High level of adherence to HAART among refugees and internally displaced persons on HAART in western equatorial region of Southern Sudan

Salami, Olawale; Buzu, A; Nzeme, C

doi:10.1186/1758-2652-13-s4-p123

Cited by 7 publications

(6 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The conflict setting had higher 12-month mortality (7.9%, 95%CI 3.6, 12.1) than comparison settings, but the six-month median CD4 cell gain of 163 cells/mm 3 compared favourably with cohorts from a resource-limited setting (106 cells/mm 3 ) and a resource-rich setting (103 cells/mm 3 ). In the Equatorial province of Sudan, Salami and colleagues [17] found that 88% of refugees and IDPs on HAART for ≥6 months self-reported ≥95% adherence. A South African study comparing self-identified foreigners with local citizens reported that foreigners were less than half as likely (OR=0.45, 95%CI 0.23, 0.87; p = 0.017) to have suffered viral failure, defined as ART cessation, any decrease in CD4 from pre-ART levels, a viral load of >1000 copies/mL, or death [18].…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Adherence to antiretroviral therapy and treatment outcomes among conflict-affected and forcibly displaced populations: a systematic review

et al. 2012

View full text Add to dashboard Cite

BackgroundOptimal adherence to highly active antiretroviral therapy (HAART) is required to promote viral suppression and to prevent disease progression and mortality. Forcibly displaced and conflict-affected populations may face challenges succeeding on HAART. We performed a systematic review of the literature on adherence to HAART and treatment outcomes in these groups, including refugees and internally-displaced persons (IDPs), assessed the quality of the evidence and suggest a future research program.MethodsMedline, Embase, and Global Health databases for 1995–2011 were searched using the Ovid platform. A backward citation review of subsequent work that had cited the Ovid results was performed using the Web of Science database. ReliefWeb and Médecins Sans Frontières (MSF) websites were searched for additional grey literature.Results and conclusionWe screened 297 records and identified 17 reports covering 15 quantitative and two qualitative studies from 13 countries. Three-quarters (11/15) of the quantitative studies were retrospective studies based on chart review; five studies included <100 clients. Adherence or treatment outcomes were reported in resettled refugees, conflict-affected persons, internally-displaced persons (IDPs), and combinations of refugees, IDPs and other foreign-born persons. The reviewed reports showed promise for conflict-affected and forcibly-displaced populations; the range of optimal adherence prevalence reported was 87–99.5%. Treatment outcomes, measured using virological, immunological and mortality estimates, were good in relation to non-affected groups. Given the diversity of settings where forcibly-displaced and conflict-affected persons access ART, further studies on adherence and treatment outcomes are needed to support scale-up and provide evidence-based justifications for inclusion of these vulnerable groups in national treatment plans. Future studies and program evaluations should focus on systematic monitoring of adherence and treatment interruptions by using facility-based pharmacy records, understanding threats to optimal adherence and timely linkage to care throughout the displacement cycle, and testing interventions designed to support adherence and treatment outcomes in these settings.

show abstract

Section: Resultsmentioning

confidence: 99%

“…Notably, only one study dealt with documented refugees in low-income settings [17]. The limited number of studies, small sample sizes (five included <100 clients), lack of comparison groups and varied outcomes and indicators suggest that estimates may have suffered from selection and response biases.…”

Section: Discussionmentioning

confidence: 99%

Adherence to antiretroviral therapy and treatment outcomes among conflict-affected and forcibly displaced populations: a systematic review

et al. 2012

View full text Add to dashboard Cite

show abstract

“…In a Ugandan cross-sectional study of IDPs, mean self-reported adherence was 99.5 % [ 19 ]. In the western Equatorial province of Sudan, 12 % of refugees and IDPs on HAART for ≥6 months self-reported <95 % adherence [ 20 ]. During active conflict in the Democratic Republic of the Congo, sub-optimal adherence (measured by pill counts) was found in only 1 % of clients while CD4 gain at six months was similar to other stable cohorts [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Is Forced Migration a Barrier to Treatment Success? Similar HIV Treatment Outcomes Among Refugees and a Surrounding Host Community in Kuala Lumpur, Malaysia

