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

Griffiths, Karolina; Ford, Nathan

doi:10.1080/13623699.2013.813108

Cited by 13 publications

(11 citation statements)

References 22 publications

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“…Few studies, however, have sought to rigorously compare HIV treatment outcomes between refugee and host national groups. Previous work has shown high levels of adherence to ART, increases in CD4 counts, and increases in survival among confict-affected populations [4, 5]. In a study comparing urban refugees situated in Kuala Lumpur with Malaysian host nationals, we found comparable levels of viral suppression [6].…”

Section: Introductionsupporting

confidence: 54%

Low levels of viral suppression among refugees and host nationals accessing antiretroviral therapy in a Kenyan refugee camp

et al. 2017

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BackgroundRefugees and host nationals who accessed antiretroviral therapy (ART) in a remote refugee camp in Kakuma, Kenya (2011–2013) were compared on outcome measures that included viral suppression and adherence to ART.MethodsThis study used a repeated cross-sectional design (Round One and Round Two). All adults (≥18 years) receiving care from the refugee camp clinic and taking antiretroviral therapy (ART) for ≥30 days were invited to participate. Adherence was measured by self-report and monthly pharmacy refills. Whole blood was measured on dried blood spots. HIV-1 RNA was quantified and treatment failures were submitted for drug resistance testing. A remedial intervention was implemented in response to baseline testing. The primary outcome was viral load <5000 copies/mL. The two study rounds took place in 2011-2013.ResultsAmong eligible adults, 86% (73/85) of refugees and 84% (86/102) of Kenyan host nationals participated in the Round One survey; 60% (44/73) and 58% (50/86) of Round One participants were recruited for Round Two follow-up viral load testing. In Round One, refugees were older than host nationals (median age 36 years, interquartile range, IQR 31, 41 vs 32 years, IQR 27, 38); the groups had similar time on ART (median 147 weeks, IQR 38, 64 vs 139 weeks, IQR 39, 225). There was weak evidence for a difference in the proportion of refugees and host nationals who were virologically suppressed (<5000 copies/mL) after 25 weeks on ART (58% vs 43%, p = 0.10) and no difference in the proportions suppressed at Round Two (74% vs 70%, p = 0.66). Mean adherence within each group in Round One was similar. Refugee status was not associated with viral suppression in multivariable analysis (adjusted odds ratio: 1.69, 95% CI 0.79, 3.57; p = 0.17). Among those not suppressed at either timepoint, 69% (9/13) exhibited resistance mutations.ConclusionsVirologic outcomes among refugees and host nationals were similar but unacceptably low. Slight improvements were observed after a remedial intervention. Virologic monitoring was important for identifying an underperforming ART program in a remote facility that serves refugees alongside host nationals. This work highlights the importance of careful laboratory monitoring of vulnerable populations accessing ART in remote settings.Electronic supplementary materialThe online version of this article (doi:10.1186/s13031-017-0111-3) contains supplementary material, which is available to authorized users.

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Section: Introductionsupporting

confidence: 54%

Low levels of viral suppression among refugees and host nationals accessing antiretroviral therapy in a Kenyan refugee camp

et al. 2017

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“…The medical organisation Médecins Sans Frontières (MSF) reported results from 22 ART programs in conflict or postconflict settings in sub-Saharan Africa, finding that patient outcomes were comparable to those in stable resource-limited settings [3]. These findings were also shown in a systematic review and meta-analysis that found mortality and loss to follow-up (LTFU) of patients on ART in conflict settings after twelve months was 9.0% and 8.1% respectively, which are within the range of mortality and LTFU estimates from stable settings [4].…”

Section: Introductionmentioning

confidence: 57%

What drives mortality among HIV patients in a conflict setting? A prospective cohort study in the Central African Republic

