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Gillette E, Nyandiko W, Baum A, Chory A, Aluoch J, Ashimosi C, Lidweye J, Njorge T, Sang F, Nyagaya J, Scanlon M, Vreeman R. Comparison of Self and Caregiver Reports of Antiretroviral Treatment Adherence among Children and Adolescents Living with HIV in Western Kenya. J Int Assoc Provid AIDS Care 2024; 23:23259582241242335. [PMID: 38562058 PMCID: PMC10989044 DOI: 10.1177/23259582241242335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 02/29/2024] [Accepted: 03/05/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Youth living with HIV with perinatal infection spend a lifetime taking antiretroviral treatment (ART) to suppress the virus, and face significant challenges to successfully maintaining ART adherence. Tools to measure adherence include self-report, medication event monitoring system (MEMS) pill bottle caps, pill counts, and plasma or hair drug levels; however, the inter-rater agreement between child and caregiver self-report has not been validated in an African setting. This study aims to assess inter-rater agreement between child and caregiver self-reports, compared to reporting from MEMS pill bottle caps. METHODS This was a secondary analysis of a cluster-randomized trial to evaluate an intervention for children living with HIV, conducted at the Academic Model Providing Access to Healthcare in western Kenya. We analyzed data from 285 child-caregiver dyads to compare adherence self-reported by children and their caregivers, and subsequently compared all self-reports to adherence reported by MEMS pill bottle caps to determine whether child or caregiver self-reports aligned more closely with adherence measured by MEMS. RESULTS Children and their caregivers reported similar levels of adherence and numbers of missed doses in the past month, and both reports were similarly associated with adherence reported by MEMS pill bottle caps. Children with a caregiver that was not a biological parent were significantly more likely to report more missed doses than their caregiver. The correlation coefficient for the relationship between the child and caregiver self-reports was 0.71; for the relationship between child report and MEMS was 0.23; and for the relationship between caregiver report and MEMS was 0.20. Both children and caregivers under-reported non-adherence compared to MEMS data. CONCLUSION Children and caregiver self-reports were generally similar in reporting adherence and were not highly correlated with MEMS reports of adherence, with children and caregivers reporting higher level of adherence than the MEMS data. This may indicate that children and caregiver reports are similarly inaccurate or biased; however, further research with larger sample sizes is required to further understand the differences in these reports.
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Affiliation(s)
- Emma Gillette
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Winstone Nyandiko
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Moi University College of Health Sciences, Eldoret, Kenya
| | - Aaron Baum
- Waymark Care, San Fransico, United States
| | - Ashley Chory
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Josephine Aluoch
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | | | - Janet Lidweye
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Tabitha Njorge
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Festus Sang
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Jack Nyagaya
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Michael Scanlon
- Center for Global Health Equity, Indiana University, Indianapolis, Indiana, United States
| | - Rachel Vreeman
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, New York, United States
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
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Gillette E, Nyandiko W, Chory A, Scanlon M, Aluoch J, Choudhury N, Lagat D, Ashimosi C, Biegon W, Munyoro D, Lidweye J, Nyagaya J, Wilets I, DeLong A, Kantor R, Vreeman R, Naanyu V. Ethical Considerations for Engaging Children and Adolescents Living with HIV in Research in African Countries: A Systematic Review. J Empir Res Hum Res Ethics 2023; 18:346-362. [PMID: 37872659 DOI: 10.1177/15562646231208991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Research engaging children and adolescents living with HIV (CALWH) is critical for youth-friendly services and HIV care, and researchers need to ensure that such engagement is ethical. We conducted a systematic review to identify key ethical considerations for the engagement of CALWH in research. The review focused on primary research articles conducted in African countries that examined ethical issues in CALWH engaged in research. Ten studies met the inclusion criteria; the following seven key domains were extracted: 1) justifications for engaging CALWH in research; 2) community involvement; 3) informed consent/assent; 4) caregiver involvement; 5) perceptions of benefits; 6) perception of the risks of involvement; and 7) confidentiality. These domains can inform the ethical engagement of CALWH in research.
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Affiliation(s)
- Emma Gillette
- Department of Global Health and Health Systems Design, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Winstone Nyandiko
- Moi University College of Health Sciences, Eldoret, Kenya
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Ashley Chory
- Department of Global Health and Health Systems Design, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael Scanlon
- Indiana University Center for Global Health, Indianapolis, Indiana, USA
| | - Josephine Aluoch
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Nandini Choudhury
- Department of Global Health and Health Systems Design, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Daniel Lagat
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | | | - Whitney Biegon
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Dennis Munyoro
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Janet Lidweye
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Jack Nyagaya
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Ilene Wilets
- Department of Global Health and Health Systems Design, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | - Rachel Vreeman
- Department of Global Health and Health Systems Design, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Violet Naanyu
- Moi University College of Health Sciences, Eldoret, Kenya
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
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Chory A, Nyandiko W, Gillette E, Scanlon M, Aluoch J, Koros H, Munyoro D, Ashimosi C, Beigon W, Lidweye J, Nyagaya J, DeLong A, Kantor R, Vreeman R, Naanyu V. Ethical Considerations for Engaging Youth Living with HIV in Research: Perspectives from Youth, Their Caregivers and Subject Matter Experts in Kenya. J Empir Res Hum Res Ethics 2023; 18:175-188. [PMID: 37574803 DOI: 10.1177/15562646231193949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Introduction: Engaging youth living with HIV (YLWH) in research is critical to improving HIV-related outcomes, but their involvement raises unaddressed bioethical questions. Methods: This study used qualitative inquiry with Kenyan YLWH, caregivers, and subject matter experts (SMEs) to evaluate ethical considerations and strategies for research involving YLWH. Results: Interviews were conducted with 99 participants: 40 YLWH (median age 17.5, 50% female), 20 caregivers (70% female), and 39 SMEs (44% female). All participant groups discussed the need for HIV disclosure status assessment, confidentiality, and engagement of caregivers. Youth participants discussed the importance of clear protocol explanations and developing good rapport. All participant groups perceived youth under 18 to be harder to recruit due to a number of identified barriers. Clinic settings were the most acceptable place for recruitment. Conclusion: Participants provided perspectives on engaging YLWH in research that can be incorporated into protocols and regulatory guidelines.
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Affiliation(s)
- Ashley Chory
- Department of Global Health and Health Systems Design, Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Winstone Nyandiko
- Moi University College of Health Sciences, Eldoret, Kenya
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Emma Gillette
- Department of Global Health and Health Systems Design, Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael Scanlon
- Indiana University Center for Global Health, Indianapolis, Indiana, USA
| | - Josephine Aluoch
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Hillary Koros
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Dennis Munyoro
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | | | - Whitney Beigon
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Janet Lidweye
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Jack Nyagaya
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Allison DeLong
- Alpert Medical School at Brown University, Providence, RI, USA
| | - Rami Kantor
- Alpert Medical School at Brown University, Providence, RI, USA
| | - Rachel Vreeman
- Department of Global Health and Health Systems Design, Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Violet Naanyu
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Moi University School of Arts and Social Sciences, Eldoret, Kenya
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Chory A, Gillette E, Callen G, Wachira J, Sam-Agudu NA, Bond K, Vreeman R. Gender differences in HIV knowledge among adolescents and young people in low-and middle-income countries: a systematic review. Front Reprod Health 2023; 5:1154395. [PMID: 37434701 PMCID: PMC10332462 DOI: 10.3389/frph.2023.1154395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 06/12/2023] [Indexed: 07/13/2023] Open
Abstract
Objectives This review seeks to critically analyze studies assessing gender differences in HIV-related knowledge among adolescents and young people in low- and middle-income countries. Methods Using PRISMA guidelines and searching Pubmed and Scopus online databases, the search strategy combined search keywords with Boolean operators: (HIV OR AIDS) AND (knowledge) AND (gender) AND (adolescents). AC and EG conducted the search and independently reviewed all articles in Covidence software; conflicts were resolved by GC. Articles were included if they evaluated differences in HIV knowledge in at least two groups ages 10-24 and were implemented in a low or middle-income country. Results The search resulted in 4,901 articles, of which fifteen studies, implemented in 15 countries, met selection criteria. Twelve evaluated differences in HIV knowledge in school settings; three evaluated participants in clinic settings. Adolescent males consistently scored higher in composite knowledge scores, as well as knowledge of HIV transmission, prevention, attitudes and sexual decision-making. Conclusion We found gender-based discrepancies between knowledge, perception of risk and HIV prevalence among youth globally, with boys consistently scoring higher in HIV knowledge. However, there is significant evidence that social and cultural contexts render girls at high risk of HIV infection, and the gaps in girls' knowledge and boys' roles in HIV risk must be addressed urgently. Future research should consider interventions that facilitate discussion and HIV knowledge building across genders.
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Affiliation(s)
- Ashley Chory
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Emma Gillette
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Grant Callen
- Center for Global Health, Indiana University School of Medicine - Lafayette, West Lafayette, IN, United States
| | - Juddy Wachira
- Department of Media Studies, School of Literature, Language and Media, University of the Witwatersrand, Johannesburg, South Africa
- Department of Mental Health and Behavioral Sciences, Moi University, Eldoret, Kenya
| | - Nadia A. Sam-Agudu
- School of Medicine, Institute of Human Virology, Baltimore, MD, United States
- Institute for Human Virology, Institute of Human Virology Nigeria, International Research Centre of Excellence (IRCE), Abuja, Nigeria
- School of Medical Sciences, University of Cape Coast, Cape-Coast, Ghana
| | - Keosha Bond
- Department of Community Health & Social Medicine, The City University of New York, New York, NY, United States
- Center for Interdisciplinary Research on AIDS Yale University, New Haven, CT, United States
| | - Rachel Vreeman
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Novitsky V, Nyandiko W, Vreeman R, DeLong AK, Howison M, Manne A, Aluoch J, Chory A, Sang F, Ashimosi C, Jepkemboi E, Orido M, Hogan JW, Kantor R. Added Value of Next Generation Sequencing in Characterizing the Evolution of HIV-1 Drug Resistance in Kenyan Youth. Viruses 2023; 15:1416. [PMID: 37515104 PMCID: PMC10383797 DOI: 10.3390/v15071416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 06/14/2023] [Accepted: 06/20/2023] [Indexed: 07/30/2023] Open
Abstract
Drug resistance remains a global challenge in children and adolescents living with HIV (CALWH). Characterizing resistance evolution, specifically using next generation sequencing (NGS) can potentially inform care, but remains understudied, particularly in antiretroviral therapy (ART)-experienced CALWH in resource-limited settings. We conducted reverse-transcriptase NGS and investigated short-and long-term resistance evolution and its predicted impact in a well-characterized cohort of Kenyan CALWH failing 1st-line ART and followed for up to ~8 years. Drug resistance mutation (DRM) evolution types were determined by NGS frequency changes over time, defined as evolving (up-trending and crossing the 20% NGS threshold), reverting (down-trending and crossing the 20% threshold) or other. Exploratory analyses assessed potential impacts of minority resistance variants on evolution. Evolution was detected in 93% of 42 participants, including 91% of 22 with short-term follow-up, 100% of 7 with long-term follow-up without regimen change, and 95% of 19 with long-term follow-up with regimen change. Evolving DRMs were identified in 60% and minority resistance variants evolved in 17%, with exploratory analysis suggesting greater rate of evolution of minority resistance variants under drug selection pressure and higher predicted drug resistance scores in the presence of minority DRMs. Despite high-level pre-existing resistance, NGS-based longitudinal follow-up of this small but unique cohort of Kenyan CALWH demonstrated continued DRM evolution, at times including low-level DRMs detected only by NGS, with predicted impact on care. NGS can inform better understanding of DRM evolution and dynamics and possibly improve care. The clinical significance of these findings should be further evaluated.
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Affiliation(s)
- Vlad Novitsky
- Alpert Medical School, Brown University, Providence, RI 02912, USA
| | - Winstone Nyandiko
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret 30100, Kenya
- College of Health Sciences, Moi University, Eldoret 30100, Kenya
| | - Rachel Vreeman
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret 30100, Kenya
- Department of Global Health and Health System Design, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Allison K DeLong
- School of Public Health, Brown University, Providence, RI 02912, USA
| | - Mark Howison
- Research Improving People's Lives, Providence, RI 02903, USA
| | - Akarsh Manne
- Alpert Medical School, Brown University, Providence, RI 02912, USA
| | - Josephine Aluoch
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret 30100, Kenya
| | - Ashley Chory
- Department of Global Health and Health System Design, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Festus Sang
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret 30100, Kenya
| | - Celestine Ashimosi
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret 30100, Kenya
| | - Eslyne Jepkemboi
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret 30100, Kenya
| | - Millicent Orido
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret 30100, Kenya
| | - Joseph W Hogan
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret 30100, Kenya
- School of Public Health, Brown University, Providence, RI 02912, USA
| | - Rami Kantor
- Alpert Medical School, Brown University, Providence, RI 02912, USA
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Nyandiko W, Chory A, Baum A, Aluoch J, Ashimosi C, Scanlon M, Martin R, Wachira J, Beigon W, Munyoro D, Apondi E, Vreeman R. Multi-media teacher training and HIV-related stigma among primary and secondary school teachers in Western Kenya. AIDS Care 2023; 35:643-650. [PMID: 36062364 PMCID: PMC9985657 DOI: 10.1080/09540121.2022.2119473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 08/25/2022] [Indexed: 10/14/2022]
Abstract
ABSTRACTHIV stigma is associated with delayed HIV disclosure and worse clinical outcomes for adolescents living with HIV (ALWH). Teachers critically influence school environments, but are understudied in terms of HIV stigma. We implemented a school-level, cluster-randomized trial to assess the impact of a one-day multi-media training on the knowledge, attitudes and beliefs (K/A/B) of school teachers in western Kenya. Teachers' K/A/B were evaluated at baseline and six months. Additionally, we assessed stigma with ALWH enrolled in the included schools to explore the impact of the training. Teachers (N = 311) and ALWH (N = 19) were enrolled from 10 primary and 10 secondary schools. The intervention and control groups did not significantly differ in overall stigma score (mean 1.83 vs. 1.84; adjusted difference, 0.18 [95% CI, -0.082 to 0.045]) at six months; however, we found a trend towards improvement in overall stigma score and a significant difference in the community discrimination sub-scale among secondary school teachers (mean 3.02 vs. 3.19; adjusted difference, -0.166 [95% CI, -0.310 to -0.022]). ALWH reported few experiences of discrimination, but emphasized keeping their HIV status secret (84%). The teacher-training reduced secondary school teacher perceptions of community-level stigma, but did not impact individual attitudes or beliefs..
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Affiliation(s)
- Winstone Nyandiko
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Department of Child Health and Paediatrics, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Ashley Chory
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Arnhold Institute for Global Health, Department of Global Health and Health Systems Design, Icahn School of Medicine at Mount Sinai, NY, NY, USA
| | - Aaron Baum
- Arnhold Institute for Global Health, Department of Global Health and Health Systems Design, Icahn School of Medicine at Mount Sinai, NY, NY, USA
| | - Josephine Aluoch
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | | | - Michael Scanlon
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Indiana University Center for Global Health, Indianapolis, Indiana
| | - Roxanne Martin
- Arnhold Institute for Global Health, Department of Global Health and Health Systems Design, Icahn School of Medicine at Mount Sinai, NY, NY, USA
| | - Juddy Wachira
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Department of Behavioral Sciences, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Whitney Beigon
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Dennis Munyoro
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Edith Apondi
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Rachel Vreeman
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Department of Child Health and Paediatrics, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
- Arnhold Institute for Global Health, Department of Global Health and Health Systems Design, Icahn School of Medicine at Mount Sinai, NY, NY, USA
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Magill EB, Nyandiko W, Baum A, Aluoch J, Chory A, Ashimoshi C, Lidweye J, Njoroge T, Sang F, Nyagaya J, Scanlon M, Hogan J, Vreeman R. Factors associated with caregiver compliance to an HIV disclosure intervention and its effect on HIV and mental health outcomes among children living with HIV: post-hoc instrumental variable-based analysis of a cluster randomized trial in Eldoret, Kenya. Front Public Health 2023; 11:1150744. [PMID: 37213654 PMCID: PMC10196043 DOI: 10.3389/fpubh.2023.1150744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 04/03/2023] [Indexed: 05/23/2023] Open
Abstract
Background The HADITHI study is a cluster-randomized trial of children living with HIV and their caregivers in Kenya that aimed to increase rates of caregiver disclosure of their child's HIV status, encourage earlier status disclosure, and improve pediatric mental health and HIV outcomes. This analysis identified characteristics predicting caregiver non-responsiveness and compared outcomes among children based on disclosure status. Methods A penalized logistic regression model with lasso regularization identified the most important predictors of disclosure. The two-stage least squares instrumental variable approach was used to assess outcomes accounting for non-compliance to disclosure. Results Caregiver non-isolation and shorter time on antiretroviral therapy were predictive of HIV status disclosure. There were no statistically significant differences found in CD4 percentage, depression status, or mental and emotional status based on disclosure status up to 24 months-post intervention. Conclusion These findings have implications for specialists seeking to tailor disclosure interventions to improve caregiver-child dyad responsiveness.
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Affiliation(s)
- Elizabeth B. Magill
- Department of Health Systems Design and Global Health, Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Elizabeth B. Magill
| | - Winstone Nyandiko
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Department of Child Health and Pediatrics, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Aaron Baum
- Department of Health Systems Design and Global Health, Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Josephine Aluoch
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Ashley Chory
- Department of Health Systems Design and Global Health, Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | | | - Janet Lidweye
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Tabitha Njoroge
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Festus Sang
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Jack Nyagaya
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Michael Scanlon
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Center for Global Health, Indiana School of Medicine, Bloomington, IN, United States
| | - Joseph Hogan
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Department of Biostatistics, Brown University School of Public Health, Providence, RI, United States
| | - Rachel Vreeman
- Department of Health Systems Design and Global Health, Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- *Correspondence: Rachel Vreeman
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Gillette E, Naanyu V, Nyandiko W, Chory A, Scanlon M, Aluoch J, Koros H, Ashimosi C, Beigon W, Munyoro D, Lidweye J, Nyagaya J, DeLong A, Kantor R, Vreeman R. HIV-Related Stigma Shapes Research Participation for Youth Living With HIV in Kenya. J Int Assoc Provid AIDS Care 2023; 22:23259582231170732. [PMID: 37101381 PMCID: PMC10141251 DOI: 10.1177/23259582231170732] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023] Open
Abstract
Introduction: HIV stigma affects medication adherence, psychosocial outcomes, and clinical management for youth living with HIV (YLWH). We explored the impact of HIV stigma on research participation, to inform the ethical engagement of this vulnerable group. Methods: We interviewed 40 YLWH, 20 caregivers, and 39 subject matter experts (SMEs); transcripts were analyzed by HK and EG, with emerging themes confirmed by JA and AC. Results: All categories of participants identified the impacts of stigma on YLWH research participation, suggesting implementing privacy protections, considering recruitment locations carefully, and developing supportive relationships with YLWH. SMEs suggested that YLWH experience uniquely high risks from stigma due to the compounding effects of developmental challenges and transitionary life period. Accidental HIV disclosure and subsequent stigma were identified as a risk of research participation; some viewed the creation of community through research as a benefit. Conclusion: Participants provided insights into stigma-related considerations for research with YLWH, which may guide engagement protocols.
