1
|
Odhiambo F, Onyango R, Mulwa E, Aluda M, Otieno L, Bukusi EA, Cohen CR, Murnane PM. Evaluation of person-centered interventions to eliminate perinatal HIV transmission in Kisumu County, Kenya: A repeated cross-sectional study using aggregated registry data. PLoS Med 2024; 21:e1004441. [PMID: 39146355 DOI: 10.1371/journal.pmed.1004441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 07/10/2024] [Indexed: 08/17/2024] Open
Abstract
BACKGROUND Following a decline in perinatal HIV transmission from 20% to 10% between 2010 and 2017 in Kenya, rates have since plateaued with an estimated 8% transmission rate in 2021. Between October 2016 and September 2021, Family AIDS Care & Education Services (FACES) supported HIV care and treatment services across 61 facilities in Kisumu County, Kenya with an emphasis on service strengthening for pregnant and postpartum women living with HIV to reduce perinatal HIV transmission. This included rigorous implementation of national HIV guidelines and implementation of 3 locally adapted evidence-based interventions targeted to the unique needs of women and their infants. We examined whether these person-centered program enhancements were associated with changes in perinatal HIV transmission at FACES-supported sites over time. METHODS AND FINDINGS We conducted a repeated cross-sectional study of annually aggregated routinely collected documentation of perinatal HIV transmission risk through the end of breastfeeding at FACES-supported facilities between October 2016 and September 2021. Data included 12,599 women living with HIV with baseline antenatal care metrics, and, a separate data set of 11,879 mother-infant pairs who were followed from birth through the end of breastfeeding (overlapping with those in antenatal care 2 years prior). FACES implemented 3 interventions for pregnant and postpartum women living with HIV in 2019: (1) high-risk clinics; (2) case management; and (3) a mobile app to support treatment engagement. Our primary outcome was infant HIV acquisition by the end of breastfeeding (18 to 24 months). We compared infant HIV acquisition risk in the final year of the FACES program (2021) to the year before intervention scale-up and following implementation of the "Treat All" policy (2018). Mother-infant pair loss to follow-up was a secondary outcome. Program data were aggregated by year and site, thus in multivariable regression, we adjusted for site-level characteristics, including facility type, urban versus rural, number of women with HIV in antenatal care each year, and the proportion among them under 25 years of age. Between October 2016 and September 2021, 81,172 pregnant women received HIV testing at the initiation of antenatal care, among whom 12,599 (15.5%) were living with HIV, with little variation in HIV prevalence over time. The risk of infant HIV acquisition by 24 months of age declined from 4.9% (101/2,072) in 2018 to 2.2% (48/2,156) in 2021 (adjusted risk difference -2.6% [95% confidence interval (CI): -3.7, -1.6]; p < 0.001). Loss to follow-up declined from 9.9% (253/2,556) in 2018 to 2.5% (59/2,393) in 2021 (risk difference -7.5% [95% CI: -8.8, -6.2]; p < 0.001). During the same period, UNAIDS estimated rates of perinatal transmission in the broader Nyanza region and in Kenya as a whole did not decline. The main limitation of this study is that we lacked a comparable control group. CONCLUSIONS These findings suggest that implementation of person-centered interventions was associated with significant declines in perinatal HIV transmission and loss to follow-up of pregnant and postpartum women.
Collapse
Affiliation(s)
- Francesca Odhiambo
- Centre for Microbiology Research, Research Care and Training Program, Kenya Medical Research Institute, Nairobi, Kenya
| | - Raphael Onyango
- Centre for Microbiology Research, Research Care and Training Program, Kenya Medical Research Institute, Nairobi, Kenya
| | - Edwin Mulwa
- Centre for Microbiology Research, Research Care and Training Program, Kenya Medical Research Institute, Nairobi, Kenya
| | - Maurice Aluda
- Centre for Microbiology Research, Research Care and Training Program, Kenya Medical Research Institute, Nairobi, Kenya
| | - Linda Otieno
- Centre for Microbiology Research, Research Care and Training Program, Kenya Medical Research Institute, Nairobi, Kenya
| | - Elizabeth A Bukusi
- Centre for Microbiology Research, Research Care and Training Program, Kenya Medical Research Institute, Nairobi, Kenya
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California, United States of America
| | - Craig R Cohen
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California, United States of America
- Bixby Center for Global Reproductive Health, University of California San Francisco, San Francisco, California, United States of America
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, United States of America
| | - Pamela M Murnane
- Bixby Center for Global Reproductive Health, University of California San Francisco, San Francisco, California, United States of America
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, United States of America
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America
| |
Collapse
|
2
|
Bakoyannis G, Elul B, Wools-Kaloustian KK, Brown S, Semeere A, Castelnuovo B, Diero L, Nakigozi G, Lyamuya R, Yiannoutsos CT. Modeling the HIV Cascade of Care Using Routinely Collected Clinical Data to Guide Programmatic Interventions and Policy Decisions. J Acquir Immune Defic Syndr 2024; 96:223-230. [PMID: 38905474 DOI: 10.1097/qai.0000000000003413] [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: 03/22/2023] [Accepted: 07/05/2023] [Indexed: 06/23/2024]
Abstract
BACKGROUND The HIV care cascade is a framework to examine effectiveness of HIV programs and progress toward global targets to end the epidemic but has been conceptualized as a unidirectional process that ignores cyclical care patterns. We present a dynamic cascade that accounts for patient "churn" and apply novel analytic techniques to readily available clinical data to robustly estimate program outcomes and efficiently assess progress toward global targets. METHODS Data were assessed for 35,649 people living with HIV and receiving care at 78 clinics in East Africa between 2014 and 2020. Patients were aged ≥15 years and had ≥1 viral load measurements. We used multi-state models to estimate the probability of being in 1 of 5 states of a dynamic HIV cascade: (1) in HIV care but not on antiretroviral therapy (ART), (2) on ART, (3) virally suppressed, (4) in a gap-in-care, and (5) deceased and compared these among subgroups. To assess progress toward global targets, we summed those probabilities across patients and generated population-level proportions of patients on ART and virally suppressed in mid-2020. RESULTS One year after enrollment, 2.8% of patients had not initiated ART, 86.7% were receiving ART, 57.4% were virally suppressed, 10.2% were disengaged from care, and 0.3% had died. At 5 years, the proportion on ART remained steady but viral suppression increased to 77.2%. Of those aged 15-25, >20% had disengaged from care and <60% were virally suppressed. In mid-2020, 90.1% of the cohort was on ART, 90.7% of whom had suppressed virus. CONCLUSIONS Novel analytic approaches can characterize patient movement through a dynamic HIV cascade and, importantly, by capitalizing on readily available data from clinical cohorts, offer an efficient approach to estimate population-level proportions of patients on ART and virally suppressed. Significant progress toward global targets was observed in our cohort but challenges remain among younger patients.
