JOSEPH FOKAM
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management, Yaoundé
- Faculty of Medicine and Biomedical Sciences, Yaoundé
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
- National HIV Drug Resistance Group, Ministry of Public Health, Yaoundé, Cameroon
| | - ALEXIS NDJOLO
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management, Yaoundé
- Faculty of Medicine and Biomedical Sciences, Yaoundé
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Mbébi Enoné PJ, Penda CI, Ngondi G, Fokam J, Ebong SB, Mekoulou Ndongo J, Essangui Same EG, Ndjengue Nson LS, Mandengue SH, Eboumbou Moukoko CE. High risk of virologic failure among HIV-infected children and adolescents routinely followed-up in Littoral region of Cameroon. PLoS One 2023; 18:e0289426. [PMID: 37561800 PMCID: PMC10414642 DOI: 10.1371/journal.pone.0289426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 07/19/2023] [Indexed: 08/12/2023] Open
Abstract
Virological response to antiretroviral therapy (ART) remains a challenge for HIV-infected children and adolescents due to non-optimization of pediatric ART for resource-limited settings. In this study, we aimed to investigate factors associated with virologic failure (VF) in HIV-infected-children and adolescents on ART in Cameroon. A prospective patient-based cohort study was conducted among HIV-infected children (0-9 years) and adolescents (10-19 years) followed-up between November 2018 and October 2019 in 38 healthcare centers located in the Littoral region of Cameroon. The 1st viral load (VL) was assessed after 6 months of ART initiation and the 2nd VL between 3 and 6 six months later in patients with VL ≥1000 copies/ml in accordance with the national algorithm using Abbott Real-Time HIV-1 Viral Load Assay. Multivariate analyses were performed to identify the determinants of higher risk of VF. Of 1,029 HIV-infected children and adolescents (393 children and 636 adolescents), 801 (77.8%) cumulatively presented with VL <1000 copies/mL within 12 months on ART. Adolescents were more likely to have VF than children (24.5% vs 18.3%, OR: 1.39; 95%CI: 1.00-1.93; p = 0.047). Patients followed-up in decentralized care units were significantly more likely to have VF compared to those attending the accredited treatment centers (26.1% vs 16.6%, OR: 1.88, 95%CI: 1.37-2.58; p<0.001). Our findings show a high rate of VL suppression (VLS, 77.8%) among HIV-infected children and adolescents, albeit lower than the established target of 90%. Being adolescent and patients followed in the decentralized care units are high risk factors for VF, thereby necessitating routine therapeutic education of patients and guardians in resource limited countries to improve VLS.
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Affiliation(s)
- Patient Juste Mbébi Enoné
- Faculty of Sciences, Department of Animal Biology and Physiology, University of Douala, Douala, Cameroon
| | - Calixte Ida Penda
- Faculty of Medicine and Pharmaceutical Sciences, Clinical Sciences Department, University of Douala, Douala, Cameroon
- Accredited HIV Care Center, Laquintinie Hospital of Douala, Douala, Cameroon
| | - Grâce Ngondi
- Faculty of Medicine and Pharmaceutical Sciences, Biological Sciences Department, University of Douala, Douala, Cameroon
- Biological Laboratory, Laquintinie Hospital of Douala, Douala, Cameroon
| | - Joseph Fokam
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), Yaounde, Cameroon
- Faculty of Health Sciences, Department of Medical Laboratory Science, University of Buea, Buea, Cameroon
| | - Serge Bruno Ebong