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Affiliation(s)
- Emma Gillette
- Department of Health Systems Design and Global Health, Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Violet Naanyu
- Moi University School of Arts and Social Sciences, Eldoret, Kenya
| | - Winstone Nyandiko
- Moi University College of Health Sciences, Eldoret, Kenya
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Ashley Chory
- Department of Health Systems Design and Global Health, Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael Scanlon
- Center for Global Health, Indiana University, Indianapolis, IN, USA
| | - Josephine Aluoch
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Hillary Koros
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | | | - Whitney Beigon
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Dennis Munyoro
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Janet Lidweye
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Jack Nyagaya
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Allison DeLong
- Alpert Medical School, Brown University, Providence, RI, USA
| | - Rami Kantor
- Alpert Medical School, Brown University, Providence, RI, USA
| | - Rachel Vreeman
- Department of Health Systems Design and Global Health, Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
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Novitsky V, Nyandiko W, Vreeman R, DeLong AK, Manne A, Scanlon M, Ngeresa A, Aluoch J, Sang F, Ashimosi C, Jepkemboi E, Orido M, Hogan JW, Kantor R. Added Value of Next Generation over Sanger Sequencing in Kenyan Youth with Extensive HIV-1 Drug Resistance. Microbiol Spectr 2022; 10:e0345422. [PMID: 36445146 PMCID: PMC9769539 DOI: 10.1128/spectrum.03454-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 11/16/2022] [Indexed: 12/03/2022] Open
Abstract
HIV-1 drug resistance testing in children and adolescents in low-resource settings is both important and challenging. New (more sensitive) drug resistance testing technologies may improve clinical care, but evaluation of their added value is limited. We assessed the potential added value of using next-generation sequencing (NGS) over Sanger sequencing for detecting nucleoside reverse transcriptase inhibitor (NRTI) and nonnucleoside reverse transcriptase inhibitor (NNRTI) drug resistance mutations (DRMs). Participants included 132 treatment-experienced Kenyan children and adolescents with diverse HIV-1 subtypes and with already high levels of drug resistance detected by Sanger sequencing. We examined overall and DRM-specific resistance and its predicted impact on antiretroviral therapy and evaluated the discrepancy between Sanger sequencing and six NGS thresholds (1%, 2%, 5%, 10%, 15%, and 20%). Depending on the NGS threshold, agreement between the two technologies was 62% to 88% for any DRM, 83% to 92% for NRTI DRMs, and 73% to 94% for NNRTI DRMs, with more DRMs detected at low NGS thresholds. NGS identified 96% to 100% of DRMs detected by Sanger sequencing, while Sanger identified 83% to 99% of DRMs detected by NGS. Higher discrepancy between technologies was associated with higher DRM prevalence. Even in this resistance-saturated cohort, 12% of participants had higher, potentially clinically relevant predicted resistance detected only by NGS. These findings, in a young, vulnerable Kenyan population with diverse HIV-1 subtypes and already high resistance levels, suggest potential benefits of more sensitive NGS over existing technology. Good agreement between technologies at high NGS thresholds supports their interchangeable use; however, the significance of DRMs identified at lower thresholds to patient care should be explored further. IMPORTANCE HIV-1 drug resistance in children and adolescents remains a significant problem in countries facing the highest burden of the HIV epidemic. Surveillance of HIV-1 drug resistance in children and adolescents is an important public health strategy, particularly in resource-limited settings, and yet, it is limited due mostly to cost and infrastructure constraints. Whether newer and more sensitive next-generation sequencing (NGS) adds substantial value beyond traditional Sanger sequencing in detecting HIV-1 drug resistance in real life settings remains an open and debatable question. In this paper, we attempt to address this issue by performing a comprehensive comparison of drug resistance identified by Sanger sequencing and six NGS thresholds. We conducted this study in a well-characterized, vulnerable cohort of children and adolescents living with diverse HIV-1 subtypes in Kenya and, importantly, failing antiretroviral therapy (ART) with already extensive drug resistance. Our findings suggest a potential added value of NGS over Sanger even in this unique cohort.
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Affiliation(s)
- V. Novitsky
- Brown University, Providence, Rhode Island, USA
| | - W. Nyandiko
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Moi University, Eldoret, Kenya
| | - R. Vreeman
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Arnhold Institute for Global Health, New York, New York, USA
| | | | - A. Manne
- Brown University, Providence, Rhode Island, USA
| | - M. Scanlon
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Arnhold Institute for Global Health, New York, New York, USA
| | - A. Ngeresa
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - J. Aluoch
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - F. Sang
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - C. Ashimosi
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - E. Jepkemboi
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - M. Orido
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - J. W. Hogan
- Brown University, Providence, Rhode Island, USA
| | - R. Kantor
- Brown University, Providence, Rhode Island, USA
| | - for the RESistance in a PEdiatric CohorT (RESPECT) Study
- Brown University, Providence, Rhode Island, USA
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Moi University, Eldoret, Kenya
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Arnhold Institute for Global Health, New York, New York, USA
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10
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Maskew M, Technau K, Davies MA, Vreeman R, Fox MP. Adolescent retention in HIV care within differentiated service-delivery models in sub-Saharan Africa. Lancet HIV 2022; 9:e726-e734. [PMID: 36088915 PMCID: PMC9927242 DOI: 10.1016/s2352-3018(22)00137-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 04/11/2022] [Accepted: 05/06/2022] [Indexed: 02/05/2023]
Abstract
Adolescents and young people living with HIV are at risk of disengaging from HIV care at all stages of the care cascade. Differentiated models of care offer simplified HIV-service delivery options in the hope of improving treatment outcomes, including retention on antiretroviral therapy. However, it remains unclear how successful and widespread these models are for adolescents in sub-Saharan Africa, where the burden of HIV is the greatest. Very few differentiated models of care specifically targeted to adolescents can be found and this priority group are currently ineligible from several models that exist. Where differentiated care has been made available to adolescents, data on the implementation and effectiveness of these interventions remain scarce. Despite this scarcity of evidence on the effectiveness of differentiated care among adolescent populations, several interventions, particularly community-based groups with peer navigators or supporters, might have potential to increase the reach, effectiveness, and adoption of differentiated care in adolescent HIV-care programmes.
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Affiliation(s)
- Mhairi Maskew
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa.
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11
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Posada R, Waldman R, Chory A, Martin R, Cohen A, Chiacchia S, Childs J, Enane LA, Vreeman R. Longitudinal impacts of the COVID-19 pandemic on adolescents living with HIV in New York City. AIDS Care 2022; 35:629-633. [PMID: 35761785 DOI: 10.1080/09540121.2022.2090491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Adolescents living with HIV (ALWH) are particularly susceptible to disruptions in care, which may lead to poor HIV-related health outcomes. Here, we report the results of a longitudinal phone-based study investigating impacts of the COVID-19 pandemic on ALWH in New York City. Participants (N = 10, mean age 21.2 years, 50% female) demonstrated substantial COVID-19 knowledge and identified Instagram as their primary source of COVID-19 information. Nearly all participants reported loss of income, and 50% reported experiencing food insecurity as a result of the pandemic. These findings highlight existing vulnerabilities among ALWH that may threaten the continuum of care.
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Affiliation(s)
- Roberto Posada
- Mount Sinai Health System, New York, NY, USA.,Departments of Pediatrics and Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rachel Waldman
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ashley Chory
- Arnhold Institute for Global Health, Department of Global Health and Health Systems Design, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Roxanne Martin
- Arnhold Institute for Global Health, Department of Global Health and Health Systems Design, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ariella Cohen
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sam Chiacchia
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Leslie A Enane
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Rachel Vreeman
- Arnhold Institute for Global Health, Department of Global Health and Health Systems Design, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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12
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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13
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Oyungu E, El Kebbi O, Vreeman R, Nyandiko W, Monahan PO, Tu W, Khaitan A, Desta Z, Slogrove AL, Humphrey JM, Were E, Patel RC, Carlucci JG, Wools-Kaloustian K, McHenry MS. Predicting neurodevelopmental risk in children born to mothers living with HIV in Kenya: protocol for a prospective cohort study (Tabiri Study). BMJ Open 2022; 12:e061051. [PMID: 35379648 PMCID: PMC8981283 DOI: 10.1136/bmjopen-2022-061051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION For the growing number of children with in utero and postpartum exposure to HIV and/or antiretrovirals, it is unclear which exposures or risk factors play a significant role in predicting worse neurodevelopmental outcomes. This protocol describes a prospective longitudinal cohort study of infants born to mothers living with HIV and those born to mothers without HIV. We will determine which risk factors are most predictive of child neurodevelopment at 24 months. We aim to create a risk assessment tool to help predict which children are at risk for worse neurodevelopment outcomes. METHODS AND ANALYSIS This study leverages an existing Kenyan cohort to prospectively enrol 500 children born to mothers living with HIV and 500 to those without HIV (n=1000 total) and follow them from birth to age 24 months. The following factors will be measured every 6 months: infectious morbidity and biological/sociodemographic/psychosocial risk factors. We will compare these factors between the two groups. We will then measure and compare neurodevelopment within children in both groups at 24 months of age using the Child Behaviour Checklist and the Bayley Scales of Infant and Toddler Development, third edition. Finally, we will use generalised linear mixed modelling to quantify associations with neurodevelopment and create a risk assessment tool for children ≤24 months. ETHICS AND DISSEMINATION The study is approved by the Moi University's Institutional Research and Ethics Committee (IREC/2021/55; Approval #0003892), Kenya's National Commission for Science, Technology and Innovation (NACOSTI, Reference #700244) and Indiana University's Institutional Review Board (IRB Protocol #110990). This study carries minimal risk to the children and their mothers, and all mothers will provide written consent for participation in the study. Results will be disseminated to maternal child health clinics within Uasin Gishu County, Kenya and via papers submitted to peer-reviewed journals and presentation at international conferences.
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Affiliation(s)
- Eren Oyungu
- Department of Medical Physiology, Moi University College of Health Sciences, Eldoret, Kenya
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Ola El Kebbi
- Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon
| | - Rachel Vreeman
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
- Arnold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Winstone Nyandiko
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
- Department of Child Health, Moi University College of Health Sciences, Eldoret, Kenya
| | - Patrick O Monahan
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Wanzhu Tu
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Alka Khaitan
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Zeruesenay Desta
- Department of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Amy L Slogrove
- Department of Paediatrics & Child Health, Faculty of Medicine & Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - John M Humphrey
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Edwin Were
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
- Division of Obstetrics and Gynecology, Moi University College of Health Sciences, Eldoret, Kenya
| | - Rena C Patel
- University of Washington School of Medicine, Seattle, Washington, USA
| | - James G Carlucci
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Kara Wools-Kaloustian
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Megan S McHenry
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
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14
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Sors T, Wools-Kaloustian K, O'Brien RC, Bermel LY, Chikowe I, Gardner A, Kiplagat J, Lieberman M, Moe S, Morales-Soto N, Nyandiko W, Plater D, Rono BC, Scanlon M, Tierney W, Vreeman R, Wiehe S, Litzelman D. Reciprocal innovation: a new approach to equitable and mutually beneficial global health research and partnerships. The Lancet Global Health 2022. [DOI: 10.1016/s2214-109x(22)00159-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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15
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Jesson J, Crichton S, Quartagno M, Yotebieng M, Abrams EJ, Chokephaibulkit K, Le Coeur S, Aké‐Assi M, Patel K, Pinto J, Paul M, Vreeman R, Davies M, Ben‐Farhat J, Van Dyke R, Judd A, Mofenson L, Vicari M, Seage G, Bekker L, Essajee S, Gibb D, Penazzato M, Collins IJ, Wools‐Kaloustian K, Slogrove A, Powis K, Williams P, Matshaba M, Thahane L, Nyasulu P, Lukhele B, Mwita L, Kekitiinwa‐Rukyalekere A, Wanless S, Goetghebuer T, Thorne C, Warszawski J, Galli L, van Rossum AM, Giaquinto C, Marczynska M, Marques L, Prata F, Ene L, Okhonskaya L, Navarro M, Frick A, Naver L, Kahlert C, Volokha A, Chappell E, Pape JW, Rouzier V, Marcelin A, Succi R, Sohn AH, Kariminia A, Edmonds A, Lelo P, Lyamuya R, Ogalo EA, Odhiambo FA, Haas AD, Bolton C, Muhairwe J, Tweya H, Sylla M, D'Almeida M, Renner L, Abzug MJ, Oleske J, Purswani M, Teasdale C, Nuwagaba‐Biribonwoha H, Goodall R, Leroy V. Growth and CD4 patterns of adolescents living with perinatally acquired HIV worldwide, a CIPHER cohort collaboration analysis. J Int AIDS Soc 2022; 25:e25871. [PMID: 35255197 PMCID: PMC8901148 DOI: 10.1002/jia2.25871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 12/20/2021] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Adolescents living with HIV are subject to multiple co-morbidities, including growth retardation and immunodeficiency. We describe growth and CD4 evolution during adolescence using data from the Collaborative Initiative for Paediatric HIV Education and Research (CIPHER) global project. METHODS Data were collected between 1994 and 2015 from 11 CIPHER networks worldwide. Adolescents with perinatally acquired HIV infection (APH) who initiated antiretroviral therapy (ART) before age 10 years, with at least one height or CD4 count measurement while aged 10-17 years, were included. Growth was measured using height-for-age Z-scores (HAZ, stunting if <-2 SD, WHO growth charts). Linear mixed-effects models were used to study the evolution of each outcome between ages 10 and 17. For growth, sex-specific models with fractional polynomials were used to model non-linear relationships for age at ART initiation, HAZ at age 10 and time, defined as current age from 10 to 17 years of age. RESULTS A total of 20,939 and 19,557 APH were included for the growth and CD4 analyses, respectively. Half were females, two-thirds lived in East and Southern Africa, and median age at ART initiation ranged from <3 years in North America and Europe to >7 years in sub-Saharan African regions. At age 10, stunting ranged from 6% in North America and Europe to 39% in the Asia-Pacific; 19% overall had CD4 counts <500 cells/mm3 . Across adolescence, higher HAZ was observed in females and among those in high-income countries. APH with stunting at age 10 and those with late ART initiation (after age 5) had the largest HAZ gains during adolescence, but these gains were insufficient to catch-up with non-stunted, early ART-treated adolescents. From age 10 to 16 years, mean CD4 counts declined from 768 to 607 cells/mm3 . This decline was observed across all regions, in males and females. CONCLUSIONS Growth patterns during adolescence differed substantially by sex and region, while CD4 patterns were similar, with an observed CD4 decline that needs further investigation. Early diagnosis and timely initiation of treatment in early childhood to prevent growth retardation and immunodeficiency are critical to improving APH growth and CD4 outcomes by the time they reach adulthood.
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16
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Nyandiko W, Holland S, Vreeman R, DeLong AK, Manne A, Novitsky V, Ngeresa A, Chory A, Aluoch J, Orido M, Jepkemboi E, Sam SS, Caliendo AM, Ayaya S, Hogan JW, Kantor R. HIV-1 Treatment Failure, Drug Resistance, and Clinical Outcomes in Perinatally Infected Children and Adolescents Failing First-Line Antiretroviral Therapy in Western Kenya. J Acquir Immune Defic Syndr 2022; 89:231-239. [PMID: 34723922 PMCID: PMC8752470 DOI: 10.1097/qai.0000000000002850] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 10/19/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Long-term impact of drug resistance in perinatally infected children and adolescents living with HIV (CALWH) is poorly understood. We determined drug resistance and examined its long-term impact on failure and mortality in Kenyan CALWH failing first-line non-nucleoside reverse transcriptase inhibitor-based antiretroviral therapy (ART). SETTING Academic Model Providing Access to Healthcare, western Kenya. METHODS Participants were enrolled in 2010-2013 (timepoint 1) and a subsample re-enrolled after 4-7 years (timepoint 2). Viral load (VL) was performed on timepoint 1 samples, with genotyping of those with detectable VL. Primary endpoints were treatment failure (VL >1000 copies/mL) at and death before timepoint 2. Multinomial regression analysis was used to characterize resistance effect on death, failure, and loss-to-follow-up, adjusting for key variables. RESULTS The initial cohort (n = 480) was 52% (n = 251) female, median age 8 years, median CD4% 31%, 79% (n = 379) on zidovudine/abacavir + lamivudine + efavirenz/nevirapine for median 2 years. Of these, 31% (n = 149) failed at timepoint 1. Genotypes at timepoint 1, available on n = 128, demonstrated 93% (n = 119) extensive resistance, affecting second line. Of 128, 22 failed at timepoint 2, 17 died, and 32 were lost to follow-up before timepoint 2. Having >5 resistance mutations at timepoint 1 was associated with higher mortality [relative risk ratio (RRR) = 8.7, confidence interval (CI) 2.1 to 36.3] and loss to follow-up (RRR = 3.2, CI 1.1 to 9.2). Switching to second line was associated with lower mortality (RRR <0.05, CI <0.05 to 0.1) and loss to follow-up (RRR = 0.1, CI <0.05 to 0.3). CONCLUSION Extensive resistance and limited switch to second line in perinatally infected Kenyan CALWH failing first-line ART were associated with long-term failure and mortality. Findings emphasize urgency for interventions to sustain effective, life-long ART in this vulnerable population.
