Trends Over Time for Adolescents Enrolling in HIV Care in Kenya, Tanzania, and Uganda From 2001–2014

Apondi, Edith; Humphrey, John M.; Sang, Edwin; Mwangi, Ann; Keter, Alfred; Musick, Beverly; Nalugoda, Fred; Ssali, John; Bukusi, Elizabeth A.; Yiannoutsos, Constantin T.; Wools‐Kaloustian, Kara; Ayaya, Samuel

doi:10.1097/qai.0000000000001796

Cited by 5 publications

(5 citation statements)

References 46 publications

(45 reference statements)

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“…Along with the two-fold increase in the proportion of younger adolescents and the three-fold increase in the proportion of older adolescents over the study period, their median CD4 count at ART start also increased from 2011–2013 and reached up to over 350 cells/μl in 2017–2020. This finding is consistent with that of Apondi et al who has shown similar increase in the proportion of older adolescents at ART start in their study in East Africa [ 29 ]. Implementation of the Treat All strategy, rise in HIV testing and linkage to care, education on the AIDS epidemic, and counselling are described by the authors as likely contributing factors to this increase [ 30 , 31 ].…”

Section: Discussionsupporting

confidence: 93%

The changing characteristics of a cohort of children and adolescents living with HIV at antiretroviral therapy initiation in Asia

Sornillo,

Ditangco,

Kinikar

et al. 2023

PLoS ONE

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Despite improvements in HIV testing and earlier antiretroviral therapy (ART) initiation in children living with HIV through the years, a considerable proportion start treatment with advanced disease. We studied characteristics of children and adolescents living with HIV and their level of immunodeficiency at ART initiation using data from a multi-country Asian cohort. We included children and adolescents who were ART-naïve and <18 years of age at ART initiation from 2011 to 2020 at 17 HIV clinics in six countries. Incidence rates of opportunistic infections (OIs) in the first two years of triple-drug ART (≥3 antiretrovirals) was also reported. Competing risk regression analysis was performed to identify factors associated with first occurrence of OI. In 2,027 children and adolescents (54% males), median age at ART initiation increased from 4.5 years in 2011–2013 to 6.7 in 2017–2020, median CD4 count doubled from 237 cells/μl to 466 cells/μl, and proportion of children who initiated ART as severely immunodeficient decreased from 70% to 45%. During follow-up, 275 (14%) children who received triple-drug ART as first treatment and had at least one clinic visit, developed at least one OI in the first two years of treatment (9.40 per 100 person-years). The incidence rate of any first OI declined from 12.52 to 7.58 per 100 person-years during 2011–2013 and 2017–2020. Lower hazard of OIs were found in those with age at first ART 2–14 years, current CD4 ≥200 cells/μl, and receiving ART between 2017 and 2020. The analysis demonstrated increasing number of children and adolescents starting ART with high CD4 count at ART start. The rate of first OI markedly decreased in children who started ART in more recent years. There remains a clear need for improvement in HIV control strategies in children, by promoting earlier diagnosis and timely treatment.

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Section: Discussionsupporting

confidence: 93%

The changing characteristics of a cohort of children and adolescents living with HIV at antiretroviral therapy initiation in Asia

Sornillo,

Ditangco,

Kinikar

et al. 2023

PLoS ONE

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“…These findings are in accordance with previous research that has highlighted a range of social and structural barriers to HIV The absolute effect of treatment eligibility expansions for young adolescents was greater under general Treat All policies than under earlier pediatric Treat All policies. This was noteworthy, given that large numbers of adult patients, newly-eligible under Treat All, could potentially strain HIV service provision, leading to the crowding out of vulnerable groups, such as young adolescents, for whom tailored interventions and services are recommended [11,15,[38][39][40]. These results lend support for the supposition that general Treat All policies, with harmonized treatment recommendations for different population groups, are easier to implement in real-world treatment settings than prior policies targeting specific groups.…”

Section: Discussionmentioning

confidence: 83%

“…Increases in rapid ART initiation were particularly large following national adoptions of a general Treat All policy (i.e., for all ages) in 2016 in Burundi, DRC, Kenya, Malawi, and Rwanda. Observed increases in the proportion of young adolescents rapidly initiating ART following national adoption of Treat All policies may have substantial clinical importance, given evidence indicating that young adolescents with perinatally-acquired HIV often enroll in care late and do not initiate ART until they are at advanced stages of disease [14,15,[33][34][35].…”

Section: Discussionmentioning

confidence: 99%

“…Disproportionately high HIV-related mortality rates have been reported for young adolescents, compared with older adolescents who likely acquire HIV later in life [2]. Young adolescents enrolling in HIV care are often underweight and stunted, and they tend to have lower CD4 counts and more advanced disease than both older adolescents [14,15] and younger children diagnosed earlier following perinatal infection [16]. Research has shown that adolescents are also at greater risk of failing to initiate antiretroviral treatment (ART), particularly if they are ineligible for treatment at the time they enroll in HIV care [17].…”

Section: Introductionmentioning

confidence: 99%

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Impact of Universal Antiretroviral Treatment Eligibility on Rapid Treatment Initiation Among Young Adolescents with Human Immunodeficiency Virus in Sub-Saharan Africa