- Faculty of Sciences, Department of Animal Biology and Physiology, University of Douala, Douala, Cameroon
| | - Jerson Mekoulou Ndongo
- Faculty of Sciences, Department of Animal Biology and Physiology, University of Douala, Douala, Cameroon
| | | | | | - Samuel Honoré Mandengue
- Faculty of Sciences, Department of Animal Biology and Physiology, University of Douala, Douala, Cameroon
| | - Carole Else Eboumbou Moukoko
- Faculty of Medicine and Pharmaceutical Sciences, Biological Sciences Department, University of Douala, Douala, Cameroon
- Laboratory of Parasitology, Mycology and Virology, Postgraduate Training Unit for Health Sciences, Postgraduate School for Pure and Applied Sciences, University of Douala, Douala, Cameroon
- Centre Pasteur of Cameroon, Yaounde, Cameroon
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Owusu LB, Ababio C, Boahene S, Zakaria AFS, Emikpe AO, Dwumfour CK, Appiagyei KA, Apiribu F. The predictors of unsuppressed viremia among PLHIV: a cross-sectional study in Ghana. BMC Public Health 2023; 23:1113. [PMID: 37296400 PMCID: PMC10257285 DOI: 10.1186/s12889-023-16032-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 05/31/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Unsuppressed viremia in HIV infected patients is generally associated with increased rates of disease transmission and poor patient survival. This study assessed the socio-demographic determinants of People Living with HIV/AIDS, having viral load non-suppression and who are receiving antiretroviral therapy in a District Hospital in Ghana. METHODS The study utilized the cross-sectional research design with both primary and secondary data conducted from September to October 2021 in Ghana. Data were collected from 331 PLHIV who were placed on Anti-Retroviral Therapy (ART) for more than 12 months at the ART centre at a District Hospital in Ghana. Unsuppressed viremia was defined as plasma viral load of ≥ 1000 copies/mL after 12 months on an ART with effective adherent support. A structured questionnaire was used to collect primary data on participants and a Secondary data was also collected from patients' folders, hospital registers and the computerized health information systems at the study site. SPSS was used to analyse descriptive and inferential data. Pearson's chi-square and Fisher's exact test were used to assess the independent determinants of viral load non-suppression. Pearson's chi-square test was used for tests giving ≤ 20% of expected cell counts less than five while Fisher's exact test was used for tests giving > 20% of expected cell counts less than five. A p value of < 0.05 was considered statistically significant. RESULTS Out of the 331 PLHIV who participated in the study, 174 (53%) were female and 157 (47%) were Male. The study found viral load non-suppression of 19% with age (p = 0.03), income (p = 0.02), employment (p = 0.04), means of transportation (p = 0.02), cost of transportation to the ART centre (p = 0.03) and level of medication adherence (p = 0.02) as determinants of viral load non-suppression. CONCLUSION There was a low level of viral load non-suppression among PLHIV after 12 months of active antiretroviral therapy with age, income, employment, means of transportation, cost of transportation and level of medication adherence influencing viral non-suppression. Thus, ART drugs and services should be decentralized to the community health workers' level within the various localities of patients to decrease the economic consequences involved in accessing health care for PLHIV/AIDS. This will minimize defaulting, improve adherence and promote viral load suppression.