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Affiliation(s)
- Winstone Nyandiko
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Moi University College of Health Sciences, Eldoret, Kenya
| | | | - Rachel Vreeman
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | - Anthony Ngeresa
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Ashley Chory
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Josephine Aluoch
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Millicent Orido
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Eslyne Jepkemboi
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | | | | | - Samuel Ayaya
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Moi University College of Health Sciences, Eldoret, Kenya
| | - Joseph W Hogan
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Brown University, Providence, RI, USA
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17
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Callen G, Chory A, Sang F, Munyoro D, Aluoch J, Scanlon M, Enane L, McHenry M, Wools-Kaloustian K, Apondi E, Vreeman R. A Qualitative Examination of Perceived Stigma and its Sources Among Adolescents Living With HIV in Western Kenya. Glob Pediatr Health 2022; 9:2333794X211065335. [PMID: 35024383 PMCID: PMC8744199 DOI: 10.1177/2333794x211065335] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 11/20/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction. Adolescents (10-19 years) living with HIV (ALWH) face unique challenges in controlling HIV long-term, including stigma and perception of stigma within their communities. Methods. We conducted a qualitative investigation of the sources of perceived HIV-related stigma with ALWH in western Kenya. Forty-six ALWH on ART, aware of their status, and engaged in care were enrolled. Interviews explored perceived stigma by probing the individuals and experiences that adolescents identify as causing or perpetuating their ongoing fears. Results. Participants (54% male, mean age 17.4) reported ongoing fears of stigmatization related to friends and peers not living with HIV. They described previous enacted and first-hand observations of stigma, most often occurring in pre-adolescence, by age mates or peers at school as the most common cause for their ongoing fears. Conclusions. Perceived stigma is prevalent among ALWH and develops from experiences in pre-adolescence. Anti-HIV stigma interventions addressing educators and children in school settings to combat perceived stigma at its source should be investigated.
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Affiliation(s)
- Grant Callen
- Indiana University School of Medicine,
Indianapolis, IN, USA
- Academic Model Providing Access to
Healthcare, Eldoret, Kenya
| | - Ashley Chory
- Academic Model Providing Access to
Healthcare, Eldoret, Kenya
- Arnhold Institute for Global Health,
Department of Health Systems Design and Global Health, Icahn School of Medicine at
Mt. Sinai, New York City, NY, USA
| | - Festus Sang
- Academic Model Providing Access to
Healthcare, Eldoret, Kenya
| | - Dennis Munyoro
- Academic Model Providing Access to
Healthcare, Eldoret, Kenya
| | | | - Michael Scanlon
- Indiana University School of Medicine,
Indianapolis, IN, USA
- Academic Model Providing Access to
Healthcare, Eldoret, Kenya
| | - Leslie Enane
- Indiana University School of Medicine,
Indianapolis, IN, USA
- Academic Model Providing Access to
Healthcare, Eldoret, Kenya
| | - Megan McHenry
- Indiana University School of Medicine,
Indianapolis, IN, USA
- Academic Model Providing Access to
Healthcare, Eldoret, Kenya
| | - Kara Wools-Kaloustian
- Indiana University School of Medicine,
Indianapolis, IN, USA
- 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
- Academic Model Providing Access to
Healthcare, Eldoret, Kenya
- Arnhold Institute for Global Health,
Department of Health Systems Design and Global Health, Icahn School of Medicine at
Mt. Sinai, New York City, NY, USA
- Moi University, Eldoret, Kenya
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18
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Oliver K, Raut A, Pierre S, Silvera L, Boulos A, Gale A, Baum A, Chory A, Davis NJ, D'Souza D, Freeman A, Goytia C, Hamilton A, Horowitz C, Islam N, Jeavons J, Knudsen J, Li S, Lupi J, Martin R, Maru S, Nabeel I, Pimenova D, Romanoff A, Rusanov S, Schwalbe NR, Vangeepuram N, Vreeman R, Masci J, Maru D. Factors associated with COVID-19 vaccine receipt at two integrated healthcare systems in New York City: a cross-sectional study of healthcare workers. BMJ Open 2022; 12:e053641. [PMID: 34992113 PMCID: PMC8739539 DOI: 10.1136/bmjopen-2021-053641] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 10/28/2021] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVES To examine the factors associated with COVID-19 vaccine receipt among healthcare workers and the role of vaccine confidence in decisions to vaccinate, and to better understand concerns related to COVID-19 vaccination. DESIGN Cross-sectional anonymous survey among front-line, support service and administrative healthcare workers. SETTING Two large integrated healthcare systems (one private and one public) in New York City during the initial roll-out of the COVID-19 vaccine. PARTICIPANTS 1933 healthcare workers, including nurses, physicians, allied health professionals, environmental services staff, researchers and administrative staff. PRIMARY OUTCOME MEASURES The primary outcome was COVID-19 vaccine receipt during the initial roll-out of the vaccine among healthcare workers. RESULTS Among 1933 healthcare workers who had been offered the vaccine, 81% had received the vaccine at the time of the survey. Receipt was lower among black (58%; OR: 0.14, 95% CI 0.1 to 0.2) compared with white (91%) healthcare workers, and higher among non-Hispanic (84%) compared with Hispanic (69%; OR: 2.37, 95% CI 1.8 to 3.1) healthcare workers. Among healthcare workers with concerns about COVID-19 vaccine safety, 65% received the vaccine. Among healthcare workers who agreed with the statement that the vaccine is important to protect family members, 86% were vaccinated. Of those who disagreed, 25% received the vaccine (p<0.001). In a multivariable analysis, concern about being experimented on (OR: 0.44, 95% CI 0.31 to 0.6), concern about COVID-19 vaccine safety (OR: 0.39, 95% CI 0.28 to 0.55), lack of influenza vaccine receipt (OR: 0.28, 95% CI 0.18 to 0.44), disagreeing that COVID-19 vaccination is important to protect others (OR: 0.37, 95% CI 0.27 to 0.52) and black race (OR: 0.38, 95% CI 0.24 to 0.59) were independently associated with COVID-19 vaccine non-receipt. Over 70% of all healthcare workers responded that they had been approached for vaccine advice multiple times by family, community members and patients. CONCLUSIONS Our data demonstrated high overall receipt among healthcare workers. Even among healthcare workers with concerns about COVID-19 vaccine safety, side effects or being experimented on, over 50% received the vaccine. Attitudes around the importance of COVID-19 vaccination to protect others played a large role in healthcare workers' decisions to vaccinate. We observed striking inequities in COVID-19 vaccine receipt, particularly affecting black and Hispanic workers. Further research is urgently needed to address issues related to vaccine equity and uptake in the context of systemic racism and barriers to care. This is particularly important given the influence healthcare workers have in vaccine decision-making conversations in their communities.
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Affiliation(s)
- Kristin Oliver
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Global Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Anant Raut
- Department of Global Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Stanley Pierre
- NYC Health and Hospitals -Queens Hospital Center, Queens, New York, USA
| | | | - Alexander Boulos
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Alyssa Gale
- Health Education, Mount Sinai Hospital, New York, New York, USA
| | - Aaron Baum
- Department of Global Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ashley Chory
- Department of Global Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Nichola J Davis
- NYC Health + Hospitals/Office of Ambulatory Care and Population Health, New York, New York, USA
| | - David D'Souza
- Department of Family Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Amy Freeman
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Crispin Goytia
- Department of Population Health Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Andrea Hamilton
- NYC Health and Hospitals -Queens Hospital Center, Queens, New York, USA
| | - Carol Horowitz
- Department of Population Health Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nadia Islam
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Jessica Jeavons
- New York City Department of Health and Mental Hygiene, Long Island City, NY, USA
| | - Janine Knudsen
- New York City Department of Health and Mental Hygiene, Long Island City, NY, USA
- NYC Health and Hospitals/Bellevue Hospital Center, New York, New York, USA
- Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Sheng Li
- Department of Epidemiology, City University of New York, New York, New York, USA
| | - Jenna Lupi
- Office of Population Health, New York City Health and Hospitals, New York, New York, USA
| | - Roxanne Martin
- Department of Global Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sheela Maru
- Department of Global Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Deopartment of Obstetrics and Gynecology, NYC Health + Hospitals/Elmhurst, Queens, New York, USA
| | - Ismail Nabeel
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Dina Pimenova
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Anya Romanoff
- Department of Global Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sonya Rusanov
- Department of Global Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Nina R Schwalbe
- Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York City, New York, USA
| | - Nita Vangeepuram
- Department of Population Health Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rachel Vreeman
- Department of Global Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Joseph Masci
- Department of Global Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- NYC Health + Hospitals/Elmhurst, Elmhurst, New York, USA
| | - Duncan Maru
- Department of Global Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- NYC Health + Hospitals/Elmhurst, Elmhurst, New York, USA
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19
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Martin R, Ashimosi C, Nyandiko W, Chory A, Aluoch J, Scanlon M, Vreeman R. A systematic review of interventions to reduce HIV-related stigma among primary and secondary school teachers. AIDS Care 2022; 34:1-6. [PMID: 34330183 PMCID: PMC8758510 DOI: 10.1080/09540121.2021.1960264] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
HIV/AIDS-related stigma (HIV stigma) affects every aspect of adolescents' HIV management. Adolescents living with HIV (ALWH) are particularly vulnerable in schools where they have described experiencing HIV stigma. Teachers play a significant role in their students' lives. Stigmatizing attitudes or behaviors by teachers not only impact ALWH directly, but may influence the attitudes and behaviors of their peers. There is a dearth of literature exploring interventions to address HIV stigma in school-based settings. The objective of this review is to examine interventions to reduce HIV stigma among teachers globally. To conduct this systematic review, we used the PRISMA guidelines. Two articles met the inclusion criteria. Both eligible studies aimed to reduce HIV stigma among teachers or teachers in training through teacher training interventions in sub-Saharan Africa. The interventions included an interactive CD-ROM, a 2-day workshop, and peer facilitated workshops. Both studies demonstrated a significant decrease in HIV stigma in at least one study measure. Findings from this review are inconclusive. There is evidence to suggest that interventions can successfully decrease HIV stigma among teachers, but it is very limited. More research is needed in order to develop, implement, and evaluate stigma reducing interventions in the classroom.
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Affiliation(s)
- Roxanne Martin
- Arnhold Institute for Global Health, Department of Health Systems Design and Global Health, Icahn School of Medicine at Mount Sinai, New York, USA
| | | | - Winstone Nyandiko
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya,Moi Teaching and Referral Hospital, Eldoret, Kenya,Department of Child Health and Paediatrics, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Ashley Chory
- Arnhold Institute for Global Health, Department of Health Systems Design and Global Health, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Josephine Aluoch
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Michael Scanlon
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya,Center for Global Health, Indiana School of Medicine, Indiana, USA
| | - Rachel Vreeman
- Arnhold Institute for Global Health, Department of Health Systems Design and Global Health, Icahn School of Medicine at Mount Sinai, New York, USA,Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
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20
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Tiwari A, Wu WJ, Citrin D, Bhatta A, Bogati B, Halliday S, Goldberg A, Khadka S, Khatri R, Kshetri Y, Rayamazi HJ, Sapkota S, Saud S, Thapa A, Vreeman R, Maru S. “Our mothers do not tell us”: a qualitative study of adolescent girls’ perspectives on sexual and reproductive health in rural Nepal. Sex Reprod Health Matters 2022; 29:2068211. [PMID: 35695251 PMCID: PMC9225746 DOI: 10.1080/26410397.2022.2068211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Adolescent girls in low- and middle-income countries continue to face poor sexual and reproductive health (SRH). In Nepal, early marriage and motherhood, gender-based violence, and unmet need for contraception remain pervasive. Adolescent girls in rural areas bear a disproportionate burden of poor reproductive health outcomes, but there are limited context-specific data. This is a qualitative study to identify factors that impact adolescent girls’ utilisation of and access to SRH services in a rural district of Nepal. We conducted 21 individual interviews with adolescent girls aged 15–19 years, and three focus group discussions with community health workers. We used an inductive analytic approach to identify emergent and recurrent themes and present the themes using the social ecological model. Individual-level factors that contribute to low uptake of services among adolescent girls include lack of knowledge, self-perceived lack of need, low decision-making autonomy, and shyness. Interpersonal factors that impact access include unsupportive family norms, absence of open communication, and need for permission from family members to access care. At the community level, disparate gender norms, son preference, and judgment by community members affect adolescent SRH. Inadequate sex education, far travel distance to facilities, lack of female healthcare providers and teachers, and inability to access abortion services were identified as organisational and systems barriers. Stigma was a factor cross-cutting several levels. Our findings suggest the need for multi-level strategies to address these factors to improve adolescent girls’ SRH.
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Affiliation(s)
| | - Wan-Ju Wu
- Assistant Professor, Boston Medical Center, Department of Obstetrics and Gynecology, Boston, MA, USA; Boston University School of Medicine, Department of Obstetrics and Gynecology, Boston, MA, USA; Possible, New York, USA
| | - David Citrin
- Adviser, Possible, New York, USA; University of Washington, Department of Global Health, Seattle, WA, USA; University of Washington, Department of Anthropology, Seattle, WA, USA; Icahn School of Medicine at Mount Sinai, Arnhold Institute for Global Health, New York, NY, USA
| | - Aasha Bhatta
- Community Health Program Associate, Nyaya Health Nepal, Kathmandu, Nepal
| | - Bhawana Bogati
- Community Health Program Associate, Nyaya Health Nepal, Kathmandu, Nepal
| | - Scott Halliday
- Adviser, Possible, New York, USA; University of Washington, Department of Global Health, Seattle, WA, USA
| | - Alisa Goldberg
- Associate Professor, Brigham and Women's Hospital, Department of Obstetrics, Gynecology, and Reproductive Biology, Boston, MA, Harvard Medical School, Boston MA, USA
| | - Sonu Khadka
- Community Health Program Associate, Nyaya Health Nepal, Kathmandu, Nepal
| | - Rekha Khatri
- Qualitative Research Manager, Possible, Kathmandu, Nepal
| | - Yashoda Kshetri
- Community Health Program Associate, Nyaya Health Nepal, Kathmandu, Nepal
| | | | - Sabitri Sapkota
- Director of Research, Possible, Kathmandu, Nepal; Icahn School of Medicine at Mount Sinai, Arnhold Institute for Global Health, New York, NY, USA
| | - Sita Saud
- Community Health Program Associate, Nyaya Health Nepal, Kathmandu, Nepal
| | | | - Rachel Vreeman
- Chair, Department of Health Systems Design and Global Health, Icahn School of Medicine at Mount Sinai New York, USA; Department of Pediatrics, Icahn School of Medicine at Mount Sinai; Arnhold Institute for Global Health, New York, NY, USA
| | - Sheela Maru
- Assistant Professor, Icahn School of Medicine at Mount Sinai, Arnhold Institute for Global Health, New York, NY, USA; Icahn School of Medicine at Mount Sinai, Department of Health Systems Design and Global Health, New York, USA; Icahn School of Medicine at Mount Sinai, Department of Obstetrics, Gynecology and Reproductive Science, New York, NY, USA; Possible, New York, USA
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21
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Chory A, Nyandiko W, Ashimosi C, Aluoch J, Martin R, Biegon W, Munyoro D, Apondi E, Vreeman R. Social Stigma Related to COVID-19 Disease Described by Primary and Secondary School Teachers and Adolescents Living With HIV in Western Kenya. Front Public Health 2021; 9:757267. [PMID: 34869172 PMCID: PMC8635633 DOI: 10.3389/fpubh.2021.757267] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 10/13/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction: Understanding community members' knowledge, attitudes, and beliefs about the novel SARS-CoV-2 virus and the prevalence of associated stigma are critical steps for increasing accurate public health knowledge, encouraging uptake of preventative or mitigating health behaviors, and ultimately bringing the COVID-19 pandemic under control. Methods: We conducted a one-time, phone-based assessment to assess the presence of perceived COVID-19 community stigma reported by Kenyan primary and secondary school teachers, as well as adolescents living with HIV. Participants were previously enrolled in an ongoing, cluster-randomized trial to evaluate the impact of multi-media teacher training on teachers' negative attitudes and beliefs around HIV. The SAFI Stigma Questionnaire, a validated tool to assess HIV-related stigma in this setting, was adapted to ask questions regarding the stigma and discrimination experienced or perceived during the COVID-19 pandemic. Results: We enrolled 330 participants in this study, including 311 primary and secondary teachers (56% female, average age 36 years) and 19 adolescents living with HIV (57.89% female, average age 16.37 years). None of the adolescent participants reported witnessing or experiencing discrimination related to COVID-19, nor did they report losing financial and/or social support. In contrast, the teacher participants reported prominent social stigma experiences of various levels and related to COVID-19. Teachers in the intervention group, who had completed the multi-media training on HIV-related stigma, were significantly less likely to think that the community viewed COVID-19 as a dirty or shameful disease, and less likely to feel it was important to keep their COVID-19 infection a secret, compared to the teacher control group. Conclusion: These findings suggest that COVID-19-related stigma may be prevalent in western Kenya and that interventions to reduce community-level stigma for HIV may also have a protective impact on other stigmatized infectious diseases such as COVID-19.
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Affiliation(s)
- Ashley Chory
- Department of Global Health and Health System Design, Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Winstone Nyandiko
- Department of Child Health and Paediatrics, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya.,Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | | | - Josephine Aluoch
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Roxanne Martin
- Department of Global Health and Health System Design, Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Whitney Biegon
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Dennis Munyoro
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Edith Apondi
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Rachel Vreeman
- Department of Global Health and Health System Design, Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States.,Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
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22
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Kassanjee R, Johnson LF, Zaniewski E, Ballif M, Christ B, Yiannoutsos CT, Nyakato P, Desmonde S, Edmonds A, Sudjaritruk T, Pinto J, Vreeman R, Dahourou DL, Twizere C, Kariminia A, Carlucci JG, Kasozi C, Davies M. Global HIV mortality trends among children on antiretroviral treatment corrected for under-reported deaths: an updated analysis of the International epidemiology Databases to Evaluate AIDS collaboration. J Int AIDS Soc 2021; 24 Suppl 5:e25780. [PMID: 34546646 PMCID: PMC8454681 DOI: 10.1002/jia2.25780] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 07/14/2021] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION The Joint United Nations Programme on HIV/AIDS (UNAIDS) projections of paediatric HIV prevalence and deaths rely on the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium for mortality estimates among children living with HIV (CHIV) receiving antiretroviral therapy (ART). Previous estimates, based on data through 2014, may no longer be accurate due to expanded paediatric HIV care and treatment eligibility, and the possibility of unreported deaths in CHIV considered lost to follow-up (LTFU). We therefore estimated all-cause mortality and its trends in CHIV (<15 years old) on ART using extended and new IeDEA data. METHODS We analysed (i) IeDEA observational data from CHIV in routine care globally, and (ii) novel data from an IeDEA tracing study that determined outcomes in a sample of CHIV after being LTFU in southern Africa. We included 45,711 CHIV on ART during 2004 to 2017 at 72 programmes in Africa, Asia-Pacific and Latin America. We used mixed effects Poisson regression to estimate mortality by age, sex, CD4 at ART start, time on ART, region and calendar year. For Africa, in an adjusted analysis that accounts for unreported deaths among those LTFU, we first modified the routine data by simulating mortality outcomes within six months after LTFU, based on a Gompertz survival model fitted to the tracing data (n = 221). RESULTS Observed mortality rates were 1.8 (95% CI: 1.7 to 1.9) and 9.4 (6.3 to 13.4) deaths per 100 person-years in the routine and tracing data, respectively. We found strong evidence of higher mortality at shorter ART durations, lower CD4 values, and in infancy. Averaging over covariate patterns, the adjusted mortality rate was 54% higher than the unadjusted rate. In unadjusted analyses, mortality reduced by an average 60% and 73% from 2005 to 2017, within and outside of Africa, respectively. In the adjusted analysis for Africa, this temporal reduction was 42%. CONCLUSIONS Mortality rates among CHIV have decreased substantially over time. However, when accounting for worse outcomes among those LTFU, mortality estimates increased and temporal improvements were slightly reduced, suggesting caution in interpreting analyses based only on programme data. The improved and updated IeDEA estimates on mortality among CHIV on ART support UNAIDS efforts to accurately model global HIV statistics.
