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Kay A, Lukhele B, Dlamini S, Seeger A, Dlamini P, Ndabezitha S, Mthethwa N, Steffy T, Komba L, Amuge P, Ketangenyi E, Elyanu P, Munthali A, Msekandiana A, Maldonado Y, Chiao E, Kekitiinwa A, Thahane L, Mwita L, Kirchner HL, Mandalakas AM. Predicting mortality within 1 year of ART initiation in children and adolescents living with HIV in sub-Saharan Africa: a retrospective observational cohort study. Lancet Glob Health 2024; 12:e929-e937. [PMID: 38762295 PMCID: PMC11149103 DOI: 10.1016/s2214-109x(24)00091-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 01/26/2024] [Accepted: 02/22/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Differentiated service delivery (DSD) for children and adolescents living with HIV can improve targeted resource use. We derived a mortality prediction score to guide clinical decision making for children and adolescents living with HIV. METHODS Data for this retrospective observational cohort study were evaluated for all children and adolescents living with HIV and initiating antiretroviral therapy (ART); aged 0-19 years; and enrolled at Baylor clinics in Eswatini, Malawi, Lesotho, Tanzania, and Uganda between 2005 and 2020. Data for clinical prediction, including anthropometric values, physical examination, ART, WHO stage, and laboratory tests were captured at ART initiation. Backward stepwise variable selection and logistic regression were performed to develop predictive models for mortality within 1 year of ART initiation. Probabilities of mortality were generated, compared with true outcomes, internally validated, and evaluated against WHO advanced HIV criteria. FINDINGS The study population included 16 958 children and adolescents living with HIV and initiated on ART between May 18, 2005, and Dec 18, 2020. Predictive variables for the most accurate model included: age, CD4 percentage, white blood cell count, haemoglobin concentration, platelet count, and BMI Z score as continuous variables, and WHO clinical stage and oedema, abnormal muscle tone and respiratory distress on examination as categorical variables. The area under the curve (AUC) of the predictive model was 0·851 (95% CI 0·839-0·863) in the training set and 0·822 (0·800-0·845) in the test set, compared with 0·606 (0·595-0·617) for the WHO advanced HIV criteria (p<0·0001). INTERPRETATION This study evaluated a large, multinational population to derive a mortality prediction tool for children and adolescents living with HIV. The model more accurately predicted clinical outcomes than the WHO advanced HIV criteria and has the potential to improve DSD for children and adolescents living with HIV in high-burden settings. FUNDING National Institute of Health Fogarty International Center.
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Affiliation(s)
- Alexander Kay
- Baylor College of Medicine, Houston, TX, USA; Baylor College of Medicine Children's Foundation-Eswatini, Mbabane, Eswatini.
| | - Bhekumusa Lukhele
- Department of Health Policy and Organization, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sandile Dlamini
- Baylor College of Medicine Children's Foundation-Eswatini, Mbabane, Eswatini
| | | | - Phumzile Dlamini
- Baylor College of Medicine Children's Foundation-Eswatini, Mbabane, Eswatini
| | - Sandile Ndabezitha
- Baylor College of Medicine Children's Foundation-Eswatini, Mbabane, Eswatini
| | | | - Teresa Steffy
- Baylor College of Medicine, Houston, TX, USA; Baylor College of Medicine Children's Foundation-Lesotho, Maseru, Lesotho
| | - Lilian Komba
- Baylor College of Medicine Children's Foundation-Tanzania, Mbeya and Mwanza, Tanzania
| | - Pauline Amuge
- Baylor College of Medicine Children's Foundation-Uganda, Kampala, Uganda
| | - Eunice Ketangenyi
- Baylor College of Medicine Children's Foundation-Tanzania, Mbeya and Mwanza, Tanzania
| | - Peter Elyanu
- Baylor College of Medicine Children's Foundation-Uganda, Kampala, Uganda
| | - Adamson Munthali
- Baylor College of Medicine Children's Foundation-Malawi, Lilongwe, Malawi
| | - Amos Msekandiana
- Baylor College of Medicine Children's Foundation-Malawi, Lilongwe, Malawi
| | - Yvonne Maldonado
- Department of Pediatrics, Stanford University, Stanford, CA, USA
| | | | - Adeodata Kekitiinwa
