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Amuge PM, Becker GL, Ssebunya RN, Nalumansi E, Adaku A, Juma M, Jackson JB, Kekitiinwa AR, Elyanu PJ, Wobudeya E, Blount R. Patient characteristics and predictors of mortality among children hospitalised with tuberculosis: A six-year case series study in Uganda. PLoS One 2024; 19:e0301107. [PMID: 38805452 PMCID: PMC11132474 DOI: 10.1371/journal.pone.0301107] [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] [Received: 11/08/2023] [Accepted: 03/11/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND The high case-fatality rates among children with tuberculosis (TB) are reportedly driven by in-hospital mortality and severe forms of TB. Therefore, there is need to better understand the predictors of mortality among children hospitalised with TB. We examined the patient clinical profiles, length of hospital stay from date of admission to date of final admission outcome, and predictors of mortality among children hospitalised with TB at two tertiary hospitals in Uganda. METHODS We conducted a case-series study of children below 15 years of age hospitalised with TB, from January 1st, 2016, to December 31st, 2021. Convenience sampling was done to select TB cases from paper-based medical records at Mulago National Referral Hospital (MNRH) in urban Kampala, and Fort Portal Regional Referral Hospital (FRRH) in rural Fort Portal. We fitted linear and logistic regression models with length of stay and in-hospital mortality as key outcomes. RESULTS Out of the 201 children hospitalised with TB, 50 were at FRRH, and 151 at MNRH. The male to female ratio was 1.5 with median age of 2.6 years (Interquartile range-IQR 1-6). There was a high prevalence of HIV (67/171, 39%), severe malnutrition reported as weight-for-age Z-score <-3SD (51/168, 30%). Among children with pulmonary TB who initiated anti-tuberculosis therapy (ATT) either during hospitalisation or within seven days prior to hospitalisation; cough (134/143, 94%), fever (111/143, 78%), and dyspnoea (78/143, 55%) were common symptoms. Children with TB meningitis commonly presented with fever (17/24, 71%), convulsions (14/24 58%), and cough (13/24, 54%). The median length of hospital stay was 8 days (IQR 5-15). Of the 199 children with known in-hospital outcomes, 34 (17.1%) died during hospitalisation. TB meningitis was associated with in-hospital mortality (aOR = 3.50, 95% CI = 1.10-11.17, p = 0.035), while male sex was associated with reduced mortality (aOR = 0.33, 95% CI = 0.12-0.95, p = 0.035). Hospitalisation in the urban hospital predicted a 0.48-day increase in natural log-transformed length of hospital stay (ln-length of stay) (95% CI 0.15-0.82, p = 0.005), but not age, sex, HIV, malnutrition, or TB meningitis. CONCLUSIONS In-hospital mortality was high, and significantly driven almost four times higher by TB meningitis, with longer hospital stay among children in urban hospitals. The high in-hospital mortality and long hospital stay may be reduced by timely TB diagnosis and treatment initiation among children.
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Affiliation(s)
- Pauline Mary Amuge
- Research Department, Baylor College of Medicine Children’s Foundation-Uganda, Kampala, Uganda
| | - Greta Lassance Becker
- Division of Pulmonary and Critical Care Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa, United States of America
| | - Rogers Nelson Ssebunya
- Research Department, Baylor College of Medicine Children’s Foundation-Uganda, Kampala, Uganda
| | - Esther Nalumansi
- Department of Medical Records, Mulago National Referral Hospital, Kampala, Uganda
| | - Alex Adaku
- Fort Portal Regional Referral Hospital, Kabarole District, Fort Portal City, Uganda
| | - Michael Juma
- Research Department, Baylor College of Medicine Children’s Foundation-Uganda, Kampala, Uganda
| | - Jay Brooks Jackson
- Department of Pathology, University of Iowa, Iowa City, Iowa, United States of America
| | | | - Peter James Elyanu
- Research Department, Baylor College of Medicine Children’s Foundation-Uganda, Kampala, Uganda
| | - Eric Wobudeya
- Department of Paediatrics & Child Health, Mulago National Referral Hospital, Kampala, Uganda
| | - Robert Blount
- Division of Pulmonary and Critical Care Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa, United States of America
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Johnson SM, Teh JJ, Pasvol TJ, Ayres S, Lyall H, Fidler S, Foster C. Hospitalisation rates for youth living with perinatally acquired HIV in England. PLoS One 2024; 19:e0295639. [PMID: 38502654 PMCID: PMC10950242 DOI: 10.1371/journal.pone.0295639] [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] [Received: 11/04/2021] [Accepted: 11/27/2023] [Indexed: 03/21/2024] Open
Abstract
INTRODUCTION Complex challenges amongst ageing cohorts of adolescents and adults living with perinatally acquired HIV (PaHIV) may impact on hospitalisation. We report hospitalisation rates and explored predictive factors for hospitalisation in adolescents and adults (10-35 years) living with PaHIV in England. METHOD Retrospective observational cohort study over a three-year period 2016-2019. Data collected included cause and duration of hospitalisation, HIV viral load and CD4 lymphocyte count. The primary outcome was overnight hospitalisation. Patients exited at study end/ transfer of care (TOC)/ loss to follow up (LTFU) or death. Maternity/hospital admissions at other centres were excluded. Admission rates per 100 person-years (95% CI) were calculated by age group. Negative binomial regression with generalized estimating equations was performed. RESULTS 255 patients contributed 689 person-years of follow up. 56% were female and 83% were of a Black, Black British, Caribbean or African ethnicity. At baseline, the median age was 19 years (IQR 16-22). 36 individuals experienced a total of 62 admissions which resulted in 558 overnight stays (median stay was 5 nights). One person died (lymphoma), six had TOC and one was LTFU by the end of the three-year study period. Crude incidence of admission for the whole cohort was 9.0 per 100 PY (6.9-11.6). The respective crude incidence rates were 1.5 PY (0.0-8.2) in those aged 10-14 years and 3.5 PY (1.5-7.0) in the 15-19-year-olds. In those aged 20-24 years it was 14.5 PY (10.1-20.2) and in those >25 years the crude incidence rate was 11.7 PY (6.9-18.5). Factors significantly associated with admission were a CD4 lymphocyte count <200 cells/uL, adjusted IRR 4.0 (1.8-8.8) and a history of a CDC-C diagnosis, adjusted IRR 2.9 (1.6-5.3). 89% admissions were HIV-related: 45% new/current CDC-C diagnoses, 76% due to infection. CONCLUSIONS Hospitalisation rates were four-fold higher in adults (>20 years of age) compared to adolescents (10-19-year-olds). The continuing challenges experienced by PaHIV youth require enhanced multidisciplinary support throughout adulthood.
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Affiliation(s)
- Sarah May Johnson
- Department of Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, London, United Kingdom
- Department of Infectious Diseases, Imperial College London, London, United Kingdom
| | - Jhia Jiat Teh
- Department of Infectious Diseases, Imperial College London, London, United Kingdom
| | - Thomas Joshua Pasvol
- Department of HIV Medicine, Imperial College Healthcare NHS Trust, London, United Kingdom
- University College London, London, United Kingdom
| | - Sara Ayres
- Department of HIV Medicine, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Hermione Lyall
- Department of Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, London, United Kingdom
- Department of Infectious Diseases, Imperial College London, London, United Kingdom
| | - Sarah Fidler
- Department of Infectious Diseases, Imperial College London, London, United Kingdom
- Department of HIV Medicine, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Caroline Foster
- Department of Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, London, United Kingdom
- Department of Infectious Diseases, Imperial College London, London, United Kingdom
- Department of HIV Medicine, Imperial College Healthcare NHS Trust, London, United Kingdom
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3
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Flygel TT, Hameiri-Bowen D, Simms V, Rowland-Jones S, Ferrand RA, Bandason T, Yindom LM, Odland JØ, Cavanagh JP, Flaegstad T, Sovershaeva E. Exhaled nitric oxide is associated with inflammatory biomarkers and risk of acute respiratory exacerbations in children with HIV-associated chronic lung disease. HIV Med 2024; 25:223-232. [PMID: 37804064 DOI: 10.1111/hiv.13565] [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] [Received: 04/18/2023] [Accepted: 09/26/2023] [Indexed: 10/08/2023]
Abstract
OBJECTIVES Chronic lung disease is a recognized complication in children with HIV. Acute respiratory exacerbations (ARE) are common among this group and cause significant morbidity. Exhaled nitric oxide (eNO) is a known marker of local airway inflammation. We investigated the association between eNO and ARE, biomarkers of systemic inflammation, and the effect of azithromycin on eNO levels. METHODS Individuals aged 6-19 years with HIV-associated chronic lung disease in Harare, Zimbabwe, were enrolled in a placebo-controlled randomized trial investigating the effect of 48-week azithromycin treatment on lung function and ARE. eNO levels and biomarkers were measured at inclusion and after treatment in a consecutively enrolled subset of participants. Linear regression and generalized linear models were used to study associations between eNO and ARE, biomarkers, and the effect of azithromycin on eNO levels. RESULTS In total, 172 participants were included in this sub-study, 86 from the placebo group and 86 from the azithromycin group. Participants experiencing at least one ARE during follow-up had significantly higher eNO levels at baseline than participants who did not (geometric mean ratio 1.13, 95% confidence interval [CI] 1.03-1.24, p = 0.015), adjusted for trial arm, age, sex and history of tuberculosis. Matrix metalloproteinase (MMP)-3, -7, and -10 were significantly associated with higher baseline eNO levels. At 48 weeks, azithromycin treatment did not affect eNO levels (geometric mean ratio 0.86, 95% CI 0.72-1.03, p = 0.103). CONCLUSION Higher baseline eNO levels were a risk factor for ARE. eNO was associated with proinflammatory biomarkers previously found to contribute to the development of chronic lung disease. The potential use of eNO as a marker of inflammation and risk factor for ARE in HIV-associated chronic lung disease needs further investigation.
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Affiliation(s)
- Trym Thune Flygel
- Paediatric Research Group, Department of Clinical Medicine, Faculty of Health sciences, UiT - The Arctic University of Norway, Tromsø, Norway
- Department of Paediatrics, University Hospital of North Norway, Tromsø, Norway
| | | | - Victoria Simms
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Rashida Abbas Ferrand
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Tsitsi Bandason
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | | | - Jon Øyvind Odland
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU The Norwegian University of Science and Technology, Trondheim, Norway
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Jorunn Pauline Cavanagh
- Paediatric Research Group, Department of Clinical Medicine, Faculty of Health sciences, UiT - The Arctic University of Norway, Tromsø, Norway
- Department of Paediatrics, University Hospital of North Norway, Tromsø, Norway
| | - Trond Flaegstad
- Paediatric Research Group, Department of Clinical Medicine, Faculty of Health sciences, UiT - The Arctic University of Norway, Tromsø, Norway
- Department of Paediatrics, University Hospital of North Norway, Tromsø, Norway
| | - Evgeniya Sovershaeva
- Department of Paediatrics, University Hospital of North Norway, Tromsø, Norway
- Department of Microbiology and Infection Control, Akershus University Hospital, Nordbyhagen, Norway
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Dufour I, Fougère Y, Goetghebuer T, Hainaut M, Mbiya B, Kakkar F, Yombi JC, Van der Linden D. Gen Z and HIV-Strategies for Optimizing the Care of the Next Generation of Adolescents Living with HIV. Viruses 2023; 15:2023. [PMID: 37896800 PMCID: PMC10611287 DOI: 10.3390/v15102023] [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: 09/04/2023] [Revised: 09/25/2023] [Accepted: 09/26/2023] [Indexed: 10/29/2023] Open
Abstract
The management of adolescents living with HIV represents a particular challenge in the global response to HIV. The challenges specific to this age group include difficulties engaging and maintaining them in care, challenges with transition to adult care, and limited therapeutic options for treatment-experienced patients, all of which have been jeopardized by the COVID-19 pandemic. This paper summarizes some of the challenges in managing adolescents living with HIV, as well as some of the most recent and innovative therapeutic approaches in this population.
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Affiliation(s)
- Inès Dufour
- Department of Internal Medicine and Infectious Diseases, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, 1200 Brussels, Belgium;
| | - Yves Fougère
- Division of Infectious Diseases, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, QC H3T 1J4, Canada; (Y.F.); (F.K.)
- Centre d’Infectiologie Mère-Enfant (CIME), Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, QC H3T 1J4, Canada
| | - Tessa Goetghebuer
- Department of Pediatrics, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles, 1000 Brussels, Belgium; (T.G.); (M.H.)
| | - Marc Hainaut
- Department of Pediatrics, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles, 1000 Brussels, Belgium; (T.G.); (M.H.)
| | - Benoît Mbiya
- Pediatrics Department, Faculty of Medicine, University of Mbujimayi, Mbujimayi 06201, Democratic Republic of the Congo;
- Sickle Cell Reference Center, Clinique Pédiatrique de Mbujimayi, Pediatrics Clinic of Mbujimayi, Mbujimayi 06201, Democratic Republic of the Congo
| | - Fatima Kakkar
- Division of Infectious Diseases, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, QC H3T 1J4, Canada; (Y.F.); (F.K.)
