1
|
Tukei VJ, Herrera N, Masitha M, Masenyetse L, Mokone M, Mokone M, Maile L, Gill MM. Optimizing antiretroviral therapy for children living with HIV: Experience from an observational cohort in Lesotho. PLoS One 2023; 18:e0288619. [PMID: 37459349 PMCID: PMC10351696 DOI: 10.1371/journal.pone.0288619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 06/30/2023] [Indexed: 07/20/2023] Open
Abstract
INTRODUCTION We describe transition of HIV-positive children from efavirenz- or nevirapine-based antiretroviral therapy (ART) to optimal dolutegravir (DTG) or lopinavir/ritonavir (LPV/r) (solid formulation)-based ART in Lesotho. METHODS We followed a cohort of children less than 15 years of age who were initiated on ART on or after January 1, 2018 from 21 selected health facilities in Lesotho. From March 2020 to May 2022, we collected data retrospectively through chart abstraction and prospectively through caregiver interviews to cover a period of 24 months following treatment initiation. We used a structured questionnaire to collect data on demographics, ART regimen, drug formulations and switches, viral suppression, retention, and drug administration challenges. Data were summarized as frequencies and percentages, using SAS ver.9.4. RESULTS Of 310 children enrolled in the study, 169 (54.5%) were female, and median age at ART initiation was 5.9 years (IQR 1.1-11.1). During follow-up, 19 (6.1%) children died, 41 (13.2%) were lost to follow-up and 74 (23.9%) transferred to non-study sites. At baseline, 144 (46.4%) children were receiving efavirenz-based ART regimen, 133 (42.9%) LPV/r, 27 (8.7%) DTG, 5 (1.6%) nevirapine; 1 child had incomplete records. By study end, 143 (46.1%) children were receiving LPV/r-based ART regimen, 109 (35.2%) DTG, and 58 (18.7%) were on efavirenz or nevirapine-based regimen. Of 116 children with viral load results after six months or more on a consistent regimen, viral suppression was seen in 35/53 (66.0%) children on LPV/r, 36/38 (94.7%) children on DTG and 19/24 (79.2%) children on efavirenz. CONCLUSION Following optimal ART introduction in Lesotho, most children in the cohort were transitioned and many attained or maintained viral suppression after transition; however, we recommend more robust viral load monitoring and patient tracking to reduce losses and improve outcomes after ART transition.
Collapse
Affiliation(s)
| | - Nicole Herrera
- Elizabeth Glaser Pediatric AIDS Foundation, Washington, D.C., United States of America
| | | | | | | | - Mafusi Mokone
- Elizabeth Glaser Pediatric AIDS Foundation, Maseru, Lesotho
| | | | - Michelle M. Gill
- Elizabeth Glaser Pediatric AIDS Foundation, Washington, D.C., United States of America
| |
Collapse
|
2
|
Sarode IM, Jindal AB. Current status of dolutegravir delivery systems for the treatment of HIV-1 infection. J Drug Deliv Sci Technol 2022; 76:103802. [DOI: 10.1016/j.jddst.2022.103802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
3
|
Abstract
INTRODUCTION The field of neonatal, infant and toddler pharmaceutical development is constantly improving, however a lag still remains in comparison to older children and adults. Their rapid anatomical, physiological and behavioural developmental rates pose extra challenges in diagnosing, treating, or preventing their disease. In turn, this brings complexity in formulating truly age-appropriate medicinal products that suit this heterogeneous paediatric subset. Progress in the availability of such products has ensued following the introduction of the 2007 European Union Paediatric Regulation, and in recent years, oral multiparticulate and dispersible solid formulations have gained interest alongside liquid formulations. However, the need is still great for dosage forms that do not compromise on pharmaceutical efficacy, safety and global accessibility in those aged under 2. AREAS COVERED This article highlights some of the formulation challenges correlated with this age group and critically explores recent solid age-appropriate formulations and their administration devices for enteral drug delivery. EXPERT OPINION There are many formulation requirements to consider when formulating drug products for children aged under 2. Efforts are required into understanding acceptability in this age group and of their carers, and whether innovation or optimisation is required, to help guide formulators towards optimal approaches without impacting access.