Collapse
Affiliation(s)
| | - Batya Elul
- Mailman School of Public Health, Columbia University, New York, NY
| | | | - Steven Brown
- Indiana University School of Medicine, Indianapolis, IN
| | - Aggrey Semeere
- Infectious Disease Institutes, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Barbara Castelnuovo
- Infectious Disease Institutes, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Lameck Diero
- Department of Medicine, Moi University School of Medicine, Eldoret, Kenya
| | | | | | | |
Collapse
|
3
|
Toska E, Zhou S, Laurenzi CA, Saal W, Rudgard W, Wittesaele C, Langwenya N, Jochim J, Banougnin BH, Gulaid L, Armstrong A, Sherman G, Edun O, Sherr L, Cluver L. Healthcare provisions associated with multiple HIV-related outcomes among adolescent girls and young women living with HIV in South Africa: a cross-sectional study. J Int AIDS Soc 2024; 27:e26212. [PMID: 38332518 PMCID: PMC10853575 DOI: 10.1002/jia2.26212] [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] [Received: 04/02/2023] [Accepted: 01/16/2024] [Indexed: 02/10/2024] Open
Abstract
INTRODUCTION Adolescent girls and young women (AGYW) living with HIV experience poor HIV outcomes and high rates of unintended pregnancy. Little is known about which healthcare provisions can optimize their HIV-related outcomes, particularly among AGYW mothers. METHODS Eligible 12- to 24-year-old AGYW living with HIV from 61 health facilities in a South African district completed a survey in 2018-2019 (90% recruited). Analysing surveys and medical records from n = 774 participants, we investigated associations of multiple HIV-related outcomes (past-week adherence, consistent clinic attendance, uninterrupted treatment, no tuberculosis [TB] and viral suppression) with seven healthcare provisions: no antiretroviral therapy (ART) stockouts, kind and respectful providers, support groups, short travel time, short waiting time, confidentiality, and safe and affordable facilities. Further, we compared HIV-related outcomes and healthcare provisions between mothers (n = 336) and nulliparous participants (n = 438). Analyses used multivariable regression models, accounting for multiple outcomes. RESULTS HIV-related outcomes were poor, especially among mothers. In multivariable analyses, two healthcare provisions were "accelerators," associated with multiple improved outcomes, with similar results among mothers. Safe and affordable facilities, and kind and respectful staff were associated with higher predicted probabilities of HIV-related outcomes (p<0.001): past-week adherence (62% when neither accelerator was reported to 87% with both accelerators reported), clinic attendance (71%-89%), uninterrupted ART treatment (57%-85%), no TB symptoms (49%-70%) and viral suppression (60%-77%). CONCLUSIONS Accessible and adolescent-responsive healthcare is critical to improving HIV-related outcomes, reducing morbidity, mortality and onward HIV transmission among AGYW. Combining these provisions can maximize benefits, especially for AGYW mothers.
Collapse
Affiliation(s)
- Elona Toska
- Centre for Social Science ResearchUniversity of Cape TownCape TownSouth Africa
- Department of Social Policy and InterventionUniversity of OxfordOxfordUK
| | - Siyanai Zhou
- Centre for Social Science ResearchUniversity of Cape TownCape TownSouth Africa
- Division of Social and Behavioural SciencesFaculty of Health SciencesUniversity of Cape TownCape TownSouth Africa
| | - Christina A. Laurenzi
- Institute for Life Course Health ResearchDepartment of Global HealthFaculty of Medicine and Health SciencesStellenbosch UniversityCape TownSouth Africa
| | - Wylene Saal
- Centre for Social Science ResearchUniversity of Cape TownCape TownSouth Africa
| | - William Rudgard
- Department of Social Policy and InterventionUniversity of OxfordOxfordUK
| | - Camille Wittesaele
- Department of Infectious Disease EpidemiologyLondon School of Hygiene & Tropical MedicineLondonUK
| | | | - Janina Jochim
- Department of Social Policy and InterventionUniversity of OxfordOxfordUK
| | | | - Laurie Gulaid
- UNICEF Eastern and Southern Africa Office (UNICEF‐ESARO)NairobiKenya
| | - Alice Armstrong
- UNICEF Eastern and Southern Africa Office (UNICEF‐ESARO)NairobiKenya
| | - Gayle Sherman
- National Institute for Communicable DiseasesJohannesburgSouth Africa
- Department of Paediatrics and Child HealthFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Olanrewaju Edun
- MRC Centre for Global Infectious Disease AnalysisSchool of Public HealthImperial College LondonLondonUK
| | - Lorraine Sherr
- Institute for Global HealthUniversity College LondonLondonUK
| | - Lucie Cluver
- Division of Social and Behavioural SciencesFaculty of Health SciencesUniversity of Cape TownCape TownSouth Africa
- Department of Psychiatry and Mental HealthUniversity of Cape TownCape TownSouth Africa
| |
Collapse
|
4
|
Osmundo Junior GDS, Cabar FR, Peres SV, Waissman AL, Galletta MAK, Francisco RPV. Adverse Perinatal Outcomes among Adolescent Pregnant Women Living with HIV: A Propensity-Score-Matched Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20085447. [PMID: 37107729 PMCID: PMC10138774 DOI: 10.3390/ijerph20085447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 03/03/2023] [Accepted: 04/04/2023] [Indexed: 05/11/2023]
Abstract
HIV infection and adolescent pregnancy are known to increase the risk of adverse perinatal outcomes. However, data are limited concerning the outcomes of pregnancies among adolescent girls living with HIV. This retrospective propensity-score matched study aimed to compare adverse perinatal outcomes in adolescent pregnant women living with HIV (APW-HIV-positive) with HIV-negative adolescent pregnant women (APW-HIV-negative) and adult pregnant women with HIV (PW-HIV). APW-HIV-positive were propensity-score matched with APW-HIV-negative and PW-HIV. The primary endpoint was a composite endpoint of adverse perinatal outcomes, comprising preterm birth and low birth weight. There were 15 APW-HIV-positive and 45 women in each control group. The APW-HIV-positive were aged 16 (13-17) years and had had HIV for 15.5 (4-17) years, with 86.7% having perinatally acquired HIV. The APW-HIV-positive had higher rates of perinatally acquired HIV infection (86.7 vs. 24.4%, p < 0.001), a longer HIV infection time (p = 0.021), and longer exposure to antiretroviral therapy (p = 0.034) compared with the PW-HIV controls. The APW-HIV-positive had an almost five-fold increased risk of adverse perinatal outcomes compared with healthy controls (42.9% vs. 13.3%, p = 0.026; OR 4.9, 95% CI 1.2-19.1). The APW-HIV-positive and APW-HIV-negative groups had similar perinatal outcomes.