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Affiliation(s)
| | - Christiana Ababio
- New Edubiase Government Hospital, Adansi South District, Ashanti Region, Ghana
| | - Selina Boahene
- New Edubiase Government Hospital, Adansi South District, Ashanti Region, Ghana
| | | | | | | | | | - Felix Apiribu
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Rate of virological failure and HIV-1 drug resistance among HIV-infected adolescents in routine follow-up on health facilities in Cameroon. PLoS One 2022; 17:e0276730. [PMID: 36288365 PMCID: PMC9604952 DOI: 10.1371/journal.pone.0276730] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 10/12/2022] [Indexed: 11/17/2022] Open
Abstract
The objective of this study was to determine the rates of virological failure (VF) and HIV drug resistance (HIVDR) amongst adolescents on antiretroviral Therapy (ART). A retrospectively designed study was conducted in 10 healthcare centers for adolescents living with HIV (ALHIV) in the two main cities of Cameroon (Yaoundé and Douala), from November 2018 to May 2019. Sociodemographic, clinical, therapeutic and laboratory parameters were collected from medical records. All enrolled ALHIV had viral load (VL) measurements following the national guidelines. All patients with a VL ≥ 1000 copies/ml were called to perform genotyping tests. The chi-square test was used to determine the factors associated with VF. Out of the 1316 medical records of ALHIV, we included 1083 ALHIV having a VL result. Among them, 276 (25.5%) were experiencing VF, and VF was significantly higher in ALHIV with suboptimal adherence (p<0.001), older adolescents (p<0.05), those who lived outside the city where they were receiving ART (p<0.006), severely immunocompromised (p<0.01) and started ART at infancy (p<0.02). Among the 45/276 (16.3%) participants with an available genotyping resistance testing (GRT) result, the overall rate of HIVDR was 93.3% (42/45). The most common mutations were K103N (n = 21/42, 52.3%) resulting in high-level resistance to Efavirenz and Nevirapine, followed by M184V (n = 20/42, 47.6%) and thymidine analog mutations (n = 15/42, 35.7%) associated with high-level resistance to Lamivudine and Zidovudine respectively. The high rate of VF and HIVDR among ALHIV regularly followed in health facilities in Cameroon highlights the need to develop interventions adapted to an adolescent-centered approach to preserve future ART options.
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Mhlanga TT, Jacobs BKM, Decroo T, Govere E, Bara H, Chonzi P, Sithole N, Apollo T, Van Damme W, Rusakaniko S, Lynen L, Makurumidze R. Virological outcomes and risk factors for non-suppression for routine and repeat viral load testing after enhanced adherence counselling during viral load testing scale-up in Zimbabwe: analytic cross-sectional study using laboratory data from 2014 to 2018. AIDS Res Ther 2022; 19:34. [PMID: 35810317 PMCID: PMC9270749 DOI: 10.1186/s12981-022-00458-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 06/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Since the scale-up of routine viral load (VL) testing started in 2016, there is limited evidence on VL suppression rates under programmatic settings and groups at risk of non-suppression. We conducted a study to estimate VL non-suppression (> 1000 copies/ml) and its risk factors using "routine" and "repeat after enhanced adherence counselling (EAC)" VL results. METHODS We conducted an analytic cross-sectional study using secondary VL testing data collected between 2014 and 2018 from a centrally located laboratory. We analysed data from routine tests and repeat tests after an individual received EAC. Our outcome was viral load non-suppression. Bivariable and multivariable logistic regression was performed to identify factors associated with having VL non-suppression for routine and repeat VL. RESULTS We analysed 103,609 VL test results (101,725 routine and 1884 repeat test results) collected from the country's ten provinces. Of the 101,725 routine and 1884 repeat VL tests, 13.8% and 52.9% were non-suppressed, respectively. Only one in seven (1:7) of the non-suppressed routine VL tests had a repeat test after EAC. For routine VL tests; males (vs females, adjusted odds ratio (aOR) = 1.19, [95% CI 1.14-1.24]) and adolescents (10-19 years) (vs adults (25-49 years), aOR = 3.11, [95% CI 2.9-3.31]) were more at risk of VL non-suppression. The patients who received care at the secondary level (vs primary, aOR = 1.21, [95% CI 1.17-1.26]) and tertiary level (vs primary, aOR = 1.63, [95% CI 1.44-1.85]) had a higher risk of VL non-suppression compared to the primary level. Those that started ART in 2014-2015 (vs < 2010, aOR = 0.83, [95% CI 0.79-0.88]) and from 2016 onwards (vs < 2010, aOR = 0.84, [95% CI 0.79-0.89]) had a lower risk of VL non-suppression. For repeat VL tests; young adults (20-24 years) (vs adults (25-49 years), (aOR) = 3.48, [95% CI 2.16 -5.83]), adolescents (10-19 years) (vs adults (25-49 years), aOR = 2.76, [95% CI 2.11-3.72]) and children (0-9 years) (vs adults (25-49 years), aOR = 1.51, [95% CI 1.03-2.22]) were at risk of VL non-suppression. CONCLUSION Close to 90% suppression in routine VL shows that Zimbabwe is on track to reach the third UNAIDS target. Strategies to improve the identification of clients with high routine VL results for repeating testing after EAC and ART adherence in subpopulations (men, adolescents and young adolescents) at risk of viral non-suppression should be prioritised.
