Cohort profile: The International epidemiology Databases to Evaluate AIDS (IeDEA) in sub-Saharan Africa, 2012-2019

Chammartin, Frédérique; Ostinelli, Cam Ha Dao; Anastos, Kathryn; Jaquet, Antoine; Brazier, Ellen; Brown, Steven A.; Dabis, François; Davies, Mary‐Ann; Duda, Stephany N.; Malateste, Karen; Nash, Denis; Wools‐Kaloustian, Kara; Groote, Per M von; Egger, Matthias

doi:10.1101/19010231

Cited by 4 publications

(7 citation statements)

References 64 publications

(70 reference statements)

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“…Therefore, data on the care cascade may still be lacking for some countries, including countries profoundly affected by the HIV epidemic. The IeDEA collaboration is an extensive network of clinical cohorts, which can address the later steps of the HIV cascade in a standardized way [ 17 , 111 ].…”

Section: Discussionmentioning

confidence: 99%

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The HIV care cascade in sub‐Saharan Africa: systematic review of published criteria and definitions

et al. 2021

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Introduction:The HIV care cascade examines the attrition of people living with HIV from diagnosis to the use of antiretroviral therapy (ART) and suppression of viral replication. We reviewed the literature from sub-Saharan Africa to assess the definitions used for the different steps in the HIV care cascade. Methods: We searched PubMed, Embase and CINAHL for articles published from January 2004 to December 2020. Longitudinal and cross-sectional studies were included if they reported on at least one step of the UNAIDS 90-90-90 cascade or two steps of an extended 7-step cascade. A step was clearly defined if authors reported definitions for numerator and denominator, including the description of the eligible population and methods of assessment or measurement. The review protocol has been published and registered in Prospero. Results and discussion: Overall, 3364 articles were screened, and 82 studies from 19 countries met the inclusion criteria. Most studies were from Southern (38 studies, 34 from South Africa) and East Africa (29 studies). Fifty-eight studies (71.6%) were longitudinal, with a median follow-up of three years. The medium number of steps covered out of 7 steps was 3 (interquartile range [IQR] 2 to 4); the median year of publication was 2015 (IQR 2013(IQR to 2019. The number of different definitions for the numerators ranged from four definitions (for step "People living with HIV") to 21 (step "Viral suppression"). For the denominators, it ranged from three definitions ("Diagnosed and aware of HIV status") to 14 ("Viral suppression"). Only 12 studies assessed all three of the 90-90-90 steps. Most studies used longitudinal data, but denominator-denominator or denominator-numerator linkages over several steps were rare. Also, cascade data are lacking for many countries. Our review covers the academic literature but did not consider other data, such as government reports on the HIV care cascade. Also, it did not examine disengagement and reengagement in care. Conclusions: The proportions of patients retained at each step of the HIV care cascade cannot be compared between studies, countries and time periods, nor meta-analysed, due to the many different definitions used for numerators and denominators. There is a need for standardization of methods and definitions.

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Section: Discussionmentioning

confidence: 99%

“…We classified study design into cross‐sectional studies, longitudinal studies and studies that combine both designs (mixed design). We defined regions of sub‐Saharan Africa according to the classification used by the International epidemiological Databases to Evaluate AIDS (IeDEA) [ 17 ].…”

Section: Methodsmentioning

confidence: 99%

The HIV care cascade in sub‐Saharan Africa: systematic review of published criteria and definitions

et al. 2021

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“…We included all ART‐naïve (defined as not being on any ART regimen) adolescents aged 15–19 years initiating ART between 2004 and 2019 from six South African cohorts of the IeDEA‐SA collaboration [ 20 , 21 ]. These cohorts are in both rural (Hlabisa) and urban (Harriet Shezi, Themba Lethu, Khayelitsha, Kheth'Impilo and AfA) locations entailing public hospitals (Harriet Shezi, Themba Lethu), public sector primary healthcare centre (Khayelitsha) not‐for‐profit organizations (Kheth'Impilo, Hlabisa) and one private sector managed‐care HIV program (AfA), across three South African provinces: the individual cohort profiles have been described elsewhere [ 22 , 23 , 24 , 25 , 26 , 27 ].…”

Section: Methodsmentioning

confidence: 99%

Virologic non‐suppression and early loss to follow up among pregnant and non‐pregnant adolescents aged 15–19 years initiating antiretroviral therapy in South Africa: a retrospective cohort study