Collapse
Affiliation(s)
- Gilmar de Souza Osmundo Junior
- Disciplina de Obstetricia, Departamento de Obstetricia e Ginecologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo 05403-000, Brazil
- Correspondence: ; Tel.: +55-11-2661-6209
| | - Fábio Roberto Cabar
- Disciplina de Obstetricia, Departamento de Obstetricia e Ginecologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo 05403-000, Brazil
| | - Stela Verzinhasse Peres
- Divisao de Clinica Obstetrica, Hospital das Clinicas HCMFUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 05403-000, Brazil
| | - Adriana Lippi Waissman
- Divisao de Clinica Obstetrica, Hospital das Clinicas HCMFUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 05403-000, Brazil
| | - Marco Aurélio Knippel Galletta
- Disciplina de Obstetricia, Departamento de Obstetricia e Ginecologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo 05403-000, Brazil
| | - Rossana Pulcineli Vieira Francisco
- Disciplina de Obstetricia, Departamento de Obstetricia e Ginecologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo 05403-000, Brazil
| |
Collapse
|
5
|
Li M, Wang Q. Predicting the loss to follow-up (LTFU) of HIV/AIDS patients in China using a recency-frequency (RF) model. HIV Med 2023; 24:82-92. [PMID: 35758518 DOI: 10.1111/hiv.13324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 05/04/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND We constructed a recency-frequency (RF) model for predicting the loss to follow-up (LTFU) in HIV/AIDS patients in China. METHODS Data on HIV/AIDS outpatients in the research unit from 1 August 2009 to 30 September 2020 and from 1 October to 31 December 2020 were exported as the observation and prediction datasets, respectively. The classic recency-frequency-monetary (RFM) model was expanded into RFm, RF, RFL and RFmL models. In the observation dataset, the best predictive model was obtained using k-means clustering and C5.0 verification. Then, two rounds of k-means modelling were performed on the best model: data with R ≤ 6 months were retained, randomly divided into a training set (70%) and a testing set (30%) and used to perform the second round of modelling to subdivide the churn and non-churn patients. Next, an ANN algorithm was used to predict LTFU, and the confusion matrix with prediction datasets was constructed. RESULTS The observation and prediction datasets included 16 949 and 10 748 samples, respectively. The RF model with three clusters and a quality of 0.82 was the best predictive model. From the observation set, 13 799 samples were retained, and the model accuracy was 100% on the training and testing sets. These 13 799 samples were subdivided into 1563 samples of churn patients and 12 216 samples of non-churn patients. The accuracy of ANN prediction was 99.89%. The accuracy and precision of the confusion matrix were 85.41% and 99.76%, respectively. CONCLUSION The RF model is effective in predicting the LTFU of HIV/AIDS patients in China and preventing its occurrence.
Collapse
Affiliation(s)
- Min Li
- College of Economics and Management, Nanjing University of Aeronautics and Astronautics, Nanjing, China.,Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Qunwei Wang
- College of Economics and Management, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| |
Collapse
|
6
|
Laurenzi C, Ronan A, Phillips L, Nalugo S, Mupakile E, Operario D, Toska E. Enhancing a peer supporter intervention for young mothers living with HIV in Malawi, Tanzania, Uganda, and Zambia: Adaptation and co-development of a psychosocial component. Glob Public Health 2023; 18:2081711. [PMID: 35634944 PMCID: PMC9705607 DOI: 10.1080/17441692.2022.2081711] [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] [Received: 09/13/2021] [Accepted: 05/03/2022] [Indexed: 11/04/2022]
Abstract
ABSTRACTYoung mothers living with HIV (YMHIV) experience heightened risks to their mental health, as their transition to adulthood is marked by social stigma, health and socioeconomic challenges. Targeted psychosocial interventions may improve the mental health of YMHIV; however, no evidence-based interventions have been developed for this group. Peer support models, more common for youth living with HIV, show promise as a design to reach YMHIV in a non-stigmatising way. This manuscript describes the process of adapting and co-developing an evidence-based psychosocial component (Boost) of a larger intervention called Ask-Boost-Connect-Discuss. Peer supporters in Malawi, Tanzania, Uganda, and Zambia used ABCD to guide group sessions with YMHIV. The research team partnered with an implementing partner, Paediatric-Adolescent Treatment Africa, to undertake this work in three phases: 1) formative research, 2) content adaptation and development, and 3) consultation, refinement, and modification. YMHIV (n = 4), peer supporters (n = 21), and technical advisors (n = 4) were engaged as co-developers, shaping the resulting Boost intervention component at each phase. Peer support models may effectively reach young mothers, and consultation, co-creation, and integration with existing programming can offer rich insights to inform these models. We discuss the implications and promise of this approach.
