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Frederix K, Schwitters A, Chung G, McCracken S, Kupamundi T, Patel HK, Arpadi S, Domaoal RA, Ntene-Sealiete K, Thin K, Wiesner L, Low A. The state of the pediatric HIV epidemic in Lesotho. AIDS 2023; 37:1377-1386. [PMID: 37070538 DOI: 10.1097/qad.0000000000003581] [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] [Indexed: 04/19/2023]
Abstract
OBJECTIVE Lesotho does not have reliable data on HIV prevalence in children, relying on estimates generated from program data. The 2016 Lesotho Population-based HIV Impact Assessment (LePHIA) aimed to determine HIV prevalence among children 0-14 years to assess the effectiveness of the prevention of mother-to-child transmission (PMTCT) program and guide future policy. METHODS A nationally representative sample of children under 15 years underwent household-based, two-stage HIV testing from November 2016-May 2017. Children <18 months with a reactive screening test were tested for HIV infection using total nucleic acid (TNA) PCR. Parents (61.1%) or legal guardians (38.9%) provided information on children's clinical history. Children aged 10-14 years also answered a questionnaire on knowledge and behaviors. RESULTS HIV prevalence was 2.1% [95% confidence interval (CI): 1.5-2.6]. Prevalence in 10-14 year olds (3.2%; 95% CI: 2.1, 4.2) was significantly greater compared to 0-4 year olds (1.0%; 95% CI: 0.5, 1.6). HIV prevalence in girls and boys was 2.6% (95% CI: 1.8-3.3) and 1.5% (95% CI: 1.0-2.1), respectively. Based on reported status and/or the presence of detectable antiretrovirals, 81.1% (95% CI: 71.7-90.4) of HIV-positive children were aware of their status, 98.2% (95% CI: 90.7-100.0) of those aware were on antiretroviral therapy (ART) and 73.9% (95% CI: 62.1-85.8) of those on ART were virally suppressed. CONCLUSIONS Despite the roll-out of Option B+ in Lesotho in 2013, pediatric HIV prevalence remains high. Further research is required to understand the greater prevalence among girls, barriers to PMTCT, and how to better achieve viral suppression in children with HIV.
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Affiliation(s)
| | - Amee Schwitters
- US Centers for Disease Control, Division of Global HIV&TB, Atlanta, Georgia
| | - Grace Chung
- ICAP at Columbia University, New York, New York
| | - Stephen McCracken
- US Centers for Disease Control, Division of Global HIV&TB, Atlanta, Georgia
| | | | - Hetal K Patel
- US Centers for Disease Control, Division of Global HIV&TB, Atlanta, Georgia
| | - Stephen Arpadi
- ICAP at Columbia University, New York, New York
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Robert A Domaoal
- US Centers for Disease Control, Division of Global HIV&TB, Atlanta, Georgia
| | | | | | - Lubbe Wiesner
- University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
| | - Andrea Low
- ICAP at Columbia University, New York, New York
- Department of Epidemiology, Mailman School of Public Health, New York, New York, USA
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Mageda K, Kulemba K, Kilimba E, Katalambula LK, Kapologwe N, Petrucka P. Effectiveness of a community-based intervention (Konga model) to address factors contributing to low viral load suppression among children living with HIV in Tanzania: a preliminary, cluster, randomized clinical trial report. BMC Public Health 2023; 23:1280. [PMID: 37400790 DOI: 10.1186/s12889-023-16181-x] [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: 02/10/2023] [Accepted: 06/23/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND Despite effective antiretroviral therapy (ART) coverage in other groups living with human immunodeficiency virus (HIV) in Tanzania, virologic suppression among HIV-positive children receiving ART remains unacceptably low. This study evaluated the effectiveness of a community-based intervention (Konga model) in addressing the factor contributing to low viral load suppression among children living with HIV in the Simiyu region, Tanzania. METHODS This study used a parallel cluster randomized trial. The cluster was only eligible if the health facility provided HIV care and treatment. All eligible resident children aged 2‒14 years who attended the cluster with a viral load > 1,000 cells/mm were enrolled. The intervention included three distinct activities: adherence counseling, psychosocial support, and co-morbidity screening such as tuberculosis. The evaluation was based on patient-centered viral load outcomes measured at baseline and 6 months later. Using a pre- and post-test design, we compared the means of participants in the intervention and