- Baylor College of Medicine, Houston, TX, USA; Baylor College of Medicine Children's Foundation-Uganda, Kampala, Uganda
| | - Lineo Thahane
- Baylor College of Medicine, Houston, TX, USA; Baylor College of Medicine Children's Foundation-Lesotho, Maseru, Lesotho
| | - Lumumba Mwita
- Baylor College of Medicine, Houston, TX, USA; Baylor College of Medicine Children's Foundation-Tanzania, Mbeya and Mwanza, Tanzania
| | - H Lester Kirchner
- Baylor College of Medicine, Houston, TX, USA; Department of Population Health Sciences, Geisinger Health, Danville, VA, USA
| | - Anna Maria Mandalakas
- Baylor College of Medicine, Houston, TX, USA; Research Center Borstel, Sülfeld, Germany
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Iwelunmor J, Ezechi O, Obiezu-Umeh C, Gbaja-Biamila T, Musa AZ, Nwaozuru U, Obasi N, Ojo V, Xian H, Oladele D, Airhihenbuwa CO, Muessig K, Rosenberg N, Conserve DF, Ong JJ, Nkengasong S, Tahlil KM, BeLue R, Engelhart A, Mason S, Tang W, Ogedegbe G, Tucker JD. Tracking adaptation strategies of an HIV prevention intervention among youth in Nigeria: a theoretically informed case study analysis of the 4 Youth by Youth Project. Implement Sci Commun 2023; 4:44. [PMID: 37101190 PMCID: PMC10131455 DOI: 10.1186/s43058-023-00404-8] [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: 09/14/2022] [Accepted: 02/27/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Although many behavioral interventions are adapted, little is known about the reasons for adaptations and the process and outcomes influencing adaptations. To address this gap, we explored the adaptations made to promote HIV prevention services, including HIV self-testing (HIVST), among Nigerian youth. METHODS The main objective of this qualitative case study design was to document the adaptations made over time using the Framework for Reporting Adaptations and Modifications - Expanded (FRAME). Between 2018 and 2020, we organized four participatory activities as part of the 4 Youth by Youth project to increase the uptake of HIVST services in Nigeria-an open call, a designathon, a capacity-building bootcamp and a pilot feasibility trial. We also began the process of implementing a final intervention using a pragmatic randomized control trial (RCT). The open call solicited creative strategies to promote HIVST among Nigerian youth and then had experts evaluate them. The designathon brought together youth teams to further develop their HIVST service strategies into implementation protocols. Teams determined to be exceptional were invited to a four-week capacity-building bootcamp. The five teams that emerged from the bootcamp were supported to pilot their HIVST service strategies over a 6-month period. The adapted intervention is currently being evaluated in a pragmatic RCT. We transcribed meeting reports and conducted document reviews of study protocols and training manuals. RESULTS Sixteen adaptations were identified and categorized into three domains: (1) modifications to the content of the intervention (i.e. photo verification system and/or Unstructured Supplementary Service Data (USSD) system to verify HIVST); (2) modifications to the delivery the intervention (i.e. implement participatory learning community sessions to provide supportive supervision and technical support); (3) modifications to the evaluation processes (i.e. economic evaluation to estimate the cost of implementing intervention on a larger scale). Frequent reasons for adaptation included increasing intervention reach, modifying interventions to enhance their appropriateness and fit with the recipient, and increasing the intervention's feasibility and acceptability. Most adaptations were planned and reactive, and the need for modifications was determined by the youths, 4YBY program staff, and advisory group. CONCLUSIONS Findings suggest that the nature of adaptations made throughout the implementation process reflects the necessity of evaluating services in context while adjusting to specific challenges as they are identified. Further research is needed to understand the effect of these adaptations on the overall intervention effect as well as the quality of youth engagement.
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Affiliation(s)
- Juliet Iwelunmor
- College for Public Health & Social Justice, Saint Louis University, 3545 Lafayette Avenue, Saint Louis, MO, 63104, USA.