- Centre d’Infectiologie Mère-Enfant (CIME), Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, QC H3T 1J4, Canada
| | - Jean Cyr Yombi
- Department of Internal Medicine and Infectious Diseases, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, 1200 Brussels, Belgium;
- Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, 1348 Brussels, Belgium;
| | - Dimitri Van der Linden
- Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, 1348 Brussels, Belgium;
- Pediatric Infectious Diseases, Service of Specialized Pediatrics, Department of Pediatrics, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, 1200 Brussels, Belgium
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5
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Chiang SS, Waterous PM, Atieno VF, Bernays S, Bondarenko Y, Cruz AT, de Oliveira MCB, Del Castillo Barrientos H, Enimil A, Ferlazzo G, Ferrand RA, Furin J, Hoddinott G, Isaakidis P, Kranzer K, Maleche-Obimbo E, Mansoor H, Marais BJ, Mohr-Holland E, Morales M, Nguyen AP, Oliyo JO, Sant'Anna CC, Sawyer SM, Schaaf HS, Seddon JA, Sharma S, Skrahina A, Starke JR, Triasih R, Tsogt B, Welch H, Enane LA. Caring for Adolescents and Young Adults With Tuberculosis or at Risk of Tuberculosis: Consensus Statement From an International Expert Panel. J Adolesc Health 2023; 72:323-331. [PMID: 36803849 PMCID: PMC10265598 DOI: 10.1016/j.jadohealth.2022.10.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 10/25/2022] [Indexed: 02/19/2023]
Abstract
Background: Despite being a preventable and treatable disease, tuberculosis (TB) is a leading cause of death among young people globally. Each year, an estimated 1.8 million adolescents and young adults (AYAs; 10–24 years old) develop TB. In 2019, an estimated 161,000 AYAs died of the disease. AYAs have unique developmental, psychosocial, and healthcare needs, but these needs have been neglected in both TB care and research agendas. In order to improve outcomes in this age group, the specific needs of AYAs must be considered and addressed. Methods: Through a consensus process, an international panel of 34 clinicians, researchers, TB survivors, and advocates with expertise in child/adolescent TB and/or adolescent health proposed interventions for optimizing AYA engagement in TB care. The process consisted of reviewing the literature on TB in AYAs; identifying and discussing priority areas; and drafting and revising proposed interventions until consensus, defined a priori , was reached. Results: The panel acknowledged the dearth of evidence on best practices for identifying and managing AYAs with TB. The final consensus statement, based on expert opinion, proposes nine interventions to reform current practices that may harm AYA health and well-being, and nine interventions to establish high-quality AYA-centered TB services. Conclusion: AYA-specific interventions for TB care and research are critical for improving outcomes in this age group. In the absence of evidence on best practices, this consensus statement from an international group of experts can help address the needs of AYA with TB or at risk for TB.
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Affiliation(s)
- Silvia S Chiang
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Alpert Medical School of Brown University, Providence, Rhode Island; Center for International Health Research, Rhode Island Hospital, Providence, Rhode Island.
| | - Patricia M Waterous
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Sarah Bernays
- School of Public Health, University of Sydney, Sydney, Australia; Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Yaroslava Bondarenko
- Department of Phthisiology and Pulmonology, Bogomolets National Medical University, Kyiv, Ukraine
| | - Andrea T Cruz
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Márcia C B de Oliveira
- Department of Pediatrics, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; Department of Pediatrics, Souza Marques School of Medicine, Rio de Janeiro, Brazil
| | | | - Anthony Enimil
- Child Health Department, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; Child Health Directorate, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Gabriella Ferlazzo
- Médecins Sans Frontières, Cape Town, South Africa; Médecins Sans Frontières, Mumbai, India
| | - Rashida Abbas Ferrand
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom; Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Jennifer Furin
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts; Sentinel Project on Pediatric Drug-Resistant Tuberculosis, Boston, Massachusetts
| | - Graeme Hoddinott
- Department of Paediatrics and Child Health, Desmond Tutu TB Centre, Stellenbosch University, Cape Town, South Africa
| | - Petros Isaakidis
- Médecins Sans Frontières, Cape Town, South Africa; Médecins Sans Frontières, Mumbai, India
| | - Katharina Kranzer
- School of Public Health, University of Sydney, Sydney, Australia; Biomedical Research and Training Institute, Harare, Zimbabwe
| | | | | | - Ben J Marais
- Sydney Infectious Diseases Institute (Sydney ID), University of Sydney, Sydney, Australia; Department of Infectious Diseases and Microbiology, The Children's Hospital at Westmead, Sydney, Australia
| | | | | | | | | | - Clemax Couto Sant'Anna
- Department of Pediatrics, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Susan M Sawyer
- Centre for Adolescent Health, Royal Children's Hospital and Murdoch Children's Research Institute, Melbourne, Australia; Department of Peadiatrics, The University of Melbourne, Melbourne, Australia
| | - H Simon Schaaf
- Department of Paediatrics and Child Health, Desmond Tutu TB Centre, Stellenbosch University, Cape Town, South Africa
| | - James A Seddon
- Department of Paediatrics and Child Health, Desmond Tutu TB Centre, Stellenbosch University, Cape Town, South Africa; Department of Infectious Diseases, Imperial College London, London, United Kingdom
| | - Sangeeta Sharma
- Department of Paediatrics, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | - Alena Skrahina
- Clinical Department, The Republican Research and Practica Centre for Pulmonology and TB, Minsk, Belarus
| | - Jeffrey R Starke
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Rina Triasih
- Department of Pediatrics, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | | | - Henry Welch
- Department of Pediatrics, Souza Marques School of Medicine, Rio de Janeiro, Brazil; Department of Pediatrics, School of Medicine and Health Sciences, The University of Papua New Guinea, Port Moresby, Papua New Guinea; Port Moresby General Hospital, Port Moresby, Papua New Guinea
| | - Leslie A Enane
- Department of Pediatrics, The Ryan White Center for Pediatric Infectious Diseases and Global Health, Indiana University School of Medicine, Indianapolis, Indiana; Indiana University Center for Global Health, Indianapolis, Indiana.
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6
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Humphrey J, Triedman M, Nyandiko W, Sang E, Kemboi E, Alera M, Novitsky V, Manne A, Jepkemboi E, Orido M, Apondi E, Vreeman R, Wools-Kaloustian K, Kantor R. A Challenging Knowledge Gap: Estimating Modes of HIV Acquisition Among Adolescents Entering HIV Care During Adolescence. Glob Pediatr Health 2022; 9:2333794X221101768. [PMID: 35664047 PMCID: PMC9160889 DOI: 10.1177/2333794x221101768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 04/30/2022] [Indexed: 11/15/2022] Open
Abstract
Characterizing HIV acquisition modes among adolescents with HIV (AHIV) enrolling in care during adolescence is a challenging gap that impacts differential interventions. We explored whether primary data collection with targeted questionnaires may address this gap and improve understanding of risk factors and perceptions about adolescents’ HIV acquisition, in Kenyan AHIV entering care at ≥10 years, and their mothers with HIV (MHIV). Clinical data were derived through chart review. Among 1073 AHIV in care, only 26 (2%) met eligibility criteria of being ≥10 years at care enrollment, disclosed to, and with living MHIV. Among 18/26 AHIV-MHIV dyads enrolled (median age of AHIV 14 years), none had documented HIV acquisition modes. Data suggested perinatal infection in 17/18 AHIV, with 1 reported non-perinatal acquisition risk factor, and some discordance between adolescent-mother perceptions of HIV acquisition. In this difficult-to-enroll, vulnerable population of AHIV-MHIV dyads, primary data collection can enhance understanding of AHIV acquisition modes.
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Affiliation(s)
| | | | - Winstone Nyandiko
- Moi University College of Health Sciences, Eldoret, Kenya.,Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Edwin Sang
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Emmanuel Kemboi
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Marsha Alera
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | | | | | | | - Millicent Orido
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Edith Apondi
- Academic Model Providing Access to Healthcare, Eldoret, Kenya.,Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Rachel Vreeman
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
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7
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Fairlie L, Chernoff M, Cotton MF, Bwakura-Dangarembizi M, Violari A, Familiar-Lopez I, Barlow-Mosha L, Kamthunzi P, McCarthy K, Jean-Philippe P, Laughton B, Palumbo PE, Boivin MJ. Antiretroviral choice and severe disease predict poorer neuropsychological outcomes in HIV+ children from Africa. Front Pediatr 2022; 10:899002. [PMID: 35989995 PMCID: PMC9382189 DOI: 10.3389/fped.2022.899002] [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: 03/18/2022] [Accepted: 07/13/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The International Maternal Pediatric Adolescent AIDS Clinical Trials Network (IMPAACT) P1104s study evaluated neuropsychological outcomes over 96 weeks in children living with HIV (CLHIV) aged 5-11 years at 6 Sub-Saharan African sites to explore associations between HIV-illness related biomarkers and neuropsychological outcomes. METHODS Children living with HIV had participated in IMPAACT P1060, which compared efficacy of nevirapine versus lopinavir/ritonavir in children initiating ART at <3 years of age. At age 5-11, neuropsychological evaluations of KABC cognitive ability, TOVA attention-impulsivity and BOT-2 motor domains were assessed and repeated after 48 and 96 weeks. Clinical, antiretroviral therapy (ART) and laboratory (immunological and virological) parameters were used to predict neuropsychological outcomes using linear mixed-effects multivariable regression models, controlling for child and caregiver characteristics. RESULTS 246 CLHIV (45% male, mean age at initial neuropsychological evaluation 7.1 yrs [SD 1.2]) began ART at a median age 14.9 months (IQR 8.2, 25.2). Nadir CD4 percentage was 14.7% (IQR 11.0, 19.5); the median peak viral load (VL) was 750 000 copies/ml (IQR 366 000, 750 000) and 63% had ≥WHO stage 3 clinical disease; 164 (67%) were on lopinavir/ritonavir, 71 (29%) were on nevirapine and 7 (3%) were on efavirenz. Other antiretrovirals were similar. Nevirapine at P1104s study start or later was associated with poorer neuropsychological scores across all domains except Global Executive Composite, even when controlling for nadir CD4 percent and time-varying HIV VL. Other predictors of poorer scores in KABC domains included low birth weight, WHO stage 4 disease and serious illness history and elevated VL was associated with worse BOT-2 scores. CONCLUSION Children receiving nevirapine had poorer neuropsychological scores than those on lopinavir/ritonavir. Antiretroviral choice might adversely impact neuropsychological performance. In addition, low birth weight and markers of severe HIV disease: advanced WHO clinical HIV disease, history of serious illness and an elevated VL, were associated with lower neuropsychological scores.
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Affiliation(s)
- Lee Fairlie
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Miriam Chernoff
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Mark F Cotton
- Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, Tygerberg Hospital, Stellenbosch University, Tygerberg, South Africa
| | - Mutsa Bwakura-Dangarembizi
- Harare Family Care CRS, College of Health Sciences Clinical Trials Unit, University of Zimbabwe, Harare, Zimbabwe
| | - Avy Violari
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Itziar Familiar-Lopez
- Department of Psychiatry, Michigan State University, East Lansing, MI, United States
| | - Linda Barlow-Mosha
- Makerere University-Johns Hopkins University Research Collaboration, MU-JHU Care Ltd., CRS, Kampala, Uganda
| | - Portia Kamthunzi
- University of North Carolina Project-Lilongwe, Malawi CRS, Lilongwe, Malawi
| | | | - Patrick Jean-Philippe
- National Institute of Allergy and Infectious Diseases, National Institute of Health, Rockville, MD, United States
| | - Barbara Laughton
- Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, Tygerberg Hospital, Stellenbosch University, Tygerberg, South Africa
| | - Paul E Palumbo
- Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Michael J Boivin
- Department of Psychiatry, Michigan State University, East Lansing, MI, United States.,Department of Neurology and Ophthalmology, Michigan State University, East Lansing, MI, United States.,Department of Psychiatry, The University of Michigan, Ann Arbor, MI, United States
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8
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Malungani NF, Rasweswe MM, Peu MD. “I’m angry with my mother”: Lived psychosocial experiences of adolescents with peri-natal-acquired HIV in Limpopo, South Africa. JOURNAL OF PSYCHOLOGY IN AFRICA 2021. [DOI: 10.1080/14330237.2021.2001991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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9
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Ajaykumar A, Wong GC, Yindom LM, McHugh G, Dauya E, Majonga E, Mujuru H, Ferrand RA, Rowland-Jones SL, Côté HCF. Shorter Granulocyte Telomeres Among Children and Adolescents With Perinatally Acquired Human Immunodeficiency Virus Infection and Chronic Lung Disease in Zimbabwe. Clin Infect Dis 2021; 73:e2043-e2051. [PMID: 32766884 PMCID: PMC8492138 DOI: 10.1093/cid/ciaa1134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 08/06/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Chronic lung disease (CLD) has been reported among African children with perinatally acquired human immunodeficiency virus (HIV) infection (C-PHIV), despite combination antiretroviral therapy (cART). In adults, shorter telomere length (TL) has been reported in association with both CLD and HIV. As little is known in children, our objective was to compare TL in HIV-positive (cART-naive or -treated) and HIV-negative children with and without CLD. METHODS Participants included Zimbabwean C-PHIV, aged 6-16, who were either newly diagnosed and cART-naive, or on cART for >6 months, and HIV-negative controls of similar age and sex. Packed blood cell (granulocyte) TLs from 621 children were compared cross-sectionally between groups. For a subset of newly diagnosed C-PHIV, changes in TL following cART initiation were evaluated. RESULTS C-PHIV had shorter granulocyte TL compared with uninfected peers, regardless of cART. Among 255 C-PHIV without CLD, TL was shorter in cART-naive participants. In multivariable analyses adjusted for age, sex, CLD, and HIV/cART status, shorter TL was independently associated with older age, being HIV positive, and having reduced forced vital capacity (FVC). Last, cART initiation increased TL. CONCLUSIONS In this cohort, C-PHIV and those with reduced FVC have shorter granulocyte TL, possibly the result of increased immune activation and cellular turnover due to longstanding HIV infection with delayed cART initiation.