Collapse
Affiliation(s)
- Christina Laurenzi
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Tygerberg, South Africa
| | - Agnes Ronan
- Paediatric Adolescent Treatment Africa, Cape Town, South Africa
| | - Lynn Phillips
- Paediatric Adolescent Treatment Africa, Cape Town, South Africa
| | - Sharifah Nalugo
- Paediatric Adolescent Treatment Africa, Cape Town, South Africa
| | - Eugene Mupakile
- Paediatric Adolescent Treatment Africa, Cape Town, South Africa
| | - Don Operario
- Department of Behavior and Social Sciences, School of Public Health, Brown University, Providence, RI, USA
| | - Elona Toska
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
- Department of Sociology, University of Cape Town, Cape Town, South Africa
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| |
Collapse
|
7
|
Okonji EF, Wyk BV, Mukumbang FC. Two-year retention in care for adolescents on antiretroviral therapy in Ehlanzeni district, South Africa: a baseline cohort analysis. AIDS Care 2022; 35:374-384. [PMID: 35357245 DOI: 10.1080/09540121.2022.2057409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Adolescents living with HIV (ALHIV) struggle to remain engaged in HIV-related care and adhere to antiretroviral treatment (ART) due to a myriad of physical, psychological and cognitive-developmental challenges. We report on the profile of ALHIV aged 10-19 years on ART and the clinical factors associated with their retention in care. A retrospective cohort analysis was conducted with 16,108 ALHIV, aged 10-19 years, who were enrolled in 136 ART clinics in the Ehlanzeni district. Anonymised data were obtained from electronic medical records (Tier.net). Trends in retention in care among adolescents on ART was described using Kaplan-Meier survival estimates. Cox proportional analysis was performed to identify factors associated with retention in care over 2 years. More than half (53%) were females, and median duration on ART was 8 months. Retention in care among adolescents at months 6, 12, 18 and 24 was 90.5%, 85.4%, 80.8% and 76.2%, respectively. After controlling for confounders, risk of dying or lost to follow up increased for female adolescents (aHR = 1.28, 95% CI 1.10-1.49); being initiated on ART while pregnant (aHR = 2.72, 95% CI 1.99-3.69); history of TB infection (aHR = 1.71, 95% CI 1.10-2.65); and started ART at age 10-14 years (aHR = 2.45, 95% CI 1.96-3.05), and 15-19 years (aHR = 9.67, 95% CI 7.25-12.89). Retention in care among adolescents on ART over two-year period was considerably lower than the UNAIDS 2030 target of 95%. Of particular concern for intervention is the lower rates of retention in care among females and pregnant adolescents and starting ART between the ages of 10 and 19 years. Family or caregivers and peer support groups centred interventions designed to promote early initiation and retention in care through early case identification are needed.
Collapse
Affiliation(s)
- Emeka F Okonji
- School of Public Health, Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
| | - Brian Van Wyk
- School of Public Health, Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
| | - Ferdinand C Mukumbang
- School of Public Health, Community and Health Sciences, University of the Western Cape, Cape Town, South Africa.,Department of global Health, School of Medicine, University of Washington, Seattle, WA, USA
| |
Collapse
|
8
|
Myers C, Apondi E, Toromo JJ, Omollo M, Bakari S, Aluoch J, Sang F, Njoroge T, Morris Z, Kantor R, Braitstein P, Nyandiko WM, Wools-Kaloustian K, Elul B, Vreeman RC, Enane LA. "Who am I going to stay with? Who will accept me?": family-level domains influencing HIV care engagement among disengaged adolescents in Kenya. J Int AIDS Soc 2022; 25:e25890. [PMID: 35192747 PMCID: PMC8863355 DOI: 10.1002/jia2.25890] [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: 08/27/2021] [Accepted: 02/01/2022] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Adolescents living with HIV (ALHIV, ages 10-19) have developmentally specific needs in care, and have lower retention compared to other age groups. Family-level contexts may be critical to adolescent HIV outcomes, but have often been overlooked. We investigated family-level factors underlying disengagement and supporting re-engagement among adolescents disengaged from HIV care. METHODS Semi-structured interviews were performed with 42 disengaged ALHIV, 32 of their caregivers and 28 healthcare workers (HCW) in the Academic Model Providing Access to Healthcare (AMPATH) program in western Kenya, from 2018 to 2020. Disengaged ALHIV had ≥1 visit within the 18 months prior to data collection at one of two sites and nonattendance ≥60 days following their last scheduled appointment. HCW were recruited from 10 clinics. Transcripts were analysed through thematic analysis. A conceptual model for family-level domains influencing adolescent HIV care engagement was developed from these themes. RESULTS Family-level factors emerged as central to disengagement. ALHIV-particularly those orphaned by the loss of one or both parents-experienced challenges when new caregivers or unstable living situations limited support for HIV care. These challenges were compounded by anticipated stigma; resultant non-disclosure of HIV status to household members; enacted stigma in the household, with overwhelming effects on adolescents; or experiences of multiple forms of trauma, which undermined HIV care engagement. Some caregivers lacked finances or social support to facilitate care. Others did not feel equipped to support adolescent engagement or adherence. Regarding facilitators to re-engagement, participants described roles for household disclosure; and solidarity from caregivers, especially those also living with HIV. Family-level domains influencing HIV care engagement were conceptualized as follows: (1) adolescent living situation and contexts; (2) household material resources or poverty; (3) caregiver capacities and skills to support adolescent HIV care; and (4) HIV stigma or solidarity at the household level. CONCLUSIONS Family-level factors are integral to retention in care for ALHIV. The conceptual model developed in this study for family-level influences on care engagement may inform holistic approaches to promote healthy outcomes for ALHIV. Developmentally appropriate interventions targeting household relationships, disclosure, HIV stigma reduction, HIV care skills and resources, and economic empowerment may promote adolescent engagement in HIV care.