et al. 2013

View full text Add to dashboard Cite

In response to an absence of studies among refugees and host communities accessing highly active antiretroviral therapy (HAART) in urban settings, our objective was to compare adherence and virological outcomes among clients attending a public clinic in Kuala Lumpur, Malaysia. A cross-sectional survey was conducted among adult clients (≥18 years). Data sources included a structured questionnaire that measured self-reported adherence, a pharmacy-based measure of HAART prescription refills over the previous 24 months, and HIV viral loads. The primary outcome was unsuppressed viral load (≥40 copies/mL). Among a sample of 153 refugees and 148 host community clients, refugees were younger (median age 35 [interquartile range, IQR 31, 39] vs 40 years [IQR 35, 48], p < 0.001), more likely to be female (36 vs 21 %, p = 0.004), and to have been on HAART for less time (61 [IQR 35, 108] vs 153 weeks [IQR 63, 298]; p < 0.001). Among all clients, similar proportions of refugee and host clients were <95 % adherent to pharmacy refills (26 vs 34 %, p = 0.15). When restricting to clients on treatment for ≥25 weeks, similar proportions from each group were not virologically suppressed (19 % of refugees vs 16 % of host clients, p = 0.54). Refugee status was not independently associated with the outcome (adjusted odds ratio, aOR = 1.28, 95 % CI 0.52, 3.14). Overall, the proportions of refugee and host community clients with unsuppressed viral loads and sub-optimal adherence were similar, supporting the idea that refugees in protracted asylum situations are able to sustain good treatment outcomes and should explicitly be included in the HIV strategic plans of host countries with a view to expanding access in accordance with national guidelines for HAART.Electronic supplementary materialThe online version of this article (doi:10.1007/s10461-013-0494-0) contains supplementary material, which is available to authorized users.

show abstract

“…After screening 6457 titles, fourteen studies were included in this review (Figure 1). Six studies were carried out in armed conflict settings (Kiboneka et al 2008;Garang, Odoi, and Kalyango 2009;Kiboneka et al 2009;O'Brien et al 2010;Salami, Buzu, and Nzeme 2010;Autino et al 2012). Two studies (Culbert et al 2007, Vreeman et al 2009 reported results that were reported by other included studies (O'Brien et al 2010;Yoder et al 2012) and were excluded from the final review.…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

“…All of the included studies were observational cohorts. Three of the studies were published as abstracts, and did not provide enough information to fully assess the study methodology (Salami, Buzu, and Nzeme 2010;Doumbouya et al 2012;Bhakeecheep et al 2012). Nine of the studies did not statistically adjust for confounders and seven studies did not follow up patients for more than six months.…”

Section: Assessment Of Study Qualitymentioning

confidence: 99%

Provision of antiretroviral care to displaced populations in humanitarian settings: a systematic review

Griffiths

Ford

2013

Medicine, Conflict and Survival

View full text Add to dashboard Cite

Providing antiretroviral treatment (ART) in humanitarian settings is challenging. Reports suggest that ART provision is feasible, but the evidence base is scarce. We systematically searched three databases for studies reporting ART outcomes among displaced populations in settings of conflict, natural disasters or political instability, and estimated overall mortality using random effects models. Fourteen studies were identified, six in conflict areas, five in areas of post-election violence and three in natural disaster settings. The pooled proportion for mortality was 7.6% (95% CI 5.3-10.0%) at six months and 9.0% (95% CI 5.8-12.2%) at 12 months. Loss-to-follow-up at six months was 6.3% (95% CI 4.3-8.3%) and at 12 months was 8.1% (4.9-11.2%). Adherence was comparable to stable settings. Strategies used to support ART provision included additional drug stocks and establishing peer communication networks. Good clinical outcomes can be achieved with ART in disaster setting, in particular if supported by regional collaboration, standardized drug regimens and contingency planning.

show abstract

High level of adherence to HAART among refugees and internally displaced persons on HAART in western equatorial region of Southern Sudan

Abstract: 7‐11 November 2010, Tenth International Congress on Drug Therapy in HIV Infection, Glasgow, UK

Cited by 7 publications

References 0 publications

Adherence to antiretroviral therapy and treatment outcomes among conflict-affected and forcibly displaced populations: a systematic review

Adherence to antiretroviral therapy and treatment outcomes among conflict-affected and forcibly displaced populations: a systematic review

Is Forced Migration a Barrier to Treatment Success? Similar HIV Treatment Outcomes Among Refugees and a Surrounding Host Community in Kuala Lumpur, Malaysia

Provision of antiretroviral care to displaced populations in humanitarian settings: a systematic review

Contact Info

Product

Resources

About