control groups. We performed an analysis of covariance. The effect of a Konga was calculated using omega-squared. We used F-tests, with their corresponding p-values, as measures of improvement. RESULTS We randomly assigned 45 clusters to the treatment (15) and control (30) groups. We enrolled 82 children with amedian age of 8.8 years(interquartile range(IQR);5.5-11.2), and a baseline median viral load of 13,150 cells/mm (interquartile range (IQR);3600-59,200). After the study, both children in each group had good adherence, with children in the treatment group scoring slightly higher than those in the control group, 40 (97.56%) versus 31(75%61), respectively. At the end of the study, the difference in viral load suppression between the two groups was significant. The median viral load suppression at the end of the study was 50 cells/mm [IQR, (20-125)]. After adjusting for the viral load before the intervention, the effect size of the Konga intervention explained 4% (95% confidence interval [0%, 14.1%]) of the viral load variation at the end of the intervention. CONCLUSION The Konga model demonstrated significant positive effects that improved viral load suppression. We recommend implementing the Konga model trial in other regions to improve the consistency of results.
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Affiliation(s)
- Kihulya Mageda
- School of Nursing and Public Health, University of Dodoma, PO Box 395, Dodoma, Tanzania.
| | | | | | | | - Ntuli Kapologwe
- School of Nursing and Public Health, University of Dodoma, PO Box 395, Dodoma, Tanzania
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Affiliation(s)
- Hugo Soudeyns
- Centre de recherche du CHU Sainte-Justine
- Department of Microbiology, Infectiology & Immunology, Faculty of Medicine
- Department of Pediatrics, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Caroline Quach
- Centre de recherche du CHU Sainte-Justine
- Department of Microbiology, Infectiology & Immunology, Faculty of Medicine
- Department of Pediatrics, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
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Nicolau IA, Shokoohi M, McBane JE, Pogany L, Popovic N, Nicholson V, Hillier S, Aran N, Brophy J, Burt K, Cox J, de Pokomandy A, Kakkar F, Kelly D, Kerkerian G, Kogilwaimath S, Kroch A, Dias Lima V, Linthwaite B, Mbuagbaw L, McClarty L, Turvey S, Owino M, Martin C, Hogg RS, Loutfy M. A two-day workshop reviewing Canadian provincial and national HIV care cascade indicators, reporting, challenges, and recommendations. JOURNAL OF THE ASSOCIATION OF MEDICAL MICROBIOLOGY AND INFECTIOUS DISEASE CANADA = JOURNAL OFFICIEL DE L'ASSOCIATION POUR LA MICROBIOLOGIE MEDICALE ET L'INFECTIOLOGIE CANADA 2022; 7:247-268. [PMID: 36337608 PMCID: PMC9629730 DOI: 10.3138/jammi-2022-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/31/2022] [Accepted: 04/02/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The HIV care cascade is an indicators-framework used to assess achievement of HIV clinical targets including HIV diagnosis, HIV care initiation and retention, initiation of antiretroviral therapy, and attainment of viral suppression for people living with HIV. METHODS The HIV Care Cascade Research Development Team at the CIHR Canadian HIV Trials Network Clinical Care and Management Core hosted a two-day virtual workshop to present HIV care cascade data collected nationally from local and provincial clinical settings and national cohort studies. The article summarizes the workshop presentations including the indicators used and available findings and presents the discussed challenges and recommendations. RESULTS Identified challenges included (1) inconsistent HIV care cascade indicator definitions, (2) variability between the use of nested UNAIDS's targets and HIV care cascade indicators, (3) variable analytic approaches based on differing data sources, (4) reporting difficulties in some regions due to a lack of integration across data platforms, (5) lack of robust data on the first stage of the care cascade at the sub-national level, and (6) inability to integrate key socio-demographic data to estimate population-specific care cascade shortfalls. CONCLUSION There were four recommendations: standardization of HIV care cascade indicators and analyses, additional funding for HIV care cascade data collection, database maintenance and analyses at all levels, qualitative interviews and case studies characterizing the stories behind the care cascade findings, and employing targeted positive-action programs to increase engagement of key populations in each HIV care cascade stage.