Collapse
Affiliation(s)
- Courtney Myers
- Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Edith Apondi
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Judith J Toromo
- The Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Mark Omollo
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Salim Bakari
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Josephine Aluoch
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Festus Sang
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Tabitha Njoroge
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Zariel Morris
- Indiana University-Purdue University-Indianapolis, Indiana University, Indianapolis, Indiana, USA
| | - Rami Kantor
- Division of Infectious Diseases, Department of Medicine, Brown University Apert Medical School, Providence, Rhode Island, USA
| | - Paula Braitstein
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Department of Epidemiology, Indiana University Fairbanks School of Public Health, Indianapolis, Indiana, USA.,Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Winstone M Nyandiko
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Department of Child Health and Pediatrics, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Kara Wools-Kaloustian
- Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.,Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Indiana University Center for Global Health, Indianapolis, Indiana, USA
| | - Batya Elul
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Rachel C Vreeman
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Department of Child Health and Pediatrics, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya.,Department of Health System Design and Global Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Arnhold Institute for Global Health, New York, New York, USA
| | - Leslie A Enane
- The Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA.,Indiana University Center for Global Health, Indianapolis, Indiana, USA
| |
Collapse
|
9
|
Nyakato P, Schomaker M, Fatti G, Tanser F, Euvrard J, Sipambo N, Fox MP, Haas AD, Yiannoutsos CT, Davies MA, Cornell M. Virologic non-suppression and early loss to follow up among pregnant and non-pregnant adolescents aged 15-19 years initiating antiretroviral therapy in South Africa: a retrospective cohort study. J Int AIDS Soc 2022; 25:e25870. [PMID: 35032096 PMCID: PMC8760609 DOI: 10.1002/jia2.25870] [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: 07/13/2021] [Accepted: 12/20/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction Older adolescents aged 15–19 years continue to have high rates of loss to follow up (LTFU), and high rates of virologic non‐suppression (VNS) compared to younger adolescents and adults. Adolescent females are at risk of pregnancy, which puts those living with HIV at a dual vulnerability. Our study assessed the factors associated with VNS and LTFU in older adolescents (including pregnant females) who initiated antiretroviral therapy (ART) in South Africa. Methods We included adolescents aged 15–19 years initiating ART between 2004 and 2019, with ≥ one viral load (VL) measurement between 4 and 24.5 months, and ≥ 6 months follow‐up, from six South African cohorts of the International epidemiology Databases to Evaluate AIDS‐Southern Africa (IeDEA‐SA). We defined VNS as VL ≥400 copies/ml and LTFU as not being in care for ≥180 days from ART start and not known as transferred out of the clinic or dead in the first 24 months on ART. We examined factors associated with VNS and LTFU using Fine&Gray competing risk models. Results We included a total of 2733 adolescents, 415 (15.2%) males, median (IQR) age at ART start of 18.6 (17.3, 19.4) years. Among females, 585/2318 (25.2%) were pregnant. Over the 24‐month follow‐up, 424 (15.5%) of all adolescents experienced VNS: range (11.1% pregnant females and 20.5% males). Over half of all adolescents were LTFU before any other event could occur. The hazard of VNS reduced with increasing age and CD4 count above 200 cells/μl at ART initiation among all adolescents having adjusted for all measured patient characteristics [adjusted sub‐distribution hazard ratio (aSHR) 19 vs. 15 years: 0.50 (95% CI: 0.36, 0.68), aSHR: >500 vs. ≤200 cells/μl: 0.22 (95% CI: 0.16, 0.31)]. The effect of CD4 count persisted in pregnant females. Increasing age and CD4 count >200 cells/μl were risk factors for LTFU among all adolescents. Conclusions Older adolescents had a high risk of LTFU shortly after ART start and a low risk of VNS, especially those initiating treatment during pregnancy. Interventions addressing adherence and retention should be incorporated into adolescent‐friendly services to prevent VNS and LTFU and endeavour to trace lost adolescents as soon as they are identified.
Collapse
Affiliation(s)
- Patience Nyakato
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Michael Schomaker
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.,Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Tyrol, Austria
| | - Geoffrey Fatti
- Kheth'Impilo AIDS-Free Living, Cape Town, South Africa.,Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Frank Tanser
- Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, South Africa
| | - Jonathan Euvrard
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.,Khayelitsha ART Programme and Medecins Sans Frontieres, Cape Town, South Africa
| | - Nosisa Sipambo
- Harriet Shezi Children's Clinic, Chris Hani Baragwanath Academic Hospital, Soweto, South Africa
| | - Matthew P Fox
- Department of Epidemiology, Boston University School of Public Health, Boston University, Boston, Massachusetts, USA.,Health Economics & Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Andreas D Haas
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Constantin T Yiannoutsos
- Department of Biostatistics, R.M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA
| | - Mary-Ann Davies
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Morna Cornell
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
10
|
Falcão J, Zerbe A, Mellins CA, Mantell J, Brittain K, Kapogiannis B, de Gusmao EP, Simione TB, Abrams EJ. The secret life of young adolescents living with HIV in northern Mozambique - a mixed methods study. BMC Public Health 2021; 21:1650. [PMID: 34503473 PMCID: PMC8431874 DOI: 10.1186/s12889-021-11707-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 08/29/2021] [Indexed: 11/24/2022] Open
Abstract
Background In Mozambique, HIV infection remains a leading cause of adolescent mortality. With advances in antiretroviral treatment (ART), the population of adolescents living with vertically-acquired HIV is growing. Most studies of adolescents living with HIV (ALHIV) focus on older youth with horizontal infection. As part of a larger study, we examined the characteristics and health care needs of younger ALHIV, including those with vertically-acquired infection to inform preventive interventions. Methods We used a convergent mixed-methods design and recruited ALHIV aged 12–14 years who were enrolled in HIV care in three health clinics in Nampula, Mozambique. From 11/2019–3/2020, we conducted 61 quantitative surveys and 14 in-depth interviews with a purposively selected subset of ALHIV who were aware of their HIV status. Descriptive statistical analysis was conducted for quantitative data. Qualitative data were transcribed and analyzed using thematic analysis. Results The median age of ALHIV was 13 years, 50% were female, 67% lived with ≥1 parent, 70% had lost a parent, 100% were in school; 10% were in a relationship, and 3% had initiated sexual activity. Among 31 ALHIV aware of their serostatus, the median age of antiretroviral treatment (ART) initiation was 8 years (IQR: 6–11); 55% received caregiver support for ART management; 35% reported missing ≥1 ART dose in the last 30 days; 6% had disclosed their HIV-status to friends and 48% reported no one to talk to about HIV-specific issues. Four main themes emerged from the qualitative interviews with ALHIV: a) learning one’s HIV-positive status as the beginning of a secret life; b) importance of caregivers’ support for ART management; c) high value of ALHIV peer support to overcome isolation, increase HIV literacy, and support adherence; and d) unmet needs for sexual and reproductive health education. Conclusion HIV-related secrecy prevails among ALHIV, a situation exacerbated by caregivers and healthcare providers. Caregivers play a major role in supporting adherence among young ALHIV, yet ALHIV could also benefit from adolescent-friendly services, including peer support, sexual and reproductive health services and preparation for independent health management. Integrating such programs into ART services in Mozambique may be critical to promoting ALHIV health.
