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Chem ED, Ferry A, Seeley J, Weiss HA, Simms V. Health-related needs reported by adolescents living with HIV and receiving antiretroviral therapy in sub-Saharan Africa: a systematic literature review. J Int AIDS Soc 2022; 25:e25921. [PMID: 35983685 PMCID: PMC9389275 DOI: 10.1002/jia2.25921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 04/28/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction Adolescents living with HIV (ALHIV) on antiretroviral therapy (ART) have specific health needs that can be challenging to deliver. Sub‐Saharan Africa (SSA) is home to 84% of the global population of ALHIV, of whom about 59% receive ART. Several studies in SSA have demonstrated health service gaps due to lack of synchronized healthcare for ALHIV receiving ART. We conducted a systematic review of health‐related needs among ALHIV on ART in SSA to inform decisions and policies on care. Methods We searched MEDLINE, Web of Science, EMBASE, PsycINFO, Cochrane library and grey literature for studies reporting health‐related needs among ALHIV receiving ART in SSA, between January 2003 and May 2020. Results and discussion Of the 2333 potentially eligible articles identified, 32 were eligible. Eligible studies were published between 2008 and 2019, in 11 countries: Zambia (7), Uganda (6), Tanzania (4), South Africa (4), Kenya (3), Ghana (2), Zimbabwe (2), Rwanda (1), Malawi (1), Botswana (1) and Democratic Republic of Congo (1). Seven categories of health needs among ALHIV were identified. In descending order of occurrence, these were: psychosocial needs (stigma reduction, disclosure and privacy support, and difficulty accepting diagnosis); dependency of care (need for family and provider support, and desire for autonomy); self‐management needs (desire for better coping strategies, medication adherence support and reduced ART side effects); non‐responsive health services (non‐adolescent friendly facility services and non‐compatible school system); need for food, financial and material support; inadequate information about HIV (desire for more knowledge to fight misinformation and misconception); and developmental and growth needs (desire to experience sex, parenthood and love). Ecological analysis identified different priority needs between ALHIV, their caregivers and healthcare providers, including psychosocial needs, financial challenges and non‐responsive health services, respectively. Conclusions To respond effectively to the health needs of ALHIV and improve ART adherence, interventions should focus on stigma reduction, disclosure challenges and innovative coping mechanisms for ART. Interventions that address the health needs of ALHIV from the perspective of carers and providers, such as financial support schemes and adolescent‐friendly healthcare strategies, should supplement efforts to improve adolescent ART adherence outcomes.
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Affiliation(s)
- Elvis D Chem
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Janet Seeley
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Helen A Weiss
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Victoria Simms
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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Mabaso M, Maseko G, Sewpaul R, Naidoo I, Jooste S, Takatshana S, Reddy T, Zuma K, Zungu N. Trends and correlates of HIV prevalence among adolescents in South Africa: evidence from the 2008, 2012 and 2017 South African National HIV Prevalence, Incidence and Behaviour surveys. AIDS Res Ther 2021; 18:97. [PMID: 34906170 PMCID: PMC8670218 DOI: 10.1186/s12981-021-00422-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 12/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adolescents are at increased risk of HIV infection compared to other age groups. There is an urgent need for strategic information that will inform programmes to reduce risk and vulnerability to HIV and reverse the pattern of increasing HIV infection as they transition to adulthood. This paper analysed trends and factors associated with HIV prevalence among adolescents in South Africa using the national HIV population-based household surveys conducted in 2008, 2012 and 2017. METHODS All three surveys used a multistage cross-sectional design. A trend analysis was conducted to assess the differences in HIV prevalence and covariates overtime using P-trend Chi-squared statistic. Univariate and multivariate logistic regression models were used to determine factors associated with HIV prevalence. RESULTS Overall there was a significant increase in HIV prevalence among adolescents aged 12-19 years from 3.0% (n = 2892) in 2008 to 3.2% (n = 4829) in 2012 and 4.1% (n = 3937) in 2017 (p = 0.031). The odds of being HIV positive among adolescents aged 12-19 years was significantly higher among females [AOR = 2.24; 95% CI (1.73-2.91); p < 0.001] than males, those residing in KwaZulu-Natal province [AOR = 2.01; 95% CI (1.-3.99); p = 0.027] than Northern Cape, and those who did not attend an educational institution and were unemployed [AOR = 2.66; 95% CI (1.91-3.67); p < 0.001] compared to those attending an educational institution. The odds were significantly lower among Whites [AOR = 0.29; 95% CI (0.09-0.93); p = 0.037], Coloureds [AOR = 0.21; 95% CI (0.11-0.37); p ≤ 0.001] and Indian/Asian [AOR = 0.08; 95% CI (0.02-0.34); p = 0.001] population groups than Black Africans. CONCLUSION The observed increasing trend and gender disparities in HIV prevalence suggests an urgent need for age appropriate and gender specific HIV interventions tailored and targeted at identified drivers of HIV infection among adolescents.
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Affiliation(s)
- Musawenkosi Mabaso
- Human and Social Capabilities Research Division, Human Sciences Research Council, Pretoria, South Africa.
| | - Goitseone Maseko
- Human and Social Capabilities Research Division, Human Sciences Research Council, Pretoria, South Africa
| | - Ronel Sewpaul
- Human and Social Capabilities Research Division, Human Sciences Research Council, Pretoria, South Africa
| | - Inbarani Naidoo
- Human and Social Capabilities Research Division, Human Sciences Research Council, Pretoria, South Africa
| | - Sean Jooste
- Human and Social Capabilities Research Division, Human Sciences Research Council, Pretoria, South Africa
| | - Sinovuyo Takatshana
- Human and Social Capabilities Research Division, Human Sciences Research Council, Pretoria, South Africa
| | - Tarylee Reddy
- Biostatistics Unit, South African Medical Research Council, Durban, South Africa
| | - Khangelani Zuma
- Human and Social Capabilities Research Division, Human Sciences Research Council, Pretoria, South Africa
| | - Nompumelelo Zungu
- Human and Social Capabilities Research Division, Human Sciences Research Council, Pretoria, South Africa
- Department of Psychology, University of Pretoria, Pretoria, South Africa
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Characteristics and outcomes of adolescents living with perinatally acquired HIV within Southern Africa. AIDS 2020; 34:2275-2284. [PMID: 32910063 DOI: 10.1097/qad.0000000000002683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Using data from 15 International epidemiology Databases to Evaluate AIDS in Southern Africa sites, we compared the characteristics and outcomes of adolescents living with perinatally acquired HIV (ALPH). METHODS We included ALPH entering care aged less than 13 years with at least one HIV care visit during adolescence (10-19 years). We compared the characteristics and cross-sectional outcomes: transfer out, loss to follow-up (no visit in the 12 months prior to database closure), mortality, and retention between those who entered care aged less than 10 vs. aged 10-13 years; and explored predictors of mortality after age 13 years using Cox Proportional Hazards models. RESULTS Overall, 16 229 (50% female) ALPH who entered HIV care aged less than 10 years and 8897 (54% female) aged 10-13 years were included and followed for 152 574 person-years. During follow-up, 94.1% initiated antiretroviral therapy, with those who entered care aged less than 10 more likely to have initiated antiretroviral therapy [97.9%, 95% confidence interval (CI) 97.6; 98.1%] than those who presented aged 10-13 years (87.3%, 95% CI 86.6; 88.0%). At the end of follow-up, 3% had died (entered care aged <10 vs. 10-13 years; 1.4 vs. 5.1%), 22% were loss to follow-up (16.2 vs. 33.4%), and 59% (66.4 vs. 45.4%) were retained. There was no difference in the risk of dying after the age of 13 years between adolescents entering care aged less than 10 vs. 10-13 years (adjusted hazard ratio 0.72; 95% CI 0.36; 1.42). CONCLUSION Retention outcomes for ALPH progressively worsened with increasing age, with these outcomes substantially worse among adolescents entering HIV care aged 10-13 vs. less than 10 years.
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Langhaug L, Finnegan A, Schenk K, Puffer ES, Rusakaniko S, Green EP. Caregiver self-efficacy to talk about sex predicts conversations about HIV transmission risk with perinatally infected young people in Zimbabwe. AIDS Care 2020; 32:1524-1528. [PMID: 32093483 PMCID: PMC9942532 DOI: 10.1080/09540121.2020.1724253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Given advances in care and treatment for HIV, perinatally infected young people are surviving into adolescence. These young people are making decisions about engaging in sexual relationships and it is critical to ensure they have the information they need to engage responsibly in sexual activity, particularly in an era where adherence to treatment could make their virus undetectable. The main objective of this analysis was to examine whether an HIV-positive young person's knowledge about forward transmission is associated with caregiver self-efficacy to talk about sex and general caregiver communication. Using data from a 12-month prospective cohort of caregivers of HIV-positive children aged 9-15 on ART and pre-ART in rural Zimbabwe, we found that caregiver self-efficacy to talk about sex predicted whether conversations about HIV transmission would occur between caregiver and the young person. However, by the end of 12-months, nearly two-thirds of caregivers of HIV-positive teenagers in our sample had still not explained how their adolescents could spread the virus to others despite these caregivers saying their adolescent should know this information at baseline. We discuss the implications for designing sexual and reproductive health (SRH) programs among populations of young people perinatally infected with HIV to ensure that this breakthrough generation receives the SRH support they need.
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Affiliation(s)
| | - A. Finnegan
- Duke Global Health Institute, Box 90519, Durham, North
Carolina 27708, USA,IntraHealth International, 6340 Quadrangle Dr #200, Chapel
Hill, North Carolina 27517, USA,Please address correspondence to Amy Finnegan
()
| | - K. Schenk
- George Mason University, College of Health and Human
Services, Department of Global and Community Health, MS: 5B7, 4400 University Drive,
Fairfax, Virginia 22030-4444, USA,American University, Department of Health Studies, 4400
Massachusetts Avenue NW, Washington, DC 20016
| | - E. S. Puffer
- Duke Global Health Institute, Box 90519, Durham, North
Carolina 27708, USA,Duke University, Department of Psychology and Neuroscience,
Box 90086, 417 Chapel Drive, Durham, NC 27708-0086, USA
| | - S. Rusakaniko
- University of Zimbabwe, Faculty of Medicine, Department of
Community Medicine, P.O.Box MP167, Mount Pleasant, Harare, Zimbabwe
| | - E. P. Green
- Duke Global Health Institute, Box 90519, Durham, North
Carolina 27708, USA
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Govindasamy D, Seeley J, Olaru ID, Wiyeh A, Mathews C, Ferrari G. Informing the measurement of wellbeing among young people living with HIV in sub-Saharan Africa for policy evaluations: a mixed-methods systematic review. Health Qual Life Outcomes 2020; 18:120. [PMID: 32370772 PMCID: PMC7201613 DOI: 10.1186/s12955-020-01352-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 04/03/2020] [Indexed: 12/11/2022] Open
Abstract
Young people living with HIV (YPLHIV) in sub-Saharan Africa (SSA) are at high risk of having a poor quality of life. Addressing wellbeing explicitly within HIV/AIDS policies could assist mitigation efforts. However, guidance on wellbeing measures to evaluate policies for YPLHIV is scarce. The aims of this mixed-methods review were to identify: i) key dimensions of wellbeing and ii) wellbeing measures that align to these dimensions among YPLHIV (15-24 years) in SSA. We searched six social science and medical databases, including grey literature. We included studies that examined correlates and lived experiences of wellbeing, among YPLHIV in SSA, from January 2000 to May 2019. Two reviewers independently screened abstracts and full texts and assessed methodological quality of included articles. We analysed quantitative and qualitative data using descriptive and meta-ethnographic approaches, respectively. Thereafter, we integrated findings using a framework approach. We identified 6527 citations. Of these, 10 quantitative and 30 qualitative studies were included. Being male, higher educational status, less stigma and more social support were likely correlates of wellbeing. Themes that shaped experiences suggestive of wellbeing were: 1) acceptance and belonging- stigma, social support; 2) coping; 3) standard of living. Our final synthesis found that the following dimensions potentially characterise wellbeing: self-acceptance, belonging, autonomy; positive relations, environmental mastery, purpose in life. Wellbeing for YPLHIV is multi-dimensional and relational. Relevant measures include the Personal Wellbeing Index, Ryff's Psychological Wellbeing Scale and Mental Health Continuum Short Form. However, psychometric evaluations of these scales among YPLHIV in SSA are needed.