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Affiliation(s)
- Ioana A Nicolau
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Mostafa Shokoohi
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
| | - Joanne E McBane
- The Canadian HIV Trials Network (CTN), Vancouver, British Columbia, Canada
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Lisa Pogany
- Public Health Agency of Canada (PHAC), Ottawa, Ontario, Canada
| | - Nashira Popovic
- Public Health Agency of Canada (PHAC), Ottawa, Ontario, Canada
| | - Valerie Nicholson
- Communities, Alliances & Networks (CAAN), Montreal, Quebec, Canada
- British Columbia Centre for Excellence in HIV/AIDS Care (BC-CfE), Vancouver, British Columbia, Canada
| | - Sean Hillier
- The Canadian HIV Trials Network (CTN), Vancouver, British Columbia, Canada
- School of Health Policy and Management, York University, Toronto, Ontario, Canada
| | - Niloufar Aran
- British Columbia Centre for Excellence in HIV/AIDS Care (BC-CfE), Vancouver, British Columbia, Canada
| | - Jason Brophy
- The Canadian HIV Trials Network (CTN), Vancouver, British Columbia, Canada
- Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Kimberley Burt
- HIV Program, Eastern Health, St. John’s, Newfoundland, Canada
| | - Joseph Cox
- The Canadian HIV Trials Network (CTN), Vancouver, British Columbia, Canada
- Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, Quebec, Canada
- McGill University, Montreal, Quebec, Canada
| | - Alexandra de Pokomandy
- The Canadian HIV Trials Network (CTN), Vancouver, British Columbia, Canada
- Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, Quebec, Canada
- McGill University, Montreal, Quebec, Canada
| | - Fatima Kakkar
- The Canadian HIV Trials Network (CTN), Vancouver, British Columbia, Canada
- Centre de Recherche, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Deborah Kelly
- The Canadian HIV Trials Network (CTN), Vancouver, British Columbia, Canada
- Department of Pharmacy, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
| | - Geneviève Kerkerian
- Infectious Diseases Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
| | - Siddharth Kogilwaimath
- The Canadian HIV Trials Network (CTN), Vancouver, British Columbia, Canada
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Abigail Kroch
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- The Canadian HIV Trials Network (CTN), Vancouver, British Columbia, Canada
- Ontario HIV Treatment Network, Toronto, Ontario, Canada
| | - Viviane Dias Lima
- British Columbia Centre for Excellence in HIV/AIDS Care (BC-CfE), Vancouver, British Columbia, Canada
| | - Blake Linthwaite
- Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, Quebec, Canada
| | - Lawrence Mbuagbaw
- The Canadian HIV Trials Network (CTN), Vancouver, British Columbia, Canada
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | | | | | - Maureen Owino
- The Canadian HIV Trials Network (CTN), Vancouver, British Columbia, Canada
- Committee for Accessible AIDS Treatment, Toronto, Ontario, Canada
- York University, Toronto, Ontario, Canada
| | - Carrie Martin
- The Canadian HIV Trials Network (CTN), Vancouver, British Columbia, Canada
- Communities, Alliances & Networks (CAAN), Montreal, Quebec, Canada
- Concordia, Montreal, Quebec, Canada
| | - Robert S Hogg
- The Canadian HIV Trials Network (CTN), Vancouver, British Columbia, Canada
- British Columbia Centre for Excellence in HIV/AIDS Care (BC-CfE), Vancouver, British Columbia, Canada
- Simon Fraser University, Vancouver, British Columbia, Canada
| | - Mona Loutfy
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
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Zhang J, Olatosi B, Yang X, Weissman S, Li Z, Hu J, Li X. Studying patterns and predictors of HIV viral suppression using A Big Data approach: a research protocol. BMC Infect Dis 2022; 22:122. [PMID: 35120435 PMCID: PMC8817473 DOI: 10.1186/s12879-022-07047-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 01/11/2022] [Indexed: 11/10/2022] Open
Abstract
Background Given the importance of viral suppression in ending the HIV epidemic in the US and elsewhere, an optimal predictive model of viral status can help clinicians identify those at risk of poor viral control and inform clinical improvements in HIV treatment and care. With an increasing availability of electronic health record (EHR) data and social environmental information, there is a unique opportunity to improve our understanding of the dynamic pattern of viral suppression. Using a statewide cohort of people living with HIV (PLWH) in South Carolina (SC), the overall goal of the proposed research is to examine the dynamic patterns of viral suppression, develop optimal predictive models of various viral suppression indicators, and translate the models to a beta version of service-ready tools for clinical decision support. Methods The PLWH cohort will be identified through the SC Enhanced HIV/AIDS Reporting System (eHARS). The SC Office of Revenue and Fiscal Affairs (RFA) will extract longitudinal EHR clinical data