Evidence of reduced treatment adherence among HIV infected paediatric and adolescent populations in Nairobi at the onset of the UNAIDS Universal Test and Treat Program

Abstract

ObjectiveWe conducted a retrospective cohort study to evaluate the efficacy of the World Health Organization (WHO) “Universal Test and Treat” (UTT) policy, initiated in Kenya in September 2016. Under this policy, every human immunodeficiency virus (HIV)-infected person should be initiated on antiretroviral therapy (ART). We compared intra- and inter-group viral suppression and ART adherence rates for pre-UTT (initiated on ART in March–August 2016) and UTT groups (initiated in September 2016). The study was conducted in a community outreach Program in Nairobi with 3500 HIV-infected children enrolled.Results122 children and adolescents were initiated on first-line ART pre-UTT, and 197 during the UTT period. The 6 month viral suppression rate was 79.7% pre-UTT versus 76.6% UTT (P < 0.05). Suboptimal adherence was higher in the UTT than pre-UTT period (88 of 197, 44.7% and 44 of 122, 34%; P < 0.001). The decrease in adherence was greater among orphans (91.7% pre-UTT and 87.2% UTT, P = 0.001) and children 11–18 years. Our results show that successful implementation of the UTT policy in Africa is challenged by an increased risk of suboptimal adherence. There is a need to develop extra strategies to support adherence, especially among orphans and teenagers.Electronic supplementary materialThe online version of this article (10.1186/s13104-018-3205-0) contains supplementary material, which is available to authorized users.

Patient-mix, programmatic characteristics, retention and predictors of attrition among patients starting antiretroviral therapy (ART) before and after the implementation of HIV “Treat All” in Zimbabwe

“…Compared to other implementation studies conducted to date comparing outcomes before and after "Treat All" [6][7][8][9][10][11][12][13], our study sample size was large. The pilot districts were distributed across all the regions of the country.…”

“…Multiple studies have assessed the real-world effects of “Treat All” on ART initiation, linkage, virologic suppression, and retention. However, these studies have reported inconsistent results [ 6 – 13 ]. None of these previous studies has assessed if predictors for attrition changed since the transition to “Treat All”.…”

A Phenomenological Account of HIV Disclosure Experiences of Children and Adolescents from Northern and Southern Ghana

“…Child HIV status disclosure is complex and brings about hesitancy and ethical dilemmas taking into consideration the socio-cultural and stigma related issues and secrecy surrounding HIV infection [10]. As a result, caregivers have a dilemma whether to disclose or not to to a child the child’s own HIV/AIDS status, principally due to their inability to trade-off between the benefit and challenges that comes with paediatric disclosure considered to contribute to increasing child survival [11,12]. Disclosure offers a psychological boost, facilitates better coping strategies for the child and gives a protection mechanism for potentially early sexual initiation and risky sexual behaviour [11,13].…”

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“…Rates a f c ; a m c represent negative attitudes affecting the efficacy of condom use rate in the AGYW and ABYM populations such as religion, peer influence, perceived individual's risk among others [3,[12][13][14][15]. Also, a f t ; a m t represent negative attitudes affecting the efficacy of ART usage rate among the infected AGYW and ABYM such as stigma, poverty, caregivers waning support, confidentiality breaches by health workers among others [9,10,20,21]. Section 1 highlights how societal attitudes affect HIV testing rates, condom use and adherence to ART among the youth in Kenya.…”

“…Universal Test and Treat strategy by the World Health Organization (WHO) requires that all persons testing positive for HIV/AIDS be initiated on ART immediately irrespective of their CD4+ T cell count so as to achieve 90% diagnosis of all HIV positive persons with 90% of those positively diagnosed initiated on ART so as to achieve 90% viral load suppression [19]. Unfortunately, the adherence rates to ART is proving to be an uphill task among the youth in Kenya [20]. Factors influencing non adherence to ART among the youth in Kenya include stigma associated with disclosure of HIV/AIDS status, lack of adequate support from primary care givers and health workers, treatment fatigue, lack of adequate support structures in schools for youth living with HIV/AIDS, confidentiality breaches by health providers leading to disclosure of patients status to the community, fear of gossip and ridicule, financial constraints leading to failure to honor medical appointments or collect ART drugs and physical and emotional violence meted to orphaned perinatally infected youth by their care givers prompting them to fend for themselves or forcing them to street life [9,10,20,21].…”