scholarly journals Adherence, resistance, and viral suppression on dolutegravir in sub-Saharan Africa: implications for the TLD era

AIDS ◽  
2021 ◽  
Vol 35 (Supplement 2) ◽  
pp. S127-S135
Author(s):  
Suzanne M. McCluskey ◽  
Toby Pepperrell ◽  
Andrew Hill ◽  
Willem D.F. Venter ◽  
Ravindra K. Gupta ◽  
...  
Keyword(s):  
Viral Suppression ◽  
Sub Saharan Africa ◽  
Sub Saharan

scholarly journals Children and adolescents on anti-retroviral therapy in Bulawayo, Zimbabwe: How many are virally suppressed by month six?

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 191
Author(s):  
Silungile Moyo ◽  
Ronald Thulani Ncube ◽  
Hemant Deepak Shewade ◽  
Solwayo Ngwenya ◽  
Wedu Ndebele ◽  
...  
Keyword(s):  
Viral Suppression ◽  
Secondary Data ◽  
Tertiary Hospital ◽  
Sub Saharan Africa ◽  
Second Line ◽  
Immunodeficiency Virus ◽  
Unknown Status ◽  
Sub Saharan ◽  
Adherence Counselling ◽  
Treat All

Background: Zimbabwe is one of the countries in sub-Saharan Africa disproportionately affected by human immunodeficiency virus. In the “treat all” era, we assessed the gaps in routine viral load (VL) monitoring at six months for children (0-9 years) and adolescents (10-19 years) newly initiated on anti-retroviral therapy (ART) from January 2017 to September 2018 at a large tertiary hospital in Bulawayo. Methods: In this cohort study using secondary data, we considered first VL done within six to nine months of starting therapy as ‘undergoing VL test at six months’. We classified repeat VL≥1000 copies/ml despite enhanced adherence counselling as virally unsuppressed. Results: Of 295 patients initiated on ART, 196 (66%) were children and 99 (34%) adolescents. A total 244 (83%) underwent VL test at six months, with 161 (54%) virally suppressed, 52 (18%) unsuppressed and 82 (28%) with unknown status (due to losses in the cascade). Switch to second line was seen in 35% (18/52). When compared to children, adolescents were less likely to undergo a VL test at six months (73% versus 88%, p=0.002) and more likely to have an unknown VL status (40% versus 22%, p=0.001). Conclusion: At six months of ART, viral suppression was low and losses in the cascade high.

scholarly journals Retrospective Review of Virologic and Immunologic Response in Treatment-Experienced Patients on Third-Line HIV Therapy in Lusaka, Zambia

2021 ◽  
Vol 20 ◽  
pp. 232595822110224
Author(s):  
Paul Msanzya Zulu ◽  
Mona-Gekanju Toeque ◽  
Lottie Hachaambwa ◽  
Lameck Chirwa ◽  
Sombo Fwoloshi ◽  
...  
Keyword(s):  
Retrospective Review ◽  
Viral Suppression ◽  
Sub Saharan Africa ◽  
University Teaching ◽  
Line Therapy ◽  
Resource Limited ◽  
Third Line Therapy ◽  
Sub Saharan ◽  
Third Line ◽  
The Impact

Established antiretroviral therapy (ART) programs in sub-Saharan Africa have well-defined first-and second-line therapies but no standard third-line ART regimen. The impact of third-line ART on patients with multiclass-resistant HIV in resource-limited settings has not been well characterized. We conducted a retrospective review of patients on third-line ART at the University Teaching Hospital in Lusaka, Zambia. We assessed virologic and immunologic outcomes following 6 months of third-line therapy and found among those with a documented viral load, viral suppression (≤1000 copies/ml) at 24 weeks was 95% (63/66) with a mean increase in CD4 count of 116 cells/mm3 and viral suppression of 63% (63/100) by imputation of missing data. This study suggests that third-line therapy is clinically and virologically effective among patients with multiclass-resistance in a resource-limited setting in sub-Saharan Africa.

scholarly journals Long-term outcomes of early initiated antiretroviral therapy in sub-Saharan children: a Cameroonian cohort study (ANRS-12140 Pediacam study, 2008–2013, Cameroon)

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Francis Ateba Ndongo ◽  
Mathurin Cyrille Tejiokem ◽  
Calixte Ida Penda ◽  
Suzie Tetang Ndiang ◽  
Jean-Audrey Ndongo ◽  
...  
Keyword(s):  
Cohort Study ◽  
Viral Load ◽  
Antiretroviral Therapy ◽  
Antiretroviral Treatment ◽  
Viral Suppression ◽  
Virologic Response ◽  
Sub Saharan Africa ◽  
Factors Associated ◽  
Sub Saharan