| | - Oliver Ezechi
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Chisom Obiezu-Umeh
- College for Public Health & Social Justice, Saint Louis University, 3545 Lafayette Avenue, Saint Louis, MO, 63104, USA
| | - Titilola Gbaja-Biamila
- College for Public Health & Social Justice, Saint Louis University, 3545 Lafayette Avenue, Saint Louis, MO, 63104, USA
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Adesola Z Musa
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Ucheoma Nwaozuru
- Department of Implementation Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Nnamdi Obasi
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
- College of Medicine, University of Nigeria, Nsukka, Nigeria
| | - Victor Ojo
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
- Federal University of Technology Akure, Akure, Ondo State, Nigeria
| | - Hong Xian
- College for Public Health & Social Justice, Saint Louis University, 3545 Lafayette Avenue, Saint Louis, MO, 63104, USA
| | - David Oladele
- College for Public Health & Social Justice, Saint Louis University, 3545 Lafayette Avenue, Saint Louis, MO, 63104, USA
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Collins O Airhihenbuwa
- Heath Policy and Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Kathryn Muessig
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Nora Rosenberg
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Donaldson F Conserve
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Jason J Ong
- Central Clinical School, Monash University, Melbourne, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
- Clinical Research Department, London, School of Hygiene and Tropical Medicine, London, UK
| | - Susan Nkengasong
- Clinical Research Department, London, School of Hygiene and Tropical Medicine, London, UK
| | - Kadija M Tahlil
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rhonda BeLue
- Community and Policy, College for Health, University of Texas at San Antonio, San Antonio, TX, USA
| | - Alexis Engelhart
- College for Public Health & Social Justice, Saint Louis University, 3545 Lafayette Avenue, Saint Louis, MO, 63104, USA
| | - Stacey Mason
- College for Public Health & Social Justice, Saint Louis University, 3545 Lafayette Avenue, Saint Louis, MO, 63104, USA
| | - Weiming Tang
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Gbenga Ogedegbe
- Center for Healthful Behavior Change, Division of Health and Behavior, Department of Population Health, New York University School of Medicine, NY, New York, NY, USA
| | - Joseph D Tucker
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
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Putta N, Hansen CE, Funaro MC, Campbell M, Essajee S, Mbori-Ngacha D, Frimpong S, Wang SY, Paintsil E. Evidence-based service delivery interventions for testing, linking, treating, and retaining children and adolescents living with HIV in primary health care settings: Protocol for a systematic review. PLoS One 2022; 17:e0269063. [PMID: 35709211 PMCID: PMC9202933 DOI: 10.1371/journal.pone.0269063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 05/07/2022] [Indexed: 11/18/2022] Open
Abstract
Background
At the end of 2019, there were about 2.8 million children and adolescents aged 0–19 living with HIV. In contrast to pregnant women and adults, service delivery for children and adolescents living with HIV continues to lag behind with regard to access to care, components of care delivery, treatment options, and clinical and immunologic outcomes.
Aim
The aim of this systematic review is to synthesize the evidence on the most effective interventions, models, programs, and strategies to optimize the delivery of services for the testing, linkage, treatment and retention of children and adolescents living with HIV globally.
Methods
This review protocol is registered at PROSPERO with Registration number: CRD42020209553. The systematic review will be conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P). We will use a comprehensive search strategy to search several bibliographic databases including MEDLINE, Embase, CINAHL, Cochrane Library, Global Health, and Psycinfo to identify relevant studies published in the last ten years (2010 to 2020). In addition, we will review cited and citing references of included studies. A pair of reviewers will independently screen titles, abstracts and full texts of articles, extract data from articles meeting inclusion criteria and perform quality assessments of the evidence collected. We will conduct a narrative synthesis of our findings, and if there are sufficient clinically similar studies available, we will conduct meta-analysis using a random-effects model.
Discussion
This review will provide evidence on service delivery models that have been evaluated in a range of settings to efficiently and effectively locate, link, treat and retain in care, children and adolescents living with HIV. The synthesized evidence will help guide national governments and health care providers in prioritizing and adopting evidence-based service delivery approaches for children and adolescents living with HIV.
Systematic review registration
PROSPERO CRD42020209553.
