scholarly journals The Impact of Same-Day Antiretroviral Therapy Initiation under the WHO Treat-All Policy

2021 ◽  
Author(s):  
Bernhard Kerschberger ◽  
Andrew Boulle ◽  
Rudo Kuwengwa ◽  
Iza Ciglenecki ◽  
Michael Schomaker
Keyword(s):  
Antiretroviral Therapy ◽  
Directed Acyclic Graphs ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Unfavourable Outcome ◽  
Old Patients ◽  
Loss To Follow Up ◽  
Treat All ◽  
The Impact

Abstract Rapid initiation of antiretroviral therapy (ART) is recommended for people living with HIV, with the option to start treatment on the day of diagnosis (same-day-ART). However, the effect of same-day-ART remains unknown in realistic public sector settings. We established a cohort of ≥16-year-old patients who initiated first-line ART under Treat-All in Nhlangano (Eswatini) between 2014-2016, either on the day of HIV care enrolment (same-day-ART) or 1–14 days thereafter (early-ART). Directed acyclic graphs, flexible parametric survival analysis and targeted maximum likelihood estimation (TMLE) were used to estimate the effect of same-day-ART initiation on the composite unfavourable treatment outcome (loss to follow-up;death;viral failure). Of 1328 patients, 839 (63.2%) initiated same-day ART. The adjusted hazard ratio of the unfavourable outcome was increased by 1.48 (95% CI:1.16–1.89) for same-day-ART compared with early-ART. TMLE suggested that after 1 year, 28.9% of patients would experience the unfavourable outcome under same-day-ART compared with 21.2% under early-ART (difference: 7.7%; 1.3–14.1%). This estimate was driven by loss to follow-up and varied over time, with a higher hazard during the first year after HIV care enrolment and a similar hazard thereafter. We found an increased risk with same-day-ART. A limitation was possible silent transfers that were not captured.

scholarly journals The impact of same-day antiretroviral therapy initiation under the WHO Treat-All policy

2020 ◽  
Author(s):  
Bernhard Kerschberger ◽  
Andrew Boulle ◽  
Rudo Kuwengwa ◽  
Iza Ciglenecki ◽  
Michael Schomaker
Keyword(s):  
Antiretroviral Therapy ◽  
Likelihood Estimation ◽  
Directed Acyclic Graphs ◽  
World Health ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Unfavourable Outcome ◽  
Old Patients ◽  
Treat All ◽  
The Impact

ABSTRACTBackgroundThe World Health Organization recommends rapid initiation of antiretroviral therapy (ART) for people living with HIV, with the option to start treatment on the day of diagnosis (same-day-ART). However, the effect of same-day-ART remains unknown in realistic public sector settings.MethodsWe established a cohort of ≥16-year-old patients who initiated first-line ART under Treat-All in Eswatini between 2014-2016, either on the day of HIV care enrolment (same-day-ART) or 1–14 days thereafter (early-ART). Directed acyclic graphs, flexible parametric survival analysis and targeted maximum likelihood estimation (TMLE) were used to estimate the effect of same-day ART initiation on the composite unfavourable treatment outcome (loss to follow-up;death;viral failure).ResultsOf 1328 patients, 839 (63.2%) initiated same-day ART. The adjusted hazard ratio of the unfavourable outcome was increased by 48% (95% CI:1.16–1.89) for same-day ART compared with early ART. TMLE suggested that after 1 year, 28.9% of patients would experience the unfavourable outcome under same-day ART compared with 21.2% under early ART (difference: 7.7%; 1.3–14.1%). This effect varied over time in regression analysis and TMLE, with a higher hazard during the first year after HIV care enrolment and a similar hazard thereafter.ConclusionsCaution is needed in implementing same-day ART in routine settings.

scholarly journals International epidemiology databases to evaluate AIDS (IeDEA) in sub-Saharan Africa, 2012–2019

