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Gabre MK, Tafesse TB, Geleta LA, Asfaw CK, Delelegn HA. The effect of late presentation on HIV related mortality among adolescents in public hospitals of north showa zone Oromiya, Ethiopia; 2022: a retrospective cohort study. BMC Infect Dis 2024; 24:644. [PMID: 38926656 PMCID: PMC11209987 DOI: 10.1186/s12879-024-09550-3] [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: 12/03/2023] [Accepted: 06/21/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Late human immunodeficiency virus (HIV) diagnosis is the most prominent cause of HIV/AIDS-related mortality and also increases the risk of transmission and spread of the disease in society. Adolescents are the most vulnerable population's age group for HIV infection in several settings, but expanding access to early HIV testing remains a challenge. Consequently, a significant proportion of adolescents are still dying of HIV-related causes, and the current study aimed at assessing the effect of late presentation on HIV-related mortality among adolescents living with HIV. METHODS An institutional-based retrospective cohort study was conducted from August 21-November 21, 2022, at selected public hospitals in the North Showa Zone of Oromiya, Ethiopia. All adolescents living with HIV who had received no ART and presented for ART follow-up at public hospitals from September 1, 2012, to August 31, 2021, were included in the study. Data entry was done by Epi-data version 3.1.1 software and exported to Stata version 16 for further analysis. Both bi-variable and multivariable analyses were performed using the Cox proportional hazard model to compare the HIV-related mortality of early and late-presented adolescents using an adjusted hazard ratio at a 95% confidence interval (CI). RESULTS A total of 341 medical records of adolescents were included in the study, contributing an overall incidence rate of 3.15 (95% CI: 2.21-4.26) deaths per 100 person-years of observation throughout the total follow-up period of 1173.98 person-years. Adolescents with late presentation for HIV care had three times the higher hazard of mortality (adjusted hazard ratio (aHR) = 3.00; 95% CI: 1.22-7.37) as compared to those with early presentation for HIV/AIDS care. Adolescents within the age range of 15-19 years old (aHR = 3.56; 95% CI: 1.44-8.77), rural residence (aHR = 2.81; 95% CI: 1.39-5.68), poor adherence to ART (aHR = 3.17; 95% CI: 1.49-6.76), and being anemic (aHR = 3.09; 95% CI: 1.52-6.29) were other independent predictors of HIV-related mortality. CONCLUSION The study found a substantial link between HIV late presentation to care and mortality among adolescents. Residence, age, antiretroviral therapy (ART) medication adherence, and anemia status were also found to be other independent predictors of HIV-related mortality. To achieve the ultimate aim of lowering mortality among adolescents living with HIV, rigorous emphasis must be placed on early presentation for HIV/AIDS care. In addition, counseling on adherence and prompt diagnosis and treatment of anemia are highly recommended to reduce mortality.
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Affiliation(s)
- Misgana Kebede Gabre
- Department of Public Health, College of Health Sciences, Salale University, Fitche, Ethiopia.
| | | | - Leta Adugna Geleta
- Department of Public Health, College of Health Sciences, Salale University, Fitche, Ethiopia
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Ounchanum P, Aurpibul L, Teeraananchai S, Lumbiganon P, Songtaweesin WN, Sudjaritruk T, Chokephaibulkit K, Rungmaitree S, Kosalaraksa P, Suwanlerk T, Ross JL, Sohn AH, Puthanakit T. High mortality in adolescents and young adults with perinatally-acquired HIV in Thailand during the transition to adulthood. AIDS Care 2024:1-10. [PMID: 38447043 DOI: 10.1080/09540121.2024.2325100] [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: 10/16/2023] [Accepted: 02/22/2024] [Indexed: 03/08/2024]
Abstract
Transitioning from pediatric to adult care remains a challenge for adolescents and young adults with perinatally-acquired HIV (AYA-PHIV). We assessed treatment outcomes and mortality among Thai AYA-PHIV. The study included AYA-PHIV who reached age 18-24 years who started antiretroviral treatment during childhood at five pediatric HIV clinics across Thailand. From November 2020-July 2021, data were gathered from a cohort database, medical records, and the Thai National AIDS Program. Of 811 eligible AYA-PHIV, 93% were alive; median age 22.3 years (IQR 20.6-23.7), treatment duration 16.1 years (IQR 13.4-18.0). Current HIV care was provided in adults (71%) and pediatric clinics (29%). Treatment regimens included non-nucleoside reverse transcriptase inhibitors (55%), protease inhibitors (36%), and integrase inhibitors (8%); 78% had HIV RNA <200 copies/ml. Of the 7.0% who died, median age at death was 20.8 years (IQR 20.6-22.1); 88% were AIDS-related death. Mortality after age 18 was 1.76 per 100-person years (95% confidence interval 1.36-2.28). Those with CD4 <200 cell/mm3 at age 15 had higher risk of mortality (adjusted hazard ratio 6.16, 95% CI 2.37-16.02). In conclusion, the high mortality among Thai AYA-PHIV indicated the need for better systems to support AYA-PHIV during the transition to adulthood.
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Affiliation(s)
- Pradthana Ounchanum
- Department of Pediatrics, Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand
| | - Linda Aurpibul
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Sirinya Teeraananchai
- Department of Statistics, Faculty of Science, Kasetsart University, Bangkok, Thailand
| | - Pagakrong Lumbiganon
- Department of Pediatrics, Faculty of Medicine, Srinagarind Hospital, Khon Kaen University, Khon Kean, Thailand
| | | | - Tavitiya Sudjaritruk
- Department of Pediatrics and Clinical and Molecular Epidemiology of Emerging and Re-emerging Infectious Diseases Research Cluster, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Kulkanya Chokephaibulkit
- Siriraj Institute of Clinical Research and Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Supattra Rungmaitree
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pope Kosalaraksa
- Department of Pediatrics, Faculty of Medicine, Srinagarind Hospital, Khon Kaen University, Khon Kean, Thailand
| | | | - Jeremy L Ross
- TREAT Asia/amfAR - The Foundation for AIDS Research, Bangkok, Thailand
| | - Annette H Sohn
- TREAT Asia/amfAR - The Foundation for AIDS Research, Bangkok, Thailand
| | - Thanyawee Puthanakit
- Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Ahonkhai AA, Kuti KM, Hirschhorn LR, Kuhns LM, Garofalo R, Johnson AK, Adetunji A, Berzins B, Okonkwor O, Awolude O, Omigbodun O, Taiwo BO. Successful Implementation Strategies in iCARE Nigeria-A Pilot Intervention with Text Message Reminders and Peer Navigation for Youth Living with HIV. Trop Med Infect Dis 2023; 8:498. [PMID: 37999617 PMCID: PMC10675344 DOI: 10.3390/tropicalmed8110498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/31/2023] [Accepted: 11/13/2023] [Indexed: 11/25/2023] Open
Abstract
To address poor outcomes among adolescents and young adults living with HIV (AYA-HIV), iCARE Nigeria successfully piloted two-way text message antiretroviral therapy (ART) reminders together with peer navigation. Study participants had significant improvement in ART adherence and viral suppression at 48 weeks. Understanding facto of this intervention. We used explanatory, mixed methods to assess implementation outcomes (feasibility, acceptability, and adoption) and identify implementation strategies used or adapted to promote intervention success. Quantitative data included participant surveys, program records, and back-end mHealth data, and were summarized using descriptive statistics. Qualitative data were collected from key informants and focus group discussions with program staff and summarized using directed content analysis. iCARE Nigeria was feasible as evidenced by ease of recruitment, high retention of patients and peer navigators (PN), and successful deployment of initial text message reminders (99.9%). Most participants (95%) and PN (90%) found text message reminders were not bothersome or intrusive. Implementation strategies employed to facilitate intervention success included: (1) selecting, training, supervising, and matching of PN to patients; (2) tailoring frequency (daily to weekly) and mode of communication between PN and patients according to patient need; (3) routine screening for adherence challenges; (4) changing phone airtime stipends from monthly to weekly in response to rapid depletion; and (5) conducting telecommunication needs assessments, to identify and troubleshoot implementation barriers (issues with mobile devices, power availability). iCARE Nigeria was feasible and acceptable with high adoption by stakeholders. The implementation strategies identified here can be tailored for intervention scale-up in similar environments to promote ART adherence for AYA-HIV.
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Affiliation(s)
- Aima A. Ahonkhai
- Department of Medicine, Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN 37203, USA
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN 37203, USA
- Department of Medicine, Infectious Diseases, Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Kehinde M. Kuti
- Department of Family Medicine, University College Hospital, Ibadan 200005, Nigeria; (K.M.K.)
| | - Lisa R. Hirschhorn
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA;
| | - Lisa M. Kuhns
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA; (L.M.K.); (R.G.); (A.K.J.)
- Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA
| | - Robert Garofalo
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA; (L.M.K.); (R.G.); (A.K.J.)
- Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Amy K. Johnson
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA; (L.M.K.); (R.G.); (A.K.J.)
- Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA
| | - Adedotun Adetunji
- Department of Family Medicine, University College Hospital, Ibadan 200005, Nigeria; (K.M.K.)
| | - Baiba Berzins
- Division of Infectious Diseases, Northwestern University, Chicago, IL 60611, USA (O.O.)
| | - Ogochukwu Okonkwor
- Division of Infectious Diseases, Northwestern University, Chicago, IL 60611, USA (O.O.)
| | - Olutosin Awolude
- Department of Obstetrics and Gynecology, College of Medicine, University of Ibadan, Ibadan 200212, Nigeria;
- Infectious Disease Institute, College of Medicine, University of Ibadan, Ibadan 200212, Nigeria
| | - Olayinka Omigbodun
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan 200212, Nigeria;
| | - Babafemi O. Taiwo
- Division of Infectious Diseases, Northwestern University, Chicago, IL 60611, USA (O.O.)
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Improving Outcomes for Adolescents and Young Adults Living With HIV. J Adolesc Health 2023; 73:605-609. [PMID: 37422741 DOI: 10.1016/j.jadohealth.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 05/15/2023] [Indexed: 07/10/2023]
Abstract
Adolescents and young adults living with HIV (AYLHIV), ages 10-24, experience inferior outcomes across the HIV care continuum compared to adults. Inferior outcomes are caused by clinical systems that are not tailored to AYLHIV, structural barriers that prevent equitable care, and lack of engagement of AYLHIV by care teams. This position paper outlines three recommendations to bridge these gaps in care outcomes. The first advocates for offering differentiated and integrated health services. The second addresses structural changes that can improve outcomes for AYLHIV. The third calls for actively including input from AYLHIV about the care designed for them.
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Thomadakis C, Yiannoutsos CT, Pantazis N, Diero L, Mwangi A, Musick BS, Wools-Kaloustian K, Touloumi G. The Effect of HIV Treatment Interruption on Subsequent Immunological Response. Am J Epidemiol 2023; 192:1181-1191. [PMID: 37045803 PMCID: PMC10326612 DOI: 10.1093/aje/kwad076] [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: 01/21/2022] [Revised: 11/03/2022] [Accepted: 03/27/2023] [Indexed: 04/14/2023] Open
Abstract
Recovery of CD4-positive T lymphocyte count after initiation of antiretroviral therapy (ART) has been thoroughly examined among people with human immunodeficiency virus infection. However, immunological response after restart of ART following care interruption is less well studied. We compared CD4 cell-count trends before disengagement from care and after ART reinitiation. Data were obtained from the East Africa International Epidemiology Databases to Evaluate AIDS (IeDEA) Collaboration (2001-2011; n = 62,534). CD4 cell-count trends before disengagement, during disengagement, and after ART reinitiation were simultaneously estimated through a linear mixed model with 2 subject-specific knots placed at the times of disengagement and treatment reinitiation. We also estimated CD4 trends conditional on the baseline CD4 value. A total of 10,961 patients returned to care after disengagement from care, with the median gap in care being 2.7 (interquartile range, 2.1-5.4) months. Our model showed that CD4 cell-count increases after ART reinitiation were much slower than those before disengagement. Assuming that disengagement from care occurred 12 months after ART initiation and a 3-month treatment gap, CD4 counts measured at 3 years since ART initiation would be lower by 36.5 cells/μL than those obtained under no disengagement. Given that poorer CD4 restoration is associated with increased mortality/morbidity, specific interventions targeted at better retention in care are urgently required.
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Affiliation(s)
- Christos Thomadakis
- Correspondence to Dr. Christos Thomadakis, Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece (e-mail: )
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Mburu C, Njuguna I, Neary J, Mugo C, Moraa H, Beima-Sofie K, Onyango A, Oyiengo L, Richardson BA, John-Stewart G, Wamalwa D. Mortality and Loss to Follow-Up Among Adolescents and Young Adults Attending HIV Care Programs in Kenya. AIDS Patient Care STDS 2023; 37:323-331. [PMID: 37432311 PMCID: PMC10354300 DOI: 10.1089/apc.2023.0019] [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] [Indexed: 07/12/2023] Open
Abstract
Mortality and loss to follow-up (LTFU) among adolescents and youth living with HIV (AYLHIV) remain high. We evaluated mortality and LTFU during the test and treat era. We abstracted medical records of AYLHIV for 10-24 years between January 2016 and December 2017 in 87 HIV clinics in Kenya. Using competing risk survival analysis, we compared incidence rates and determined correlates of mortality and LTFU among newly enrolled [<2 years since antiretroviral therapy (ART) initiation] and AYLHIV on ART for ≥2 years. Among 4201 AYLHIV, 1452 (35%) and 2749 (65%) were new enrollments and on ART for ≥2 years, respectively. AYLHIV on antiretroviral therapy (ART) for ≥2 years were younger and more likely to have perinatally acquired HIV (p < 0.001). Incidence of mortality and LTFU per 100 person-years were 2.32 [95% confidence interval (CI): 1.64-3.28] and 37.8 (95% CI: 34.7-41.3), respectively, among new enrollments and 1.22 (95% CI: 0.94-1.59) and 10.2 (95% CI: 9.3-11.1), respectively, among those on ART for ≥2 years. New enrollments had almost twice higher risk of mortality [subdistribution hazard ratio (sHR) 1.92 (1.30, 2.84), p = 0.001] and sevenfold higher risk of LTFU [sHR 7.71 (6.76, 8.79), p < 0.001] than those on ART for ≥2 years. Among new enrollments, mortality was higher in males and those with World Health Organization (WHO) stage III/IV disease at enrollment, and LTFU was associated with pregnancy, older age, and nonperinatal acquisition. Female sex and WHO stage (I/II) were associated with LTFU among those on ART for ≥2 years. During the study period from January 1, 2016, to December 31, 2017, the mortality incidence observed did not demonstrate improvement from earlier studies despite universal test and treat and better ART regimens. This trial was registered with ClinicalTrials.gov, NCT03574129.
