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Tsikhutsu I, Bii M, Dear N, Ganesan K, Kasembeli A, Sing’oei V, Rombosia K, Ochieng C, Desai P, Wolfman V, Coakley P, Lee EH, Hickey PW, Livezey J, Agaba P. Prevalence and Correlates of Viral Load Suppression and Human Immunodeficiency Virus (HIV) Drug Resistance Among Children and Adolescents in South Rift Valley and Kisumu, Kenya. Clin Infect Dis 2022; 75:936-944. [PMID: 35092424 PMCID: PMC9522406 DOI: 10.1093/cid/ciac059] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Children and adolescents living with HIV (CALHIV) face unique challenges, including poorer treatment outcomes, risk for drug-resistance mutations (HIVDRMs), and limited drug formulations. We estimated viral suppression (VS) prevalence and evaluated predictors of VS and HIVDRMs in Kenya. METHODS From 2018-2020, CALHIV 1-19 years on antiretroviral therapy (ART) >6 months were enrolled in this cross-sectional study. Participants underwent viral load (VL) testing; those with VL ≥1000 copies/mL had HIVDRM testing. Sociodemographic questionnaires and medical record abstraction were completed. VS prevalence (VL <1000 copies/mL) was estimated; robust Poisson regression models were used to estimate prevalence ratios (PRs) and 95% CIs for associations between potential predictors of VS. RESULTS Nine hundred and sixty-nine participants were enrolled. VS prevalence was .80 (95% CI: .78-.83). Being on ART >24 months (adjusted PR [aPR]: 1.22; 95% CI: 1.06-1.41), an integrase strand transfer inhibitor-containing regimen (1.13; 1.02-1.26), and attending a level 3 health facility (1.23; 1.11-1.36) were associated with VS. Missing ≥3 doses of ART in the past month (aPR: .73; 95% CI: .58-.92), having a viremic mother with HIV (.72; .53-.98), and having 3-7 (.90; .83-.97), 8-13 (.89; .82-.97), or ≥14 (.84; .77-.92) compared with <2 adherence counseling referrals were inversely associated with VS. A high proportion (n = 119, 81.5%) of unsuppressed participants had evidence of any major HIVDRM. CONCLUSIONS HIV treatment programs should target interventions for pediatric patients at risk for treatment failure-namely, those with a caregiver with failed VS and those struggling with adherence.
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Affiliation(s)
| | | | - Nicole Dear
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Kavitha Ganesan
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Alex Kasembeli
- US Army Medical Research Directorate–Africa, Nairobi, Kenya,HJF Medical Research International, Kericho, Kenya
| | - Valentine Sing’oei
- US Army Medical Research Directorate–Africa, Nairobi, Kenya,HJF Medical Research International, Kisumu, Kenya
| | | | - Christopher Ochieng
- US Army Medical Research Directorate–Africa, Nairobi, Kenya,HJF Medical Research International, Kericho, Kenya
| | - Priyanka Desai
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Vanessa Wolfman
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Peter Coakley
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Elizabeth H Lee
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA,The Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Patrick W Hickey
- The Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | | | - Patricia Agaba
- Correspondence: Patricia Agaba, 6720A Rockledge Dr, Suite 400, Bethesda, MD 20817, USA ()
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Schue JL, van Dijk JH, Hamangaba F, Hamahuwa M, Moyo N, Thuma PE, Moss WJ, Sutcliffe CG. Treatment outcomes among children younger than five years living with HIV in rural Zambia, 2008-2018: a cohort study. BMC Pediatr 2021; 21:315. [PMID: 34261465 PMCID: PMC8278691 DOI: 10.1186/s12887-021-02793-y] [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: 03/16/2021] [Accepted: 06/30/2021] [Indexed: 12/01/2022] Open
Abstract
Background HIV testing and treatment guidelines for children in sub-Saharan Africa have evolved over time, such that children are now treated at younger ages. The objective of this study was to describe the treatment experience for immunologic, virologic, and growth outcomes among HIV-infected Zambian children younger than 5 years of age from 2008 to 2018. Methods Participants enrolled in a clinical cohort study in Macha, Zambia and initiating antiretroviral treatment before 5 years of age between 2008 and 2015 were included in the analysis and followed up to the end of 2018. Outcomes, including growth, CD4+ T-cell percentage, viral suppression, and mortality, were evaluated among all children using longitudinal and survival analyses. Comparisons by age at treatment initiation (< 1, 1 to < 2, and 2 to < 5 years) were also evaluated. Results Three hundred eighty-one children initiating treatment before 5 years of age between 2008 and 2015 were included in the analysis. Growth metrics and CD4+ T-cell percentage improved over time after treatment initiation. However, 20% of children remained underweight and 40% of children remained stunted after the first 36 months of treatment. 85% of children had a viral load < 400 copies/mL after 12 months of treatment. However, children < 1 year at treatment initiation were more likely to have a detectable viral load in the first 12 months of treatment and less likely to achieve viral suppression compared to older children. Mortality was highest in the first 12 months of treatment, among underweight children, and among children initiating treatment in 2008–2010 compared to 2011–2015. Conclusions Most children initiating antiretroviral treatment from 2008 to 2015 in rural Zambia responded well to treatment. However, many children remained underweight and stunted, and experienced high mortality rates during the first few months of treatment. This supports continued efforts to improve early infant diagnosis, nutritional support, and pediatric drug formulations. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-021-02793-y.