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Affiliation(s)
- Darshini Govindasamy
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
- Health Systems Research Unit, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, PO Box 19070, Tygerberg, 7501, South Africa.
- Adolescent Health Research Unit, Department of Child and Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa.
| | - Janet Seeley
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Ioana D Olaru
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Alison Wiyeh
- Cochrane South Africa, South African Medical Research Council, Tygerberg, South Africa
- Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington, USA
| | - Catherine Mathews
- Health Systems Research Unit, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, PO Box 19070, Tygerberg, 7501, South Africa
- Adolescent Health Research Unit, Department of Child and Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Giulia Ferrari
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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The Invisible Product: Preferences for Sustained-Release, Long-Acting Pre-exposure Prophylaxis to HIV Among South African Youth. J Acquir Immune Defic Syndr 2019; 80:542-550. [PMID: 30865050 DOI: 10.1097/qai.0000000000001960] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Long-acting injectable and implantable approaches aim to overcome some of the documented challenges with uptake and adherence to current HIV prevention methods. Youth are a key end-user population for these methods. We used qualitative methods to examine product attributes and preferences for current and future long-acting HIV prevention approaches. METHODS Ninety-five South African youth aged 18-24 years, of whom 62 were female and 33 male, completed 50 interviews and 6 focus groups. We purposively selected for previous product experience, including oral pre-exposure prophylaxis, injectable pre-exposure prophylaxis, or the vaginal ring, to ensure participants' opinions were rooted in actual experience. RESULTS Irrespective of previous method-use experience, gender, or sexual orientation, the majority expressed a preference for prevention methods formulated as injectables or implants. Several mentioned that their top priority in any product was efficacy, and for some, this overrode other concerns; for example, even if they feared pain, an implant or an injectable would be used if fully protective. Although efficacy was a top priority, there was also a clear desire across all subgroups for a product that would not interfere with sex, would stay in the system to provide protection, and that caused minimal burden, or was not apparent to others, and these characteristics were most salient for long-acting methods. CONCLUSIONS Narrative explanations for preferences converged thematically around different dimensions of "invisibility" including invisibility to oneself, one's partner and household members, and community members. End-user preferences can be used to inform product development of long-acting HIV prevention approaches formulated as injections or implants to optimize adherence and impact.
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Panayidou K, Davies M, Anderegg N, Egger M. Global temporal changes in the proportion of children with advanced disease at the start of combination antiretroviral therapy in an era of changing criteria for treatment initiation. J Int AIDS Soc 2018; 21:e25200. [PMID: 30614622 PMCID: PMC6275813 DOI: 10.1002/jia2.25200] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 10/08/2018] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION The CD4 cell count and percent at initiation of combination antiretroviral therapy (cART) are measures of advanced HIV disease and thus are important indicators of programme performance for children living with HIV. In particular, World Health Organization (WHO) 2017 guidelines on advanced HIV disease noted that >80% of children aged <5 years started cART with WHO Stage 3 or 4 disease or severe immune suppression. We compared temporal trends in CD4 measures at cART start in children from low-, middle- and high-income countries, and examined the effect of WHO treatment initiation guidelines on reducing the proportion of children initiating cART with advanced disease. METHODS We included children aged <16 years from the International Epidemiology Databases to Evaluate acquired immunodeficiency syndrome (AIDS) (IeDEA) Collaboration (Caribbean, Central and South America, Asia-Pacific, and West, Central, East and Southern Africa), the Collaboration of Observational HIV Epidemiological Research in Europe (COHERE), the North American Pediatric HIV/AIDS Cohort Study (PHACS) and International Maternal Pediatric Adolescent AIDS Clinical Trials (IMPAACT) 219C study. Severe immunodeficiency was defined using WHO guidelines. We used generalized weighted additive mixed effect models to analyse temporal trends in CD4 measurements and piecewise regression to examine the impact of 2006 and 2010 WHO cART initiation guidelines. RESULTS We included 52,153 children from fourteen low-, eight lower middle-, five upper middle- and five high-income countries. From 2004 to 2013, the estimated percentage of children starting cART with severe immunodeficiency declined from 70% to 42% (low-income), 67% to 64% (lower middle-income) and 61% to 43% (upper middle-income countries). In high-income countries, severe immunodeficiency at cART initiation declined from 45% (1996) to 14% (2012). There were annual decreases in the percentage of children with severe immunodeficiency at cART initiation after the WHO guidelines revisions in 2006 (low-, lower middle- and upper middle-income countries) and 2010 (all countries). CONCLUSIONS By 2013, less than half of children initiating cART had severe immunodeficiency worldwide. WHO treatment initiation guidelines have contributed to reducing the proportion of children and adolescents starting cART with advanced disease. However, considerable global inequity remains, in 2013, >40% of children in low- and middle-income countries started cART with severe immunodeficiency compared to <20% in high-income countries.
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Affiliation(s)
- Klea Panayidou
- Institute of Social and Preventive MedicineUniversity of BernBernSwitzerland
| | - Mary‐Ann Davies
- Centre for Infectious Disease Epidemiology and ResearchSchool of Public Health and Family MedicineUniversity of Cape TownCape TownSouth Africa
| | - Nanina Anderegg
- Institute of Social and Preventive MedicineUniversity of BernBernSwitzerland
| | - Matthias Egger
- Institute of Social and Preventive MedicineUniversity of BernBernSwitzerland
- Centre for Infectious Disease Epidemiology and ResearchSchool of Public Health and Family MedicineUniversity of Cape TownCape TownSouth Africa
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Barro M, Sanogo B, Ouermi AS, Zio BR, Ouattara ABI, Nacro B. Acceptability of children's testing for HIV infection during routine care activities in the Pediatrics Department of Sourô Sanou Teaching Hospital in Bobo-Dioulasso (Burkina Faso). Rev Epidemiol Sante Publique 2018; 66:363-367. [PMID: 30366870 DOI: 10.1016/j.respe.2018.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 08/05/2018] [Accepted: 09/11/2018] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND In order to contribute to the fight against the pediatric HIV infection, we have assessed, through a study in which we have systematically proposed to carry out children's testing, the rate of acceptability and the feasibility of children's HIV testing during the routine activities of the department. We have also analyzed the reasons for the acceptability or the refusal of the child's HIV testing by the accompanying person. METHODS The study took place from May to September 2015 including all the parents/legal guardians of any child aged 0 to 14 years coming for a consultation or who was hospitalized in the Pediatric Department of Souro Sanou Teaching Hospital. Counseling sessions conducted by community health workers focused on informing and proposing the principle of child testing. After obtaining the verbal and informed consent of the accompanying person, the first test was performed with Determine® by a hospital health worker. A second SD Bioline®/ImmunoCombII® test was performed if the first test was positive. With children aged less than 18 months, after a positive antibody test, we resorted to PCR for confirmation. RESULTS A total of 848 accompanying persons, 568 of whom were female, underwent a pre-test interview during which the HIV test was offered to them. The mean age of accompanying persons was 30 (25.5 to 38) years; 747 accompanying persons (88.1%) accepted the testing of their child. We have found an influence of the accompanying person's religion (P=0.02) and the type of accompanying person on the acceptability of children's testing. Mothers were more willing to accept the test compared to other accompanying persons (P=0.002). The main reason for refusing the child's testing was the absence of one of the child's parents, mainly the father whose opinion was needed. The test was positive for HIV1 in 10 children. CONCLUSION In health centers, getting the informed consent from parents to test their children is a big challenge. However, our study shows that this is possible, through the high rate of acceptability obtained.
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Affiliation(s)
- M Barro
- Pediatrics Department, Souro Sanou Teaching Hospital, Bobo-Dioulasso, Burkina Faso.
| | - B Sanogo
- Pediatrics Department, Souro Sanou Teaching Hospital, Bobo-Dioulasso, Burkina Faso
| | - A S Ouermi
- Pediatrics Department, Regional Teaching Hospital of Ouahigouya, Ouahigouya, Burkina Faso
| | - B R Zio
- Pediatrics Department, Souro Sanou Teaching Hospital, Bobo-Dioulasso, Burkina Faso
| | - A B I Ouattara
- Pediatrics Department, Souro Sanou Teaching Hospital, Bobo-Dioulasso, Burkina Faso
| | - B Nacro
- Pediatrics Department, Souro Sanou Teaching Hospital, Bobo-Dioulasso, Burkina Faso
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Montalto GJ, Sawe FK, Miruka A, Maswai J, Kiptoo I, Aoko A, Oreyo C, Obiero E, Korir S, Bii SK, Song KX, Kunz AN. Diagnosis disclosure to adolescents living with HIV in rural Kenya improves antiretroviral therapy adherence and immunologic outcomes: A retrospective cohort study. PLoS One 2017; 12:e0183180. [PMID: 28991913 PMCID: PMC5633147 DOI: 10.1371/journal.pone.0183180] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 07/31/2017] [Indexed: 11/24/2022] Open
Abstract
Background & aims Emphasis on adolescent HIV has increased worldwide as antiretroviral treatment has greatly extended life expectancies of HIV-positive children. Few evidence-based guidelines exist on the optimal time to disclose to an adolescent living with HIV (ALHIV); little is known about the medical effects of disclosure. This study looked to determine whether disclosure is associated with improved medical outcomes in ALHIV. Prior work has tended to be qualitative, cross-sectional, and with an emphasis on psychosocial outcomes. This paper addresses the adolescent cohort retrospectively (longitudinally), building upon what is already known about disclosure. Methods Retrospective, longitudinal clinical record reviews of ALHIV seen at Kericho District Hospital between April 2004 and November 2012 were performed. Patient demographics and clinical outcomes were systematically extracted. The student’s t-test was used to calculate changes in mean CD4 count, antiretroviral therapy (ART), and cotrimoxazole adherence pre- vs. post-disclosure. Linear regression modelling assessed for trends in those clinical outcomes associated with age of disclosure. Results Ninety-six ALHIV (54 female, 42 male) were included; most (73%) entered care through the outpatient department. Nearly half were cared for by parents, and 20% experienced a change in their primary caregiver. The mean time in the study was 2.47 years; mean number of visits 10.97 per patient over the mean time in the study. Mean disclosure age was 12.34 years. An increase in mean ART adherence percentage was found with disclosure (0.802 vs. 0.917; p = 0.0015). Younger disclosure age was associated with significantly higher mean CD4 counts over the course of the study (p = 0.001), and a nonsignificant trend toward a higher mean ART adherence percentage (p = 0.055). Conclusion ART adherence and improved immunologic status are both associated with disclosure of HIV infection to adolescent patients. Disclosure of an HIV diagnosis to an adolescent is an important means to improve HIV care.