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Affiliation(s)
- Caren Mburu
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Irene Njuguna
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Jillian Neary
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Cyrus Mugo
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Hellen Moraa
- Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Kristin Beima-Sofie
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Alvin Onyango
- Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Laura Oyiengo
- United Nations International Emergency Children's Fund, Department of Maternal and Newborn Health
| | - Barbra A. Richardson
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Grace John-Stewart
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Dalton Wamalwa
- Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
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Wilson K, Agot K, Dyer J, Badia J, Kibugi J, Bosire R, Neary J, Inwani I, Beima-Sofie K, Shah S, Chakhtoura N, John-Stewart G, Kohler P. Development and validation of a prediction tool to support engagement in HIV care among young people ages 10-24 years in Kenya. PLoS One 2023; 18:e0286240. [PMID: 37390119 PMCID: PMC10313055 DOI: 10.1371/journal.pone.0286240] [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: 06/15/2022] [Accepted: 05/11/2023] [Indexed: 07/02/2023] Open
Abstract
INTRODUCTION Loss to follow-up (LTFU) among adolescents and young adults living with HIV (AYALWH) is a barrier to optimal health and HIV services. We developed and validated a clinical prediction tool to identify AYALWH at risk of LTFU. METHODS We used electronic medical records (EMR) of AYALWH ages 10 to 24 in HIV care at 6 facilities in Kenya and surveys from a subset of participants. Early LTFU was defined as >30 days late for a scheduled visit in the last 6 months, which accounts for clients with multi-month refills. We developed a tool combining surveys with EMR ('survey-plus-EMR tool'), and an 'EMR-alone' tool to predict high, medium, and low risk of LTFU. The survey-plus-EMR tool included candidate sociodemographics, partnership status, mental health, peer support, any unmet clinic needs, WHO stage, and time in care variables for tool development, while the EMR-alone included clinical and time in care variables only. Tools were developed in a 50% random sample of the data and internally validated using 10-fold cross-validation of the full sample. Tool performance was evaluated using Hazard Ratios (HR), 95% Confidence Intervals (CI), and area under the curve (AUC) ≥ 0.7 for good performance and ≥0.60 for modest performance. RESULTS Data from 865 AYALWH were included in the survey-plus-EMR tool and early LTFU was (19.2%, 166/865). The survey-plus-EMR tool ranged from 0 to 4, including PHQ-9 ≥5, lack of peer support group attendance, and any unmet clinical need. High (3 or 4) and medium (2) prediction scores were associated with greater risk of LTFU (high, 29.0%, HR 2.16, 95%CI: 1.25-3.73; medium, 21.4%, HR 1.52, 95%CI: 0.93-2.49, global p-value = 0.02) in the validation dataset. The 10-fold cross validation AUC was 0.66 (95%CI: 0.63-0.72). Data from 2,696 AYALWH were included in the EMR-alone tool and early LTFU was 28.6% (770/2,696). In the validation dataset, high (score = 2, LTFU = 38.5%, HR 2.40, 95%CI: 1.17-4.96) and medium scores (1, 29.6%, HR 1.65, 95%CI: 1.00-2.72) predicted significantly higher LTFU than low-risk scores (0, 22.0%, global p-value = 0.03). Ten-fold cross-validation AUC was 0.61 (95%CI: 0.59-0.64). CONCLUSIONS Clinical prediction of LTFU was modest using the surveys-plus-EMR tool and the EMR-alone tool, suggesting limited use in routine care. However, findings may inform future prediction tools and intervention targets to reduce LTFU among AYALWH.
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Affiliation(s)
- Kate Wilson
- Department of Global Health, University of Washington, Seattle, WA, United States of America
| | - Kawango Agot
- Impact Research and Development Organization, Kisumu, Kenya
| | - Jessica Dyer
- Department of Global Health, University of Washington, Seattle, WA, United States of America
| | - Jacinta Badia
- Impact Research and Development Organization, Kisumu, Kenya
| | - James Kibugi
- Impact Research and Development Organization, Kisumu, Kenya
| | - Risper Bosire
- Impact Research and Development Organization, Kisumu, Kenya
| | - Jillian Neary
- Department of Epidemiology, University of Washington, Seattle, WA, United States of America
| | - Irene Inwani
- University of Nairobi/Kenyatta National Hospital, Nairobi, Kenya
| | - Kristin Beima-Sofie
- Department of Global Health, University of Washington, Seattle, WA, United States of America
| | - Seema Shah
- Northwestern University Medical School/Bioethics Program at Lurie Children’s Hospital, Chicago, IL, United States of America
| | - Nahida Chakhtoura
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Washington, DC, United States of America
| | - Grace John-Stewart
- Department of Global Health, University of Washington, Seattle, WA, United States of America
- Department of Epidemiology, University of Washington, Seattle, WA, United States of America
- Department of Medicine, University of Washington, Seattle, WA, United States of America
- Department of Pediatrics, University of Washington, Seattle, WA, United States of America
| | - Pamela Kohler
- Department of Global Health, University of Washington, Seattle, WA, United States of America
- Department of Child, Family, Population Health Nursing, University of Washington, Seattle, WA, United States of America
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Njuguna I, Moraa H, Mugo C, Mbwayo A, Nyapara F, Aballa C, Wagner AD, Wamalwa D, John-Stewart G, Inwani I, O’Malley G. 'They should show them love even if their status of being HIV positive is known': Youth and caregiver stigma experience and strategies to end HIV stigma in schools. Trop Med Int Health 2023; 28:466-475. [PMID: 37177902 PMCID: PMC10278085 DOI: 10.1111/tmi.13878] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
OBJECTIVE HIV stigma and discrimination is widespread in sub-Saharan Africa and is associated with poor clinical outcomes. Schools play a critical role in the life of youth and have been identified as a potentially stigmatising environment. We sought to explore school HIV stigma drivers, facilitators, manifestations and outcomes among youth living with HIV (YLH) as well as potential stigma reduction interventions in Kenya. METHODS Semi-structured in-depth qualitative interviews with 28 school-attending YLH aged 14-19 years and 24 caregivers of YLH were analysed using directed content analysis. Results were summarised using the Health and Stigma Framework. RESULTS Drivers and facilitators of HIV stigma in the school environment included misconceptions about HIV transmission, HIV treatment outcomes and long-term overall health of people living with HIV. HIV stigma manifested largely as gossip, isolation and loss of friendships. Fear of HIV stigma or experienced stigma resulted in poor adherence to antiretroviral treatment-particularly among YLH in boarding schools-and poor mental health. Stigma also impacted school choice (boarding vs. day school) and prevented HIV disclosure to schools which was necessary for optimal support for care. Proposed interventions to address HIV stigma in schools included HIV education, psychosocial support for YLH, support for HIV disclosure to schools while ensuring confidentiality and building YLH resilience. CONCLUSION There is an urgent need to develop interventions to address HIV stigma in schools to ensure optimised health and social outcomes for YLH. Future studies to understand the most effective and efficient interventions are needed.
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Affiliation(s)
- Irene Njuguna
- Kenyatta National Hospital, Research and Programs, P.O. Box 20723-00202, Nairobi, Kenya
- Departments of Global Health, University of Washington, Box 359931, Seattle, WA 98104, USA
| | - Hellen Moraa
- Kenyatta National Hospital, Research and Programs, P.O. Box 20723-00202, Nairobi, Kenya
| | - Cyrus Mugo
- Kenyatta National Hospital, Research and Programs, P.O. Box 20723-00202, Nairobi, Kenya
| | - Anne Mbwayo
- Department of Psychiatry, University of Nairobi P.O. Box 19676-00202, Nairobi, Kenya
| | - Florence Nyapara
- Kenyatta National Hospital, Research and Programs, P.O. Box 20723-00202, Nairobi, Kenya
| | - Calvins Aballa
- Kenyatta National Hospital, Research and Programs, P.O. Box 20723-00202, Nairobi, Kenya
| | - Anjuli D. Wagner
- Departments of Global Health, University of Washington, Box 359931, Seattle, WA 98104, USA
| | - Dalton Wamalwa
- Department of Pediatrics and Child Health, University of Nairobi P.O. Box 19676-00202, Nairobi, Kenya
| | - Grace John-Stewart
- Departments of Global Health, University of Washington, Box 359931, Seattle, WA 98104, USA
- Departments of Epidemiology, University of Washington, Box 359931, Seattle, WA 98104, USA
- Departments of Medicine, University of Washington, Box 359931, Seattle, WA 98104, USA
- Departments of Pediatrics, University of Washington, Box 359931, Seattle, WA 98104, USA
| | - Irene Inwani
- Kenyatta National Hospital, Research and Programs, P.O. Box 20723-00202, Nairobi, Kenya
| | - Gabrielle O’Malley
- Departments of Global Health, University of Washington, Box 359931, Seattle, WA 98104, USA
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Mode of HIV acquisition among adolescents living with HIV in resource-limited settings: A data-driven approach from South Africa. PLoS One 2023; 18:e0281298. [PMID: 36827268 PMCID: PMC9955664 DOI: 10.1371/journal.pone.0281298] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 01/19/2023] [Indexed: 02/25/2023] Open
Abstract
Adolescents living with HIV (ALHIV) face unique treatment and care challenges which may differ by how they acquired HIV, whether vertically (in-utero, perinatal or postnatal exposure during breastfeeding) or sexually (sexual exposure). Distinguishing and documenting the mode of HIV acquisition (MOHA) is crucial to further research on the different needs and outcomes for ALHIV and to tailor HIV services to their needs. Age-based cut-offs have been used to attribute MOHA but have not been validated. We analysed data from a three-wave cohort of n = 1107 ALHIV part of a longitudinal study in South Africa. Age-based MOHA was allocated using age at ART initiation, validated against a logic-tree model based on literature-hypothesised factors: self-reported HIV, sexual, and family history. After testing six ART initiation age cut-offs (10 to 15 years old), we determined the optimal MOHA cut-off age by calculating the sensitivity and specificity for each cut-off, measured against the final logic-tree allocation. Following validation using this longitudinal study, the methodology is extended to 214 additional third-wave participants-adolescent girls and young women living with HIV who became mothers before the age of 20. Finally, descriptive statistics of the final allocations are presented. Among the 1,063 (96.0%) cohort study participants classified, 68.7% acquired HIV vertically, following validation. ART initiation before cut-off age 10 had the highest sensitivity (58.9%) but cut-off age 12 had the largest area under the curve (AUC) (0.712). Among the additional young mothers living with HIV, 95.3% were estimated to have acquired it sexually, following the same algorithm. For this group, while cut-off ages 10 to 12 had the highest sensitivity (92.2%), age 14 had the highest AUC (0.703). ART initiation before 10 years old is strongly associated with vertical HIV acquisition. Therefore, a cut-off age of 10 would remain the recommendation in LMIC regions with similar epidemiology as South Africa for determining MOHA in research and clinic settings.
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Rudgard WE, Saminathen MG, Banougnin BH, Shenderovich Y, Toska E. The role of structural factors for preventing HIV risk practices among adolescents in South Africa: A three-wave analysis of caregiving, education, food security, and social protection. RESEARCH SQUARE 2023:rs.3.rs-2164051. [PMID: 36798325 PMCID: PMC9934770 DOI: 10.21203/rs.3.rs-2164051/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Structural interventions are endorsed to enhance biomedical and behavioural HIV prevention programmes for adolescents. Aiming to inform future interventions, we evaluated longitudinal associations between six structural factors and five HIV risk practices in a cohort of adolescents in South Africa. METHODS We used three rounds of data between 2014-2018 on 1046 adolescents living with HIV and 483 age-matched community peers in South Africa's Eastern Cape (Observations = 4402). We used multivariable random effects within-between logistic regression to estimate sex-specific associations between six time-varying structural factors - number of social grants, education enrolment, days with enough food, caregiver supervision, positive caregiving, and adolescent-caregiver communication - and five HIV risk practices - multiple sexual partners, transactional sex, age-disparate sex, condomless sex, and sex on substances. We calculated probability differences, contrasting predicted probabilities at average and maximum values of structural factors associated with multiple risk practices. FINDINGS The sample mean age was 15.29 (SD: 3.23) years and 58% were female. In females, compared to average, maximum positive caregiving scores were associated with lower probability of transactional sex (-1.06 percentage points [ppts], 95%CI=-1.60; -0.52ppts), and age-disparate sex (-0.73ppts; 95%CI=-1.26; -0.19ppts); maximum caregiver supervision scores were associated with lower probability of multiple sexual partners (-3.11ppts; 95%CI=-3.87; -2.35ppts) transactional sex (-1.07ppts, 95%CI=-1.42; -0.71ppts), age-disparate sex (-0.67ppts; 95%CI=-1.08; -0.25ppts), condomless sex (-3.96ppts; 95%CI=-5.65; -2.26ppts), and sex on substances (-0.93ppts; 95%CI=-1.50; -0.37ppts); and, seven days with enough food was associated with lower probability of multiple sexual partners (-1.18ppts, 95%CI=-2.06; -0.30ppts), and transactional sex (-0.91ppts; 95%CI=-1.41; -0.42ppts). Relative to non-enrolment, education enrolment was associated with lower probability of age-disparate sex (-3.18ppts; 95%CI=-5.35; -1.01ppts), and condomless sex (-11.32ppts; 95%CI=-19.15; -3.49ppts). In males, compared to average, maximum caregiver supervision scores were associated with lower probability of multiple sexual partners (-2.83ppts; 95%CI=-3.66; -2.00ppts), transactional sex (-0.90ppts; 95%CI=-1.20; -0.60ppts), age-disparate sex (-0.46ppts; 95%CI=-0.77; -0.15ppts), and sex on substances (-1.42ppts; 95%CI=-2.06; -0.78ppts). No other structural factors were associated with multiple risk practices. INTERPRETATION Structural interventions to improve food security and education enrolment among adolescent girls, and positive and supervisory caregiving among adolescent girls and boys are likely to translate into crucial reductions in HIV risk.
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Affiliation(s)
| | | | | | | | - Elona Toska
- University of Cape Town Centre for Social Science Research
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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.
