The global epidemiology of adolescents living with HIV

Slogrove, Amy L.; Sohn, Annette H.

doi:10.1097/coh.0000000000000449

Cited by 134 publications

(81 citation statements)

References 31 publications

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“…Similar to other study findings, 8 11 12 18 higher proportions (65%) of young adolescents were retained in care compared with older adolescents (56%) and young adults living with HIV (59%). Despite their higher rates of retention, young adolescents had comparatively much lower viral suppression rates (47%) compared with older adolescents (78%) and young adults (86%).…”

Section: Discussionsupporting

confidence: 90%

“…Compared with adults, adolescents and youths engage less with healthcare services and have lower viral suppression rates, [1][2][3][4][5] resulting in increases in AIDS-related deaths despite a global reduction of AIDS mortality among other age groups. [6][7][8] Under current circumstances, the global optimism to eliminate HIV by 2030 does not appear to hold for adolescents and youths. 9 10 Suboptimal outcomes among adolescents and youths living with HIV (AYLHIV) have been ascribed to vulnerabilities associated with the developmental challenges faced in the transition to adulthood.…”

Section: Introductionmentioning

confidence: 99%

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Multilevel modelling and multiple group analysis of disparities in continuity of care and viral suppression among adolescents and youths living with HIV in Nigeria

et al. 2020

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IntroductionSubstantial disparities in care outcomes exist between different subgroups of adolescents and youths living with HIV (AYLHIV). Understanding variation in individual and health facility characteristics could be key to identifying targets for interventions to reduce these disparities. We modelled variation in AYLHIV retention in care and viral suppression, and quantified the extent to which individual and facility characteristics account for observed variations.MethodsWe included 1170 young adolescents (10–14 years), 3206 older adolescents (15–19 years) and 9151 young adults (20–24 years) who were initiated on antiretroviral therapy (ART) between January 2015 and December 2017 across 124 healthcare facilities in Nigeria. For each age group, we used multilevel modelling to partition observed variation of main outcomes (retention in care and viral suppression at 12 months after ART initiation) by individual (level one) and health facility (level two) characteristics. We used multiple group analysis to compare the effects of individual and facility characteristics across age groups.ResultsFacility characteristics explained most of the observed variance in retention in care in all the age groups, with smaller contributions from individual-level characteristics (14%–22.22% vs 0%–3.84%). For viral suppression, facility characteristics accounted for a higher proportion of variance in young adolescents (15.79%), but not in older adolescents (0%) and young adults (3.45%). Males were more likely to not be retained in care (adjusted OR (aOR)=1.28; p<0.001 young adults) and less likely to achieve viral suppression (aOR=0.69; p<0.05 older adolescent). Increasing facility-level viral load testing reduced the likelihood of non-retention in care, while baseline regimen TDF/3TC/EFV or NVP increased the likelihood of viral suppression.ConclusionsDifferences in characteristics of healthcare facilities accounted for observed disparities in retention in care and, to a lesser extent, disparities in viral suppression. An optimal combination of individual and health services approaches is, therefore, necessary to reduce disparities in the health and well-being of AYLHIV.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Multilevel modelling and multiple group analysis of disparities in continuity of care and viral suppression among adolescents and youths living with HIV in Nigeria

et al. 2020

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“…Of the 1.8 million adolescents living with the HIV (ALWH) between the ages of 10 and 19 years [ 2 ], most ALWH were vertically infected due to maternal-to-child transmission (approximately 70%) [ 3 ]. Nearly 71% of all ALWH reside in one of 10 countries, with nine of these countries being in sub-Saharan Africa [ 4 ]. Adolescent girls accounted for around 60 to 74% of all ALWH between the ages of 15 and 19 years [ 4 – 6 ], with nearly 65% of infections being attributed to heterosexual sex, which is disproportionately higher than that of their male peers, in which 43% were due to horizontal infection [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Healthcare retention and clinical outcomes among adolescents living with HIV after transition from pediatric to adult care: a systematic review

et al. 2020

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Background: Adolescents living with HIV (ALWH) who transition from pediatric to adult care face several challenges that increase their risk of experiencing treatment interruptions and being lost to HIV care with resultant increased morbidity and mortality. To date, few studies have examined their outcomes post-healthcare transition (HCT), precluding the development and dissemination of evidence-based interventions aimed at retaining ALWH in HIV care both during and after HCT. We conducted a systematic review to synthesize the outcomes of ALWH post-HCT to provide suggestions for future directions. Methods: We systematically searched several electronic databases through October 2019 using keywords for HIV, HCT and ALWH. We categorized studies by target population, country (i.e., upper-high income and low-middle income), study design (i.e., descriptive, mixed methods, quantitative), outcomes measured, and follow-up period. Results: A total of 24 studies met inclusion criteria. Studies were categorized according to the following HCT outcomes: retention in HIV care post-HCT (n = 13), changes in CD4+ count and viral load post-HCT (n = 16), and mortality among ALWH post-HCT (n = 7). Most studies (n = 11) examining retention in HIV care indicated that more than 70% of ALWH were retained in care 1-2 years post-HCT while the remaining studies (n = 2) reported retention rates less than 55%. While studies indicated that CD4+ counts and viral loads tended to worsen during the first few years post-HCT, these differences were often not statistically significant. Among all ALWH who transitioned to adult care, a small proportion died within their first seven years post-HCT. Among qualitative studies, common themes included transition readiness (n = 6), provider-patient relationship in the adult clinic setting (n = 6), and concern about the adult clinic setting (n = 4). Conclusions: Transition outcomes were poorest for ALWH with unsuppressed viremia pre-HCT, suggesting that this subgroup of ALWH may need greater support from their treatment teams and caregivers during and post-HCT to improve clinical outcomes.

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“…Thanks to the success of antiretroviral therapy (ART), perinatally HIV-infected children are now living longer and the number of adolescents living with HIV is increasing worldwide [7]. Perinatally HIV-infected women (PHIV) are now experiencing pregnancy and recent reports from developed countries indicate that the first pregnancy occurs early, between 16 and 20 years [7,8].…”

Section: Introductionmentioning

confidence: 99%

High rate of rubella seronegativity in perinatally-infected HIV women of childbearing age: A case-control study

Beun

Grammens

Hainaut

et al. 2019

Vaccine

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Rubella infection is a vaccine preventable disease. Maternal infection during pregnancy may lead to congenital infection and severe foetal malformations. Thanks to antiretroviral therapy, perinatally HIVinfected women have better prognosis and are now experiencing pregnancy. We evaluated the rate of rubella seronegativity in a cohort of HIV perinatally-infected women of childbearing age. A high rate of seronegativity was found in this group as compared to age-matched non-perinatally infected HIVinfected women (34.5% vs 6.90%, p < 0.01). MMR administration before rubella testing was identified in 75.8% of perinatally-infected women (22/29) with a mean of 2 doses (range: 1-3 doses). HIV perinatally-infected women of childbearing age should be screened repeatedly for rubella immunity.

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The global epidemiology of adolescents living with HIV

Cited by 134 publications

References 31 publications

Multilevel modelling and multiple group analysis of disparities in continuity of care and viral suppression among adolescents and youths living with HIV in Nigeria

Multilevel modelling and multiple group analysis of disparities in continuity of care and viral suppression among adolescents and youths living with HIV in Nigeria

Healthcare retention and clinical outcomes among adolescents living with HIV after transition from pediatric to adult care: a systematic review

High rate of rubella seronegativity in perinatally-infected HIV women of childbearing age: A case-control study

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