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Affiliation(s)
- Reshma Kassanjee
- Centre for Infectious Disease Epidemiology and Research (CIDER)School of Public Health and Family MedicineUniversity of Cape TownCape TownSouth Africa
| | - Leigh F. Johnson
- Centre for Infectious Disease Epidemiology and Research (CIDER)School of Public Health and Family MedicineUniversity of Cape TownCape TownSouth Africa
| | - Elizabeth Zaniewski
- Institute of Social and Preventive Medicine (ISPM)University of BernBernSwitzerland
| | - Marie Ballif
- Institute of Social and Preventive Medicine (ISPM)University of BernBernSwitzerland
| | - Benedikt Christ
- Institute of Social and Preventive Medicine (ISPM)University of BernBernSwitzerland
| | | | - Patience Nyakato
- Centre for Infectious Disease Epidemiology and Research (CIDER)School of Public Health and Family MedicineUniversity of Cape TownCape TownSouth Africa
| | - Sophie Desmonde
- Centre d'Epidémiologie et de Recherche en santé des Populations (CERPOP)Inserm U1027/University Toulouse 3ToulouseFrance
| | - Andrew Edmonds
- Department of EpidemiologyGillings School of Global Public HealthThe University of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Tavitiya Sudjaritruk
- Department of PediatricsFaculty of MedicineChiang Mai UniversityChiang MaiThailand
- Clinical and Molecular Epidemiology of Emerging and Re‐emerging Infectious Diseases Research ClusterFaculty of MedicineChiang Mai UniversityChiang MaiThailand
| | - Jorge Pinto
- School of MedicineFederal University of Minas GeraisBelo HorizonteBrazil
| | - Rachel Vreeman
- Department of Global Health and Health System DesignIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
- Arnhold Institute for Global HealthIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
- Academic Model Providing Access to Healthcare (AMPATH)EldoretKenya
| | - Désiré Lucien Dahourou
- Centre d'Epidémiologie et de Recherche en santé des Populations (CERPOP)Inserm U1027/University Toulouse 3ToulouseFrance
- Département Biomédical/Santé PubliqueInstitut de Recherche en Sciences de la SantéOuagadougouBurkina Faso
| | - Christelle Twizere
- CA‐IeDEA BurundiCentre National de Référence en matière de VIH/SIDA (CNR)BujumburaBurundi
| | | | - James G. Carlucci
- Ryan White Center for Pediatric Infectious Diseases and Global HealthIndiana University School of MedicineIndianapolisIndianaUSA
| | | | - Mary‐Ann Davies
- Centre for Infectious Disease Epidemiology and Research (CIDER)School of Public Health and Family MedicineUniversity of Cape TownCape TownSouth Africa
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23
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Chory A, Nyandiko W, Beigon W, Aluoch J, Ashimosi C, Munyoro D, Scanlon M, Apondi E, Vreeman R. Perspectives of education sector stakeholders on a teacher training module to reduce HIV/AIDS stigma in Western Kenya. BMC Public Health 2021; 21:1281. [PMID: 34193095 PMCID: PMC8247165 DOI: 10.1186/s12889-021-11331-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 06/18/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND For adolescents living with HIV (ALWH), school may be the most important but understudied social sphere related to HIV stigma. Teachers are role models in the classroom and within the community, and their attitudes and behavior towards people living with HIV may have critical psychosocial and treatment ramifications. Altering teachers' knowledge, attitudes and beliefs (K/A/B) about HIV could reduce the stigmatizing content within their teaching, classrooms and school, improving the environment for ALWH. METHODS We developed a one-day teacher training module to enrich teacher K/A/B that included lecture presentations, HIV films and educational animation, structured instructions for teacher role play scenarios, and a question-and-answer session facilitated by a trained ALWH peer educator. We also conducted key informant interviews with education sector subject matter experts (SMEs), including education officers, county commissioners and head teachers to review and provide feedback on the teacher training module. RESULTS We assembled an adolescent community advisory board and recruited 50 SMEs to review the training module and provide feedback. All SME participants stressed the importance and need for interventions to reduce stigma in the classroom, highlighting their own experiences observing stigmatizing behaviors in the community. The participants perceived the training as culturally relevant and easy to understand and had minor suggestions for improvement, including using image-based resources and brighter colors for ease of reading. All participants thought that the training should be expanded outside of the schools, as all people in a community have a role in the reduction of HIV stigma, and offered suggestions for other settings for implementation. CONCLUSION Data from interviews with education sector stakeholders demonstrate that our process for developing a culturally appropriate multi-media intervention to reduce HIV stigma in the schools was feasible.
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Affiliation(s)
- Ashley Chory
- Department of Global Health and Health Systems Design, Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, 1216 Fifth Avenue, Fifth Floor, Room 556, New York, NY USA
| | - Winstone Nyandiko
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Department of Child Health and Paediatrics, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Whitney Beigon
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Josephine Aluoch
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | | | - Dennis Munyoro
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Michael Scanlon
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Indiana University School of Medicine, Indianapolis Indiana, USA
| | - Edith Apondi
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Rachel Vreeman
- Department of Global Health and Health Systems Design, Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, 1216 Fifth Avenue, Fifth Floor, Room 556, New York, NY USA
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
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24
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Iyun V, Technau KG, Vinikoor M, Yotebieng M, Vreeman R, Abuogi L, Desmonde S, Edmonds A, Amorissani-Folquet M, Davies MA. Variations in the characteristics and outcomes of children living with HIV following universal ART in sub-Saharan Africa (2006-17): a retrospective cohort study. Lancet HIV 2021; 8:e353-e362. [PMID: 33932330 DOI: 10.1016/s2352-3018(21)00004-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 12/22/2020] [Accepted: 01/11/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND The proportion of children living with HIV and receiving antiretroviral therapy (ART) in sub-Saharan Africa has increased greatly since 2006, yet the changes in their demographic characteristics and treatment outcomes have not been well described. We examine the trends in characteristics and outcomes of children living with HIV who were younger than 5 years at ART initiation, and compare outcomes over time and across country income groups. METHODS We conducted a retrospective cohort analysis of data from children living with HIV who were younger than 5 years at ART initiation from 45 paediatric sites in 16 low-income, lower-middle-income, and upper-middle-income countries in sub-Saharan Africa (Benin, Burundi, Côte d'Ivoire, Democratic Republic of the Congo, Ghana, Kenya, Lesotho, Malawi, Mali, Mozambique, Rwanda, South Africa, Togo, Uganda, Zambia, and Zimbabwe). Outcomes were trends in patient characteristics at ART initiation (age, weight, height, and CD4%), and comparisons of mortality and loss to follow-up during ART over time and in various economic settings. We identified risk factors for mortality using Cox proportional hazards models. Each participating region had relevant institutional ethics review board approvals to contribute data to the analysis. FINDINGS We included 32 221 children living with HIV and initiating ART younger than 5 years between Jan 1, 2006, and Dec 31, 2017. Median age at ART initiation was 20·4 months (IQR 9·4-36·0) in 2006-10, 19·2 months (8·3-33·6) in 2011-13, and 19·2 months (8·8-33·7) in 2014-17. Median age at ART initiation was 13·2 months (IQR 4·7-26·8) in upper-middle-income countries, 22·6 months (13·2-37·5) in lower-middle-income countries and 24·2 months (13·5-39·1) in low-income countries. The proportion of children initiating ART younger than 3 months increased from 770 (5·1%) of 14 943 children in 2006-10 to 728 (10·0%) of 7290 children in 2014-17. The proportion of children initiating ART with severe immunosuppression decreased from 5469 (74·7%) of 7314 children for whom CD4% data were available in 2006-10 to 2353 (55·2%) of 4269 children in 2014-17. Mortality at 24 months on ART decreased from 970 (6·5%) of 14 943 children in 2006-10 to 214 (2·9%) of 7290 children in 2014-17. Loss to follow-up was 20·5% (95% CI 20·1-21·0) overall, and was similar across time periods. In multivariable analysis, lower mortality was observed for more recent ART initiation cohorts (adjusted hazard ratio 0·70, 95% CI 0·63-0·79 for 2011-13; 0·53, 0·45-0·72 for 2014-17 vs 2006-10) and for those residing in an upper-middle-income country (0·42, 0·35-0·49 vs low-income countries). INTERPRETATION Mortality declined significantly after universal ART recommendations for children younger than 2 years in 2010 and children younger than 5 years in 2013. However, substantial variations persisted across country income groups, and one in five children continue to be lost to follow-up. Targeted interventions are required to improve outcomes of children living with HIV, especially in the poorest countries. FUNDING National Institute of Allergy and Infectious Disease.
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Affiliation(s)
- Victoria Iyun
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
| | - Karl-Gunter Technau
- Empilweni Service and Research Centre, Rahima Moosa Mother and Child Hospital, University of Witwatersrand, Johannesburg, South Africa
| | - Michael Vinikoor
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Marcel Yotebieng
- Department of Medicine, Division of General Internal Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Rachel Vreeman
- Department of Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lisa Abuogi
- Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA
| | - Sophie Desmonde
- Inserm U1027, Université Paul Sabatier Toulouse 3, Toulouse, France
| | - Andrew Edmonds
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Mary-Ann Davies
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa; Health Impact Assessment, Western Cape Department of Health, Cape Town, South Africa
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Tymejczyk O, Brazier E, Wools-Kaloustian K, Davies MA, Dilorenzo M, Edmonds A, Vreeman R, Bolton C, Twizere C, Okoko N, Phiri S, Nakigozi G, Lelo P, von Groote P, Sohn AH, Nash D. Impact of Universal Antiretroviral Treatment Eligibility on Rapid Treatment Initiation Among Young Adolescents with Human Immunodeficiency Virus in Sub-Saharan Africa. J Infect Dis 2021; 222:755-764. [PMID: 31682261 DOI: 10.1093/infdis/jiz547] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 10/19/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Young adolescents with perinatally acquired human immunodeficiency virus (HIV) are at risk for poor care outcomes. We examined whether universal antiretroviral treatment (ART) eligibility policies (Treat All) improved rapid ART initiation after care enrollment among 10-14-year-olds in 7 sub-Saharan African countries. METHODS Regression discontinuity analysis and data for 6912 patients aged 10-14-years were used to estimate changes in rapid ART initiation (within 30 days of care enrollment) after adoption of Treat All policies in 2 groups of countries: Uganda and Zambia (policy adopted in 2013) and Burundi, Democratic Republic of the Congo, Kenya, Malawi, and Rwanda (policy adopted in 2016). RESULTS There were immediate increases in rapid ART initiation among young adolescents after national adoption of Treat All. Increases were greater in countries adopting the policy in 2016 than in those adopting it in 2013: 23.4 percentage points (pp) (95% confidence interval, 13.9-32.8) versus 11.2pp (2.5-19.9). However, the rate of increase in rapid ART initiation among 10-14-year-olds rose appreciably in countries with earlier treatment expansions, from 1.5pp per year before Treat All to 7.7pp per year afterward. CONCLUSIONS Universal ART eligibility has increased rapid treatment initiation among young adolescents enrolling in HIV care. Further research should assess their retention in care and viral suppression under Treat All.
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Affiliation(s)
- Olga Tymejczyk
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA
| | - Ellen Brazier
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA
| | | | - Mary-Ann Davies
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Madeline Dilorenzo
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA.,Boston Medical Center, Boston, Massachusetts, USA
| | - Andrew Edmonds
- Department of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Rachel Vreeman
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Carolyn Bolton
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | | | | | | | | | - Patricia Lelo
- Kalembelembe Pediatric Hospital, Kinshasa, Democratic Republic of the Congo
| | - Per von Groote
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Annette H Sohn
- TREAT Asia, amfAR-The Foundation for AIDS Research, Bangkok, Thailand
| | - Denis Nash
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA.,Department of Epidemiology and Biostatistics, School of Public Health, City University of New York, New York, NY, USA
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Chory A, Nyandiko W, Martin R, Aluoch J, Scanlon M, Ashimosi C, Njoroge T, McAteer C, Apondi E, Vreeman R. HIV-Related Knowledge, Attitudes, Behaviors and Experiences of Kenyan Adolescents Living with HIV Revealed in WhatsApp Group Chats. J Int Assoc Provid AIDS Care 2021; 20:2325958221999579. [PMID: 33657911 PMCID: PMC7940722 DOI: 10.1177/2325958221999579] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 02/02/2021] [Accepted: 02/08/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Mobile technologies represent a scalable platform for delivering knowledge and interventions targeting adolescents living with HIV (ALWH) in low and middle income countries. Data from mobile interventions can be used to assess the contextual understanding and experiences of ALWH. METHODS We examined HIV-related knowledge, attitudes, beliefs, behaviors, and experiences of Kenyan ALWH revealed in the contextual data from enrollment in a WhatsApp® group chat intervention. RESULTS Thirty ALWH (17 female, mean age 15.4) on ART, engaged in HIV care and aware of their status, were enrolled. Qualitative analysis of WhatsApp® chat discussions identified a gap in HIV knowledge, high medication-taking literacy, need for mental health support and significant barriers to adherence. Participants discussed challenges with HIV stigma and medication-taking in the school setting. CONCLUSION These discussions demonstrate a need for education on HIV topics, mental health support for ALWH, and interventions for stigma mitigation in the school setting.
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Affiliation(s)
- Ashley Chory
- Department of Global Health and Health System Design, Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Winstone Nyandiko
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Moi Teaching and Referral Hospital, Eldoret, Kenya
- Department of Child Health and Paediatrics, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Roxanne Martin
- Department of Global Health and Health System Design, Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Josephine Aluoch
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Michael Scanlon
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Indiana University School of Medicine, Indiana, USA
| | | | - Tabitha Njoroge
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | | | - Edith Apondi
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Moi Teaching and Referral Hospital, Eldoret, Kenya
- Department of Child Health and Paediatrics, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Rachel Vreeman
- Department of Global Health and Health System Design, Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Indiana University School of Medicine, Indiana, USA
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Maru S, Patil U, Carroll-Bennett R, Baum A, Bohn-Hemmerdinger T, Ditchik A, Scanlon ML, Krishnan P, Bogaert K, Woodbury C, Maru D, Noble L, Wasserman R, Brown B, Vreeman R, Masci J. Universal screening for SARS-CoV-2 infection among pregnant women at Elmhurst Hospital Center, Queens, New York. PLoS One 2020; 15:e0238409. [PMID: 33301498 PMCID: PMC7728244 DOI: 10.1371/journal.pone.0238409] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 08/17/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Universal screening for SARS-CoV-2 infection on Labor and Delivery (L&D) units is a critical strategy to manage patient and health worker safety, especially in a vulnerable high-prevalence community. We describe the results of a SARS-CoV-2 universal screening program at the L&D Unit at Elmhurst Hospital in Queens, NY, a 545-bed public hospital serving a diverse, largely immigrant and low-income patient population and an epicenter of the global pandemic. METHODS AND FINDINGS We conducted a retrospective cross-sectional study. All pregnant women admitted to the L&D Unit of Elmhurst Hospital from March 29, 2020 to April 22, 2020 were included for analysis. The primary outcomes of the study were: (1) SARS-CoV-2 positivity among universally screened pregnant women, stratified by demographic characteristics, maternal comorbidities, and delivery outcomes; and (2) Symptomatic or asymptomatic presentation at the time of testing among SARS-CoV-2 positive women. A total of 126 obstetric patients were screened for SARS-CoV-2 between March 29 and April 22. Of these, 37% were positive. Of the women who tested positive, 72% were asymptomatic at the time of testing. Patients who tested positive for SARS-CoV-2 were more likely to be of Hispanic ethnicity (unadjusted difference 24.4 percentage points, CI 7.9, 41.0) and report their primary language as Spanish (unadjusted difference 32.9 percentage points, CI 15.8, 49.9) than patients who tested negative. CONCLUSIONS In this retrospective cross-sectional study of data from a universal SARS-Cov-2 screening program implemented in the L&D unit of a safety-net hospital in Queens, New York, we found over one-third of pregnant women testing positive, the majority of those asymptomatic. The rationale for universal screening at the L&D Unit at Elmhurst Hospital was to ensure safety of patients and staff during an acute surge in SARS-Cov-2 infections through appropriate identification and isolation of pregnant women with positive test results. Women were roomed by their SARS-CoV-2 status given increasing space limitations. In addition, postpartum counseling was tailored to infection status. We quickly established discharge counseling and follow-up protocols tailored to their specific social needs. The experience at Elmhurst Hospital is instructive for other L&D units serving vulnerable populations and for pandemic preparedness.