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Affiliation(s)
- Nande Putta
- United Nations Children’s Fund (UNICEF), Health Programme, New York, New York, United States of America
| | - Caitlin E. Hansen
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Melissa C. Funaro
- Harvey Cushing/John Hay Whitney Medical Library, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Melissa Campbell
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Shaffiq Essajee
- United Nations Children’s Fund (UNICEF), Health Programme, New York, New York, United States of America
| | - Dorothy Mbori-Ngacha
- United Nations Children’s Fund (UNICEF), Health Programme, New York, New York, United States of America
| | - Shadrack Frimpong
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, United States of America
- Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Shi-Yi Wang
- Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Elijah Paintsil
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, United States of America
- Yale School of Public Health, New Haven, Connecticut, United States of America
- Department of Pharmacology, Yale School of Medicine, New Haven, Connecticut, United States of America
- Yale School of Management, New Haven, Connecticut, United States of America
- * E-mail:
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Munyayi FK, van Wyk B, Mayman Y. Interventions to Improve Treatment Outcomes among Adolescents on Antiretroviral Therapy with Unsuppressed Viral Loads: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19073940. [PMID: 35409621 PMCID: PMC8997420 DOI: 10.3390/ijerph19073940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/16/2022] [Accepted: 03/21/2022] [Indexed: 01/02/2023]
Abstract
Adolescents living with HIV (ALHIV) face unique developmental challenges that increase the risk of unsuppressed viral loads. Current reviews present a need for proven interventions to improve viral suppression among ALHIV on ART, who have a history of unsuppressed viral loads. This systematic review aims to synthesize and appraise evidence of the effectiveness of interventions to improve treatment outcomes among ALHIV with unsuppressed viral loads. Six bibliographic databases were searched for published studies and gray literature from 2010 to 2021. The risk of bias and certainty of evidence was assessed using the ROBINS-I tool, CASP checklists and GRADE. A total of 28 studies were eligible for full-text screening; and only three were included in the qualitative synthesis. In addition, two studies were included from website searches. Four types of interventions to improve viral suppression were identified, namely: intensive adherence counselling; community- and facility-based peer-led differentiated service delivery (DSD); family based economic empowerment; and conditional economic incentives and motivational interviewing. We strongly recommend peer-led community-based DSD interventions, intensive adherence counselling, and family-based economic empowerment as potential interventions to improve viral suppression among ALHIV.
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Affiliation(s)
- Farai Kevin Munyayi
- School of Public Health, University of the Western Cape, Cape Town 7535, South Africa;
- Correspondence:
| | - Brian van Wyk
- School of Public Health, University of the Western Cape, Cape Town 7535, South Africa;
| | - Yolanda Mayman
- Department of Psychology, University of the Western Cape, Cape Town 7535, South Africa;
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Mehari M, Weldu MG, Angesom T, Hidru HD, Teame H, Gebremedhin H, Angaw Y, Alemseged EA. Human Immune Deficiency Virus Serostatus and Associated Factors Among Children of Adult Index Cases in Northern Ethiopia. HIV AIDS (Auckl) 2021; 13:699-707. [PMID: 34211299 PMCID: PMC8240846 DOI: 10.2147/hiv.s267848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 06/04/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Children whose parents with human immunodeficiency virus (HIV) and family of index clients are at high risk of HIV infection. Family testing is an efficient and effective way of identifying children's HIV. The number of children becoming newly infected with HIV remains unacceptably high. This study is to assess human immune deficiency, virus serostatus, and associated factors among children of adult index cases in central Tigrai, Northern Ethiopia, 2019. METHODS An institution-based cross-sectional study design was conducted to select a total of 454 index cases from February 01 to April 30, 2019. Data were collected from adult clients on antiretroviral treatment who have children using administered questionnaires and data extraction from the hospital antiretroviral register. Simple random sampling was used to select the index cases using the medical record number. Binary logistic regression analysis, odds ratio, and 95% confidence interval were used to determine the strength of association between dependent and independent variables. Statistical significance was declared a P-value <0.05. RESULTS The prevalence of HIV in children from family index case testing was 8.9% with 95% CI (6.5-11.6). Female index clients [AOR=0.18, 95% CI: 06-0.55], the age of the child [AOR=0.86, 95% CI: 0.76, 0.97], importance of HIV testing [AOR=5.20, 95% CI: 2.2011.96], and discussion HIV testing [AOR=3.22, 95% CI: 1.5-16.84]. Participants who did not discuss HIV were 3.2 more likely have HIV positive child than who discussed with family members. CONCLUSION The majority of the index clients test their children, but the prevalence rate of HIV in children from family index case testing is high. Strategies should be developed on how to communicate with household members about HIV.