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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
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Hlophe LD, Tamuzi JL, Shumba CS, Nyasulu PS. Barriers and facilitators to anti-retroviral therapy adherence among adolescents aged 10 to 19 years living with HIV in sub-Saharan Africa: A mixed-methods systematic review and meta-analysis. PLoS One 2023; 18:e0276411. [PMID: 37200399 DOI: 10.1371/journal.pone.0276411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 05/02/2023] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND Human Immunodeficiency Virus (HIV) significantly affects adolescents globally, with the sub-Saharan Africa (SSA) reporting a high burden of the disease. HIV testing, treatment, and retention to care are low among adolescents. We conducted a mixed-method systematic review to assess anti-retroviral therapy (ART) adherence; barriers and facilitators to ART adherence and ART outcomes among adolescents living with HIV and on ART in sub-Saharan Africa. METHODS We conducted searches in four scientific databases for studies conducted between 2010 and March 2022 to identify relevant primary studies. Studies were screened against inclusion criteria and assessed for quality, and data was extracted. Meta-analysis of rates and odd ratios was used to plot the quantitative studies and meta-synthesis summarized the evidence from qualitative studies. RESULTS A total of 10 431 studies were identified and screened against the inclusion/ exclusion criteria. Sixty-six studies met the inclusion criteria (41 quantitative, 16 qualitative, and 9 mixed-methods study designs). Fifty-three thousand two hundred and seventeen (53 217) adolescents (52 319 in quantitative studies and 899 in qualitative studies) were included in the review. Thirteen support focused interventions for improved ART adherence were identified from quantitative studies. The plotted results from the meta-analysis found an ART adherence rate of 65% (95%CI 56-74), viral load suppression was 55% (95%CI 46-64), un-suppressed viral load rate of 41% (95%CI 32-50), and loss to follow up of 17% (95%CI 10-24) among adolescents. Meta-synthesis found six themes of barriers to ART (social, patient-based, economic, health system-based, therapy-based, and cultural barriers) in both the qualitative and quantitative studies, and three themes of facilitators to ART were also identified (social support, counselling, and ART education and secrecy or confidentiality) from qualitative studies. CONCLUSION ART adherence remains low among adolescents in SSA despite multiple interventions implemented to improve ART adherence. The low adherence rate may hinder the attainment of the UNAIDS 2030 targets. Additionally, various barriers to ART adherence due to lack of support have been reported among this age group. However, interventions aimed at improving social support, educating, and counselling adolescents may improve and sustain ART adherence. TRIAL REGISTRATION Systematic review registration: PROSPERO CRD42021284891.
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Affiliation(s)
- Londiwe D Hlophe
- Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Department of Environmental Health Sciences, Faculty of Health Sciences, University of Eswatini, Mbabane, Kingdom of Eswatini
| | - Jacques L Tamuzi
- Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | | | - Peter S Nyasulu
- Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Leshargie CT, Demant D, Burrowes S, Frawley J. Incidence and predictors of mortality among adolescents on antiretroviral therapy in Amhara Region, Ethiopia: a retrospective cohort analysis. BMJ Open 2022; 12:e063879. [PMID: 36351711 PMCID: PMC9664312 DOI: 10.1136/bmjopen-2022-063879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE This study aimed to assess the incidence and predictors of mortality in adolescents receiving antiretroviral therapy (ART) in Ethiopia's Amhara Region. DESIGN We conducted an institution-based retrospective follow-up study. SETTINGS The study was conducted at Amhara Region's comprehensive specialised hospitals in Ethiopia. PARTICIPANTS We included 961 randomly selected medical records of adolescents receiving ART between January 2005 and June 2020. PRIMARY AND SECONDARY OUTCOMES The incidence of mortality since ART treatment initiation served as the primary outcome, and predictors of mortality served as secondary outcomes. We used Cox proportional hazard regression to examine the relationship between mortality and its predictors. Variables with p values<0.05 in the multivariable analysis were considered statistically significant mortality predictors. Adjusted HR (aHR) with 95% CI was used to measure the strength of association. RESULTS More than half (n=496, 53.5%) of the adolescents living with HIV (ALHIV) were girls. The adolescent mortality rate was 1.52 (95% CI: 1.04 to 1.53) per 100 person-years throughout the follow-up period of 81 583 adolescent months. Mortality was higher for ALHIV who had not received formal education (aHR: 3.27, 95% CI: 1.36 to 7.87), had widowed parents (aHR: 1.85, CI: 95% 1.01 to 3.56) or received no social support (aHR: 2.81, 95% CI: 1.69 to 4.67). Adolescents who had opportunistic infections (OIs) at ART initiation (aHR: 1.94, 95% CI: 1.19 to 3.14), low haemoglobin (Hgb/g/l) levels (aHR: 2.17, 95% CI: 1.08 to 4.18), a bedridden functional status (aHR: 3.11, 95% CI: 1.64 to 5.72), stage IV clinical staging (aHR: 3.03, 95% CI: 1.46 to 6.30), non-disclosing status (aHR: 2.24, 95% CI:1.36 to 3.69) and CD4 count 200-350 cells/mm3 (aHR: 2.17, 95% CI: 1.08 to 4.18) also had a higher risk of death. Not receiving cotrimoxazole preventive therapy (aHR: 1.85, 95% CI: 1.07 to 3.22) and poor adherence to ART (aHR: 2.24, 95% CI: 1.27 to 3.95), compared with adherent, was associated with higher mortality risk. Changed treatment regimens were associated with lower mortality (aHR: 0.59, 95% CI: 0.35 to 0.98). CONCLUSIONS Our study found a lower mortality rate for adolescents with HIV than previous Ethiopian studies, but our significant mortality predictors were similar to those found in earlier studies of adults and adolescents. Our findings reveal a potential point for health service improvement in Ethiopia: incorporating monitoring of Hgb levels into patient follow-up care, supporting recommendations that clinicians emphasise managing OIs and providing counselling services to improve adherence.
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Affiliation(s)
- Cheru Tesema Leshargie
- Department of Public Health, College of Health Science, Debre Markos University, Debre Markos, Amhara, Ethiopia
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Daniel Demant
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | | | - Jane Frawley
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
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Jonas K, Zani B, Ramraj T, Chirinda W, Jama N, Basera W, McClinton Appollis T, Pass D, Govindasamy D, Mukumbang FC, Mathews C, Nicol E. Service delivery models for enhancing linkage to and retention in HIV care services for adolescent girls and young women and adolescent boys and young men: a protocol for an overview of systematic reviews. BMJ Open 2022; 12:e060778. [PMID: 36123080 PMCID: PMC9486299 DOI: 10.1136/bmjopen-2022-060778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Recent advances in the HIV care continuum have shown that an individual diagnosed with HIV should be initiated on antiretroviral therapy as soon as possible regardless of the CD4 count levels and retained in HIV care services. Studies have reported large losses in the HIV continuum of care, before and after the era of universal test and treat. Several systematic reviews have reported on the strategies for improving linkage to and retention in HIV treatment and care. The purpose of this overview of systematic reviews is to identify HIV care interventions or service delivery models (SDMs) and synthesise evidence on the effects of these to link adolescent girls and young women (AGYW) and adolescent boys and young men (ABYM) to care and retain them in care. We also aim to highlight gaps in the evidence on interventions and SDMs to improve linkage and retention in HIV care of AGYW and ABYM. METHODS AND ANALYSIS An electronic search of four online databases: PubMed, Cochrane Database of Systematic Reviews, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Web of Science will be performed to identify systematic reviews on the effects of linkage to and retention in HIV care interventions or SDMs for AGYW aged 15-24 years and ABYM aged 15-35 years. Our findings on the effects of interventions and SDMs will be interpreted considering the intervention and or SDMs' effectiveness by the time period, setting and population of interest. Two or more authors will independently screen articles for inclusion using a priori criteria. ETHICS AND DISSEMINATION Ethics approval is not required for this study as only published secondary data will be used. Our findings will be disseminated through peer-reviewed publication, conference abstracts and through presentations to stakeholders and other community fora. The findings from this overview of systematic reviews will inform mixed-methods operations research on HIV intervention programming and delivery of HIV care services for AGYW and ABYM in South Africa. PROSPERO REGISTRATION NUMBER CRD42020177933.
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Affiliation(s)
- Kim Jonas
- Health Systems Research, South African Medical Research Council, Parow, South Africa
- Adolescent Health Research, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Babalwa Zani
- Knowledge Translation Unit, University of Cape Town Lung Institute, Rondebosch, Western Cape, South Africa
| | - Trisha Ramraj
- Health Systems Research Unit, South African Medical Research Council Durban, Durban, KwaZulu-Natal, South Africa
- HIV Prevention Research Unit, South African Medical Research Council Durban, Durban, KwaZulu-Natal, South Africa
| | - Witness Chirinda
- Burden of Disease Research, South African Medical Research Council, Tygerberg, South Africa
| | - Ngcwalisa Jama
- Burden of Disease Research, South African Medical Research Council, Tygerberg, South Africa
| | - Wisdom Basera
- Burden of Disease Research, South African Medical Research Council, Tygerberg, South Africa
| | | | - Desiree Pass
- Burden of Disease Research, South African Medical Research Council, Tygerberg, South Africa
| | - Darshini Govindasamy
- Health Systems Research, South African Medical Research Council, Parow, South Africa
| | | | - Catherine Mathews
- Health Systems Research, South African Medical Research Council, Parow, South Africa
- Adolescent Health Research, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Edward Nicol
- Burden of Disease Research, South African Medical Research Council, Tygerberg, South Africa
- University of Stellenbosch, Stellenbosch, Western Cape, South Africa
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Hendricks LA, Young T, Van Wyk SS, Matheï C, Hannes K. Storyboarding HIV Infected Young People's Adherence to Antiretroviral Therapy in Lower- to Upper Middle-Income Countries: A New-Materialist Qualitative Evidence Synthesis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11317. [PMID: 36141589 PMCID: PMC9517626 DOI: 10.3390/ijerph191811317] [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: 06/06/2022] [Revised: 08/15/2022] [Accepted: 08/16/2022] [Indexed: 06/16/2023]
Abstract
Young people living with perinatal infections of Human Immunodeficiency Virus (YLPHIV) face a chronic disease, with treatment including adherence to lifelong antiretroviral treatment (ART). The aim of this QES was to explore adherence to ART for YLPHIV as an assemblage within the framework of the biopsychosocial model with a new materialist perspective. We searched up to November 2021 and followed the ENTREQ and Cochrane guidelines for QES. All screening, data extraction, and critical appraisal were done in duplicate. We analysed and interpreted the findings innovatively by creating images of meaning, a storyboard, and storylines. We then reported the findings in a first-person narrative story. We included 47 studies and identified 9 storylines. We found that treatment adherence has less to do with humans' preferences, motivations, needs, and dispositions and more to do with how bodies, viruses, things, ideas, institutions, environments, social processes, and social structures assemble. This QES highlights that adherence to ART for YLPHIV is a multisensorial experience in a multi-agentic world. Future research into rethinking the linear and casual inferences we are accustomed to in evidence-based health care is needed if we are to adopt multidisciplinary approaches to address pressing issues such as adherence to ART.
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Affiliation(s)
- Lynn A. Hendricks
- Centre for Evidence Based Health Care, Division of Epidemiology and Biostatistics, Stellenbosch University, Cape Town 3000, South Africa
- Research Group SoMeTHin’K (Social, Methodological and Theoretical Innovation/Kreative), Faculty of Social Sciences, Katholieke Universiteit, 3000 Leuven, Belgium
| | - Taryn Young
- Centre for Evidence Based Health Care, Division of Epidemiology and Biostatistics, Stellenbosch University, Cape Town 3000, South Africa
| | - Susanna S. Van Wyk
- Centre for Evidence Based Health Care, Division of Epidemiology and Biostatistics, Stellenbosch University, Cape Town 3000, South Africa
| | - Catharina Matheï
- Department of Public Health and Primary Care, Katholieke Universiteit, 3000 Leuven, Belgium
| | - Karin Hannes
- Research Group SoMeTHin’K (Social, Methodological and Theoretical Innovation/Kreative), Faculty of Social Sciences, Katholieke Universiteit, 3000 Leuven, Belgium
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Shulock K, Beima-Sofie K, Apriyanto H, Njuguna I, Mburu C, Mugo C, Itindi J, Onyango A, Wamalwa D, John-Stewart G, O'Malley G. "It's about making adolescents in charge of their health": policy-makers' perspectives on optimizing the health care transition among adolescents living with HIV in Kenya. AIDS Care 2022; 34:1127-1134. [PMID: 34482776 DOI: 10.1080/09540121.2021.1971606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
ABSTRACTThe health care transition (HCT) from pediatric to adult care is a potential contributor to poor clinical outcomes among adolescents living with HIV (ALHIV). In sub-Saharan Africa (SSA), there is limited information on effective tools and processes to prepare and support ALHIV through this transition. This study elicited perspectives of policy-makers regarding barriers and facilitators to successful HCT among ALHIV in Kenya. Twenty in-depth interviews (IDIs) were conducted with policy-makers using a semi-structured guide. Using the socio-ecological model (SEM) as an organizing framework, directed content and thematic network analyses methods were used to characterize themes related to key influences on HCT processes and to describe actionable recommendations for improved tools and resources. Policy-makers identified multilevel support, including the development of a triadic relationship between the caregiver, healthcare worker (HCW) and adolescent, as an essential strategy for improved HCT success. Across the SEM, policy-makers described the importance of actively engaging adolescents in their care to promote increased ownership and autonomy over health decisions. At the structural level, the need for more comprehensive HCT guidelines and improved HCW training was highlighted. Expanded HCT tools and guidelines, that emphasize supportive relationships and intensified adolescent engagement, may improve HCT processes and outcomes.
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Affiliation(s)
- Katherine Shulock
- Department of Global Health, University of Washington, Seattle, WA, USA
| | | | - Haris Apriyanto
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Irene Njuguna
- Department of Global Health, University of Washington, Seattle, WA, USA
- Kenyatta National Hospital, Research and Programs, Nairobi, Kenya
| | - Caren Mburu
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Cyrus Mugo
- Kenyatta National Hospital, Research and Programs, Nairobi, Kenya
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | | | - Alvin Onyango
- Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Dalton Wamalwa
- Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Grace John-Stewart
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Pediatrics, University of Washington, Seattle, WA, USA
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Leshargie CT, Demant D, Burrowes S, Frawley J. The proportion of loss to follow-up from antiretroviral therapy (ART) and its association with age among adolescents living with HIV in sub-Saharan Africa: A systematic review and meta-analysis. PLoS One 2022; 17:e0272906. [PMID: 35951621 PMCID: PMC9371308 DOI: 10.1371/journal.pone.0272906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/29/2022] [Indexed: 11/25/2022] Open
Abstract
Background Human immunodeficiency virus (HIV) remains a global health threat, especially in developing countries. The successful scale-up of antiretroviral therapy (ART) programs to address this threat is hindered by a high proportion of patient loss to follow-up (LTFU). LTFU is associated with poor viral suppression and increased mortality. It is particularly acute among adolescents, who face unique adherence challenges. Although LTFU is a critical obstacle on the continuum of care for adolescents, few regional-level studies report the proportion of LTFU among adolescents receiving ART. Therefore, a systematic review and meta-analysis were conducted to estimate the pooled LTFU in ART programs among adolescents living with HIV in sub-Saharan Africa (SSA). Methods We searched five databases (PubMed, Embase (Elsevier), PsycINFO, CINAHL, and Scopus) for articles published between 2005 and 2020 and reference lists of included articles. The PRISMA guidelines for systematic reviews were followed. A standardised checklist to extract data was used. Descriptive summaries were presented using narrative tables and figures. Heterogeneity within the included studies was examined using the Cochrane Q test statistics and I2 test. Random effect models were used to estimate the pooled prevalence of LTFU among ALHIV. We used Stata version 16 statistical software for our analysis. Results Twenty-nine eligible studies (n = 285,564) were included. An estimated 15.07% (95% CI: 11.07, 19.07) of ALHIV were LTFU. Older adolescents (15–19 years old) were 43% (AOR = 0.57, 95% CI: 0.37, 0.87) more likely to be LTFU than younger (10–14 years old) adolescents. We find an insignificant relationship between gender and LTFU (AOR = 0.95, 95% CI: 0.87, 1.03). A subgroup analysis found that regional differences in the proportion of adolescent LTFU were not statistically significant. The trend analysis indicates an increasing proportion of adolescent LTFU over time. Conclusions and recommendations The proportion of LTFU among HIV-positive adolescents in SSA seems higher than those reported in other regions. Older adolescents in the region are at an increased risk for LTFU than younger adolescents. These findings may help policymakers develop appropriate strategies to retain ALHIV in ART services. Such strategies could include community ART distribution points, appointment spacing, adherence clubs, continuous free access to ART, and community-based adherence support.
