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Girma D, Abita Z, Guteta M, Abebe A, Adugna A, Alie MS, Abebe GF. Incidence density mortality rate among HIV-positive children on antiretroviral therapy in Ethiopia: a systematic review and meta-analysis. BMC Public Health 2024; 24:2061. [PMID: 39085806 PMCID: PMC11290179 DOI: 10.1186/s12889-024-19579-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 07/24/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Human Immunodeficiency Virus (HIV) continues to be the major cause of childhood deaths, particularly in the sub-Saharan African region. In Ethiopia, though several primary studies have been conducted on the incidence of HIV-related child mortality, the pooled incidence density mortality rate among HIV-positive children is unknown. Therefore, this systematic review and meta-analysis aimed to estimate the pooled incidence density mortality rate among HIV-positive children and identify its associated factors in Ethiopia. METHODS We browsed PubMed, HINARI, Science Direct, Google Scholar, African Journals Online, and cross-references using different search terms to identify articles. Quality appraisal was done using the Joanna Briggs Institute checklist. Meta-package was used to estimate the pooled incidence of mortality and hazard ratio (HR) of predictors. Heterogeneity was tested using the I-square statistics. Publication bias was tested using a funnel plot visual inspection and Egger's test. Data was presented using forest plots and tables. The random effect model was used to compute the pooled estimate. RESULTS The overall pooled incidence density mortality rate among HIV-positive children was 2.52 (95% CI: 1.82, 3.47) per 100 child years. Advanced HIV disease (hazard ratio (HR): 3.45, 95% CI (Confidence Interval): 2.64, 4.51), tuberculosis co-infection (HR: 3.19, 95% CI: 2.08, 4.88), stunting (3.22, 95% CI: 2.46, 4.22), underweight (HR: 2.71, 95% CI: 1.72, 4.26), wasting (HR: 4.14, 95% CI: 2.27, 7.58), didn't receive Isoniazid preventive therapy (HR: 3.33, 95% CI: 2.22, 4.99), anemia (HR: 3.03, 95% CI: 2.52, 3.64), fair or poor antiretroviral therapy adherence (HR: 4.14, 95% CI: 3.28, 5.28) and didn't receive cotrimoxazole preventive therapy (HR: 3.82, 95% CI: 2.49, 5.86) were factors associated with a higher hazard of HIV related child mortality. CONCLUSIONS The overall pooled incidence density mortality rate among HIV-positive children was high in Ethiopia as compared to the national strategy target. Therefore, counseling on antiretroviral therapy adherence should be strengthened. Regular monitoring of hemoglobin levels and assessment of nutritional status should be done for all children living with HIV. Moreover, healthcare professionals should follow the national HIV treatment guidelines and provide cotrimoxazole preventive therapy and Isoniazid preventive therapy up on the guidelines for children living with HIV. REGISTRATION Registered in PROSPERO with ID: CRD42023486902.
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Affiliation(s)
- Desalegn Girma
- College of Health Science, Department of Midwifery, Mizan-Tepi University, Mizan-Teferi, Ethiopia.
