Gaps in Adolescent Engagement in Antenatal Care and Prevention of Mother-to-Child HIV Transmission Services in Kenya

Ronen, Keshet; McGrath, Christine J.; Langat, Agnes; Kinuthia, John; Omolo, Danvers; Singa, Benson; Katana, Abraham; Ng’ang’a, Lucy; John‐Stewart, Grace

doi:10.1097/qai.0000000000001176

Cited by 53 publications

(74 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Younger mothers were significantly more likely to have children <12 months of age who were, in turn, more likely to have high VL; however, even in multivariable models adjusted for child's age and VL, maternal age was still a significant predictor of VS. While lower VS for children with younger mothers has not been previously reported, existing data show that younger women are less likely to complete PMTCT and to be retained in care . It is possible that the poor treatment outcomes among young mothers has an impact on their children's health; however, this question warrants further investigation.…”

Section: Discussionmentioning

confidence: 88%

HIV viral suppression and longevity among a cohort of children initiating antiretroviral therapy in Eastern Cape, South Africa

et al. 2018

View full text Add to dashboard Cite

IntroductionThere are limited data on viral suppression (VS) in children with HIV receiving antiretroviral therapy (ART) in routine care in low‐resource settings. We examined VS in a cohort of children initiating ART in routine HIV care in Eastern Cape Province, South Africa.MethodsThe Pediatric Enhanced Surveillance Study enrolled HIV‐infected ART eligibility children zero to twelve years at five health facilities from 2012 to 2014. All children received routine HIV care and treatment services and attended quarterly study visits for up to 24 months. Time to VS among those starting treatment was measured from ART start date to first viral load (VL) result <1000 and VL <50 copies/mL using competing risk estimators (death as competing risk). Multivariable sub‐distributional hazards models examined characteristics associated with VS and VL rebound following suppression among those with a VL >30 days after the VS date.ResultsOf 397 children enrolled, 349 (87.9%) started ART: 118 (33.8%) children age <12 months, 122 (35.0%) one to five years and 109 (31.2%) six to twelve years. At study enrolment, median weight‐for‐age z‐score (WAZ) was −1.7 (interquartile range (IQR):−3.1 to −0.4) and median log VL was 5.6 (IQR: 5.0 to 6.2). Cumulative incidence of VS <1000 copies/mL at six, twelve and twenty‐four months was 57.6% (95% CI 52.1 to 62.7), 78.7% (95% CI 73.7 to 82.9) and 84.0% (95% CI 78.9 to 87.9); for VS <50 copies/mL: 40.3% (95% CI 35.0 to 45.5), 63.9% (95% CI 58.2 to 69.0) and 72.9% (95% CI 66.9 to 78.0). At 12 months only 46.6% (95% CI 36.6 to 56.0) of children <12 months had achieved VS <50 copies/mL compared to 76.9% (95% CI 67.9 to 83.7) of children six to twelve years (p < 0.001). In multivariable models, children with VL >1 million copies/mL at ART initiation were half as likely to achieve VS <50 copies/mL (adjusted sub‐distributional hazards 0.50; 95% CI 0.36 to 0.71). Among children achieving VS <50 copies/mL, 37 (19.7%) had VL 50 to 1000 copies/mL and 31 (16.5%) had a VL >1000 copies/mL. Children <12 months had twofold increased risk of VL rebound to VL >1000 copies/mL (adjusted relative risk 2.03, 95% CI: 1.10 to 3.74) compared with six to twelve year olds.ConclusionsWe found suboptimal VS among South African children initiating treatment and high proportions experiencing VL rebound, particularly among younger children. Greater efforts are needed to ensure that all children achieve optimal outcomes.

show abstract

Section: Discussionmentioning

confidence: 88%

HIV viral suppression and longevity among a cohort of children initiating antiretroviral therapy in Eastern Cape, South Africa

et al. 2018

View full text Add to dashboard Cite

show abstract

“…[13] Briefly, we used probability proportionate to size sampling to select 121 MCH clinics in seven of the eight geographical regions in Kenya from which all mother-infant pairs were sampled to participate during a 5-day period per clinic. We classified facility size based on annual number of ANC clinic visits in 2011 and excluded “small” (<500 visits) and/or North Eastern Province facilities due to logistical constraints.…”