of all PLWH in SC from multiple health systems, obtain data from other state agencies, and link the patient-level data with county-level data from multiple publicly available data sources. Using the deidentified data, the proposed study will consist of three operational phases: Phase 1: “Pattern Analysis” to identify the longitudinal dynamics of viral suppression using multiple viral load indicators; Phase 2: “Model Development” to determine the critical predictors of multiple viral load indicators through artificial intelligence (AI)-based modeling accounting for multilevel factors; and Phase 3: “Translational Research” to develop a multifactorial clinical decision system based on a risk prediction model to assist with the identification of the risk of viral failure or viral rebound when patients present at clinical visits. Discussion With both extensive data integration and data analytics, the proposed research will: (1) improve the understanding of the complex inter-related effects of longitudinal trajectories of HIV viral suppressions and HIV treatment history while taking into consideration multilevel factors; and (2) develop empirical public health approaches to achieve ending the HIV epidemic through translating the risk prediction model to a multifactorial decision system that enables the feasibility of AI-assisted clinical decisions.
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Affiliation(s)
- Jiajia Zhang
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA.,South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA.,Big Data Health Science Center (BDHSC), University of South Carolina, Columbia, SC, 29208, USA
| | - Bankole Olatosi
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA. .,Big Data Health Science Center (BDHSC), University of South Carolina, Columbia, SC, 29208, USA. .,Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA.
| | - Xueying Yang
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA.,Big Data Health Science Center (BDHSC), University of South Carolina, Columbia, SC, 29208, USA.,Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
| | - Sharon Weissman
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA.,Department of Internal Medicine, School of Medicine, University of South Carolina, Columbia, SC, 29208, USA
| | - Zhenlong Li
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA.,Big Data Health Science Center (BDHSC), University of South Carolina, Columbia, SC, 29208, USA.,Geoinformation and Big Data Research Laboratory, University of South Carolina, Columbia, SC, 29208, USA
| | - Jianjun Hu
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA.,Department of Computer Science and Engineering, University of South Carolina, Columbia, SC, 29208, USA
| | - Xiaoming Li
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA.,Big Data Health Science Center (BDHSC), University of South Carolina, Columbia, SC, 29208, USA.,Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
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6
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Mageda K, Katalambula LK, Kapologwe NA, Petrucka P. Effectiveness of a community-based intervention (Konga model) to address the factors contributing to viral load suppression among children living with HIV in Tanzania: A cluster-randomized clinical trial protocol. Biol Methods Protoc 2022; 7:bpac002. [PMID: 35155815 PMCID: PMC8827055 DOI: 10.1093/biomethods/bpac002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/22/2021] [Accepted: 01/06/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
This study aims to test the effectiveness of a community-based intervention (Konga model) to improve viral-load suppression in children living with human immunodeficiency virus (HIV) and enrolled in care and treatment centers in Tanzania mainland. The study will be a cluster-randomized clinical trial study designed with both intervention and control arms. The study will involve 268 children with a viral load of > 1,000 copies/mLwho are aged between 2 and 14 years. The children will be randomly allocated into the intervention and control arms. The intervention will include three distinct activities: adherence and retention counseling, psychosocial support, and comorbidity screening (i.e., tuberculosis [TB]). The outcome of the study will be assessment of the success of the intervention to increase medication adherence with the immediate result of reducing the viral load below 1,000 copies/mL. Descriptive statistics will be used to calculate the mean, median, standard deviation, and interquartile range of continuous data. We will use frequencies and percentages to summarize categorical data. As for the primary outcome (proportion of HIV- infected children with viral suppression), we will compare the proportion of successful participants in the intervention and control arms. Proportions and tests for different proportions will be used as a measure of improvement. All statistical tests will be two-sided, and p < 0.05 will be considered statistically significant.