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Affiliation(s)
- Abhinav Ajaykumar
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Blood Research, University of British Columbia, Vancouver, British Columbia, Canada
| | - Glenn C Wong
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Louis-Marie Yindom
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Grace McHugh
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Ethel Dauya
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Edith Majonga
- Biomedical Research and Training Institute, Harare, Zimbabwe
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Rashida A Ferrand
- Biomedical Research and Training Institute, Harare, Zimbabwe
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Hélène C F Côté
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Blood Research, University of British Columbia, Vancouver, British Columbia, Canada
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Influence of Childhood Adversity and Infection on Timing of Menarche in a Multiethnic Sample of Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084080. [PMID: 33924338 PMCID: PMC8070127 DOI: 10.3390/ijerph18084080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/07/2021] [Accepted: 04/08/2021] [Indexed: 01/18/2023]
Abstract
Childhood adversities (CAs) and infections may affect the timing of reproductive development. We examined the associations of indicators of CAs and exposure to tonsillitis and infectious mononucleosis (mono) with age at menarche. A multiethnic cohort of 400 women (ages 40–64 years) reported exposure to parental maltreatment and maladjustment during childhood and any diagnosis of tonsillitis and/or mono; infections primarily acquired in early life and adolescence, respectively. We used linear and relative risk regression models to examine the associations of indicators of CAs individually and cumulatively, and history of tonsillitis/mono with an average age at menarche and early onset of menarche (<12 years of age). In multivariable models, histories of mental illness in the household (RR = 1.44, 95% CI: 1.01–2.06), and tonsillitis diagnosis (RR = 1.67, 95% CI: 1.20–2.33) were associated with early menarche (<12 years), and with an earlier average age at menarche by 7.1 months (95% CI: −1.15, −0.02) and 8.8 months (95% CI: −1.26, −0.20), respectively. Other adversities indicators, cumulative adversities, and mono were not statistically associated with menarcheal timing. These findings provided some support for the growing evidence that early life experiences may influence the reproductive development in girls.
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11
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Frigati LJ, Wilkinson KA, le Roux S, Brown K, Ruzive S, Githinji L, Petersen W, Belard S, Cotton MF, Myer L, Zar HJ. Tuberculosis infection and disease in South African adolescents with perinatally acquired HIV on antiretroviral therapy: a cohort study. J Int AIDS Soc 2021; 24:e25671. [PMID: 33719199 PMCID: PMC7957181 DOI: 10.1002/jia2.25671] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 12/22/2020] [Accepted: 01/27/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION There are limited data on Tuberculosis (TB) in adolescents with perinatally acquired HIV (APHIV). We examined the incidence and determinants of TB infection and disease in the Cape Town Adolescent Antiretroviral Cohort (CTAAC). METHODS Youth between nine and fourteen years on antiretroviral therapy (ART) for more than six months in public sector care, and age-matched HIV-negative adolescents, were enrolled between July 2013 through March 2015 and followed six-monthly. Data were censored on 31 October 2018. Symptom screening, chest radiograph, viral load, CD4 count, QuantiFERON (QFT) and sputum for Xpert MTB/RIF, microscopy, culture and sensitivity were performed annually. TB infection was defined by a QFT of >0.35 IU/mL. TB diagnosis was defined as confirmed (culture or Xpert MTB/RIF positive) or unconfirmed (clinical diagnosis and started on TB treatment). Analyses examined the incidence and determinants of TB infection and disease. RESULTS Overall 496 HIV+ and 103 HIV-negative participants (median age at enrolment 12 years (interquartile range, IQR 10.6 to 13.3) were followed for a median of 3.1 years (IQR 3.0 to 3.4); 50% (298/599) were male. APHIV initiated ART at median age 4.4 years (IQR 2.1 to 7.6). At enrolment, 376/496 (76%) had HIV viral load <40 copies/mL, median CD4 count was 713 cells/mm3 and 179/559 (32%) were QFT+, with no difference by HIV status (APHIV 154/468, 33%; HIV negative 25/91, 27%; p = 0.31). The cumulative QFT+ prevalence was similar (APHIV 225/492, 46%; 95%CI 41% to 50%; HIV negative 44/98, 45%; 95% CI 35% to 55%; p = 0.88). APHIV had a higher incidence of all TB disease than HIV-negative adolescents (2.2/100PY, 95% CI 1.6 to 3.1 vs. 0.3/100PY, 95% CI 0.04 to 2.2; IRR 7.36, 95% CI 1.01 to 53.55). The rate of bacteriologically confirmed TB in APHIV was 1.3/100 PY compared to 0.3/100PY for HIV-negative adolescents, suggesting a fourfold increased risk of developing TB disease in APHIV despite access to ART. In addition, a positive QFT at enrolment was not predictive of TB in this population. CONCLUSIONS High incidence rates of TB disease occur in APHIV despite similar QFT conversion rates to HIV-negative adolescents. Strategies to prevent TB in this vulnerable group must be strengthened.
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Affiliation(s)
- Lisa J Frigati
- Department of Paediatrics and Child HealthUniversity of Cape TownCapeSouth Africa
- Family Center for Research with Ubuntu (FAMCRU)Department of Paediatrics and Child HealthStellenbosch UniversityCape TownSouth Africa
| | - Katalin A Wilkinson
- Wellcome Centre for Infectious Disease Research in AfricaInstitute of Infectious Disease and Molecular MedicineUniversity of Cape TownCape TownSouth Africa
- The Francis Crick InstituteLondonUnited Kingdom
| | - Stanzi le Roux
- Division of Epidemiology and BiostatisticsSchool of Public Health and Family MedicineUniversity of Cape TownCape TownSouth Africa
| | - Karryn Brown
- Division of Epidemiology and BiostatisticsSchool of Public Health and Family MedicineUniversity of Cape TownCape TownSouth Africa
| | - Sheena Ruzive
- Wellcome Centre for Infectious Disease Research in AfricaInstitute of Infectious Disease and Molecular MedicineUniversity of Cape TownCape TownSouth Africa
| | - Leah Githinji
- Department of Paediatrics and Child HealthUniversity of Cape TownCapeSouth Africa
| | - Wonita Petersen
- Department of Paediatrics and Child HealthUniversity of Cape TownCapeSouth Africa
| | - Sabine Belard
- Department of Pediatric Pulmonology, Immunology and Intensive Care MedicineCharité ‐ Universitätsmedizin BerlinBerlinGermany
- Berlin Institute of HealthBerlinGermany
| | - Mark F Cotton
- Family Center for Research with Ubuntu (FAMCRU)Department of Paediatrics and Child HealthStellenbosch UniversityCape TownSouth Africa
| | - Landon Myer
- Division of Epidemiology and BiostatisticsSchool of Public Health and Family MedicineUniversity of Cape TownCape TownSouth Africa
| | - Heather J Zar
- Department of Paediatrics and Child HealthUniversity of Cape TownCapeSouth Africa
- SAMRC Unit on Child and Adolescent HealthUniversity of Cape TownCape TownSouth Africa
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12
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Githinji L, Zar HJ. Respiratory Complications in Children and Adolescents with Human Immunodeficiency Virus. Pediatr Clin North Am 2021; 68:131-145. [PMID: 33228928 DOI: 10.1016/j.pcl.2020.09.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Respiratory complications comprise a large proportion of the burden of mortality and morbidity in children with human immunodeficiency virus (HIV). HIV-associated lower respiratory tract infection (LRTI) has declined in incidence with early diagnosis and use of antiretroviral therapy (ART) but is widespread in areas with limited access to ART. HIV-exposed uninfected infants have a higher risk of LRTI early in life than unexposed infants. Pulmonary tuberculosis (PTB) presenting as acute or chronic disease is common in highly TB endemic areas. Chronic lung disease is common; preceding LRTI, PTB or late initiation of ART are risk factors.
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Affiliation(s)
- Leah Githinji
- Department of Paediatrics and Child Health, South Africa MRC Unit on Child & Adolescent Health, University of Cape Town, Red Cross War Memorial Children's Hospital, ICH Building, Klipfontein Road, Rondebosch 7700, South Africa
| | - Heather J Zar
- Department of Paediatrics and Child Health, South Africa MRC Unit on Child & Adolescent Health, University of Cape Town, Red Cross War Memorial Children's Hospital, ICH Building, Klipfontein Road, Rondebosch 7700, South Africa.
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13
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Githinji LN, Gray DM, Hlengwa S, Machemedze T, Zar HJ. Longitudinal Changes in Spirometry in South African Adolescents Perinatally Infected With Human Immunodeficiency Virus Who Are Receiving Antiretroviral Therapy. Clin Infect Dis 2021; 70:483-490. [PMID: 30938406 DOI: 10.1093/cid/ciz255] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 03/22/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Despite increased access to highly active antiretroviral therapy (HAART), lung disease remains common in human immunodeficiency virus (HIV)-infected (HIV+) adolescents. There is limited information on changes in lung function over time in perinatally HIV+ adolescents on HAART. The objective was to investigate the progression of spirometry findings over 2 years in HIV+ adolescents on HAART in a prospective cohort, the Cape Town Adolescent Antiretroviral Cohort (CTAAC). METHODS HIV+ adolescents aged 9-14 years, with at least 6 months of HAART, and a comparator group of healthy HIV-uninfected (HIV-), age-matched controls were enrolled in CTAAC. Spirometry and bronchodilator testing were done at baseline, 12 months, and 24 months. Mixed-effect models were used to compute longitudinal changes in lung function. RESULTS Five hundred fifteen HIV+ adolescents, mean age 12 (standard deviation [SD], 1.6) years, 50.4% male, and 110 HIV- adolescents, mean age 11.8 (SD, 1.8) years, 45.6% male, were tested at baseline; 477 (93%) HIV+ and 102 (93%) HIV- adolescents at 12 months; and 473 (92%) HIV+ and 97 (88%) HIV- adolescents at 24 months. Only 5.4% of the HIV+ adolescents had HIV viral load >10 000 copies/mL at baseline. Forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) were lower in the HIV+ compared to the HIV- adolescents and tracked with no deterioration or catch-up over 2 years. Previous pulmonary tuberculosis (PTB) or lower respiratory tract infection (LRTI) was significantly associated with reduced FEV1 and FVC (P < .05 for both). CONCLUSIONS HIV+ adolescents had lower lung function over 2 years than HIV- adolescents. This study highlights the need for lung function surveillance and prevention of LRTIs and PTB in HIV+ adolescents.
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Affiliation(s)
- Leah N Githinji
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, Cape Town.,Medical Research Council Unit on Child and Adolescent Health, Cape Town, South Africa
| | - Diane M Gray
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, Cape Town.,Medical Research Council Unit on Child and Adolescent Health, Cape Town, South Africa
| | - Sipho Hlengwa
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, Cape Town.,Medical Research Council Unit on Child and Adolescent Health, Cape Town, South Africa
| | - Takwanisa Machemedze
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, Cape Town.,Medical Research Council Unit on Child and Adolescent Health, Cape Town, South Africa
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, Cape Town.,Medical Research Council Unit on Child and Adolescent Health, Cape Town, South Africa
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Njuguna IN, Beima-Sofie K, Mburu CW, Mugo C, Neary J, Itindi J, Onyango A, Richardson BA, Rubin Means A, Sharma M, Weiner BJ, Wagner AD, Oyiengo L, Wamalwa D, John-Stewart G. Adolescent transition to adult care for HIV-infected adolescents in Kenya (ATTACH): study protocol for a hybrid effectiveness-implementation cluster randomised trial. BMJ Open 2020; 10:e039972. [PMID: 33268417 PMCID: PMC7713196 DOI: 10.1136/bmjopen-2020-039972] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 08/20/2020] [Accepted: 11/02/2020] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Successfully transitioning adolescents to adult HIV care is critical for optimising outcomes. Disclosure of HIV status, a prerequisite to transition, remains suboptimal in sub-Saharan Africa. Few interventions have addressed both disclosure and transition. An adolescent transition package (ATP) that combines disclosure and transition tools could support transition and improve outcomes. METHODS AND ANALYSIS In this hybrid type 1 effectiveness-implementation cluster randomised controlled trial, 10 HIV clinics with an estimated ≥100 adolescents and young adults age 10-24 living with HIV (ALWHIV) in Kenya will be randomised to implement the ATP and compared with 10 clinics receiving standard of care. The ATP includes provider tools to assist disclosure and transition. Healthcare providers at intervention clinics will receive training on ATP use and support to adapt it through continuous quality improvement cycles over the initial 6 months of the study, with continued implementation for 1 year. The primary outcome is transition readiness among ALWHIV ages 15-24 years, assessed 6 monthly using a 22-item readiness score. Secondary outcomes including retention and viral suppression among ALWHIV at the end of the intervention period (month 18), implementation outcomes (acceptability, feasibility, fidelity, coverage and penetration) and programme costs complement effectiveness outcomes. The primary analysis will be intent to treat, using mixed-effects linear regression models to compare transition readiness scores (overall and by domain (HIV literacy, self-management, communication, support)) over time in control and intervention sites with adjustment for multiple testing, accounting for clustering by clinic and repeated assessments. We will estimate the coefficients and 95% CIs with a two- sided α=0.05. ETHICS AND DISSEMINATION The study was approved by the University of Washington Institutional Review Board and the Kenyatta National Hospital Ethics and Research Committee. Study results will be shared with participating facilities, county and national policy-makers. TRIALS REGISTRATION NUMBER NCT03574129; Pre-results.