Section: 0 Materials and Methodsmentioning

confidence: 99%

Uptake and correlates of contraception among postpartum women in Kenya: results from a national cross-sectional survey

et al. 2018

Self Cite

View full text Add to dashboard Cite

Objectives To characterize uptake and correlates of effective contraceptive use postpartum. Study Design We analyzed data from a national, cross-sectional evaluation of prevention of mother-to-child HIV transmission programs that enrolled women attending 6-week or 9-month infant immunization visits at 120 Kenyan maternal and child health clinics. We classified women who resumed sexual activity postpartum and did not desire a child within 2 years as having a need for family planning (FP). Results We included 955 (94%) of 1012 women 8–10 months postpartum in the analysis. Mean age was 25.8 years and 36% were primigravidas. By 9-months postpartum 62% of all women used contraception and 59% used effective contraception (injectables, implants, intrauterine devices [IUDs], oral contraceptives [OCs], and tubal ligations). Most contraceptive users (61%) used injectables, followed by implants (10%), OCs (6%), IUDs (4%), and condoms alone (2%). The majority (n=733, 77%) had a need for FP and 67% of 733 women with FP need used effective contraception. Among women with a need for FP, effective contraception use was higher among those who discussed FP in postnatal care (PNC) than who did not discuss FP in PNC (Prevalence Ratio (PR) for PNC alone: 1.35 (95% Confidence Interval [CI]:1.16-1.58; PR for PNC and antenatal care [ANC]:1.42, 95% CI: 1.21-1.67; p=0.001 for both). Conclusions Two-thirds of postpartum women with a need for FP used effective contraception at 9-months postpartum, and use was associated with discussing FP during PNC. Implications Integrating FP counseling in ANC/PNC could be an effective strategy to increase effective contraception use.

show abstract

“…Adolescents and young adults had specific expectations of transition services; as reported in Burkina Faso, reaching adulthood raises particular problems for HIV-infected adolescent females with the issues of relationship to self (biographical disruption and jeopardized female identity) and to others (weakening of social ties in situations of dependency and of pursuit of social advancement, marriage and procreation) [32]. In one study, female adolescents and youth engagement in the prevention of mother-to-child HIV transmission (PMTCT) services showed that they had poorer antenatal care attendance and uptake of ART compared to adult pregnant women [36]. This vulnerability needs to be taken into account when managing the transition process [32].…”

Section: Barriers Facilitators Expectations and Needs Associated Wimentioning

confidence: 99%

Transition from paediatric to adult care of adolescents living with HIV in sub‐Saharan Africa: challenges, youth‐friendly models, and outcomes

Dahourou

Gautier-Lafaye

Teasdale

et al. 2017

Journal of the International AIDS Society

110

149

View full text Add to dashboard Cite

Introduction: The number of adolescents with perinatally or behaviourally acquired HIV is increasing in low-income countries, and especially in sub-Saharan Africa where HIV prevalence and incidence are the highest. As they survive into adulthood in the era of antiretroviral therapy, there is a pressing need to transfer them from paediatric to adult care, known as the transition of care. We conducted a narrative review of recent evidence on their transition outcomes in Africa, highlighting the specific needs and challenges in these populations and settings, and the different models of care for transition.Areas covered: We searched PubMed bibliographic database, HIV conference content, and grey literature from January 2000 to August 2016 with the following keywords: HIV infections AND (adolescents or youth) AND transition AND Africa. All qualitative and quantitative, experimental and observational studies including HIV-infected patients aged 10–24 years with information on transition were eligible.Results: Few data on transition outcomes for HIV-infected adolescents are available from Africa settings. Studies mainly from Southern and East Africa reported on the barriers to successful transition, highlighting several gaps. These included lack of adequate infrastructure, staff training and communication between paediatric and adult clinicians as well as the fear of stigma of adolescents and youth living with HIV. Most countries have no specific national guidelines on when to disclose HIV status or when and how to transition to adult care. Several models of care adapted to the adolescent transition question have been implemented in specific settings. These models include teen clinics, peer educators or the use of social media. However, regardless of the model, services are increasingly overburdened and have insufficient human resources. Furthermore, very high attrition has been observed among adolescents and youth compared to younger children or older adults. There is a need to identify sub-groups at higher risk of loss to follow-up for targeted care and peer support.Expert commentary: Although the available HIV-related data on adolescent transition outcomes are limited, there is evidence of their increased vulnerability during this period. Standardized data gathering, analysis, and reporting systems specific to adolescent transition are essential to improve understanding and adolescent outcomes in Africa.

show abstract

Gaps in Adolescent Engagement in Antenatal Care and Prevention of Mother-to-Child HIV Transmission Services in Kenya

Cited by 53 publications

References 25 publications

HIV viral suppression and longevity among a cohort of children initiating antiretroviral therapy in Eastern Cape, South Africa

HIV viral suppression and longevity among a cohort of children initiating antiretroviral therapy in Eastern Cape, South Africa

Uptake and correlates of contraception among postpartum women in Kenya: results from a national cross-sectional survey

Transition from paediatric to adult care of adolescents living with HIV in sub‐Saharan Africa: challenges, youth‐friendly models, and outcomes

Contact Info

Product

Resources

About