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Affiliation(s)
- Gregg Joseph Montalto
- Division of Adolescent Medicine, Department of Pediatrics, Naval Medical Center San Diego, San Diego, California, United States of America
- * E-mail:
| | - Fredrick K. Sawe
- Kenya Medical Research Institute, Walter Reed Project, Kericho, Kenya
| | - Argwings Miruka
- Kenya Medical Research Institute, Walter Reed Project, Kericho, Kenya
| | - Jonah Maswai
- Kenya Medical Research Institute, Walter Reed Project, Kericho, Kenya
| | - Ignatius Kiptoo
- Kenya Medical Research Institute, Walter Reed Project, Kericho, Kenya
| | - Appolonia Aoko
- Kenya Medical Research Institute, Walter Reed Project, Kericho, Kenya
| | - Chrispine Oreyo
- Kenya Medical Research Institute, Walter Reed Project, Kericho, Kenya
| | - Eunice Obiero
- Ministry of Medical Services, Kericho District Hospital, Kericho, Kenya
| | - Sheila Korir
- Ministry of Medical Services, Kericho District Hospital, Kericho, Kenya
| | - Stephen K. Bii
- Ministry of Medical Services, Kericho District Hospital, Kericho, Kenya
| | - Katherine X. Song
- United States Military HIV Research Program, Rockville, Maryland, United States of America
| | - Anjali N. Kunz
- Department of Pediatrics, Madigan Army Medical Center, Joint Base Lewis-McChord, Washington, United States of America
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Cluver LD, Toska E, Orkin FM, Meinck F, Hodes R, Yakubovich AR, Sherr L. Achieving equity in HIV-treatment outcomes: can social protection improve adolescent ART-adherence in South Africa? AIDS Care 2017; 28 Suppl 2:73-82. [PMID: 27392002 PMCID: PMC4991216 DOI: 10.1080/09540121.2016.1179008] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Low ART-adherence amongst adolescents is associated with morbidity, mortality and onward HIV transmission. Reviews find no effective adolescent adherence-promoting interventions. Social protection has demonstrated benefits for adolescents, and could potentially improve ART-adherence. This study examines associations of 10 social protection provisions with adherence in a large community-based sample of HIV-positive adolescents. All 10–19-year-olds ever ART-initiated in 53 government healthcare facilities in a health district of South Africa’s Eastern Cape were traced and interviewed in 2014–2015 (n = 1175 eligible). About 90% of the eligible sample was included (n = 1059). Social protection provisions were “cash/cash in kind”: government cash transfers, food security, school fees/materials, school feeding, clothing; and “care”: HIV support group, sports groups, choir/art groups, positive parenting and parental supervision/monitoring. Analyses used multivariate regression, interaction and marginal effects models in SPSS and STATA, controlling for socio-demographic, HIV and healthcare-related covariates. Findings showed 36% self-reported past-week ART non-adherence (<95%). Non-adherence was associated with increased opportunistic infections (p = .005, B .269, SD .09), and increased likelihood of detectable viral load at last test (>75 copies/ml) (aOR 1.98, CI 1.1–3.45). Independent of covariates, three social protection provisions were associated with reduced non-adherence: food provision (aOR .57, CI .42–.76, p < .001); HIV support group attendance (aOR .60, CI .40–.91, p < .02), and high parental/caregiver supervision (aOR .56, CI .43–.73, p < .001). Combination social protection showed additive benefits. With no social protection, non-adherence was 54%, with any one protection 39–41%, with any two social protections, 27–28% and with all three social protections, 18%. These results demonstrate that social protection provisions, particularly combinations of “cash plus care”, may improve adolescent adherence. Through this they have potential to improve survival and wellbeing, to prevent HIV transmission, and to advance treatment equity for HIV-positive adolescents.
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Affiliation(s)
- L D Cluver
- a Centre for Evidence-Based Intervention, Department of Social Policy and Intervention , University of Oxford , Oxford , UK.,b Department of Psychiatry and Mental Health , University of Cape Town , Cape Town , South Africa
| | - E Toska
- a Centre for Evidence-Based Intervention, Department of Social Policy and Intervention , University of Oxford , Oxford , UK.,c AIDS and Society Research Unit, Centre for Social Science Research , University of Cape Town , Cape Town , South Africa
| | - F M Orkin
- d DPHRU, School of Clinical Medicine, and DST-NRF Centre of Excellence in Human Development , University of the Witwatersrand , Johannesburg , South Africa
| | - F Meinck
- a Centre for Evidence-Based Intervention, Department of Social Policy and Intervention , University of Oxford , Oxford , UK
| | - R Hodes
- a Centre for Evidence-Based Intervention, Department of Social Policy and Intervention , University of Oxford , Oxford , UK.,c AIDS and Society Research Unit, Centre for Social Science Research , University of Cape Town , Cape Town , South Africa
| | - A R Yakubovich
- a Centre for Evidence-Based Intervention, Department of Social Policy and Intervention , University of Oxford , Oxford , UK
| | - L Sherr
- e Health Psychology Unit, Research Department of Infection & Population Health, University College London , London , UK
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11
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Sibanda E, Khumalo P. A review of interprovincial variations in HIV prevalence rates in Zimbabwe. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2017. [PMID: 28639500 DOI: 10.2989/16085906.2017.1330274] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Despite the proven remarkable decline of HIV prevalence in the sub-Saharan Africa region, both sub-regional and within-country disparities in HIV prevalence persist. This paper is a survey of literature on HIV prevalence and spread in Zimbabwe, focusing on provincial differences within the national picture of a decline in new infections. In particular, it raises the question of why prevalence and infection rates seem to be disproportionately higher in Matabeleland relative to other provinces of the country. This disparity cannot be adequately explained on the basis of national behavioural analyses as has been the case. The paper suggests possible additional nuances in the forms of analysis and proposes a change of focus in HIV-prevention strategies from national level to provincial considerations of the multiple factors influencing variations in HIV infection rates at provincial level. Using the different contextual conditions between provinces as a way to examine what might be the additional significant variables, the paper brings variations that go beyond sexual behaviour.
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Affiliation(s)
- Elisa Sibanda
- a Department of Development Studies , University of Fort Hare , Alice , South Africa
| | - Prudence Khumalo
- b Department of Public Administration , University of South Africa , Pretoria , South Africa
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Williams BG, Gupta S, Wollmers M, Granich R. Progress and prospects for the control of HIV and tuberculosis in South Africa: a dynamical modelling study. LANCET PUBLIC HEALTH 2017; 2:e223-e230. [PMID: 29253488 DOI: 10.1016/s2468-2667(17)30066-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 02/21/2017] [Accepted: 02/23/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND In September, 2016, South Africa adopted a policy of providing antiretroviral treatment to everyone infected with HIV irrespective of their CD4 cell count. Studies of universal treatment and expanded prevention of HIV differ widely in their projections of effects and the associated costs, so we did this analysis to attempt to find a consensus. METHODS We used data on HIV from the Joint UN Programme on HIV and AIDS (UNAIDS) from 1988 to 2013 and from data from WHO on tuberculosis from 1980 to to 2013 to fit a dynamical model to time trends in HIV prevalence, antiretroviral therapy (ART) coverage, and tuberculosis notification rates in South Africa. We then used the model to estimate current trends and project future patterns in HIV prevalence and incidence, AIDS-related mortality, and tuberculosis notification rates, and we used data from the South African National AIDS Council to assess current and future costs under different combinations of treatment and prevention approaches. We considered two treatment strategies: the Constant Effort strategy, in which people infected with HIV continue to start treatment at the rate in 2016, and the Expanded Treatment and Prevention (ETP) strategy, in which testing rates are increased, treatment is started immediately after HIV is detected, and prevention programmes are expanded. FINDINGS Our estimates show that HIV incidence among adults aged 15 years or older fell from 2·3% per year in 1996 to 0·65% per year in 2016, AIDS-related mortality decreased from 1·4% per year in 2006 to 0·37% per year in 2016, and both continue to fall at a relative rate of 17% per year. Our model shows that maintenance of Constant Effort will have a substantial effect on HIV but will not end AIDS, whereas ETP could end AIDS by 2030, with incidence of HIV and AIDs-related mortality rates both at less than one event per 1000 adults per year. Under ETP the annual cost of health care and prevention will increase from US$2·3 billion in 2016 to $2·9 billion in 2018, then decrease to $1·7 billion in 2030 and $0·9 billion in 2050. Over the next 35 years, the expansion of treatment will avert an additional 3·8 million new infections, save 1·1 million lives, and save $3·2 billion compared with continuing Constant Effort up to 2050. Expansion of prevention, including provision of pre-exposure prophylaxis, condom distribution, and male circumcision, could avert a further 150 000 new infections, save 5000 lives, and cost an additional $5·7 billion compared with Constant Effort. INTERPRETATION Our results suggest that South Africa is on track to reduce HIV incidence and AIDS-related mortality substantially by 2030, saving both lives and money. Success will depend on high rates of HIV testing, ART delivery and adherence, good patient monitoring and support, and data to monitor progress. FUNDING None.
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Affiliation(s)
- Brian G Williams
- South African Centre for Epidemiological Modelling and Analysis, University of Stellenbosch, Stellenbosch, South Africa.
| | - Somya Gupta
- International Association of Providers of AIDS Care, Washington, DC, USA
| | | | - Reuben Granich
- International Association of Providers of AIDS Care, Washington, DC, USA
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Chawana TD, Katzenstein D, Nathoo K, Ngara B, Nhachi CFB. Evaluating an enhanced adherence intervention among HIV positive adolescents failing atazanavir/ritonavir-based second line antiretroviral treatment at a public health clinic. ACTA ACUST UNITED AC 2017; 9:17-30. [PMID: 31649827 PMCID: PMC6812532 DOI: 10.5897/jahr2016.0406] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Sustaining virological suppression among HIV-infected adolescents is challenging. We evaluated a home-based adherence intervention and characterized self-reported adherence, virological response and drug resistance among adolescents failing atazanavir/ritonavir (ATV/r)-based 2nd line treatment.
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Affiliation(s)
| | - David Katzenstein
- Department of Medicine, Division of Infectious Diseases, Stanford University, California
| | - Kusum Nathoo
- Department of Paediatrics, University of Zimbabwe, Harare 00263, Zimbabwe
| | - Bernard Ngara
- Department of Community Medicine, University of Zimbabwe, Harare 00263, Zimbabwe
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14
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Abstract
Objective: Respiratory disease is a major cause of morbidity and mortality in HIV-infected children. Despite antiretroviral therapy (ART), children suffer chronic symptoms. We investigated symptom prevalence, lung function and exercise capacity among older children established on ART and an age-matched HIV-uninfected group. Design: A cross-sectional study in Zimbabwe of HIV-infected children aged 6–16 years receiving ART for over 6 months and HIV-uninfected children attending primary health clinics from the same area. Methods: Standardized questionnaire, spirometry, incremental shuttle walk testing, CD4+ cell count, HIV viral load and sputum culture for tuberculosis were performed. Results: A total of 202 HIV-infected and 150 uninfected participants (median age 11.1 years in each group) were recruited. Median age at HIV diagnosis and ART initiation was 5.5 (interquartile range 2.8–7.5) and 6.1 (interquartile range 3.6–8.4) years, respectively. Median CD4+ cell count was 726 cells/μl, and 79% had HIV viral load less than 400 copies/ml. Chronic respiratory symptoms were rare in HIV-uninfected children [n = 1 (0.7%)], but common in HIV-infected participants [51 (25%)], especially cough [30 (15%)] and dyspnoea [30 (15%)]. HIV-infected participants were more commonly previously treated for tuberculosis [76 (38%) vs 1 (0.7%), P < 0.001], had lower exercise capacity (mean incremental shuttle walk testing distance 771 vs 889 m, respectively, P < 0.001) and more frequently abnormal spirometry [43 (24.3%) vs 15 (11.5%), P = 0.003] compared with HIV-uninfected participants. HIV diagnosis at an older age was associated with lung function abnormality (P = 0.025). No participant tested positive for Mycobacterium tuberculosis. Conclusion: In children, despite ART, HIV is associated with significant respiratory symptoms and functional impairment. Understanding pathogenesis is key, as new treatment strategies are urgently required.