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Affiliation(s)
| | | | - Tom Decroo
- Institute of Tropical Medicine, Antwerp, Belgium.,Research Foundation of Flanders, Brussels, Belgium
| | - Emma Govere
- Harare City Council, Department of Health, Harare, Zimbabwe
| | - Hilda Bara
- Harare City Council, Department of Health, Harare, Zimbabwe
| | - Prosper Chonzi
- Harare City Council, Department of Health, Harare, Zimbabwe
| | - Ngwarai Sithole
- AIDS & TB Unit, Ministry of Health & Child Care, Harare, Zimbabwe
| | - Tsitsi Apollo
- AIDS & TB Unit, Ministry of Health & Child Care, Harare, Zimbabwe
| | - Wim Van Damme
- Institute of Tropical Medicine, Antwerp, Belgium.,Gerontology, Faculty of Medicine & Pharmacy, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | | | | | - Richard Makurumidze
- Institute of Tropical Medicine, Antwerp, Belgium. .,Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe. .,Gerontology, Faculty of Medicine & Pharmacy, Vrije Universiteit Brussel (VUB), Brussels, Belgium.
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Kasimonje B, Shamu T, Mudzviti T, Luethy R. Group counselling for adherence support among young people failing first-line antiretroviral therapy in Zimbabwe. South Afr J HIV Med 2021; 22:1292. [PMID: 34858653 PMCID: PMC8603063 DOI: 10.4102/sajhivmed.v22i1.1292] [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: 08/05/2021] [Accepted: 09/17/2021] [Indexed: 11/20/2022] Open
Abstract
Background Sub-optimal adherence to antiretroviral therapy (ART) is reportedly worse amongst young people living with HIV (YPLHIV). Group adherence counselling can be useful to improve adherence. Objectives We evaluated an enhanced adherence counselling group intervention (EACGI) amongst YPLHIV failing a non-nucleoside reverse transcriptase (NNRTI)-based first-line ART regimen. Method This was a retrospective cohort study using routinely collected data of YPLHIV failing NNRTI-based first-line ART. Patients with confirmed virological failure were referred for EACGI, a 12-week curriculum of weekly, 1.5-h sessions accommodating 8–15 people per group. It aimed to facilitate readiness to switch to second-line ART and improve adherence through a mental health intervention. Viral loads of HIV were measured pre-EACGI; at baseline; 3, 6 and 12 months post switch. Results Fifty-seven patients aged 13–25 years were invited to EACGI and followed for up to 48 weeks. Thirty-three (58%) patients attended at least four sessions, whilst 24 (42%) attended none. Amongst those who attended none, two (8%) were transferred out, three (13%) were lost to follow-up and two (8%) had died by week 48 of follow-up, whilst all who attended were still in care. By week 48, amongst patients still in care, 29%, 44% and 67% of those who attended no sessions, 4–9 and 10–12 sessions, respectively, had viral loads of < 50 copies/mL. Conclusion An EACGI is a promising intervention for YPLHIV failing ART prior to treatment switch, leading to improved adherence. This study’s findings support the need for further enquiry into rigorous, evidence-based multilevel adherence interventions that are acceptable and effective for YPLHIV.
