scholarly journals Determinants of Viral Suppression Among Adolescents on Antiretroviral Therapy in Ehlanzeni District, South Africa: A Retrospective Cohort Analysis

2021 ◽  
Author(s):  
Emeka Francis Okonji ◽  
Brian Van Wyk ◽  
Ferdinand C. Mukumbang ◽  
Gail Hughes
Keyword(s):  
South Africa ◽  
Viral Load ◽  
Antiretroviral Therapy ◽  
Retrospective Cohort ◽  
Viral Suppression ◽  
Cohort Analysis ◽  
Cd4 Count ◽  
Second Line ◽  
Retrospective Cohort Analysis ◽  
Living With Hiv

Abstract Background Achieving undetectable viral loads is crucial for the reduction of HIV transmissions, AIDS related illnesses and death. Adolescents living with HIV on antiretroviral therapy (ART) have worse treatment adherence and lower viral suppression rates compared to adults. We report on the clinical factors associated with viral suppression among adolescents 10–19 years living with HIV in the Ehlanzeni district, Mpumalanga in South Africa. Methods A retrospective cohort analysis was conducted with 9,543 adolescents living with HIV, aged 10–19 years, who were enrolled in 136 ART clinics in the Ehlanzeni district. Clinical and immunological data were obtained from electronic medical records (Tier.net). Adolescents were categorized as having achieved viral suppression if their latest viral load count was < 1000 ribonucleic acid (RNA) copies/mL. Using a backward stepwise approach, a multivariate logistic regression analysis was performed to identify factors independently associated with viral suppression. Results The mean age of the participants was 14.75 years (SD = 2.8), and 55.43% were female. Mean duration on ART was 72.26 (SD = 42.3) months. Of the 9,543 adolescents with viral load results recorded, 74% had achieved viral suppression. After adjusting for other covariates, the likelihood of achieving viral suppression remained significantly higher among adolescents who were: female (AOR = 1.21, 95% CI 1.05–1.38), had CD4 count > 200 (AOR = 2.29, 95% CI 1.89–2.79), and on ART for more than 6 months (AOR = 2.75, 95% CI 1.74–4.34). Furthermore, the likelihood of having viral suppression was lower among adolescents with CD4 count < 200 at baseline (AOR = 0.76, 95% CI 0.64–0.90), and who were switched to second line regimen (AOR = 0.42, 95% CI 0.35–0.49). Conclusions Viral suppression amongst adolescents at 74% is considerably lower than the WHO target of 90%. Of particular concern for intervention is the lower rates of viral suppression amongst male adolescents. Greater emphasis should be placed to enrol adolescents on ART earlier before CD4 counts are depleted (< 200) and keeping them engaged in care (beyond 6 months). Furthermore, improved viral load monitoring may prevent unnecessary switching to second line treatment, which are costly and is a risk factor for viral non suppression.

scholarly journals Impact of age on CD4 recovery and viral suppression over time among adults living with HIV who initiated antiretroviral therapy in the African Cohort Study

2020 ◽  
Vol 17 (1) ◽  
Author(s):  
Emmanuel Bahemana ◽  
◽  
Allahna Esber ◽  
Nicole Dear ◽  
Kavitha Ganesan ◽  
...  
Keyword(s):  
Cohort Study ◽  
Viral Load ◽  
Antiretroviral Therapy ◽  
Viral Suppression ◽  
Cd4 Count ◽  
Age Group ◽  
Art Initiation ◽  
Living With Hiv ◽  
Over Time