| | - Zinie Abita
- College of Health Science, department of public health, Mizan-Tepi University, Mizan-Teferi, Ethiopia
| | - Mirresa Guteta
- College of Health Science, Department of Nursing, Mizan Tepi University, Mizan-Teferi, Ethiopia
| | - Abinet Abebe
- College of Health Science, school of pharmacy, department of clinical pharmacy, Mizan Tepi University, Mizan-Teferi, Ethiopia
| | - Amanuel Adugna
- College of Health Science, Department of Midwifery, Mizan-Tepi University, Mizan-Teferi, Ethiopia
| | - Melsew Setegn Alie
- College of Health Science, department of public health, Mizan-Tepi University, Mizan-Teferi, Ethiopia
| | - Gossa Fetene Abebe
- College of Health Science, Department of Midwifery, Mizan-Tepi University, Mizan-Teferi, Ethiopia
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Prendergast AJ, Szubert AJ, Pimundu G, Berejena C, Pala P, Shonhai A, Hunter P, Arrigoni FIF, Musiime V, Bwakura-Dangarembizi M, Musoke P, Poulsom H, Kihembo M, Munderi P, Gibb DM, Spyer MJ, Walker AS, Klein N. The impact of viraemia on inflammatory biomarkers and CD4+ cell subpopulations in HIV-infected children in sub-Saharan Africa. AIDS 2021; 35:1537-1548. [PMID: 34270487 PMCID: PMC7611315 DOI: 10.1097/qad.0000000000002916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the impact of virological control on inflammation and cluster of differentiation 4 depletion among HIV-infected children initiating antiretroviral therapy (ART) in sub-Saharan Africa. DESIGN Longitudinal cohort study. METHODS In a sub-study of the ARROW trial (ISRCTN24791884), we measured longitudinal HIV viral loads, inflammatory biomarkers (C-reactive protein, tumour necrosis factor alpha, interleukin 6 (IL-6), soluble CD14) and (Uganda only) whole blood immunophenotype by flow cytometry in 311 Zimbabwean and Ugandan children followed for median 3.5 years on first-line ART. We classified each viral load measurement as consistent suppression, blip/post-blip, persistent low-level viral load or rebound. We used multi-level models to estimate rates of increase or decrease in laboratory markers, and Poisson regression to estimate the incidence of clinical events. RESULTS Overall, 42% children experienced viral blips, but these had no significant impact on immune reconstitution or inflammation. Persistent detectable viraemia occurred in one-third of children and prevented further immune reconstitution, but had little impact on inflammatory biomarkers. Virological rebound to ≥5000 copies/ml was associated with arrested immune reconstitution, rising IL-6 and increased risk of clinical disease progression. CONCLUSIONS As viral load testing becomes more available in sub-Saharan Africa, repeat testing algorithms will be required to identify those with virological rebound, who need switching to prevent disease progression, whilst preventing unnecessary second-line regimen initiation in the majority of children with detectable viraemia who remain at low risk of disease progression.
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Affiliation(s)
| | | | | | | | - Pietro Pala
- MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda
| | | | | | | | - Victor Musiime
- Joint Clinical Research Centre, Kampala, Uganda
- Makerere University College of Health Sciences
| | | | | | | | | | | | | | | | | | - Nigel Klein
- UCL Great Ormond Street Institute of Child Health
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Dziuban EJ, Rivadeneira ED. Universal Antiretroviral Treatment Eligibility for Children and Adolescents Living With HIV: A New Era. Pediatr Infect Dis J 2016; 35:1225-1228. [PMID: 27294308 PMCID: PMC6403488 DOI: 10.1097/inf.0000000000001276] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Antiretroviral treatment coverage for children living with HIV is low, and new efforts are underway to expand eligibility so that all children and adolescents qualify for the treatment regardless of immune suppression or clinical stage. Although recent trials provide direct evidence of the benefit of this approach in adults, no such studies have been performed in children. This report examines the available body of evidence regarding universal HIV treatment for children and adolescents and assesses the benefits and challenges both at individual patient health, as well as at programmatic level. Universal treatment eligibility for children with HIV has great potential for improved growth and neurodevelopment and fewer morbidities for children, and treatment coverage would be expected to increase through guideline simplification. However, concerns regarding toxicities, drug resistance and costs require careful planning. Successful implementation will depend on effective strategies for case-finding, treatment adherence support and program monitoring that will contribute to the growing evidence base for this pivotal pediatric HIV policy shift.
