scholarly journals Factors affecting adherence to antiretroviral therapy among children and adolescents living with HIV in the Mbita Sub County Hospital, Homa Bay- Kenya

2021 ◽  
Vol 21 ◽  
pp. 18-24
Author(s):  
William N Tanyi ◽  
Onesmus Gachuno ◽  
Theresa Odero ◽  
Carey Farquhar ◽  
David Kimosop ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Children And Adolescents ◽  
Viral Suppression ◽  
County Hospital ◽  
Virologic Suppression ◽  
Clinic Attendance ◽  
Psychosocial Support System ◽  
Adherence Counseling ◽  
Living With Hiv ◽  
Out Of School

Background: Adequate adherence to antiretroviral therapy (ART) is key to the successful treatment of children and adoles- cents living with HIV. Continuous ART Adherence is the key factor for virologic suppression and stability of the immune system and prevents the occurrence of opportunistic infections. Children and adolescents struggle with adherence to ART for various reasons, including a poor psychosocial support system and clinic attendance. Objectives: To describe the uptake of HIV treatment services among children and adolescents in the Mbita Sub-County Hospital, Homa Bay and determine how schooling, clinic attendance, and type of pill/regimen affect adherence to ART and viral suppression. Methods: This retrospective study was conducted at the Mbita Sub-County Hospital. Medical chart data was abstracted from the hospital files of children and adolescents between the ages of 0-19 years on antiretroviral therapy, between the periods of October 2016 and September, 2017. Data was analyzed using measures of central tendency, and cross-tabulations were done to compare schooling, clinic attendance, type of pill/regimen and viral suppression. Univariate and multivariate logistic regression analyses were conducted to determine associations between groups. Results: According to patient files reviewed, majority of patients, 244(91.4%) were enrolled into care within 2 weeks of HIV diagnosis according to guidelines, and 193(73.1 %) remained enrolled in care at end of study period. An overall viral suppression of 74.2 %( 132) was recorded. Of all the files reviewed, 121(74.7%) of patients attending school suppressed against 11(68.8 %) out of school, p=0.280. Suppression among Day and boarding reported at 78.6 %( 11) and 74.8 %( 113) of those out of school, respectively, p=0.533. Participants in primary school, 17(85.0%) suppressed better than those in secondary school, 102(73.4%), p=0.263. Keeping clinic appointments among eligible patient files reviewed decreased from 83.1% at 3 months, p=0.016, to 76.6%, p=0.526 at 6 months and to 52.9% at 12 months, p=0.278. Only 3- month clinic appointment return rates and Enhanced Adherence Counseling (EAC) were significant predictors of viral supression χ2 (2) = 0.280, p = 0.869 (> 0.05). Conclusion: The clinic attendance rate within the first 3 months, and Enhanced Adherence Counseling (EAC) were signif- icant predictors of viral suppression, and therefore adherence to antiretroviral therapy. Keywords: Adherence; clinic attendance; antiretroviral therapy; HIV; virologic suppression.

scholarly journals Factors affecting adherence to antiretroviral therapy among children and adolescents living with HIV in the Mbita Sub County Hospital, Homa Bay- Kenya

2021 ◽  
Vol 21 (1) ◽  
pp. 18-24
Author(s):  
William N Tanyi ◽  
Onesmus Gachuno ◽  
Theresa Odero ◽  
Carey Farquhar ◽  
David Kimosop ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Children And Adolescents ◽  
Viral Suppression ◽  
County Hospital ◽  
Virologic Suppression ◽  
Clinic Attendance ◽  
Psychosocial Support System ◽  
Adherence Counseling ◽  
Living With Hiv ◽  
Out Of School