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15
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Okoboi S, Ssali L, Yansaneh AI, Bakanda C, Birungi J, Nantume S, Okullu JL, Sharp AR, Moore DM, Kalibala S. Factors associated with long-term antiretroviral therapy attrition among adolescents in rural Uganda: a retrospective study. J Int AIDS Soc 2016; 19:20841. [PMID: 27443271 PMCID: PMC4956735 DOI: 10.7448/ias.19.5.20841] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 04/27/2016] [Accepted: 05/09/2016] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION As access to antiretroviral therapy (ART) increases, the success of treatment programmes depends on ensuring high patient retention in HIV care. We examined retention and attrition among adolescents in ART programmes across clinics operated by The AIDS Support Organization (TASO) in Uganda, which has operated both facility- and community-based distribution models of ART delivery since 2004. METHODS Using a retrospective cohort analysis of patient-level clinical data, we examined attrition and retention in HIV care and factors associated with attrition among HIV-positive adolescents aged 10-19 years who initiated ART at 10 TASO clinics between January 2006 and December 2011. Retention in care was defined as the proportion of adolescents who had had at least one facility visit within the six months prior to 1 June 2013, and attrition was defined as the proportion of adolescents who died, were lost to follow-up, or stopped treatment. Descriptive statistics and Cox proportional hazards regression models were used to determine the levels of retention in HIV care and the factors associated with attrition following ART initiation. RESULTS A total of 1228 adolescents began ART between 2006 and 2011, of whom 57% were female. The median duration in HIV care was four years (IQR=3-6 years). A total of 792 (65%) adolescents were retained in care over the five-year period; 36 (3%) had died or transferred out and 400 (32%) were classified as loss to follow-up. Factors associated with attrition included being older (adjusted hazard ratio (AHR)=1.38, 95% confidence interval (CI) 1.02-1.86), having a higher CD4 count (250+ cells/mm(3)) at treatment initiation (AHR=0.49, 95% CI 0.34-0.69) and HIV care site with a higher risk of attrition among adolescents in Gulu (AHR=2.26; 95% CI 1.27-4.02) and Masindi (AHR=3.30, 95% CI 1.87-5.84) and a lower risk of attrition in Jinja (AHR=0.24, 95% CI 0.08-0.70). Having an advanced WHO clinical stage at initiation was not associated with attrition. CONCLUSIONS We found an overall retention rate of 65%, which is comparable to rates achieved by TASO's adult patients and adolescents in other studies in Africa. Variations in the risk of attrition by TASO treatment site and by clinical and demographic characteristics suggest the need for early diagnosis of HIV infection, use of innovative approaches to reach and retain adolescents living with HIV in treatment and identifying specific groups, such as older adolescents, that are at high risk of dropping out of treatment for targeted care and support.
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Affiliation(s)
- Stephen Okoboi
- The AIDS Support Organization (TASO), Kampala, Uganda; @tasouganda.org
| | | | - Aisha I Yansaneh
- Office of HIV/AIDS, Global Health Bureau, United States Agency for International Development (USAID), Arlington, VA, USA
| | | | | | | | | | - Alana R Sharp
- Department of Health Management and Policy, University of Michigan, School of Public Health, Ann Arbor, MI, USA
| | - David M Moore
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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16
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Lessons learned and study results from HIVCore, an HIV implementation science initiative. J Int AIDS Soc 2016. [DOI: 10.7448/ias.19.5.21261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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17
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Kyu HH, Pinho C, Wagner JA, Brown JC, Bertozzi-Villa A, Charlson FJ, Coffeng LE, Dandona L, Erskine HE, Ferrari AJ, Fitzmaurice C, Fleming TD, Forouzanfar MH, Graetz N, Guinovart C, Haagsma J, Higashi H, Kassebaum NJ, Larson HJ, Lim SS, Mokdad AH, Moradi-Lakeh M, Odell SV, Roth GA, Serina PT, Stanaway JD, Misganaw A, Whiteford HA, Wolock TM, Wulf Hanson S, Abd-Allah F, Abera SF, Abu-Raddad LJ, AlBuhairan FS, Amare AT, Antonio CAT, Artaman A, Barker-Collo SL, Barrero LH, Benjet C, Bensenor IM, Bhutta ZA, Bikbov B, Brazinova A, Campos-Nonato I, Castañeda-Orjuela CA, Catalá-López F, Chowdhury R, Cooper C, Crump JA, Dandona R, Degenhardt L, Dellavalle RP, Dharmaratne SD, Faraon EJA, Feigin VL, Fürst T, Geleijnse JM, Gessner BD, Gibney KB, Goto A, Gunnell D, Hankey GJ, Hay RJ, Hornberger JC, Hosgood HD, Hu G, Jacobsen KH, Jayaraman SP, Jeemon P, Jonas JB, Karch A, Kim D, Kim S, Kokubo Y, Kuate Defo B, Kucuk Bicer B, Kumar GA, Larsson A, Leasher JL, Leung R, Li Y, Lipshultz SE, Lopez AD, Lotufo PA, Lunevicius R, Lyons RA, Majdan M, Malekzadeh R, Mashal T, Mason-Jones AJ, Melaku YA, Memish ZA, Mendoza W, Miller TR, Mock CN, Murray J, Nolte S, Oh IH, Olusanya BO, Ortblad KF, Park EK, Paternina Caicedo AJ, Patten SB, Patton GC, Pereira DM, Perico N, Piel FB, Polinder S, Popova S, Pourmalek F, Quistberg DA, Remuzzi G, Rodriguez A, Rojas-Rueda D, Rothenbacher D, Rothstein DH, Sanabria J, Santos IS, Schwebel DC, Sepanlou SG, Shaheen A, Shiri R, Shiue I, Skirbekk V, Sliwa K, Sreeramareddy CT, Stein DJ, Steiner TJ, Stovner LJ, Sykes BL, Tabb KM, Terkawi AS, Thomson AJ, Thorne-Lyman AL, Towbin JA, Ukwaja KN, Vasankari T, Venketasubramanian N, Vlassov VV, Vollset SE, Weiderpass E, Weintraub RG, Werdecker A, Wilkinson JD, Woldeyohannes SM, Wolfe CDA, Yano Y, Yip P, Yonemoto N, Yoon SJ, Younis MZ, Yu C, El Sayed Zaki M, Naghavi M, Murray CJL, Vos T. Global and National Burden of Diseases and Injuries Among Children and Adolescents Between 1990 and 2013: Findings From the Global Burden of Disease 2013 Study. JAMA Pediatr 2016; 170:267-87. [PMID: 26810619 PMCID: PMC5076765 DOI: 10.1001/jamapediatrics.2015.4276] [Citation(s) in RCA: 397] [Impact Index Per Article: 49.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
IMPORTANCE The literature focuses on mortality among children younger than 5 years. Comparable information on nonfatal health outcomes among these children and the fatal and nonfatal burden of diseases and injuries among older children and adolescents is scarce. OBJECTIVE To determine levels and trends in the fatal and nonfatal burden of diseases and injuries among younger children (aged <5 years), older children (aged 5-9 years), and adolescents (aged 10-19 years) between 1990 and 2013 in 188 countries from the Global Burden of Disease (GBD) 2013 study. EVIDENCE REVIEW Data from vital registration, verbal autopsy studies, maternal and child death surveillance, and other sources covering 14,244 site-years (ie, years of cause of death data by geography) from 1980 through 2013 were used to estimate cause-specific mortality. Data from 35,620 epidemiological sources were used to estimate the prevalence of the diseases and sequelae in the GBD 2013 study. Cause-specific mortality for most causes was estimated using the Cause of Death Ensemble Model strategy. For some infectious diseases (eg, HIV infection/AIDS, measles, hepatitis B) where the disease process is complex or the cause of death data were insufficient or unavailable, we used natural history models. For most nonfatal health outcomes, DisMod-MR 2.0, a Bayesian metaregression tool, was used to meta-analyze the epidemiological data to generate prevalence estimates. FINDINGS Of the 7.7 (95% uncertainty interval [UI], 7.4-8.1) million deaths among children and adolescents globally in 2013, 6.28 million occurred among younger children, 0.48 million among older children, and 0.97 million among adolescents. In 2013, the leading causes of death were lower respiratory tract infections among younger children (905.059 deaths; 95% UI, 810,304-998,125), diarrheal diseases among older children (38,325 deaths; 95% UI, 30,365-47,678), and road injuries among adolescents (115,186 deaths; 95% UI, 105,185-124,870). Iron deficiency anemia was the leading cause of years lived with disability among children and adolescents, affecting 619 (95% UI, 618-621) million in 2013. Large between-country variations exist in mortality from leading causes among children and adolescents. Countries with rapid declines in all-cause mortality between 1990 and 2013 also experienced large declines in most leading causes of death, whereas countries with the slowest declines had stagnant or increasing trends in the leading causes of death. In 2013, Nigeria had a 12% global share of deaths from lower respiratory tract infections and a 38% global share of deaths from malaria. India had 33% of the world's deaths from neonatal encephalopathy. Half of the world's diarrheal deaths among children and adolescents occurred in just 5 countries: India, Democratic Republic of the Congo, Pakistan, Nigeria, and Ethiopia. CONCLUSIONS AND RELEVANCE Understanding the levels and trends of the leading causes of death and disability among children and adolescents is critical to guide investment and inform policies. Monitoring these trends over time is also key to understanding where interventions are having an impact. Proven interventions exist to prevent or treat the leading causes of unnecessary death and disability among children and adolescents. The findings presented here show that these are underused and give guidance to policy makers in countries where more attention is needed.