BMJ Open ◽  
2020 ◽  
Vol 10 (5) ◽  
pp. e035246 ◽  
Author(s):  
Frédérique Chammartin ◽  
Cam Ha Dao Ostinelli ◽  
Kathryn Anastos ◽  
Antoine Jaquet ◽  
Ellen Brazier ◽  
...  
Keyword(s):  
Drug Resistance ◽  
Clinical Stage ◽  
Sub Saharan Africa ◽  
People Living With Hiv ◽  
Loss To Follow Up ◽  
Sub Saharan ◽  
Treat All ◽  
The Impact ◽  
International Epidemiology

PurposeThe objectives of the International epidemiology databases to evaluate AIDS (IeDEA) are to (i) evaluate the delivery of combination antiretroviral therapy (ART) in children, adolescents and adults in sub-Saharan Africa, (ii) to describe ART regimen effectiveness, durability and tolerability, (iii) to examine HIV-related comorbidities and coinfections and (iv) to examine the pregnancy-related and HIV-related outcomes of women on ART and their infants exposed to HIV or ART in utero or via breast milk.ParticipantsIeDEA is organised in four regions (Central, East, Southern and West Africa), with 240 treatment and care sites, six data centres at African, European and US universities, and almost 1.4 million children, adolescents and adult people living with HIV (PLWHIV) enrolled.Findings to dateThe data include socio-demographic characteristics, clinical outcomes, opportunistic events, treatment regimens, clinic visits and laboratory measurements. They have been used to analyse outcomes in PLWHIV-1 or PLWHIV-2 who initiate ART, including determinants of mortality, of switching to second-line and third-line ART, drug resistance, loss to follow-up and the immunological and virological response to different ART regimens. Programme-level estimates of mortality have been corrected for loss to follow-up. We examined the impact of coinfection with hepatitis B and C, and the epidemiology of different cancers and of (multidrug resistant) tuberculosis, renal disease and of mental illness. The adoption of ‘Treat All’, making ART available to all PLWHIV regardless of CD4+ cell count or clinical stage was another important research topic.Future plansIeDEA has formulated several research priorities for the ‘Treat All’ era in sub-Saharan Africa. It recently obtained funding to set up sentinel sites where additional data are prospectively collected on cardiometabolic risks factors as well as mental health and liver diseases, and is planning to create a drug resistance database.

scholarly journals Incidence and predictors of early loss to follow up among patients initiated on protease inhibitor-based second-line antiretroviral therapy in southwestern Uganda

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Edwin Nuwagira ◽  
Boniface A. E. Lumori ◽  
Rose Muhindo ◽  
Michael Kanyesigye ◽  
Abdallah Amir ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Protease Inhibitor ◽  
Sub Saharan Africa ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Second Line ◽  
Current Increase ◽  
Loss To Follow Up ◽  
Southwestern Uganda

Abstract Background Good adherence to antiretroviral therapy (ART) and retention in care are essential for the effectiveness of an HIV care program. With the current increase in numbers of people living with HIV taking second-line ART in sub-Saharan Africa, there is a need to establish their treatment outcomes and the rate of loss to follow up. In this study, we determined the incidence and predictors of loss to follow up among patients taking second-line ART at an experienced HIV treatment center in southwestern Uganda. Methods This was a retrospective review of an electronic database at Mbarara Regional Referral Hospital HIV clinic in southwestern Uganda. Second-line ART included at least two of the nucleoside reverse transcriptase inhibitors and a boosted protease inhibitor. Loss to follow-up was defined as failure to return to the health facility for care or treatment refill for 180 days or more from the previous visit. After excluding children less than 15 years, we pooled data that included socio-demographic, clinical, and laboratory data for patients who started second-line ART between 2002 and 2017. Multiple imputation was done for variables with missing data. Variables that had a p < 0.05 in unadjusted bivariate analyses were included in a multivariate binomial regression model using a stepwise backward selection procedure to describe the factors that independently predicted loss to follow-up. Results Between 2002 and 2017, 1121 patients had been initiated on second-line ART. We included data from 924 participants and of these, 518 (56.1%) were female, the mean age (SD) was 38.4 (± 10.5) years, and 433 (52.4%) had a CD4 count less than 100 cells/µl at the start of second-line ART. The incidence of loss to follow-up was 26.7 per 100 person-years. Male gender (Adjusted risk ratio (ARR) = 1.8, 95% CI 1.5–2.0) p < 0.001 and anemia ARR 1.4, 95% CI 1.1–1.6) p < 0.001 were strongly associated with loss to follow up. Conclusions There is a high incidence of loss to follow up among patients taking protease-inhibitor based second-line ART at a tertiary HIV center in southwestern Uganda. There is a need to routinely measure hemoglobin during clinic reviews, and establish mechanisms to retain males initiated on second-line ART in care. The association of anemia and loss to follow up needs to be investigated.