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Affiliation(s)
- Sheela Maru
- Department of Health System Design and Global Health and the Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York City, NY, United States of America
- Department of Obstetrics, Gynecology and Reproductive Science at the Icahn School of Medicine at Mount Sinai, New York City, NY, United States of America
- New York City Health + Hospitals/Elmhurst, New York City, NY, United States of America
| | - Uday Patil
- New York City Health + Hospitals/Elmhurst, New York City, NY, United States of America
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York City, NY, United States of America
| | - Rachel Carroll-Bennett
- Department of Obstetrics, Gynecology and Reproductive Science at the Icahn School of Medicine at Mount Sinai, New York City, NY, United States of America
- New York City Health + Hospitals/Elmhurst, New York City, NY, United States of America
| | - Aaron Baum
- Department of Health System Design and Global Health and the Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York City, NY, United States of America
| | - Tracy Bohn-Hemmerdinger
- Department of Obstetrics, Gynecology and Reproductive Science at the Icahn School of Medicine at Mount Sinai, New York City, NY, United States of America
- New York City Health + Hospitals/Elmhurst, New York City, NY, United States of America
| | - Andrew Ditchik
- Department of Obstetrics, Gynecology and Reproductive Science at the Icahn School of Medicine at Mount Sinai, New York City, NY, United States of America
- New York City Health + Hospitals/Elmhurst, New York City, NY, United States of America
| | - Michael L. Scanlon
- Department of Health System Design and Global Health and the Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York City, NY, United States of America
| | - Parvathy Krishnan
- New York City Health + Hospitals/Elmhurst, New York City, NY, United States of America
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York City, NY, United States of America
| | - Kelly Bogaert
- Department of Obstetrics, Gynecology and Reproductive Science at the Icahn School of Medicine at Mount Sinai, New York City, NY, United States of America
- New York City Health + Hospitals/Elmhurst, New York City, NY, United States of America
| | - Carson Woodbury
- Department of Obstetrics, Gynecology and Reproductive Science at the Icahn School of Medicine at Mount Sinai, New York City, NY, United States of America
- New York City Health + Hospitals/Elmhurst, New York City, NY, United States of America
| | - Duncan Maru
- Department of Health System Design and Global Health and the Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York City, NY, United States of America
- New York City Health + Hospitals/Elmhurst, New York City, NY, United States of America
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York City, NY, United States of America
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY, United States of America
| | - Lawrence Noble
- New York City Health + Hospitals/Elmhurst, New York City, NY, United States of America
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York City, NY, United States of America
| | - Randi Wasserman
- New York City Health + Hospitals/Elmhurst, New York City, NY, United States of America
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York City, NY, United States of America
| | - Barry Brown
- Department of Obstetrics, Gynecology and Reproductive Science at the Icahn School of Medicine at Mount Sinai, New York City, NY, United States of America
- New York City Health + Hospitals/Elmhurst, New York City, NY, United States of America
| | - Rachel Vreeman
- Department of Health System Design and Global Health and the Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York City, NY, United States of America
| | - Joseph Masci
- New York City Health + Hospitals/Elmhurst, New York City, NY, United States of America
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY, United States of America
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Jesson J, Schomaker M, Malasteste K, Wati DK, Kariminia A, Sylla M, Kouadio K, Sawry S, Mubiana‐Mbewe M, Ayaya S, Vreeman R, McGowan CC, Yotebieng M, Leroy V, Davies M. Stunting and growth velocity of adolescents with perinatally acquired HIV: differential evolution for males and females. A multiregional analysis from the IeDEA global paediatric collaboration. J Int AIDS Soc 2019; 22:e25412. [PMID: 31702088 PMCID: PMC6839428 DOI: 10.1002/jia2.25412] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 09/30/2019] [Accepted: 10/16/2019] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Stunting is a key issue for adolescents with perinatally acquired HIV (APH) that needs to be better understood. As part of the IeDEA multiregional consortium, we described growth evolution during adolescence for APH on antiretroviral therapy (ART). METHODS We included data from sub-Saharan Africa, the Asia-Pacific, and the Caribbean, Central and South America regions collected between 2003 and 2016. Adolescents on ART, reporting perinatally acquired infection or entering HIV care before 10 years of age, with at least one height measurement between 10 and 16 years of age, and followed in care until at least 14 years of age were included. Characteristics at ART initiation and at 10 years of age were compared by sex. Correlates of growth defined by height-for-age z-scores (HAZ) between ages 10 and 19 years were studied separately for males and females, using linear mixed models. RESULTS Overall, 8737 APH were included, with 46% from Southern Africa. Median age at ART initiation was 8.1 years (interquartile range (IQR) 6.1 to 9.6), 50% were females, and 41% were stunted (HAZ<-2 SD) at ART initiation. Males and females did not differ by age and stunting at ART initiation, CD4 count over time or retention in care. At 10 years of age, 34% of males were stunted versus 39% of females (p < 0.001). Females had better subsequent growth, resulting in a higher prevalence of stunting for males compared to females by age 15 (48% vs. 25%) and 18 years (31% vs. 15%). In linear mixed models, older age at ART initiation and low CD4 count were associated with poor growth over time (p < 0.001). Those stunted at 10 years of age or at ART initiation had the greatest growth improvement during adolescence. CONCLUSIONS Prevalence of stunting is high among APH worldwide. Substantial sex-based differences in growth evolution during adolescence were observed in this global cohort, which were not explained by differences in age of access to HIV care, degree of immunosuppression or region. Other factors influencing growth differences in APH, such as differences in pubertal development, should be better documented, to guide further research and inform interventions to optimize growth and health outcomes among APH.
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Affiliation(s)
- Julie Jesson
- Inserm U1027Université Paul Sabatier Toulouse 3ToulouseFrance
| | - Michael Schomaker
- University of Cape TownCentre for Infectious Disease Epidemiology and ResearchCape TownSouth Africa
- Medical Informatics and TechnologyInstitute of Public HealthUMIT ‐ University for Health SciencesMedical Decision Making and Health Technology AssessmentHall in TirolAustria
| | - Karen Malasteste
- Inserm U1219Bordeaux Population Health CenterUniversité de BordeauxBordeauxFrance
| | | | | | | | | | - Shobna Sawry
- Harriet Shezi Children’s ClinicChris Hani Baragwanath Academic HospitalSowetoSouth Africa
- Faculty of Health ScencesWits Reproductive Health and HIV InstituteUniversity of the WitwatersrandJohannesburgSouth Africa
| | | | - Samuel Ayaya
- Department of Child Health and PaediatricsSchool of MedicineCollege of Health SciencesMoi UniversityEldoretKenya
| | - Rachel Vreeman
- Ryan White Center for Pediatric Infectious Disease and Global HealthDepartment of PediatricsIndiana University School of MedicineIndianapolisINUSA
| | | | - Marcel Yotebieng
- Division of EpidemiologyCollege of Public HealthThe Ohio State UniversityColumbusOHUSA
| | - Valériane Leroy
- Inserm U1027Université Paul Sabatier Toulouse 3ToulouseFrance
| | - Mary‐Ann Davies
- University of Cape TownCentre for Infectious Disease Epidemiology and ResearchCape TownSouth Africa
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Nyandiko W, Holland S, Vreeman R, DeLong A, Manne A, Novitsky V, Coetzer M, Ngeresa A, McAteer C, Aluoch J, Orido M, Sam S, Caliendo A, Ayaya S, Hogan J, Kantor R. 885. HIV-1 Treatment Failure and Extensive Drug Resistance in Perinatally Infected Children Failing First-Line Antiretroviral Therapy in Western Kenya. Open Forum Infect Dis 2019. [PMCID: PMC6809452 DOI: 10.1093/ofid/ofz359.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Understanding drug resistance in perinatally HIV-infected children (PHIC) when viral load (VL) monitoring is limited is critical for life-long antiretroviral use. Resistance data in PHIC in sub-Saharan Africa are limited. Though guidelines recommend PI-based first-line regimens in PHIC, many worldwide remain on NNRTI-based regimens. We examined treatment failure, resistance, and outcomes in Kenyan PHIC on first-line NNRTI-based therapy. Methods PHIC were enrolled in 2010–2013 at the Academic Model Providing Access to Healthcare in Eldoret, Kenya, a large program caring for >160,000 HIV patients; >15,000 PHIC. VL testing, not routinely available then, was done for all, and resistance testing was done in viremic PHIC. Clinical data were derived from medical records. Subtype and resistance interpretation were with Stanford Database tools. Associations between failure (>1,000 copies/mL) or resistance, and demographic, clinical or lab variables were evaluated with Fisher exact and Wilcoxon rank-sum tests. Results Of 482 PHIC enrolled, 52% were female, median age 8.4 years (range 1–15), median CD4% 28 (range 0–53), 79% on zidovudine (AZT)/abacavir (ABC)+lamivudine(3TC)+efavirenz (EFV)/nevirapine (NVP) for median 2.3 years. Treatment failure was seen in 31%, associated with low CD4% and count. Genotypes were available in 124, 47% female, median age 8.3 years (range 2–15), median CD4% 22 (range 0–45), 81% on AZT/ABC+3TC+EFV/NVP for median 2.5 years, median VL 7,515 copies/mL. Subtypes were A 76%, C 3%, D 15%, recombinants 6%. Reverse transcriptase mutations were in 93%; 93%-NNRTIs, median 2/patient, most common Y181C (44%); 89%-NRTIs, median 3/patient, most common M184V (85%); 89%-dual class, median 5/patient. Intermediate-high resistance to potential second-line drugs included 62% etravirine, 66% rilpivirine, and 19% tenofovir. Of 92/124 (74%) PHIC with follow-up data, 27% remained on NNRTI-based first-line (median CD4 count 461), of whom 24% had suppressed VL and 48% died; and 73% switched to PI-based second-line (median CD4 count 591), of whom 72% had suppressed VL and 6% died (P < 0.05 for both). Conclusion PHIC in western Kenya on NNRTI-based first-line regimens had high treatment failure rates and extensive drug resistance with poor clinical outcomes, demanding urgent interventions. Disclosures All Authors: No reported Disclosures.
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Affiliation(s)
- Winstone Nyandiko
- Academic Model Providence Access to Healthcare (AMPATH), Eldoret, Western, Kenya
| | | | | | | | | | | | | | - Anthony Ngeresa
- Academic Model Providence Access to Healthcare (AMPATH), Eldoret, Western, Kenya
| | | | - Josephine Aluoch
- Academic Model Providence Access to Healthcare (AMPATH), Eldoret, Western, Kenya
| | - Millicent Orido
- Academic Model Providence Access to Healthcare (AMPATH), Eldoret, Western, Kenya
| | - Soya Sam
- Lifespan, Providence, Rhode Island
| | | | - Samuel Ayaya
- Academic Model Providence Access to Healthcare (AMPATH), Eldoret, Western, Kenya
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Kariminia A, Law M, Davies M, Vinikoor M, Wools‐Kaloustian K, Leroy V, Edmonds A, McGowan C, Vreeman R, Fairlie L, Ayaya S, Yotebieng M, Takassi E, Pinto J, Adedimeji A, Malateste K, Machado DM, Penazzato M, Hazra R, Sohn AH. Mortality and losses to follow-up among adolescents living with HIV in the IeDEA global cohort collaboration. J Int AIDS Soc 2018; 21:e25215. [PMID: 30548817 PMCID: PMC6291755 DOI: 10.1002/jia2.25215] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 11/15/2018] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION We assessed mortality and losses to follow-up (LTFU) during adolescence in routine care settings in the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium. METHODS Cohorts in the Asia-Pacific, the Caribbean, Central, and South America, and sub-Saharan Africa (Central, East, Southern, West) contributed data, and included adolescents living with HIV (ALHIV) enrolled from January 2003 and aged 10 to 19 years (period of adolescence) while under care up to database closure (June 2016). Follow-up started at age 10 years or the first clinic visit, whichever was later. Entering care at <15 years was a proxy for perinatal infection, while entering care ≥15 years represented infection acquired during adolescence. Competing risk regression was used to assess associations with death and LTFU among those ever receiving triple-drug antiretroviral therapy (triple-ART). RESULTS Of the 61,242 ALHIV from 270 clinics in 34 countries included in the analysis, 69% (n = 42,138) entered care <15 years of age (53% female), and 31% (n = 19,104) entered care ≥15 years (81% female). During adolescence, 3.9% died, 30% were LTFU and 8.1% were transferred. For those with infection acquired perinatally versus during adolescence, the four-year cumulative incidences of mortality were 3.9% versus 5.4% and of LTFU were 26% versus 69% respectively (both p < 0.001). Overall, there were higher hazards of death for females (adjusted sub-hazard ratio (asHR) 1.19, 95% confidence interval (CI) 1.07 to 1.33), and those starting treatment at ≥5 years of age (highest asHR for age ≥15: 8.72, 95% CI 5.85 to 13.02), and in care in mostly urban (asHR 1.40, 95% CI 1.13 to 1.75) and mostly rural settings (asHR 1.39, 95% CI 1.03 to 1.87) compared to urban settings. Overall, higher hazards of LTFU were observed among females (asHR 1.12, 95% CI 1.07 to 1.17), and those starting treatment at age ≥5 years (highest asHR for age ≥15: 11.11, 95% CI 9.86 to 12.53), in care at district hospitals (asHR 1.27, 95% CI 1.18 to 1.37) or in rural settings (asHR 1.21, 95% CI 1.13 to 1.29), and starting triple-ART after 2006 (highest asHR for 2011 to 2016 1.84, 95% CI 1.71 to 1.99). CONCLUSIONS Both mortality and LTFU were worse among those entering care at ≥15 years. ALHIV should be evaluated apart from younger children and adults to identify population-specific reasons for death and LTFU.
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Affiliation(s)
| | - Matthew Law
- The Kirby InstituteUNSW SydneySydneyAustralia
| | - Mary‐Ann Davies
- Centre for Infectious Disease Epidemiology and ResearchUniversity of Cape TownCape TownSouth Africa
| | | | | | | | - Andrew Edmonds
- The University of North Carolina at Chapel HillChapel HillNCUSA
| | | | | | - Lee Fairlie
- Wits Reproductive Health and HIV InstituteJohannesburgSouth Africa
| | - Samuel Ayaya
- Moi University College of Health SciencesEldoretKenya
| | | | | | - Jorge Pinto
- Federal University of Minas GeraisBelo HorizoneBrazil
| | | | | | | | | | - Rohan Hazra
- Eunice Kennedy Shriver National Institute of Child Health and Human DevelopmentBethesdaMDUSA
| | - Annette H Sohn
- TREAT Asia/amfARThe Foundation for AIDS ResearchBangkokThailand
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Boettiger DC, Law MG, Sohn AH, Davies MA, Wools-Kaloustian K, Leroy V, Yotebieng M, Vinikoor M, Vreeman R, Amorissani-Folquet M, Edmonds A, Fatti G, Batte J, Renner L, Adedimeji A, Kariminia A. Temporal Trends in Co-trimoxazole Use Among Children on Antiretroviral Therapy and the Impact of Co-trimoxazole on Mortality Rates in Children Without Severe Immunodeficiency. J Pediatric Infect Dis Soc 2018; 8:450-460. [PMID: 30215763 PMCID: PMC6831936 DOI: 10.1093/jpids/piy087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 08/10/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Co-trimoxazole is recommended for all children with human immunodeficiency virus. In this analysis, we evaluate trends in pediatric co-trimoxazole use and survival on co-trimoxazole in children using antiretroviral therapy (ART). METHODS We used data collected between January 1, 2006, and March 31, 2016, from the International Epidemiology Databases to Evaluate AIDS. Logistic regression was used to evaluate factors associated with using co-trimoxazole at ART initiation. Competing risk regression was used to assess factors associated with death. RESULTS A total of 54113 children were included in this study. The prevalence of co-trimoxazole use at ART initiation increased from 66.5% in 2006 to a peak of 85.6% in 2010 and then declined to 48.5% in 2015-2016. A similar trend was observed among children who started ART with severe immunodeficiency. After adjusting for year of ART initiation, younger age (odds ratio [OR], 1.18 for <1 vs 1 to <5 years of age [95% confidence interval (CI), 1.09-1.28]), lower height-for-age z score (OR, 1.15 for less than -3 vs greater than -2 [95% CI, 1.08-1.22]), anemia (OR, 1.08 [95% CI, 1.02-1.15]), severe immunodeficiency (OR, 1.25 [95% CI, 1.18-1.32]), and receiving care in East Africa (OR, 8.97 vs Southern Africa [95% CI, 8.17-9.85]) were associated with a high prevalence of co-trimoxazole use. Survival did not differ according to co-trimoxazole use in children without severe immunodeficiency (hazard ratio, 1.01 for nonusers versus users [95% CI, 0.77-1.34]). CONCLUSIONS Recent declines in co-trimoxazole use may not be linked to the current shift toward early ART initiation. Randomized trial data might be needed to establish the survival benefit of co-trimoxazole in children without severe immunodeficiency.
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Affiliation(s)
- David C Boettiger
- The Kirby Institute, University of New South Wales, Sydney, Australia,Correspondence: D. C. Boettiger, Wallace Wurth Building, UNSW, Sydney, NSW 2252, Australia ()
| | - Matthew G Law
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Annette H Sohn
- TREAT Asia/amfAR–Foundation for AIDS Research, Bangkok, Thailand
| | - Mary-Ann Davies
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, South Africa
| | | | - Valeriane Leroy
- INSERM, Laboratoire d’Epidémiologie et Analyses en Santé Publique (LEASP)–UMR 1027, Toulouse, France
| | | | - Michael Vinikoor
- Department of Medicine, University of North Carolina at Chapel Hill,Centre for Infectious Disease Research in Zambia, Lusaka
| | | | | | - Andrew Edmonds
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Geoffrey Fatti
- Kheth’Impilo AIDS Free Living, Cape Town, South Africa,Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | | | - Lorna Renner
- Department of Paediatrics, Korlebu Hospital, Accra, Ghana
| | - Adebola Adedimeji
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Azar Kariminia
- The Kirby Institute, University of New South Wales, Sydney, Australia
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Desmonde S, Tanser F, Vreeman R, Takassi E, Edmonds A, Lumbiganon P, Pinto J, Malateste K, McGowan C, Kariminia A, Yotebieng M, Dicko F, Yiannoutsos C, Mubiana-Mbewe M, Wools-Kaloustian K, Davies MA, Leroy V. Access to antiretroviral therapy in HIV-infected children aged 0-19 years in the International Epidemiology Databases to Evaluate AIDS (IeDEA) Global Cohort Consortium, 2004-2015: A prospective cohort study. PLoS Med 2018; 15:e1002565. [PMID: 29727458 PMCID: PMC5935422 DOI: 10.1371/journal.pmed.1002565] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 04/04/2018] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Access to antiretroviral therapy (ART) is a global priority. However, the attrition across the continuum of care for HIV-infected children between their HIV diagnosis and ART initiation is not well known. We analyzed the time from enrollment into HIV care to ART initiation in HIV-infected children within the International Epidemiology Databases to Evaluate AIDS (IeDEA) Global Cohort Consortium. METHODS AND FINDINGS We included 135,479 HIV-1-infected children, aged 0-19 years and ART-naïve at enrollment, between 1 January 2004 and 31 December 2015, in IeDEA cohorts from Central Africa (3 countries; n = 4,948), East Africa (3 countries; n = 22,827), West Africa (7 countries; n = 7,372), Southern Africa (6 countries; n = 93,799), Asia-Pacific (6 countries; n = 4,045), and Latin America (7 countries; n = 2,488). Follow-up in these cohorts is typically every 3-6 months. We described time to ART initiation and missed opportunities (death or loss to follow-up [LTFU]: last clinical visit >6 months) since baseline (the date of HIV diagnosis or, if unavailable, date of enrollment). Cumulative incidence functions (CIFs) for and determinants of ART initiation were computed, with death and LTFU as competing risks. Among the 135,479 children included, 99,404 (73.4%) initiated ART, 1.9% died, 1.4% were transferred out, and 20.4% were lost to follow-up before ART initiation. The 24-month CIF for ART initiation was 68.2% (95% CI: 67.9%-68.4%); it was lower in sub-Saharan Africa-ranging from 49.8% (95% CI: 48.4%-51.2%) in Central Africa to 72.5% (95% CI: 71.5%-73.5%) in West Africa-compared to Latin America (71.0%, 95% CI: 69.1%-72.7%) and the Asia-Pacific (78.3%, 95% CI: 76.9%-79.6%). Adolescents aged 15-19 years and infants <1 year had the lowest cumulative incidence of ART initiation compared to other ages: 62.2% (95% CI: 61.6%-62.8%) and 66.4% (95% CI: 65.7%-67.0%), respectively. Overall, 49.1% were ART-eligible per local guidelines at baseline, of whom 80.6% initiated ART. The following children had lower cumulative incidence of ART initiation: female children (p < 0.01); those aged <1 year, 2-4 years, 5-9 years, and 15-19 years (versus those aged 10-14 years, p < 0.01); those who became eligible during follow-up (versus eligible at enrollment, p < 0.01); and those receiving care in low-income or lower-middle-income countries (p < 0.01). The main limitations of our study include left truncation and survivor bias, caused by deaths of children prior to enrollment, and use of enrollment date as a proxy for missing data on date of HIV diagnosis, which could have led to underestimation of the time between HIV diagnosis and ART initiation. CONCLUSIONS In this study, 68% of HIV-infected children initiated ART by 24 months. However, there was a substantial risk of LTFU before ART initiation, which may also represent undocumented mortality. In 2015, many obstacles to ART initiation remained, with substantial inequities. More effective and targeted interventions to improve access are needed to reach the target of treating 90% of HIV-infected children with ART.