Abstract Background In most studies, the virological response is assessed during the first two years of antiretroviral treatment initiated in HIV-infected infants. However, early initiation of antiretroviral therapy exposes infants to very long-lasting treatment. Moreover, maintaining viral suppression in children is difficult. We aimed to assess the virologic response and mortality in HIV-infected children after five years of early initiated antiretroviral treatment (ART) and identify factors associated with virologic success in Cameroon. Methods In the ANRS-12140 Pediacam cohort study, 2008–2013, Cameroon, we included all the 149 children who were still alive after two years of early ART. Virologic response was assessed after 5 years of treatment. The probability of maintaining virologic success between two and five years of ART was estimated using Kaplan-Meier curve. The immune status and mortality were also studied at five years after ART initiation. Factors associated with a viral load < 400 copies/mL in children still alive at five years of ART were studied using logistic regressions. Results The viral load after five years of early ART was suppressed in 66.8% (60.1–73.5) of the 144 children still alive and in care. Among the children with viral suppression after two years of ART, the probability of maintaining viral suppression after five years of ART was 64.0% (54.0–74.0). The only factor associated with viral suppression after five years of ART was achievement of confirmed virological success within the first two years of ART (OR = 2.7 (1.1–6.8); p = 0.033). Conclusions The probability of maintaining viral suppression between two and five years of early initiated ART which was quite low highlights the difficulty of parents to administer drugs daily to their children in sub-Saharan Africa. It also stressed the importance of initial viral suppression for achieving and maintaining virologic success in the long-term. Further studies should focus on identifying strategies that would enhance better retention in care and improved adherence to treatment within the first two years of ART early initiated in Sub-Saharan HIV-infected children.

Human immunodeficiency virus funding and access to treatment in sub-Saharan Africa

2021 ◽  
pp. 095646242110422
Author(s):  
Reuben Granich ◽  
Somya Gupta ◽  
Brian Williams
Keyword(s):  
Human Immunodeficiency Virus ◽  
Viral Suppression ◽  
Hiv Treatment ◽  
Sub Saharan Africa ◽  
People Living With Hiv ◽  
Access To Treatment ◽  
Immunodeficiency Virus ◽  
Sub Saharan ◽  
Living With Hiv ◽  
Hiv Funding

Human immunodeficiency virus (HIV) treatment prevents illness, death, and transmission. The 90-90-90 disease control target is only 73% of people living with HIV virally suppressed. For 2010 to 2019, we abstracted HIV funding data for 40 countries in sub-Saharan Africa (70% of global HIV burden and >99% of HIV burden in the region in 2018). During 2010–2019, there was ∼$52 billion funding for 40 countries (99% Africa HIV burden). Domestic funding ranged from $0 to $3.2 billion. PEPFAR funding was $32 billion (average $1.4 billion; range $0.089–4.3 billion) among 22 countries. Global Fund averaged $306 million ($1.9 million to $1.1 billion) for 40 countries. Among PLHIV, known HIV status averaged 80% (11% to 94%). ART coverage averaged 64% (9% to 90%). Viral suppression among PLHIV ranged from 8% to 87%. Of the 40 countries, 21 reported under 60% of PLHIV to be on treatment and 13 did not report viral suppression for 2018. Achieving 90-90-90 is feasible in challenging settings if resources are used efficiently. Despite the significant investment in the HIV response, many countries have not reached the 90-90-90 target. Greater attention to efficiency and prioritizing important targets will be required to end AIDS in Africa.

scholarly journals Retention in Care and Viral Suppression in Differentiated Service Delivery Models for HIV Treatment in Sub-Saharan Africa: A Rapid Systematic Review

2020 ◽  
Author(s):  
Lawrence Long ◽  
Salome Kuchukhidze ◽  
Sophie Pascoe ◽  
Brooke E. Nichols ◽  
Matthew P. Fox ◽  
...  
Keyword(s):  
Systematic Review ◽  
Service Delivery ◽  
Clinical Outcomes ◽  
Viral Suppression ◽  
Retention In Care ◽  
Conventional Care ◽  
Hiv Treatment ◽  
Sub Saharan Africa ◽  
Differentiated Service ◽  
Sub Saharan

Introduction: Differentiated service delivery (DSD) models for antiretroviral treatment (ART) for HIV are being scaled up in the expectation that they will improve the quality and efficiency of treatment delivery and reduce costs while maintaining at least equivalent clinical outcomes. Even this minimum requirement of equivalent clinical outcomes is poorly documented for most models and settings, however. We reviewed the recent literature on DSD models to describe what is known about clinical outcomes. Methods: We conducted a rapid systematic review of peer-reviewed publications in PubMed, Embase, and the Web of Science and major international conference abstracts that reported outcomes of DSD models for the provision of ART in sub-Saharan Africa from January 1, 2016 to September 12, 2019. Sources reporting standard clinical HIV treatment metrics, primarily retention in care and viral load suppression, were reviewed and categorized by DSD model and source quality assessed. Results and Discussion: Twenty-nine papers and abstracts describing 37 DSD models and reporting 52 discrete outcomes met search inclusion criteria. Of the 37 models, 7 (19%) were facility-based individual models, 12 (32%) out-of-facility based individual models, 5 (14%) client-led groups, and 13 (35%) healthcare worker-led groups. Retention was reported for 73% of the models and viral suppression for 57%. Where a comparison with conventional care was provided, retention in most DSD models was within 5% of that for conventional care; where no comparison was provided, retention generally exceeded 80%. For viral suppression, all those with a comparison to conventional care reported a small increase in suppression in the DSD model; reported suppression exceeded 90% in 11/21 models. Analysis was limited by the extensive heterogeneity of study designs, outcomes, models, and populations. Most sources did not provide comparisons with conventional care, and metrics for assessing outcomes varied widely and were in many cases poorly defined. Conclusion: Existing evidence on the clinical outcomes of DSD models for HIV treatment in sub-Saharan Africa is limited in both quantity and quality but suggests that retention in care and viral suppression are roughly equivalent to those in conventional models of care.

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