Collapse
Affiliation(s)
- Joana Falcão
- ICAP at Columbia University, Mailman School of Public Health, New York, USA.
| | - Allison Zerbe
- ICAP at Columbia University, Mailman School of Public Health, New York, USA
| | - Claude Ann Mellins
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Joanne Mantell
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Kirsty Brittain
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Bill Kapogiannis
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | | | | | - Elaine J Abrams
- ICAP at Columbia University, Mailman School of Public Health, New York, USA
| |
Collapse
|
11
|
Ahonkhai AA, Aliyu MH, Audet CM, Bravo M, Simmons M, Claquin G, Memiah P, Fernando AN, Carlucci JG, Shepherd BE, Van Rompaey S, Yu Z, Gong W, Vermund SH, Wester CW. Poor retention and care-related sex disparities among youth living with HIV in rural Mozambique. PLoS One 2021; 16:e0250921. [PMID: 34019582 PMCID: PMC8139489 DOI: 10.1371/journal.pone.0250921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 04/16/2021] [Indexed: 11/18/2022] Open
Abstract
Background There are few studies that characterize sex-related differences in HIV outcomes among adolescents and young adults (AYA) 15–24 years of age. Methods We conducted a retrospective cohort study among AYA who enrolled in a comprehensive HIV program in Mozambique between 2012–2016. We assessed patients by sex and pregnancy/lactation status, comparing time to combination antiretroviral therapy (ART) initiation using Cox proportional hazard models. We employed multivariable logistic regression to investigate pre- and post-ART retention. Patients were defined as ‘retained pre-ART’ if they attended at least 3 of 4 required visits or started ART in the 6 months after enrollment, and ‘retained post-ART’ if they had any ART pickup or clinical visit during the last 90 days of the one-year follow-up period. Results Of 47,702 patients in the cohort, 81% (n = 38,511) were female and 19% (n = 9,191) were male. Of the females, 57% (n = 21,770) were non-pregnant and non-lactating (NPNL) and 43% (n = 16,741) were pregnant or lactating (PL). PL (aHR 2.64, 95%CI:2.47–2.81) and NPNL females (aHR 1.36, 95%CI:1.30–1.42) were more likely to initiate ART than males. PL females had higher odds of pre-ART retention in care (aOR 3.56, 95%CI: 3.30–3.84), as did NPNL females (aOR 1.71, 95%CI: 1.62–1.81), compared to males. This was also true for retention post-ART initiation, with higher odds for both PL (aOR 1.78, 95%CI:1.63–1.94) and NPNL females (aOR 1.50, 95%CI:1.35–1.65) compared to males. Conclusions PL females were most likely to initiate ART and remain in care post-ART in this AYA cohort, likely reflecting expansion of Option B+. Despite pregnancy and policy driven factors, we observed important sex-related disparities in this cohort. NPNL females were more likely to initiate ART and be retained in care before and after ART initiation than males. These data suggest that young males need targeted interventions to improve these important care continuum outcomes.
Collapse
Affiliation(s)
- Aima A. Ahonkhai
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- * E-mail:
| | - Muktar H. Aliyu
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Carolyn M. Audet
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Friends in Global Health (FGH), Maputo, Mozambique
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Melynda Simmons
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Gael Claquin
- Friends in Global Health (FGH), Maputo, Mozambique
| | - Peter Memiah
- Division of Epidemiology and Prevention, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | | | - James G. Carlucci
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Division of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Bryan E. Shepherd
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | | | - Zhihong Yu
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | - Wu Gong
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | - Sten H. Vermund
- Yale School of Public Health, Yale University, New Haven, Connecticut, United States of America
| | - C. William Wester
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| |
Collapse
|
12
|
Njah J, Chiasson MA, Reidy W. Known HIV status among adolescent women attending antenatal care services in Eswatini, Ethiopia and Mozambique. Reprod Health 2021; 18:90. [PMID: 33941205 PMCID: PMC8091526 DOI: 10.1186/s12978-021-01090-2] [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] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 01/27/2021] [Indexed: 11/23/2022] Open
Abstract
Background Antenatal care (ANC) clinics remain important entry points to HIV care for pregnant women living with HIV—including adolescents. Prior knowledge of their HIV status at ANC enrollment is crucial to providing services for prevention of mother-to-child transmission (PMTCT) of HIV. We examined known HIV status of pregnant adolescents and women in other age groups at ANC enrollment. Methods A descriptive study of routinely reported PMTCT data from 419 facilities in Eswatini, Ethiopia, and Mozambique, from January through December 2018 was conducted. We assessed knowledge of HIV status by country for three age groups: adolescents aged 15–19 years, young women aged 20–24 years, and older women aged 25–49 years. We report HIV prevalence and proportions of known and newly diagnosed HIV infections in women, by age group and country. The data were summarized by frequencies and proportions, including their 95% confidence intervals. Results Among the facilities examined, 52 (12.4%) were in Eswatini, 63 (15.0%) in Ethiopia, and 304 (72.6%) in Mozambique. Across three countries, 488,121 women attended a first ANC visit and 23,917 (4.9%) were HIV-positive. Adolescents constituted 22% of all ANC attendees, whereas young and older women represented 33% and 45%, respectively. HIV prevalence was lowest among adolescents than in other age groups in Eswatini (adolescents 11.9%, young 24.2% and older 47.3%), but comparable to young women in Ethiopia (adolescents 