Collapse
Affiliation(s)
- Nicole Sheena Kaneria
- University College London, School of Pharmacy, 29-39 Brunswick Square, Bloomsbury, London, WC1N 1AX UK
| | - Catherine Tuleu
- University College London, School of Pharmacy, 29-39 Brunswick Square, Bloomsbury, London, WC1N 1AX UK
| | - Terry Ernest
- GlaxoSmithKline, New Frontiers Science Park, Third Avenue Essex, Harlow, CM19 5AW UK.,GlaxoSmithKline, Hertfordshire, Park Road, Ware, UK, SG12 0DP
| |
Collapse
|
4
|
Nhampossa T, Fernández-Luis S, Fuente-Soro L, Bernardo E, Nhacolo A, Augusto O, Nhacolo A, Sacoor C, Saura-Lázaro A, Lopez-Varela E, Naniche D. The impact of the caregiver mobility on child HIV care in the Manhiça District, Southern Mozambique: A clinical based study. PLoS One 2021; 16:e0261356. [PMID: 34914769 PMCID: PMC8675651 DOI: 10.1371/journal.pone.0261356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 11/30/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction Manhiça District, in Southern Mozambique harbors high HIV prevalence and a long history of migration. To optimize HIV care, we sought to assess how caregiver’s mobility impacts children living with HIV (CLHIV)´s continuation in HIV care and to explore the strategies used by caregivers to maintain their CLHIV on antiretroviral treatment (ART). Methods A clinic-based cross-sectional survey conducted at the Manhiça District Hospital between December-2017 and February-2018. We enrolled CLHIV with a self-identified migrant caregiver (moved outside of Manhiça District ≤12 months prior to survey) and non-migrant caregiver, matched by the child age and sex. Survey data were linked to CLHIV clinical records from the HIV care and treatment program. Results Among the 975 CLHIV screened, 285 (29.2%) were excluded due to absence of an adult at the appointment. A total of 232 CLHIV-caregiver pairs were included. Of the 41 (35%) CLHIV migrating with their caregivers, 38 (92.6%) had access to ART at the destination because either the caregivers travelled with it 24 (63%) or it was sent by a family member 14 (36%). Among the 76 (65%) CLHIV who did not migrate with their caregivers, for the purpose of pharmacy visits, 39% were cared by their grandfather/grandmother, 28% by an aunt/uncle and 16% by an adult brother/sister. CLHIV of migrant caregivers had a non-statistically significant increase in the number of previous reported sickness episodes (OR = 1.38, 95%CI: 0.79–2.42; p = 0.257), ART interruptions (OR = 1.73; 95%CI: 0.82–3.63; p = 0.142) and lost-to-follow-up episodes (OR = 1.53; 95%CI: 0.80–2.94; p = 0.193). Conclusions Nearly one third of the children attend their HIV care appointments unaccompanied by an adult. The caregiver mobility was not found to significantly affect child’s retention on ART. Migrant caregivers adopted strategies such as the transportation of ART to the mobility destination to avoid impact of mobility on the child’s HIV care. However this may have implications on ART stability and effectiveness that should be investigated in rural areas.
Collapse
Affiliation(s)
- Tacilta Nhampossa
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Instituto Nacional de Saúde, Ministério de Saúde (INS), Maputo, Mozambique
- * E-mail:
| | - Sheila Fernández-Luis
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic de Barcelona, Barcelona, Spain
| | - Laura Fuente-Soro
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic de Barcelona, Barcelona, Spain
| | - Edson Bernardo
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Serviço Distrital de Saúde, Mulher e Acção Social de Manhiça, Maputo, Mozambique
| | - Arsenio Nhacolo
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Orvalho Augusto
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Ariel Nhacolo
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Charfudin Sacoor
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Anna Saura-Lázaro
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic de Barcelona, Barcelona, Spain
| | - Elisa Lopez-Varela
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic de Barcelona, Barcelona, Spain
| | - Denise Naniche
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic de Barcelona, Barcelona, Spain
| |
Collapse
|
5
|
Jonnalagadda S, Auld A, Jahn A, Saito S, Bello G, Sleeman K, Ogollah FM, Cuervo-Rojas J, Radin E, Kayira D, Kim E, Payne D, Burnett J, Hrapcak S, Patel H, Voetsch AC. Opportunities for Closing the Gap in HIV Diagnosis, Treatment, and Viral Load Suppression in Children in Malawi: Results From a 2015-2016 Population-based HIV Impact Assessment Survey. Pediatr Infect Dis J 2021; 40:1011-1018. [PMID: 34382613 DOI: 10.1097/inf.0000000000003288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Control of the pediatric HIV epidemic is hampered by gaps in diagnosis and linkage to effective treatment. The 2015-2016 Malawi Population-based HIV impact assessment data were analyzed to identify gaps in pediatric HIV diagnosis, treatment, and viral load suppression. METHODS In half of the surveyed households, children ages ≥18 months to <15 years were tested using the national HIV rapid test algorithm. Children ≤18 months reactive by the initial rapid test underwent HIV total nucleic acid polymerase chain reaction confirmatory testing. Blood from HIV-positive children was tested for viral load (VL) and presence of antiretroviral drugs. HIV diagnosis and antiretroviral treatment (ART) use were defined using guardian-reporting or antiretroviral detection. RESULTS Of the 6166 children tested, 99 were HIV-positive for a prevalence of 1.5% (95% confidence intervals [CI]: 1.1-1.9) and 8.0% (95% CI: 5.6-10.5) among HIV-exposed children. The prevalence of 1.5% was extrapolated to a national estimate of 119,501 (95% CI: 89,028-149,974) children living with HIV (CLHIV), of whom, 30.7% (95% CI: 20.3-41.1) were previously undiagnosed. Of the 69.3% diagnosed CLHIV, 86.1% (95% CI: 76.8-95.6) were on ART and 57.9% (95% CI: 41.4-74.4) of those on ART had suppressed VL (<1000 HIV RNA copies/mL). Among all CLHIV, irrespective of HIV diagnosis or ART use, 57.7% (95% CI: 45.0-70.5) had unsuppressed VL. CONCLUSIONS Critical gaps in HIV diagnosis in children persist in Malawi. The large proportion of CLHIV with unsuppressed VL reflects gaps in diagnosis and need for more effective first- and second-line ART regimens and adherence interventions.