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Affiliation(s)
- Cheru Tesema Leshargie
- Department of Public Health, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, Australia
- * E-mail:
| | - Daniel Demant
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, Australia
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Sahai Burrowes
- Public Health Program, College of Education and Health Sciences, Touro University California, Vallejo, CA, United States of America
| | - Jane Frawley
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, Australia
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Tesha ED, Kishimba R, Njau P, Revocutus B, Mmbaga E. Predictors of loss to follow up from antiretroviral therapy among adolescents with HIV/AIDS in Tanzania. PLoS One 2022; 17:e0268825. [PMID: 35857796 PMCID: PMC9299289 DOI: 10.1371/journal.pone.0268825] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 05/09/2022] [Indexed: 11/30/2022] Open
Abstract
Access to Antiretroviral Therapy (ART) is threatened by the increased rate of loss to follow-up (LTFU) among adolescents on ART care. We investigated the rate of LTFU from HIV care and associated predictors among adolescents living with HIV/AIDS in Tanzania. A retrospective cohort analysis of adolescents on ART from January 2014 to December 2016 was performed. Kaplan-Meier method was used to determine failure probabilities and the Cox proportion hazard regression model was used to determine predictors of loss to follow up. A total of 25,484 adolescents were on ART between 2014 and 2016, of whom 78.4% were female and 42% of adolescents were lost to follow-up. Predictors associated with LTFU included; adolescents aged 15–19 years (adjusted hazard ratio (aHR): 1.57; 95% Confidence Interval (CI); 1.47–1.69), having HIV/TB co-infection (aHR: 1.58; 95% CI, 1.32–1.89), attending care at dispensaries (aHR: 1.12; 95% CI, 1.07–1.18) or health center (aHR: 1.10; 95% CI, 1.04–1.15), and being malnourished (aHR: 2.27; 95% CI,1.56–3.23). Moreover, residing in the Lake Zone and having advanced HIV disease were associated with LTFU. These findings highlight the high rate of LTFU and the need for intervention targeting older adolescents with advanced diseases and strengthening primary public facilities to achieve the 2030 goal of ending HIV as a public health threat.
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Affiliation(s)
- Esther-Dorice Tesha
- Department of Epidemiology and Biostatistics at Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Tanzania Field of Epidemiology and Laboratory Training Program, Dar es Salaam, Tanzania
- * E-mail:
| | - Rogath Kishimba
- Tanzania Field of Epidemiology and Laboratory Training Program, Dar es Salaam, Tanzania
| | - Prosper Njau
- National AIDS Control Program, Ministry of Health, Community Development, Gender, Elderly, and Children, Dodoma, Tanzania
| | - Baraka Revocutus
- National AIDS Control Program, Ministry of Health, Community Development, Gender, Elderly, and Children, Dodoma, Tanzania
| | - Elia Mmbaga
- Department of Epidemiology and Biostatistics at Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Department of Community Medicine and Global Health, University of Oslo, Oslo, Norway
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19
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Lost but not missing: factors associated with loss of follow-up in a paediatric cardiology clinic. Cardiol Young 2022; 32:1061-1065. [PMID: 34470682 DOI: 10.1017/s1047951121003619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Loss of follow-up is a barrier to providing adequate care to paediatric cardiac patients. The purpose of this study was to determine variables associated with loss of appropriate paediatric cardiology follow-up, including potentially modifiable factors. We hypothesised having earlier recommend follow-up intervals was associated with less likelihood of loss of follow-up. METHODS We performed a retrospective cohort study of patients >5 years old seen in a large, outpatient paediatric practice from 2013 to 2016. Subjects were considered to be lost to follow-up if they did not have a subsequent outpatient encounter by 6 months after their recommend follow-up time interval. RESULTS Of the 8940 eligible patients, 45.9% were lost to follow-up. Recommended follow-up interval of 1 year was associated with less loss of follow-up (41.4%) as compared to 2-year intervals (51.6%) and 3 years (55.7%) (p < 0.001 for both). Other significant predictors of loss of follow-up included less severe heart disease, older age, and non-Hispanic Black race/ethnicity. Sex and payor type were not significant predictors. In the stratified analyses by severity of disease and age, longer recommended follow-up time was associated with greater loss of follow-up among all severity and age categories. CONCLUSIONS Almost half of the patients in our cohort did not return to clinic within the recommended timeline. Shorter follow-up time was associated with less loss of follow-up among all categories of disease severity and age groups. Recommending shorter follow-up intervals may be one initiative for paediatric cardiologists to improve rates of follow-up.
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20
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Humphrey J, Triedman M, Nyandiko W, Sang E, Kemboi E, Alera M, Novitsky V, Manne A, Jepkemboi E, Orido M, Apondi E, Vreeman R, Wools-Kaloustian K, Kantor R. A Challenging Knowledge Gap: Estimating Modes of HIV Acquisition Among Adolescents Entering HIV Care During Adolescence. Glob Pediatr Health 2022; 9:2333794X221101768. [PMID: 35664047 PMCID: PMC9160889 DOI: 10.1177/2333794x221101768] [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: 03/17/2022] [Accepted: 04/30/2022] [Indexed: 11/15/2022] Open
Abstract
Characterizing HIV acquisition modes among adolescents with HIV (AHIV) enrolling in care during adolescence is a challenging gap that impacts differential interventions. We explored whether primary data collection with targeted questionnaires may address this gap and improve understanding of risk factors and perceptions about adolescents’ HIV acquisition, in Kenyan AHIV entering care at ≥10 years, and their mothers with HIV (MHIV). Clinical data were derived through chart review. Among 1073 AHIV in care, only 26 (2%) met eligibility criteria of being ≥10 years at care enrollment, disclosed to, and with living MHIV. Among 18/26 AHIV-MHIV dyads enrolled (median age of AHIV 14 years), none had documented HIV acquisition modes. Data suggested perinatal infection in 17/18 AHIV, with 1 reported non-perinatal acquisition risk factor, and some discordance between adolescent-mother perceptions of HIV acquisition. In this difficult-to-enroll, vulnerable population of AHIV-MHIV dyads, primary data collection can enhance understanding of AHIV acquisition modes.
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Affiliation(s)
| | | | - Winstone Nyandiko
- Moi University College of Health Sciences, Eldoret, Kenya.,Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Edwin Sang
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Emmanuel Kemboi
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Marsha Alera
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | | | | | | | - Millicent Orido
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Edith Apondi
- Academic Model Providing Access to Healthcare, Eldoret, Kenya.,Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Rachel Vreeman
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
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21
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Jesson J, Crichton S, Quartagno M, Yotebieng M, Abrams EJ, Chokephaibulkit K, Le Coeur S, Aké‐Assi M, Patel K, Pinto J, Paul M, Vreeman R, Davies M, Ben‐Farhat J, Van Dyke R, Judd A, Mofenson L, Vicari M, Seage G, Bekker L, Essajee S, Gibb D, Penazzato M, Collins IJ, Wools‐Kaloustian K, Slogrove A, Powis K, Williams P, Matshaba M, Thahane L, Nyasulu P, Lukhele B, Mwita L, Kekitiinwa‐Rukyalekere A, Wanless S, Goetghebuer T, Thorne C, Warszawski J, Galli L, van Rossum AM, Giaquinto C, Marczynska M, Marques L, Prata F, Ene L, Okhonskaya L, Navarro M, Frick A, Naver L, Kahlert C, Volokha A, Chappell E, Pape JW, Rouzier V, Marcelin A, Succi R, Sohn AH, Kariminia A, Edmonds A, Lelo P, Lyamuya R, Ogalo EA, Odhiambo FA, Haas AD, Bolton C, Muhairwe J, Tweya H, Sylla M, D'Almeida M, Renner L, Abzug MJ, Oleske J, Purswani M, Teasdale C, Nuwagaba‐Biribonwoha H, Goodall R, Leroy V. Growth and CD4 patterns of adolescents living with perinatally acquired HIV worldwide, a CIPHER cohort collaboration analysis. J Int AIDS Soc 2022; 25:e25871. [PMID: 35255197 PMCID: PMC8901148 DOI: 10.1002/jia2.25871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 12/20/2021] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Adolescents living with HIV are subject to multiple co-morbidities, including growth retardation and immunodeficiency. We describe growth and CD4 evolution during adolescence using data from the Collaborative Initiative for Paediatric HIV Education and Research (CIPHER) global project. METHODS Data were collected between 1994 and 2015 from 11 CIPHER networks worldwide. Adolescents with perinatally acquired HIV infection (APH) who initiated antiretroviral therapy (ART) before age 10 years, with at least one height or CD4 count measurement while aged 10-17 years, were included. Growth was measured using height-for-age Z-scores (HAZ, stunting if <-2 SD, WHO growth charts). Linear mixed-effects models were used to study the evolution of each outcome between ages 10 and 17. For growth, sex-specific models with fractional polynomials were used to model non-linear relationships for age at ART initiation, HAZ at age 10 and time, defined as current age from 10 to 17 years of age. RESULTS A total of 20,939 and 19,557 APH were included for the growth and CD4 analyses, respectively. Half were females, two-thirds lived in East and Southern Africa, and median age at ART initiation ranged from <3 years in North America and Europe to >7 years in sub-Saharan African regions. At age 10, stunting ranged from 6% in North America and Europe to 39% in the Asia-Pacific; 19% overall had CD4 counts <500 cells/mm3 . Across adolescence, higher HAZ was observed in females and among those in high-income countries. APH with stunting at age 10 and those with late ART initiation (after age 5) had the largest HAZ gains during adolescence, but these gains were insufficient to catch-up with non-stunted, early ART-treated adolescents. From age 10 to 16 years, mean CD4 counts declined from 768 to 607 cells/mm3 . This decline was observed across all regions, in males and females. CONCLUSIONS Growth patterns during adolescence differed substantially by sex and region, while CD4 patterns were similar, with an observed CD4 decline that needs further investigation. Early diagnosis and timely initiation of treatment in early childhood to prevent growth retardation and immunodeficiency are critical to improving APH growth and CD4 outcomes by the time they reach adulthood.
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22
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Amour MA, Shayo GA, Matee MM, Machumi L, Rugarabamu A, Aris EA, Sunguya BF, Mugusi FM. Predictors of mortality among adolescents and young adults living with HIV on antiretroviral therapy in Dar es Salaam, Tanzania: a retrospective cohort study. J Int AIDS Soc 2022; 25:e25886. [PMID: 35192739 PMCID: PMC8863353 DOI: 10.1002/jia2.25886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 01/21/2022] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Global AIDS-related deaths have declined by only 10% among adolescents since its peak in 2003. This is disproportionately low compared to a decline of 74% among children aged 0-9 years old. We determined the magnitude of, and predictors of mortality among adolescents and young adults living with HIV on antiretroviral therapy (ART) in Dar-es-Salaam, Tanzania. METHODS A retrospective cohort study was conducted among adolescents (aged 10-19) and young adults (aged 20-24) living with HIV and enrolled in care and treatment centres in Dar es Salaam, Tanzania between January 2015 and December 2019. Data were analysed using STATA version 16. Cumulative hazard curves were used to estimate and illustrate 1-year mortality. Predictors for mortality were assessed by the Fine and Gray competing risk regression model. Sub-hazard ratios (SHR) and 95% confidence intervals (95% CI) were then reported. RESULTS A total of 15,874 young people living with HIV were included: 4916 (31.3%) were adolescents and 10,913 (68.7%) were young adults. A total of 3843 (77.5%) adolescents and 9517 (87.2%) young adults were female. Deaths occurred in 2.3% (114/4961) of adolescents and 1.2% (135/10,913) of young adults (p < 0.001). Over a follow-up of 9292 person-years, the mortality rate was 3.8 per 100 person years [95% CI 3.2-4.6/100 person-years] among adolescents and 2.1 per 100 person-years among young adults [95% CI 1.8-2.5/100 person-years]. Independent predictors of mortality among adolescents were male sex (adjusted (SHR) aSHR = 1.90, 95% CI: 1.3-2.8), CD4 count < 200 cells/mm3 (aSHR = 2.7, 95% CI: 1.4-5.0) and attending a private health facility (aSHR = 1.7, 95% CI: 1.1-2.5). Predictors of mortality among young adults were CD4 count < 200 cells/mm3 (aSHR = 2.8, 95% CI 1.7-4.5), being underweight (aSHR = 2.1, 95% CI: 1.4-3.3) and using nevirapine-based therapy (aHR = 8.3, 95% CI: 3.5-19.5). CONCLUSIONS The mortality rate for persons living with HIV and on ART in Tanzania was significantly higher in adolescents than young adults. Age- and sex-specific risk factors identify targets for intervention to reduce mortality among affected adolescents and young adults.
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Affiliation(s)
- Maryam A Amour
- Department of Community Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Grace A Shayo
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Mecky M Matee
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Lameck Machumi
- Management and Development for Health, Dar es Salaam, Tanzania
| | | | - Eric A Aris
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Bruno F Sunguya
- Department of Community Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Ferdinand M Mugusi
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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23
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Kose J, Tiam A, Siamba S, Lenz C, Okoth E, Wolters T, van de Vijver D, Rakhmanina N. Clinical outcomes among adolescents living with HIV in Kenya following initiation on antiretroviral treatment. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000094. [PMID: 36962291 PMCID: PMC10022018 DOI: 10.1371/journal.pgph.0000094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 02/01/2022] [Indexed: 11/19/2022]
Abstract
In Kenya, HIV/AIDS remains a leading cause of morbidity and mortality among adolescents living with HIV (ALHIV). Our study evaluated associations between demographic and healthcare factors and HIV treatment outcomes among ALHIV in care in Kenya. This retrospective cohort study evaluated the clinical outcomes of newly diagnosed ALHIV enrolled in HIV care during January 2017-June 2018 at 32 healthcare facilities in Homabay and Kakamega Counties. Demographic and clinical data were abstracted from patient clinical records and registers during the follow up study period January 2017-through May 2019. ALHIV were stratified by age (10-14 versus 15-19 years). Categorical variables were summarized using descriptive statistics; continuous variables were analyzed using mean values. The latest available treatment and virological outcomes for ALHIV were assessed. 330 ALHIV were included in the study (mean age 15.9 years; 81.8% female, 63.0% receiving HIV care at lower-level healthcare facilities). Most (93.2%) were initiated on ART within 14 days of diagnosis; 91.4% initiated EFV-based regimens. Of those on ART, only 44.6% were active on care at the end of the study period. Of those eligible for viral load testing, 83.9% were tested with 84.4% viral suppression rate. Retention in care was higher at higher-level facilities (67.5%) compared to lower-level facilities (28.6%). Factors associated with higher retention in care were school attendance (aRR = 1.453), receipt of disclosure support (aRR = 13.315), and receiving care at a high-level health facility (aRR = 0.751). Factors associated with viral suppression included older age (15-19 years) (aRR = 1.249) and pre-ART clinical WHO stage I/II (RR = .668). Viral suppression was higher among older ALHIV. Studies are needed to evaluate effective interventions to improve outcomes among ALHIV in Kenya.
