Variations in the characteristics and outcomes of children living with HIV following universal ART in sub-Saharan Africa (2006–17): a retrospective cohort study

Iyun, Victoria; Technau, Karl-Günter; Vinikoor, Michael J.; Yotebieng, Marcel; Vreeman, Rachel C.; Abuogi, Lisa; Desmonde, Sophie; Edmonds, Andrew; Amorissani‐Folquet, Madeleine; Davies, Mary‐Ann

doi:10.1016/s2352-3018(21)00004-7

Cited by 21 publications

(25 citation statements)

References 21 publications

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“…CALHIV who did not become virally suppressed were more likely to be aged 0-4 years or 15-19 years old, had higher disease burden (WHO stage 3 or 4, or TB), less treatment experience, and less use of DTG-based regimens. Severe immunosuppression and high disease burden from untreated HIV-typically from delays in diagnosis and difficulties accessing to ART-is associated with worse outcomes in CALHIV, 5,34 and was again observed in our study. This highlights the importance of intensive efforts to diagnose and treat CALHIV as early as possible to preserve immune function, prevent opportunistic infections, and allow these children to thrive.…”

Section: Discussionsupporting

confidence: 82%

“…3,4 Lack of consistent, standardized, and comprehensive reporting of 90-90-90 targets among CALHIV has made it difficult to know their true target progress. Current estimates put 54% (37%–69%) of children living with HIV receiving ART, with minimal data on viral suppression resulting in wide variation of estimates—from 30% 5 to 68% 6 —and huge disparities across countries. 7 Eastern and Southern Africa is the region with largest overall HIV burden, with over half of all PLHIV and 2 thirds of all CALHIV in the world, 58% of all new HIV infections, and 51% of all HIV deaths among CALHIV.…”

Section: Introductionmentioning

confidence: 99%

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Achieving Antiretroviral Therapy Uptake and Viral Suppression Among Children and Adolescents Living With HIV in the UNAIDS 90-90-90 Era Across Six Countries in Eastern and Southern Africa—Lessons From the BIPAI Network

Bacha

Dlamini

Anabwani³

et al. 2022

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Section: Discussionsupporting

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Achieving Antiretroviral Therapy Uptake and Viral Suppression Among Children and Adolescents Living With HIV in the UNAIDS 90-90-90 Era Across Six Countries in Eastern and Southern Africa—Lessons From the BIPAI Network

Bacha

Dlamini

Anabwani³

et al. 2022

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…However, the findings reported lower VLS rates compared to 2012 findings where VLS was at 84% in low-and middle-income countries yet was in consistent with findings of a systematic review reporting 59% in SSA [101,102] . Secondly, loss to follow up in our review was 17% (95% CI [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] which is lower to findings of a study conducted in 34 countries under the International epidemiology Database to Evaluate AIDS (IeDEA) where LTFU was reported to be 30% in 2018 [105]. Loss to follow up rate in this review indicate improvement when compared to studies conducted in 2007 in SSA where LTFU was 51% [106].…”

Section: (Which Was Not Certified By Peer Review)contrasting

confidence: 55%

“…However, adolescents in the SSA region present poor outcomes as 43% are initiated on ART treatment with only 31% of those initiated on ART continue to access ART. Among those continually accessing ART, 30% are viral load suppressed [17, 18]. The COVID-19 pandemic has further negatively influenced the HIV outcomes globally [19, 20].…”

Section: Introductionmentioning

confidence: 99%

Barriers and facilitators to anti-retroviral therapy adherence among adolescents aged 10 to 19 years living with HIV in sub-Saharan Africa: A mixed-methods systematic review

Hlophe

Tamuzi

Shumba

et al. 2022

Preprint

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Background: Human Immunodeficiency Virus (HIV) significantly affects adolescents globally, with the sub-Saharan Africa (SSA) reporting a high burden of the disease. HIV testing, treatment, and retention to care are low among adolescents. We conducted a mixed-method systematic review to assess anti-retroviral therapy (ART) adherence; barriers and facilitators to ART adherence and ART outcomes among adolescents living with HIV and on ART in sub-Saharan Africa. Methods: We conducted searches in four scientific databases for studies conducted between 2010 and March 2022 to identify relevant primary studies. Studies were screened against inclusion criteria and assessed for quality, and data was extracted. Meta-analysis of rates and odd ratios was used to plot the quantitative studies and meta-synthesis summarized the evidence from qualitative studies. Results: A total of 10 431 studies were identified and screened against the inclusion/ exclusion criteria. Sixty-six studies met the inclusion criteria (41 quantitative, 16 qualitative, and 9 mixed-methods study designs). Fifty-three thousand two hundred and seventeen (53 217) adolescents (52 319 in quantitative studies and 899 in qualitative studies) were included in the review. Thirteen support focused interventions for improved ART adherence were identified from quantitative studies. The plotted results from the meta-analysis found an ART adherence rate of 65% (95%CI 56-74), viral load suppression was 55% (95%CI 46-64), un-suppressed viral load rate of 41% (95%CI 32-50), and loss to follow up of 17% (95%CI 10-24) among adolescents. Meta-synthesis found six themes of barriers to ART (social, patient-based, economic, health system-based, therapy-based, and cultural barriers) in both the qualitative and quantitative studies, and three themes of facilitators to ART were also identified (social support, counselling, and ART education and secrecy or confidentiality) from qualitative studies. Conclusion: ART adherence remains low among adolescents in SSA despite multiple interventions implemented to improve ART adherence. The low adherence rate may hinder the attainment of the UNAIDS 2030 targets. Additionally, various barriers to ART adherence due to lack of support have been reported among this age group. However, interventions aimed at improving social support, educating, and counselling adolescents may improve and sustain ART adherence.

