HIV virological non-suppression is highly prevalent among 18- to 24-year-old youths on antiretroviral therapy at the Kenyan coast

A Meta-Analysis of Prevalence and Moderating Factors of Malnutrition Among People Living With HIV Across Countries

ABSTRACT

Malnutrition is a critical issue for people living with HIV (PLWH), affecting their immune function, health outcomes, and response to antiretroviral therapy. This meta-analysis assessed the prevalence of malnutrition among PLWH and explored key moderating factors across countries. A systematic search of six databases-Cumulative Index to Nursing and Allied Health Literature, Embase, ProQuest, PubMed, Scopus, and Web of Science, included 103 studies involving 240,879 PLWH. The pooled prevalence of malnutrition was 16.6% (95% confidence interval = 14.1-19.5). Subgroup analysis revealed higher prevalence in Southeast Asia (31.1%), PLWH with primary education (37.7%), those on antiretroviral therapy for over a year (51.7%), and World Health Organization Stage 3 (36.4%). Meta-regression identified alcohol consumption, smoking, hepatitis, and tuberculosis as significant moderators. The prevalence of malnutrition among PLWH is substantial, with several moderating factors identified. Addressing malnutrition among PLWH requires routine nutritional assessments and targeted interventions to improve health outcomes and quality of life for PLWH globally.

Trajectories to HIV Viral Suppression and Nonsuppression: Case Studies From Rural East African Adolescents and Young Adults in the SEARCH-Youth Trial

BackgroundWhile research has identified many associations between socioeconomic factors and human immunodeficiency virus (HIV) nonsuppression, few qualitative studies have defined the mechanisms by which these factors interrelate and lead to HIV nonsuppression. The development of interventions to achieve universal virologic suppression and eliminate transmission will require a deeper understanding of the individual and social processes that drive antiretroviral therapy (ART) nonadherence and consequent viral nonsuppression.MethodsWe used a semistructured interview-based case-study approach to characterize changes across 3 time points in the lived contexts of 11 adolescents and young adults (aged 15-24 years) from intervention and control arms of a longitudinal HIV intervention trial in rural Kenyan and Ugandan communities. We sought to determine commonalities among those who never virally suppressed, those who became nonsuppressed, and those who moved from nonsuppression to viral suppression, exploring social and behavioral micro-processes or causal chains observed among individuals who share these trajectories.ResultsWe found that supportive family environments, high-quality service provision, and residential and partnership stability free of violence, or that permitted freedom to move and maintain extensive social ties both inside and outside one's immediate community, enabled ART adherence. We also found that several factors combine to have effects beyond each individual factor taken singly, for example, medication side effects were influenced by food insecurity; disclosure was most effective with individuals around whom one may potentially take medication, such as co-resident partners; and mobility compromised adherence when patients did not know how or where to access care in new places.RecommendationsOur findings suggest that to improve virologic suppression, clinical care and interventions should include assessment and strategies to address food insecurity, ART disclosure, and home-based violence from intimate partners or other family members. When such factors are present, we suggest referral for services, including violence prevention and protection services, and food provision for those patients who do not adhere because of medication side effects amplified by lack of food. We further recommend that clinics coordinate regionally to anticipate mobility, facilitate transfer of care to other areas, and ensure clients have access to information about care clinics elsewhere in the region.

Viral load non-suppression among adolescents and youth living with HIV in South Africa

Background

Despite the increased initiation and uptake of antiretroviral therapy (ART) in South Africa, some people living with HIV (PLHIV) who are on ART still have non-suppressed viral load (VL).

Objectives

This study aimed to determine the prevalence of VL non-suppression among adolescents and youth (aged 12 years - 24 years) living with HIV and on ART in South Africa, as well as the factors associated with it.

Method

Data from the 2017 South African national HIV prevalence, incidence, behaviour, and communication survey were analysed. The survey used a multistage-stratified cluster sampling design. A backward stepwise multivariable generalised linear model was used to identify factors associated with VL non-suppression.