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Affiliation(s)
| | - Tinei Shamu
- Newlands Clinic, Harare, Zimbabwe.,Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Graduate School of Health Sciences, University of Bern, Bern, Switzerland
| | - Tinashe Mudzviti
- Newlands Clinic, Harare, Zimbabwe.,Department of Pharmacy and Pharmaceutical Sciences, University of Zimbabwe, Harare, Zimbabwe
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9
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Qiu M, Paina L, Rodríguez DC, Wilhelm JA, Eze-Ajoku E, Searle A, Zakumumpa H, Ssengooba F, MacKenzie C, Bennett S. Exploring perceived effects from loss of PEPFAR support for outreach in Kenya and Uganda. Global Health 2021; 17:80. [PMID: 34273988 PMCID: PMC8285775 DOI: 10.1186/s12992-021-00729-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 06/29/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction In 2015, the President’s Emergency Plan for AIDS Relief undertook policy shifts to increase efficiencies in its programming, including transitioning HIV/AIDS funding away from low burden areas. We examine the impact of these changes on HIV outreach in Kenya and Uganda. Methods Qualitative data collection was conducted as a part of a broader mixed-methods evaluation. Two rounds of facility-level case studies and national-level interviews were conducted in Kenya and Uganda, with health facility, sub-national and central Ministry of Health staff, HIV clients, and implementing partners. Results In both countries, the loss of outreach support affected community-based HIV/AIDS education, testing, peer support, and defaulter tracing. Discussion Loss of external support for outreach raises concerns for countries’ ability to reach the 90–90-90 UNAIDS target, as key linkages between vulnerable communities and health systems can be adversely affected. Conclusion Development partners should consider how to mitigate potential consequences of transition policies to prevent negative effects at the community level.
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Affiliation(s)
- Mary Qiu
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Ligia Paina
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Daniela C Rodríguez
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jess A Wilhelm
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ezinne Eze-Ajoku
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Alexandra Searle
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Henry Zakumumpa
- Makerere University School of Public Health, Kampala, Uganda
| | | | | | - Sara Bennett
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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10
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Badejo O, Noestlinger C, Jolayemi T, Adeola J, Okonkwo P, Van Belle S, Wouters E, Laga M. Multilevel modelling and multiple group analysis of disparities in continuity of care and viral suppression among adolescents and youths living with HIV in Nigeria. BMJ Glob Health 2021; 5:bmjgh-2020-003269. [PMID: 33154102 PMCID: PMC7646327 DOI: 10.1136/bmjgh-2020-003269] [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: 07/01/2020] [Revised: 10/05/2020] [Accepted: 10/07/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Substantial disparities in care outcomes exist between different subgroups of adolescents and youths living with HIV (AYLHIV). Understanding variation in individual and health facility characteristics could be key to identifying targets for interventions to reduce these disparities. We modelled variation in AYLHIV retention in care and viral suppression, and quantified the extent to which individual and facility characteristics account for observed variations. METHODS We included 1170 young adolescents (10-14 years), 3206 older adolescents (15-19 years) and 9151 young adults (20-24 years) who were initiated on antiretroviral therapy (ART) between January 2015 and December 2017 across 124 healthcare facilities in Nigeria. For each age group, we used multilevel modelling to partition observed variation of main outcomes (retention in care and viral suppression at 12 months after ART initiation) by individual (level one) and health facility (level two) characteristics. We used multiple group analysis to compare the effects of individual and facility characteristics across age groups. RESULTS Facility characteristics explained most of the observed variance in retention in care in all the age groups, with smaller contributions from individual-level characteristics (14%-22.22% vs 0%-3.84%). For viral suppression, facility characteristics accounted for a higher proportion of variance in young adolescents (15.79%), but not in older adolescents (0%) and young adults (3.45%). Males were more likely to not be retained in care (adjusted OR (aOR)=1.28; p<0.001 young adults) and less likely to achieve viral suppression (aOR=0.69; p<0.05 older adolescent). Increasing facility-level viral load testing reduced the likelihood of non-retention in care, while baseline regimen TDF/3TC/EFV or NVP increased the likelihood of viral suppression. CONCLUSIONS Differences in characteristics of healthcare facilities accounted for observed disparities in retention in care and, to a lesser extent, disparities in viral suppression. An optimal combination of individual and health services approaches is, therefore, necessary to reduce disparities in the health and well-being of AYLHIV.