Collapse
Affiliation(s)
| | - Andrew Auld
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Lilongwe, Malawi
| | - Andreas Jahn
- Ministry of Health, Government of Malawi, Lilongwe, Malawi
| | | | - George Bello
- Ministry of Health, Government of Malawi, Lilongwe, Malawi
| | - Katrina Sleeman
- From the Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Juliana Cuervo-Rojas
- ICAP at Columbia University, New York, NY
- Faculty of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
| | | | - Dumbani Kayira
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Lilongwe, Malawi
| | - Evelyn Kim
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Lilongwe, Malawi
| | - Danielle Payne
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Lilongwe, Malawi
| | - Janet Burnett
- From the Centers for Disease Control and Prevention, Atlanta, GA
| | - Susan Hrapcak
- From the Centers for Disease Control and Prevention, Atlanta, GA
| | - Hetal Patel
- From the Centers for Disease Control and Prevention, Atlanta, GA
| | - Andrew C Voetsch
- From the Centers for Disease Control and Prevention, Atlanta, GA
| |
Collapse
|
6
|
Castor D, Meyers K, Allen S. The only way is up: priorities for implementing long-acting antiretrovirals for HIV prevention and treatment. Curr Opin HIV AIDS 2020; 15:73-80. [PMID: 31688333 DOI: 10.1097/COH.0000000000000601] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Purpose of review Long-acting HIV treatment and prevention (LAHTP) can address some of the achievement gaps of daily oral therapy to bring us closer to achieving Joint United Nations Programme on HIV/AIDS Fast-track goals. Implementing these new technologies presents individual-level, population-level, and health systems-level opportunities and challenges. Recent findings To optimize LAHTP implementation and impact, decision-makers should define and gather relevant data to inform their investment case within the existing health systems context. Programmatic observations from scale-up of antiretroviral therapy, oral preexposure prophylaxis, voluntary medical male circumcision, and family planning offer lessons as planning begins for implementation of LAHTP. Additional data intelligence should be derived from formative studies, pragmatic clinical trials, epidemiologic and economic modeling of LAHTP. Key implementation issues that need to be addressed include optimal communication strategies for demand creation; target setting; logistics and supply chain of commodities needed for LAHTP delivery; human resource planning; defining and operationalizing monitoring and evaluating metrics; integration into health systems. Summary Successful LAHTP implementation can bolster treatment and prevention coverage levels if implementation issues outlined above are proactively addressed in parallel with research and development so that health systems can more rapidly integrate new technologies as they gain regulatory approval.
Collapse
|
7
|
Golin R, Samuel JM, Phelps BR, Persaud U, Malati CY, Siberry GK. The promise of paediatric dolutegravir. J Int AIDS Soc 2021; 24:e25660. [PMID: 33522081 PMCID: PMC7848097 DOI: 10.1002/jia2.25660] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 12/02/2020] [Accepted: 12/07/2020] [Indexed: 11/23/2022] Open
Affiliation(s)
- Rachel Golin
- Office of HIV/AIDSUnited States Agency for International DevelopmentWashingtonDCUSA
| | - Jeffrey M Samuel
- Office of HIV/AIDSUnited States Agency for International DevelopmentWashingtonDCUSA
| | - B Ryan Phelps
- Office of HIV/AIDSUnited States Agency for International DevelopmentWashingtonDCUSA
| | - Udita Persaud
- Office of HIV/AIDSUnited States Agency for International DevelopmentWashingtonDCUSA
| | - Christine Y Malati
- Office of HIV/AIDSUnited States Agency for International DevelopmentWashingtonDCUSA
| | - George K Siberry
- Office of HIV/AIDSUnited States Agency for International DevelopmentWashingtonDCUSA
| |
Collapse
|