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Affiliation(s)
- Hmwe H Kyu
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Christine Pinho
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Joseph A Wagner
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Jonathan C Brown
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | | | - Fiona J Charlson
- Institute for Health Metrics and Evaluation, University of Washington, Seattle2School of Public Health, University of Queensland, Brisbane, Australia3Queensland Centre for Mental Health Research, Brisbane, Australia
| | - Luc Edgar Coffeng
- Institute for Health Metrics and Evaluation, University of Washington, Seattle4Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Lalit Dandona
- Institute for Health Metrics and Evaluation, University of Washington, Seattle5Public Health Foundation of India, New Delhi, India
| | - Holly E Erskine
- Institute for Health Metrics and Evaluation, University of Washington, Seattle2School of Public Health, University of Queensland, Brisbane, Australia3Queensland Centre for Mental Health Research, Brisbane, Australia
| | - Alize J Ferrari
- Institute for Health Metrics and Evaluation, University of Washington, Seattle2School of Public Health, University of Queensland, Brisbane, Australia3Queensland Centre for Mental Health Research, Brisbane, Australia
| | - Christina Fitzmaurice
- Institute for Health Metrics and Evaluation, University of Washington, Seattle6Division of Hematology, Department of Medicine, University of Washington, Seattle7Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Thomas D Fleming
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | | | - Nicholas Graetz
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Caterina Guinovart
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Juanita Haagsma
- Institute for Health Metrics and Evaluation, University of Washington, Seattle4Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Hideki Higashi
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Nicholas J Kassebaum
- Institute for Health Metrics and Evaluation, University of Washington, Seattle8Department of Anesthesiology and Pain Medicine, Seattle Children's Hospital, Seattle, Washington
| | - Heidi J Larson
- Institute for Health Metrics and Evaluation, University of Washington, Seattle9Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, England
| | - Stephen S Lim
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Maziar Moradi-Lakeh
- Institute for Health Metrics and Evaluation, University of Washington, Seattle10Department of Community Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Shaun V Odell
- University of Washington Medical Center, Seattle12Seattle Children's Hospital, Seattle, Washington13Intermountain Healthcare, Salt Lake City, Utah
| | - Gregory A Roth
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Peter T Serina
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Jeffrey D Stanaway
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Awoke Misganaw
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Harvey A Whiteford
- Institute for Health Metrics and Evaluation, University of Washington, Seattle2School of Public Health, University of Queensland, Brisbane, Australia3Queensland Centre for Mental Health Research, Brisbane, Australia
| | - Timothy M Wolock
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Sarah Wulf Hanson
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | | | - Semaw Ferede Abera
- Kilte Awlaelo Health and Demographic Surveillance Site, Mekelle, Ethiopia16School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Laith J Abu-Raddad
- Infectious Disease Epidemiology Group, Weill Cornell Medical College in Qatar, Doha, Qatar
| | - Fadia S AlBuhairan
- King Abdullah Specialized Children's Hospital, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia19King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Azmeraw T Amare
- Department of Epidemiology, University of Groningen, Groningen, the Netherlands21College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia22Discipline of Psychiatry, School of Medicine, University of Adelaide, Adelaide, Australia
| | - Carl Abelardo T Antonio
- Department of Health Policy and Administration, College of Public Health, University of the Philippines Manila, Manila, Philippines
| | | | | | - Lope H Barrero
- Department of Industrial Engineering, School of Engineering, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Corina Benjet
- National Institute of Psychiatry Ramon de la Fuente, Mexico City, Mexico
| | | | - Zulfiqar A Bhutta
- Medical Center, Aga Khan University, Karachi, Pakistan30The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Boris Bikbov
- A. I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia32Academician V. I. Shumakov Federal Research Center of Transplantology and Artificial Organs, Moscow, Russia
| | - Alexandra Brazinova
- International Neurotrama Research Organization, Vienna, Austria34Faculty of Health Sciences and Social Work, Trnava University, Trnava, Slovakia
| | - Ismael Campos-Nonato
- National Institute of Public Health, Cuernavaca, Mexico36School of Public Health, Harvard University, Boston, Massachusetts
| | - Carlos A Castañeda-Orjuela
- Colombian National Health Observatory, Instituto Nacional de Salud, Bogotá, Colombia38Epidemiology and Public Health Evaluation Group, Public Health Department, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Ferrán Catalá-López
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada40Department of Medicine, University of Valencia, INCLIVA/CIBERSAM, Valencia, Spain
| | - Rajiv Chowdhury
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, England
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, England43National Institute for Health Research Biomedical Research Centre, University of Southampton and University Hospital Southampton National Health Service Foundation Trust, S
| | - John A Crump
- Centre for International Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | | | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Robert P Dellavalle
- University of Colorado School of Medicine and the Colorado School of Public Health, Aurora
| | - Samath D Dharmaratne
- Department of Community Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Emerito Jose A Faraon
- Department of Health Policy and Administration, College of Public Health, University of the Philippines Manila, Manila, Philippines49Office for Technical Services, Department of Health, Manila, Philippines
| | - Valery L Feigin
- National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | - Thomas Fürst
- Department of Infectious Disease Epidemiology, Imperial College London, London, England
| | - Johanna M Geleijnse
- Division of Human Nutrition, Wageningen University, Wageningen, the Netherlands
| | | | - Katherine B Gibney
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia55Melbourne Health, Parkville, Australia
| | - Atsushi Goto
- Department of Public Health, Tokyo Women's Medical University, Tokyo, Japan
| | - David Gunnell
- School of Social and Community Medicine, University of Bristol, Bristol, England
| | - Graeme J Hankey
- School of Medicine and Pharmacology, University of Western Australia, Perth, Australia59Harry Perkins Institute of Medical Research, Nedlands, Australia60Western Australian Neuroscience Research Institute, Nedlands, Australia
| | - Roderick J Hay
- International Foundation for Dermatology, London, England62King's College London, London, England
| | - John C Hornberger
- Cedar Associates, Menlo Park, California64Stanford University, Stanford, California
| | | | - Guoqing Hu
- Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Changsha, China
| | | | | | - Panniyammakal Jeemon
- Centre for Chronic Disease Control, New Delhi, India70Centre for Control of Chronic Conditions, Public Health Foundation of India, New Delhi, India
| | - Jost B Jonas
- Department of Ophthalmology, Medical Faculty Mannheim, Ruprecht-Karls-Universität Heidelberg, Mannheim, Germany
| | - André Karch
- Epidemiological and Statistical Methods Research Group, Helmholtz Centre for Infection Research, Braunschweig, Germany73Hannover-Braunschweig Site, German Center for Infection Research, Braunschweig, Germany
| | - Daniel Kim
- Department of Health Sciences, Northeastern University, Boston, Massachusetts
| | | | - Yoshihiro Kokubo
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Barthelemy Kuate Defo
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Québec, Canada78Department of Demography, University of Montreal, Montreal, Québec, Canada79Public Health Research Institute, University of Montreal
| | | | - G Anil Kumar
- Public Health Foundation of India, New Delhi, India
| | - Anders Larsson
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Janet L Leasher
- Nova Southeastern University College of Optometry, Fort Lauderdale, Florida
| | - Ricky Leung
- State University of New York at Albany, Rensselaer
| | - Yongmei Li
- Genentech, South San Francisco, California
| | - Steven E Lipshultz
- School of Medicine, Wayne State University, Detroit, Michigan86Children's Hospital of Michigan, Detroit
| | - Alan D Lopez
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | | | - Raimundas Lunevicius
- Aintree University Hospital National Health Service Foundation Trust, Liverpool, England89School of Medicine, University of Liverpool, Liverpool, England
| | | | - Marek Majdan
- Faculty of Health Sciences and Social Work, Trnava University, Trnava, Slovakia
| | - Reza Malekzadeh
- Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Yohannes Adama Melaku
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia94School of Public Health, Mekelle University, Mekelle, Ethiopia95School of Medicine, University of Adelaide, Adelaide, Australia
| | - Ziad A Memish
- Saudi Ministry of Health, Riyadh, Saudi Arabia97College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | | | - Ted R Miller
- Pacific Institute for Research and Evaluation, Calverton, Maryland100Centre for Population Health Research, Curtin University, Perth, Australia
| | - Charles N Mock
- Harborview Injury Prevention and Research Center, University of Washington, Seattle
| | - Joseph Murray
- Department of Psychiatry, University of Cambridge, Cambridge, England
| | - Sandra Nolte
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité Universitätsmedizin, Berlin, Germany104Population Health Strategic Research Centre, School of Health and Social Development, Deakin University, Melbourne, Australi
| | - In-Hwan Oh
- Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, South Korea
| | | | - Katrina F Ortblad
- Harvard T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Eun-Kee Park
- Department of Medical Humanities and Social Medicine, College of Medicine, Kosin University, Busan, South Korea
| | | | - Scott B Patten
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - George C Patton
- Murdoch Childrens Research Institute, University of Melbourne, Melbourne, Australia
| | - David M Pereira
- REQUIMTE/LAQV, Laboratório de Farmacognosia, Departamento de Química, Faculdade de Farmácia, Universidade do Porto, Porto, Portugal
| | - Norberto Perico
- Istituto di Ricovero e Cura a Carattere Scientifico, Mario Negri Institute for Pharmacological Research, Bergamo, Italy
| | - Frédéric B Piel
- Department of Zoology, University of Oxford, Oxford, England
| | - Suzanne Polinder
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Svetlana Popova
- Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - Farshad Pourmalek
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - D Alex Quistberg
- Harborview Injury Prevention and Research Center, University of Washington, Seattle117Department of Pediatrics, University of Washington, Seattle
| | - Giuseppe Remuzzi
- Centro Anna Maria Astori, Istituto di Ricovero e Cura a Carattere Scientifico, Mario Negri Institute for Pharmacological Research, Bergamo, Italy119Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Alina Rodriguez
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, England121Mid Sweden University, Östersund, Sweden
| | - David Rojas-Rueda
- Centre for Research in Environmental Epidemiology, Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
| | | | - David H Rothstein
- Department of Pediatric Surgery, Women and Children's Hospital of Buffalo, Buffalo, New York125Department of Surgery, University at Buffalo, State University of New York, Buffalo
| | - Juan Sanabria
- Case Western Reserve University, Cleveland, Ohio127Chicago Medical School, Rosalind Franklin University of Medicine and Science, Cancer Treatment Centers of America, North Chicago, Illinois
| | - Itamar S Santos
- Internal Medicine Department, University of São Paulo, São Paulo, Brazil
| | | | - Sadaf G Sepanlou
- Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Amira Shaheen
- Department of Public Health, An-Najah National University, Nablus, Palestine
| | - Rahman Shiri
- Finnish Institute of Occupational Health, Helsinki, Finland132School of Health Sciences, University of Tampere, Tampere, Finland
| | - Ivy Shiue
- Health and Life Sciences, Northumbria University, Newcastle upon Tyne, England134Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, Scotland
| | | | - Karen Sliwa
- Faculty of Health Sciences, Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa
| | | | - Dan J Stein
- Department of Psychiatry, University of Cape Town, Cape Town, South Africa139South African Medical Research Council Unit on Anxiety and Stress Disorders, Cape Town, South Africa
| | - Timothy J Steiner
- Division of Brain Sciences, Imperial College London, London, England141Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway
| | - Lars Jacob Stovner
- Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway142Norwegian Advisory Unit on Headache, St Olavs Hospital, Trondheim, Norway
| | - Bryan L Sykes
- Department of Criminology, Law and Society, University of California, Irvine144Department of Sociology, University of California, Irvine145Department of Public Health, University of California, Irvine
| | - Karen M Tabb
- School of Social Work, University of Illinois at Urbana-Champaign, Champaign
| | - Abdullah Sulieman Terkawi
- Department of Anesthesiology, University of Virginia, Charlottesville148Outcomes Research Consortium, Cleveland Clinic, Cleveland, Ohio149Department of Anesthesiology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Alan J Thomson
- Adaptive Knowledge Management, Victoria, British Columbia, Canada
| | - Andrew L Thorne-Lyman
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts152WorldFish, Penang, Malaysia
| | - Jeffrey Allen Towbin
- Le Bonheur Children's Hospital, Memphis, Tennessee154University of Tennessee Health Science Center, Memphis155St Jude Children's Research Hospital, Memphis, Tennessee
| | | | - Tommi Vasankari
- UKK Institute for Health Promotion Research, Tampere, Finland
| | | | | | - Stein Emil Vollset
- Norwegian Institute of Public Health, Oslo, Norway161Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Elisabete Weiderpass
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden163Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway164Department of Community Medicine, Faculty of H
| | - Robert G Weintraub
- University of Melbourne, Melbourne, Australia167Royal Children's Hospital, Melbourne, Australia168Murdoch Childrens Research Institute, Melbourne, Australia
| | - Andrea Werdecker
- Competence Center Mortality Follow-up of the German National Cohort, Federal Institute for Population Research, Wiesbaden, Germany
| | - James D Wilkinson
- School of Medicine, Wayne State University, Detroit, Michigan86Children's Hospital of Michigan, Detroit
| | | | - Charles D A Wolfe
- Division of Health and Social Care Research, King's College London, London, England172National Institute for Health Research Comprehensive Biomedical Research Centre, Guy's and St Thomas' National Health Service Foundation Trust and King's College London
| | - Yuichiro Yano
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois
| | - Paul Yip
- Social Work and Social Administration Department, University of Hong Kong, Hong Kong, China175Hong Kong Jockey Club Centre for Suicide Research and Prevention, University of Hong Kong, Hong Kong, China
| | | | - Seok-Jun Yoon
- Department of Preventive Medicine, College of Medicine, Korea University, Seoul, South Korea
| | | | - Chuanhua Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, Wuhan, China180Global Health Institute, Wuhan University, Wuhan, China
| | | | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | | | - Theo Vos
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
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Winskell K, Miller KS, Allen KA, Obong’o CO. Guiding and supporting adolescents living with HIV in sub-Saharan Africa: The development of a curriculum for family and community members. CHILDREN AND YOUTH SERVICES REVIEW 2016; 61:253-260. [PMID: 27141147 PMCID: PMC4850830 DOI: 10.1016/j.childyouth.2015.12.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Although HIV-related deaths declined globally by 30% between 2005 and 2012, those among adolescents living with HIV (ALHIV) rose by 50%. This discrepancy is primarily due to failure to address the specific needs of ALHIV and resulting poor clinical outcomes related to late diagnosis and poor adherence to antiretroviral therapy. The Families Matter! Program (FMP) is an evidence-based intervention for parents and caregivers of 9-12 year-olds that promotes positive parenting practices and effective parent-child communication about sexuality and sexual risk reduction. It is delivered to groups of participants at the community level through a series of six weekly three-hour sessions. Recognizing family and community members' need for guidance on issues specific to ALHIV, we developed a seventh FMP session to address their needs. Key themes treated in the curriculum for this session include: stigma and mental health, disclosure, ART adherence and self-care, and responsible sexual relationships. In developing the curriculum, we drew on narratives about growing up with HIV contributed by young Africans to a 2013 scriptwriting competition. We describe the data-driven process of developing this curriculum with a view to informing the development of much-needed interventions to serve this vulnerable population.