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Affiliation(s)
- Irene N Njuguna
- Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
- Global Health, University of Washington, Seattle, Washington, USA
| | | | - Caren W Mburu
- Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Cyrus Mugo
- Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
- Epidemiology, University of Washington, Seattle, Washington, United States
| | - Jillian Neary
- Global Health, University of Washington, Seattle, Washington, USA
| | - Janet Itindi
- Kenya Medical Research Institute, Nairobi, Kenya
| | | | - Barbra A Richardson
- Global Health, University of Washington, Seattle, Washington, USA
- Biostatistics, University of Washington, Seattle, Washington, United States
| | | | - Monisha Sharma
- Global Health, University of Washington, Seattle, Washington, USA
| | - Bryan J Weiner
- Global Health, University of Washington, Seattle, Washington, USA
- Department of Health Services, University of Washington, Seattle, Washington, USA
| | - Anjuli D Wagner
- Global Health, University of Washington, Seattle, Washington, USA
| | - Laura Oyiengo
- Neonatal and Child Health Services, Ministry of Health, Nairobi, Kenya
| | - Dalton Wamalwa
- Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Grace John-Stewart
- Global Health, University of Washington, Seattle, Washington, USA
- Epidemiology, University of Washington, Seattle, Washington, United States
- Pediatrics, University of Washington, Seattle, Washington, United States
- Medicine, University of Washington, Seattle, Washington, United States
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15
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Characteristics and outcomes of adolescents living with perinatally acquired HIV within Southern Africa. AIDS 2020; 34:2275-2284. [PMID: 32910063 DOI: 10.1097/qad.0000000000002683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Using data from 15 International epidemiology Databases to Evaluate AIDS in Southern Africa sites, we compared the characteristics and outcomes of adolescents living with perinatally acquired HIV (ALPH). METHODS We included ALPH entering care aged less than 13 years with at least one HIV care visit during adolescence (10-19 years). We compared the characteristics and cross-sectional outcomes: transfer out, loss to follow-up (no visit in the 12 months prior to database closure), mortality, and retention between those who entered care aged less than 10 vs. aged 10-13 years; and explored predictors of mortality after age 13 years using Cox Proportional Hazards models. RESULTS Overall, 16 229 (50% female) ALPH who entered HIV care aged less than 10 years and 8897 (54% female) aged 10-13 years were included and followed for 152 574 person-years. During follow-up, 94.1% initiated antiretroviral therapy, with those who entered care aged less than 10 more likely to have initiated antiretroviral therapy [97.9%, 95% confidence interval (CI) 97.6; 98.1%] than those who presented aged 10-13 years (87.3%, 95% CI 86.6; 88.0%). At the end of follow-up, 3% had died (entered care aged <10 vs. 10-13 years; 1.4 vs. 5.1%), 22% were loss to follow-up (16.2 vs. 33.4%), and 59% (66.4 vs. 45.4%) were retained. There was no difference in the risk of dying after the age of 13 years between adolescents entering care aged less than 10 vs. 10-13 years (adjusted hazard ratio 0.72; 95% CI 0.36; 1.42). CONCLUSION Retention outcomes for ALPH progressively worsened with increasing age, with these outcomes substantially worse among adolescents entering HIV care aged 10-13 vs. less than 10 years.
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Abstract
BACKGROUND Little is known about hospitalization in African adolescents with perinatally acquired HIV (PHIV+ adolescents). We described the incidence and causes of hospitalization in participants enrolled in the Cape Town Adolescent Antiretroviral Cohort in South Africa. METHODS Data collected from July 2013 to October 2018 from PHIV+ and HIV- adolescents were analyzed. Participants were assessed every 6 months and data on intercurrent hospitalization were abstracted. Causes of hospitalizations were classified according to ICD-10 codes. Descriptive statistics, time-to-event analysis and Poisson regression were used to describe causes and incidence and to determine incidence rate ratios for factors associated with hospitalization. RESULTS Five hundred fifteen PHIV+ and 109 HIV- participants had a median follow-up of 4.1 years [interquartile range (IQR): 3.7-4.6]. At enrollment HIV+ participants had a median duration of ART of 7.6 years (IQR: 4.6-9.2), median CD4 count of 713 cells/mm (IQR: 561.0-957.5) and 387 (75%) had a viral load <50 copies/mL. There were 149 hospital admissions over 64 months. Crude incidence rates for hospitalization were 6.6 [95% confidence interval (CI): 5.7-7.8] and 2.2 (95% CI: 1.2-4.3) per 100-person-years (P = <0.01) in HIV + and HIV-, respectively. Ninety of 149 (60%) admissions in HIV+ participants were classified as non-infectious, 36/149 (24%) were infectious and 23/149 (16%) were "other HIV-related" or "unknown." Older age (15-19 years) and maintaining a CD4 >500 cells/cm were associated with decreased risk of hospitalization: adjusted incidence rate ratios of 0.61 (CI: 0.44-0.86, P = <0.01) and 0.68 (CI: 0.49-0.94, P = 0.02), respectively. CONCLUSIONS PHIV+ adolescents had a high incidence of hospitalization despite ART. Strategies addressing infectious and non-infectious morbidity must be strengthened.
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Pacheco ALO, Sabidó M, Monteiro WM, Andrade SDD. Unsatisfactory long-term virological suppression in human immunodeficiency virus-infected children in the Amazonas State, Brazil. Rev Soc Bras Med Trop 2020; 53:e20200333. [PMID: 33111912 PMCID: PMC7580278 DOI: 10.1590/0037-8682-0333-2020] [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: 06/17/2020] [Accepted: 08/03/2020] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION: Achieving viral suppression (VS) in children is challenging despite the
exponential increase in access to antiretroviral therapy (ART). We evaluated
VS in children >1 year of age and adolescents 5 years after they had
begun ART, in Manaus, Amazonas state, Brazil. METHODS: HIV-infected, ART-naive children >1 year of age between 1999
and 2016 were eligible. Analysis was stratified by age at ART initiation:
1-5 y, >5-10 y, and >10-19 y. CD4+ T-cell count and viral
load were assessed on arrival at the clinic, on ART initiation, and at 6
months, 1 year, 2 years, and 5 years after ART initiation. The primary
outcome was a viral load <50 copies/mL 5 years after ART initiation. RESULTS: Ultimately, 121 patients were included. The mean age at diagnosis was 4.8
years (SD 3.5), mean CD4% was 17.9 (SD 9.8), and mean viral load was 4.6
log10 copies/ml (SD 0.8). Five years after ART initiation, the overall VS
rate was 46.9%. VS by patient age group was as follows: 36.6% for 1-5 y,
53.3% for >5-10 y, and 30% for >10-19 y. Almost all children (90,4%)
showed an increase in CD4%+ T cell count. There were no statistically
significant predictors for detecting children who do not achieve VS with
treatment. VS remained below 65% in all the evaluated periods. CONCLUSIONS: Considerable immunological improvement is seen in children after ART
initiation. Further efforts are needed to maintain adequate long-term VS
levels and improve the survival of this vulnerable population.
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Affiliation(s)
- Ana Luisa Opromolla Pacheco
- Universidade do Estado do Amazonas, Departamento de Medicina, Manaus, AM, Brasil.,Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Programa de Pós-Graduação em Medicina Tropical, Manaus AM, Brasil
| | - Meritxell Sabidó
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Programa de Pós-Graduação em Medicina Tropical, Manaus AM, Brasil.,Universitat de Girona, Department of Medical Sciences, Catalunya, Spain
| | - Wuelton Marcelo Monteiro
- Universidade do Estado do Amazonas, Departamento de Medicina, Manaus, AM, Brasil.,Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Programa de Pós-Graduação em Medicina Tropical, Manaus AM, Brasil
| | - Solange Dourado de Andrade
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Programa de Pós-Graduação em Medicina Tropical, Manaus AM, Brasil
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18
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Matsena Zingoni Z, Chirwa T, Todd J, Musenge E. Competing risk of mortality on loss to follow-up outcome among patients with HIV on ART: a retrospective cohort study from the Zimbabwe national ART programme. BMJ Open 2020; 10:e036136. [PMID: 33028546 PMCID: PMC7539573 DOI: 10.1136/bmjopen-2019-036136] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 08/24/2020] [Accepted: 09/01/2020] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To determine the loss to follow-up (LTFU) rates at different healthcare levels after antiretroviral therapy (ART) services decentralisation among ART patients who initiated ART between 2004 and 2017 using the competing risk model in addition to the Kaplan-Meier and Cox regressions analysis. DESIGN A retrospective cohort study. SETTING The study was done in Zimbabwe using a nationwide routinely collected HIV patient-level data from various health levels of care facilities compiled through the electronic patient management system (ePMS). PARTICIPANTS We analysed 390 771 participants aged 15 years and above from 538 health facilities. OUTCOMES The primary endpoint was LTFU defined as a failure of a patient to report for drug refill for at least 90 days from last appointment date or if the patient missed the next scheduled visit date and never showed up again. Mortality was considered a secondary outcome if a patient was reported to have died. RESULTS The total exposure time contributed was 1 544 468 person-years. LTFU rate was 5.75 (95% CI 5.71 to 5.78) per 100 person-years. Adjustment for the competing event independently increased LTFU rate ratio in provincial and referral (adjusted sub-HRs (AsHR) 1.22; 95% CI 1.18 to 1.26) and district and mission (AsHR 1.47; 95% CI 1.45 to 1.50) hospitals (reference: primary healthcare); in urban sites (AsHR 1.61; 95% CI 1.59 to 1.63) (reference: rural); and among adolescence and young adults (15-24 years) group (AsHR 1.19; 95% CI 1.16 to 1.21) (reference: 35-44 years). We also detected overwhelming association between LTFU and tuberculosis-infected patients (AsHR 1.53; 95% CI 1.45 to 1.62) (reference: no tuberculosis). CONCLUSIONS We have observed considerable findings that 'leakages' (LTFU) within the ART treatment cascade persist even after the decentralisation of health services. Risk factors for LTFU reflect those found in sub-Saharan African studies. Interventions that retain patients in care by minimising any 'leakages' along the treatment cascade are essential in attaining the 90-90-90 UNAIDS fast-track targets.
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Affiliation(s)
- Zvifadzo Matsena Zingoni
- Division of Epidemiology and Biostatistics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- National Institute of Health Research, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Tobias Chirwa
- Division of Epidemiology and Biostatistics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jim Todd
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Eustasius Musenge
- Division of Epidemiology and Biostatistics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Bernays S, Lanyon C, Paparini S. Adolescents Living With HIV: Checking Unhelpful Terminology. J Adolesc Health 2020; 67:477-478. [PMID: 32792257 DOI: 10.1016/j.jadohealth.2020.07.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/12/2020] [Accepted: 07/12/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Sarah Bernays
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia; Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | - Chloe Lanyon
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Sara Paparini
- Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, University of Oxford, Oxford, United Kingdom
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20
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Sindelar K, Maponga C, Lekoala F, Mandara E, Mohoanyane M, Sanders J, Joseph J. Beyond the facility: An evaluation of seven community-based pediatric HIV testing strategies and linkage to care outcomes in a high prevalence, resource-limited setting. PLoS One 2020; 15:e0236985. [PMID: 32877441 PMCID: PMC7467225 DOI: 10.1371/journal.pone.0236985] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 07/18/2020] [Indexed: 11/18/2022] Open
Abstract
Diverse challenges in expanding pediatric HIV testing and treatment coverage persist, making the investigation and adoption of innovative strategies urgent. Evidence is mounting for the effectiveness of community-based testing in bringing such lifesaving services to those in need, particularly in resource-limited settings. The Mobilizing HIV Identification and Treatment project piloted seven community-based testing strategies to assess their effectiveness in reaching HIV-positive children and linking them to care in two districts of Lesotho from October 2015 to March 2018. Children testing HIV-positive were enrolled into the project's mHealth system where they received e-vouchers for transportation assistance to the facility for treatment initiation and were followed-up for a minimum of three months. An average of 7,351 HIV tests were conducted per month across all strategies for all age groups, with 46% of these tests on children 0-14 years. An average of 141.65 individuals tested positive each month; 9% were children. Among the children tested 55% were over 5 years. The yield in children was low (0.38%), however facility-based yields were only slightly higher (0.72%). Seventy-five percent of children were first-time testers and 86% of those testing HIV-positive were first-time testers. Seventy-one percent of enrolled children linked to care, all but one initiated treatment, and 82% were retained in care at three months. As facility-based testing remains the core of HIV programs, this evaluation demonstrates the effectiveness of community-based strategies in finding previously untested children and those over 5 years who have limited interactions with the conventional health system. Utilizing active follow-up mechanisms, linkage rates were high suggesting accessing treatment in a facility after community testing is not a barrier. Overall, these community-based testing strategies contributed markedly to the HIV testing landscape in which they were implemented, demonstrating their potential to help close the gap of unidentified HIV-positive children and achieve universal testing coverage.
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Affiliation(s)
- Kathleen Sindelar
- Clinton Health Access Initiative, Maseru, Lesotho
- * E-mail: (KS); (JJ)
| | | | | | | | | | - Jill Sanders
- Baylor College of Medicine Children’s Foundation – Lesotho, Maseru, Lesotho
| | - Jessica Joseph
- Clinton Health Access Initiative, Boston, Massachusetts, United States of America
- * E-mail: (KS); (JJ)
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21
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Yindom LM, Simms V, Majonga ED, McHugh G, Dauya E, Bandason T, Vincon H, Rylance J, Munyati S, Ferrand RA, Rowland-Jones SL. Unexpectedly High Prevalence of Cytomegalovirus DNAemia in Older Children and Adolescents With Perinatally Acquired Human Immunodeficiency Virus Infection. Clin Infect Dis 2020; 69:580-587. [PMID: 30828710 PMCID: PMC6669294 DOI: 10.1093/cid/ciy961] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Indexed: 12/12/2022] Open
Abstract
Background Older children and adolescents with perinatally acquired human immunodeficiency virus (PHIV) infection in Africa experience multiple comorbidities that are not typical of HIV-associated opportunistic infections, including growth impairment and chronic lung disease. We examined associations between plasma cytomegalovirus (CMV) DNA and lung function and growth. Methods Plasma CMV DNA loads were measured children aged 6–16 years with PHIV (n = 402) and HIV-uninfected controls (n = 224). The HIV-infected children were either newly diagnosed or known HIV infected and stable on antiretroviral therapy (ART) for >6 months. CMV DNA loads were measured using quantitative polymerase chain reaction. CMV DNAemia was modeled as a time-varying outcome using longitudinal mixed-effects logistic regression. Results At enrollment, CMV DNAemia ≥1000 copies/mL (defined as “clinically significant”) was detected in 5.8% of uninfected children, 14.7% of HIV-infected participants stable on ART, and 22.6% of HIV-infected ART-naive children (χ2 = 23.8, P < .001). The prevalence of CMV DNAemia ≥1000 copies/mL was associated with CD4 counts <350 cells/µL. Among HIV-infected ART-naive children, the presence of CMV DNAemia of ≥1000 copies/mL was independently associated with reduced lung function (adjusted odds ratio [aOR] = 3.23; 95% confidence interval [CI], 1.23–8.46; P = .017). Among ART-treated children, stunting was associated with CMV DNAemia of ≥1000 copies/mL (aOR = 2.79; 95% CI, 0.97–8.02; P = .057). Conclusions Clinically significant levels of CMV DNAemia were common in older children with PHIV, even those on ART, suggesting a role for inadequately controlled CMV infection in the pathogenesis of PHIV comorbidities in Africa.