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Affiliation(s)
- Okikiolu Badejo
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium .,APIN Public Health Initiative, Abuja, Nigeria.,Department of Sociology, University of Antwerp, Antwerpen, Belgium
| | | | | | | | | | - Sara Van Belle
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Edwin Wouters
- Department of Sociology, University of Antwerp, Antwerpen, Belgium
| | - Marie Laga
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
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11
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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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12
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Miti S, Handema R, Mulenga L, Mwansa JK, Abrams E, Frimpong C, Burke VM, Zulu M, Siwingwa M, Mwakazanga D, Kalibala S, Denison JA. Prevalence and characteristics of HIV drug resistance among antiretroviral treatment (ART) experienced adolescents and young adults living with HIV in Ndola, Zambia. PLoS One 2020; 15:e0236156. [PMID: 32804970 PMCID: PMC7430722 DOI: 10.1371/journal.pone.0236156] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 06/29/2020] [Indexed: 01/24/2023] Open
Abstract
Background HIV drug resistance (HIVDR) poses a threat to the HIV epidemic control in Zambia especially in sub-populations such as the 15–24 years where there is poor virological suppression. Understanding the prevalence and patterns of HIVDR in this population (15–24 years) will contribute to defining effective antiretroviral therapy (ART) regimens, improving clinical decision making, and supporting behavioral change interventions needed to achieve HIV epidemic control. Methods A cross-sectional analysis of study enrollment data from the Project YES! Youth Engaging for Success randomized controlled trial was conducted. Participants were 15 to 24 years old, who knew their HIV status, and had been on ART for at least 6 months. All participants completed a survey and underwent viral load (VL) testing. Participants with viral failure (VL ≥1,000 copies/mL) underwent HIVDR testing which included analysis of mutations in the protease and reverse transcriptase genes. Results A total of 99 out of 273 analyzed participants receiving ART had VL failure, of whom 77 had successful HIVDR amplification and analysis. Out of the 77, 75% (58) had at least one drug resistant mutation, among which 83% (48/58) required a drug change. Among the 58 with HIVDR mutations, the prevalence of at least one HIVDR mutation to nucleoside reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs) and protease inhibitors (PIs) were 81%, 65.5% and 1.7%. The mutation M184V which confers resistance to NRTI drugs of lamivudine (3TC) and emtricitabine (FTC) was the most common (81%) among NRTI associated mutations followed by K65R (34.5%) which is associated with both tenofovir disoproxil fumarate (TDF) and tenofovir alafenamide fumarate (TAF) resistance. Thymidine analogue mutations (TAMs) which confer resistance primarily to zidovudine (AZT), stavudine (d4T) and other NRTIs were observed at 32.8%. Common TAMs were K70RTQNE (32.8%), K219QE (22.4%), D67N (17.2%) and T215IT (15.5%). The most common NNRTI associated mutation was the K103N (65.5%) which confers resistance to both efavirenz (EFV) and nevirapine (NVP). There was a relatively high occurrence of other NNRTI mutations V106A (36.2%), as well as Y188C (36.2%) and Y181C (36.2%) which confer resistance to etravirine. Conclusions There is a high prevalence of HIVDR including TAMs despite majority of these patients (90.48%) being on AZT or d4T sparing first line ART among the youth. Emergence of these mutations including the NNRTI associated mutations (Y181C and Y188C) may compromise future second- and third-line regimens in the absence of routine HIVDR testing. HIVDR monitoring at start of ART or at first-line failure can better inform clinical decision making and ART programing.