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Affiliation(s)
- Kate Winskell
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, United States
- Corresponding author
| | - Kim S. Miller
- Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV/AIDS, 1600 Clifton Road, NE, Mailstop E-04, Atlanta, GA 30333, United States
| | - Kristi Ann Allen
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, United States
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Lowenthal ED, Marukutira T, Tshume O, Chapman J, Anabwani GM, Gross R. Prediction of HIV Virologic Failure Among Adolescents Using the Pediatric Symptom Checklist. AIDS Behav 2015; 19:2044-8. [PMID: 25855047 DOI: 10.1007/s10461-015-1061-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Psychosocial dysfunction is a risk factor for treatment non-adherence among children and adolescents. A previous study showed that high scores on the Pediatric Symptom Checklist (PSC) were associated with a history of HIV virologic failure. We assessed whether high scores on the PSC could predict virologic failure in HIV-infected youth. Caregivers of 234 adolescents between the ages of 10 and 16 years were asked to complete a PSC at baseline. Elevated PSC scores were associated with virologic failure in the subsequent 6 months. PSC scores may help guide resource utilization when viral load monitoring is limited.
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Affiliation(s)
- Elizabeth D Lowenthal
- Departments of Pediatrics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Children's Hospital of Philadelphia, 3535 Market Street, Room 1513, Philadelphia, 19104, PA, USA.
| | - Tafireyi Marukutira
- Botswana-Baylor Children's Clinical Centre of Excellence, Gaborone, Botswana
| | - Ontibile Tshume
- Botswana-Baylor Children's Clinical Centre of Excellence, Gaborone, Botswana
| | - Jennifer Chapman
- Children's Hospital of Philadelphia, 3535 Market Street, Room 1513, Philadelphia, 19104, PA, USA
| | - Gabriel M Anabwani
- Botswana-Baylor Children's Clinical Centre of Excellence, Gaborone, Botswana
| | - Robert Gross
- Departments of Medicine (Infectious Diseases) and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Immunodeficiency in children starting antiretroviral therapy in low-, middle-, and high-income countries. J Acquir Immune Defic Syndr 2015; 68:62-72. [PMID: 25501345 DOI: 10.1097/qai.0000000000000380] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The CD4 cell count or percent (CD4%) at the start of combination antiretroviral therapy (cART) is an important prognostic factor in children starting therapy and an important indicator of program performance. We describe trends and determinants of CD4 measures at cART initiation in children from low-, middle-, and high-income countries. METHODS We included children aged <16 years from clinics participating in a collaborative study spanning sub-Saharan Africa, Asia, Latin America, and the United States. Missing CD4 values at cART start were estimated through multiple imputation. Severe immunodeficiency was defined according to World Health Organization criteria. Analyses used generalized additive mixed models adjusted for age, country, and calendar year. RESULTS A total of 34,706 children from 9 low-income, 6 lower middle-income, 4 upper middle-income countries, and 1 high-income country (United States) were included; 20,624 children (59%) had severe immunodeficiency. In low-income countries, the estimated prevalence of children starting cART with severe immunodeficiency declined from 76% in 2004 to 63% in 2010. Corresponding figures for lower middle-income countries were from 77% to 66% and for upper middle-income countries from 75% to 58%. In the United States, the percentage decreased from 42% to 19% during the period 1996 to 2006. In low- and middle-income countries, infants and children aged 12-15 years had the highest prevalence of severe immunodeficiency at cART initiation. CONCLUSIONS Despite progress in most low- and middle-income countries, many children continue to start cART with severe immunodeficiency. Early diagnosis and treatment of HIV-infected children to prevent morbidity and mortality associated with immunodeficiency must remain a global public health priority.
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Pufall EL, Nyamukapa C, Eaton JW, Mutsindiri R, Chawira G, Munyati S, Robertson L, Gregson S. HIV in children in a general population sample in East Zimbabwe: prevalence, causes and effects. PLoS One 2014; 9:e113415. [PMID: 25412251 PMCID: PMC4239054 DOI: 10.1371/journal.pone.0113415] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 10/23/2014] [Indexed: 11/23/2022] Open
Abstract
Background There are an estimated half-million children living with HIV in sub-Saharan Africa. The predominant source of infection is presumed to be perinatal mother-to-child transmission, but general population data about paediatric HIV are sparse. We characterise the epidemiology of HIV in children in sub-Saharan Africa by describing the prevalence, possible source of infection, and effects of paediatric HIV in a southern African population. Methods From 2009 to 2011, we conducted a household-based survey of 3389 children (aged 2–14 years) in Manicaland, eastern Zimbabwe (response rate: 73.5%). Data about socio-demographic correlates of HIV, risk factors for infection, and effects on child health were analysed using multi-variable logistic regression. To assess the plausibility of mother-to-child transmission, child HIV infection was linked to maternal survival and HIV status using data from a 12-year adult HIV cohort. Results HIV prevalence was (2.2%, 95% CI: 1.6–2.8%) and did not differ significantly by sex, socio-economic status, location, religion, or child age. Infected children were more likely to be underweight (19.6% versus 10.0%, p = 0.03) or stunted (39.1% versus 30.6%, p = 0.04) but did not report poorer physical or psychological ill-health. Where maternal data were available, reported mothers of 61/62 HIV-positive children were deceased or HIV-positive. Risk factors for other sources of infection were not associated with child HIV infection, including blood transfusion, vaccinations, caring for a sick relative, and sexual abuse. The observed flat age-pattern of HIV prevalence was consistent with UNAIDS estimates which assumes perinatal mother-to-child transmission, although modelled prevalence was higher than observed prevalence. Only 19/73 HIV-positive children (26.0%) were diagnosed, but, of these, 17 were on antiretroviral therapy. Conclusions Childhood HIV infection likely arises predominantly from mother-to-child transmission and is associated with poorer physical development. Overall antiretroviral therapy uptake was low, with the primary barrier to treatment appearing to be lack of diagnosis.
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Affiliation(s)
- Erica L. Pufall
- Department of Infectious Disease Epidemiology, Imperial College London, St. Mary's Campus, Norfolk Place, London, United Kingdom
- * E-mail:
| | - Constance Nyamukapa
- Department of Infectious Disease Epidemiology, Imperial College London, St. Mary's Campus, Norfolk Place, London, United Kingdom
- Biomedical Research and Training Institute, Avondale, Harare, Zimbabwe
| | - Jeffrey W. Eaton
- Department of Infectious Disease Epidemiology, Imperial College London, St. Mary's Campus, Norfolk Place, London, United Kingdom
| | - Reggie Mutsindiri
- Biomedical Research and Training Institute, Avondale, Harare, Zimbabwe
| | - Godwin Chawira
- Biomedical Research and Training Institute, Avondale, Harare, Zimbabwe
| | - Shungu Munyati
- Biomedical Research and Training Institute, Avondale, Harare, Zimbabwe
| | - Laura Robertson
- Department of Infectious Disease Epidemiology, Imperial College London, St. Mary's Campus, Norfolk Place, London, United Kingdom
| | - Simon Gregson
- Department of Infectious Disease Epidemiology, Imperial College London, St. Mary's Campus, Norfolk Place, London, United Kingdom
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Kranzer K, Meghji J, Bandason T, Dauya E, Mungofa S, Busza J, Hatzold K, Kidia K, Mujuru H, Ferrand RA. Barriers to provider-initiated testing and counselling for children in a high HIV prevalence setting: a mixed methods study. PLoS Med 2014; 11:e1001649. [PMID: 24866209 PMCID: PMC4035250 DOI: 10.1371/journal.pmed.1001649] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 04/16/2014] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND There is a substantial burden of HIV infection among older children in sub-Saharan Africa, the majority of whom are diagnosed after presentation with advanced disease. We investigated the provision and uptake of provider-initiated HIV testing and counselling (PITC) among children in primary health care facilities, and explored health care worker (HCW) perspectives on providing HIV testing to children. METHODS AND FINDINGS Children aged 6 to 15 y attending six primary care clinics in Harare, Zimbabwe, were offered PITC, with guardian consent and child assent. The reasons why testing did not occur in eligible children were recorded, and factors associated with HCWs offering and children/guardians refusing HIV testing were investigated using multivariable logistic regression. Semi-structured interviews were conducted with clinic nurses and counsellors to explore these factors. Among 2,831 eligible children, 2,151 (76%) were offered PITC, of whom 1,534 (54.2%) consented to HIV testing. The main reasons HCWs gave for not offering PITC were the perceived unsuitability of the accompanying guardian to provide consent for HIV testing on behalf of the child and lack of availability of staff or HIV testing kits. Children who were asymptomatic, older, or attending with a male or a younger guardian had significantly lower odds of being offered HIV testing. Male guardians were less likely to consent to their child being tested. 82 (5.3%) children tested HIV-positive, with 95% linking to care. Of the 940 guardians who tested with the child, 186 (19.8%) were HIV-positive. CONCLUSIONS The HIV prevalence among children tested was high, highlighting the need for PITC. For PITC to be successfully implemented, clear legislation about consent and guardianship needs to be developed, and structural issues addressed. HCWs require training on counselling children and guardians, particularly male guardians, who are less likely to engage with health care services. Increased awareness of the risk of HIV infection in asymptomatic older children is needed.
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Affiliation(s)
- Katharina Kranzer
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Jamilah Meghji
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Tsitsi Bandason
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Ethel Dauya
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | | | - Joanna Busza
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Khameer Kidia
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Hilda Mujuru
- Department of Paediatrics, University of Zimbabwe, Harare, Zimbabwe
| | - Rashida A. Ferrand
- Biomedical Research and Training Institute, Harare, Zimbabwe
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail:
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Mburu G, Hodgson I, Teltschik A, Ram M, Haamujompa C, Bajpai D, Mutali B. Rights-based services for adolescents living with HIV: adolescent self-efficacy and implications for health systems in Zambia. REPRODUCTIVE HEALTH MATTERS 2014; 21:176-85. [PMID: 23684200 DOI: 10.1016/s0968-8080(13)41701-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A rights-based approach in HIV service delivery for adults is increasingly taking root in sub-Saharan Africa in the context of greater availability of antiretroviral therapy. Yet there has been comparatively little progress in strengthening a rights-based approach to adolescent HIV services, which we learned during a qualitative study in 2010 among 111 adolescents living with HIV, 21 parents and 38 health providers in three districts in Zambia. Adolescents in the study expressed a range of information and support needs and wanted locally relevant interventions to meet those needs. They wanted greater access to HIV, sexual and reproductive health information, information on how to protect themselves, privacy and confidentiality in service sites, skills training so as to be able to earn money, and better control over disclosure of their HIV status to others. Both health workers and parents acknowledged that information and services needed to be improved to meet those needs far better. This paper provides examples of successful programmes in Zimbabwe, Uganda, Tanzania, Botswana and South Africa and calls for adolescent services to be linked to both paediatric and adult services, peer networks to be established to increase adolescents' ability to collectively voice their concerns and support each other, interventions supporting adolescents' control over self-disclosure, and lastly that adolescent health should become a training specialty in sub-Saharan Africa.