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Affiliation(s)
- Kihulya Mageda
- School of Nursing and Public Health, University of Dodoma, PO Box 395, Dodoma, Tanzania
- President’s Office –Regional Administration and Local Government, P.O Box 1923, Dodoma
| | | | - Ntuli A Kapologwe
- School of Nursing and Public Health, University of Dodoma, PO Box 395, Dodoma, Tanzania
- President’s Office –Regional Administration and Local Government, P.O Box 1923, Dodoma
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7
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Onyango DO, van der Sande MAB, Musingila P, Kinywa E, Opollo V, Oyaro B, Nyakeriga E, Waruru A, Waruiru W, Mwangome M, Macharia T, Young PW, Junghae M, Ngugi C, De Cock KM, Rutherford GW. High HIV prevalence among decedents received by two high-volume mortuaries in Kisumu, western Kenya, 2019. PLoS One 2021; 16:e0253516. [PMID: 34197509 PMCID: PMC8248726 DOI: 10.1371/journal.pone.0253516] [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: 10/15/2020] [Accepted: 06/07/2021] [Indexed: 11/28/2022] Open
Abstract
Background Accurate data on HIV-related mortality are necessary to evaluate the impact of HIV interventions. In low- and middle-income countries (LMIC), mortality data obtained through civil registration are often of poor quality. Though not commonly conducted, mortuary surveillance is a potential complementary source of data on HIV-associated mortality. Methods During April-July 2019, we assessed HIV prevalence, the attributable fraction among the exposed, and the population attributable fraction among decedents received by two high-volume mortuaries in Kisumu County, Kenya, where HIV prevalence in the adult population was estimated at 18% in 2019 with high ART coverage (76%). Stillbirths were excluded. The two mortuaries receive 70% of deaths notified to the Kisumu East civil death registry; this registry captures 45% of deaths notified in Kisumu County. We conducted hospital chart reviews to determine the HIV status of decedents. Decedents without documented HIV status, including those dead on arrival, were tested using HIV antibody tests or polymerase chain reaction (PCR) consistent with national HIV testing guidelines. Decedents aged less than 15 years were defined as children. We estimated annual county deaths by applying weights that incorporated the study period, coverage of deaths, and mortality rates observed in the study. Results The two mortuaries received a total of 1,004 decedents during the study period, of which 95.1% (955/1004) were available for study; 89.1% (851/955) of available decedents were enrolled of whom 99.4% (846/851) had their HIV status available from medical records and post-mortem testing. The overall population-based, age- and sex-adjusted mortality rate was 12.4 per 1,000 population. The unadjusted HIV prevalence among decedents was 28.5% (95% confidence interval (CI): 25.5–31.6). The age- and sex-adjusted mortality rate in the HIV-infected population (40.7/1000 population) was four times higher than in the HIV-uninfected population (10.2/1000 population). Overall, the attributable fraction among the HIV-exposed was 0.71 (95% CI: 0.66–0.76) while the HIV population attributable fraction was 0.17 (95% CI: 0.14–0.20). In children the attributable fraction among the exposed and population attributable fraction were 0.92 (95% CI: 0.89–0.94) and 0.11 (95% CI: 0.08–0.15), respectively. Conclusions Over one quarter (28.5%) of decedents received by high-volume mortuaries in western Kenya were HIV-positive; overall, HIV was considered the cause of death in 17% of the population (19% of adults and 11% of children). Despite substantial scale-up of HIV services, HIV disease remains a leading cause of death in western Kenya. Despite progress, increased efforts remain necessary to prevent and treat HIV infection and disease.