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Affiliation(s)
| | - Victoria Simms
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Edith D Majonga
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, United Kingdom.,Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Grace McHugh
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, United Kingdom.,Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Ethel Dauya
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Tsitsi Bandason
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Helene Vincon
- University of Oxford, Nuffield Department of Medicine, United Kingdom
| | - Jamie Rylance
- Department of Clinical Research, Liverpool School of Tropical Medicine, United Kingdom
| | - Shungu Munyati
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Rashida A Ferrand
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, United Kingdom.,Biomedical Research and Training Institute, Harare, Zimbabwe
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22
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Impact of WHO guidelines on trends in HIV testing and ART initiation among children living with HIV in Zambia. AIDS Res Ther 2020; 17:18. [PMID: 32408890 PMCID: PMC7226945 DOI: 10.1186/s12981-020-00277-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 05/05/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND About 13 years since the introduction of antiretroviral therapy (ART) for children living with HIV (CLHIV) in Zambia, HIV/AIDS testing and treatment guidelines for children have evolved over the years with limited documentation of long-term trends in the numbers testing HIV positive and initiating ART. We examined trends in HIV testing and ART initiation in Zambia. METHODS We conducted a retrospective cohort study using routinely collected patient level data from 496 health facilities across Zambia. We used Poisson regression to derive incident rate ratios and 95% confidence intervals (95% CI) for background characteristics and used a Cuzick non-parametric test for trends to test the 13-year trends. Median time from testing to ART initiation in days and incidence rates were derived using life tables in survival analysis. We used multi-level random effects Poisson regression model to determine variations in time from HIV testing to ART initiation by facility. RESULTS Overall, the cumulative proportion of the children who tested positive and initiated antiretroviral therapy (ART for HIV) from 2004 to 2017 was 69% (n = 99 592). During the period under review proportions of ART initiation increased from 52% in 2004-2006 to 97% in 2016-2017 (P < 0.001) and time from testing to ART initiation reduced from a median of 17 days IQR (1-161) in 2004 to one day IQR (1-14), P < 0.001 in 2016-2017. CLHIV were 15 times more likely to be initiated on ART in 2016-17 compared to period 2004-6 (IRR = 15.2, 95% CI 14.7-15.7). Time to ART initiation increased with age and was higher in rural health facilities compared to urban facilities. About 11% of the variability in time to ART initiation in children could be attributed to differences between facilities. CONCLUSIONS The substantial increase in ART initiation and reduction in time to ART initiation among CLHIV identified in this study, reflects improvements in the paediatric HIV programme in Zambia in relation to health care delivery and adherence to national testing and treatment guidelines that were adapted from WHO guidelines. However, age-related differentials in rates of ART initiation suggests that urgent interventions are needed to sustain and further improve programme performance.
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23
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Snow KJ, Cruz AT, Seddon JA, Ferrand RA, Chiang SS, Hughes JA, Kampmann B, Graham SM, Dodd PJ, Houben RM, Denholm JT, Sawyer SM, Kranzer K. Adolescent tuberculosis. THE LANCET. CHILD & ADOLESCENT HEALTH 2020; 4:68-79. [PMID: 31753806 PMCID: PMC7291359 DOI: 10.1016/s2352-4642(19)30337-2] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/20/2019] [Accepted: 09/23/2019] [Indexed: 02/08/2023]
Abstract
Adolescence is characterised by a substantial increase in the incidence of tuberculosis, a known fact since the early 20th century. Most of the world's adolescents live in low-income and middle-income countries where tuberculosis remains common, and where they comprise a quarter of the population. Despite this, adolescents have not yet been addressed as a distinct population in tuberculosis policy or within tuberculosis treatment services, and emerging evidence suggests that current models of care do not meet their needs. This Review discusses up-to-date information about tuberculosis in adolescence, with a focus on the management of infection and disease, including HIV co-infection and rifampicin-resistant tuberculosis. We outline the progress in vaccine development and highlight important directions for future research.
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Affiliation(s)
- Kathryn J Snow
- Department of Paediatrics and Murdoch Children's Research Institute, University of Melbourne, Melbourne, VIC, Australia; Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia; Centre for Adolescent Health, Royal Children's Hospital Melbourne, Melbourne, Australia
| | - Andrea T Cruz
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - James A Seddon
- Department of Infectious Diseases, Imperial College London, London, UK; Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Rashida A Ferrand
- Clinical Research Department, Medical Research Centre Unit, The Gambia; Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Silvia S Chiang
- Department of Pediatrics, Alpert Medical School of Brown University, Providence, RI, USA; Center for International Health Research, Rhode Island Hospital, Providence, RI, USA
| | - Jennifer A Hughes
- Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Beate Kampmann
- The Vaccine Centre, Medical Research Centre Unit, The Gambia; Vaccines & Immunity Research, Medical Research Centre Unit, The Gambia
| | - Steve M Graham
- Department of Paediatrics and Murdoch Children's Research Institute, University of Melbourne, Melbourne, VIC, Australia; The Burnet Institute, Melbourne, VIC, Australia; International Union Against Tuberculosis and Lung Disease, Paris, France
| | - Peter J Dodd
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Rein M Houben
- Tuberculosis Modelling Group, Tuberculosis Centre, London School of Hygiene and Tropical Medicine, London, UK; Infectious Disease Epidemiology Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Justin T Denholm
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity University of Melbourne, University of Melbourne, Melbourne, VIC, Australia; Victorian Tuberculosis Program, Melbourne Health, Melbourne, VIC, Australia
| | - Susan M Sawyer
- Department of Paediatrics and Murdoch Children's Research Institute, University of Melbourne, Melbourne, VIC, Australia; Centre for Adolescent Health, Royal Children's Hospital Melbourne, Melbourne, Australia
| | - Katharina Kranzer
- Clinical Research Department, Medical Research Centre Unit, The Gambia; Biomedical Research and Training Institute, Harare, Zimbabwe.
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24
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Matsena Zingoni Z, Chirwa TF, Todd J, Musenge E. HIV Disease Progression Among Antiretroviral Therapy Patients in Zimbabwe: A Multistate Markov Model. Front Public Health 2019; 7:326. [PMID: 31803702 PMCID: PMC6873884 DOI: 10.3389/fpubh.2019.00326] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 10/23/2019] [Indexed: 12/21/2022] Open
Abstract
Background: Antiretroviral therapy (ART) impact has prolonged survival of people living with HIV. We evaluated HIV disease progression among ART patients using routinely collected patient-level data between 2004 and 2017 in Zimbabwe. Methods: We partitioned HIV disease progression into four transient CD4 cell counts states: state 1 (CD4 ≥ 500 cells/μl), state 2 (350 cells/μl ≤ CD4 < 500 cells/μl), state 3 (200 cells/μl ≤ CD4 < 350 cells/μl), state 4 (CD4 < 200 cells/μl), and the absorbing state death (state 5). We proposed a semiparametric time-homogenous multistate Markov model to estimate bidirectional transition rates. Covariate effects (age, gender, ART initiation period, and health facility level) on the transition rates were assessed. Results: We analyzed 204,289 clinic visits by 63,422 patients. There were 24,325 (38.4%) patients in state 4 (CD4 < 200) at ART initiation, and 7,995 (12.6%) deaths occurred by December 2017. The overall mortality rate was 3.9 per 100 person-years. The highest mortality rate of 5.7 per 100 person-years (4,541 deaths) was from state 4 (CD4 < 200) compared to other states. Mortality rates decreased with increase in time since ART initiation. Health facility type was the strongest predictor for immune recovery. Provincial or central hospital patients showed a diminishing dose-response effect on immune recovery by state from a hazard ratio (HR) of 8.30 [95% confidence interval (95% CI), 6.64-10.36] (state 4 to 3) to HR of 3.12 (95% CI, 2.54-4.36) (state 2 to 1) compared to primary healthcare facilities. Immune system for male patients was more likely to deteriorate, and they had a 32% increased mortality risk (HR, 1.32; 95% CI, 1.23-1.42) compared to female patients. Elderly patients (45+ years) were more likely to immune deteriorate compared to 25-34 years age group: HR, 1.35; 95% CI, 1.18-1.54; HR, 1.56; 95% CI, 1.34-1.81 and HR, 1.53; 95% CI, 1.32-1.79 for states 1 to 2, state 2 to 3, and states 3 to 4, respectively. Conclusion: Immune recovery was pronounced among provincial or central hospitals. Male patients with lower CD4 cell counts were at a higher risk of immune deterioration and mortality, while elderly patients were more likely to immune deteriorate. Early therapeutic interventions when the immune system is relatively stable across gender and age may contain mortality and increase survival outcomes. Interventions which strengthen ART services in primary healthcare facilities are essential.
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Affiliation(s)
- Zvifadzo Matsena Zingoni
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Ministry of Health and Child Care, National Institute of Health Research, Harare, Zimbabwe
| | - Tobias F. Chirwa
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jim Todd
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Eustasius Musenge
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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25
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du Plessis AM, Andronikou S, Machemedze T, Griffith-Richards S, Myer L, Mahtab S, Zar HJ. High-resolution computed tomography features of lung disease in perinatally HIV-infected adolescents on combined antiretroviral therapy. Pediatr Pulmonol 2019; 54:1765-1773. [PMID: 31338996 DOI: 10.1002/ppul.24450] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 06/17/2019] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Chronic lung disease is common in perinatally HIV-infected children as they increasingly surviving into adolescence. There are few data on the radiologic spectrum of disease in this population. METHODS Contrasted high-resolution computed tomography (HRCT) was performed in ambulatory South African adolescents enrolled in a prospective study of perinatally-infected adolescents aged 9 to 14 years established on combined antiretroviral therapy (cART) and followed for 36 months. Consecutive participants with reduced lung function (defined by a forced expiratory volume in 1 second [FEV1] of <80% normal and/or lung diffusion capacity [DLCO] <80% normal] underwent HRCT. History, clinical, and laboratory data were collected. Two radiologists blinded to clinical data and to each other, reported scans using standardized methodology; a third radiologist resolved discrepancies. RESULTS Amongst 100 participants undergoing HRCT, median age was 13.8 years (12.8-15.1). The median duration on cART was 8.4 years (IQR = 5.7-9.8). Mosaic attenuation was the most common finding (73%). Of these 71 (91%) demonstrated associated air trapping radiologically consistent with bronchiolitis obliterans. Bronchiectasis occurred in 39% with significant correlation between extent of bronchiectasis and mosaic attenuation (r = 0.57, P < .001). Prior hospitaliszation for childhood pneumonia at any time before enrollment was associated with mosaic attenuation (OR = 3.9, 95%CI, [1.2-12.5]); prior pulmonary tuberculosis (TB) was associated with the combination of mosaic attenuation and bronchiectasis (OR = 4.9, 95%CI, [1.6-15.7]). Most participants (86%) with mosaic attenuation had stage III or IV HIV disease at time of HIV diagnosis (OR = 3.6; [0.9-14.9]). Inter observer agreement between the two readers was good for bronchiectasis (K = 0.71) and moderate for mosaic attenuation (K = 0.51). DISCUSSION Despite well-controlled HIV and long duration of cART, HRCT changes were common in perinatally HIV-infected adolescents. There was a high prevalence of small airways disease with and without associated bronchiectasis. These changes were associated with prior pulmonary TB or prior severe pneumonia. Strategies to prevent and treat early life respiratory infection must be strengthened to reduce the burden of chronic lung disease in HIV-infected adolescents.