Tymejczyk

Brazier

Wools‐Kaloustian

et al. 2019

The Journal of Infectious Diseases

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Background Young adolescents with perinatally-acquired HIV are at risk for poor care outcomes. We examined whether universal antiretroviral treatment (ART) eligibility policies (Treat All) improved rapid ART initiation following care enrollment among 10-14-year-olds in seven sub-Saharan African countries. Methods Regression discontinuity analysis and data for 6,912 10-14-year-old patients were used to estimate changes in rapid ART initiation (within 30 days of care enrollment) following adoption of Treat All policies in two groups of countries: Uganda and Zambia (policy adopted in 2013) and Burundi, Democratic Republic of the Congo, Kenya, Malawi, and Rwanda (policy adopted in 2016). Results There were immediate increases in rapid ART initiation among young adolescents after national adoption of Treat All. Increases were greater in countries adopting the policy in 2016, compared with those adopting it in 2013: 23.4 percentage points (pp) (95%CI: 13.9-32.8) vs. 11.2pp (95%CI: 2.5-19.9). However, the rate of increase in rapid ART initiation among 10-14-year-olds rose appreciably in countries with earlier treatment expansions, from 1.5pp per year before Treat All to 7.7pp afterwards. Conclusions Universal ART eligibility has increased rapid treatment initiation among young adolescents enrolling in HIV care. Further research should assess their retention in care and viral suppression under Treat All.

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“…Additional factors unique to this setting that were associated with attrition included male sex, residence outside Asmara, enrolment in later years and late presentation. In general, data on the relationship between sex and attrition are inconsistent, with most studies reporting a null relationship, while others skew toward either sex 8 26 27. We believe that these inconsistencies and paradoxical results in cohorts across SSA mirror the disparate context-specific influences in the region.…”

Section: Discussionmentioning

confidence: 90%

Attrition and associated factors among children living with HIV at a tertiary hospital in Eritrea: a retrospective cohort analysis

Mengistu

Ghebremeskel

Rezene

et al. 2022

bmjpo

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BackgroundReducing attrition in paediatric HIV-positive patients using combined antiretroviral therapy (cART) programmes in sub-Saharan Africa is a challenge. This study explored the rates and predictors of attrition in children started on cART in Asmara, Eritrea.MethodsThis was a retrospective cohort study using data from all paediatric patients on cART between 2005 and 2020, conducted at the Orotta National Referral and Teaching Hospital. Kaplan-Meier estimates of the likelihood of attrition and multivariate Cox proportional hazards models were used to assess the factors associated with attrition. All p values were two sided and p<0.05 was considered statistically significant.ResultsThe study enrolled 710 participants with 374 boys (52.7%) and 336 girls (47.3%). After 5364 person-years’ (PY) follow-up, attrition occurred in 172 (24.2%) patients: 65 (9.2%) died and 107 (15.1%) were lost to follow-up (LTFU). The crude incidence rate of attrition was 3.2 events/100 PY, mortality rate was 2.7/100 PY and LTFU was 1.2/100 PY. The independent predictors of attrition included male sex (adjusted HR (AHR)=1.6, 95% CI: 1 to 2.4), residence outside Zoba Maekel (AHR=1.5, 95% CI: 1 to 2.3), later enrolment years (2010–2015: AHR=3.2, 95% CI: 1.9 to 5.3; >2015: AHR=6.1, 95% CI: 3 to 12.2), WHO body mass index-for-age z-score <−2 (AHR=1.4, 95% CI: 0.9 to 2.1), advanced HIV disease (WHO III or IV) at enrolment (AHR=2.2, 95% CI: 1.2 to 3.9), and initiation of zidovudine+lamivudine or other cART backbones (unadjusted HR (UHR)=2, 95% CI: 1.2 to 3.2). In contrast, a reduced likelihood of attrition was observed in children with a record of cART changes (UHR=0.2, 95% CI: 0.15 to 0.4).ConclusionA low incidence of attrition was observed in this study. However, the high mortality rate in the first 24 months of treatment and late presentation are concerning. Therefore, data-driven interventions for improving programme quality and outcomes should be prioritised.

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Trends Over Time for Adolescents Enrolling in HIV Care in Kenya, Tanzania, and Uganda From 2001–2014

Abstract: Expanding HIV services and ART coverage was likely associated with earlier adolescent enrollment and ART initiation but also with higher attrition rates before and after ART initiation. Interventions are needed to promote retention in care among adolescents.

Cited by 5 publications

References 46 publications

The changing characteristics of a cohort of children and adolescents living with HIV at antiretroviral therapy initiation in Asia

The changing characteristics of a cohort of children and adolescents living with HIV at antiretroviral therapy initiation in Asia

Impact of Universal Antiretroviral Treatment Eligibility on Rapid Treatment Initiation Among Young Adolescents with Human Immunodeficiency Virus in Sub-Saharan Africa

Attrition and associated factors among children living with HIV at a tertiary hospital in Eritrea: a retrospective cohort analysis

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