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Mulinge MM, Kibui NK, Kimani H, Wainaina J, Bwana P, Omondi M, Wafula K, Wamalwa DC, Omondi EO, Nduati RW, Mwau M. Factors associated with viral load non-suppression among treatment-experienced pre-teenage children living with HIV in Kenya: a nationwide population-based cohort study, 2015-2021. EClinicalMedicine 2024; 68:102454. [PMID: 38333535 PMCID: PMC10850406 DOI: 10.1016/j.eclinm.2024.102454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 01/13/2024] [Accepted: 01/15/2024] [Indexed: 02/10/2024] Open
Abstract
Background Viral load non-suppression (VLNS) in children is a major public health concern because of attendant HIV disease progression and risk of morbidity and mortality. Based on a nationally representative database we present estimates of the prevalence, trends and factors associated with VLNS in Kenyan pre-teenage children between 2015 and 2021. Methods Kenya National AIDS & STI Control Program's (NASCOP) maintains an early infant diagnosis and viral load (EID/VL) database for all persons living with HIV who are enrolled in the country's primary care clinics for purposes of monitoring progress towards achievement of the 95% viral suppression goals. Participants were eligible if they were children living with HIV (CLHIV), on combination ART (cART) treatment, and ≤12 years old. The modified Mann-Kendall trend test for serially correlated data was used to identify VLNS trends. Generalized estimating equations (GEE) with a logit link was used to assess the effects of covariates on the odds of VLNS (VL ≥1,000 copies/mL) over repeated points in time, allowing for the correlation among the repeated measures. Findings Between January 2015 and December 2021, 508,743 viral load tests were performed on samples collected from 109,682 pre-teenage children. The prevalence of VLNS decreased from 22.9% (95% CI 22.4-23.3) to 12.5% (95% CI 12.1-12.9), p < 0.0001, and mean age increased from 3.1 (4.2) to 8.0 (3.2) years in 2015 and 2021 respectively. A modified Mann-Kendall trend test for serially correlated data denotes a statistically significant decreasing trend (τ = -0.300, p < 0.0001) over the study period. In the multivariable GEE analysis adjusted for covariates, the odds of VLNS decreased by 11% per year during the study period, (GEE-aOR 0.89, 95% CI 0.88-0.90; p < 0.0001). Factors positively associated with VLNS were EFV/NVP-based first-line cART regimen (GEE-aOR 1.74, 95% CI 1.65-1.84, p < 0.0001), PI-based cART regimen (GEE-aOR 1.82, 95% CI 1.72-1.92, p < 0.0001), and children aged 1-3 years (toddlers) (GEE-aOR: 1.84, 95% CI 1.79-1.90, p < 0.0001). On the contrary, DTG-based cART regimen, were negatively associated with VLNS (GEE-aOR 0.70, 95% CI 0.65-0.75, p < 0.0001). Interpretation There is a strong evidence of decreasing viremia between 2015 and 2021. To sustain the decreasing trend, accelerating the switch from the suboptimal EVP/NVP first-line regimen to optimised DTG regimen is warranted. Funding U.S. President's Emergency Plan for AIDS Relief (PEPFAR) and Clinton Health Access Initiative (CHAI).
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Affiliation(s)
| | - Nancy K. Kibui
- Department of Biochemistry, University of Nairobi, Nairobi, Kenya
- Centre for Infectious and Parasitic Diseases Control Research, Kenya Medical Research Institute, Busia, Kenya
| | - Humphrey Kimani
- Centre for Infectious and Parasitic Diseases Control Research, Kenya Medical Research Institute, Busia, Kenya
| | - Joseph Wainaina
- Centre for Infectious and Parasitic Diseases Control Research, Kenya Medical Research Institute, Busia, Kenya
| | - Priska Bwana
- Centre for Infectious and Parasitic Diseases Control Research, Kenya Medical Research Institute, Busia, Kenya
| | - Martin Omondi
- Centre for Infectious and Parasitic Diseases Control Research, Kenya Medical Research Institute, Busia, Kenya
| | - Kevin Wafula
- Centre for Infectious and Parasitic Diseases Control Research, Kenya Medical Research Institute, Busia, Kenya
| | - Dalton C. Wamalwa
- Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Evans O. Omondi
- African Population and Health Research Center, Nairobi, Kenya
- Institute of Mathematical Sciences, Strathmore University, Nairobi, Kenya
| | - Ruth W. Nduati
- Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Matilu Mwau
- Centre for Infectious and Parasitic Diseases Control Research, Kenya Medical Research Institute, Busia, Kenya
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Mburia-Mwalili A, Wagner KD, Kwobah EK, Atwoli L, Aluda M, Simmons B, Lewis-Kulzer J, Goodrich S, Wools-Kaloustian K, Syvertsen JL. Social support and the effects of the COVID-19 pandemic among a cohort of people living with HIV (PLWH) in Western Kenya. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0000778. [PMID: 36962963 PMCID: PMC10022114 DOI: 10.1371/journal.pgph.0000778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 01/22/2023] [Indexed: 03/04/2023]
Abstract
As coronavirus disease (COVID-19) was declared a pandemic in 2020, countries around the world implemented various prevention strategies, such as banning of public and social gatherings, restriction in movement, etc. These efforts may have had a deleterious effect on already vulnerable populations, including people living with HIV (PLWH). PLWH were concerned about contracting COVID-19, the impact of COVID-19 on their social networks that provide social support, and the continued availability of antiretroviral medications during the pandemic. In addition, their mental health may have been exacerbated by the pandemic. The purpose of this study was to explore pandemic-related concerns among a cohort of PLWH in Kenya and investigate social support factors associated with symptoms of depression and anxiety. This study is part of a larger cohort study that recruited from two clinics in Western Kenya. Data are drawn from 130 PLWH who participated in two phone surveys about experiences during the pandemic in 2020 and 2021. Participants reported a variety of concerns over the course of the pandemic and we documented statistically significant increases in symptoms of depression and anxiety over time, which affected some participants' ability to adhere to their antiretroviral medication. However, a small but statistically significant group of participants reached out to expand their networks and mobilize support in the context of experiencing mental health and adherence challenges, speaking to the importance of social support as a coping strategy during times of stress. Our findings call for holistic approaches to HIV care that consider the broader political, economic, and social contexts that shape its effectiveness.