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Affiliation(s)
| | - Franck Tanser
- Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, South Africa
| | - Rachel Vreeman
- School of Medicine, Indiana University, Indianapolis, Indiana, United States of America
| | | | - Andrew Edmonds
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | | | - Jorge Pinto
- School of Medicine, Universide Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Karen Malateste
- Inserm U1219, University of Bordeaux, Bordeaux, France
- Bordeaux School of Public Health, University of Bordeaux, Bordeaux, France
| | - Catherine McGowan
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Azar Kariminia
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Marcel Yotebieng
- Division of Epidemiology, College of Public Health, Ohio State University, Columbus, Ohio, United States of America
| | | | - Constantin Yiannoutsos
- Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, United States of America
| | | | - Kara Wools-Kaloustian
- School of Medicine, Indiana University, Indianapolis, Indiana, United States of America
| | - Mary-Ann Davies
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Valériane Leroy
- Inserm U1027, Toulouse III University, Toulouse, France
- * E-mail:
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Slogrove AL, Schomaker M, Davies MA, Williams P, Balkan S, Ben-Farhat J, Calles N, Chokephaibulkit K, Duff C, Eboua TF, Kekitiinwa-Rukyalekere A, Maxwell N, Pinto J, Seage G, Teasdale CA, Wanless S, Warszawski J, Wools-Kaloustian K, Yotebieng M, Timmerman V, Collins IJ, Goodall R, Smith C, Patel K, Paul M, Gibb D, Vreeman R, Abrams EJ, Hazra R, Van Dyke R, Bekker LG, Mofenson L, Vicari M, Essajee S, Penazzato M, Anabwani G, Q. Mohapi E, N. Kazembe P, Hlatshwayo M, Lumumba M, Goetghebuer T, Thorne C, Galli L, van Rossum A, Giaquinto C, Marczynska M, Marques L, Prata F, Ene L, Okhonskaia L, Rojo P, Fortuny C, Naver L, Rudin C, Le Coeur S, Volokha A, Rouzier V, Succi R, Sohn A, Kariminia A, Edmonds A, Lelo P, Ayaya S, Ongwen P, Jefferys LF, Phiri S, Mubiana-Mbewe M, Sawry S, Renner L, Sylla M, Abzug MJ, Levin M, Oleske J, Chernoff M, Traite S, Purswani M, Chadwick EG, Judd A, Leroy V. The epidemiology of adolescents living with perinatally acquired HIV: A cross-region global cohort analysis. PLoS Med 2018; 15:e1002514. [PMID: 29494593 PMCID: PMC5832192 DOI: 10.1371/journal.pmed.1002514] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 01/24/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Globally, the population of adolescents living with perinatally acquired HIV (APHs) continues to expand. In this study, we pooled data from observational pediatric HIV cohorts and cohort networks, allowing comparisons of adolescents with perinatally acquired HIV in "real-life" settings across multiple regions. We describe the geographic and temporal characteristics and mortality outcomes of APHs across multiple regions, including South America and the Caribbean, North America, Europe, sub-Saharan Africa, and South and Southeast Asia. METHODS AND FINDINGS Through the Collaborative Initiative for Paediatric HIV Education and Research (CIPHER), individual retrospective longitudinal data from 12 cohort networks were pooled. All children infected with HIV who entered care before age 10 years, were not known to have horizontally acquired HIV, and were followed up beyond age 10 years were included in this analysis conducted from May 2016 to January 2017. Our primary analysis describes patient and treatment characteristics of APHs at key time points, including first HIV-associated clinic visit, antiretroviral therapy (ART) start, age 10 years, and last visit, and compares these characteristics by geographic region, country income group (CIG), and birth period. Our secondary analysis describes mortality, transfer out, and lost to follow-up (LTFU) as outcomes at age 15 years, using competing risk analysis. Among the 38,187 APHs included, 51% were female, 79% were from sub-Saharan Africa and 65% lived in low-income countries. APHs from 51 countries were included (Europe: 14 countries and 3,054 APHs; North America: 1 country and 1,032 APHs; South America and the Caribbean: 4 countries and 903 APHs; South and Southeast Asia: 7 countries and 2,902 APHs; sub-Saharan Africa, 25 countries and 30,296 APHs). Observation started as early as 1982 in Europe and 1996 in sub-Saharan Africa, and continued until at least 2014 in all regions. The median (interquartile range [IQR]) duration of adolescent follow-up was 3.1 (1.5-5.2) years for the total cohort and 6.4 (3.6-8.0) years in Europe, 3.7 (2.0-5.4) years in North America, 2.5 (1.2-4.4) years in South and Southeast Asia, 5.0 (2.7-7.5) years in South America and the Caribbean, and 2.1 (0.9-3.8) years in sub-Saharan Africa. Median (IQR) age at first visit differed substantially by region, ranging from 0.7 (0.3-2.1) years in North America to 7.1 (5.3-8.6) years in sub-Saharan Africa. The median age at ART start varied from 0.9 (0.4-2.6) years in North America to 7.9 (6.0-9.3) years in sub-Saharan Africa. The cumulative incidence estimates (95% confidence interval [CI]) at age 15 years for mortality, transfers out, and LTFU for all APHs were 2.6% (2.4%-2.8%), 15.6% (15.1%-16.0%), and 11.3% (10.9%-11.8%), respectively. Mortality was lowest in Europe (0.8% [0.5%-1.1%]) and highest in South America and the Caribbean (4.4% [3.1%-6.1%]). However, LTFU was lowest in South America and the Caribbean (4.8% [3.4%-6.7%]) and highest in sub-Saharan Africa (13.2% [12.6%-13.7%]). Study limitations include the high LTFU rate in sub-Saharan Africa, which could have affected the comparison of mortality across regions; inclusion of data only for APHs receiving ART from some countries; and unavailability of data from high-burden countries such as Nigeria. CONCLUSION To our knowledge, our study represents the largest multiregional epidemiological analysis of APHs. Despite probable under-ascertained mortality, mortality in APHs remains substantially higher in sub-Saharan Africa, South and Southeast Asia, and South America and the Caribbean than in Europe. Collaborations such as CIPHER enable us to monitor current global temporal trends in outcomes over time to inform appropriate policy responses.
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Affiliation(s)
| | - Amy L. Slogrove
- Center for Infectious Diseases Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Michael Schomaker
- Center for Infectious Diseases Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Mary-Ann Davies
- Center for Infectious Diseases Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Paige Williams
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Suna Balkan
- Epicentre, Médecins Sans Frontières, Paris, France
| | | | - Nancy Calles
- Baylor International Pediatric AIDS Initiative, Texas Children’s Hospital-USA, Houston, Texas, United States of America
| | | | - Charlotte Duff
- MRC Clinical Trials Unit at University College London, London, United Kingdom
| | - Tanoh François Eboua
- Yopougon University Hospital, University Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire
| | | | - Nicola Maxwell
- Center for Infectious Diseases Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Jorge Pinto
- School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - George Seage
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Chloe A. Teasdale
- ICAP at Columbia University Mailman School of Public Health, New York, New York, United States of America
| | - Sebastian Wanless
- Baylor International Pediatric AIDS Initiative, Texas Children’s Hospital-USA, Houston, Texas, United States of America
| | - Josiane Warszawski
- Inserm (French Institute of Health and Medical Research), CESP UMR Villejuif, France
| | - Kara Wools-Kaloustian
- Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Marcel Yotebieng
- College of Public Health, Ohio State University, Columbus, Ohio, United States of America
| | - Venessa Timmerman
- Center for Infectious Diseases Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Intira J. Collins
- MRC Clinical Trials Unit at University College London, London, United Kingdom
| | - Ruth Goodall
- MRC Clinical Trials Unit at University College London, London, United Kingdom
| | - Colette Smith
- MRC Clinical Trials Unit at University College London, London, United Kingdom
| | - Kunjal Patel
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Mary Paul
- Baylor International Pediatric AIDS Initiative, Texas Children’s Hospital-USA, Houston, Texas, United States of America
| | - Diana Gibb
- MRC Clinical Trials Unit at University College London, London, United Kingdom
| | - Rachel Vreeman
- Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Elaine J. Abrams
- ICAP at Columbia University Mailman School of Public Health, New York, New York, United States of America
| | - Rohan Hazra
- National Institute of Child Health and Human Development (NICHD), US National Institutes of Health, Rockville, Maryland, United States of America
| | - Russell Van Dyke
- Tulane University, New Orleans, Louisiana, United States of America
| | - Linda-Gail Bekker
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Lynne Mofenson
- Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, United States of America
| | | | | | | | - Gabriel Anabwani
- Baylor International Pediatric AIDS Initiative, Gaborone, Botswana
| | - Edith Q. Mohapi
- Baylor International Pediatric AIDS Initiative, Maseru, Lesotho
| | - Peter N. Kazembe
- Baylor International Pediatric AIDS Initiative, Lilongwe, Malawi
| | | | - Mwita Lumumba
- Baylor International Pediatric AIDS Initiative, Mbeya, Tanzania
| | | | - Claire Thorne
- Institute of Child Health, University College London, London, United Kingdom
| | - Luisa Galli
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Annemarie van Rossum
- Erasmus MC University Medical Center Rotterdam-Sophia Children’s Hospital, Rotterdam, the Netherlands
| | | | - Magdalena Marczynska
- Medical University of Warsaw, Hospital of Infectious Diseases in Warsaw, Warsaw, Poland
| | | | | | | | - Liubov Okhonskaia
- Republican Hospital of Infectious Diseases, St Petersburg, Russian Federation
| | | | - Claudia Fortuny
- Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Lars Naver
- Karolinska University Hospital, Stockholm, Sweden
| | | | - Sophie Le Coeur
- Institut de Recherche pour le Développement (IRD) 174/PHPT, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
- Institut National d'Etudes Démograhiques (Ined), F-75020 Paris, France
| | - Alla Volokha
- Shupyk National Medical Academy of Postgraduate Education, Kiev, Ukraine
| | | | - Regina Succi
- Universidade Federal de São Paulo, São Paulo, Brazil
| | | | | | - Andrew Edmonds
- Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Patricia Lelo
- Pediatric Hospital Kalembe Lembe, Lingwala, Kinshasa, Democratic Republic of Congo
| | - Samuel Ayaya
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Patricia Ongwen
- Family AIDS Care and Education Services, Kenya Medical Research Institute, Kisumu, Kenya
| | | | - Sam Phiri
- Lighthouse Trust Clinic, Lilongwe, Malawi
| | | | - Shobna Sawry
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Harriet Shezi Children’s Clinic, Chris Hani Baragwanath Hospital, Johannesburg, South Africa
| | - Lorna Renner
- University of Ghana School of Medicine and Dentistry, Accra, Ghana
| | | | - Mark J. Abzug
- University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado, United States of America
| | - Myron Levin
- University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado, United States of America
| | - James Oleske
- Rutgers New Jersey Medical School, Newark, New Jersey, United States of America
| | - Miriam Chernoff
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Shirley Traite
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Murli Purswani
- Bronx-Lebanon Hospital Center (Icahn School of Medicine at Mount Sinai), Bronx, New York, United States of America
| | - Ellen G. Chadwick
- Feinberg School of Medicine, Northwestern University, Evanston, Illinois, United States of America
| | - Ali Judd
- MRC Clinical Trials Unit at University College London, London, United Kingdom
- * E-mail: (AJ); (VL)
| | - Valériane Leroy
- Inserm (French Institute of Health and Medical Research), UMR 1027 Université Toulouse 3, Toulouse, France
- * E-mail: (AJ); (VL)
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Embleton L, Nyandat J, Ayuku D, Sang E, Kamanda A, Ayaya S, Nyandiko W, Gisore P, Vreeman R, Atwoli L, Galarraga O, Ott MA, Braitstein P. Sexual Behavior Among Orphaned Adolescents in Western Kenya: A Comparison of Institutional- and Family-Based Care Settings. J Adolesc Health 2017; 60:417-424. [PMID: 28110864 PMCID: PMC5389113 DOI: 10.1016/j.jadohealth.2016.11.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 09/28/2016] [Accepted: 11/15/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE This study sought to assess whether risky sexual behaviors and sexual exploitation of orphaned adolescents differed between family-based and institutional care environments in Uasin Gishu County, Kenya. METHODS We analyzed baseline data from a cohort of orphaned adolescents aged 10-18 years living in 300 randomly selected households and 19 charitable children's institutions. The primary outcomes were having ever had consensual sex, number of sex partners, transactional sex, and forced sex. Multivariate logistic regression compared these between participants in institutional care and family-based care while adjusting for age, sex, orphan status, importance of religion, caregiver support and supervision, school attendance, and alcohol and drug use. RESULTS This analysis included 1,365 participants aged ≥10 years: 712 (52%) living in institutional environments and 653 (48%) in family-based care. Participants in institutional care were significantly less likely to report engaging in transactional sex (adjusted odds ratio, .46; 95% confidence interval, .3-.72) or to have experienced forced sex (adjusted odds ratio, .57; 95% confidence interval, .38-.88) when controlling for age, sex, and orphan status. These associations remained when adjusting for additional variables. CONCLUSIONS Orphaned adolescents living in family-based care in Uasin Gishu, Kenya, may be at increased risk of transactional sex and sexual violence compared to those in institutional care. Institutional care may reduce vulnerabilities through the provision of basic material needs and adequate standards of living that influence adolescents' sexual risk-taking behaviors. The use of single items to assess outcomes and nonexplicit definition of sex suggest the findings should be interpreted with caution.
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Affiliation(s)
- Lonnie Embleton
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto Canada
| | | | - David Ayuku
- Department of Behavioral Sciences, College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya
| | - Edwin Sang
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | | | - Samuel Ayaya
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya,Department of Child Health and Paediatrics, Moi University, College of Health Sciences, School of Medicine, Eldoret, Kenya
| | - Winstone Nyandiko
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya,Department of Child Health and Paediatrics, Moi University, College of Health Sciences, School of Medicine, Eldoret, Kenya
| | - Peter Gisore
- Department of Child Health and Paediatrics, Moi University, College of Health Sciences, School of Medicine, Eldoret, Kenya
| | - Rachel Vreeman
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya,Department of Child Health and Paediatrics, Moi University, College of Health Sciences, School of Medicine, Eldoret, Kenya,Department of Pediatrics, Indiana University, School of Medicine, Indianapolis, USA,Indiana University School of Medicine, Department of Pediatrics, Indianapolis, IN, USA
| | - Lukoye Atwoli
- Department of Mental Health, Moi University, College of Health Sciences, School of Medicine, Eldoret, Kenya
| | - Omar Galarraga
- Department of Health Policy, Services, and Practice, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Mary A. Ott
- Indiana University School of Medicine, Department of Pediatrics, Indianapolis, IN, USA
| | - Paula Braitstein
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya; Department of Medicine, College of Health Sciences, School of Medicine, Eldoret, Kenya; Regenstrief Institute, Inc, Indianapolis, Indiana; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
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Shubber Z, Mills EJ, Nachega JB, Vreeman R, Freitas M, Bock P, Nsanzimana S, Penazzato M, Appolo T, Doherty M, Ford N. Patient-Reported Barriers to Adherence to Antiretroviral Therapy: A Systematic Review and Meta-Analysis. PLoS Med 2016; 13:e1002183. [PMID: 27898679 PMCID: PMC5127502 DOI: 10.1371/journal.pmed.1002183] [Citation(s) in RCA: 299] [Impact Index Per Article: 37.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 10/21/2016] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Maintaining high levels of adherence to antiretroviral therapy (ART) is a challenge across settings and populations. Understanding the relative importance of different barriers to adherence will help inform the targeting of different interventions and future research priorities. METHODS AND FINDINGS We searched MEDLINE via PubMed, Embase, Web of Science, and PsychINFO from 01 January 1997 to 31 March 2016 for studies reporting barriers to adherence to ART. We calculated pooled proportions of reported barriers to adherence per age group (adults, adolescents, and children). We included data from 125 studies that provided information about adherence barriers for 17,061 adults, 1,099 children, and 856 adolescents. We assessed differences according to geographical location and level of economic development. The most frequently reported individual barriers included forgetting (adults 41.4%, 95% CI 37.3%-45.4%; adolescents 63.1%, 95% CI 46.3%-80.0%; children/caregivers 29.2%, 95% CI 20.1%-38.4%), being away from home (adults 30.4%, 95% CI 25.5%-35.2%; adolescents 40.7%, 95% CI 25.7%-55.6%; children/caregivers 18.5%, 95% CI 10.3%-26.8%), and a change to daily routine (adults 28.0%, 95% CI 20.9%-35.0%; adolescents 32.4%, 95% CI 0%-75.0%; children/caregivers 26.3%, 95% CI 15.3%-37.4%). Depression was reported as a barrier to adherence by more than 15% of patients across all age categories (adults 15.5%, 95% CI 12.8%-18.3%; adolescents 25.7%, 95% CI 17.7%-33.6%; children 15.1%, 95% CI 3.9%-26.3%), while alcohol/substance misuse was commonly reported by adults (12.9%, 95% CI 9.7%-16.1%) and adolescents (28.8%, 95% CI 11.8%-45.8%). Secrecy/stigma was a commonly cited barrier to adherence, reported by more than 10% of adults and children across all regions (adults 13.6%, 95% CI 11.9%-15.3%; children/caregivers 22.3%, 95% CI 10.2%-34.5%). Among adults, feeling sick (15.9%, 95% CI 13.0%-18.8%) was a more commonly cited barrier to adherence than feeling well (9.3%, 95% CI 7.2%-11.4%). Health service-related barriers, including distance to clinic (adults 17.5%, 95% CI 13.0%-21.9%) and stock outs (adults 16.1%, 95% CI 11.7%-20.4%), were also frequently reported. Limitations of this review relate to the fact that included studies differed in approaches to assessing adherence barriers and included variable durations of follow up. Studies that report self-reported adherence will likely underestimate the frequency of non-adherence. For children, barriers were mainly reported by caregivers, which may not correspond to the most important barriers faced by children. CONCLUSIONS Patients on ART face multiple barriers to adherence, and no single intervention will be sufficient to ensure that high levels of adherence to treatment and virological suppression are sustained. For maximum efficacy, health providers should consider a more triaged approach that first identifies patients at risk of poor adherence and then seeks to establish the support that is needed to overcome the most important barriers to adherence.