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Affiliation(s)
- Sam Miti
- Arthur Davison Children’s Hospital, Ndola, Zambia
- Tropical Diseases Research Center, Ndola, Zambia
- * E-mail:
| | - Ray Handema
- Tropical Diseases Research Center, Ndola, Zambia
| | - Lloyd Mulenga
- University Teaching Hospital, Adult Infectious Diseases Center, Lusaka, Zambia
- Vanderbilt University Medical Center, Division of Infectious Diseases, Nashville, Tennessee, Zambia
- University of Zambia, School of Medicine, Division of Infectious Diseases, Lusaka, Zambia
| | | | - Elizabeth Abrams
- John Hopkins University Bloomberg School of Public Health, Department of International Health, Baltimore, Maryland, United States of America
| | | | - Virginia M. Burke
- John Hopkins University Bloomberg School of Public Health, Department of International Health, Baltimore, Maryland, United States of America
| | - Mangani Zulu
- Arthur Davison Children’s Hospital, Ndola, Zambia
| | - Mpanji Siwingwa
- University Teaching Hospital, Adult Infectious Diseases Center, Lusaka, Zambia
| | | | - Sam Kalibala
- Population Council, Washington, DC, United States of America
| | - Julie A. Denison
- John Hopkins University Bloomberg School of Public Health, Department of International Health, Baltimore, Maryland, United States of America
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Anderson K, Muloiwa R, Davies MA. Long-term outcomes in perinatally HIV-infected adolescents and young adults on antiretroviral therapy: a review of South African and global literature. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2020; 19:1-12. [PMID: 32122278 DOI: 10.2989/16085906.2019.1676802] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Paediatric antiretroviral programmes have been implemented globally for more than a decade, yet information on long-term treatment outcomes in perinatally HIV-infected adolescents is limited. Published literature on long-term treatment outcomes was reviewed, including virologic, immunologic and growth outcomes, as well as drug resistance and factors associated with drug resistance. Outcomes were compared between high-income countries and low- and middle-income countries (LMIC), with additional focus on South Africa, the country with the biggest HIV epidemic in the world and the largest treatment programme. Treatment outcomes varied but viral suppression results globally were generally concerning. No studies from LMIC have reported on outcomes after >10 years follow-up, demonstrating that further studies are needed.
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Affiliation(s)
- Kim Anderson
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Rudzani Muloiwa
- Department of Paediatrics, Groote Schuur Hospital, Cape Town, South Africa
| | - Mary-Ann Davies
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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Community and activists demand for tenofovir/emtricitabine or lamivudine/dolutegravir and routine viral load testing. Curr Opin HIV AIDS 2020; 14:7-12. [PMID: 30451698 DOI: 10.1097/coh.0000000000000515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Since the beginning of the HIV epidemic, informed communities have demanded and fought for access to life-saving treatment. The last several years have seen interesting developments in this area - particularly with respect to the switch to dolutegravir (DTG)-based regimens and scale-up of routine viral load testing (RVLT), and how these directly and indirectly impact issues of treatment optimization, HIV drug resistance, and sexual and reproductive health. In this review, we present recent advances in antiretroviral treatment and monitoring in the context of how treatment education and community demand for them. RECENT FINDINGS The latest developments with DTG and RVLT highlight underlying issues for global health systems that need to be addressed - including drug surveillance, supply chain management, and comprehensive care linkages - and the importance of community engagement in such issues. SUMMARY Decisions about treatment must be grounded in informed community demand, and should exist in the context of optimal care and treatment across the entire HIV cascade. Informed advocacy is essential for people living with HIV and their communities, so that they benefit from existing and future therapeutic advances. Research is needed on the importance of community demand across the HIV treatment cascade.