scholarly journals Cohort profile: The International epidemiology Databases to Evaluate AIDS (IeDEA) in sub-Saharan Africa, 2012-2019

2019 ◽  
Author(s):  
Frédérique Chammartin ◽  
Cam Ha Dao Ostinelli ◽  
Kathryn Anastos ◽  
Antoine Jaquet ◽  
Ellen Brazier ◽  
...  
Keyword(s):  
Drug Resistance ◽  
Antiretroviral Therapy ◽  
Sub Saharan Africa ◽  
People Living With Hiv ◽  
Loss To Follow Up ◽  
Sub Saharan ◽  
Treat All ◽  
Living With Hiv ◽  
International Epidemiology

ABSTRACTPurposeThe objectives of the International epidemiology Databases to Evaluate AIDS (IeDEA) are to (i) evaluate the delivery of combination antiretroviral therapy (ART) in children, adolescents and adults in sub-Saharan Africa, (ii) to describe ART regimen effectiveness, durability and tolerability, (iii) to examine HIV-related comorbidities and co-infections, and (iv) to examine the pregnancy- and HIV-related outcomes of women on ART and their infants exposed to HIV or antiretroviral therapy in utero or via breastmilk.ParticipantsIeDEA is organized in four regions (Central, East, Southern and West Africa), with 240 treatment and care sites, six data centres at African, European and US universities, and almost 1.4 million children, adolescents and adult people living with HIV (PLWHIV) enrolled.Findings to dateThe data include socio-demographic characteristics, clinical outcomes, opportunistic events, treatment regimens, clinic visits and laboratory measurements. They have been used to analyse outcomes in people living with HIV-1 or HIV-2 who initiate ART, including determinants of mortality, of switching to second-line and third-line ART, drug resistance, loss to follow-up and the immunological and virological response to different ART regimens. Programme-level estimates of mortality have been corrected for loss to follow-up. We examined the impact of co-infection with hepatitis B and C, and the epidemiology of different cancers and of (multi-drug resistant) tuberculosis, renal disease and of mental illness. The adoption of “Treat All”, making ART available to all PLWHIV regardless of CD4+ cell count or clinical stage was another important research topic.Future plansIeDEA has formulated several research priorities for the “Treat All” era in sub-Saharan Africa. It recently obtained funding to set up sentinel sites where additional data are prospectively collected on cardiometabolic risks factors as well as mental health and liver diseases, and is planning to create a drug resistance database.

scholarly journals Impact of a child -friendly clinic on retention of HIV-infected children in care: an intervention study

1970 ◽  
Vol 44 (4) ◽  
pp. 175-179
Author(s):  
OR Ugwu
Keyword(s):  
Highly Active Antiretroviral Therapy ◽  
Retention Rate ◽  
Retention In Care ◽  
Hiv Care ◽  
Satisfaction Survey ◽  
Loss To Follow Up ◽  
Child Friendly ◽  
Children In Care ◽  
The Impact