1.6%, young 1.6% and older 2.2%) and Mozambique (adolescents 2.5%, young 2.5% and older 5.8%), However, in each of the three countries, lower proportions of adolescents knew their HIV-positive status before ANC enrollment compared to other age groups: in Eswatini (adolescents 51.3%, young 59.9% and older 79.2%), in Ethiopia (adolescents 42.9%, young 63.7% and older 75.2%), and in Mozambique (adolescents 16.4%, young 33.2% and older 45.6%). Conclusion Overall, adolescents made up nearly one-quarter of the women examined and had the least knowledge of their HIV status at ANC enrollment. Their HIV prevalence and known HIV-positive status varied widely across the countries examined. Adolescent-friendly sexual and reproductive health, and PMTCT services, before pregnancy, are needed to improve knowledge of HIV status and support pregnant adolescents and their infants. Plain English summary Antenatal care (ANC) clinics are important for HIV testing of pregnant adolescents, who may not know their HIV-positive status at the first ANC visit. We describe data on pregnant adolescents and women in other age groups in ANC services to examine their prior HIV status at ANC enrollment across three African countries. We examined data from 419 PMTCT sites in Eswatini, Ethiopia, and Mozambique from January-December 2018, to evaluate HIV testing results for adolescents, young and older women aged 15–19, 20–24 and 25–49 years, respectively. We report the number of women living with HIV and the proportions of known and newly identified women living with HIV, by age-group and country. Across three countries, 488,121 women attended ANC and 23,917 (4.9%) were living with HIV. Adolescents constituted 22% of all ANC attendees, whereas young and older women represented 33% and 45%, respectively. HIV prevalence in each country compared to other age groups was lowest and varied among adolescents from 11.9% in Eswatini, to 1.6% in Ethiopia and to 2.5% in Mozambique. Also, fewer adolescents knew their HIV-positive status before ANC enrollment compared to young and older women from 51.3% in Eswatini, 42.9% in Ethiopia to only 16.4% in Mozambique. Pregnant adolescents made up nearly one-quarter of all ANC attendees; a majority of them had no previously known HIV-positive status. Adolescent-friendly, sexual and reproductive health services, before pregnancy and in PMTCT services, are needed to support pregnant adolescents and their infants. Supplementary Information The online version contains supplementary material available at 10.1186/s12978-021-01090-2.
Collapse
Affiliation(s)
- Joel Njah
- ICAP At Columbia University's Mailman School of Public Health, 722 W. 168th St., New York, NY, 10032, USA
| | - Mary Ann Chiasson
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.,Division of Infectious Diseases, Columbia University Irving Medical Center, New York, NY, USA
| | - William Reidy
- ICAP At Columbia University's Mailman School of Public Health, 722 W. 168th St., New York, NY, 10032, USA. .,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
| |
Collapse
|
13
|
Toska E, Cluver L, Laurenzi CA, Wittesaele C, Sherr L, Zhou S, Langwenya N. Reproductive aspirations, contraception use and dual protection among adolescent girls and young women: the effect of motherhood and HIV status. J Int AIDS Soc 2020; 23 Suppl 5:e25558. [PMID: 32869543 PMCID: PMC7459160 DOI: 10.1002/jia2.25558] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 05/12/2020] [Accepted: 06/03/2020] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION There is a growing interest in adolescent motherhood and HIV among policymakers and programme implementers. To better shape services and health outcomes, we need evidence on reproductive aspirations and contraception use in this high-risk group, including the effect of motherhood and HIV status. We report data from a large survey of adolescent girls and young women conducted in a mixed rural-urban district in South Africa. METHODS Quantitative interviews were conducted with 1712 adolescent girls and young women (ages 10 to 24): 336 adolescent mothers living with HIV (AMLHIV), 454 nulliparous adolescent girls living with HIV (ALHIV), 744 HIV-negative adolescent mothers (control adolescent mothers) and 178 HIV-negative nulliparous adolescent girls (nulliparous controls) in 2018 to 2019. Standardized questionnaires included socio-demographic measures, reproductive health and contraception experiences. Reproductive aspirations were measured as the number of children participants wanted to have. Dual protection was computed as use of both hormonal and barrier contraception or abstinence. Multivariate logistic regression and marginal effects models in STATA 15 were used to test associations between HIV status, adolescent motherhood and outcomes of reproductive aspirations, contraception use and dual protection, controlling for covariates. RESULTS AND DISCUSSION Nearly 95% of first pregnancies were unintended. Over two-thirds of all participants wanted two or more children. Hormonal contraception, condom use and dual protection were low across all groups. In multivariate regression modelling, ALHIV were less likely to report hormonal contraception use (aOR 0.55 95% CI 0.43 to 0.70 p ≤ 0.001). In marginal effects modelling, adolescent mothers - independent of HIV status - were least likely to report condom use at last sex. Despite higher probabilities of using hormonal contraception, rates of dual protection were low: 17.1% among control adolescent mothers and 12.4% among AMLHIV. Adolescent mothers had the highest probabilities of not using any contraceptive method: 29.0% among control mothers and 23.5% among AMLHIV. CONCLUSIONS Among adolescent girls and young women in HIV-endemic communities, reproductive aspirations and contraceptive practices affect HIV risk and infection. Tailored adolescent-responsive health services could help young women plan their pregnancies for when they are healthy and well-supported, and help interrupt the cycle of HIV transmission by supporting them to practice dual protection.