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Affiliation(s)
- Gitau Mburu
- HIV and Health Systems, International HIV/AIDS Alliance, Hove, UK.
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Lowenthal ED, Bakeera-Kitaka S, Marukutira T, Chapman J, Goldrath K, Ferrand RA. Perinatally acquired HIV infection in adolescents from sub-Saharan Africa: a review of emerging challenges. THE LANCET. INFECTIOUS DISEASES 2014; 14:627-39. [PMID: 24406145 DOI: 10.1016/s1473-3099(13)70363-3] [Citation(s) in RCA: 262] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Worldwide, more than three million children are infected with HIV, 90% of whom live in sub-Saharan Africa. As the HIV epidemic matures and antiretroviral treatment is scaled up, children with HIV are reaching adolescence in large numbers. The growing population of adolescents with perinatally acquired HIV infection living within this region presents not only unprecedented challenges but also opportunities to learn about the pathogenesis of HIV infection. In this Review, we discuss the changing epidemiology of paediatric HIV and the particular features of HIV infection in adolescents in sub-Saharan Africa. Longstanding HIV infection acquired when the immune system is not developed results in distinctive chronic clinical complications that cause severe morbidity. As well as dealing with chronic illness, HIV-infected adolescents have to confront psychosocial issues, maintain adherence to drugs, and learn to negotiate sexual relationships, while undergoing rapid physical and psychological development. Context-specific strategies for early identification of HIV infection in children and prompt linkage to care need to be developed. Clinical HIV care should integrate age-appropriate sexual and reproductive health and psychological, educational, and social services. Health-care workers will need to be trained to recognise and manage the needs of these young people so that the increasing numbers of children surviving to adolescence can access quality care beyond specialist services at low-level health-care facilities.
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Affiliation(s)
- Elizabeth D Lowenthal
- Departments of Pediatrics and Epidemiology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA; Department of Paediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Botswana-UPenn Partnership, Gaborone, Botswana
| | - Sabrina Bakeera-Kitaka
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Tafireyi Marukutira
- Botswana-Baylor Children's Clinical Centre of Excellence, Gaborone, Botswana
| | - Jennifer Chapman
- Department of Paediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Kathryn Goldrath
- Departments of Pediatrics and Epidemiology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Rashida A Ferrand
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK; Biomedical Research and Training Institute, Harare, Zimbabwe.
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Kasedde S, Luo C, McClure C, Chandan U. Reducing HIV and AIDS in adolescents: opportunities and challenges. Curr HIV/AIDS Rep 2013; 10:159-68. [PMID: 23563990 DOI: 10.1007/s11904-013-0159-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Adolescents are critical to efforts to end the AIDS epidemic. Few national AIDS strategies explicitly program for children in their second decade of life. Adolescents (aged 10-19 years) are therefore largely invisible in global, regional, and country HIV and AIDS reports making it difficult to assess progress in this population. We have unprecedented knowledge to guide investment towards greater impact on HIV prevention, treatment, and care in adolescents, but it has not been applied to reach those most vulnerable and optimize efficiency and scale. The cost of this is increasing AIDS-related deaths and largely unchanged levels of new HIV infections in adolescents. An AIDS-free generation will remain out of reach if the global community does not prioritize adolescents. National AIDS responses must be accountable to adolescents, invest in strengthening and monitoring protective and supportive laws and policies and access for adolescents to high impact HIV interventions.
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Temporal trends in the characteristics of children at antiretroviral therapy initiation in southern Africa: the IeDEA-SA Collaboration. PLoS One 2013; 8:e81037. [PMID: 24363808 PMCID: PMC3867284 DOI: 10.1371/journal.pone.0081037] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Accepted: 10/18/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Since 2005, increasing numbers of children have started antiretroviral therapy (ART) in sub-Saharan Africa and, in recent years, WHO and country treatment guidelines have recommended ART initiation for all infants and very young children, and at higher CD4 thresholds for older children. We examined temporal changes in patient and regimen characteristics at ART start using data from 12 cohorts in 4 countries participating in the IeDEA-SA collaboration. METHODOLOGY/PRINCIPAL FINDINGS Data from 30,300 ART-naïve children aged <16 years at ART initiation who started therapy between 2005 and 2010 were analysed. We examined changes in median values for continuous variables using the Cuzick's test for trend over time. We also examined changes in the proportions of patients with particular disease severity characteristics (expressed as a binary variable e.g. WHO Stage III/IV vs I/II) using logistic regression. Between 2005 and 2010 the number of children starting ART each year increased and median age declined from 63 months (2006) to 56 months (2010). Both the proportion of children <1 year and ≥10 years of age increased from 12 to 19% and 18 to 22% respectively. Children had less severe disease at ART initiation in later years with significant declines in the percentage with severe immunosuppression (81 to 63%), WHO Stage III/IV disease (75 to 62%), severe anemia (12 to 7%) and weight-for-age z-score<-3 (31 to 28%). Similar results were seen when restricting to infants with significant declines in the proportion with severe immunodeficiency (98 to 82%) and Stage III/IV disease (81 to 63%). First-line regimen use followed country guidelines. CONCLUSIONS/SIGNIFICANCE Between 2005 and 2010 increasing numbers of children have initiated ART with a decline in disease severity at start of therapy. However, even in 2010, a substantial number of infants and children started ART with advanced disease. These results highlight the importance of efforts to improve access to HIV diagnostic testing and ART in children.
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Eaton JW, Garnett GP, Takavarasha FR, Mason PR, Robertson L, Schumacher CM, Nyamukapa CA, Gregson S. Increasing adolescent HIV prevalence in Eastern Zimbabwe--evidence of long-term survivors of mother-to-child transmission? PLoS One 2013; 8:e70447. [PMID: 23950938 PMCID: PMC3737189 DOI: 10.1371/journal.pone.0070447] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Accepted: 06/19/2013] [Indexed: 11/30/2022] Open
Abstract
Recent data from the Manicaland HIV/STD Prevention Project, a general-population open HIV cohort study, suggested that between 2004 and 2007 HIV prevalence amongst males aged 15–17 years in eastern Zimbabwe increased from 1.20% to 2.23%, and in females remained unchanged at 2.23% to 2.39%, while prevalence continued to decline in the rest of the adult population. We assess whether the more likely source of the increase in adolescent HIV prevalence is recent sexual HIV acquisition, or the aging of long-term survivors of perinatal HIV acquisition that occurred during the early growth of the epidemic. Using data collected between August 2006 and November 2008, we investigated associations between adolescent HIV and (1) maternal orphanhood and maternal HIV status, (2) reported sexual behaviour, and (3) reporting recurring sickness or chronic illness, suggesting infected adolescents might be in a late stage of HIV infection. HIV-infected adolescent males were more likely to be maternal orphans (RR = 2.97, p<0.001) and both HIV-infected adolescent males and females were more likely to be maternal orphans or have an HIV-infected mother (male RR = 1.83, p<0.001; female RR = 16.6, p<0.001). None of 22 HIV-infected adolescent males and only three of 23 HIV-infected females reported ever having had sex. HIV-infected adolescents were 60% more likely to report illness than HIV-infected young adults. Taken together, all three hypotheses suggest that recent increases in adolescent HIV prevalence in eastern Zimbabwe are more likely attributable to long-term survival of mother-to-child transmission rather than increases in risky sexual behaviour. HIV prevalence in adolescents and young adults cannot be used as a surrogate for recent HIV incidence, and health systems should prepare for increasing numbers of long-term infected adolescents.
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Affiliation(s)
- Jeffrey W Eaton
- Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom.
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HIV-infected adolescents in southern Africa can achieve good treatment outcomes: results from a retrospective cohort study. AIDS 2013; 27:1971-8. [PMID: 23525033 PMCID: PMC3713766 DOI: 10.1097/qad.0b013e32836149ea] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES In this study we examine whether adolescents treated for HIV/AIDS in southern Africa can achieve similar treatment outcomes to adults. DESIGN We have used a retrospective cohort study design to compare outcomes for adolescents and adults commencing antiretroviral therapy (ART) between 2004 and 2010 in a public sector hospital clinic in Bulawayo, Zimbabwe. METHODS Cox proportional hazards modelling was used to investigate risk factors for death and loss to follow-up (LTFU) (defined as missing a scheduled appointment by ≥3months). RESULTS One thousand, seven hundred and seventy-six adolescents commenced ART, 94% having had no previous history of ART. The median age at ART initiation was 13.3 years. HIV diagnosis in 97% of adolescents occurred after presentation with clinical disease and a higher proportion had advanced HIV disease at presentation compared with adults [WHO Stage 3/4 disease (79.3 versus 65.2%, P < 0.001)]. Despite this, adolescents had no worse mortality than adults, assuming 50% mortality among those LTFU (6.4 versus 7.3 per 100 person-years, P = 0.75) with rates of loss to follow-up significantly lower than in adults (4.8 versus 9.2 per 100 person-years, P < 0.001). Among those who were followed for 5 years or more, 5.8% of adolescents switched to a second-line regimen as a result of treatment failure, compared with 2.1% of adults (P < 0.001). CONCLUSION With adolescent-focused services, it is feasible to achieve good outcomes for adolescents in large-scale ART programs in sub-Saharan Africa. However, adolescents are at high risk of treatment failure, which compromises future drug options. Interventions to address poor adherence in adolescence should be prioritized.
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Ferrand RA, Desai SR, Hopkins C, Elston CM, Copley SJ, Nathoo K, Ndhlovu CE, Munyati S, Barker RD, Miller RF, Bandason T, Wells AU, Corbett EL. Chronic lung disease in adolescents with delayed diagnosis of vertically acquired HIV infection. Clin Infect Dis 2012; 55:145-52. [PMID: 22474177 PMCID: PMC3369563 DOI: 10.1093/cid/cis271] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
A high burden of chronic lung disease (CLD) was found among 116 consecutive adolescents with vertically acquired human immunodeficiency virus in Zimbabwe. The main cause of HIV-associated CLD appears to be obliterative bronchiolitis, which has not previously been recognized among this patient group. Background. Long-term survivors of vertically acquired human immunodeficiency virus (HIV) infection are reaching adolescence in large numbers in Africa and are at high risk of delayed diagnosis and chronic complications of untreated HIV infection. Chronic respiratory symptoms are more common than would be anticipated based on the HIV literature. Methods. Consecutive adolescents with presumed vertically acquired HIV attending 2 HIV care clinics in Harare, Zimbabwe, were recruited and assessed with clinical history and examination, CD4 count, pulmonary function tests, Doppler echocardiography, and chest radiography (CXR). Those with suspected nontuberculous chronic lung disease (CLD) were scanned using high-resolution computed tomography (HRCT). Results. Of 116 participants (43% male; mean age, 14 ± 2.6 years, mean age at HIV diagnosis, 12 years), 69% were receiving antiretroviral therapy. Chronic cough and reduced exercise tolerance were reported by 66% and 21% of participants, respectively; 41% reported multiple respiratory tract infections in the previous year, and 10% were clubbed. More than 40% had hypoxemia at rest (13%) or on exercise (29%), with pulmonary hypertension (mean pulmonary artery pressure >25 mm Hg) in 7%. Forced expiratory volume in 1 second (FEV1) was <80% predicted in 45%, and 47% had subtle CXR abnormalities. The predominant HRCT pattern was decreased attenuation as part of a mosaic attenuation pattern (31 of 56 [55%]), consistent with small airway disease and associated with bronchiectasis (Spearman correlation coefficient (r2 = 0.8) and reduced FEV1 (r2 = −0.26). Conclusions. Long-term survivors of vertically acquired HIV in Africa are at high risk of a previously undescribed small airway disease, with >40% of unselected adolescent clinic attendees meeting criteria for severe hypoxic CLD. This condition is not obvious at rest. Etiology, prognosis, and response to treatment are currently unknown.