Background: Certain researchers have reported that a child-friendly clinic may improve patient/caregiver satisfaction at clinic attendance. This could serve as an innovation for reducing loss-to-follow up and increasing retention in care.Aim: To assess the impact of making the clinic more child-friendly on clinic experience, retention in care and loss-to-follow up of HIV -infected children.Method: The study was carried out in three phases. Phase one was a satisfaction survey to find out the patient/caregivers’ satisfaction of the clinic environment and services provided using a selfadministered questionnaire. Phase two was the creation of the childfriendly environment and phase three was a post-provision of child-friendly clinic satisfaction survey. The loss-to-follow up rate (failure to return to clinic ≥3months after the last scheduled clinic appointment in a child not known to be dead or transferred out of the facility) and retention rate (remaining alive and receiving highly active antiretroviral therapy) were also determined before and after setting up the childfriendly clinic.Results: There were 146 respondents before the study and 206 respondents after the intervention. The retention rate increased from 62.5% to 82% (p=0.02), while the loss-to-follow up rate dropped from 27.7% to 7.0% (p=0.00).Conclusion: Making the clinic area child-friendly can impact greatly on HIV care by improving patient satisfaction and retention of HIVinfected children in care and reducing loss-to-follow up.Key words: HIV, child-friendly environment, retention in care, loss to follow-up.

scholarly journals The HIV care cascade for adolescents initiated on antiretroviral therapy in a health district of South Africa: a retrospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Roxanna Haghighat ◽  
Elona Toska ◽  
Nontuthuzelo Bungane ◽  
Lucie Cluver
Keyword(s):  
South Africa ◽  
Viral Load ◽  
Antiretroviral Therapy ◽  
Viral Suppression ◽  
Hiv Care ◽  
Loss To Follow Up ◽  
Hiv Care Cascade ◽  
Care Cascade ◽  
Clinical Records

Abstract Background Little evidence exists to comprehensively estimate adolescent viral suppression after initiation on antiretroviral therapy in sub-Saharan Africa. This study examines adolescent progression along the HIV care cascade to viral suppression for adolescents initiated on antiretroviral therapy in South Africa. Methods All adolescents ever initiated on antiretroviral therapy (n=1080) by 2015 in a health district of the Eastern Cape, South Africa, were interviewed in 2014–2015. Clinical records were extracted from 52 healthcare facilities through January 2018 (including records in multiple facilities). Mortality and loss to follow-up rates were corrected for transfers. Predictors of progression through the HIV care cascade were tested using sequential multivariable logistic regressions. Predicted probabilities for the effects of significant predictors were estimated by sex and mode of infection. Results Corrected mortality and loss to follow-up rates were 3.3 and 16.9%, respectively. Among adolescents with clinical records, 92.3% had ≥1 viral load, but only 51.1% of viral loads were from the past 12 months. Adolescents on ART for ≥2 years (AOR 3.42 [95%CI 2.14–5.47], p< 0.001) and who experienced decentralised care (AOR 1.39 [95%CI 1.06–1.83], p=0.018) were more likely to have a recent viral load. The average effect of decentralised care on recent viral load was greater for female (AOR 2.39 [95%CI 1.29–4.43], p=0.006) and sexually infected adolescents (AOR 3.48 [95%CI 1.04–11.65], p=0.043). Of the total cohort, 47.5% were recorded as fully virally suppressed at most recent test. Only 23.2% were recorded as fully virally suppressed within the past 12 months. Younger adolescents (AOR 1.39 [95%CI 1.06–1.82], p=0.017) and those on ART for ≥2 years (AOR 1.70 [95%CI 1.12–2.58], p=0.013) were more likely to be fully viral suppressed. Conclusions Viral load recording and viral suppression rates remain low for ART-initiated adolescents in South Africa. Improved outcomes for this population require stronger engagement in care and viral load monitoring.

scholarly journals Tuberculosis preventive treatment opportunities at antiretroviral therapy initiation and follow-up visits

2020 ◽  
Vol 10 (2) ◽  
pp. 64-69
Author(s):  
T. Agizew ◽  
D. Surie ◽  
J.E. Oeltmann ◽  
M. Letebele ◽  
S. Pals ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Preventive Treatment ◽  
Evaluation Study ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Control Effort ◽  
Missed Opportunities ◽  
Art Initiation ◽  
A Prospective Study

