Five-year Outcomes Among Children Receiving Antiretroviral Therapy in a Community-based Accompaniment Program in Rural Rwanda

Abstract

Of 277 HIV-infected children in rural Rwanda enrolled in a community-based accompaniment program, 95.0% were retained in care 5 years after treatment initiation, with only 9 (3.3%) deaths and 3 (1.1%) defaults. Of 235 (84.8%) children with a documented viral load result, 201 (85.5%) demonstrated viral load suppression (<1000 copies/mL).

Viral load monitoring for people living with HIV in the era of test and treat: progress made and challenges ahead – a systematic review

“…Twenty-nine of the 34 included studies were conducted in and/or had data collected from sub-Saharan Africa (SSA) countries, including South Africa [ 22 – 32 ], Zimbabwe [ 33 – 36 ], Rwanda [ 37 , 38 ], Lesotho [ 39 ], Swaziland [ 40 ], Senegal [ 41 ], Malawi [ 42 ], Democratic Republic of Congo [ 43 ], Kenya [ 44 ], Mozambique [ 45 ] and Uganda [ 46 – 48 ]. Twenty studies were designed to assess VL monitoring or VL cascade in PLHIV on ART with long-term follow-up of > = 12 months and large sample sizes (> 500).…”

“…HCs send DBS samples to laboratory for testing MSF - Initial VL monitoring - Follow-up VL monitoring - Confirmation of virological failure - Switching treatment regimen Kyaw, N.T. ; 2017 [ 51 ] Retrospective cohort study using routine program data extracted from an electronic database Non-pregnant patients aged > = 10 years who were initiated on and receive 1st line ART for > = 6 months at study sites (N = 23,248) 33 clinics (ART centres & decentralised sites) under Integrated HIV Care (IHC) program in Mandalay, Sagaing, Magway, Shan & Yangon, Myanmar Feb 2005 – Jul 2015 To describe the rates of treatment failure and switching to second-line ART in adolescent and adult patients receiving first-line ART under IHC program Laboratory-based VL testing done at a private laboratory (2009–12) or the public health laboratory in Mandalay (since 2013) The Union; DFID, - Initial VL monitoring - Switching treatment regimen Cyamatare Rwabukwisi, F.; 2016 [ 38 ] Retrospective cohort study using routinely collected data of a community-based accompaniment program (CBAP) All patients aged < 15 years who were initiated on ART in CBA program at study sites during the study period (N = 277) All 25 ART facilities offering CBAP in two rural districts of Rwanda Jan 2005 – Dec 2008 To describe 5-year outcomes of children with HIV enrolled in the CBA program Not reported None mentioned - Initial VL monitoring - Follow-up VL monitoring a Key populations include: people who inject drug, female sex worker, men who have sex with men and transgender women …”

“…; 2017 [ 27 ] 4 months 2,782/3,216 (86.5%) - - - - VL testing required at 4 months after AC enrolment and every 12 months thereafter 16 months 1,563/1,846 (84.7%) - - - 28 months 490/615 (79.7%) - - - Swannet, S.; 2017 [ 45 ] 24 months 17,236/34,514 (50%) 1,095/2,600 (42%) 678/1,095 (62%) 212/678 (31.3%) - IVL: First VL test done during the observation period - VL cut-off: 3000 copies/ml - Only 50% (339/678) patients with 2 consecutive VL ≥ 3000 copies/ml were proposed and approved for 2nd -line ART - Details of EAC (after initial elevated VL ≥ 1000 copies/ml) not provided Kyaw, N.T. ; 2017 [ 51 ] 2005–15 7,888/23,248 (34%) - - 762/1,032 (74%) - Target VL monitoring was implemented - IVL: proportion of patient who tested for VL among PLHIV on ART ≥ 6 months Cyamatare Rwabukwisi, F.; 2016 [ 38 ] 60 months 235/277 (84.8%) 25/34 (73%) - - - IVL: a documented VL result within 5 years of ART initiation - FUVL: an additional VL after a VL of ≥ 1000 copies/ml within 5 years of ART initiation - Details of EAC (after initial elevated VL ≥ 1000 copies/ml) not provided a Initial VL monitoring: - Proportion of patients on ART who receive VL monitoring test o Numerator: Number of patients active on 1st line ART who have a VL test for treatment monitoring o Denominator: Total number of patients retained in care, active on 1st line ART and eligible for VL monitoring b Follow-up VL monitoring: - Proportion of patients on ART with an initial unsuppressed VL who receives a follow-up VL test o Numerator: Number of patients active on 1st line ART who had a follow-up VL test after an initial unsuppre...…”

Viral Load Monitoring for People Living with HIV in the Era of Test and Treat: Progress Made and Challenges Ahead – A Systematic Review

“…Zimbabwe [32][33][34][35], Rwanda [36,37], Lesotho [38], Swaziland [39], Senegal [40], Malawi [41], Democratic Republic of Congo [42], Kenya [43], Mozambique [44] and Uganda [45][46][47]. Twenty studies were designed to assess VL monitoring or VL cascade in PLHIV on ART with long-term follow-up of >=12 months and large sample sizes (>500).…”