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Affiliation(s)
- Rashida A Ferrand
- Clinical Research Department, London School of Hygiene and Tropical Medicine, United Kingdom.
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Lowenthal E, Lawler K, Harari N, Moamogwe L, Masunge J, Masedi M, Matome B, Seloilwe E, Gross R. Rapid psychosocial function screening test identified treatment failure in HIV+ African youth. AIDS Care 2012; 24:722-7. [PMID: 22292411 DOI: 10.1080/09540121.2011.644233] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Psychosocial dysfunction in older children and adolescents is common and may lead to nonadherence to HIV treatments. Poor adherence leads to HIV treatment failure and the development of resistant virus. In resource-limited settings where treatment options are typically limited to only one or two available lines of therapy, identification of individuals at highest risk of failure before failure occurs is of critical importance. Rapid screening tools for psychosocial dysfunction may allow for identification of those children and adolescents who are most likely to benefit from limited psychosocial support services targeted at preventing HIV treatment failure. The Pediatric Symptom Checklist (PSC) is used in high resource settings for rapid identification of at-risk youth. In 692 HIV-infected treated children (ages of 8-< 17 years) in Botswana, having a high score on the PSC was associated with having virologic failure (OR 1.7, 95% CI: 1.1-2.6). The PSC may be a useful screening tool in pediatric HIV.
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Skovdal M, Campbell C, Madanhire C, Nyamukapa C, Gregson S. Challenges faced by elderly guardians in sustaining the adherence to antiretroviral therapy in HIV-infected children in Zimbabwe. AIDS Care 2011; 23:957-64. [PMID: 21400306 PMCID: PMC3206703 DOI: 10.1080/09540121.2010.542298] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Grandparents throughout sub-Saharan Africa have shown immense courage and fortitude in providing care and support for AIDS-affected children. However, growing old comes with a number of challenges which can compromise the quality of care and support they are able to provide, particularly for children infected by HIV and enrolled on antiretroviral therapy (ART) programmes. For ART to be effective, and for infected children not to develop drug-resistance, a complex treatment regimen must be followed. Drawing on the perspectives of 25 nurses and eight grandparents of HIV-infected children in Manicaland, eastern Zimbabwe, we explore some of the challenges faced by grandparents in sustaining children's adherence to ART. These challenges, serving as barriers to paediatric ART, are poverty, immobility, deteriorating memory and poor comprehension of complex treatments. Although older HIV-infected children were found to play an active role in sustaining the adherence to their programme of treatment by contributing to income and food generating activities and reminding their guardians about check-ups and drug administration, such contribution was not available from younger children. There is therefore an urgent need to develop ART services that both take into consideration the needs of elderly guardians and acknowledge and enhance the agency of older children as active and responsible contributors to ART adherence.
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Affiliation(s)
- M Skovdal
- Institute of Social Psychology, London School of Economics and Political Science, UK.
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Ferrand RA, Trigg C, Bandason T, Ndhlovu CE, Mungofa S, Nathoo K, Gibb DM, Cowan FM, Corbett EL. Perception of risk of vertically acquired HIV infection and acceptability of provider-initiated testing and counseling among adolescents in Zimbabwe. Am J Public Health 2011; 101:2325-32. [PMID: 22021300 DOI: 10.2105/ajph.2011.300250] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We investigated attitudes toward provider-initiated HIV testing and counseling (PITC) in the suburbs of Harare, Zimbabwe, where late presentation after mother-to-child HIV transmission (MTCT) is a major cause of adolescent mortality. METHODS Adolescents (10-18 years) attending 2 primary clinics were offered PITC. Participants completed a questionnaire investigating acceptability of PITC, and in-depth interviews with 41 adolescents and 30 guardians explored understanding of long-term survival after MTCT. RESULTS Of 506 participants, 16 were known to be HIV-positive; of the remaining 490, only 5 (1%) declined HIV testing. Infected adolescents and their guardians often anticipated a positive result and reported being advised by relatives (but not health workers) to be tested because of chronic illness, especially if parents or siblings had died or were HIV-infected. However, HIV-negative participants were not aware that long-term survival following MTCT could occur. All adolescents felt that HIV diagnosed at their age would be assumed to have been sexually acquired regardless of the true mode of transmission. CONCLUSIONS Including late diagnosis of MTCT in pretest counseling and health educational messages may facilitate PITC for older children and adolescents, especially for those who have not had their sexual debut.
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Building adherence-competent communities: factors promoting children's adherence to anti-retroviral HIV/AIDS treatment in rural Zimbabwe. Health Place 2011; 18:123-31. [PMID: 21975285 PMCID: PMC3512054 DOI: 10.1016/j.healthplace.2011.07.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Revised: 07/06/2011] [Accepted: 07/18/2011] [Indexed: 11/22/2022]
Abstract
Given relatively high levels of adherence to HIV treatment in Africa, we explore factors facilitating children's adherence, despite poverty, social disruption and limited health infrastructure. Using interviews with 25 nurses and 40 guardians in Zimbabwe, we develop our conceptualisation of an ‘adherence competent community’, showing how members of five networks (children, guardians, community members, health workers and NGOs) have taken advantage of the gradual public normalisation of HIV/AIDS and improved drug and service availability to construct new norms of solidarity with HIV and AIDS sufferers, recognition of HIV-infected children's social worth, an ethic of care/assistance and a supporting atmosphere of enablement/empowerment.
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Ferrand RA, Munaiwa L, Matsekete J, Bandason T, Nathoo K, Ndhlovu CE, Munyati S, Cowan FM, Gibb DM, Corbett EL. Undiagnosed HIV infection among adolescents seeking primary health care in Zimbabwe. Clin Infect Dis 2010; 51:844-51. [PMID: 20804412 DOI: 10.1086/656361] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Mother-to-child transmission of human immunodeficiency virus (HIV) infection was extremely common in southern Africa during the 1990s, and a substantial minority of infected infants have survived to reach adolescence undiagnosed. Studies have shown a high prevalence of HIV infection in hospitalized adolescents who have features associated with long-standing HIV infection, including stunting and frequent minor illnesses. We therefore investigated the epidemiology of HIV infection at the primary care level. METHODS Adolescents (aged 10-18 years) attending two primary care clinics underwent HIV and Herpes simplex virus-2 (HSV-2) serological testing, clinical examination, and anthropometry. All were offered routine HIV counseling and testing. Patients attending for acute primary care (APC) who were HIV infected were asked about their risk factors. RESULTS Five hundred ninety-four participants were systematically recruited (97% participation), of whom 88 (15%) were attending for antenatal care. HIV infection prevalence was higher among APC attendees than among antenatal care attendees (17% vs 6%; P < .007), but for the prevalence of HSV-2 infection, a marker of sexually acquired HIV, the converse was true (4% vs 14%; P < .002). Seventy (81%) of 86 HIV-positive APC attendees were previously undiagnosed. They had a broad range of presenting complaints, with a median CD4 cell count of 329 cells/microL (interquartile range, 176-485 cells/microL) and a high prevalence of stunting, compared with the corresponding prevalence among HIV-negative attendees (40% vs 12%; P < .001). Maternal transmission was considered to be likely by 69 (80%) of the 86 HIV-positive APC attendees, only one of whom was HSV-2 positive. CONCLUSIONS Unrecognized HIV infection was a common cause of primary care attendance. Routine HIV counseling and testing implemented at the primary care level may provide a simple and effective way of identifying older long-term survivors of mother-to-child transmission before the onset of severe immunosuppression and irreversible complications.
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Affiliation(s)
- Rashida A Ferrand
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.
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Causes of acute hospitalization in adolescence: burden and spectrum of HIV-related morbidity in a country with an early-onset and severe HIV epidemic: a prospective survey. PLoS Med 2010; 7:e1000178. [PMID: 20126383 PMCID: PMC2814826 DOI: 10.1371/journal.pmed.1000178] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2009] [Accepted: 12/18/2009] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Survival to older childhood with untreated, vertically acquired HIV infection, which was previously considered extremely unusual, is increasingly well described. However, the overall impact on adolescent health in settings with high HIV seroprevalence has not previously been investigated. METHODS AND FINDINGS Adolescents (aged 10-18 y) systematically recruited from acute admissions to the two public hospitals in Harare, Zimbabwe, answered a questionnaire and underwent standard investigations including HIV testing, with consent. Pre-set case-definitions defined cause of admission and underlying chronic conditions. Participation was 94%. 139 (46%) of 301 participants were HIV-positive (median age of diagnosis 12 y: interquartile range [IQR] 11-14 y), median CD4 count = 151; IQR 57-328 cells/microl), but only four (1.3%) were herpes simplex virus-2 (HSV-2) positive. Age (median 13 y: IQR 11-16 y) and sex (57% male) did not differ by HIV status, but HIV-infected participants were significantly more likely to be stunted (z-score<-2: 52% versus 23%, p<0.001), have pubertal delay (15% versus 2%, p<0.001), and be maternal orphans or have an HIV-infected mother (73% versus 17%, p<0.001). 69% of HIV-positive and 19% of HIV-negative admissions were for infections, most commonly tuberculosis and pneumonia. 84 (28%) participants had underlying heart, lung, or other chronic diseases. Case fatality rates were significantly higher for HIV-related admissions (22% versus 7%, p<0.001), and significantly associated with advanced HIV, pubertal immaturity, and chronic conditions. CONCLUSION HIV is the commonest cause of adolescent hospitalisation in Harare, mainly due to adult-spectrum opportunistic infections plus a high burden of chronic complications of paediatric HIV/AIDS. Low HSV-2 prevalence and high maternal orphanhood rates provide further evidence of long-term survival following mother-to-child transmission. Better recognition of this growing phenomenon is needed to promote earlier HIV diagnosis and care.
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AIDS among older children and adolescents in Southern Africa: projecting the time course and magnitude of the epidemic. AIDS 2009; 23:2039-46. [PMID: 19684508 DOI: 10.1097/qad.0b013e32833016ce] [Citation(s) in RCA: 149] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE An AIDS epidemic among older children and adolescents is clinically apparent in Southern Africa. We estimated the likely scale and time course of the epidemic in older survivors of vertical HIV infection. DESIGN We modelled demographic, HIV prevalence, mother-to-child transmission and child survival data to project HIV burden among older children in two Southern African countries at different stages of severe HIV epidemics. Using measured survival data for children, we estimate that 64% of HIV-infected infants are fast progressors with median survival 0.64 years and 36% are slow progressors with median survival 16.0 years. We confirmed model validity by comparing model predictions to available epidemiological data. FINDINGS Without treatment, HIV prevalence among 10-year-olds in South Africa is expected to increase from 2.1% in 2008 to 3.3% in 2020, whereas in Zimbabwe, it will decrease from 3.2% in 2008 to 1.6% in 2020. Deaths among untreated slow progressors will increase in South Africa from 7000/year in 2008 to 23 000/year in 2030, and in Zimbabwe from 8000/year in 2008 to peak at 9700/year in 2014. Drugs to prevent mother-to-child transmission could reduce death rate in 2030 to 8700/year in South Africa and to 2800/year in Zimbabwe in 2014. CONCLUSIONS A substantial epidemic of HIV/AIDS in older survivors of mother-to-child transmission is emerging in Southern Africa. The lack of direct observations of survival in slow progressors has resulted in failure to anticipate the magnitude of the epidemic and to adequately address the clinical needs of HIV-infected older children and adolescents. Better HIV diagnostic and care services for this age group are urgently required.
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