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Affiliation(s)
- Judith Kose
- Elizabeth Glaser Pediatric AIDS Foundation, Nairobi, Kenya
- Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, United States of America
- Department of Medical and Scientific Affairs, Washington, DC, United States of America
- ErasmusMC, Department of Viroscience, Rotterdam University, Rotterdam, Netherlands
| | - Appolinaire Tiam
- Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, United States of America
- Department of Medical and Scientific Affairs, Washington, DC, United States of America
- University of Bergen, Centre for International Health, Bergen, Norway
| | - Stephen Siamba
- Elizabeth Glaser Pediatric AIDS Foundation, Nairobi, Kenya
| | - Cosima Lenz
- Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, United States of America
- Department of Medical and Scientific Affairs, Washington, DC, United States of America
| | | | - Theresa Wolters
- Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, United States of America
- Department of Medical and Scientific Affairs, Washington, DC, United States of America
| | - David van de Vijver
- ErasmusMC, Department of Viroscience, Rotterdam University, Rotterdam, Netherlands
| | - Natella Rakhmanina
- Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, United States of America
- Department of Medical and Scientific Affairs, Washington, DC, United States of America
- Department of Pediatrics, The George Washington University, School of Medicine and Health Sciences, Washington, DC, United States of America
- Children's National Hospital, Washington, DC, United States of America
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24
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A Pilot Study of a Mobile Intervention to Support Mental Health and Adherence Among Adolescents Living with HIV in Western Kenya. AIDS Behav 2022; 26:232-242. [PMID: 34292429 PMCID: PMC8295454 DOI: 10.1007/s10461-021-03376-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2021] [Indexed: 12/13/2022]
Abstract
Mobile technologies represent potentially novel and scalable intervention delivery platforms for adolescents living with HIV (ALWH) in low- and middle-income countries. We conducted a prospective, mixed methods pilot study to evaluate the acceptability and feasibility of the WhatsApp® platform to deliver individual counseling services and facilitate peer support for ALWH in western Kenya. Thirty ALWH (17 female, mean age 15.4) on ART, engaged in HIV care and aware of their status, were enrolled. After 6 months, participants described their experiences with the intervention. Treatment adherence, stigma, and mental and behavioral health were assessed prospectively. Participants reported overall positive experiences and indicated that the platform encouraged peer network development. They endorsed potential benefits for treatment adherence, stigma reduction, and mental and behavioral health. All participants supported intervention expansion. In western Kenya, WhatsApp® was an acceptable and feasible platform for mobile counseling and peer support for ALWH.
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25
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Wilson K, Onyango A, Mugo C, Guthrie B, Slyker J, Richardson B, John-Stewart G, Inwani I, Bukusi D, Wamalwa D, Kohler P. Kenyan HIV Clinics With Youth-Friendly Services and Trained Providers Have a Higher Prevalence of Viral Suppression Among Adolescents and Young Adults: Results From an Observational Study. J Assoc Nurses AIDS Care 2022; 33:45-53. [PMID: 34939987 PMCID: PMC10329499 DOI: 10.1097/jnc.0000000000000302] [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: 09/18/2020] [Indexed: 11/25/2022]
Abstract
ABSTRACT Sustained viral suppression in adolescents and young adults living with HIV (AYALWH) is necessary for epidemic control. We evaluated facility and individual correlates of viral suppression using programmatic data from AYALWH between ages 10 and 24 years at 24 HIV clinics in Kenya. Binomial regression was used to evaluate correlates of viral load (VL) suppression (<1,000 copies/ml). Of 5,316 AYALWH on antiretroviral therapy ≥6 months, 2,081 (39%) had VLs available in the medical record, of which 76% were virally suppressed. In multivariable analyses, antiretroviral therapy initiation among AYALWH older than 10 years was associated with higher viral suppression than initiation younger than 10 years (adjusted risk ratio [aRR] 10-14 = 1.03, 95% confidence interval [CI] 0.97-1.10; aRR 15-19 = 1.30, 95% CI 1.19-1.41; aRR 20-24 = 1.43, 95% CI 1.24-1.63). Facilities with both youth-friendly services (YFS) and trained providers had significantly higher VL suppression compared with facilities without YFS or trained providers (adjusted odds ratio: 2.07, 95% CI: 1.71-2.52). Viral suppression remains suboptimal among AYALWH. YFS and trained providers plus greater use of VL data may help increase viral suppression among AYALWH.
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Affiliation(s)
- Kate Wilson
- Kate Wilson, PhD, MPH, is a Clinical Assistant Professor, Department of Global Health, University of Washington, Seattle, Washington, USA
- Alvin Onyango, BSN, is a Study Coordinator, Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
- Cyrus Mugo, MBChB, MPH, is a Doctoral Student, Department of Global Health, University of Washington, Seattle, Washington, USA
- Brandon Guthrie, PhD, MPH, is an Assistant Professor, Departments of Global Health and Epidemiology, University of Washington, Seattle, Washington, USA
- Jennifer Slyker, PhD, is an Associate Professor, Department of Global Health, University of Washington, Seattle, Washington, USA
- Barbra Richardson, PhD, is a Research Professor, Departments of Biostatistics and Global Health, University of Washington, Seattle, Washington, USA
- Grace John-Stewart, PhD, MD, is a Professor, Departments of Global Health, Medicine, Pediatrics, and Epidemiology, University of Washington, Seattle, Washington, USA
- Irene Inwani, MBChB, MPH, is an Assistant Director, Kenyatta National Hospital, Nairobi, Kenya
- David Bukusi, MBChB, MMED, is the Director of the VCT and HIV Prevention Unit, Kenyatta National Hospital, Nairobi, Kenya
- Dalton Wamalwa, MBChB, MPH, is an Associate Professor in the Department of Paediatrics, University of Nairobi, Nairobi, Kenya
- Pamela Kohler, PhD, MPH, RN, is an Associate Professor, Department of Global Health, and the Department of Child, Family, and Population Health, School of Nursing, University of Washington, Seattle, Washington, USA
| | - Alvin Onyango
- Kate Wilson, PhD, MPH, is a Clinical Assistant Professor, Department of Global Health, University of Washington, Seattle, Washington, USA
- Alvin Onyango, BSN, is a Study Coordinator, Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
- Cyrus Mugo, MBChB, MPH, is a Doctoral Student, Department of Global Health, University of Washington, Seattle, Washington, USA
- Brandon Guthrie, PhD, MPH, is an Assistant Professor, Departments of Global Health and Epidemiology, University of Washington, Seattle, Washington, USA
- Jennifer Slyker, PhD, is an Associate Professor, Department of Global Health, University of Washington, Seattle, Washington, USA
- Barbra Richardson, PhD, is a Research Professor, Departments of Biostatistics and Global Health, University of Washington, Seattle, Washington, USA
- Grace John-Stewart, PhD, MD, is a Professor, Departments of Global Health, Medicine, Pediatrics, and Epidemiology, University of Washington, Seattle, Washington, USA
- Irene Inwani, MBChB, MPH, is an Assistant Director, Kenyatta National Hospital, Nairobi, Kenya
- David Bukusi, MBChB, MMED, is the Director of the VCT and HIV Prevention Unit, Kenyatta National Hospital, Nairobi, Kenya
- Dalton Wamalwa, MBChB, MPH, is an Associate Professor in the Department of Paediatrics, University of Nairobi, Nairobi, Kenya
- Pamela Kohler, PhD, MPH, RN, is an Associate Professor, Department of Global Health, and the Department of Child, Family, and Population Health, School of Nursing, University of Washington, Seattle, Washington, USA
| | - Cyrus Mugo
- Kate Wilson, PhD, MPH, is a Clinical Assistant Professor, Department of Global Health, University of Washington, Seattle, Washington, USA
- Alvin Onyango, BSN, is a Study Coordinator, Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
- Cyrus Mugo, MBChB, MPH, is a Doctoral Student, Department of Global Health, University of Washington, Seattle, Washington, USA
- Brandon Guthrie, PhD, MPH, is an Assistant Professor, Departments of Global Health and Epidemiology, University of Washington, Seattle, Washington, USA
- Jennifer Slyker, PhD, is an Associate Professor, Department of Global Health, University of Washington, Seattle, Washington, USA
- Barbra Richardson, PhD, is a Research Professor, Departments of Biostatistics and Global Health, University of Washington, Seattle, Washington, USA
- Grace John-Stewart, PhD, MD, is a Professor, Departments of Global Health, Medicine, Pediatrics, and Epidemiology, University of Washington, Seattle, Washington, USA
- Irene Inwani, MBChB, MPH, is an Assistant Director, Kenyatta National Hospital, Nairobi, Kenya
- David Bukusi, MBChB, MMED, is the Director of the VCT and HIV Prevention Unit, Kenyatta National Hospital, Nairobi, Kenya
- Dalton Wamalwa, MBChB, MPH, is an Associate Professor in the Department of Paediatrics, University of Nairobi, Nairobi, Kenya
- Pamela Kohler, PhD, MPH, RN, is an Associate Professor, Department of Global Health, and the Department of Child, Family, and Population Health, School of Nursing, University of Washington, Seattle, Washington, USA
| | - Brandon Guthrie
- Kate Wilson, PhD, MPH, is a Clinical Assistant Professor, Department of Global Health, University of Washington, Seattle, Washington, USA
- Alvin Onyango, BSN, is a Study Coordinator, Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
- Cyrus Mugo, MBChB, MPH, is a Doctoral Student, Department of Global Health, University of Washington, Seattle, Washington, USA
- Brandon Guthrie, PhD, MPH, is an Assistant Professor, Departments of Global Health and Epidemiology, University of Washington, Seattle, Washington, USA
- Jennifer Slyker, PhD, is an Associate Professor, Department of Global Health, University of Washington, Seattle, Washington, USA
- Barbra Richardson, PhD, is a Research Professor, Departments of Biostatistics and Global Health, University of Washington, Seattle, Washington, USA
- Grace John-Stewart, PhD, MD, is a Professor, Departments of Global Health, Medicine, Pediatrics, and Epidemiology, University of Washington, Seattle, Washington, USA
- Irene Inwani, MBChB, MPH, is an Assistant Director, Kenyatta National Hospital, Nairobi, Kenya
- David Bukusi, MBChB, MMED, is the Director of the VCT and HIV Prevention Unit, Kenyatta National Hospital, Nairobi, Kenya
- Dalton Wamalwa, MBChB, MPH, is an Associate Professor in the Department of Paediatrics, University of Nairobi, Nairobi, Kenya
- Pamela Kohler, PhD, MPH, RN, is an Associate Professor, Department of Global Health, and the Department of Child, Family, and Population Health, School of Nursing, University of Washington, Seattle, Washington, USA
| | - Jennifer Slyker
- Kate Wilson, PhD, MPH, is a Clinical Assistant Professor, Department of Global Health, University of Washington, Seattle, Washington, USA
- Alvin Onyango, BSN, is a Study Coordinator, Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
- Cyrus Mugo, MBChB, MPH, is a Doctoral Student, Department of Global Health, University of Washington, Seattle, Washington, USA
- Brandon Guthrie, PhD, MPH, is an Assistant Professor, Departments of Global Health and Epidemiology, University of Washington, Seattle, Washington, USA
- Jennifer Slyker, PhD, is an Associate Professor, Department of Global Health, University of Washington, Seattle, Washington, USA
- Barbra Richardson, PhD, is a Research Professor, Departments of Biostatistics and Global Health, University of Washington, Seattle, Washington, USA
- Grace John-Stewart, PhD, MD, is a Professor, Departments of Global Health, Medicine, Pediatrics, and Epidemiology, University of Washington, Seattle, Washington, USA
- Irene Inwani, MBChB, MPH, is an Assistant Director, Kenyatta National Hospital, Nairobi, Kenya
- David Bukusi, MBChB, MMED, is the Director of the VCT and HIV Prevention Unit, Kenyatta National Hospital, Nairobi, Kenya
- Dalton Wamalwa, MBChB, MPH, is an Associate Professor in the Department of Paediatrics, University of Nairobi, Nairobi, Kenya
- Pamela Kohler, PhD, MPH, RN, is an Associate Professor, Department of Global Health, and the Department of Child, Family, and Population Health, School of Nursing, University of Washington, Seattle, Washington, USA
| | - Barbra Richardson
- Kate Wilson, PhD, MPH, is a Clinical Assistant Professor, Department of Global Health, University of Washington, Seattle, Washington, USA
- Alvin Onyango, BSN, is a Study Coordinator, Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
- Cyrus Mugo, MBChB, MPH, is a Doctoral Student, Department of Global Health, University of Washington, Seattle, Washington, USA
- Brandon Guthrie, PhD, MPH, is an Assistant Professor, Departments of Global Health and Epidemiology, University of Washington, Seattle, Washington, USA
- Jennifer Slyker, PhD, is an Associate Professor, Department of Global Health, University of Washington, Seattle, Washington, USA
- Barbra Richardson, PhD, is a Research Professor, Departments of Biostatistics and Global Health, University of Washington, Seattle, Washington, USA
- Grace John-Stewart, PhD, MD, is a Professor, Departments of Global Health, Medicine, Pediatrics, and Epidemiology, University of Washington, Seattle, Washington, USA
- Irene Inwani, MBChB, MPH, is an Assistant Director, Kenyatta National Hospital, Nairobi, Kenya
- David Bukusi, MBChB, MMED, is the Director of the VCT and HIV Prevention Unit, Kenyatta National Hospital, Nairobi, Kenya
- Dalton Wamalwa, MBChB, MPH, is an Associate Professor in the Department of Paediatrics, University of Nairobi, Nairobi, Kenya
- Pamela Kohler, PhD, MPH, RN, is an Associate Professor, Department of Global Health, and the Department of Child, Family, and Population Health, School of Nursing, University of Washington, Seattle, Washington, USA
| | - Grace John-Stewart
- Kate Wilson, PhD, MPH, is a Clinical Assistant Professor, Department of Global Health, University of Washington, Seattle, Washington, USA
- Alvin Onyango, BSN, is a Study Coordinator, Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
- Cyrus Mugo, MBChB, MPH, is a Doctoral Student, Department of Global Health, University of Washington, Seattle, Washington, USA
- Brandon Guthrie, PhD, MPH, is an Assistant Professor, Departments of Global Health and Epidemiology, University of Washington, Seattle, Washington, USA
- Jennifer Slyker, PhD, is an Associate Professor, Department of Global Health, University of Washington, Seattle, Washington, USA
- Barbra Richardson, PhD, is a Research Professor, Departments of Biostatistics and Global Health, University of Washington, Seattle, Washington, USA