et al. 2022

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Introduction Older adolescents aged 15–19 years continue to have high rates of loss to follow up (LTFU), and high rates of virologic non‐suppression (VNS) compared to younger adolescents and adults. Adolescent females are at risk of pregnancy, which puts those living with HIV at a dual vulnerability. Our study assessed the factors associated with VNS and LTFU in older adolescents (including pregnant females) who initiated antiretroviral therapy (ART) in South Africa. Methods We included adolescents aged 15–19 years initiating ART between 2004 and 2019, with ≥ one viral load (VL) measurement between 4 and 24.5 months, and ≥ 6 months follow‐up, from six South African cohorts of the International epidemiology Databases to Evaluate AIDS‐Southern Africa (IeDEA‐SA). We defined VNS as VL ≥400 copies/ml and LTFU as not being in care for ≥180 days from ART start and not known as transferred out of the clinic or dead in the first 24 months on ART. We examined factors associated with VNS and LTFU using Fine&Gray competing risk models. Results We included a total of 2733 adolescents, 415 (15.2%) males, median (IQR) age at ART start of 18.6 (17.3, 19.4) years. Among females, 585/2318 (25.2%) were pregnant. Over the 24‐month follow‐up, 424 (15.5%) of all adolescents experienced VNS: range (11.1% pregnant females and 20.5% males). Over half of all adolescents were LTFU before any other event could occur. The hazard of VNS reduced with increasing age and CD4 count above 200 cells/μl at ART initiation among all adolescents having adjusted for all measured patient characteristics [adjusted sub‐distribution hazard ratio (aSHR) 19 vs. 15 years: 0.50 (95% CI: 0.36, 0.68), aSHR: >500 vs. ≤200 cells/μl: 0.22 (95% CI: 0.16, 0.31)]. The effect of CD4 count persisted in pregnant females. Increasing age and CD4 count >200 cells/μl were risk factors for LTFU among all adolescents. Conclusions Older adolescents had a high risk of LTFU shortly after ART start and a low risk of VNS, especially those initiating treatment during pregnancy. Interventions addressing adherence and retention should be incorporated into adolescent‐friendly services to prevent VNS and LTFU and endeavour to trace lost adolescents as soon as they are identified.

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“…IeDEA pools clinical and epidemiological data on people living with HIV under care in routine settings as a cost-effective way of generating large data sets to address research questions in HIV/AIDS treatment and care that cannot be answered by single cohorts [21]. The IeDEA Southern Africa region currently includes patient-level data on more than one million adults and children living with HIV from 17 large treatment programs across Lesotho, Malawi, Mozambique, South Africa, Zambia and Zimbabwe [22].…”

Section: Methodsmentioning

confidence: 99%

“…The IeDEA Southern Africa region currently includes patient-level data on more than one million adults and children living with HIV from 17 large treatment programs across Lesotho, Malawi, Mozambique, South Africa, Zambia and Zimbabwe [22].…”

Section: Data Sourcesmentioning

confidence: 99%

Trends in CD4 and viral load testing 2005 to 2018: Multi-cohort study of people living with HIV in Southern Africa

Zaniewski

Ostinelli

Chammartin

et al. 2020

Preprint

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Introduction: WHO recommends a CD4 cell count before starting antiretroviral therapy (ART) to detect advanced HIV disease, and routine viral load (VL) testing following ART initiation to detect treatment failure. Donor support for CD4 testing has declined to prioritize access to VL monitoring. We examined trends in CD4 and VL testing among adults (≥15 years of age) starting ART in Southern Africa. Methods: We analysed data from 14 HIV treatment programs with over 300 clinics in Lesotho, Malawi, Mozambique, South Africa, Zambia and Zimbabwe in years 2005-2018. We examined the frequency of CD4 and VL testing, the percentage of adults with CD4 or VL tests, and among those having a test, the percentage starting ART with advanced HIV disease (CD4 count <200 cells/mm3) or failing to suppress viral replication (>1000 HIV-RNA copies/ml) after ART initiation. We used mixed effect logistic regression to assess time trends adjusted for age and sex. Results: Among 502,456 adults, the percentage with CD4 testing at ART initiation decreased from a high of 78.1% in 2008 to a low of 38.0% in 2017. The percentage starting with advanced HIV disease declined from 83.3% in 2005 to 23.5% in 2018. VL testing after starting ART varied; 61.0% of adults in South Africa and 10.7% in Malawi were tested but fewer than 2% were tested in the other four countries. The probability of having a CD4 cell count at ART start declined by 14% each year (odds ratio [OR] 0.86; 95% CI 0.86-0.86); the probability of advanced HIV disease declined by 20% per year (OR 0.80; 95% CI 0.80-0.81). The increase in VL testing after ART start was only modest (OR 1.06; 95% CI 1.05-1.06) and there was no evidence of a decrease in unsuppressed VL over time (OR 1.00; 95% CI 0.99-1.01). Conclusions: CD4 cell counting declined over time, including testing at the start of ART, despite the fact that many patients still initiated ART with advanced HIV disease. Without CD4 testing and expanded VL testing many patients with advanced HIV disease and treatment failure may go undetected, threatening the effectiveness of ART in sub-Saharan Africa.

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Cohort profile: The International epidemiology Databases to Evaluate AIDS (IeDEA) in sub-Saharan Africa, 2012-2019

Cited by 4 publications

References 64 publications

The HIV care cascade in sub‐Saharan Africa: systematic review of published criteria and definitions

The HIV care cascade in sub‐Saharan Africa: systematic review of published criteria and definitions

Virologic non‐suppression and early loss to follow up among pregnant and non‐pregnant adolescents aged 15–19 years initiating antiretroviral therapy in South Africa: a retrospective cohort study

Trends in CD4 and viral load testing 2005 to 2018: Multi-cohort study of people living with HIV in Southern Africa

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