Drop‐offs in the isoniazid preventive therapy cascade among children living with HIV in western Kenya, 2015–2019

Onyango, Dickens; Sande, Marianne A B van der; Yuen, Courtney M.; Mecha, Jerphason; Matemo, Daniel; Oele, Elizabeth; Kinuthia, John; John‐Stewart, Grace; LaCourse, Sylvia M

doi:10.1002/jia2.25939

Cited by 3 publications

(11 citation statements)

References 32 publications

(45 reference statements)

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“…Globally bacterial pathogens, particularly S. aureus, Pseudomonas species and E. coli are responsible for a majority of sepsis cases [71][72][73] . In our study, viral pathogens were more common than previous studies, which estimated they account for less than 1% of sepsis cases [74,75] . Among the bacterial causes, K.…”

Section: Discussioncontrasting

confidence: 48%

“…Evaluations of the IPT cascade conducted among adults reported that over 10% of PLHIV who initiated IPT did not complete the six-month course (66,74,75). In our evaluation, 22% of CLHIV who initiated IPT did not complete the six-month course.…”

Section: Interventions To Reduce Tb and Hiv Mortalitymentioning

confidence: 54%

“…HIV in children is mostly transmitted from their mothers (74); PMTCT is a strategy that entails HIV testing during pregnancy and childbirth, ART initiation among HIV-infected pregnant women and ART prophylaxis in HIV-exposed infants is crucial in reducing related mortality among children (75). HIV testing among HIV exposed infants coupled with early ART initiation is another important childhood intervention (76).…”

Section: Tb and Hiv Mortality Preventive Interventionsmentioning

confidence: 99%

“…However, most evaluation of IPT programs for PLHIV have focused on adults; our work attempted to fill the knowledge gap around IPT for children living with HIV (CLHIV). IPT initiation was suboptimal, particularly in virally non-suppressed CLHIV probably due to the difficulties that providers encounter in ruling out active TB among patients with advanced disease (74). There is evidence of decreasing momentum in IPT initiation after the rapid scale-up following the national launch in 2015 (71,74).…”

Section: Interventions To Reduce Tb and Hiv Mortalitymentioning

confidence: 99%

“…IPT initiation was suboptimal, particularly in virally non-suppressed CLHIV probably due to the difficulties that providers encounter in ruling out active TB among patients with advanced disease (74). There is evidence of decreasing momentum in IPT initiation after the rapid scale-up following the national launch in 2015 (71,74). Additional programmatic efforts, especially continuous sensitization of health providers on the benefits of IPT, are needed to sustain the initial momentum in getting PLHIV to initiate TB preventive therapy.…”

Section: Interventions To Reduce Tb and Hiv Mortalitymentioning

confidence: 99%

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Incidence, risk factors and interventions addressing mortality associated with HIV and TB infections among children and adults in Kenya

Onyango¹

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Tuberculosis (TB) and infection with human immuno-deficiency virus (HIV) are leading infectious causes of morbidity particularly in sub-Saharan Africa, which is disproportionately affected by the two epidemics. Kenya is one of the 30 countries with the highest HIV and TB burden in the world. Kenya’s HIV prevalence was estimated to be 4,900 per 100,000 in 2019 while TB prevalence was 558 per 100,000 population in a 2016 survey. Estimates of mortality from TB and HIV were based on modeling of civil registration and vital statistics (CRVS) which may not be accurate in low- and middle-income countries due to under-reporting, poor documentation of causes of death and lack of verification of causes of death. In this thesis, we provide updated estimates of TB and HIV mortality using a variety of data sources including routine surveillance, post mortem surveillance for HIV infection and minimally invasive tissue sampling (MITS). We also evaluated two mortality preventive interventions. Our mortality studies documented a higher-than-expected HIV prevalence (28.5%) among 846 decedents received by high-volume mortuaries in western Kenya; 17% of deaths were attributable to HIV-infection. Half of HIV-infected decedents had viral load of ≥1,000 copies/milliliter. Among 456 decedents whose causes of death were determined by an expert panel, HIV/AIDS was the leading underlying cause of death (HIV cause-specific mortality rate: 251/100,000 population); TB was ranked 12th among immediate causes of death. Among 176 decedents aged under-five years, malnutrition, malaria, and HIV were the top three underlying causes of death. HIV prevalence among 176 decedents aged under-five years (14%) twenty-fold higher than the estimated prevalence among children in the population (0.7%); 96% of HIV-infected decedents were virally non-suppressed. While Mycobacterium tuberculosis was not detected among under-five decedents, five decedents (four HIV-infected) had been on TB treatment antemortem. Epidemiological analysis of national TB surveillance data showed that 28% of children aged <14 years and 35% of adults on TB treatment were co-infected with HIV. The case fatality ratio during TB treatment was 4% in children and 6% in adults. The risk of death was five-fold higher among HIV-infected children who were not on ART compared to HIV-uninfected children; 42% of deaths during TB treatment were attributed to HIV-infection. In a retrospective analysis of data from an integrated TB/HIV active case-finding intervention conducted in Kisumu County, the odds of new HIV diagnoses among TB-symptomatic adults attending private not-for-profit facilities were thrice as high as those attending government facilities. An evaluation of the isoniazid preventive therapy (IPT) cascade among 856 HIV-infected children newly enrolled on HIV care over a four-year period revealed high coverage of screening for IPT eligibility (98%), but suboptimal initiation (68%) and completion (78%). Our mortality studies demonstrate that TB and HIV remain leading causes of death in Kenya despite the availability of effective interventions. Preventing mortality from these diseases would substantially contribute to a reduction in overall mortality in the population. Existing interventions against the two diseases should be evaluated to identify gaps that continue to contribute to excess mortality from TB and HIV.