- Grace John-Stewart, PhD, MD, is a Professor, Departments of Global Health, Medicine, Pediatrics, and Epidemiology, University of Washington, Seattle, Washington, USA
- Irene Inwani, MBChB, MPH, is an Assistant Director, Kenyatta National Hospital, Nairobi, Kenya
- David Bukusi, MBChB, MMED, is the Director of the VCT and HIV Prevention Unit, Kenyatta National Hospital, Nairobi, Kenya
- Dalton Wamalwa, MBChB, MPH, is an Associate Professor in the Department of Paediatrics, University of Nairobi, Nairobi, Kenya
- Pamela Kohler, PhD, MPH, RN, is an Associate Professor, Department of Global Health, and the Department of Child, Family, and Population Health, School of Nursing, University of Washington, Seattle, Washington, USA
| | - Irene Inwani
- Kate Wilson, PhD, MPH, is a Clinical Assistant Professor, Department of Global Health, University of Washington, Seattle, Washington, USA
- Alvin Onyango, BSN, is a Study Coordinator, Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
- Cyrus Mugo, MBChB, MPH, is a Doctoral Student, Department of Global Health, University of Washington, Seattle, Washington, USA
- Brandon Guthrie, PhD, MPH, is an Assistant Professor, Departments of Global Health and Epidemiology, University of Washington, Seattle, Washington, USA
- Jennifer Slyker, PhD, is an Associate Professor, Department of Global Health, University of Washington, Seattle, Washington, USA
- Barbra Richardson, PhD, is a Research Professor, Departments of Biostatistics and Global Health, University of Washington, Seattle, Washington, USA
- Grace John-Stewart, PhD, MD, is a Professor, Departments of Global Health, Medicine, Pediatrics, and Epidemiology, University of Washington, Seattle, Washington, USA
- Irene Inwani, MBChB, MPH, is an Assistant Director, Kenyatta National Hospital, Nairobi, Kenya
- David Bukusi, MBChB, MMED, is the Director of the VCT and HIV Prevention Unit, Kenyatta National Hospital, Nairobi, Kenya
- Dalton Wamalwa, MBChB, MPH, is an Associate Professor in the Department of Paediatrics, University of Nairobi, Nairobi, Kenya
- Pamela Kohler, PhD, MPH, RN, is an Associate Professor, Department of Global Health, and the Department of Child, Family, and Population Health, School of Nursing, University of Washington, Seattle, Washington, USA
| | - David Bukusi
- Kate Wilson, PhD, MPH, is a Clinical Assistant Professor, Department of Global Health, University of Washington, Seattle, Washington, USA
- Alvin Onyango, BSN, is a Study Coordinator, Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
- Cyrus Mugo, MBChB, MPH, is a Doctoral Student, Department of Global Health, University of Washington, Seattle, Washington, USA
- Brandon Guthrie, PhD, MPH, is an Assistant Professor, Departments of Global Health and Epidemiology, University of Washington, Seattle, Washington, USA
- Jennifer Slyker, PhD, is an Associate Professor, Department of Global Health, University of Washington, Seattle, Washington, USA
- Barbra Richardson, PhD, is a Research Professor, Departments of Biostatistics and Global Health, University of Washington, Seattle, Washington, USA
- Grace John-Stewart, PhD, MD, is a Professor, Departments of Global Health, Medicine, Pediatrics, and Epidemiology, University of Washington, Seattle, Washington, USA
- Irene Inwani, MBChB, MPH, is an Assistant Director, Kenyatta National Hospital, Nairobi, Kenya
- David Bukusi, MBChB, MMED, is the Director of the VCT and HIV Prevention Unit, Kenyatta National Hospital, Nairobi, Kenya
- Dalton Wamalwa, MBChB, MPH, is an Associate Professor in the Department of Paediatrics, University of Nairobi, Nairobi, Kenya
- Pamela Kohler, PhD, MPH, RN, is an Associate Professor, Department of Global Health, and the Department of Child, Family, and Population Health, School of Nursing, University of Washington, Seattle, Washington, USA
| | - Dalton Wamalwa
- Kate Wilson, PhD, MPH, is a Clinical Assistant Professor, Department of Global Health, University of Washington, Seattle, Washington, USA
- Alvin Onyango, BSN, is a Study Coordinator, Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
- Cyrus Mugo, MBChB, MPH, is a Doctoral Student, Department of Global Health, University of Washington, Seattle, Washington, USA
- Brandon Guthrie, PhD, MPH, is an Assistant Professor, Departments of Global Health and Epidemiology, University of Washington, Seattle, Washington, USA
- Jennifer Slyker, PhD, is an Associate Professor, Department of Global Health, University of Washington, Seattle, Washington, USA
- Barbra Richardson, PhD, is a Research Professor, Departments of Biostatistics and Global Health, University of Washington, Seattle, Washington, USA
- Grace John-Stewart, PhD, MD, is a Professor, Departments of Global Health, Medicine, Pediatrics, and Epidemiology, University of Washington, Seattle, Washington, USA
- Irene Inwani, MBChB, MPH, is an Assistant Director, Kenyatta National Hospital, Nairobi, Kenya
- David Bukusi, MBChB, MMED, is the Director of the VCT and HIV Prevention Unit, Kenyatta National Hospital, Nairobi, Kenya
- Dalton Wamalwa, MBChB, MPH, is an Associate Professor in the Department of Paediatrics, University of Nairobi, Nairobi, Kenya
- Pamela Kohler, PhD, MPH, RN, is an Associate Professor, Department of Global Health, and the Department of Child, Family, and Population Health, School of Nursing, University of Washington, Seattle, Washington, USA
| | - Pamela Kohler
- Kate Wilson, PhD, MPH, is a Clinical Assistant Professor, Department of Global Health, University of Washington, Seattle, Washington, USA
- Alvin Onyango, BSN, is a Study Coordinator, Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
- Cyrus Mugo, MBChB, MPH, is a Doctoral Student, Department of Global Health, University of Washington, Seattle, Washington, USA
- Brandon Guthrie, PhD, MPH, is an Assistant Professor, Departments of Global Health and Epidemiology, University of Washington, Seattle, Washington, USA
- Jennifer Slyker, PhD, is an Associate Professor, Department of Global Health, University of Washington, Seattle, Washington, USA
- Barbra Richardson, PhD, is a Research Professor, Departments of Biostatistics and Global Health, University of Washington, Seattle, Washington, USA
- Grace John-Stewart, PhD, MD, is a Professor, Departments of Global Health, Medicine, Pediatrics, and Epidemiology, University of Washington, Seattle, Washington, USA
- Irene Inwani, MBChB, MPH, is an Assistant Director, Kenyatta National Hospital, Nairobi, Kenya
- David Bukusi, MBChB, MMED, is the Director of the VCT and HIV Prevention Unit, Kenyatta National Hospital, Nairobi, Kenya
- Dalton Wamalwa, MBChB, MPH, is an Associate Professor in the Department of Paediatrics, University of Nairobi, Nairobi, Kenya
- Pamela Kohler, PhD, MPH, RN, is an Associate Professor, Department of Global Health, and the Department of Child, Family, and Population Health, School of Nursing, University of Washington, Seattle, Washington, USA
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Han WM, Law MG, Egger M, Wools-Kaloustian K, Moore R, McGowan C, Kumarasamy N, Desmonde S, Edmonds A, Davies MA, Yiannoutsos C, Althoff KN, Cortes CP, Mohamed TJ, Jaquet A, Anastos K, Euvrard J, Castelnuovo B, Salters K, Coelho LE, Ekouevi DK, Eley B, Diero L, Zaniewski E, Ford N, Sohn AH, Kariminia A. Global estimates of viral suppression in children and adolescents and adults on antiretroviral therapy adjusted for missing viral load measurements: a multiregional, retrospective cohort study in 31 countries. Lancet HIV 2021; 8:e766-e775. [PMID: 34856180 PMCID: PMC8782625 DOI: 10.1016/s2352-3018(21)00265-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 09/12/2021] [Accepted: 09/16/2021] [Indexed: 01/26/2023]
Abstract
BACKGROUND As countries move towards the UNAIDS's 95-95-95 targets and with strong evidence that undetectable equals untransmittable, it is increasingly important to assess whether those with HIV who are receiving antiretroviral therapy (ART) achieve viral suppression. We estimated the proportions of children and adolescents and adults with viral suppression at 1, 2, and 3 years after initiating ART. METHODS In this retrospective cohort study, seven regional cohorts from the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium contributed data from individuals initiating ART between Jan 1, 2010, and Dec 31, 2019, at 148 sites in 31 countries with annual viral load monitoring. Only people with HIV who started ART after the time a site started routine viral load monitoring were included. Data up to March 31, 2020, were analysed. We estimated the proportions of children and adolescents (aged <18 years at ART initiation) and adults (aged ≥18 years at ART initiation) with viral suppression (viral load <1000 copies per mL) at 1, 2, and 3 years after ART initiation using an intention-to-treat approach and an adjusted approach that accounted for missing viral load measurements. FINDINGS 21 594 children and adolescents (11 812 [55%] female, 9782 [45%] male) from 106 sites in 22 countries and 255 662 adults (163 831 [64%] female, 91 831 [36%] male) from 143 sites in 30 countries were included. Using the intention-to-treat approach, the proportion of children and adolescents with viral suppression was 7303 (36%) of 20 478 at 1 year, 5709 (30%) of 19 135 at 2 years, and 4287 (24%) of 17 589 at 3 years after ART initiation; the proportion of adults with viral suppression was 106 541 (44%) of 240 600 at 1 year, 79 141 (36%) of 220 925 at 2 years, and 57 970 (29%) of 201 124 at 3 years after ART initiation. After adjusting for missing viral load measurements among those who transferred, were lost to follow-up, or who were in follow-up without viral load testing, the proportion of children and adolescents with viral suppression was 12 048 (64% [plausible range 43-81]) of 18 835 at 1 year, 10 796 (62% [41-77]) of 17 553 at 2 years, and 9177 (59% [38-91]) of 15 667 at 3 years after ART initiation; the proportion of adults with viral suppression was 176 964 (79% [53-80]) of 225 418 at 1 year, 145 552 (72% [48-79]) of 201 238 at 2 years, and 115 260 (65% [43-69]) of 178 458 at 3 years after ART initiation. INTERPRETATION Although adults with HIV are approaching the global target of 95% viral suppression, progress among children and adolescents is much slower. Substantial efforts are still needed to reach the viral suppression target for children and adolescents. FUNDING US National Institutes of Health.
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Affiliation(s)
- Win Min Han
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia; HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand.
| | - Matthew G Law
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Center for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Richard Moore
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Catherine McGowan
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Nagalingesawaran Kumarasamy
- Chennai Antiviral Research and Treatment Clinical Research Site, The Voluntary Health Services, Chennai, India
| | | | - Andrew Edmonds
- Department of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mary-Ann Davies
- Center for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Keri N Althoff
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Claudia P Cortes
- Fundación Arriaran-Facultad de Medicina Universidad de Chile, Santiago, Chile
| | | | - Antoine Jaquet
- University of Bordeaux, Inserm, French National Research Institute for Sustainable Development, UMR 1219, Bordeaux, France
| | - Kathryn Anastos
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jonathan Euvrard
- Center for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Kate Salters
- British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, BC, Canada
| | - Lara Esteves Coelho
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Didier K Ekouevi
- Program PAC-CI, Abidjan, Côte d'Ivoire; Bordeaux Population Health (UMR1219), Bordeaux, France
| | - Brian Eley
- Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa; Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Lameck Diero
- Department of Medicine, Moi University School of Medicine and Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Elizabeth Zaniewski
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Nathan Ford
- Center for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa; HIV/AIDS Department and Global Hepatitis Program, WHO, Geneva, Switzerland
| | - Annette H Sohn
- TREAT Asia/amfAR, The Foundation for AIDS Research, Bangkok, Thailand
| | - Azar Kariminia
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
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27
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Enane LA, Apondi E, Aluoch J, Bakoyannis G, Lewis Kulzer J, Kwena Z, Kantor R, Chory A, Gardner A, Scanlon M, Goodrich S, Wools-Kaloustian K, Elul B, Vreeman RC. Social, economic, and health effects of the COVID-19 pandemic on adolescents retained in or recently disengaged from HIV care in Kenya. PLoS One 2021; 16:e0257210. [PMID: 34506555 PMCID: PMC8432853 DOI: 10.1371/journal.pone.0257210] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 08/25/2021] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Adolescents living with HIV (ALHIV, ages 10-19) experience complex challenges to adhere to antiretroviral therapy (ART) and remain in care, and may be vulnerable to wide-scale disruptions during the COVID-19 pandemic. We assessed for a range of effects of the pandemic on ALHIV in western Kenya, and whether effects were greater for ALHIV with recent histories of being lost to program (LTP). METHODS ALHIV were recruited from an ongoing prospective study at 3 sites in western Kenya. The parent study enrolled participants from February 2019-September 2020, into groups of ALHIV either 1) retained in care or 2) LTP and traced in the community. Phone interviews from July 2020-January 2021 assessed effects of the pandemic on financial and food security, healthcare access and behaviors, and mental health. Responses were compared among the parent study groups. RESULTS Phone surveys were completed with 334 ALHIV or their caregivers, including 275/308 (89.3%) in the retained group and 59/70 (84.3%) among those LTP at initial enrollment. During the pandemic, a greater proportion of LTP adolescents were no longer engaged in school (45.8% vs. 36.4%, p = 0.017). Over a third (120, 35.9%) of adolescents reported lost income for someone they relied on. In total, 135 (40.4%) did not have enough food either some (121, 36.2%) or most (14, 4.2%) of the time. More LTP adolescents (4/59, 6.8% vs. 2/275, 0.7%, p = 0.010) reported increased difficulties refilling ART. Adolescent PHQ-2 and GAD-2 scores were ≥3 for 5.6% and 5.2%, respectively. CONCLUSIONS The COVID-19 pandemic has had devastating socioeconomic effects for Kenyan ALHIV and their households. ALHIV with recent care disengagement may be especially vulnerable. Meanwhile, sustained ART access and adherence potentially signal resilience and strengths of ALHIV and their care programs. Findings from this survey indicate the critical need for support to ALHIV during this crisis.