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Affiliation(s)
- Anne-Marie du Plessis
- Department of Diagnostic Radiology, University of Stellenbosch, Cape Town, South Africa
| | - Savvas Andronikou
- Department of Paediatric Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Paediatrics and Child Health, Red Cross Children's Hospital and SA-Medical Research Council Unit on Child & Adolescent Health, South Africa
| | - Takwanisa Machemedze
- Department of Paediatrics and Child Health, Red Cross Children's Hospital and SA-Medical Research Council Unit on Child & Adolescent Health, South Africa
| | | | - Landon Myer
- Division of Epidemiology and Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Sana Mahtab
- Department of Paediatrics and Child Health, Red Cross Children's Hospital and SA-Medical Research Council Unit on Child & Adolescent Health, South Africa
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross Children's Hospital and SA-Medical Research Council Unit on Child & Adolescent Health, South Africa
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Zvandiri-Bringing a Differentiated Service Delivery Program to Scale for Children, Adolescents, and Young People in Zimbabwe. J Acquir Immune Defic Syndr 2019; 78 Suppl 2:S115-S123. [PMID: 29994833 DOI: 10.1097/qai.0000000000001737] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Since 2004, there has been a dramatic shift in the HIV response for children, adolescents, and young people in low resource settings. Previous programs and services were largely orientated to adults. This is now changing, but there is limited evidence on how to take services for children, adolescents, and young people living with HIV (CAYPLHIV) to scale. Zvandiri is a theoretically grounded, multicomponent-differentiated service delivery model for children, adolescents, and young people in Zimbabwe that integrates peer-led, community interventions within government health services. Africaid analyzed routine program and other data from November 2004 to October 2017 to document Zvandiri scale-up, framed by the World Health Organization framework for scaling up interventions. Since 2004, Zvandiri has evolved from one support group in Harare into a comprehensive model, combining community- and clinic-based health services and psychosocial support for CAYPLHIV. Zvandiri was scaled up across Zimbabwe through phased expansion into 51 of 63 districts, reaching 40,213 CAYPLHIV. Evidence indicates that this approach improved uptake of HIV testing services, adherence, and retention in care. The environment and strategic choices were critical when taking the model to scale, particularly nesting the program within existing services, and capacity strengthening of service providers working jointly with trained, mentored CAYPLHIV. The results provide a firm foundation for programming and from which to build evidence of sustainable impact. Formal impact evaluation is needed and underway. These program data contribute to the essential evidence base on strategic approaches to assist in planning services for this relatively neglected group.
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27
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Frigati L, Archary M, Rabie H, Penazzato M, Ford N. Priorities for Decreasing Morbidity and Mortality in Children With Advanced HIV Disease. Clin Infect Dis 2019. [PMID: 29514237 PMCID: PMC5850631 DOI: 10.1093/cid/ciy013] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Early mortality and morbidity remain high in children initiating antiretroviral therapy (ART), especially in sub-Saharan Africa. Many children still present with advanced human immunodeficiency virus (HIV) disease. Tuberculosis, pneumonia, and severe bacterial infections are the main causes of hospital admission in HIV-infected children. In contrast to adults with advanced HIV disease, cryptococcal disease is not common in childhood, although there is a peak in infancy and adolescence. Interventions such as TB screening in symptomatic children, and isoniazid and cotrimoxazole prophylaxis should be implemented. There is evidence suggesting that rapid initiation (within 1 week) of ART in children with severe malnutrition or those with advanced HIV disease admitted to hospital is not beneficial and should be delayed until their condition has been stabilized. Research informing the prevention of severe bacterial infections, the management of pediatric immune reconstitution inflammatory syndrome, and other potential strategies to decrease morbidity and mortality in HIV-infected children are urgently needed.
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Affiliation(s)
- Lisa Frigati
- Department of Paediatrics and Child Health, Tygerberg Hospital and Stellenbosch University, Cape Town
| | - Moherdran Archary
- University of KwaZulu Natal, Nelson R Mandela School of Medicine, Berea, South Africa
| | - Helena Rabie
- Department of Paediatrics and Child Health, Tygerberg Hospital and Stellenbosch University, Cape Town
| | | | - Nathan Ford
- HIV Department, World Health Organization, Geneva, Switzerland
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28
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Casale M, Carlqvist A, Cluver L. Recent Interventions to Improve Retention in HIV Care and Adherence to Antiretroviral Treatment Among Adolescents and Youth: A Systematic Review. AIDS Patient Care STDS 2019; 33:237-252. [PMID: 31166783 PMCID: PMC6588099 DOI: 10.1089/apc.2018.0320] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Adolescents represent a growing proportion of people living with HIV worldwide and the highest risk population group for treatment attrition and AIDS-related mortality. There is an urgent need to design, implement, and test interventions that keep young people in HIV treatment and care. However, previous systematic reviews show scarce and inconclusive evidence of effective interventions for this age group. Recent years have seen an increase in focus on adolescent health and a rapidly changing programmatic environment. This systematic review article provides an evidence update by synthesizing empirical evaluations of interventions designed to improve antiretroviral therapy adherence and retention among adolescents (10-19) and youth (15-24) living with HIV, published between January 2016 and June 2018. A search of 11 health and humanities databases generated 2425 citations and 10 relevant studies, the large majority conducted in sub-Saharan Africa. These include six clinic-level interventions, one individual-level m-Health trial, and three community- or household-level interventions. Implications of their findings for future programming and research with young adults are discussed, in relation to previous reviews and the broader empirical evidence in this area. Findings highlight the need to further develop and test multi-faceted interventions that go beyond health facilities, to address broader social barriers to adherence and retention. In particular, further intervention studies with adolescents (10-19) should be a priority, if we are to retain these young people in treatment and care and aspire to achieve the United Nation's Sustainable Development Goals and 90-90-90 targets.
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Affiliation(s)
- Marisa Casale
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Anna Carlqvist
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| | - Lucie Cluver
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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29
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Adetokunboh OO, Awotiwon A, Ndwandwe D, Uthman OA, Wiysonge CS. The burden of vaccine-preventable diseases among HIV-infected and HIV-exposed children in sub-Saharan Africa: a systematic review and meta-analysis. Hum Vaccin Immunother 2019; 15:2590-2605. [PMID: 30945963 PMCID: PMC6930054 DOI: 10.1080/21645515.2019.1599676] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 03/05/2019] [Accepted: 03/18/2019] [Indexed: 12/27/2022] Open
Abstract
There are knowledge gaps regarding evidence-based research on the burden of vaccine-preventable diseases among human immunodeficiency virus (HIV)-infected and HIV-exposed children aged <18 years in sub-Saharan Africa. It is therefore essential to determine the trend and burden of vaccine-preventable diseases. We completed a systematic review and meta-analysis to identify the incidence, prevalence and case-fatality rates (CFR) attributed to various vaccine-preventable diseases among HIV-infected and HIV-exposed children in sub-Saharan Africa. The trends in the prevalence of vaccine-preventable diseases among HIV-infected and HIV-exposed children were also determined. Nine studies on tuberculosis (TB) were pooled to give an overall incidence rate estimate of 60 (95% confidence interval [CI] 30-70) per 1,000 child-years. The incidence of pneumococcal infections varied between 109-1509 per 100,000 while pertussis was between 2.9 and 3.7 per 1000 child-year. Twenty-two TB prevalence studies reported an estimated prevalence of 16%. Fifteen prevalence studies on hepatitis B infection were pooled together with an estimated prevalence of 5%. The pooled prevalence for pneumococcal infections was 2% while rotavirus diarrhoea reported a prevalence of 13%. Twenty-nine studies on TB were pooled to give an overall CFR estimate of 17% while pneumococcal infections in HIV-infected and exposed children were pooled together with a resultant rate of 15%. Some of the vaccine-preventable diseases still have high incidences, prevalence and CFR among HIV-infected and HIV-exposed children. There is also a dearth of research data on the burden of several vaccine-preventable diseases among HIV-infected and exposed children and a need for more studies in this area.
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Affiliation(s)
- Olatunji O. Adetokunboh
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Ajibola Awotiwon
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - Duduzile Ndwandwe
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Olalekan A. Uthman
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
- Warwick Medical School - Population Evidence and Technologies, University of Warwick, Coventry, UK
| | - Charles S. Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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30
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Abstract
The acceptability of financial incentives for pediatric HIV testing was evaluated in Kenya. Sixty HIV-positive women with children of unknown status were randomized to receive $5, $10 or $15 conditional upon HIV testing. Forty-four (73%) completed child testing, with similar rates across arms. Uptake was significantly higher than a cohort with similar procedures but no incentives (73% vs. 14%, P < 0.001).
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Bandason T, Dauya E, Dakshina S, McHugh G, Chonzi P, Munyati S, Weiss HA, Simms V, Kranzer K, Ferrand RA. Screening tool to identify adolescents living with HIV in a community setting in Zimbabwe: A validation study. PLoS One 2018; 13:e0204891. [PMID: 30278064 PMCID: PMC6168137 DOI: 10.1371/journal.pone.0204891] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 09/17/2018] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION A simple cost-effective strategy to pre-screen for targeted HIV testing can have substantial benefit in high burden and resource limited settings. A 4-item (previous hospitalisation, orphanhood, poor health status, and recurring skin problems) screening tool to identify adolescents living with HIV has previously shown high sensitivity in healthcare facility settings. We validated this screening tool in a community setting, in Harare, Zimbabwe in a community-based HIV prevalence survey. METHODS A community-based HIV prevalence survey was conducted among individuals aged 8-17 years with guardian consent and child assent and residing in 7 communities during the period February 2015 to December 2015. Participants without previously diagnosed HIV were evaluated for the probability of having HIV using the screening tool. HIV status was defined using an anonymous HIV test which was done using Oral Mucosal Transudate (OMT). A questionnaire was also administered to ascertain self-reported HIV status and screening tool items. The validity of a 4-item screening tool was tested. Sensitivity and specificity of the screening tool was assessed against the HIV status based on OMT result. RESULTS Prevalence survey participants were 5386 children who had an HIV test result, aged 8-17 years. However, 5384, who did not report testing HIV positive and responded to all screening tool item questions were included in the validation. Their median age was 12 (IQR: 10-15) years, 2515 (46.7%) were male. HIV prevalence was 1.3% (95% CI:1.0-1.8%). The 4-item screening tool had poor accuracy with an area under the receiver operating curve of 0.65(95% CI: 0.60-0.72) at a cut-off score≥1. Its sensitivity was 56.3% (95% CI:44.0-68.1%) and specificity of 75.1% (95% CI:73.9-76.3%), PPV of 2.9% (95% CI:2.1-3.9%) and a NPV of 99.2% (95% CI:98.9-99.5%). The number needed to test to diagnose one child using the screening tool was 55% lower than universal testing for HIV. CONCLUSION Use of the 4-item screening tool could be a strategy that can be adopted to identify children living with HIV in a community setting in resource limited settings by reducing the number needed to test compared to universal testing since it is inexpensive, easy to administer and not harmful. However, screening items adapted to a community setting need to be explored to improve the performance of the screening tool.
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Affiliation(s)
- Tsitsi Bandason
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Ethel Dauya
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | | | - Grace McHugh
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | | | - Shungu Munyati
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Helen A. Weiss
- MRC Tropical Epidemiology Group, LSHTM, London, United Kingdom
| | - Victoria Simms
- MRC Tropical Epidemiology Group, LSHTM, London, United Kingdom
| | - Katharina Kranzer
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- Research Centre Borstel, Borstel, Germany
| | - Rashida Abbas Ferrand
- Biomedical Research and Training Institute, Harare, Zimbabwe
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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Mabaso MLH, Zungu NP, Rehle T, Moyo S, Jooste S, Zuma K. Determinants of excellent/good self-rated health among HIV positive individuals in South Africa: evidence from a 2012 nationally representative household survey. BMC Public Health 2018; 18:198. [PMID: 29378557 PMCID: PMC5789546 DOI: 10.1186/s12889-018-5102-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 01/19/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND In South Africa, HIV is increasingly becoming a chronic disease as a result of advances in HIV treatment and prevention in the last three decades. This has changed the perception from a life threating to a potentially manageable disease. However, little is known about self-perceived health status of HIV-infected individuals. Self-rated health (SRH) has been shown to be a sensitive indicator of health-relatedchanges directly linked to HIV, but can also be influenced by differences in social and material conditions. The aim of this paper was to identify determinants of excellent/good SRH among HIV-infected individuals using socio-demographic, life style and health related data. METHODS The study used data from the nationally representative 2012 South African population-based household survey on HIV prevalence, incidence and behaviour conducted using multi-stage stratified cluster sampling design. Bivariate and multivariate logistic regression models were used to identify determinants of SRH among HIV-infected individuals. RESULTS Out of a total of 2632 HIV positive participants 74.1% (95% CI: 68.4-74.2) reported excellent/good SRH. Increased likelihood of reporting excellent/good SRH was significantly associated with being Black African [OR= 1.97 (95%CI: 1.12-3.46), p = 0.019] and belonging to least poor household [OR= 3.13 (95%CI: 1.26-7.78), p = 0.014]. Decreased likelihood of reporting excellent/good SRH was significantly associated with those aged 25 to 34 years [OR= 0.49 (95% CI: 0.31-0.78), p = 0.003], 35 to 44 years[OR= 0.27 (95% CI: 0.17-0.44), p < 0.001], 45 to 54 years [OR= 0.20 (95% CI: 0.12-0.34), p < 0.001], and those 55 years and older [OR= 0.15 (95% CI: 0.09-0.26), p < 0.001], hospitalization in the past twelve months [OR= 0.40 (95% CI: 0.26-0.60), p < 0.001]. CONCLUSION To have positive health effects and improve the perceived health status for PLWH social interventions should seek to enhance to support for the elderly HIV-positive individuals, and address the challenge of socio-economic inequalities and underlying comorbid conditions resulting in hospitalization.