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Affiliation(s)
- Medhin Mehari
- Adigrat University College of Medicine and Health Science, Department of Public Health, Adigrat, Tigrai, Ethiopia
| | - Meresa Gebremedhin Weldu
- Aksum University College of Medicine and Health Science, Department of Public Health, Aksum, Tigrai, Ethiopia
| | - Teklit Angesom
- Aksum University College of Medicine and Health Science, Department of Public Health, Aksum, Tigrai, Ethiopia
| | - Hagos Degefa Hidru
- Adigrat University College of Medicine and Health Science, Department of Public Health, Adigrat, Tigrai, Ethiopia
| | - Hirut Teame
- Adigrat University College of Medicine and Health Science, Department of Public Health, Adigrat, Tigrai, Ethiopia
| | - Haftay Gebremedhin
- Adigrat University College of Medicine and Health Science, Department of Public Health, Adigrat, Tigrai, Ethiopia
| | - Yonas Angaw
- Adigrat University College of Medicine and Health Science, Department of Public Health, Adigrat, Tigrai, Ethiopia
| | - Embay Amare Alemseged
- Adigrat University College of Medicine and Health Science, Department of Public Health, Adigrat, Tigrai, Ethiopia
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Mugo C, Wang J, Begnel ER, Njuguna IN, Maleche-Obimbo E, Inwani I, Slyker JA, John-Stewart G, Wamalwa DC, Wagner AD. Home- and Clinic-Based Pediatric HIV Index Case Testing in Kenya: Uptake, HIV Prevalence, Linkage to Care, and Missed Opportunities. J Acquir Immune Defic Syndr 2021; 85:535-542. [PMID: 32932411 DOI: 10.1097/qai.0000000000002500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Gaps in HIV testing of children persist, particularly among older children born before the expansion of the prevention of mother-to-child transmission of HIV programs. METHODS The Counseling and Testing for Children at Home study evaluated an index-case pediatric HIV testing approach. Caregivers receiving HIV care at 7 health facilities in Kenya (index cases), who had children of unknown HIV status aged 0-12 years, were offered the choice of clinic-based testing (CBT) or home-based testing (HBT). Testing uptake and HIV prevalence were compared between groups choosing HBT and CBT; linkage to care, missed opportunities, and predictors of HIV-positive diagnosis were identified. RESULTS Among 493 caregivers, 70% completed HIV testing for ≥1 child. Most caregivers who tested children chose CBT (266/347, 77%), with 103 (30%) agreeing to same-day testing of an untested accompanying child. Overall HIV prevalence among 521 tested children was 5.8% (CBT 6.8% vs HBT 2.4%; P = 0.07). Within 1 month of diagnosis, 88% of 30 HIV-positive children had linked to care, and 54% had started antiretroviral treatment. For 851 children eligible for testing, the most common reason for having an unknown HIV status was that the child's mother was not tested for HIV or had tested HIV negative during pregnancy (82%). CONCLUSION Testing uptake and HIV prevalence were moderate with nonsignificant differences between HBT and CBT. Standardized offer to test children accompanying caregivers is feasible to scale-up with little additional investment. Linkage to care for HIV-positive children was suboptimal. Lack of peripartum maternal testing contributed to gaps in pediatric testing.
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Affiliation(s)
- Cyrus Mugo
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya.,Department of Global Health, University of Washington, Seattle, WA
| | - Jiayu Wang
- Department of Global Health, University of Washington, Seattle, WA
| | - Emily R Begnel
- Department of Global Health, University of Washington, Seattle, WA
| | - Irene N Njuguna
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya.,Department of Global Health, University of Washington, Seattle, WA
| | | | - Irene Inwani
- Department of Pediatrics, Kenyatta National Hospital, Nairobi, Kenya; and
| | | | - Grace John-Stewart
- Departments of Pediatrics.,Departments of Medicine, University of Washington, Seattle, WA
| | | | - Anjuli D Wagner
- Department of Global Health, University of Washington, Seattle, WA
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The Comparison of Teen Clubs vs. Standard Care on Treatment Outcomes for Adolescents on Antiretroviral Therapy in Windhoek, Namibia. AIDS Res Treat 2020; 2020:8604276. [PMID: 33178455 PMCID: PMC7609153 DOI: 10.1155/2020/8604276] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 10/07/2020] [Accepted: 10/12/2020] [Indexed: 12/13/2022] Open