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Affiliation(s)
- Leslie A. Enane
- Department of Pediatrics, The Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
- Indiana University Center for Global Health, Indianapolis, Indiana, United States of America
| | - Edith Apondi
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Josephine Aluoch
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Giorgos Bakoyannis
- Department of Biostatistics and Health Data Science, Indiana University, Indianapolis, Indiana, United States of America
| | - Jayne Lewis Kulzer
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, California, United States of America
| | - Zachary Kwena
- Research, Care and Treatment Programme, Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Rami Kantor
- Division of Infectious Diseases, Department of Medicine, Brown University Apert Medical School, Providence, Rhode Island, United States of America
| | - Ashley Chory
- Department of Health System Design and Global Health, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
- Arnhold Institute for Global Health, New York, New York, United States of America
| | - Adrian Gardner
- Indiana University Center for Global Health, Indianapolis, Indiana, United States of America
- Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Michael Scanlon
- Indiana University Center for Global Health, Indianapolis, Indiana, United States of America
| | - Suzanne Goodrich
- Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Kara Wools-Kaloustian
- Indiana University Center for Global Health, Indianapolis, Indiana, United States of America
- Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Batya Elul
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Rachel C. Vreeman
- Department of Health System Design and Global Health, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
- Arnhold Institute for Global Health, New York, New York, United States of America
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28
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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.
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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
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29
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Ballif M, Christ B, Anderegg N, Chammartin F, Muhairwe J, Jefferys L, Hector J, van Dijk J, Vinikoor MJ, van Lettow M, Chimbetete C, Phiri SJ, Onoya D, Fox MP, Egger M. Tracing people living with HIV who are lost to follow-up at ART programs in Southern Africa: A sampling-based cohort study in six countries. Clin Infect Dis 2021; 74:171-179. [PMID: 33993219 DOI: 10.1093/cid/ciab428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Attrition threatens the success of antiretroviral therapy (ART). In this cohort study, we examined outcomes of people living with HIV (PLHIV) lost to follow-up (LTFU) 2014-2017 at ART programs in Southern Africa. METHODS We confirmed LTFU (missed appointment for ≥60 or ≥90 days, according to local guidelines) by checking medical records and used a standardized protocol to trace a weighted random sample of PLHIV who were LTFU in eight ART programs in Lesotho, Malawi, Mozambique, South Africa, Zambia and Zimbabwe, 2017-2019. We ascertained vital status and identified predictors of mortality using logistic regression, adjusted for sex, age, time on ART, time since LTFU, travel time, and urban or rural setting. RESULTS Among 3,256 PLHIV, 385 (12%) were wrongly categorized as LTFU and 577 (17%) had missing contact details. We traced 2,294 PLHIV (71%) by phone calls, home visits or both: 768 (34% of 2,294) were alive and in care, including 385 (17%) silent transfers to another clinic; 528 (23%) were alive without care or unknown care; 252 (11%) had died. Overall, the status of 1,323 (41% of 3,256) PLHIV remained unknown. Mortality was higher in men than women, higher in children than in young people or adults, higher in PLHIV who had been on ART <1 year or lost >1 year, living further from the clinic or in rural areas. Results were heterogeneous across sites. CONCLUSIONS Our study highlights the urgent need for better medical record systems at HIV clinics and rapid tracing of PLHIV who are LTFU.
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Affiliation(s)
- Marie Ballif
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Benedikt Christ
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Nanina Anderegg
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | | | | | | | | | | | | | | | | | | | - Dorina Onoya
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Matthew P Fox
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, South Africa.,Department of Epidemiology and Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Centre for Infectious Disease Research and Epidemiology, University of Cape Town, Cape Town, South Africa.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
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30
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Improving Methods to Classify Perinatal versus Nonperinatal HIV Acquisition in Young Adolescents 10-14 Years of Age. Pediatr Infect Dis J 2021; 40:453-456. [PMID: 33538538 PMCID: PMC8043971 DOI: 10.1097/inf.0000000000003059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Mode of HIV acquisition for adolescents with HIV is often not recorded within routine healthcare databases. Hence, age at enrollment in HIV care is often used as a proxy for perinatal versus nonperinatal infection. Using routine cohort data from adolescents presenting for HIV care 10-14 years of age, we developed logistic regression models to predict likely mode of infection.
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31
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Agwu AL, Flynn PM. Increasing the urgency to identify adolescents and young adults with HIV infection…do or die. AIDS 2021; 35:693-695. [PMID: 33620875 DOI: 10.1097/qad.0000000000002847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Allison L Agwu
- Department of Pediatrics, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Patricia M Flynn
- Department of Infectious Diseases, St. Jude Children's Hospital, Memphis, TN, USA
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Desmonde S, Ciaranello AL, Malateste K, Musick B, Patten G, Vu AT, Edmonds A, Neilan AM, Duda SN, Wools-Kaloustian K, Davies MA, Leroy V. Age-specific mortality rate ratios in adolescents and youth aged 10-24 years living with perinatally versus nonperinatally acquired HIV. AIDS 2021; 35:625-632. [PMID: 33252479 PMCID: PMC7904586 DOI: 10.1097/qad.0000000000002765] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 11/03/2020] [Accepted: 11/09/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To measure mortality incidence rates and incidence rate ratios (IRR) in adolescents and youth living with perinatally acquired HIV (YPHIV) compared with those living with nonperinatally acquired HIV (YNPHIV), by region, by sex, and during the ages of 10-14, 15-19, and 20-24 years in IeDEA. DESIGN AND METHODS All those with a confirmed HIV diagnosis, antiretroviral therapy (ART)-naive at enrollment, and who have post-ART follow-up while aged 10-24 years between 2004 and 2016 were included. We estimated post-ART mortality incidence rates and 95% confidence intervals (95% CI) per 100 person-years for YPHIV (enrolled into care <10 years of age) and YNPHIV (enrolled ≥10 years and <25 years). We estimate mortality IRRs in a negative binomial regression model, adjusted for sex, region time-varying age, CD4+ cell count at ART initiation (<350 cells/μl, ≥350 cells/μl, unknown), and time on ART (<12 and ≥12 months). RESULTS Overall, 104 846 adolescents and youth were included: 21 340 (20%) YPHIV (50% women) and 83 506 YNPHIV (80% women). Overall mortality incidence ratios were higher among YNPHIV (incidence ratio: 2.3/100 person-years; 95% CI: 2.2-2.4) compared with YPHIV (incidence ratio: 0.7/100 person-years; 95% CI: 0.7-0.8). Among adolescents aged 10-19 years, mortality was lower among YPHIV compared with YNPHIV (all IRRs <1, ranging from 0.26, 95% CI: 0.13-0.49 in 10-14-year-old boys in the Asia-Pacific to 0.51, 95% CI: 0.30-0.87 in 15-19-year-old boys in West Africa). CONCLUSION We report substantial amount of deaths occurring during adolescence. Mortality was significantly higher among YNPHIV compared to YPHIV. Specific interventions including HIV testing and early engagement in care are urgently needed to improve survival among YNPHIV.
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Affiliation(s)
- Sophie Desmonde
- Inserm U1027, Université Paul Sabatier Toulouse 3, Toulouse, France
| | - Andrea L. Ciaranello
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Karen Malateste
- Inserm U1219
- Bordeaux Population Health Center, Université de Bordeaux, Bordeaux, France
| | - Beverly Musick
- School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Gabriela Patten
- School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - An Thien Vu
- Children's Hospital 2, Ho Chi Minh City, Vietnam
| | - Andrew Edmonds
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Anne M. Neilan
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts
| | - Stephany N. Duda
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | | | - Mary-Ann Davies
- School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Valériane Leroy
- Inserm U1027, Université Paul Sabatier Toulouse 3, Toulouse, France
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Predictors of retention in the prospective HIV prevention OKAPI cohort in Kinshasa. Sci Rep 2021; 11:5431. [PMID: 33686218 PMCID: PMC7970874 DOI: 10.1038/s41598-021-84839-w] [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: 03/10/2020] [Accepted: 02/15/2021] [Indexed: 11/08/2022] Open
Abstract
Retention is a key element in HIV prevention programs. In Sub-Saharan Africa most data on retention come from HIV clinical trials or people living with HIV attending HIV treatment and control programs. Data from observational cohorts are less frequent. Retention at 6-/12-month follow-up and its predictors were analyzed in OKAPI prospective cohort. From April 2016 to April 2018, 797 participants aged 15-59 years attending HIV Voluntary Counseling and Testing in Kinshasa were interviewed about HIV-related knowledge and behaviors at baseline and at 6- and 12-month follow-ups. Retention rates were 57% and 27% at 6- and 12-month follow up; 22% of participants attended both visits. Retention at 6-month was significantly associated with 12-month retention. Retention was associated with low economic status, being studying, daily/weekly Internet access, previous HIV tests and aiming to share HIV test with partner. Contrarily, perceiving a good health, living far from an antiretroviral center, daily/weekly alcohol consumption and perceiving frequent HIV information were inversely associated with retention. In conclusion, a high attrition was found among people attending HIV testing participating in a prospective cohort in Kinshasa. Considering the low retention rates and the predictors found in this study, more HIV cohort studies in Kinshasa need to be evaluated to identify local factors and strategies that could improve retention if needed.
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Tymejczyk O, Brazier E, Wools-Kaloustian K, Davies MA, Dilorenzo M, Edmonds A, Vreeman R, Bolton C, Twizere C, Okoko N, Phiri S, Nakigozi G, Lelo P, von Groote P, Sohn AH, Nash D. Impact of Universal Antiretroviral Treatment Eligibility on Rapid Treatment Initiation Among Young Adolescents with Human Immunodeficiency Virus in Sub-Saharan Africa. J Infect Dis 2021; 222:755-764. [PMID: 31682261 DOI: 10.1093/infdis/jiz547] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 10/19/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Young adolescents with perinatally acquired human immunodeficiency virus (HIV) are at risk for poor care outcomes. We examined whether universal antiretroviral treatment (ART) eligibility policies (Treat All) improved rapid ART initiation after care enrollment among 10-14-year-olds in 7 sub-Saharan African countries. METHODS Regression discontinuity analysis and data for 6912 patients aged 10-14-years were used to estimate changes in rapid ART initiation (within 30 days of care enrollment) after adoption of Treat All policies in 2 groups of countries: Uganda and Zambia (policy adopted in 2013) and Burundi, Democratic Republic of the Congo, Kenya, Malawi, and Rwanda (policy adopted in 2016). RESULTS There were immediate increases in rapid ART initiation among young adolescents after national adoption of Treat All. Increases were greater in countries adopting the policy in 2016 than in those adopting it in 2013: 23.4 percentage points (pp) (95% confidence interval, 13.9-32.8) versus 11.2pp (2.5-19.9). However, the rate of increase in rapid ART initiation among 10-14-year-olds rose appreciably in countries with earlier treatment expansions, from 1.5pp per year before Treat All to 7.7pp per year afterward. CONCLUSIONS Universal ART eligibility has increased rapid treatment initiation among young adolescents enrolling in HIV care. Further research should assess their retention in care and viral suppression under Treat All.
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Affiliation(s)
- Olga Tymejczyk
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA
| | - Ellen Brazier
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, 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
| | - Madeline Dilorenzo
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA.,Boston Medical Center, Boston, Massachusetts, USA
| | - Andrew Edmonds
- Department of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Rachel Vreeman
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Carolyn Bolton
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | | | | | | | | | - Patricia Lelo
- Kalembelembe Pediatric Hospital, Kinshasa, Democratic Republic of the Congo
| | - Per von Groote
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Annette H Sohn
- TREAT Asia, amfAR-The Foundation for AIDS Research, Bangkok, Thailand
| | - Denis Nash
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA.,Department of Epidemiology and Biostatistics, School of Public Health, City University of New York, New York, NY, USA
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Enane LA, Christenson JC. Global emerging resistance in pediatric infections with TB, HIV, and gram-negative pathogens. Paediatr Int Child Health 2021; 41:65-75. [PMID: 33305992 PMCID: PMC8243638 DOI: 10.1080/20469047.2020.1853350] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 11/13/2020] [Indexed: 12/28/2022]
Abstract
Infants, children and adolescents are at risk of life-threatening, antimicrobial-resistant infections. Global burdens of drug-resistant TB, HIV and gram-negative pathogens have a particular impact on paediatric age groups, necessitating a paediatric-focused agenda to address emerging resistance. Dedicated approaches are needed to find, successfully treat and prevent resistant infections in paediatric populations worldwide. Challenges include the diagnosis and identification of resistant infections, limited access to novel antimicrobials or to paediatric-friendly formulations, limited access to research and clinical trials and implementation challenges related to prevention and successful completion of treatment. In this review, the particular complexities of emerging resistance in TB, HIV and gram-negative pathogens in children, with attention to both clinical and public health challenges, are highlighted. Key principles of a paediatric-focused agenda to address antimicrobial resistance are outlined. They include quality of care, increasing equitable access to key diagnostics, expanding antimicrobial stewardship and infection prevention across global settings, and health system strengthening. Increased access to research studies, including clinical trials, is needed. Further study and implementation of care models and strategies for child- or adolescent-centred management of infections such as HIV and TB can critically improve outcome and avoid development of resistance. As the current global pandemic of a novel coronavirus, SARS-CoV-2, threatens to disrupt health systems and services for vulnerable populations, this is a critical time to mitigate against a potential surge in the incidence of resistant infections.
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Affiliation(s)
- Leslie A Enane
- Department of Pediatrics Indiana University School of Medicine, Ryan White Center for Pediatric Infectious Disease and Global Health, Indianapolis, IN, USA
| | - John C Christenson
- Department of Pediatrics Indiana University School of Medicine, Ryan White Center for Pediatric Infectious Disease and Global Health, Indianapolis, IN, USA
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Mapangisana T, Machekano R, Kouamou V, Maposhere C, McCarty K, Mudzana M, Munyati S, Mutsvangwa J, Manasa J, Shamu T, Bogoshi M, Israelski D, Katzenstein D. Viral load care of HIV-1 infected children and adolescents: A longitudinal study in rural Zimbabwe. PLoS One 2021; 16:e0245085. [PMID: 33444325 PMCID: PMC7808638 DOI: 10.1371/journal.pone.0245085] [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: 07/05/2020] [Accepted: 12/22/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Maintaining virologic suppression of children and adolescents on ART in rural communities in sub-Saharan Africa is challenging. We explored switching drug regimens to protease inhibitor (PI) based treatment and reducing nevirapine and zidovudine use in a differentiated community service delivery model in rural Zimbabwe. METHODS From 2016 through 2018, we followed 306 children and adolescents on ART in Hurungwe, Zimbabwe at Chidamoyo Christian Hospital, which provides compact ART regimens at 8 dispersed rural community outreach sites. Viral load testing was performed (2016) by Roche and at follow-up (2018) by a point of care viral load assay. Virologic failure was defined as viral load ≥1,000 copies/ml. A logistic regression model which included demographics, treatment regimens and caregiver's characteristics was used to assess risks for virologic failure and loss to follow-up (LTFU). RESULTS At baseline in 2016, 296 of 306 children and adolescents (97%) were on first-line ART, and only 10 were receiving a PI-based regimen. The median age was 12 years (IQR 8-15) and 55% were female. Two hundred and nine (68%) had viral load suppression (<1,000 copies/ml) and 97(32%) were unsuppressed (viral load ≥1000). At follow-up in 2018, 42/306 (14%) were either transferred 23 (7%) or LTFU 17 (6%) and 2 had died. In 2018, of the 264 retained in care, 107/264 (41%), had been switched to second-line, ritonavir-boosted PI with abacavir as a new nucleotide analog reverse transcriptase inhibitor (NRTI). Overall viral load suppression increased from 68% in 2016 to 81% in 2018 (P<0.001). CONCLUSION Viral load testing, and switching to second-line, ritonavir-boosted PI with abacavir significantly increased virologic suppression among HIV-infected children and adolescents in rural Zimbabwe.