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Affiliation(s)
- M. L. H. Mabaso
- Epidemiology and Strategic Information Unit, HIV/AIDS, STIs and TB Programme, Human Sciences Research Council, Private Bag X07, Dalbridge, Durban, 4014 South Africa
| | - N. P. Zungu
- HIV/AIDS, STIs and TB, Human Sciences Research Council, Pretoria, South Africa
| | - T. Rehle
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- HIV/AIDS, STIs and TB, Human Sciences Research Council, Cape Town, South Africa
| | - S. Moyo
- HIV/AIDS, STIs and TB, Human Sciences Research Council, Cape Town, South Africa
| | - S. Jooste
- HIV/AIDS, STIs and TB, Human Sciences Research Council, Cape Town, South Africa
| | - K. Zuma
- Research Methodology and Data Center, Human Sciences Research Council, Pretoria, South Africa
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Madiba S, Mokgatle M. Fear of stigma, beliefs, and knowledge about HIV are barriers to early access to HIV testing and disclosure for perinatally infected children and adolescents in rural communities in South Africa. S Afr Fam Pract (2004) 2017. [DOI: 10.1080/20786190.2017.1329489] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Sphiwe Madiba
- Department of Environmental and Occupational Health, School of Public Health, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Mathildah Mokgatle
- Department of Biostatistics, School of Public Health, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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Williams BG, Gupta S, Wollmers M, Granich R. Progress and prospects for the control of HIV and tuberculosis in South Africa: a dynamical modelling study. LANCET PUBLIC HEALTH 2017; 2:e223-e230. [PMID: 29253488 DOI: 10.1016/s2468-2667(17)30066-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 02/21/2017] [Accepted: 02/23/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND In September, 2016, South Africa adopted a policy of providing antiretroviral treatment to everyone infected with HIV irrespective of their CD4 cell count. Studies of universal treatment and expanded prevention of HIV differ widely in their projections of effects and the associated costs, so we did this analysis to attempt to find a consensus. METHODS We used data on HIV from the Joint UN Programme on HIV and AIDS (UNAIDS) from 1988 to 2013 and from data from WHO on tuberculosis from 1980 to to 2013 to fit a dynamical model to time trends in HIV prevalence, antiretroviral therapy (ART) coverage, and tuberculosis notification rates in South Africa. We then used the model to estimate current trends and project future patterns in HIV prevalence and incidence, AIDS-related mortality, and tuberculosis notification rates, and we used data from the South African National AIDS Council to assess current and future costs under different combinations of treatment and prevention approaches. We considered two treatment strategies: the Constant Effort strategy, in which people infected with HIV continue to start treatment at the rate in 2016, and the Expanded Treatment and Prevention (ETP) strategy, in which testing rates are increased, treatment is started immediately after HIV is detected, and prevention programmes are expanded. FINDINGS Our estimates show that HIV incidence among adults aged 15 years or older fell from 2·3% per year in 1996 to 0·65% per year in 2016, AIDS-related mortality decreased from 1·4% per year in 2006 to 0·37% per year in 2016, and both continue to fall at a relative rate of 17% per year. Our model shows that maintenance of Constant Effort will have a substantial effect on HIV but will not end AIDS, whereas ETP could end AIDS by 2030, with incidence of HIV and AIDs-related mortality rates both at less than one event per 1000 adults per year. Under ETP the annual cost of health care and prevention will increase from US$2·3 billion in 2016 to $2·9 billion in 2018, then decrease to $1·7 billion in 2030 and $0·9 billion in 2050. Over the next 35 years, the expansion of treatment will avert an additional 3·8 million new infections, save 1·1 million lives, and save $3·2 billion compared with continuing Constant Effort up to 2050. Expansion of prevention, including provision of pre-exposure prophylaxis, condom distribution, and male circumcision, could avert a further 150 000 new infections, save 5000 lives, and cost an additional $5·7 billion compared with Constant Effort. INTERPRETATION Our results suggest that South Africa is on track to reduce HIV incidence and AIDS-related mortality substantially by 2030, saving both lives and money. Success will depend on high rates of HIV testing, ART delivery and adherence, good patient monitoring and support, and data to monitor progress. FUNDING None.
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Affiliation(s)
- Brian G Williams
- South African Centre for Epidemiological Modelling and Analysis, University of Stellenbosch, Stellenbosch, South Africa.
| | - Somya Gupta
- International Association of Providers of AIDS Care, Washington, DC, USA
| | | | - Reuben Granich
- International Association of Providers of AIDS Care, Washington, DC, USA
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Abstract
BACKGROUND Chronic lung diseases are increasingly recognized complications of vertically-acquired HIV among adolescents in sub-Saharan Africa and may manifest with hypoxia or tachypnea. We sought to determine the prevalence of and risk factors for hypoxia and tachypnea among adolescents with vertically-acquired HIV in Nairobi, Kenya. METHODS We performed a cross-sectional analysis of 258 adolescents with vertically-acquired HIV who were initiating care at the Coptic Hope Center for Infectious Diseases. Adolescents with documented pneumonia were excluded. Hypoxia was defined as resting oxygen saturation ≤92%, and tachypnea was based on the 99th percentile of age-appropriate respiratory rates. Logistic regression models adjusted for demographics, and HIV severity estimated odds ratios for risk of hypoxia and tachypnea associated with potential risk factors. RESULTS Overall, 11% of adolescents had hypoxia and 55% had tachypnea. Advanced HIV [adjusted odds ratio (aOR): 2.41] and low CD4 (aOR: 1.74) were associated with greater hypoxia risk, but confidence intervals (CIs) were wide and included the null (95% CI: 0.93-6.23 and 0.69-4.39, respectively). Low CD4 (aOR: 2.45, 95% CI: 1.39-4.32), current antiretroviral therapy use (aOR: 0.48, 95% CI: 0.27-0.86) and stunted growth (aOR: 3.46, 95% CI: 1.94-6.18) were associated with altered tachypnea risk. CONCLUSIONS Hypoxia and tachypnea are common among adolescents with vertically-acquired HIV. There was a suggestion that advanced HIV and low CD4 were associated with greater hypoxia risk. Low CD4, lack of antiretroviral therapy use and stunted growth are risk factors for tachypnea. Our findings highlight the chronic lung disease burden in this population and may inform diagnostic algorithms.
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Vallabha T, Dhamangaonkar M, Sindgikar V, Nidoni R, Biradar H, KV A, Baloorkar R. Clinical Profile of Surgical Diseases with Emergence of New Problems in HIV+ Individuals. Indian J Surg 2017; 79:29-32. [PMID: 28331263 PMCID: PMC5346078 DOI: 10.1007/s12262-015-1417-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 12/03/2015] [Indexed: 10/22/2022] Open
Abstract
North Karnataka is one of the regions with the high prevalence of HIV+ individuals. Bijapur is a district in North Karnataka with high prevalence as per fact sheets of NACO of March 2012. Better awareness, access to health care, and antiretroviral therapy have improved survival and increase in number of people living with HIV/AIDS (PLHA). Improved survival has increased their attendance to hospitals with variety of surgical problems, some known and some less known. The percentage of HIV+ individuals was 1.64 % among all admissions. Of these individuals, 13.65 % (272) had surgical problems. Abscesses were the commonest. Abscesses at uncommon sites also were encountered. Anorectal pathologies, tuberculosis, lymphadenopathy, appendicitis, etc. commonly seen in HIV+ individuals were seen. Drug-induced pancreatitis due to anti retroviral therapy was one of the common problems encountered. Uncommon conditions like ureteric calculi, external iliac artery thrombosis, diaphragmatic eventration, and few more were observed. Even though literature on AIDS/HIV is abundant, there is less information on surgical conditions encountered more so from this part of the subcontinent. Hence, it was decided to report the profile of the conditions encountered.
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Affiliation(s)
- Tejaswini Vallabha
- Department of Surgery, BLDE University’s Shri.B.M.Patil Medical College &Research Centre, Sholapur Road, Bijapur, Karnataka 586103 India
| | - Mandar Dhamangaonkar
- Department of Surgery, BLDE University’s Shri.B.M.Patil Medical College &Research Centre, Sholapur Road, Bijapur, Karnataka 586103 India
| | - Vikram Sindgikar
- Department of Surgery, BLDE University’s Shri.B.M.Patil Medical College &Research Centre, Sholapur Road, Bijapur, Karnataka 586103 India
| | - Ravindra Nidoni
- Department of Surgery, BLDE University’s Shri.B.M.Patil Medical College &Research Centre, Sholapur Road, Bijapur, Karnataka 586103 India
| | - Harshavardhan Biradar
- Department of Surgery, BLDE University’s Shri.B.M.Patil Medical College &Research Centre, Sholapur Road, Bijapur, Karnataka 586103 India
| | - Aniketan KV
- Department of Surgery, BLDE University’s Shri.B.M.Patil Medical College &Research Centre, Sholapur Road, Bijapur, Karnataka 586103 India
| | - Ramakant Baloorkar
- Department of Surgery, BLDE University’s Shri.B.M.Patil Medical College &Research Centre, Sholapur Road, Bijapur, Karnataka 586103 India
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Jespers V, Noestlinger C, Ariën KK. Designing microbicides against HIV: innovative rings for young women urgently needed. Future Virol 2017. [DOI: 10.2217/fvl-2016-0135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Vicky Jespers
- HIV & Sexual Health Group, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Christiana Noestlinger
- HIV & Sexual Health Group, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Kevin K Ariën
- Unit of Virology, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
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Le Cœur S, Lelièvre E, Kanabkaew C, Sirirungsi W. Une enquête auprès d’adolescents nés avec le VIH : le projet TEEWA en Thaïlande. POPULATION 2017. [DOI: 10.3917/popu.1702.0343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Rabie H, Goussard P. Tuberculosis and pneumonia in HIV-infected children: an overview. Pneumonia (Nathan) 2016; 8:19. [PMID: 28702298 PMCID: PMC5471701 DOI: 10.1186/s41479-016-0021-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 11/03/2016] [Indexed: 02/07/2023] Open
Abstract
Pneumonia remains the most common cause of hospitalization and the most important cause of death in young children. In high human immunodeficiency virus (HIV)-burden settings, HIV-infected children carry a high burden of lower respiratory tract infection from common respiratory viruses, bacteria and Mycobacterium tuberculosis. In addition, Pneumocystis jirovecii and cytomegalovirus are important opportunistic pathogens. As the vertical transmission risk of HIV decreases and access to antiretroviral therapy increases, the epidemiology of these infections is changing, but HIV-infected infants and children still carry a disproportionate burden of these infections. There is also increasing recognition of the impact of in utero exposure to HIV on the general health of exposed but uninfected infants. The reasons for this increased risk are not limited to socioeconomic status or adverse environmental conditions—there is emerging evidence that these HIV-exposed but uninfected infants may have particular immune deficits that could increase their vulnerability to respiratory pathogens. We discuss the impact of tuberculosis and other lower respiratory tract infections on the health of HIV-infected infants and children.
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Affiliation(s)
- Helena Rabie
- Department of Pediatrics and Child Health, University of Stellenbosch and Tygerberg Academic Hospital, Cape Town, South Africa.,Childrens Infectious Diseases Clinical Research Unit (KidCRU), University of Stellenbosch, Cape Town, South Africa.,Division of Infectious Diseases, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town, 8000 South Africa
| | - Pierre Goussard
- Department of Pediatrics and Child Health, University of Stellenbosch and Tygerberg Academic Hospital, Cape Town, South Africa
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Abstract
The decline in age of pubertal timing has serious public health implications ranging from psychosocial adjustment problems to a possible increase in reproductive cancers. One biologically plausible explanation for the decline is a decrease in exposures to infections. To systematically review studies that assess the role of infection in pubertal timing, Medline, Web of Science and EMBASE were systematically searched and retrieved studies were reviewed for eligibility. Eligible studies examined the association between infections, including microbial exposures, and physical pubertal characteristics (breast, genitalia and pubic hair development) or age at menarche. We excluded studies that were published in a language other than English, focused on precocious puberty, were case studies, and/or included youth with autoimmune diseases. We report on study design, population characteristics, measurement of infection and puberty and the main effects of infection on pubertal development. Based on our search terms we identified 1372 unique articles, of which only 15 human and five animal studies met our eligibility criteria. Not all studies examined all outcomes. Infection was associated with later breast development (4/4 human studies), with less consistent evidence for genitalia and pubic hair development. Seven studies assessed age at menarche with inconsistent findings (three supporting later, four no association). We conclude that a small but consistent literature supports that infection is associated with later breast development; the evidence for other pubertal events and age at menarche is less clear. Where fewer childhood infections coincide with the rise in incidence of hormone-related cancers.
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Mwalukomo T, Rylance SJ, Webb EL, Anderson S, O'Hare B, van Oosterhout JJ, Ferrand RA, Corbett EL, Rylance J. Clinical Characteristics and Lung Function in Older Children Vertically Infected With Human Immunodeficiency Virus in Malawi. J Pediatric Infect Dis Soc 2016; 5:161-9. [PMID: 26407277 PMCID: PMC5407134 DOI: 10.1093/jpids/piv045] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 07/03/2015] [Indexed: 11/13/2022]
Abstract
BACKGROUND Antiretroviral therapy (ART) has led to increased survival of children with vertically acquired human immunodeficiency virus infection. Significant morbidity arises from respiratory symptoms, but aetiology and pulmonary function abnormalities have not been systematically studied. METHODS Human immunodeficiency virus-positive children aged 8-16 years were systematically recruited within clinics in Blantyre, Malawi. Clinical review, quality of life assessment, spirometry, and chest radiography were performed. RESULTS One hundred sixty participants had a mean of age 11.1 (range, 8-16) years and 50.0% were female. Cough was present in 60 (37.5%) participants, and 55 (34.4%) had moderate or severe dyspnoea. Thirty-four (22.1%) participants had digital clubbing. Thirty-three (20.6%) participants were hypoxic at rest. One hundred eighteen (73.8%) of the children were receiving ART; median CD4 count was 698 cells/µL in these compared with 406 cells/µL in ART-naive individuals (P < .001). From 145 spirometry traces (90.6%), mean forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) were 1.06 and 0.89 standard deviations below predicted mean, respectively. Twenty-one (14.5%) traces demonstrated obstructive defects and 26 (17.9%) reduced FVC. Lung function abnormality was not associated with any clinical findings. Of the 51 individuals with abnormal lung function, the mean increase in FEV1 after salbutamol was 3.8% (95% confidence interval, 0.02-7.53). "Tramlines" and ring shadows were seen on chest radiographs in over half of cases. CONCLUSIONS Symptoms of chronic lung disease were highly prevalent with 2 main clinical phenotypes: "cough" and "hypoxia". Lung function abnormalities are common, poorly responsive to bronchodilators, and apparent throughout the age range of our cohort. Pathological causes remain to be elucidated. Cough and hypoxic phenotypes could be a useful part of diagnostic algorithms if further validated.