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Affiliation(s)
- Zara Shubber
- Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| | | | - Jean B. Nachega
- Department of Epidemiology, Infectious Diseases and Microbiology, University of Pittsburgh, Graduate School of Public Health Pittsburgh, Pennsylvania, United States of America
- Department of Medicine and Centre for Infectious Diseases, Stellenbosch University, Cape Town, South Africa
- Department of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Rachel Vreeman
- Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Marcelo Freitas
- Department of HIV/AIDS, Ministry of Health, Brasilia, Brazil
| | - Peter Bock
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch, South Africa
| | - Sabin Nsanzimana
- HIV, STI, and Other Blood Borne Infections Division, Rwanda Biomedical Centre, Ministry of Health, Rwanda
- University of Basel, Swiss Tropical and Public Health Institute, and Institute for Clinical Epidemiology and Biostatistics, Basel, Switzerland
| | | | - Tsitsi Appolo
- AIDS and TB Unit, Ministry of Health and Child Welfare, Harare, Zimbabwe
| | - Meg Doherty
- Department of HIV, World Health Organization, Geneva, Switzerland
| | - Nathan Ford
- Department of HIV, World Health Organization, Geneva, Switzerland
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
- * E-mail:
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Kunapareddy CJ, Nyandiko W, Inui T, Ayaya S, Marrero DG, Vreeman R. A qualitative assessment of barriers to antiretroviral therapy adherence among adolescents in western Kenya. J HIV AIDS Soc Serv 2014; 13:383-401. [PMID: 28367106 PMCID: PMC5374741 DOI: 10.1080/15381501.2012.754392] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Antiretroviral therapy (ART) requires nearly perfect adherence to be effective. This study aims to identify key factors identified by HIV-infected adolescents on ART as contributing to medication adherence in western Kenya. Using a qualitative study design, three adolescent focus groups discussions were conducted at an urban and rural clinic site in western Kenya. The study population included HIV-infected adolescents receiving ART through the USAID-AMPATH HIV care system. A trained facilitator conducted groups in Kiswahili using a semi-structured interview guide probing multiple aspects of experience of taking medicines. Transcribed focus group dialogues were analyzed using constant comparison, progressive coding, and triangulation. The adolescents described a context of negative societal beliefs about HIV, necessitating a lifestyle of secrecy and minimizing the information shared about HIV or ART. Assessing and addressing adolescents' fears and behaviors regarding medication secrecy and disclosure may enable more accurate monitoring of adherence and development of intervention strategies.
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Affiliation(s)
| | - Winstone Nyandiko
- Moi University School of Medicine, Department of Child Health and Pediatrics, Eldoret, Kenya, and USAID, Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Thomas Inui
- USAID, Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya, Indian University School of Medicine, Department of Medicine, Indianapolis, IN, USA, and Regenstrief Institute, Inc., Indianapolis, IN, USA
| | - Samwel Ayaya
- USAID, Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya and Moi University School of Medicine, Department of Child Health and Pediatrics, Eldoret, Kenya
| | - David G Marrero
- Indiana University School of Medicine, Department of Medicine, Indianapolis, United States, and Indiana University School of Medicine, Diabetes Translational Research Center, Indianapolis, IN, USA
| | - Rachel Vreeman
- USAID, Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya, Regenstrief Institute, Inc., Indianapolis, IN, USA, and Indiana University School of Medicine, Children Health Services Research, Indianapolis, IN, USA
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Ayuku D, Embleton L, Koech J, Atwoli L, Hu L, Ayaya S, Hogan J, Nyandiko W, Vreeman R, Kamanda A, Braitstein P. The government of Kenya cash transfer for orphaned and vulnerable children: cross-sectional comparison of household and individual characteristics of those with and without. BMC Int Health Hum Rights 2014; 14:25. [PMID: 25239449 PMCID: PMC4175501 DOI: 10.1186/1472-698x-14-25] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 09/15/2014] [Indexed: 11/16/2022]
Abstract
Background The ‘Cash Transfer to Orphans and Vulnerable Children’ (CT-OVC) in Kenya is a government-supported program intended to provide regular and predictable cash transfers (CT) to poor households taking care of OVC. CT programs can be an effective means of alleviating poverty and facilitating the attainment of an adequate standard of living for people’s health and well-being and other international human rights. The objective of this analysis was to compare the household socioeconomic status, school enrolment, nutritional status, and future outlook of orphaned and separated children receiving the CT compared to those not receiving a CT. Methods This project analyzes baseline data from a cohort of orphaned and separated children aged <19 years and non-orphaned children living in 300 randomly selected households (HH) in 8 Locations of Uasin Gishu County, Kenya. Baseline data were analyzed using multivariable logistic and Poisson regression comparing children in CT-HH vs. non-CT HH. Odds ratios are adjusted (AOR) with 95% confidence intervals (CI) for guardian age and sex, child age and sex, and intra-HH correlation. Results Included in this analysis were data from 1481 children and adolescents in 300 HH (503 participants in CT, 978 in non-CT households). Overall there were 922 (62.3%) single orphans, 324 (21.9%) double orphans, and 210 (14.2%) participants had both parents alive and were living with them. Participants in CT-HH were less likely to have ≥2 pairs of clothes compared to non-CT HH (AOR: 0.32, 95% CI: 0.16-0.63). Those in CT HH were less likely to have missed any days of school in the preceding month (AOR: 0.62, 95% CI: 0.42-0.94) and those aged <1-18 years in CT-HH were less likely to have height stunting for their age (AOR: 0.65, 95% CI: 0.47-0.89). Participants aged at least 10 years in CT-HH were more likely to have a positive future outlook (AOR: 1.72, 95% CI: 1.12-2.65). Conclusions Children and adolescents in households receiving the CT-OVC appear to have better nutritional status, school attendance, and optimism about the future, compared to those in households not receiving the CT, in spite of some evidence of continued material deprivation. Consideration should be given to expanding the program further.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Paula Braitstein
- College of Health Sciences, School of Medicine, Department of Medicine, Moi University, Eldoret, Kenya.
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Ciaranello A, Lu Z, Ayaya S, Losina E, Musick B, Vreeman R, Freedberg KA, Abrams EJ, Dillabaugh L, Doherty K, Ssali J, Yiannoutsos CT, Wools-Kaloustian K. Incidence of World Health Organization stage 3 and 4 events, tuberculosis and mortality in untreated, HIV-infected children enrolling in care before 1 year of age: an IeDEA (International Epidemiologic Databases To Evaluate AIDS) East Africa regional analysis. Pediatr Infect Dis J 2014; 33:623-9. [PMID: 24378935 PMCID: PMC4024340 DOI: 10.1097/inf.0000000000000223] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Few studies have reported CD4%- and age-stratified rates of World Health Organization Stage 3 (WHO3) events, World Health Organization Stage 4 (WHO4) events, tuberculosis (TB) and mortality in HIV-infected infants before initiation of antiretroviral therapy. METHODS HIV-infected children enrolled before 1 year of age in the International Epidemiologic Databases to Evaluate AIDS East Africa region (October 1, 2002, to November, 2008) were included. We estimated incidence rates of earliest clinical event (WHO3, WHO4 and TB), before antiretroviral therapy initiation per local guidelines, stratified by current age (< or ≥6 months) and current CD4% (<15%, 15-24%, ≥25%). CD4%-stratified mortality rates were estimated separately for children who did not experience a clinical event ("background" mortality) and for children who experienced an event, including "acute" mortality (≤30 days post event) and "later" mortality (>30 days post event). RESULTS Among 847 children (median enrollment age: 4.8 months; median pre-antiretroviral therapy follow up: 10.8 months; 603 (71%) with ≥1 CD4% recorded), event rates were comparable for those aged <6 and ≥6 months. Current CD4% was associated with risk of WHO4 events for children <6 months of age and with all evaluated events for children ≥6 months old (P < 0.05). "Background" mortality was 3.7-8.4/100 person-years (PY). "Acute" mortality (≤30 days post event) was 33.8/100 PY (after TB) and 41.1/100 PY (after WHO3 or WHO4). "Later" mortality (>30 days post event) ranged by CD4% from 4.7 to 29.1/100 PY. CONCLUSIONS In treatment-naïve, HIV-infected infants, WHO3, WHO4 and TB events were common before and after 6 months of age and led to substantial increases in mortality. Early infant HIV diagnosis and treatment are critically important, regardless of CD4%.
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Affiliation(s)
- Andrea Ciaranello
- Division of Infectious Diseases and Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
| | - Zhigang Lu
- Division of General Medicine and Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
| | - Samuel Ayaya
- Department of Child Health and Paediatrics, Moi University School of Medicine, Eldoret, KENYA
| | - Elena Losina
- Division of General Medicine and Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA,Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Beverly Musick
- Department of Biostatistics, Indiana University, Indianapolis, IN, USA
| | - Rachel Vreeman
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Kenneth A. Freedberg
- Division of Infectious Diseases and Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA,Division of General Medicine and Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
| | - Elaine J. Abrams
- ICAP, Mailman School of Public Health, Columbia University and College of Physicians & Surgeons, Columbia University, NY, USA
| | - Lisa Dillabaugh
- Family AIDS Care and Education Service (FACES) program, Kisumu, KENYA, and Department of Pediatrics, University of California, San Francisco, CA, USA
| | - Katie Doherty
- Division of General Medicine and Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
| | - John Ssali
- Masaka Regional Referral Hospital, AHF-Uganda Cares Masaka, Uganda
| | | | - Kara Wools-Kaloustian
- Division of Infectious Disease, Indiana University School of Medicine, Indianapolis, IN, USA
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Embleton L, Ayuku D, Kamanda A, Atwoli L, Ayaya S, Vreeman R, Nyandiko W, Gisore P, Koech J, Braitstein P. Models of care for orphaned and separated children and upholding children's rights: cross-sectional evidence from western Kenya. BMC Int Health Hum Rights 2014; 14:9. [PMID: 24685118 PMCID: PMC4021203 DOI: 10.1186/1472-698x-14-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 03/24/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND Sub-Saharan Africa is home to approximately 55 million orphaned children. The growing orphan crisis has overwhelmed many communities and has weakened the ability of extended families to meet traditional care-taking expectations. Other models of care and support have emerged in sub-Saharan Africa to address the growing orphan crisis, yet there is a lack of information on these models available in the literature. We applied a human rights framework using the United Nations Convention on the Rights of the Child to understand what extent children's basic human rights were being upheld in institutional vs. community- or family-based care settings in Uasin Gishu County, Kenya. METHODS The Orphaned and Separated Children's Assessments Related to their Health and Well-Being Project is a 5-year cohort of orphaned children and adolescents aged ≤18 year. This descriptive analysis was restricted to baseline data. Chi-Square test was used to test for associations between categorical /dichotomous variables. Fisher's exact test was also used if some cells had expected value of less than 5. RESULTS Included in this analysis are data from 300 households, 19 Charitable Children's Institutions (CCIs) and 7 community-based organizations. In total, 2871 children were enrolled and had baseline assessments done: 1390 in CCI's and 1481 living in households in the community. We identified and described four broad models of care for orphaned and separated children, including: institutional care (sub-classified as 'Pure CCI' for those only providing residential care, 'CCI-Plus' for those providing both residential care and community-based supports to orphaned children , and 'CCI-Shelter' which are rescue, detention, or other short-term residential support), family-based care, community-based care and self-care. Children in institutional care (95%) were significantly (p < 0.0001) more likely to have their basic material needs met in comparison to those in family-based care (17%) and institutions were better able to provide an adequate standard of living. CONCLUSIONS Each model of care we identified has strengths and weaknesses. The orphan crisis in sub-Saharan Africa requires a diversity of care environments in order to meet the needs of children and uphold their rights. Family-based care plays an essential role; however, households require increased support to adequately care for children.
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Affiliation(s)
- Lonnie Embleton
- Department of Medicine, Moi University, College of Health Sciences, Eldoret, Kenya
| | - David Ayuku
- College of Health Sciences, Department of Behavioral Sciences, Moi University, Eldoret, Kenya
| | | | - Lukoye Atwoli
- College of Health Sciences, Department of Mental Health, Moi University, Eldoret, Kenya
| | - Samuel Ayaya
- College of Health Sciences, Department of Child Health and Pediatrics, Moi University, Eldoret, Kenya
| | - Rachel Vreeman
- Department of Pediatrics, Indiana University, Indianapolis, USA
| | - Winstone Nyandiko
- College of Health Sciences, Department of Child Health and Pediatrics, Moi University, Eldoret, Kenya
| | - Peter Gisore
- College of Health Sciences, Department of Child Health and Pediatrics, Moi University, Eldoret, Kenya
| | - Julius Koech
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Paula Braitstein
- Department of Medicine, Moi University, College of Health Sciences, Eldoret, Kenya
- Department of Medicine, Indiana University, 1001 West 10th Street, OPW M200 Indianapolis, IN, USA
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Regenstrief Institute Inc., Indianapolis, USA
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Nichols J, Embleton L, Mwangi A, Morantz G, Vreeman R, Ayaya S, Ayuku D, Braitstein P. Physical and sexual abuse in orphaned compared to non-orphaned children in sub-Saharan Africa: a systematic review and meta-analysis. Child Abuse Negl 2014; 38:304-16. [PMID: 24210283 PMCID: PMC3965611 DOI: 10.1016/j.chiabu.2013.09.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 09/17/2013] [Accepted: 09/21/2013] [Indexed: 05/26/2023]
Abstract
This systematic review assessed the quantitative literature to determine whether orphans are more likely to experience physical and/or sexual abuse compared to non-orphans in sub-Saharan Africa (SSA). It also evaluated the quality of evidence and identified research gaps. Our search identified 10 studies, all published after 2005, from Zimbabwe, South Africa, Kenya and Uganda. The studies consisted of a total 17,336 participants (51% female and 58% non-orphans). Of those classified as orphans (n=7,315), 73% were single orphans, and 27% were double orphans. The majority of single orphans were paternal orphans (74%). Quality assessment revealed significant variability in the quality of the studies, although most scored higher for general design than dimensions specific to the domain of orphans and abuse. Combined estimates of data suggested that, compared to non-orphans, orphans are not more likely to experience physical abuse (combined OR=0.96, 95% CI [0.79, 1.16]) or sexual abuse (combined OR=1.25, 95% CI [0.88, 1.78]). These data suggest that orphans are not systematically at higher risk of experiencing physical or sexual abuse compared to non-orphans in sub-Saharan Africa. However, because of inconsistent quality of data and reporting, these findings should be interpreted with caution. Several recommendations are made for improving data quality and reporting consistency on this important issue.
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Affiliation(s)
- J Nichols
- University of Toronto, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario, Canada M5T 3M7
| | - L Embleton
- Moi University, College of Health Sciences, School of Medicine, P.O. Box 4606, 0301000 Eldoret, Kenya
| | - A Mwangi
- Moi University, College of Health Sciences, Department of Behavioral Sciences, P.O. Box 4606, 0301000 Eldoret, Kenya
| | - G Morantz
- McGill University, Department of Pediatrics, 2300 Tupper, Montreal, Quebec, Canada H3H 1P3
| | - R Vreeman
- Moi University, College of Health Sciences, School of Medicine, Department of Child Health and Paediatrics, P.O. Box 4606, 0301000 Eldoret, Kenya; Indiana University, School of Medicine, Department of Pediatrics, 410 West 10th Street, Suite 1000, Indianapolis, IN 46202, USA; Regenstrief Institute, Inc., 410 West 10th Street, Indianapolis, IN 46202-3012, USA
| | - S Ayaya
- Moi University, College of Health Sciences, School of Medicine, Department of Child Health and Paediatrics, P.O. Box 4606, 0301000 Eldoret, Kenya
| | - D Ayuku
- Moi University, College of Health Sciences, School of Medicine, P.O. Box 4606, 0301000 Eldoret, Kenya
| | - P Braitstein
- University of Toronto, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario, Canada M5T 3M7; Moi University, College of Health Sciences, School of Medicine, Department of Medicine, P.O. Box 4606, 0301000 Eldoret, Kenya; Indiana University, School of Medicine, Department of Medicine, 1001 West 10th Street, OPW M200, Indianapolis, IN 46202, USA; Regenstrief Institute, Inc., 410 West 10th Street, Indianapolis, IN 46202-3012, USA
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Embleton L, Mwangi A, Vreeman R, Ayuku D, Braitstein P. The epidemiology of substance use among street children in resource-constrained settings: a systematic review and meta-analysis. Addiction 2013; 108:1722-33. [PMID: 23844822 PMCID: PMC3776018 DOI: 10.1111/add.12252] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 01/11/2013] [Accepted: 05/13/2013] [Indexed: 11/30/2022]
Abstract
AIMS To compile and analyze critically the literature published on street children and substance use in resource-constrained settings. METHODS We searched the literature systematically and used meta-analytical procedures to synthesize literature that met the review's inclusion criteria. Pooled-prevalence estimates and 95% confidence intervals (CI) were calculated using the random-effects model for life-time substance use by geographical region as well as by type of substance used. RESULTS Fifty studies from 22 countries were included into the review. Meta-analysis of combined life-time substance use from 27 studies yielded an overall drug use pooled-prevalence estimate of 60% (95% CI = 51-69%). Studies from 14 countries contributed to an overall pooled prevalence for street children's reported inhalant use of 47% (95% CI = 36-58%). This review reveals significant gaps in the literature, including a dearth of data on physical and mental health outcomes, HIV and mortality in association with street children's substance use. CONCLUSIONS Street children from resource-constrained settings reported high life-time substance use. Inhalants are the predominant substances used, followed by tobacco, alcohol and marijuana.