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Affiliation(s)
- Tichaona Mapangisana
- Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, University of Stellenbosch, Cape Town, South Africa
| | - Rhoderick Machekano
- Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, University of Stellenbosch, Cape Town, South Africa
- Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, United States of America
| | - Vinie Kouamou
- Department of Medicine, University of Zimbabwe, Harare, Zimbabwe
| | | | | | | | - Shungu Munyati
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | | | - Justen Manasa
- Department of Medical Microbiology, University of Zimbabwe, Harare, Zimbabwe
- African Institute for Biomedical Sciences and Technology, Harare, Zimbabwe
| | - Tinei Shamu
- Newlands Clinic, Harare, Zimbabwe
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Mampedi Bogoshi
- Gilead Sciences Inc., Foster City, California, United States of America
| | - Dennis Israelski
- Gilead Sciences Inc., Foster City, California, United States of America
| | - David Katzenstein
- Biomedical Research and Training Institute, Harare, Zimbabwe
- Department of Medicine, Stanford University School of Medicine, Stanford, California, United States of America
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Chory A, Nyandiko W, Martin R, Aluoch J, Scanlon M, Ashimosi C, Njoroge T, McAteer C, Apondi E, Vreeman R. HIV-Related Knowledge, Attitudes, Behaviors and Experiences of Kenyan Adolescents Living with HIV Revealed in WhatsApp Group Chats. J Int Assoc Provid AIDS Care 2021; 20:2325958221999579. [PMID: 33657911 PMCID: PMC7940722 DOI: 10.1177/2325958221999579] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 02/02/2021] [Accepted: 02/08/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Mobile technologies represent a scalable platform for delivering knowledge and interventions targeting adolescents living with HIV (ALWH) in low and middle income countries. Data from mobile interventions can be used to assess the contextual understanding and experiences of ALWH. METHODS We examined HIV-related knowledge, attitudes, beliefs, behaviors, and experiences of Kenyan ALWH revealed in the contextual data from enrollment in a WhatsApp® group chat intervention. RESULTS Thirty ALWH (17 female, mean age 15.4) on ART, engaged in HIV care and aware of their status, were enrolled. Qualitative analysis of WhatsApp® chat discussions identified a gap in HIV knowledge, high medication-taking literacy, need for mental health support and significant barriers to adherence. Participants discussed challenges with HIV stigma and medication-taking in the school setting. CONCLUSION These discussions demonstrate a need for education on HIV topics, mental health support for ALWH, and interventions for stigma mitigation in the school setting.
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Affiliation(s)
- Ashley Chory
- Department of Global Health and Health System Design, Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Winstone Nyandiko
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Moi Teaching and Referral Hospital, Eldoret, Kenya
- Department of Child Health and Paediatrics, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Roxanne Martin
- Department of Global Health and Health System Design, Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Josephine Aluoch
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Michael Scanlon
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Indiana University School of Medicine, Indiana, USA
| | | | - Tabitha Njoroge
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | | | - Edith Apondi
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Moi Teaching and Referral Hospital, Eldoret, Kenya
- Department of Child Health and Paediatrics, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Rachel Vreeman
- Department of Global Health and Health System Design, Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Indiana University School of Medicine, Indiana, USA
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Sohn AH, Bekker LG. Rethinking the challenges of paediatric HIV diagnosis. Lancet HIV 2020; 8:e123-e124. [PMID: 33197392 DOI: 10.1016/s2352-3018(20)30270-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 09/18/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Annette H Sohn
- TREAT Asia, amfAR-The Foundation for AIDS Research, Bangkok 10110, Thailand.
| | - Linda-Gail Bekker
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
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Abstract
Human immunodeficiency virus (HIV) is one of the most serious pediatric infectious diseases, affecting around 3 million children and adolescents worldwide. Lifelong antiretroviral treatment (ART) provides multiple benefits including sustained virologic suppression, restoration and preservation of immune function, decreased morbidity and mortality, and improved quality of life. However, access to ART, particularly among neonates and young infants, continues to be challenging due to limited number of suitable formulations and limited access to pediatric ARV drug. Moreover, children and adolescents living with HIV may experience long-term HIV- and ART-associated comorbidities including cardiovascular, renal, neurological, and metabolic complications. We provide an overview of currently available formulations, dosing, and safety considerations for pediatric antiretroviral drugs by drug classes and according to the three age groups including neonates, children, and adolescents.
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Affiliation(s)
- Sahera Dirajlal-Fargo
- Pediatric Infectious Diseases, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
| | - Wei Li A Koay
- Department of Pediatrics, School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA.,Division of Infectious Diseases, Children's National Medical Center, Washington, DC, USA
| | - Natella Rakhmanina
- Department of Pediatrics, School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA.,Division of Infectious Diseases, Children's National Medical Center, Washington, DC, USA.,Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, USA
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Determining standardized causes of death of infants, children, and adolescents living with HIV in Asia. AIDS 2020; 34:1527-1537. [PMID: 32443064 DOI: 10.1097/qad.0000000000002583] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To implement a standardized cause of death reporting and review process to systematically disaggregate causes of HIV-related deaths in a cohort of Asian children and adolescents. DESIGN Death-related data were retrospectively and prospectively assessed in a longitudinal regional cohort study. METHODS Children under routine HIV care at sites in Cambodia, India, Indonesia, Malaysia, Thailand, and Vietnam between 2008 and 2017 were followed. Causes of death were reported and then independently and centrally reviewed. Predictors were compared using competing risks survival regression analyses. RESULTS Among 5918 children, 5523 (93%; 52% male) had ever been on combination antiretroviral therapy. Of 371 (6.3%) deaths, 312 (84%) occurred in those with a history of combination antiretroviral therapy (crude all-cause mortality 9.6 per 1000 person-years; total follow-up time 32 361 person-years). In this group, median age at death was 7.0 (2.9-13) years; median CD4 cell count was 73 (16-325) cells/μl. The most common underlying causes of death were pneumonia due to unspecified pathogens (17%), tuberculosis (16%), sepsis (8.0%), and AIDS (6.7%); 12% of causes were unknown. These clinical diagnoses were further grouped into AIDS-related infections (22%) and noninfections (5.8%), and non-AIDS-related infections (47%) and noninfections (11%); with 12% unknown, 2.2% not reviewed. Higher CD4 cell count and better weight-for-age z-score were protective against death. CONCLUSION Our standardized cause of death assessment provides robust data to inform regional resource allocation for pediatric diagnostic evaluations and prioritization of clinical interventions, and highlight the continued importance of opportunistic and nonopportunistic infections as causes of death in our cohort.
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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
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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.
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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
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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.
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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
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Chammartin F, Dao Ostinelli CH, Anastos K, Jaquet A, Brazier E, Brown S, Dabis F, Davies MA, Duda SN, Malateste K, Nash D, Wools-Kaloustian K, von Groote PM, Egger M. International epidemiology databases to evaluate AIDS (IeDEA) in sub-Saharan Africa, 2012-2019. BMJ Open 2020; 10:e035246. [PMID: 32414825 PMCID: PMC7232622 DOI: 10.1136/bmjopen-2019-035246] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 02/21/2020] [Accepted: 04/14/2020] [Indexed: 02/06/2023] Open
Abstract
PURPOSE The objectives of the International epidemiology databases to evaluate AIDS (IeDEA) are to (i) evaluate the delivery of combination antiretroviral therapy (ART) in children, adolescents and adults in sub-Saharan Africa, (ii) to describe ART regimen effectiveness, durability and tolerability, (iii) to examine HIV-related comorbidities and coinfections and (iv) to examine the pregnancy-related and HIV-related outcomes of women on ART and their infants exposed to HIV or ART in utero or via breast milk. PARTICIPANTS IeDEA is organised in four regions (Central, East, Southern and West Africa), with 240 treatment and care sites, six data centres at African, European and US universities, and almost 1.4 million children, adolescents and adult people living with HIV (PLWHIV) enrolled. FINDINGS TO DATE The data include socio-demographic characteristics, clinical outcomes, opportunistic events, treatment regimens, clinic visits and laboratory measurements. They have been used to analyse outcomes in PLWHIV-1 or PLWHIV-2 who initiate ART, including determinants of mortality, of switching to second-line and third-line ART, drug resistance, loss to follow-up and the immunological and virological response to different ART regimens. Programme-level estimates of mortality have been corrected for loss to follow-up. We examined the impact of coinfection with hepatitis B and C, and the epidemiology of different cancers and of (multidrug resistant) tuberculosis, renal disease and of mental illness. The adoption of 'Treat All', making ART available to all PLWHIV regardless of CD4+ cell count or clinical stage was another important research topic. FUTURE PLANS IeDEA has formulated several research priorities for the 'Treat All' era in sub-Saharan Africa. It recently obtained funding to set up sentinel sites where additional data are prospectively collected on cardiometabolic risks factors as well as mental health and liver diseases, and is planning to create a drug resistance database.
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Affiliation(s)
| | - Cam Ha Dao Ostinelli
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Kathryn Anastos
- Departments of Medicine and Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Antoine Jaquet
- French National Research Institute for Sustainable Development (IRD), Inserm, UMR 1219, University of Bordeaux, Bordeaux, France
| | - Ellen Brazier
- Institute for Implementation Science in Population Health, City University of New York, New York, New York, USA
- Graduate School of Public Health and Health Policy, City University of New York, New York, New York, USA
| | - Steven Brown
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Francois Dabis
- French National Research Institute for Sustainable Development (IRD), Inserm, UMR 1219, University of Bordeaux, Bordeaux, France
| | - Mary-Ann Davies
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Stephany N Duda
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Karen Malateste
- French National Research Institute for Sustainable Development (IRD), Inserm, UMR 1219, University of Bordeaux, Bordeaux, France
| | - Denis Nash
- Institute for Implementation Science in Population Health, City University of New York, New York, New York, USA
- Graduate School of Public Health and Health Policy, City University of New York, New York, New York, USA
| | - Kara Wools-Kaloustian
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Per M von Groote
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Rondebosch, Western Cape, South Africa
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45
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Adolescents living with HIV are at higher risk of death and loss to follow up from care: Analysis of cohort data from eight health facilities in Ethiopia. PLoS One 2019; 14:e0223655. [PMID: 31622391 PMCID: PMC6797201 DOI: 10.1371/journal.pone.0223655] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 09/25/2019] [Indexed: 11/23/2022] Open
Abstract
Background There are limited data on the treatment outcomes of adolescents living with HIV. Our objective was to compare mortality and loss to follow up (LTFU) rates between adolescent and younger age groups at enrollment in care. Methods This was a retrospective cohort study carried out in eight health facilities in two regions of Ethiopia. Adolescents (age 10–14 and 15–19 year) and children (age 0–9 year) enrolled in chronic HIV care between 2005 and 2013 constituted the study population. We reviewed the individual patient charts between March and June 2014 and updated the data on the status of each patient through December 2015. We used death and loss-to-follow up as primary endpoints and used the Cox-regression analysis where age, categorized as adolescent versus child, was the main predictor variable. Results Of 2058 participants studied, 52.1% were adolescents. The cohort contributed 2422 person-years of observation (PYO) during the pre-ART follow-up, whereas 1531 patients put on ART contributed 5984 PYO. Of those put on ART, 209 (13.7%) LTFU and 92 (6%) deaths were reported. Adolescents in age group 15–19 yr had the highest risk of LTFU [adjusted hazard ratio, aHR (95% CI) = 3.1 2.1, 5.0 ] followed by those in age group 10–14 yr (aHR = 1.5 [0.9, 2.3]) compared with children aged 0–9 yr. Mortality hazard was significantly higher among younger adolescents (aHR = 2.8 [1.4, 5.4]) and older adolescents (aHR = 2.3 [1.1, 4.9]) compared with children. Conclusions Adolescents are at higher risk of mortality and LTFU as compared to children ages 0–9. Younger adolescents and children had similar LTFU rates. Narrow age band disaggregated analysis can serve as useful guide for tailoring interventions to the specific needs of different age groups.
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Enane LA, Apondi E, Toromo J, Bosma C, Ngeresa A, Nyandiko W, Vreeman RC. "A problem shared is half solved" - a qualitative assessment of barriers and facilitators to adolescent retention in HIV care in western Kenya. AIDS Care 2019; 32:104-112. [PMID: 31554414 DOI: 10.1080/09540121.2019.1668530] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Adolescents living with HIV (ALHIV, ages 10-19) are retained in care at low rates, resulting in poor clinical outcomes. We investigated barriers and facilitators to retention experienced by perinatally infected ALHIV in western Kenya. This qualitative study purposefully sampled hospitalized ALHIV (engaged and not currently engaged in care), ALHIV engaged in outpatient care, and caregivers of ALHIV. In total, 116 ALHIV and caregivers participated in interviews or focus group discussions. Challenges related to the effects of both stigma and poverty at multiple socio-ecological levels pose the greatest barriers to adolescent retention in HIV care. Adolescents with positive relationships with family, clinic, and/or peers with the resources to support their care are facilitated to overcome these barriers. Conversely, adolescents with few of these supports due to orphanhood, caregiver illness, severe poverty, family conflicts, negative relationships with healthcare workers, or isolation, have the greatest challenges staying in care, and maybe at risk of disengagement. Experiences of trauma emerged from narratives of disengagement, and contribute to isolation, mental health challenges, and difficulties engaging in care. Retention of the most vulnerable adolescents will require interventions to mitigate the impacts of stigma, poverty, mental health issues, and limited social support on HIV care engagement.
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Affiliation(s)
- Leslie A Enane
- The Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.,Academic Model Providing Access To Healthcare (AMPATH), Eldoret, Kenya
| | - Edith Apondi
- Academic Model Providing Access To Healthcare (AMPATH), Eldoret, Kenya.,Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Judith Toromo
- Academic Model Providing Access To Healthcare (AMPATH), Eldoret, Kenya
| | | | - Antony Ngeresa
- Academic Model Providing Access To Healthcare (AMPATH), Eldoret, Kenya
| | - Winstone Nyandiko
- Academic Model Providing Access To Healthcare (AMPATH), Eldoret, Kenya.,Department of Child Health and Pediatrics, School of Medicine, Moi University College of Health Sciences, Eldoret, Kenya
| | - Rachel C Vreeman
- The Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.,Academic Model Providing Access To Healthcare (AMPATH), Eldoret, Kenya.,Department of Child Health and Pediatrics, School of Medicine, Moi University College of Health Sciences, Eldoret, Kenya.,Department of Health System Design and Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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