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Affiliation(s)
- Dickens O. Onyango
- Kisumu County Department of Health, Kisumu, Kenya
- Ministry of Health, Nairobi, Kenya
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht, Netherlands
- * E-mail:
| | - Marianne A. B. van der Sande
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht, Netherlands
| | - Paul Musingila
- Division of Global HIV & TB (DGHT), US Centres for Disease Control and Prevention, Nairobi, Kenya
| | - Eunice Kinywa
- Kisumu County Department of Health, Kisumu, Kenya
- Ministry of Health, Nairobi, Kenya
| | | | - Boaz Oyaro
- Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | | | - Anthony Waruru
- Division of Global HIV & TB (DGHT), US Centres for Disease Control and Prevention, Nairobi, Kenya
| | | | - Mary Mwangome
- Global Programs for Research and Training, Nairobi, Kenya
| | | | - Peter W. Young
- Division of Global HIV & TB (DGHT), US Centres for Disease Control and Prevention, Nairobi, Kenya
| | - Muthoni Junghae
- Division of Global HIV & TB (DGHT), US Centres for Disease Control and Prevention, Nairobi, Kenya
| | - Catherine Ngugi
- Ministry of Health, Nairobi, Kenya
- Ministry of Health, National AIDS and STI Control Program (NASCOP), Nairobi, Kenya
| | - Kevin M. De Cock
- Division of Global HIV & TB (DGHT), US Centres for Disease Control and Prevention, Nairobi, Kenya
| | - George W. Rutherford
- Institute for Global Health Sciences, University of California, San-Francisco, California, United States of America
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Frange P, Montange T, Le Chenadec J, Batalie D, Fert I, Dollfus C, Faye A, Blanche S, Chacé A, Fourcade C, Hau I, Levine M, Mahlaoui N, Marcou V, Tabone MD, Veber F, Hoctin A, Wack T, Avettand-Fenoël V, Warszawski J, Buseyne F. Impact of Early Versus Late Antiretroviral Treatment Initiation on Naive T Lymphocytes in HIV-1-Infected Children and Adolescents - The-ANRS-EP59-CLEAC Study. Front Immunol 2021; 12:662894. [PMID: 33968064 PMCID: PMC8100053 DOI: 10.3389/fimmu.2021.662894] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/24/2021] [Indexed: 12/15/2022] Open
Abstract
Background The early initiation of antiretroviral therapy (ART) in HIV-1-infected infants reduces mortality and prevents early CD4 T-cell loss. However, the impact of early ART on the immune system has not been thoroughly investigated in children over five years of age or adolescents. Here, we describe the levels of naive CD4 and CD8 T lymphocytes (CD4/CD8TN), reflecting the quality of immune reconstitution, as a function of the timing of ART initiation (early (<6 months) versus late (≥24 months of age)). Methods The ANRS-EP59-CLEAC study enrolled 27 children (5-12 years of age) and nine adolescents (13-17 years of age) in the early-treatment group, and 19 children (L-Ch) and 21 adolescents (L-Ado) in the late-treatment group. T lymphocytes were analyzed by flow cytometry and plasma markers were analyzed by ELISA. Linear regression analysis was performed with univariate and multivariate models. Results At the time of evaluation, all patients were on ART and had a good immunovirological status: 83% had HIV RNA loads below 50 copies/mL and the median CD4 T-cell count was 856 cells/µL (interquartile range: 685-1236 cells/µL). In children, early ART was associated with higher CD8TN percentages (medians: 48.7% vs. 31.0%, P = 0.001), and a marginally higher CD4TN (61.2% vs. 53.1%, P = 0.33). In adolescents, early ART was associated with low CD4TN percentages and less differentiated memory CD8 T cells. CD4TN and CD8TN levels were inversely related to cellular activation and gut permeability. Conclusion In children and adolescents, the benefits of early ART for CD8TN were clear after long-term ART. The impact of early ART on CD4TN appears to be modest, because pediatric patients treated late respond to HIV-driven CD4 T-lymphocyte loss by the de novo production of TN cells in the thymus. Our data also suggest that current immune activation and/or gut permeability has a negative impact on TN levels. Clinical Trial Registration ClinicalTrials.gov, identifier NCT02674867.