Abstract Introduction With increased use of antiretroviral therapy (ART), HIV mortality rates are declining and people living with HIV (PLWH) are surviving longer. We characterized CD4 recovery and viral suppression among adults aged < 50 and ≥ 50 years living with HIV who initiated ART in the African Cohort Study (AFRICOS). Methods Beginning in January 2013, PLWH at twelve clinics in Kenya, Uganda, Tanzania and Nigeria underwent medical history review, CD4 and viral load testing as part of the ongoing African Cohort Study (AFRICOS). ART-naïve PLWH who initiated ART within 30 days of enrollment and had at least one year of follow-up were included in these analyses. To compare ART response in participants < 50 years and ≥ 50 years old, changes in CD4 count and viral load suppression after ART initiation were examined at different time points using linear and binomial regression with generalized estimating equations. Variables for time since ART initiation and the interaction between age group and time on ART were included in the model to evaluate longitudinal changes in CD4 recovery and viral suppression by age. Results Between January 2013 and September 2019, 2918 PLHV were enrolled in the cohort. Of these, 443 were ART naïve and initiated on ART within 30 days of enrollment, with 90% (n = 399) aged < 50 years old at ART initiation. At ART initiation, participants aged 50 and older had a higher median CD4 count compared to participants younger than 50 years of age although it did not reach statistical significance (306 cells/mm3, IQR:130–547 vs. 277cells/mm3, IQR: 132–437). In adjusted models examining CD4 recovery and viral suppression there were no significant differences by age group over time. By the end of follow-up viral suppression was high among both groups of adults (96% of adults ≥ 50 years old and 92% of adults < 50 years old). Conclusion This study found no difference in long-term CD4 recovery or viral suppression by age at ART initiation. We found that particularly among younger adults participants had lower median CD4 counts at ART initiation, suggesting the importance of identifying and putting this population on treatment earlier in the disease course.

scholarly journals Determinants of viral suppression among adolescents on antiretroviral treatment in Ehlanzeni district, South Africa: a cross-sectional analysis

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Emeka F. Okonji ◽  
Brian van Wyk ◽  
Ferdinand C. Mukumbang ◽  
Gail D. Hughes
Keyword(s):  
South Africa ◽  
Viral Load ◽  
Antiretroviral Treatment ◽  
Viral Suppression ◽  
Multivariate Logistic Regression Analysis ◽  
Cd4 Count ◽  
Second Line ◽  
Cross Sectional ◽  
Cross Sectional Analysis ◽  
Sectional Analysis

Abstract Background Achieving undetectable viral load is crucial for the reduction of HIV transmissions, AIDS-related illnesses and death. Adolescents (10 to19 years) living with HIV (ALHIV) on antiretroviral treatment (ART) have worse treatment adherence and lower viral suppression rates compared to adults. We report on the clinical factors associated with viral suppression among ALHIV in the Ehlanzeni district, Mpumalanga in South Africa. Methods A cross-sectional analysis was conducted with 9386 ALHIV, aged 10 to 19 years, who were enrolled in 136 ART clinics in the Ehlanzeni district. Clinical and immunological data were obtained from electronic medical records (Tier.net). ALHIV were categorised as having achieved viral suppression if their latest viral load count was < 1000 ribonucleic acid (RNA) copies/mL. Using a backward stepwise approach, a multivariate logistic regression analysis was performed to identify factors independently associated with viral suppression. Results The mean age of the participants was 14.75 years (SD = 2.9), and 55.43% were female. Mean duration on ART was 72.26 (SD = 42.3) months. Of the 9386 adolescents with viral load results recorded, 74% had achieved viral suppression. After adjusting for other covariates, the likelihood of achieving viral suppression remained significantly higher among ALHIV who were: female (AOR = 1.21, 95% CI 1.05–1.39), and had most recent CD4 count > 200 (AOR = 2.53, 95% CI 2.06–3.11). Furthermore, the likelihood of having viral suppression was lower among adolescents with CD4 count > 200 at baseline (AOR = 0.73, 95% CI 0.61–0.87), and who were switched to second line regimen (AOR = 0.41, 95% CI 0.34–0.49). Conclusions Viral suppression amongst ALHIV at 74% is considerably lower than the WHO target of 95%. Of particular concern for intervention is the lower rates of viral suppression amongst male ALHIV. Greater emphasis should be placed to early enrolment of ALHIV on ART and keeping them engaged in care (beyond 6 months). Furthermore, improved and regular viral load monitoring will help to adequately identify and manage ALHIV with unsuppressed viral load and subsequently switching to second line treatment.

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 Retention in Care and Outpatient Costs for Children Receiving Antiretroviral Therapy in Zambia: A Retrospective Cohort Analysis

PLoS ONE ◽  
2013 ◽  
Vol 8 (6) ◽  
pp. e67910 ◽  
Author(s):  
Callie A. Scott ◽  
Hari Iyer ◽  
Deophine Lembela Bwalya ◽  
Kelly McCoy ◽  
Gesine Meyer-Rath ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Retrospective Cohort ◽  
Cohort Analysis ◽  
Retention In Care ◽  
Retrospective Cohort Analysis
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