Abstract
Background Adolescents living with HIV (ALHIV) are challenged to adhere to antiretroviral therapy (ART) and achieve and maintain virologic suppression. Group-based adherence support interventions, such as adherence clubs, have been shown to improve long-term adherence in ART patients. The teen club intervention was introduced in 2010 in Namibia to improve treatment outcomes for ALHIV by providing adherence support in a peer-group environment. Adolescents who have completed the full HIV disclosure process can voluntarily join the teen clubs. The current study compared treatment outcomes of ALHIV receiving ART at a specialized paediatric HIV clinic between 1 July 2015 and 30 June 2017 in Windhoek, Namibia. Methods A retrospective cohort analysis was conducted on routine patient data extracted from the electronic Patient Monitoring System, individual Patient Care Booklets, and teen club attendance registers. A sample of 385 adolescents were analysed: 78 in teen clubs and 307 in standard care. Virologic suppression was determined at 6, 12, and 18 months from study start date, and compared by model of care, age, sex, disclosure status, and ART regimen. Comparisons between adolescents in teen clubs and those receiving standard care were performed using the chi-square test, and risk ratios were calculated to analyze differences in ART adherence and virologic suppression. Results The average clinician-measured ART adherence was 89% good, 6% fair, and 5% poor amongst all adolescents, with no difference between teen club members and adolescents in standard care (p = 0.277) at 3 months. Virologic suppression over the 2-year observation period was 87% (68% fully suppressed <40 copies/ml and 19% suppressed between 40–999 copies/ml), with no difference between teen club members and those in standard care. However, there were statistically significant differences in virologic suppression levels between the younger (10–14 years) adolescents and older (15–19 years) adolescents at 6 months (p = 0.015) and at 12 months (p = 0.021) and between adolescents on first-line and second-line ART regimen at 6 months (p = 0.012), 12 months (p = 0.004), and 18 months (p = 0.005). Conclusion The teen club model delivering psychosocial support only did not improve adherence and virologic suppression levels for adolescents in a specialized paediatric ART clinic, neither were they inferior to standard care. Considering the limitations of this study, teen clubs may still hold potential for improving adherence and virologic suppression levels for older adolescents, and more robust research on adherence interventions for adolescents with higher methodological quality is required.
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8
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Nakalema HS, Rajan SS, Morgan RO, Lee M, Gillespie SL, Kekitiinwa A. The effect of antiretroviral therapy guideline change on health outcomes among youth living with HIV in Uganda. AIDS Care 2020; 33:904-913. [PMID: 33021095 DOI: 10.1080/09540121.2020.1829533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
ABSTRACTOpportunistic infections (OIs) are the primary cause of HIV-related morbidity and mortality. To reduce the risk, the ART eligibility criteria were revised to start treatment before advanced disease onset. We evaluated the effect of 2014 HIV clinical guideline changes in Uganda on opportunistic infections and survival among Youth Living with HIV (YLWH). This retrospective cohort analysis used administrative data from the District Health Information System (DHIS2) and the national referral hospital, to compare YLWH, 15-24 years old, who started ART pre-guideline (January 2012-June 2014) and post-guideline (July 2014-December 2016). We assessed the effect using multivariable logistic and Cox Proportional Hazards regression models, respectively. Post-guideline youth had 18% and 30% lower adjusted odds of having an OI at 6 (aOR: 0.82, 95%CI: 0.67, 0.99), and 12 months (aOR: 0.70, 95%CI: 0.58, 0.85) after ART initiation, compared to pre-guideline youth. No significant differences were observed in survival probabilities (Z = 2.56, P-value = 0.11) and adjusted hazard ratios (aHR: 1.55, 95%CI: 0.46, 5.28). Early ART initiation reduced the risk of OIs among YLWH. However, given the existence of geographical and clinical variations in the endemicity, morbidity and mortality associated with different OIs, additional research is still needed.