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Affiliation(s)
- Pierre Frange
- Immunologie, hématologie et rhumatologie pédiatrique, hôpital Necker–Enfants malades, AP–HP- Centre – Université de Paris, Paris, France
- Laboratoire de microbiologie clinique, hôpital Necker–Enfants malades, AP–HP-Centre – Université de Paris, Paris, France
- EHU 7328 PACT, Institut Imagine, Université de Paris, Paris, France
| | - Thomas Montange
- Unité Epidémiologie et Physiopathologie des Virus Oncogènes, Institut Pasteur, Paris, France
- Département de Virologie, UMR CNRS 3569 Institut Pasteur, Paris, France
| | - Jérôme Le Chenadec
- Départment d’épidémiologie, Centre de Recherche en Épidémiologie et Santé des Populations, INSERM U1018, Le Kremlin-Bicêtre, Villejuif, France
| | - Damien Batalie
- Unité Epidémiologie et Physiopathologie des Virus Oncogènes, Institut Pasteur, Paris, France
- Département de Virologie, UMR CNRS 3569 Institut Pasteur, Paris, France
| | - Ingrid Fert
- Unité Epidémiologie et Physiopathologie des Virus Oncogènes, Institut Pasteur, Paris, France
- Département de Virologie, UMR CNRS 3569 Institut Pasteur, Paris, France
| | - Catherine Dollfus
- Hémato-oncologie pédiatrique, Hôpital Trousseau, AP-HP, Paris, France
| | - Albert Faye
- Pédiatrie Générale, Hôpital Robert Debré, AP-HP, Paris, France
| | - Stéphane Blanche
- Immunologie, hématologie et rhumatologie pédiatrique, hôpital Necker–Enfants malades, AP–HP- Centre – Université de Paris, Paris, France
| | - Anne Chacé
- Pédiatrie et néonatologie, Centre hospitalier intercommunal de Villeuneuve-Saint-Georges, Villeuneuve-Saint-Georges, France
| | | | - Isabelle Hau
- Pédiatrie Générale, Centre hospitalier intercommunal de Créteil, Créteil, France
| | - Martine Levine
- Immuno-hématologie pédiatrique, Hôpital Robert Debré, AP-HP, Paris, France
| | - Nizar Mahlaoui
- Immunologie, hématologie et rhumatologie pédiatrique, hôpital Necker–Enfants malades, AP–HP- Centre – Université de Paris, Paris, France
| | - Valérie Marcou
- Médecine et réanimation néonatale, Hôpital Cochin, AP-HP-Centre – Université de Paris, Paris, France
| | | | - Florence Veber
- Immunologie, hématologie et rhumatologie pédiatrique, hôpital Necker–Enfants malades, AP–HP- Centre – Université de Paris, Paris, France
| | - Alexandre Hoctin
- Départment d’épidémiologie, Centre de Recherche en Épidémiologie et Santé des Populations, INSERM U1018, Le Kremlin-Bicêtre, Villejuif, France
| | - Thierry Wack
- Départment d’épidémiologie, Centre de Recherche en Épidémiologie et Santé des Populations, INSERM U1018, Le Kremlin-Bicêtre, Villejuif, France
| | - Véronique Avettand-Fenoël
- Laboratoire de microbiologie clinique, hôpital Necker–Enfants malades, AP–HP-Centre – Université de Paris, Paris, France
- CNRS 8104/INSERM U1016, Institut Cochin, Université Paris Descartes, Paris, France
| | - Josiane Warszawski
- Départment d’épidémiologie, Centre de Recherche en Épidémiologie et Santé des Populations, INSERM U1018, Le Kremlin-Bicêtre, Villejuif, France
- INED, Université Paris Sud, Le Kremlin-Bicêtre, Orsay, France
| | - Florence Buseyne
- Unité Epidémiologie et Physiopathologie des Virus Oncogènes, Institut Pasteur, Paris, France
- Département de Virologie, UMR CNRS 3569 Institut Pasteur, Paris, France
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