Viral load care of HIV-1 infected children and adolescents: A longitudinal study in rural Zimbabwe

Abstract

Introduction Maintaining virologic suppression of children and adolescents on ART in rural communities in sub-Saharan Africa is challenging. We explored switching drug regimens to protease inhibitor (PI) based treatment and reducing nevirapine and zidovudine use in a differentiated community service delivery model in rural Zimbabwe. Methods From 2016 through 2018, we followed 306 children and adolescents on ART in Hurungwe, Zimbabwe at Chidamoyo Christian Hospital, which provides compact ART regimens at 8 dispersed rural community outreach sites. Viral load testing was performed (2016) by Roche and at follow-up (2018) by a point of care viral load assay. Virologic failure was defined as viral load ≥1,000 copies/ml. A logistic regression model which included demographics, treatment regimens and caregiver’s characteristics was used to assess risks for virologic failure and loss to follow-up (LTFU). Results At baseline in 2016, 296 of 306 children and adolescents (97%) were on first-line ART, and only 10 were receiving a PI-based regimen. The median age was 12 years (IQR 8–15) and 55% were female. Two hundred and nine (68%) had viral load suppression (<1,000 copies/ml) and 97(32%) were unsuppressed (viral load ≥1000). At follow-up in 2018, 42/306 (14%) were either transferred 23 (7%) or LTFU 17 (6%) and 2 had died. In 2018, of the 264 retained in care, 107/264 (41%), had been switched to second-line, ritonavir-boosted PI with abacavir as a new nucleotide analog reverse transcriptase inhibitor (NRTI). Overall viral load suppression increased from 68% in 2016 to 81% in 2018 (P<0.001). Conclusion Viral load testing, and switching to second-line, ritonavir-boosted PI with abacavir significantly increased virologic suppression among HIV-infected children and adolescents in rural Zimbabwe.

Models of lifelong care for children and adolescents with chronic conditions in low-income and middle-income countries: a scoping review

“…A comprehensive care approach to address a patients’ full range of physical, mental and social health service needs was included in the model for mental health, in both models for diabetes, and in 7 of the 11 models for HIV (table 2). 18–21 23–28 Nine models used multidisciplinary care teams, for example, physicians and specialists to manage complex clinical care, nurses and trained community health workers to manage long-term follow-up and routine care, and social workers or case managers to address family, social and community support. Similarly, the use of a case manager to oversee and manage patients’ engagement with each aspect of care—physician visits, nurse follow-up visits and social worker support was used in eight studies 19–22 24 25 27 28…”

Clinic-based SAMBA-II vs centralized laboratory viral load assays among HIV-1 infected children, adolescents and young adults in rural Zimbabwe: A randomized controlled trial

“…Care at Chidamoyo provides long-term retention and support through community-based counselling and ART [ 18 ]. Interestingly, VL testing in the community demonstrated significantly better VL suppression among those receiving care at ROS compared to those attending the clinics at CCH.…”

“…Chidamoyo Christian Hospital (CCH) is a mission hospital which serves a dispersed rural community, providing ART to over 2,500 patients in Hurungwe district, Mashonaland West, Zimbabwe. The service delivery model is a nurse-run program providing bimonthly ART drug refills and adherence counselling at either the hospital clinic or through eight ROS, 22.5 to 47 km by poor gravel roads (mean 32.8 km) from CCH [ 18 ]. Clinic and outreach visits to refill drugs, capture vital signs and provide adherence counselling are scheduled every two months.…”

Assessment of Quantity and Quality of Multidrug-Resistant Tuberculosis DNA Extracts Stored at Different Temperatures

“…The recommended standard protocol for storing mycobacteria for long periods without loss of metabolic activity, viability, or virulence is at −70 0 C to -80 0 C in enriched liquid broth [14][15][16][17][18]. However, in resource-limited settings (RLS), extensive sample archives are not stored under ideal conditions, often due to the unavailability of -80 0 C freezers, space, and limited constant power supply [19]. A study conducted in Zimbabwe by J. Chirenda et al [14] has demonstrated the possibility of recovering Mtb isolates from original culture tubes stored at ambient temperatures.…”