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Affiliation(s)
- Lonnie Embleton
- College of Health Sciences, Department of Medicine, Moi University, Eldoret, Kenya
| | - Ann Mwangi
- College of Health Sciences, School of Medicine, Department of Behavioral Sciences, Moi University, Eldoret, Kenya
| | - Rachel Vreeman
- College of Health Sciences, School of Medicine, Department of Pediatrics, Moi University, Eldoret, Kenya
- School of Medicine, Department of Pediatrics, Indiana University, Indianapolis, IN, USA
| | - David Ayuku
- College of Health Sciences, School of Medicine, Department of Behavioral Sciences, Moi University, Eldoret, Kenya
| | - Paula Braitstein
- College of Health Sciences, Department of Medicine, Moi University, Eldoret, Kenya
- School of Medicine, Department of Medicine, Indiana University, Indianapolis, IN, USA
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada and
- Regenstrief Institute, Inc., Indianapolis, IN, USA
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Wachira J, Middlestadt SE, Vreeman R, Braitstein P. Factors underlying taking a child to HIV care: implications for reducing loss to follow-up among HIV-infected and -exposed children. SAHARA J 2013; 9:20-9. [PMID: 23237018 DOI: 10.1080/17290376.2012.665255] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE With the aim of reducing pediatric loss to follow-up (LTFU) from HIV clinical care programs in sub-Saharan Africa, we sought to understand the personal and socio-cultural factors associated with the behavior of caregivers taking HIV-infected and -exposed children for care in western Kenya. METHODS Between May and August, 2010, in-depth interviews were conducted with 26 purposively sampled caregivers caring for HIV-infected (7), HIV-exposed (17) and HIV-unknown status (2) children, documented as LTFU from an urban and rural HIV care clinic. All were women with a majority (77%) being biological parents. Interviews were audio-recorded, transcribed and content analyzed. RESULTS Thematic content analysis of the women's perceptions revealed that their decision about routinely taking their children to HIV care involved multiple levels of factors including: (1) intrapersonal: transport costs, food availability, time constraints due to work commitment, disclosure of HIV status for both mother and child, perception that child is healthy and religious beliefs; (2) interpersonal: unsupportive male partner, stigma by the family and family conflicts; (3) community: cultural norms, changing community dynamics and perceived stigma; (4) health care system: clinic location, lack of patient-centered care, delays at the clinic and different appointment schedules (mother and child). Furthermore, the factors across these different levels interacted with each other in a complex way, illustrating the challenges women face in taking their children to HIV care. CONCLUSION The complexity and interconnectedness of the factors underlying retention of children in HIV care perceived by these women caregivers suggests that interventions to reduce pediatric LTFU need to be holistic and address multiple socio-ecological levels. Patient-centered care that integrates a family-centered approach to HIV pediatric care is recommended.
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Affiliation(s)
- Juddy Wachira
- Health Behavior, Indiana University, Bloomington, USA.
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Vreeman R, Kamaara E, Kamanda A, Ayuku D, Nyandiko W, Atwoli L, Ayaya S, Gisore P, Scanlon M, Braitstein P. Community perspectives on research consent involving vulnerable children in Western Kenya. J Empir Res Hum Res Ethics 2013; 7:44-55. [PMID: 23086047 DOI: 10.1525/jer.2012.7.4.44] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Involving vulnerable pediatric populations in international research requires culturally appropriate ethical protections. We sought to use mabaraza, traditional East African community assemblies, to understand how a community in western Kenya viewed participation of children in health research and informed consent and assent processes. Results from 108 participants revealed generally positive attitudes towards involving vulnerable children in research, largely because they assumed children would directly benefit. Consent from parents or guardians was understood as necessary for participation while gaining child assent was not. They felt other caregivers, community leaders, and even community assemblies could participate in the consent process. Community members believed research involving orphans and street children could benefit these vulnerable populations, but would require special processes for consent.
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Affiliation(s)
- Rachel Vreeman
- Indiana University, 107 S. Indiana Ave., Bloomington, IN 47405-7000, USA.
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Kamanda A, Embleton L, Ayuku D, Atwoli L, Gisore P, Ayaya S, Vreeman R, Braitstein P. Harnessing the power of the grassroots to conduct public health research in sub-Saharan Africa: a case study from western Kenya in the adaptation of community-based participatory research (CBPR) approaches. BMC Public Health 2013; 13:91. [PMID: 23368931 PMCID: PMC3564692 DOI: 10.1186/1471-2458-13-91] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Accepted: 01/14/2013] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Community-based participatory research (CBPR) is a collaborative approach to research that involves the equitable participation of those affected by an issue. As the field of global public health grows, the potential of CBPR to build capacity and to engage communities in identification of problems and development and implementation of solutions in sub-Saharan Africa has yet to be fully tapped. The Orphaned and Separated Children's Assessments Related to their Health and Well-Being (OSCAR) project is a longitudinal cohort of orphaned and non-orphaned children in Kenya. This paper will describe how CBPR approaches and principles can be incorporated and adapted into the study design and methods of a longitudinal epidemiological study in sub-Saharan Africa using this project as an example. METHODS The CBPR framework we used involves problem identification, feasibility and planning; implementation; and evaluation and dissemination. This case study will describe how we have engaged the community and adapted CBPR methods to OSCAR's Health and Well-being Project's corresponding to this framework in four phases: 1) community engagement, 2) sampling and recruitment, 3) retention, validation, and follow-up, and 4) analysis, interpretation and dissemination. RESULTS To date the study has enrolled 3130 orphaned and separated children, including children living in institutional environments, those living in extended family or other households in the community, and street-involved children and youth. Community engagement and participation was integral in refining the study design and identifying research questions that were impacting the community. Through the participation of village Chiefs and elders we were able to successfully identify eligible households and randomize the selection of participants. The on-going contribution of the community in the research process has been vital to participant retention and data validation while ensuring cultural and community relevance and equity in the research agenda. CONCLUSION CBPR methods have the ability to enable and strengthen epidemiological and public health research in sub-Saharan Africa within the social, political, economic and cultural contexts of the diverse communities on the continent. This project demonstrates that adaptation of these methods is crucial to the successful implementation of a community-based project involving a highly vulnerable population.
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Affiliation(s)
| | - Lonnie Embleton
- Department of Medicine, Moi University, College of Health Sciences, School of Medicine, Eldoret, Kenya
| | - David Ayuku
- Department of Behavioral Sciences, College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya
| | - Lukoye Atwoli
- Department of Medicine, Moi University, College of Health Sciences, School of Medicine, Eldoret, Kenya
| | - Peter Gisore
- Department of Pediatrics, Moi University, College of Health Sciences, School of Medicine, Eldoret, Kenya
| | - Samuel Ayaya
- Department of Pediatrics, Moi University, College of Health Sciences, School of Medicine, Eldoret, Kenya
| | - Rachel Vreeman
- Department of Pediatrics, Moi University, College of Health Sciences, School of Medicine, Eldoret, Kenya
- Department of Children’s Health Services Research, Indiana University, School of Medicine, Indianapolis, USA
| | - Paula Braitstein
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Medicine, Moi University, College of Health Sciences, School of Medicine, Eldoret, Kenya
- Department of Medicine, Indiana University, School of Medicine, Indianapolis, USA
- Regenstrief Institute, Inc, Indianapolis, USA
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Morantz G, Cole D, Vreeman R, Ayaya S, Ayuku D, Braitstein P. Child abuse and neglect among orphaned children and youth living in extended families in sub-Saharan Africa: What have we learned from qualitative inquiry? Vulnerable Child Youth Stud 2013; 8:338-352. [PMID: 24563656 PMCID: PMC3929282 DOI: 10.1080/17450128.2013.764476] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Researchers and aid organizations have reported that orphans in sub-Saharan Africa (SSA) are particularly vulnerable to abuse and neglect. This article is a review of qualitative studies that address experiences of maltreatment among orphaned children and youth living in extended families in SSA. It aims to inform policy and programming by providing a better understanding of the types of maltreatment encountered and the perceived risk factors. A literature search was carried out using Google, PubMed, Scholars Portal Search and Scopus. Searches of relevant bibliographies and publications of authors were also undertaken. Studies from peer-reviewed journals and the grey literature were reviewed for relevance and quality. Eligible studies had to include orphans living with extended family in SSA as participants, explore their maltreatment experiences and employ a sound qualitative methodology. Findings were coded, extracted, compared and synthesized. Twenty articles, representing 15 studies, were selected. These studies, from diverse SSAn countries, reported similar forms of maltreatment among orphaned children and youth: experiences of intra-household discrimination; material and educational neglect; excessive child labour; exploitation by family members and psychological, sexual and physical abuse. The perceived risk factors were poverty, living with a non-biological caregiver, stigma and alcohol abuse. The findings of the included studies suggest that awareness, prevention and intervention initiatives aimed to curb child abuse and neglect within communities in SSA are needed and should be coupled with efforts to promote education and reduce poverty and stigma.
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Affiliation(s)
- Gillian Morantz
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada
- Corresponding author.
| | - Donald Cole
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Rachel Vreeman
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Samuel Ayaya
- School of Medicine, Moi University, Eldoret, Kenya
| | - David Ayuku
- School of Medicine, Moi University, Eldoret, Kenya
| | - Paula Braitstein
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
- School of Medicine, Moi University, Eldoret, Kenya
- Academic Model Providing Access to Healthcare Partnership, United States Agency for International Development, Eldoret, Kenya
- Regenstrief Institute, Indianapolis, IN, USA
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Vreeman R, Kamaara E, Kamanda A, Ayuku D, Nyandiko W, Atwoli L, Ayaya S, Gisore P, Scanlon M, Braitstein P. A qualitative study using traditional community assemblies to investigate community perspectives on informed consent and research participation in western Kenya. BMC Med Ethics 2012; 13:23. [PMID: 23009744 PMCID: PMC3515354 DOI: 10.1186/1472-6939-13-23] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Accepted: 09/03/2012] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND International collaborators face challenges in the design and implementation of ethical biomedical research. Evaluating community understanding of research and processes like informed consent may enable researchers to better protect research participants in a particular setting; however, there exist few studies examining community perspectives in health research, particularly in resource-limited settings, or strategies for engaging the community in research processes. Our goal was to inform ethical research practice in a biomedical research setting in western Kenya and similar resource-limited settings. METHODS We sought to use mabaraza, traditional East African community assemblies, in a qualitative study to understand community perspectives on biomedical research and informed consent within a collaborative, multinational research network in western Kenya. Analyses included manual, progressive coding of transcripts from mabaraza to identify emerging central concepts. RESULTS Our findings from two mabaraza with 108 community members revealed that, while participants understood some principles of biomedical research, they emphasized perceived benefits from participation in research over potential risks. Many community members equated health research with HIV testing or care, which may be explained in part by the setting of this particular study. In addition to valuing informed consent as understanding and accepting a role in research activities, participants endorsed an increased role for the community in making decisions about research participation, especially in the case of children, through a process of community consent. CONCLUSIONS Our study suggests that international biomedical research must account for community understanding of research and informed consent, particularly when involving children. Moreover, traditional community forums, such as mabaraza in East Africa, can be used effectively to gather these data and may serve as a forum to further engage communities in community consent and other aspects of research.
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Affiliation(s)
- Rachel Vreeman
- Department of Pediatrics, Indiana University School of Medicine, 705 Riley Hospital Drive, Room 5900, Indianapolis, IN, 46202, USA
- USAID - Academic Model Providing Access to Healthcare (AMPATH) Partnership, P.O. Box 4606, Eldoret, 30100, Kenya
- Regenstrief Institute, Inc., 410 W. 10th St., Suite 2000, Indianapolis, IN, 46202-3012, USA
- Children’s Health Services Research, Health Information and Translational Sciences Building, Suite #1000, 410 W. 10th St., Indianapolis, IN, 46202, USA
| | - Eunice Kamaara
- Departments of Philosophy and Religious Studies, Moi University, P.O. Box 3990, Eldoret, 30100, Kenya
| | - Allan Kamanda
- Moi Teaching and Referral Hospital, Nandi Road, P.O. Box 3, Eldoret, 30100, Kenya
| | - David Ayuku
- Department of Behavioural Sciences, School of Medicine, Moi University College of Health Sciences, P.O. Box 4606, Eldoret, 30100, Kenya
| | - Winstone Nyandiko
- USAID - Academic Model Providing Access to Healthcare (AMPATH) Partnership, P.O. Box 4606, Eldoret, 30100, Kenya
- Department of Child Health and Paediatrics, School of Medicine, Moi University College of Health Sciences, P.O. Box 4606, Eldoret, 30100, Kenya
| | - Lukoye Atwoli
- USAID - Academic Model Providing Access to Healthcare (AMPATH) Partnership, P.O. Box 4606, Eldoret, 30100, Kenya
- Department of Mental Health, School of Medicine, Moi University College of Health Sciences, P.O. Box 4606, Eldoret, 30100, Kenya
| | - Samuel Ayaya
- USAID - Academic Model Providing Access to Healthcare (AMPATH) Partnership, P.O. Box 4606, Eldoret, 30100, Kenya
- Department of Child Health and Paediatrics, School of Medicine, Moi University College of Health Sciences, P.O. Box 4606, Eldoret, 30100, Kenya
| | - Peter Gisore
- USAID - Academic Model Providing Access to Healthcare (AMPATH) Partnership, P.O. Box 4606, Eldoret, 30100, Kenya
- Department of Child Health and Paediatrics, School of Medicine, Moi University College of Health Sciences, P.O. Box 4606, Eldoret, 30100, Kenya
| | - Michael Scanlon
- Department of Pediatrics, Indiana University School of Medicine, 705 Riley Hospital Drive, Room 5900, Indianapolis, IN, 46202, USA
| | - Paula Braitstein
- USAID - Academic Model Providing Access to Healthcare (AMPATH) Partnership, P.O. Box 4606, Eldoret, 30100, Kenya
- Regenstrief Institute, Inc., 410 W. 10th St., Suite 2000, Indianapolis, IN, 46202-3012, USA
- Department of Medicine, Indiana University School of Medicine, 545 Barnhill Drive, EH 317, Indianapolis, IN, 46202, USA
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Abstract
The study describes the knowledge of and attitudes toward substance use among street-involved youth in Kenya, and how they relate to their substance use practices. In 2011, 146 children and youth ages 10-19 years, classified as either children on the street or children of the street were recruited to participate in a cross-sectional survey in Eldoret, Kenya. Bivariate analysis using χ² or Fisher's Exact Test was used to test the associations between variables, and multiple logistic regression analysis was used to identify independent covariates associated with lifetime and current drug use. The study's limitations and source of funding are noted.
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Affiliation(s)
- Lonnie Embleton
- Department of Medicine, College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya
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Braitstein P, Katshcke A, Shen C, Sang E, Nyandiko W, Ochieng VO, Vreeman R, Yiannoutsos CT, Wools-Kaloustian K, Ayaya S. Retention of HIV-infected and HIV-exposed children in a comprehensive HIV clinical care programme in Western Kenya. Trop Med Int Health 2010; 15:833-41. [PMID: 20487430 DOI: 10.1111/j.1365-3156.2010.02539.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND To describe incidence rates (IR) and risk factors for loss-to-follow-up (LTFU) among HIV-infected and HIV-exposed children in a large HIV treatment programme in Western Kenya. METHODS The USAID-AMPATH Partnership has enrolled >100,000 patients (20% children) at 23 clinic sites throughout western Kenya. LTFU is defined as being absent from the clinic for >3 months if on combination antiretroviral treatment (cART) and >6 months if not. Included in this analysis were children aged <14 years, HIV exposed or infected at enrollment, and enrolled between April 2002 and March 2009. The IR for LTFU are presented per 100 child-years (CY) of follow-up. Proportional hazards models with time-independent and time-dependent covariates were used to model factors associated with LTFU. Weight for height Z-scores were calculated using EpiInfo, with severe malnutrition being defined as a Z-score <or=-3.0. Immune suppression was defined as per WHO age-specific categories. RESULTS There were 13,510 children eligible for analysis, comprising 3106 children who at enrollment were HIV infected and 10,404 children who were HIV exposed. The overall IR of LTFU was 18.4 (17.8-18.9) per 100 CY. Among HIV-infected children, 15.2 (13.8-16.7) and 14.1 (13.1-15.8) per 100 CY became LTFU, pre- and post-cART initiation, respectively. The only independent risk factor for becoming LTFU among the HIV-infected children was severe immune suppression (AHR: 2.17, 95% CI: 1.51-3.12). Among the HIV-exposed children, 20.1 per 100 (19.4-20.7) became LTFU. Independent risk factors for LTFU among them were being severely low weight for height (AHR: 1.69, 95% CI: 1.25-2.28), being orphaned at enrollment (AHR: 1.57, 95% CI: 1.23-1.64), being CDC Class B or C (AHR: 1.41, 95% CI: 1.14-1.74), and having received cART (AHR: 1.56, 95% CI: 1.23-1.99). Protective against becoming LTFU among the HIV exposed were testing HIV positive (AHR: 0.26, 95% CI: 0.21-0.32), older age (AHR: 0.90, 95% CI: 0.85-0.96), enrolling in later time periods, and receiving food supplementation (AHR: 0.58, 95% CI: 0.32-1.04). CONCLUSIONS There is a high rate of LTFU among these highly vulnerable children, particularly among the HIV exposed. These data suggest that HIV-infected and HIV-exposed children are at especially high risk for LTFU if they are sick or malnourished.
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