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Section: Discussioncontrasting

confidence: 48%

Section: Interventions To Reduce Tb and Hiv Mortalitymentioning

confidence: 54%

Section: Tb and Hiv Mortality Preventive Interventionsmentioning

confidence: 99%

Section: Interventions To Reduce Tb and Hiv Mortalitymentioning

confidence: 99%

Section: Interventions To Reduce Tb and Hiv Mortalitymentioning

confidence: 99%

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Incidence, risk factors and interventions addressing mortality associated with HIV and TB infections among children and adults in Kenya

Onyango¹

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Biomarker-confirmed suboptimal adherence to isoniazid preventive therapy among children with HIV in western Kenya

Onyango,

van der Sande,

Yuen

et al. 2023

Aids

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Objectives: To assess the level and correlates of biomarker-confirmed adherence to isoniazid (INH) preventive therapy (IPT) among children living with HIV (CLHIV). Design: This prospective cohort study assessed adherence among CLHIV on IPT in public sector HIV clinics from 2019 through 2020. Methods: Adherence was assessed by pill counts or caregiver- or self-reports, and urine biomarkers (in-house dipstick and IsoscreenTM©). Both urine biomarker tests detect INH metabolites within 48 hours of ingestion. Consistent adherence was defined as having positive results on either biomarker at all visits. Correlates of biomarker-confirmed nonadherence at each visit were evaluated using generalized estimating equations. The in-house dipstick was validated using IsoscreenTM© as the reference. Results: Among 97 CLHIV on IPT with adherence assessments, median age was 10 years (IQR 7–13). All were on ART at IPT initiation (median duration 46 months [IQR 4–89]); 81% were virally suppressed (<1000 copies/ml). At all visits, 59% (n = 57) of CLHIV reported taking ≥80% of their doses, while 39% (n = 38) had biomarker-confirmed adherence. Viral non-suppression (adjusted risk ratio [aRR] = 1.65; 95% CI 1.09 – 2.49) and the sixth month of IPT use (aRR = 2.49; 95% CI 1.34 – 4.65) were independent correlates of biomarker-confirmed nonadherence at each visit. Sensitivity and specificity of the in-house dipstick were 98.1% (94.7% - 99.6%) and 94.7% (88.1% - 98.3%), respectively, versus IsoscreenTM©. Conclusions: Biomarker-confirmed adherence to IPT was sub-optimal and was associated with viral non-suppression and duration of IPT. Urine dipstick testing may be useful in assessing adherence to IPT in clinical care.

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Tuberculosis Preventative Therapy Initiation and Completion Among Adolescents and Young Adults Living With HIV in Kenya

Black¹,

LaCourse

Njuguna

et al. 2023

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background:Tuberculosis is the leading cause of death among adolescents and young adults living with HIV (YWHIV) and their heightened risk warrants deeper understanding of utilization of tuberculosis-prevention measures within HIV care.Setting:Retrospective study using clinic surveys and medical record data from 86 Kenyan HIV clinics.Methods:Clinic surveys obtained information on tuberculosis preventive therapy (TPT) services. Medical records of YWHIV were abstracted. Bivariate and multivariate analyses used generalized linear models to determine individual-level and clinic-level cofactors of TPT initiation and completion.Results:Among 10,328 eligible YWHIV, 4337 (42.0%) initiated TPT. Of 3295 with ≥6 months follow-up, 1774 (53.8%) completed TPT. A lower patient-to-staff ratio was a clinic-level cofactor of TPT initiation (P = 0.044) and completion (P = 0.004); designated adolescent areas were associated with TPT initiation {prevalence ratio 2.05 [95% confidence interval (CI): 1.46 to –2.88]}. Individual cofactors of TPT initiation included younger age at HIV-care enrollment [relative risk (RR) 0.85 (95% CI: 0.80 to 0.90)] and antiretroviral therapy (ART) duration [1–2 vs. <1 year RR 1.31 (95% CI: 1.18 to 1.45)]. TPT completion was associated with younger age [RR 0.91 (95% CI: 0.85 to 0.98)] and ART duration [2–5 vs. <1 year RR 1.27 (95% CI: 1.03 to 1.57)]. In multivariate models, TPT initiation was associated with younger age and ART duration [1–2 vs. 1 year; adjusted RR 1.30 (95% CI: 1.16 to 1.46)] and TPT completion with ART duration [2–5 vs. 1 year adjusted RR 1.23 (95% CI: 0.99 to 1.52)].Conclusion:Over half of YWHIV did not initiate and >40% did not complete TPT, with distinct clinic-level and individual-level cofactors. Approaches to enhance adolescent-friendly infrastructure and support older YWHIV are necessary to improve TPT use.

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Drop‐offs in the isoniazid preventive therapy cascade among children living with HIV in western Kenya, 2015–2019

Cited by 3 publications

References 32 publications

Incidence, risk factors and interventions addressing mortality associated with HIV and TB infections among children and adults in Kenya

Incidence, risk factors and interventions addressing mortality associated with HIV and TB infections among children and adults in Kenya

Biomarker-confirmed suboptimal adherence to isoniazid preventive therapy among children with HIV in western Kenya

Tuberculosis Preventative Therapy Initiation and Completion Among Adolescents and Young Adults Living With HIV in Kenya

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