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“…Globally 1.8 million children aged <15 years living with HIV/AIDS, ~150,000 children became newly infected and 95,000 children died of HIV/AIDS-related illnesses in 2019 ( 1 ). Children with HIV disproportionally impacted middle- and low-income countries where the HIV disease burden was high and resources were limited ( 2 , 3 ). China's MTCT prevention programs have achieved full coverage in 2015, although significant improvement has been made, the MTCT rate was only 5.7% in 2016 ( 4 , 5 ).…”

Section: Introductionmentioning

confidence: 99%

Treatment Outcomes of HIV Infected Children After Initiation of Antiretroviral Therapy in Southwest China: An Observational Cohort Study

et al. 2022

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BackgroundThe number of HIV infected children receiving antiviral treatment in Guangxi is increasing. Understanding factors and trends of mortality and attrition in HIV-infected children under antiretroviral therapy (ART) was an urgent need to improve treatment outcomes. This study aimed to estimate mortality and attrition rates and identify factors that were associated with mortality and attrition after ART initiation among children with HIV in Guangxi, China between 2004 and 2018.MethodsCohort study data were extracted from the National Free Antiretroviral Treatment Program (NFATP) database, which has standard guidelines for core treatment indicators and other data at all HIV/AIDS treatment facilities in Guangxi. A total of 901 HIV-infected children who have started ART were included in the study. The study collected the following data: age, gender, WHO clinic stages before ART, CD4 cell count before ART, Cotrimoxazole prophylaxis (CTX) use before ART, initial ART regimen, malnutrition before ART, abnormal liver function before ART, abnormal kidney function before ART, severe anemia before ART, and the time lag between an HIV diagnosis and ART initiation.ResultsHIV-infected children under ART had a mortality rate of 0.87 per 100 person-years [95% Confidence Interval (CI) 0.63–1.11], and an attrition rate of 3.02 per 100 person-years (95% CI 2.57–3.47). Mortality was lower among children with a CD4 count between 200 and 500 copies/ml [Adjusted Hazard Ratio (AHR) 0.22, 95% CI 0.09–0.55], and CD4 count ≥500 copies/ml (AHR 0.10, 95% CI 0.03–0.29); but higher among children with late ART initiation at 1–3 months (AHR 2.30, 95% CI 1.07–4.94), and at ≥3 months (AHR 2.22, 95% CI 1.04–4.74). Attrition was lower among children with a CD4 count ≥500 copies/ml (AHR 0.62, 95% CI 0.41–0.95), but higher among children with late ART initiation at 1–3 months (AHR 1.55, 95% CI 1.05–2.30).ConclusionSupportive programs are needed to educate children's families and parents on early ART, link HIV-infected children to care and retain them in care among other programs that treat and manage the medical conditions of HIV-infected children before ART initiation.

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Variations in the characteristics and outcomes of children living with HIV following universal ART in sub-Saharan Africa (2006–17): a retrospective cohort study

Cited by 21 publications

References 21 publications

Achieving Antiretroviral Therapy Uptake and Viral Suppression Among Children and Adolescents Living With HIV in the UNAIDS 90-90-90 Era Across Six Countries in Eastern and Southern Africa—Lessons From the BIPAI Network

Achieving Antiretroviral Therapy Uptake and Viral Suppression Among Children and Adolescents Living With HIV in the UNAIDS 90-90-90 Era Across Six Countries in Eastern and Southern Africa—Lessons From the BIPAI Network

Barriers and facilitators to anti-retroviral therapy adherence among adolescents aged 10 to 19 years living with HIV in sub-Saharan Africa: A mixed-methods systematic review

Treatment Outcomes of HIV Infected Children After Initiation of Antiretroviral Therapy in Southwest China: An Observational Cohort Study

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