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Affiliation(s)
- Jessica L Schue
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, USA
| | - Janneke H van Dijk
- Erasmus University, Burgemeester Oudlaan 50, 3062, PA, Rotterdam, Netherlands
| | | | | | | | - Philip E Thuma
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, USA.,Macha Research Trust, Choma, Zambia
| | - William J Moss
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, USA
| | - Catherine G Sutcliffe
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, USA.
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Pierre G, Uwineza A, Dzinamarira T. Attendance to HIV Antiretroviral Collection Clinic Appointments During COVID-19 Lockdown. A Single Center Study in Kigali, Rwanda. AIDS Behav 2020; 24:3299-3301. [PMID: 32588258 PMCID: PMC7315689 DOI: 10.1007/s10461-020-02956-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Gashema Pierre
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Annette Uwineza
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Tafadzwa Dzinamarira
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, 4001, South Africa.
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Iradukunda PG, Pierre G, Muhozi V, Denhere K, Dzinamarira T. Knowledge, Attitude, and Practice Towards COVID-19 Among People Living with HIV/AIDS in Kigali, Rwanda. J Community Health 2020; 46:245-250. [PMID: 33106963 PMCID: PMC7587540 DOI: 10.1007/s10900-020-00938-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2020] [Indexed: 11/22/2022]
Abstract
As with other countries globally, Rwanda has faced a recent outbreak of the coronavirus disease 2019 (COVID-19) against a backdrop of an HIV epidemic. At present, there is no successful cure or vaccine for both COVID-19 and HIV. People with underlying conditions, including HIV, are at increased risk of severe COVID-19 manifestations. This underscores the need to enhance the knowledge, attitudes, and practice of people living with HIV (PLWH) to protect this population against COVID-19. An institution-based cross-sectional study was conducted from August 31 to September 18, 2020 among 376 participants who were selected by a simple random sampling technique. A pretested and structured self-administered questionnaire was used to collect data. Quality scores were calculated as a measure of the participants’ knowledge, attitudes, and practice (KAP) levels. The student t-test was used to compare continuous variables between low (<65%) and high (≥65%) KAP scores. The chi-square test was used to determine the association between KAP scores and categorical variables. All decisions on statistical tests were concluded at 5% level of significance. All statistical analysis was performed using STATA statistical package version 11.2 (STATA Corp., Texas, USA). Of the 376 participants, 363 (97%) obtained a high knowledge score, while more than a quarter of the participants (26%) had a poor attitude score, and the majority (90%) having a high practice score. There was no association between gender, age, place of residence, employment, or duration on ART and knowledge score. Employment status and duration on antiretroviral treatment (ART) were significantly associated with attitude scores (p = 0.004 and p = 0.013, respectively). Gender and duration on ART were significantly associated with practice scores (p = 0.02 and p = 0.012, respectively). There was a moderate positive correlation (r = 0.57) between knowledge and attitude scores, and knowledge and practice scores (r = 0.55). There was a strong positive correlation (r = 0.67) between attitude scores and practice scores. Health education programs tailored for PLWH and aimed at mobilizing and improving COVID-19-related knowledge, attitude, and practice should be prioritized in the Rwandan COVID-19 response.
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Affiliation(s)
| | - Gashema Pierre
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Valens Muhozi
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Knowledge Denhere
- School of Public Health, University of Western Cape, Bellville, South Africa
| | - Tafadzwa Dzinamarira
- Department of Public Health, Mount Kenya University, Kigali, Rwanda. .,Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, 4001, South Africa.
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