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Affiliation(s)
- Adel Mburia-Mwalili
- School of Public Health, University of Nevada, Reno, Nevada, United States of America
| | - Karla D. Wagner
- School of Public Health, University of Nevada, Reno, Nevada, United States of America
| | - Edith Kamaru Kwobah
- Mental Health Department, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Lukoye Atwoli
- Department of Mental Health and Behavioural Sciences, Moi University School of Medicine, Eldoret, Kenya
- Department of Medicine, Brain and Mind Institute, Medical College East Africa, The Aga Khan University, Nairobi, Kenya
| | - Maurice Aluda
- Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Brianna Simmons
- Department of Anthropology, University of California, Riverside, California, United States of America
| | - Jayne Lewis-Kulzer
- Department of Obstetrics, Gynecology & Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California, San Francisco, California, United States of America
| | - Suzanne Goodrich
- Department of Medicine, School of Medicine, Indiana University, Indianapolis, Indiana, United States of America
| | - Kara Wools-Kaloustian
- Department of Medicine, School of Medicine, Indiana University, Indianapolis, Indiana, United States of America
| | - Jennifer L. Syvertsen
- Department of Anthropology, University of California, Riverside, California, United States of America
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Bernard C, Hassan SA, Humphrey J, Thorne J, Maina M, Jakait B, Brown E, Yongo N, Kerich C, Changwony S, Qian SRW, Scallon AJ, Komanapalli SA, Enane LA, Oyaro P, Abuogi LL, Wools-Kaloustian K, Patel RC. Impacts of the COVID-19 pandemic on access to HIV and reproductive health care among women living with HIV (WLHIV) in Western Kenya: A mixed methods analysis. Front Glob Womens Health 2022; 3:943641. [PMID: 36578364 PMCID: PMC9790904 DOI: 10.3389/fgwh.2022.943641] [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: 05/14/2022] [Accepted: 11/18/2022] [Indexed: 12/14/2022] Open
Abstract
Introduction The COVID-19 pandemic has impacted access to health services. Our objective was to understand the pandemic's impact on access to HIV, pregnancy, and family planning (FP) care among women living with HIV (WLHIV). Methods Data were collected after June 2020, when questions about the pandemic were added to two ongoing mixed methods studies using telephone surveys and in-depth interviews among WLHIV in western Kenya. The Chaguo Langu (CL) study includes primarily non-pregnant WLHIV receiving HIV care at 55 facilities supported by AMPATH and the Opt4Mamas study includes pregnant WLHIV receiving antenatal care at five facilities supported by FACES. Our outcomes were self-reported increased difficulty refilling medication, accessing care, and managing FP during the pandemic. We summarized descriptive data and utilized multivariable logistic regression to evaluate predictors of difficulty refilling medication and accessing care. We qualitatively analyzed the interviews using inductive coding with thematic analysis. Results We analyzed 1,402 surveys and 15 in-depth interviews. Many (32%) CL participants reported greater difficulty refilling medications and a minority (14%) reported greater difficulty accessing HIV care during the pandemic. Most (99%) Opt4Mamas participants reported no difficulty refilling medications or accessing HIV/pregnancy care. Among the CL participants, older women were less likely (aOR = 0.95, 95% CI: 0.92-0.98) and women with more children were more likely (aOR = 1.13, 95% CI: 1.00-1.28) to report difficulty refilling medications. Only 2% of CL participants reported greater difficulty managing FP and most (95%) reported no change in likelihood of using FP or desire to get pregnant. Qualitative analysis revealed three major themes: (1) adverse organizational/economic implications of the pandemic, (2) increased importance of pregnancy prevention during the pandemic, and (3) fear of contracting COVID-19. Discussion The two unique participant groups included in our study encountered overlapping problems during the COVID-19 epidemic. Access to HIV services and antiretrovirals was interrupted for a large proportion of non-pregnant WLHIV in western Kenya, but access to pregnancy/family planning care was less affected in our cohort. Innovative solutions are needed to ensure HIV and reproductive health outcomes do not worsen during the ongoing pandemic.
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Affiliation(s)
- Caitlin Bernard
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Shukri A. Hassan
- Department of Medicine, University of Washington, Seattle, WA, United States
| | - John Humphrey
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Julie Thorne
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada
| | - Mercy Maina
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Beatrice Jakait
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | | | | | - Caroline Kerich
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Sammy Changwony
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Shirley Ru W. Qian
- Department of Public Health, University of Washington, Seattle, WA, United States
| | - Andrea J. Scallon
- Jackson School of International Studies, University of Washington, Seattle, WA, United States
| | | | - Leslie A Enane
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
| | | | - Lisa L. Abuogi
- Department of Pediatrics, University of Colorado, Denver, CO, United States
| | - Kara Wools-Kaloustian
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Rena C. Patel
- Department of Medicine, University of Washington, Seattle, WA, United States
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