Collapse
Affiliation(s)
- Elona Toska
- Centre for Social Science ResearchUniversity of Cape TownCape TownSouth Africa
- Department of SociologyUniversity of Cape TownCape TownSouth Africa
- Department of Social Policy and InterventionUniversity of OxfordOxfordUnited Kingdom
| | - Lucie Cluver
- Department of Social Policy and InterventionUniversity of OxfordOxfordUnited Kingdom
- Department of Child and Adolescent PsychiatryUniversity of Cape TownCape TownSouth Africa
| | - Christina A Laurenzi
- Department of Global HealthInstitute for Life Course Health ResearchStellenbosch UniversityCape TownSouth Africa
| | - Camille Wittesaele
- Department of Social Policy and InterventionUniversity of OxfordOxfordUnited Kingdom
- Department of Infectious Disease EpidemiologyFaculty of Epidemiology and Population HealthLondon School of Hygiene & Tropical MedicineLondonUnited Kingdom
| | - Lorraine Sherr
- Institute for Global HealthUniversity College LondonLondonUnited Kingdom
| | - Siyanai Zhou
- Centre for Social Science ResearchUniversity of Cape TownCape TownSouth Africa
- Department of StatisticsUniversity of Cape TownCape TownSouth Africa
| | - Nontokozo Langwenya
- Centre for Social Science ResearchUniversity of Cape TownCape TownSouth Africa
- Oxford Research South AfricaEast LondonSouth Africa
| |
Collapse
|
14
|
van Wyk B, Kriel E, Mukumbang F. Retention in care for adolescents who were newly initiated on antiretroviral therapy in the Cape Metropole in South Africa. South Afr J HIV Med 2020. [DOI: 10.4102/sajhivmed.v21i1.1077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|
15
|
van Wyk B, Kriel E, Mukumbang F. Retention in care for adolescents who were newly initiated on antiretroviral therapy in the Cape Metropole in South Africa. South Afr J HIV Med 2020; 21:1077. [PMID: 32832112 PMCID: PMC7433256 DOI: 10.4102/hivmed.v21i1.1077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 05/23/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Long-term retention of adolescents aged 10 -19 years on antiretroviral therapy (ART) is crucial to achieve viral load suppression. However, it is reported globally that adolescents have lower retention in care (RiC) on ART, compared with children and adults. OBJECTIVES To determine the prevalence and predictors of RiC of adolescents over 2 years following initiation onto ART in public health facilities in the Metropole District Health Services of the Western Cape province in 2013. METHODS Data of 220 adolescent patients who were newly initiated on ART in 2013 were extracted from the provincial electronic database, and subjected to univariate and bivariate analyses using SPSS. RESULTS The rate of RiC post-initiation was low throughout the study period, that is, 68.6%, 50.5% and 36.4% at 4, 12 and 24 months, respectively. The corresponding post-initiation viral load suppression levels on ART of those remaining in care and who had viral loads monitored were 84.1%, 77.4% and 68.8% at 4, 12 and 24 months, respectively. Retention in care after initiation on ART was higher amongst younger adolescents (10-14 years), compared with older adolescents (15-19 years). Male adolescents were significantly more likely to be retained, compared with females. Pregnant adolescents were significantly less likely to be retained compared with those who were not pregnant. CONCLUSION Key interventions are needed to motivate adolescents to remain in care, and to adhere to their treatment regimen to achieve the target of 90% viral load suppression, with specific emphasis on older and pregnant adolescents.
Collapse
Affiliation(s)
- Brian van Wyk
- School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
| | - Ebrahim Kriel
- School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
| | - Ferdinand Mukumbang
- School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
| |
Collapse
|
16
|
Risk factors for loss to follow-up from antiretroviral therapy programmes in low-income and middle-income countries. AIDS 2020; 34:1261-1288. [PMID: 32287056 DOI: 10.1097/qad.0000000000002523] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Loss to follow-up (LTFU) rates from antiretroviral treatment (ART) programmes in low- and middle-income countries (LMIC) are high, leading to poor treatment outcomes and onward transmission of HIV. Knowledge of risk factors is required to address LTFU. In this systematic review, risk factors for LTFU are identified and meta-analyses performed. METHODS PubMed, Embase, Psycinfo and Cochrane were searched for studies that report on potential risk factors for LTFU in adults who initiated ART in LMICs. Meta-analysis was performed for risk factors evaluated by at least five studies. Pooled effect estimates and their 95% confidence intervals (95% CI) were calculated using random effect models with inverse variance weights. Risk of bias was assessed and sensitivity analyses performed. RESULTS Eighty studies were included describing a total of 1 605 320 patients of which 87.4% from sub-Saharan Africa. The following determinants were significantly associated with an increased risk of LTFU in meta-analysis: male sex, older age, being single, unemployment, lower educational status, advanced WHO stage, low weight, worse functional status, poor adherence, nondisclosure, not receiving cotrimoxazole prophylactic therapy when indicated, receiving care at secondary level and more recent year of initiation. No association was seen for CD4 cell count, tuberculosis at baseline, regimen, and geographical setting. CONCLUSION There are several sociodemographic, clinical, patient behaviour, treatment-related and system level risk factors for LTFU from ART programs. Knowledge of risk factors should be used to better target retention interventions and develop tools to identify high-risk patients.
Collapse
|
17
|
Toska E, Laurenzi CA, Roberts KJ, Cluver L, Sherr L. Adolescent mothers affected by HIV and their children: A scoping review of evidence and experiences from sub-Saharan Africa. Glob Public Health 2020; 15:1655-1673. [PMID: 32507031 DOI: 10.1080/17441692.2020.1775867] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
While adolescents have received increasing attention in the global HIV response and international strategies and commitments, adolescent mothers and their children remain largely overlooked in research, funding and, programming for health-related outcomes. We conducted an extensive scoping review of current evidence on the experiences of adolescent mothers affected by HIV and their children in this region. We included published literature and conference abstracts, complemented by consultations with key stakeholders, and a review of documents through grey literature searching. First, we summarise the experiences of adolescent mothers and their children related to HIV and key health and development indicators. The syndemic of early motherhood and HIV in sub-Saharan Africa increases the vulnerability of adolescent mothers and their children. We then highlight lessons from a series of promising programmes focused on supporting adolescent mothers through novel approaches. In sub-Saharan Africa, supporting adolescent mothers living in high HIV-risk communities is critical not only to eliminate HIV/AIDS, but also to attain the Sustainable Development Goals. While research on and programming for adolescent mothers and their children is growing, the complex needs for this vulnerable group remain unmet. We conclude with evidence gaps and programming priorities for adolescent mothers affected by HIV and their children.
Collapse
Affiliation(s)
- Elona Toska
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa.,Department of Social Policy and Intervention, University of Oxford, Oxford, UK.,Department of Sociology, University of Cape Town, Cape Town, South Africa
| | - Christina A Laurenzi
- Institute for Life Course Health Research, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | | | - Lucie Cluver
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK.,Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Lorraine Sherr
- Institute for Global Health, University College London, London, UK
| |
Collapse
|