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Massavon W, Barlow-Mosha L, Mugenyi L, McFarland W, Gray G, Lundin R, Costenaro P, Nannyonga MM, Penazzato M, Bagenda D, Namisi CP, Wabwire D, Mubiru M, Kironde S, Bilardi D, Mazza A, Fowler MG, Musoke P, Giaquinto C. Factors Determining Survival and Retention among HIV-Infected Children and Adolescents in a Community Home-Based Care and a Facility-Based Family-Centred Approach in Kampala, Uganda: A Cohort Study. ISRN AIDS 2014; 2014:852489. [PMID: 25006529 PMCID: PMC4003865 DOI: 10.1155/2014/852489] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Accepted: 04/01/2014] [Indexed: 12/28/2022]
Abstract
We describe factors determining retention and survival among HIV-infected children and adolescents engaged in two health care delivery models in Kampala, Uganda: one is a community home-based care (CHBC) and the other is a facility-based family-centred approach (FBFCA). This retrospective cohort study reviewed records from children aged from 0 to 18 years engaged in the two models from 2003 to 2010 focussing on retention/loss to follow-up, mortality, use of antiretroviral therapy (ART), and clinical characteristics. Kaplan Meier survival curves with log rank tests were used to describe and compare retention and survival. Overall, 1,623 children were included, 90.0% (1460/1623) from the CHBC. Children completed an average of 4.2 years of follow-up (maximum 7.7 years). Median age was 53 (IQR: 11-109) months at enrolment. In the CHBC, retention differed significantly between patients on ART and those not (log-rank test, adjusted, P < 0.001). Comparing ART patients in both models, there was no significant difference in long-term survival (log-rank test, P = 0.308, adjusted, P = 0.489), while retention was higher in the CHBC: 94.8% versus 84.7% in the FBFCA (log-rank test, P < 0.001, adjusted P = 0.006). Irrespective of model of care, children receiving ART had better retention in care and survival.
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Affiliation(s)
- W. Massavon
- Department of Paediatrics, University of Padua, Via Giustiniani 3, 35128 Padua, Italy
- St. Raphael of St. Francis Hospital (Nsambya Hospital), Kampala, Uganda
| | - L. Barlow-Mosha
- Makerere University, Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - L. Mugenyi
- Infectious Diseases Research Collaboration, Mulago Hospital Complex, Kampala, Uganda
| | - W. McFarland
- Department of Global Health Sciences, University of California San Francisco, 50 Beale Street, 12th Floor, San Francisco, CA 94105, USA
| | - G. Gray
- University of Witwatersrand, 1 Jan Smuts Avenue, Braamfontein 2000, Johannesburg, South Africa
| | - R. Lundin
- Department of Paediatrics, University of Padua, Via Giustiniani 3, 35128 Padua, Italy
| | - P. Costenaro
- Department of Paediatrics, University of Padua, Via Giustiniani 3, 35128 Padua, Italy
| | - M. M. Nannyonga
- St. Raphael of St. Francis Hospital (Nsambya Hospital), Kampala, Uganda
| | - M. Penazzato
- Department of Paediatrics, University of Padua, Via Giustiniani 3, 35128 Padua, Italy
| | - D. Bagenda
- Makerere University, Johns Hopkins University Research Collaboration, Kampala, Uganda
- Department of Global Heath and Population, Harvard University School of Public Health, Boston, MA, USA
| | - C. P. Namisi
- St. Raphael of St. Francis Hospital (Nsambya Hospital), Kampala, Uganda
| | - D. Wabwire
- Makerere University, Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - M. Mubiru
- Makerere University, Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - S. Kironde
- St. Raphael of St. Francis Hospital (Nsambya Hospital), Kampala, Uganda
| | - D. Bilardi
- Department of Paediatrics, University of Padua, Via Giustiniani 3, 35128 Padua, Italy
| | - A. Mazza
- Santa Chiara Hospital, Via Largo Gold Medals 9, 38122 Trento, Italy
| | - M. G. Fowler
- Makerere University, Johns Hopkins University Research Collaboration, Kampala, Uganda
- Department of Pathology, Johns Hopkins School of Medicine 600 N. Wolfe Street/Carnegie 43 Baltimore, MD 21287, USA
| | - P. Musoke
- Makerere University, Johns Hopkins University Research Collaboration, Kampala, Uganda
- Department of Paediatrics and Child Health, Makerere University, Kampala, Uganda
| | - C. Giaquinto
- Department of Paediatrics, University of Padua, Via Giustiniani 3, 35128 Padua, Italy
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