An update on the HIV treatment cascade in children and adolescents

Bobat, Raziya; Archary, Moherndran; Lawler, Melissa

doi:10.1097/coh.0000000000000201

Cited by 19 publications

(13 citation statements)

References 59 publications

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“…With about 80% of sustained viremia below 1,000 copies/ml, additional efforts are required to meet the third pillar of the UNAIDS 90-90-90 target amongst ALWHIV [ 12 , 13 ], by emphasizing on factors promoting constant adherence as aforementioned (boys in general, and orphans of both parents in particular) [ 13 , 20 – 22 ]. On one hand, similar reports were shown in Asia [ 17 , 18 ], with favorable response despite delayed ART initiation and the use of drugs with low genetic barriers in some SSA settings [ 19 – 21 ]. On the other hand, our findings are far beyond previous reports from other SSA settings (50% VF, and poor immune recovery likely attributed to shorter observational periods) [ 15 , 16 ].…”

Section: Discussionsupporting

confidence: 58%

Immuno-virological response and associated factors amongst HIV-1 vertically infected adolescents in Yaoundé-Cameroon

et al. 2017

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IntroductionLimited studies have reported the outcomes of lifelong antiretroviral therapy (ART) amongst adolescents living with HIV (ALWHIV) in resource-limited settings (RLS), thus classifying this population as underserved. We therefore aimed to ascertain the immunological and virological responses, and associated factors amongst Cameroonian ALWHIV.MethodA cross-sectional and observational study was conducted from January through May 2016 at the National Social Insurance Fund Health Centre in Yaoundé-Cameroon. Immunological and virological responses were evaluated using CD4 cell count and viral load respectively, with viral suppression (VS) defined as <50 copies/ml. Adherence was evaluated using self-reported missing doses during the past 14 days. Data were analyzed using R v.3.3.0, with p<0.05 considered statistically significant.ResultsOf the 145 ALWHIV on ART enrolled in the study, 52% were female, median age [interquartile (IQR)] was 13 [11–16] years, median [IQR] time-on-ART was 7 [5–10] years, 48% were orphans, 92% were on first-line ART and 36% were adherent to ART. Following ART response, 79% (114/145) had CD4 ≥500/mm3, 71.0% (103/145) were on VS of whom 52.4% (76/145) had a sustained VS. Duration of ART was associated with immune restoration (Odd Ratio 3.73 [1.26–12.21]) but not with virological response. Risks of poor adherence were greater in orphans of both parents (p = 0.078).ConclusionIn this urban setting of Cameroon, ALWHIV receiving ART show favorable immunological and virological response in a medium run. For long-term ART success, implementing a close monitoring of adherence and risks of viral rebound would be highly relevant, especially for orphans of both parents.

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Section: Discussionsupporting

confidence: 58%

Immuno-virological response and associated factors amongst HIV-1 vertically infected adolescents in Yaoundé-Cameroon

et al. 2017

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“…Factors that were found to be significantly associated with lower linkage and retention in this study have been noted previously. Adolescents are known to be a difficult to reach population with high attrition [ 23 ] and deserve greater focus in future interventions to reduce attrition. Overall, a greater number of women are engaged in HIV care, [ 24 , 25 ] consistent with the fact that substantially more of the patients in these datasets were women.…”

Section: Discussionmentioning

confidence: 99%

Assessing linkage to and retention in care among HIV patients in Uganda and identifying opportunities for health systems strengthening: a descriptive study