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Affiliation(s)
- Hilda Sekabira Nakalema
- Department of Management, Policy and Community Health, University of Texas Health Science Center, Houston, TX, USA.,Baylor College of Medicine Children's Foundation Uganda, Kampala, Uganda.,Department of Retrovirology, Baylor College of Medicine, Houston, TX, USA
| | - Suja S Rajan
- Department of Management, Policy and Community Health, University of Texas Health Science Center, Houston, TX, USA.,Department of Biostatistics & Data Science, University of Texas Health Science Center, Houston, TX, USA
| | - Robert O Morgan
- Department of Management, Policy and Community Health, University of Texas Health Science Center, Houston, TX, USA
| | - Minjae Lee
- Department of Epidemiology, Human Genetics & Environmental Health, University of Texas Health Science Center, Houston, TX, USA.,Department of Biostatistics & Data Science, University of Texas Health Science Center, Houston, TX, USA
| | - Susan L Gillespie
- Department of Retrovirology, Baylor College of Medicine, Houston, TX, USA
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McCollum ED. Longitudinally Evaluating the Lung Function of Children in Low- and Middle-income Countries: It's About Time. Clin Infect Dis 2020; 70:491-492. [PMID: 30918951 DOI: 10.1093/cid/ciz260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 03/25/2019] [Indexed: 11/14/2022] Open
Affiliation(s)
- Eric D McCollum
- Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, School of Medicine, Baltimore, Maryland.,Global Program in Respiratory Sciences, Department of Pediatrics, School of Medicine, Baltimore, Maryland.,Health Systems, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
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Lejone TI, Kopo M, Bachmann N, Brown JA, Glass TR, Muhairwe J, Matsela T, Scherrer R, Chere L, Namane T, Labhardt ND, Amstutz A. PEBRA trial - effect of a peer-educator coordinated preference-based ART service delivery model on viral suppression among adolescents and young adults living with HIV: protocol of a cluster-randomized clinical trial in rural Lesotho. BMC Public Health 2020; 20:425. [PMID: 32228531 PMCID: PMC7106615 DOI: 10.1186/s12889-020-08535-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 03/16/2020] [Indexed: 01/10/2023] Open
Abstract
Background Despite tremendous progress in controlling the HIV epidemic in sub-Saharan Africa, HIV-related mortality continues to increase among adolescents and young people living with HIV (AYPLHIV). Globally, sub-Saharan Africa accounts for 85% of the AYPLHIV. Overall outcomes along the HIV care cascade are worse among AYPLHIV as compared to all other age groups due to various challenges in accessing and adhering to antiretroviral therapy (ART). New, innovative multicomponent packages of differentiated service delivery (DSD) models, are required to address the specific needs of AYPLHIV. This study aims to evaluate the feasibility and effectiveness of a multicomponent DSD model (PEBRA model) designed for AYPLHIV and coordinated by a peer-educator. Methods PEBRA (Peer-Educator Based Refill of ART) is a cluster randomized, open-label, superiority trial conducted at 20 health facilities in three districts of Lesotho, Southern Africa. The clusters (health facilities) are randomly assigned to either the PEBRA model or standard of care in a 1:1 ratio, stratified by district. AYPLHIV aged 15–24 years old in care and on ART at one of the clusters are eligible. In the PEBRA model, a peer-educator coordinates the antiretroviral therapy (ART) services - such as medication pick-up, SMS notifications and support options - according to the preferences of the AYPLHIV. The peer-educator delivers this personalized model using a tablet-based application called PEBRApp. The control clusters continue to offer standard of care: ART services coordinated by the nurse. The primary endpoint is viral suppression at 12 months. Secondary endpoints include self-reported adherence to ART, quality of life, satisfaction with care and engagement in care. The target sample size is 300 AYPLHIV. Statistical analyses are conducted and reported in line with CONSORT guidelines for cluster randomized trials. Discussion The PEBRA trial will provide evidence on the feasibility and effectiveness of an inclusive, holistic and preference-based DSD model for AYPLHIV that is coordinated by a peer-educator. Many countries in SSA have an existing peer-educator program. If proven effective, the PEBRA model and PEBRApp have the potential to be scaled up to similar settings. Trial registration Clinicaltrials.gov, NCT03969030. Registered on 31 May 2019. More information: www.pebra.info
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Affiliation(s)
| | | | - Nadine Bachmann
- Department of Medicine, Clinical Research Unit, Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Jennifer Anne Brown
- Department of Medicine, Clinical Research Unit, Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051, Basel, Switzerland.,University of Basel, Basel, Switzerland.,Molecular Virology, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Tracy Renée Glass
- Department of Medicine, Clinical Research Unit, Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | | | | | - Ramona Scherrer
- Department of Medicine, Clinical Research Unit, Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | | | - Tilo Namane
- Motebang Government Hospital, Leribe, Lesotho
| | - Niklaus Daniel Labhardt
- Department of Medicine, Clinical Research Unit, Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051, Basel, Switzerland.,University of Basel, Basel, Switzerland.,Department of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Alain Amstutz
- Department of Medicine, Clinical Research Unit, Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051, Basel, Switzerland. .,University of Basel, Basel, Switzerland. .,Department of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland.
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