Setting: Twenty-two clinics providing HIV care and treatment in Botswana where tuberculosis (TB) and HIV comorbidity is as high as 49%.Objectives: To assess eligibility of TB preventive treatment (TPT) at antiretroviral therapy (ART) initiation and at four follow-up visits (FUVs), and to describe the TB prevalence and associated factors at baseline and yield of TB diagnoses at each FUV.Design: A prospective study of routinely collected data on people living with HIV (PLHIV) enrolled into care for the Xpert® MTB/RIF Package Rollout Evaluation Study between 2012 and 2015.Results: Of 6041 PLHIV initiating ART, eligibility for TPT was 69% (4177/6041) at baseline and 93% (5408/5815); 95% (5234/5514); 96% (4869/5079); and 97% (3925/4055) at FUV1, FUV2, FUV3, and FUV4, respectively. TB prevalence at baseline was 11% and 2%, 3%, 3% and 6% at each subsequent FUV. At baseline, independent risk factors for prevalent TB were CD4 <200 cells/mm3 (aOR = 1.4, P = 0.030); anemia (aOR = 2.39, P < 0.001); cough (aOR = 11.21, P < 0.001); fever (aOR = 2.15, P = 0.001); and weight loss (aOR = 2.60, P = 0.002).Conclusion: Eligibility for TPT initiation is higher at visits post-ART initiation, while most cases of active TB were identified at ART initiation. Missed opportunities for TB further compromises TB control effort among PLHIV in Botswana.

scholarly journals The Association between Quality of HIV Care, Loss to Follow-Up and Mortality in Pediatric and Adolescent Patients Receiving Antiretroviral Therapy in Nigeria

PLoS ONE ◽  
2014 ◽  
Vol 9 (7) ◽  
pp. e100039 ◽  
Author(s):  
Bisola Ojikutu ◽  
Molly Higgins-Biddle ◽  
Dana Greeson ◽  
Benjamin R. Phelps ◽  
Anouk Amzel ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Hiv Care ◽  
Loss To Follow Up ◽  
Adolescent Patients

scholarly journals Follow-Up Survey of the Impact of COVID-19 on People Living with HIV during the Second Semester of the Pandemic

2021 ◽  
Vol 18 (9) ◽  
pp. 4635
Author(s):  
Joseph Nelson Siewe Fodjo ◽  
Edlaine Faria de Moura Villela ◽  
Stijn Van Hees ◽  
Pieter Vanholder ◽  
Patrick Reyntiens ◽  
...  
Keyword(s):  
Online Survey ◽  
Psychosocial Support ◽  
Well Being ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Daily Routines ◽  
Persons Living With Hiv ◽  
Living With Hiv ◽  
The Impact

COVID-19 affects persons living with HIV (PLWH) both directly (via morbidity/mortality) and indirectly (via disruption of HIV care). From July–November 2020, an online survey was conducted to investigate the psychosocial well-being of PLWH and changes in HIV care during the second semester of the COVID-19 outbreak. Data were collected on the socio-demographic characteristics of PLWH, their psychosocial well-being, impact of COVID-19 preventive measures on their daily routines and HIV follow-up. Of the 247 responses analyzed (mean age: 44.5 ± 13.2 years; 73.7% male), 67 (27.1%) and 69 (27.9%) respondents screened positive for anxiety (GAD-2 score ≥ 3) and depression (PHQ-2 score ≥ 3), respectively. HIV care had returned to pre-COVID-19 state for 48.6% PLWH, and 108 (43.7%) had no HIV follow-up during the past month. Over three quarters (76.1%) of respondents expressed willingness to receive the COVID-19 vaccine. Compared to previous findings in April 2020, substance use increased from 58.6% to 67.2% (p < 0.001). Our findings suggest that the well-being and medical follow-up of PLWH are still affected after almost a year into the COVID-19 outbreak. Remote HIV follow-up (telemedicine) with psychosocial support should be envisaged in the medium to long-term. Given that most PLWH accept COVID-19 vaccination, they may be prioritized for this intervention.

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