Results

The study included 340 participants aged 12 years - 24 years, with a median age of 21 (interquartile range [IQR]: 18-23). The proportion of adolescents and youth living with HIV and on ART with non-suppressed VL was 19.2% (95% confidence interval [CI]: 14.4-25.3). Approximately 60% of the participants were not on ART. The odds of VL non-suppression were significantly higher among youth aged 15 years - 19 years (adjusted odds ratio [AOR] = 1.63 [95% CI: 1.24-2.13], p = 0.001) and aged 20 years - 24 years (AOR = 1.22 [95% CI: 1.06-1.41], p = 0.005) compared to adolescents aged 12 years - 14 years. The odds were significantly lower among individuals of other races (AOR = 0.80 [95% CI: 0.69-0.92], p = 0.003) compared to black African people.

Conclusion

Findings suggest a need for ART education and counselling as part of treatment support. In addition, the promotion of HIV awareness as part of strengthening the HIV treatment and prevention cascade.

Contribution

The article showed the prevalence of VL non-suppression and associated factors among adolescents and youth.

A Machine Learning Approach to Predict HIV Viral Load Hotspots in Kenya Using Real-World Data

Background

Machine learning models are not in routine use for predicting HIV status. Our objective is to describe the development of a machine learning model to predict HIV viral load (VL) hotspots as an early warning system in Kenya, based on routinely collected data by affiliate entities of the Ministry of Health. Based on World Health Organization's recommendations, hotspots are health facilities with ≥20% people living with HIV whose VL is not suppressed. Prediction of VL hotspots provides an early warning system to health administrators to optimize treatment and resources distribution.

Methods

A random forest model was built to predict the hotspot status of a health facility in the upcoming month, starting from 2016. Prior to model building, the datasets were cleaned and checked for outliers and multicollinearity at the patient level. The patient-level data were aggregated up to the facility level before model building. We analyzed data from 4 million tests and 4,265 facilities. The dataset at the health facility level was divided into train (75%) and test (25%) datasets.

Results

The model discriminates hotspots from non-hotspots with an accuracy of 78%. The F1 score of the model is 69% and the Brier score is 0.139. In December 2019, our model correctly predicted 434 VL hotspots in addition to the observed 446 VL hotspots.

Conclusion

The hotspot mapping model can be essential to antiretroviral therapy programs. This model can provide support to decision-makers to identify VL hotspots ahead in time using cost-efficient routinely collected data.

A qualitative inquiry of experiences of HIV-related stigma and its effects among people living with HIV on treatment in rural Kilifi, Kenya

Background

The pervasiveness of HIV-related stigma and discrimination, and its consequences on HIV prevention and treatment, have been well documented. However, little is known about the lived experiences of HIV-related stigma and its effects among the general adult population living with HIV in rural African settings. This study set out to explore this knowledge gap.

Methods

From April to June 2018, we conducted in-depth interviews with a convenience sample of 40 adults living with HIV aged 18-58 years in Kilifi, Kenya. A semi-structured interview guide was used to explore experiences of HIV-related stigma and its impact on these adults. A framework approach was used to analyze the data using NVIVO 11 software.

Results

Participants reported experiences of HIV-related stigma in its various forms (anticipated, perceived, internalised, and enacted), as well as its effects on HIV treatment and social and personal spheres. The internalisation of stigma caused by enacted stigma impacted care-seeking behavior resulting in worse overall health. Anxiety and depression characterized by suicidal ideation were the results of internalised stigma. Anticipated stigma prompted HIV medication concealment, care-seeking in remote healthcare facilities, and care avoidance. Fewer social interactions and marital conflicts resulted from perceived stigma. Overall, HIV-related stigma resulted in partial and non-disclosure of HIV seropositivity and medication non-adherence. At a personal level, mental health issues and diminished sexual or marital prospects (for the unmarried) were reported.

Conclusion

Despite high awareness of HIV and AIDS among the general population in Kenya, adults living with HIV in rural Kilifi still experience different forms of HIV-related stigma (including self-stigma) that result in a raft of social, personal, and HIV-treatment-related consequences. Our findings underscore the urgent need to reevaluate and adopt more effective strategies for implementing HIV-related anti-stigma programs at the community level. Addressing individual-level stigma will require the design of targeted interventions. To improve the lives of adults living with HIV in Kilifi, the effects of HIV-related stigma, particularly on HIV treatment, must be addressed.