Boeke

Nabitaka²,

Rowan³

et al. 2018

BMC Infect Dis

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BackgroundWhile antiretroviral therapy (ART) availability for HIV patients has increased dramatically in Uganda, patient linkage to and retention in care remains a challenge. We assessed patterns of engagement in care in 20 Ugandan health facilities with low retention based on national reporting.MethodsWe assessed patient linkage to care (defined as registering for pre-ART or ART care at the facility within 1 month of HIV diagnosis) and 6-month retention in care (having a visit 3-6 months after ART initiation) and associations with patient−/facility-level factors using multivariate logistic regression.ResultsAmong 928 newly HIV-diagnosed patients, only 53.0% linked to care within 1 month. Of these, 83.7% linked within 1 week. Among 678 newly initiated ART patients, 14.5% never returned for a follow-up visit at the facility. Retention was 71.7% according to our primary definition but much lower if stricter definitions were used. Most patients were already falling behind appointment schedules at their first ART follow-up (median: 28 days post-initiation vs. recommended 14 days). 27.3% of newly-initiated patients had follow-up appointments scheduled 45+ days apart rather than monthly per national guidelines. Linkage and retention were not strongly correlated with each other within facilities (rs = 0.06; p = 0.82). Females, adolescents, and patients in rural settings tended to have lower linkage and retention in multivariable-adjusted models.ConclusionsLinkage support may be most critical immediately after testing positive, as patients are less likely to link over time. More information is needed on reasons for appointment schedules by clinicians and implications on retention.Trial registrationThis study was registered in the Pan African Clinical Trial Registry database (#PACTR201611001756166).Electronic supplementary materialThe online version of this article (10.1186/s12879-018-3042-8) contains supplementary material, which is available to authorized users.

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“…Loss to follow-up during the period between positive HIV testing and linkage to care, delayed initiation of antiretroviral therapy (ART), and poor levels of early retention in care significantly contribute to high HIV-related morbidity and mortality globally among adolescents and youth [8,10–14]. Addressing these challenges is particularly important during the initial stage following a new diagnosis of HIV in adolescents and youth, a time when successful initiation into the HIV care cascade may improve long-term outcomes and decrease HIV transmission among these key populations.…”

Section: Introductionmentioning

confidence: 99%

Optimizing linkage to care and initiation and retention on treatment of adolescents with newly diagnosed HIV infection

Ruria¹,

Masaba²,

Kose³

et al. 2017

Aids

117

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Objective:Unsuccessful linkage to care and treatment increases adolescent HIV-related morbidity and mortality. This study evaluated the effect of a novel adolescent and youth Red Carpet Program (RCP) on the timing and outcomes of linkage to care.Design:A prepost implementation evaluation of the pilot RCP program.Settings:Healthcare facilities (HCFs) and schools in Homa Bay County, Kenya.Study participants:HIV-infected adolescents (15–19 years) and youth (20–21 years).Interventions:RCP provided fast-track peer-navigated services, peer counseling, and psychosocial support at HCFs and schools in six Homa Bay subcounties in 2016. RCP training and sensitization was implemented in 50 HCFs and 25 boarding schools.Main outcome measures:New adolescent and youth HIV diagnosis, linkage to and retention in care and treatment.Results:Within 6 months of program rollout, 559 adolescents and youths (481 women; 78 men) were newly diagnosed with HIV (15–19 years n = 277; 20–21 years, n = 282). The majority (n = 544; 97.3%) were linked to care, compared to 56.5% at preimplementation (P < 0.001). All (100.0%; n = 559) adolescents and youths received peer counseling and psychosocial support, and the majority (n = 430; 79.0%) were initiated on treatment. Compared to preimplementation, the proportion of adolescents and youths who were retained on treatment increased from 66.0 to 90.0% at 3 months (P < 0.001), and from 54.4 to 98.6% at 6 months (P < 0.001).Conclusion:Implementation of RCP was associated with significant improvement in linkage to and early retention in care among adolescent and youth. The ongoing study will fully assess the efficacy of this linkage-to-care approach.

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An update on the HIV treatment cascade in children and adolescents

Abstract: We have a long way to go to achieve decreased attrition at each step of the cascade and retain patients in care. Recent improvements in each step of the cascade are bringing us closer to achieving treatment success.

Cited by 19 publications

References 59 publications

Immuno-virological response and associated factors amongst HIV-1 vertically infected adolescents in Yaoundé-Cameroon

Immuno-virological response and associated factors amongst HIV-1 vertically infected adolescents in Yaoundé-Cameroon

Assessing linkage to and retention in care among HIV patients in Uganda and identifying opportunities for health systems strengthening: a descriptive study

Optimizing linkage to care and initiation and retention on treatment of adolescents with newly diagnosed HIV infection

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