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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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The global epidemiology of adolescents living with HIV: time for more granular data to improve adolescent health outcomes. Curr Opin HIV AIDS 2019; 13:170-178. [PMID: 29432227 DOI: 10.1097/coh.0000000000000449] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The aim of this study was to summarize recent evidence on the global epidemiology of adolescents (age 10-19 years) living with HIV (ALHIV), the burden of HIV on the health of adolescents and HIV-associated mortality. RECENT FINDINGS In 2016, there were an estimated 2.1 million (uncertainty bound 1.4-2.7 million) ALHIV; 770 000 younger (age 10-14 years) and 1.03 million older (age 15-19 years) ALHIV, 84% living in sub-Saharan Africa. The population of ALHIV is increasing, as more peri/postnatally infected ALHIV survive into older ages; an estimated 35% of older female ALHIV were peri/postnatally infected, compared with 57% of older male ALHIV. Although the numbers of younger ALHIV deaths are declining, deaths among older ALHIV have remained static since peaking in 2012. In 2015, HIV-associated mortality was the eighth leading cause of adolescent death globally and the fourth leading cause in African low and middle-income countries. SUMMARY Needed investments into characterizing and improving adolescent HIV-related health outcomes include strengthening systems for nationally and globally disaggregated data by age, sex and mode of infection; collecting more granular data within routine programmes to identify structural, social and mental health challenges to accessing testing and care; and prioritizing viral load monitoring and adolescent-focused differentiated models of care.
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El-Sadr WM, Rabkin M, Nkengasong J, Birx DL. Realizing the potential of routine viral load testing in sub-Saharan Africa. J Int AIDS Soc 2017; 20 Suppl 7. [PMID: 29130621 PMCID: PMC5978658 DOI: 10.1002/jia2.25010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 08/23/2017] [Indexed: 12/11/2022] Open
Affiliation(s)
| | | | - John Nkengasong
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
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Marcus R, Ferrand RA, Kranzer K, Bekker L. The case for viral load testing in adolescents in resource-limited settings. J Int AIDS Soc 2017; 20 Suppl 7:e25002. [PMID: 29171180 PMCID: PMC5978738 DOI: 10.1002/jia2.25002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Accepted: 08/21/2017] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION The success of HIV treatment programmes globally has resulted in children with perinatally acquired HIV reaching adolescence in large numbers. The number of adolescents living with HIV is growing further due to persisting high HIV incidence rates among adolescents in low- and middle-income settings, particularly in sub-Saharan Africa. Although expanding access to HIV viral load monitoring is necessary to achieve the 90-90-90 targets across the HIV care continuum, implementation is incomplete. We discuss the rationale for prioritizing viral load monitoring among adolescents and the associated challenges. DISCUSSION Adolescents with HIV are a complex group to treat successfully due to extensive exposure to antiretroviral therapy for those with perinatally acquired HIV and the challenges in sustained medication adherence in this age group. Given the high risk of treatment failure among adolescents and the limited drug regimens available in limited resource settings, HIV viral load monitoring in adolescents could prevent unnecessary and costly switches to second-line therapy in virologically suppressed adolescents. Because adolescents living with HIV may be heavily treatment experienced, have suboptimal treatment adherence, or may be on second or even third-line therapy, viral load testing would allow clinicians to make informed decisions about increased counselling and support for adolescents together with the need to maintain or switch therapeutic regimens. CONCLUSIONS Given scarce resources, prioritization of viral load testing among groups with a high risk of virological failure may be required. Adolescents have disproportionately high rates of virological failure, and targeting this age group for viral load monitoring may provide valuable lessons to inform broader scale-up.
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Affiliation(s)
- Rebecca Marcus
- The Desmond Tutu HIV CentreUniversity of Cape TownCape TownSouth Africa
- Barts Health NHS TrustLondonUK
| | - Rashida A Ferrand
- Barts Health NHS TrustLondonUK
- Clinical Research DepartmentLondon School of Hygiene and Tropical MedicineLondonUK
- Biomedical Research and Training InstituteHarareZimbabwe
| | - Katharina Kranzer
- Clinical Research DepartmentLondon School of Hygiene and Tropical MedicineLondonUK
- National and Supranational Reference LaboratoryResearch Centre LeibnitzBorstelGermany
| | - Linda‐Gail Bekker
- The Desmond Tutu HIV CentreUniversity of Cape TownCape TownSouth Africa
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