Crellen

Ssonko

Piening³

et al. 2018

Preprint

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BackgroundProvision of antiretroviral therapy (ART) during conflict settings is rarely attempted and little is known about the expected patterns of mortality. The Central African Republic (CAR) continues to have a low coverage of ART despite an estimated 120,000 people living with HIV and 11,000 AIDS-related deaths in 2013. We present results from a cohort in Zemio, Haut-Mboumou prefecture. This region had the highest prevalence of HIV nationally (14.8% in 2010) and was subject to repeated attacks by armed groups on civilians during the observed period. MethodsConflict from armed groups can impact cohort mortality rates i) directly if HIV patients are victims of armed conflict, or ii) indirectly if population displacement or fear of movement reduces access to ART. Using monthly counts of civilian deaths, injuries and abductions, we estimated the impact of the conflict on patient mortality. We also determine patient-level risk factors for mortality and how this varies with time spent in the cohort. Model-fitting was performed in a Bayesian framework, using generalised-linear models with terms accounting for temporal autocorrelation. Results 2Patients were recruited and observed from October 2011 to May 2017. Overall 1631 patients were enrolled, giving 4107 person-years and 148 deaths. Our first model shows that patient mortality did not increase during periods of heightened conflict. The monthly risk (probability) of mortality was markedly higher at the beginning of the program (0.047 in November 2011 [95% credible interval; CrI 0.0078, 0.21]) and had declined greater than ten-fold by the end of the observed period (0.0016 in June 2017 [95% CrI 0.00042, 0.0036]). Our second model shows the risk of mortality for individual patients was highest in the first five months spent in the cohort. Male sex was associated with a higher mortality (odds ratio; OR 1.7 [95% CrI 1.2, 2.8]) along with the severity of opportunistic infections at baseline. ConclusionsOur results show that chronic conflict did not appear to adversely affect rates of mortality in this cohort, and that mortality was driven predominantly by patient specific risk factors. In areas initiating ART for the first time, particular attention should be focussed on stabilising patients with advanced symptoms. Funding Médecins Sans Frontières

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“…Since then, it has been established that mass rapes and survival transaction sex affecting IDP and refugee women in recent conflicts [ 21 , 40 – 42 ] may impact HIV prevalence in these vulnerable populations but also affect national HIV prevalence and incidence [ 43 ]. However, because a systematic review of interventions that target antiretroviral care for HIV in displaced populations has documented adequate adherence in IDPs, while also profiling the need for multistakeholder engagement and preparedness, it is clear that HIV test-and-treat interventions with IDPs can be successful, leading to outcomes matching those of stable settings [ 44 ]. Our results show that among the unrepresentative sample of adult IDPs in Northeast Nigeria, HIV prevalence was 1.6% whereas the estimated prevalence of HIV among adults in all 3 states was between 0.4%–1.3% [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Providing TB and HIV outreach services to internally displaced populations in Northeast Nigeria: Results of a controlled intervention study

Abdullahi¹,

Smelyanskaya²,

John³

et al. 2020

PLoS Med

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Background A decade of Boko Haram insurgency brought conflict, mass displacement, and the destruction of basic infrastructure to Northeast Nigeria. Over 2 million internally displaced persons (IDPs) suffering from lack of basic hygienic conditions, malnutrition, and disease live in camps or are hosted by communities in the region, where the conflict has contributed to a massive destruction of health facilities. Infectious diseases like tuberculosis (TB) and HIV are especially difficult to address under such conditions, and IDPs are vulnerable to both. Although international investment supports some health interventions among IDPs, locally sourced solutions are lacking.

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

Cited by 13 publications

References 22 publications

Low levels of viral suppression among refugees and host nationals accessing antiretroviral therapy in a Kenyan refugee camp

Low levels of viral suppression among refugees and host nationals accessing antiretroviral therapy in a Kenyan refugee camp

What drives mortality among HIV patients in a conflict setting? A prospective cohort study in the Central African Republic

Providing TB and HIV outreach services to internally displaced populations in Northeast Nigeria: Results of a controlled intervention study

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