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Affiliation(s)
- Thandie Mwalukomo
- College of Medicine, University of Malawi,London School of Hygiene & Tropical Medicine, United Kingdom
| | | | - Emily L. Webb
- London School of Hygiene & Tropical Medicine, United Kingdom
| | | | - Bernadette O'Hare
- College of Medicine, University of Malawi,University of St Andrews, United Kingdom
| | | | | | - Elizabeth L. Corbett
- College of Medicine, University of Malawi,London School of Hygiene & Tropical Medicine, United Kingdom
| | - Jamie Rylance
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre,Liverpool School of Tropical Medicine, United Kingdom
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Ferrand RA, Meghji J, Kidia K, Dauya E, Bandason T, Mujuru H, Ncube G, Mungofa S, Kranzer K. Implementation and Operational Research: The Effectiveness of Routine Opt-Out HIV Testing for Children in Harare, Zimbabwe. J Acquir Immune Defic Syndr 2016; 71:e24-9. [PMID: 26473799 PMCID: PMC4679347 DOI: 10.1097/qai.0000000000000867] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
HIV testing is the entry point to access HIV care. For HIV-infected children who survive infancy undiagnosed, diagnosis usually occurs on presentation to health care services. We investigated the effectiveness of routine opt-out HIV testing (ROOT) compared with conventional opt-in provider-initiated testing and counseling (PITC) for children attending primary care clinics.
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Affiliation(s)
- Rashida Abbas Ferrand
- *Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom;†Department of Clinical Research, Biomedical Research and Training Institute, Harare, Zimbabwe;‡Department of Pediatrics, University of Zimbabwe, Harare, Zimbabwe;§Department of AIDS and Tuberculosis Unit, Ministry of Health and Child Care, Harare, Zimbabwe;‖Harare City Health Department, Harare, Zimbabwe; and¶Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Validation of a screening tool to identify older children living with HIV in primary care facilities in high HIV prevalence settings. AIDS 2016; 30:779-85. [PMID: 26588175 PMCID: PMC4937807 DOI: 10.1097/qad.0000000000000959] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Objective: We previously proposed a simple tool consisting of five items to screen for risk of HIV infection in adolescents (10–19 years) in Zimbabwe. The objective of this study is to validate the performance of this screening tool in children aged 6–15 years attending primary healthcare facilities in Zimbabwe. Methods: Children who had not been previously tested for HIV underwent testing with caregiver consent. The screening tool was modified to include four of the original five items to be appropriate for the younger age range, and was administered. A receiver operator characteristic analysis was conducted to determine a suitable cut-off score. The sensitivity, specificity and predictive value of the modified tool were assessed against the HIV test result. Results: A total of 9568 children, median age 9 (interquartile, IQR: 7–11) years and 4971 (52%) men, underwent HIV testing. HIV prevalence was 4.7% (95% confidence interval, CI:4.2–5.1%) and increased from 1.4% among those scoring zero on the tool to 63.6% among those scoring four (P < 0.001). Using a score of not less than one as the cut-off for HIV testing, the tool had a sensitivity of 80.4% (95% CI:76.5–84.0%), specificity of 66.3% (95% CI:65.3–67.2%), positive predictive value of 10.4% and a negative predictive value of 98.6%. The number needed to screen to identify one child living with HIV would drop from 22 to 10 if this screening tool was used. Conclusion: The screening tool is a simple and sensitive method to identify children living with HIV in this setting. It can be used by lay healthcare workers and help prioritize limited resources.
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Kidman R, Anglewicz P. Are adolescent orphans more likely to be HIV-positive? A pooled data analyses across 19 countries in sub-Saharan Africa. J Epidemiol Community Health 2016; 70:791-7. [PMID: 26865695 DOI: 10.1136/jech-2015-206744] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 01/25/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND Despite extensive resources and numerous programmes directed towards orphans in sub-Saharan Africa, evidence of their disadvantage is surprisingly limited. While initial research suggests that orphans are at greater risk of being HIV-positive, the evidence is limited in geographic scope. METHODS To rigorously test disparities in HIV prevalence related to orphanhood and parental HIV status in sub-Saharan Africa, we used Demographic and Health Survey data from 19 countries in sub-Saharan Africa. We conducted pooled multilevel logistic regression on adolescents aged 15-17 years with HIV test results (N=22 837 girls and 20 452 boys). RESULTS Regardless of their gender, orphans who lost their mother, lost both parents or had an HIV-infected mother were two to three times more likely to test positive for HIV infection (ORs 1.87-3.17). The loss of a father was also associated with HIV infection risk for females, but of slightly lower magnitude (OR 1.63). CONCLUSIONS To better inform interventions, future research is needed to quantify the relative contribution of perinatally-acquired and sexually-acquired infections, and to investigate the specific mechanisms that may account for disparities in the latter. In the meantime, programmes serving HIV-infect adults as well as those serving orphaned and vulnerable children should invest in family-based HIV testing in order to identify adolescents in need of treatment.
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Affiliation(s)
- Rachel Kidman
- Program in Public Health and Department of Family, Population & Preventative Medicine, Stony Brook University, Health Sciences Center, Stony Brook, New York, USA
| | - Philip Anglewicz
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
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Affiliation(s)
- Mary-Ann Davies
- Center for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town Faculty of Health Sciences, Cape Town, South Africa
| | - Jorge Pinto
- Department of Pediatrics, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
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Uptake and yield of HIV testing and counselling among children and adolescents in sub-Saharan Africa: a systematic review. J Int AIDS Soc 2015; 18:20182. [PMID: 26471265 PMCID: PMC4607700 DOI: 10.7448/ias.18.1.20182] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 08/27/2015] [Accepted: 09/04/2015] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION In recent years children and adolescents have emerged as a priority for HIV prevention and care services. We conducted a systematic review to investigate the acceptability, yield and prevalence of HIV testing and counselling (HTC) strategies in children and adolescents (5 to 19 years) in sub-Saharan Africa. METHODS An electronic search was conducted in MEDLINE, EMBASE, Global Health and conference abstract databases. Studies reporting on HTC acceptability, yield and prevalence and published between January 2004 and September 2014 were included. Pooled proportions for these three outcomes were estimated using a random effects model. A quality assessment was conducted on included studies. RESULTS AND DISCUSSION A total of 16,380 potential citations were identified, of which 21 studies (23 entries) were included. Most studies were conducted in Kenya (n=5) and Uganda (n=5) and judged to provide moderate (n=15) to low quality (n=7) evidence, with data not disaggregated by age. Seven studies reported on provider-initiated testing and counselling (PITC), with the remainder reporting on family-centred (n=5), home-based (n=5), outreach (n=5) and school-linked HTC among primary schoolchildren (n=1). PITC among inpatients had the highest acceptability (86.3%; 95% confidence interval [CI]: 65.5 to 100%), yield (12.2%; 95% CI: 6.1 to 18.3%) and prevalence (15.4%; 95% CI: 5.0 to 25.7%). Family-centred HTC had lower acceptance compared to home-based HTC (51.7%; 95% CI: 10.4 to 92.9% vs. 84.9%; 95% CI: 74.4 to 95.4%) yet higher prevalence (8.4%; 95% CI: 3.4 to 13.5% vs. 3.0%; 95% CI: 1.0 to 4.9%). School-linked HTC showed poor acceptance and low prevalence. CONCLUSIONS While PITC may have high test acceptability priority should be given to evaluating strategies beyond healthcare settings (e.g. home-based HTC among families) to identify individuals earlier in their disease progression. Data on linkage to care and cost-effectiveness of HTC strategies are needed to strengthen policies.
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Risk factors affecting child cognitive development: a summary of nutrition, environment, and maternal-child interaction indicators for sub-Saharan Africa. J Dev Orig Health Dis 2015; 7:197-217. [PMID: 26358240 DOI: 10.1017/s2040174415001427] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
An estimated 200 million children worldwide fail to meet their development potential due to poverty, poor health and unstimulating environments. Missing developmental milestones has lasting effects on adult human capital. Africa has a large burden of risk factors for poor child development. The objective of this paper is to identify scope for improvement at the country level in three domains--nutrition, environment, and mother-child interactions. We used nationally representative data from large-scale surveys, data repositories and country reports from 2000 to 2014. Overall, there was heterogeneity in performance across domains, suggesting that each country faces distinct challenges in addressing risk factors for poor child development. Data were lacking for many indicators, especially in the mother-child interaction domain. There is a clear need to improve routine collection of high-quality, country-level indicators relevant to child development to assess risk and track progress.
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Mokgatle MM, Madiba S. The burden of disease on HIV-infected orphaned and non-orphaned children accessing primary health facilities in a rural district with poor resources in South Africa: a cross-sectional survey of primary caregivers of HIV-infected children aged 5-18 years. Infect Dis Poverty 2015; 4:18. [PMID: 25954505 PMCID: PMC4423522 DOI: 10.1186/s40249-015-0049-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Accepted: 04/01/2015] [Indexed: 11/22/2022] Open
Abstract
Background Provider-initiated HIV testing and counseling (PITC) is offered as part of the normal standard of care to increase access to treatment for HIV-infected children. In practice, HIV diagnosis occurs in late childhood following recurrent and chronic infections. We investigated primary caregivers’ reported reasons for seeking HIV testing for children aged 5–18 years, determined the orphan status of the children, and compared the clinical profile and disease burden of orphans and non-orphans. Methods This was a cross-sectional survey of primary caregivers of HIV-infected children accessing antiretroviral treatment (ART) from two community hospitals and 34 primary healthcare facilities in a rural district in Mpumalanga province, South Africa. Results The sample consisted of 406 primary caregivers: 319 (78.6%) brought the child to the health facility for HIV testing because of chronic and recurrent infections. Almost half (n = 183, 45.1%) of the children were maternal orphans, 128 (31.5%) were paternal orphans, and 73 (39.9%) were double orphans. A univariate analysis showed that maternal orphans were significantly more likely to be older (OR = 2.57, p = 0.000, CI: 1.71–3.84), diagnosed late (OR = 2.48, p = 0.009, CI: 1.26–4.88), and to start ART later (OR = 2.5, p = 0.007, CI: 1.28–4.89) than non-orphans. There was a high burden of infection among the children prior to HIV diagnosis; 274 (69.4%) presented with multiple infections. Multiple logistic regression showed that ART start age (aOR = 1.19, p = 0.000, CI: 1.10–1.29) and time on ART (aOR = 2.30, p = 0.000, CI: 1.45–3.64) were significantly associated with orphanhood status. Half (n = 203, (50.2%) of the children were admitted to hospital prior to start of ART, and hospitalization was associated with multiple infections (OR = 1.27, p = 0.004, CI: 1.07–1.51). Conclusions The study found late presentation with undiagnosed perinatal HIV infection and high prevalence of orphanhood among the children. The health of maternal orphans was more compromised than non-orphans. Routine PICT should be strengthened to increase community awareness about undiagnosed HIV among older children and to encourage primary caregivers to accept HIV testing for children. Electronic supplementary material The online version of this article (doi:10.1186/s40249-015-0049-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mathildah M Mokgatle
- Department of Biostatistics, School of Public Health, Sefako Makgatho Health Sciences University, P O Box 215, Medunsa, South Africa
| | - Sphiwe Madiba
- Department of Environmental and Occupational Health, School of Public Health, Sefako Makgatho Health Sciences University, Medunsa, South Africa
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Shepherd BL, Ferrand R, Munyati S, Folkard S, Boyd K, Bandason T, Jallow S, Rowland-Jones SL, Yindom LM. HLA Correlates of Long-Term Survival in Vertically Infected HIV-1-Positive Adolescents in Harare, Zimbabwe. AIDS Res Hum Retroviruses 2015; 31:504-7. [PMID: 25560566 PMCID: PMC4426308 DOI: 10.1089/aid.2014.0338] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
African infants with vertically acquired HIV infection progress rapidly, with only 50% surviving beyond 2 years in the absence of treatment. Despite this high initial mortality, recent reports describe a substantial burden of older children living with untreated vertically acquired HIV infection in Southern Africa. The immunological and genetic factors associated with long-term survival following vertical infection are poorly understood. We performed medium-to-high resolution HLA typing on DNA samples obtained from a cohort of presumed vertically HIV-1-infected children and age-matched uninfected controls in Harare, Zimbabwe. Overall, 93 HLA class I alleles were detected in the study population with a significant enrichment of HLA-C*08:02 and -C*08:04 in the HIV-1-infected long-term survivor group. Conversely, HLA-A*02:01, A*34:02, and -B*58:02 were overrepresented in the uninfected control group. Our data indicate that HLA alleles may have differential effects against HIV acquisition and disease progression in vertical HIV-1 infection.
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Affiliation(s)
- Brittany L. Shepherd
- Nuffield Department of Medicine, University of Oxford, Headington, Oxford, United Kingdom
| | - Rashida Ferrand
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Shungu Munyati
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Samuel Folkard
- Nuffield Department of Medicine, University of Oxford, Headington, Oxford, United Kingdom
| | - Kathryn Boyd
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Tsitsi Bandason
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Sabelle Jallow
- Nuffield Department of Medicine, University of Oxford, Headington, Oxford, United Kingdom
| | - Sarah L. Rowland-Jones
- Nuffield Department of Medicine, University of Oxford, Headington, Oxford, United Kingdom
| | - Louis-Marie Yindom
- Nuffield Department of Medicine, University of Oxford, Headington, Oxford, United Kingdom
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