Background: Adequate adherence to antiretroviral therapy (ART) is key to the successful treatment of children and adoles- cents living with HIV. Continuous ART Adherence is the key factor for virologic suppression and stability of the immune system and prevents the occurrence of opportunistic infections. Children and adolescents struggle with adherence to ART for various reasons, including a poor psychosocial support system and clinic attendance. Objectives: To describe the uptake of HIV treatment services among children and adolescents in the Mbita Sub-County Hospital, Homa Bay and determine how schooling, clinic attendance, and type of pill/regimen affect adherence to ART and viral suppression. Methods: This retrospective study was conducted at the Mbita Sub-County Hospital. Medical chart data was abstracted from the hospital files of children and adolescents between the ages of 0-19 years on antiretroviral therapy, between the periods of October 2016 and September, 2017. Data was analyzed using measures of central tendency, and cross-tabulations were done to compare schooling, clinic attendance, type of pill/regimen and viral suppression. Univariate and multivariate logistic regression analyses were conducted to determine associations between groups. Results: According to patient files reviewed, majority of patients, 244(91.4%) were enrolled into care within 2 weeks of HIV diagnosis according to guidelines, and 193(73.1 %) remained enrolled in care at end of study period. An overall viral suppression of 74.2 %( 132) was recorded. Of all the files reviewed, 121(74.7%) of patients attending school suppressed against 11(68.8 %) out of school, p=0.280. Suppression among Day and boarding reported at 78.6 %( 11) and 74.8 %( 113) of those out of school, respectively, p=0.533. Participants in primary school, 17(85.0%) suppressed better than those in secondary school, 102(73.4%), p=0.263. Keeping clinic appointments among eligible patient files reviewed decreased from 83.1% at 3 months, p=0.016, to 76.6%, p=0.526 at 6 months and to 52.9% at 12 months, p=0.278. Only 3- month clinic appointment return rates and Enhanced Adherence Counseling (EAC) were significant predictors of viral supression χ2 (2) = 0.280, p = 0.869 (> 0.05). Conclusion: The clinic attendance rate within the first 3 months, and Enhanced Adherence Counseling (EAC) were signif- icant predictors of viral suppression, and therefore adherence to antiretroviral therapy. Keywords: Adherence; clinic attendance; antiretroviral therapy; HIV; virologic suppression.

scholarly journals Factors Associated with Poor Viral Suppression Among Children and Adolescents Accessing Antiretroviral Therapy in Selected Health Facilities in Lagos, Nigeria

2021 ◽  
Author(s):  
Nneka Egbonrelu ◽  
Adeola Awolola ◽  
Teniola Lawanson ◽  
Olabanjo Ogunsola ◽  
Oluwagbemisola Odole-Akinyemi ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Viral Load ◽  
Antiretroviral Therapy ◽  
Children And Adolescents ◽  
Viral Suppression ◽  
Binary Logistic Regression ◽  
Health Facilities ◽  
Rural Setting ◽  
Factors Associated ◽  
Living With Hiv

Abstract IntroductionNigeria has the second largest HIV burden in Sub-Saharan Africa, with high burden amongst children and adolescents. In 2017, it was estimated that 160,000 children (0-9 years) and 230,000 adolescents (10-19 years) are living with HIV globally, with death in 21,000 children and 5400 adolescents resulting from AIDS-related illnesses. The main objective of the study was to determine the factors associated with poor viral suppression in children and adolescents accessing antiretroviral therapy in secondary health facilities in Lagos State.MethodsA descriptive retrospective study of children and adolescents living with HIV accessing care and support in 7 Global Fund supported ART treatment facilities in Lagos between January 2013 and June 2020. Data extraction was done between July 2020 and August 2020. The sociodemographic, clinical and laboratory data were extracted from patients’ folders. Binary logistic regression model was done to identify the determinants of viral non-suppression among children and adolescents age groups. ResultsThe study population consisted of 363 children (age 0-9 years) and 275 adolescents (age 10-19 years). The mean age of children was 5.8±2.2 years and that of adolescent was 13.21±2.8years. About 256(70 %) of children were virally unsuppressed and 118(43 %) had non-suppressed viral load status among adolescents. Binary logistic regression showed that children with WHO stage IV of HIV disease had greater odds (OR=7.984, 95% CI=1.042-61.163) of having suppressed viral load and children who live with their non-biological caregiver had greater odds of having a suppressed viral load compared to the biological caregiver group (OR=2.0421, 95% CI=1.083-10.965). Among adolescents, binary logistic regression showed location of abode and drug pick-up pattern as independent predictors of poor viral suppression. Adolescent patients living in rural setting had greater odds of being virally unsuppressed compared to those living in urban settlement (OR=1.755, 95% CI=1.001-3.083) while patients who have regular drug pick-up pattern from their ART health centres had lesser odds (OR=0.585, 95% CI=0.591-0.912) of viral non-suppression.CONCLUSIONThe findings highlight the need for a renewed focus on developing and strengthening HIV programmes in rural areas where children and adolescents living with HIV are more likely to be virally unsuppressed. More emphasis and resources should be channelled to Public health intervention such as health education, social support group programmes to improve drug pick up and adherence in adolescents living with HIV.

scholarly journals The Promise of Improved Adherence With Long-Acting Antiretroviral Therapy: What Are the Data?

2021 ◽  
Vol 20 ◽  
pp. 232595822110090
Author(s):  
Kimberly K. Scarsi ◽  
Susan Swindells
Keyword(s):  
Medication Adherence ◽  
Antiretroviral Therapy ◽  
Hiv Treatment ◽  
Virologic Suppression ◽  
Social Barriers ◽  
Treatment And Prevention ◽  
Undetectable Viremia ◽  
Long Acting ◽  
Available Information ◽  
Living With Hiv

As with other chronic conditions, adherence to daily medications remains a challenge for many individuals living with HIV due to structural, behavioral, and social barriers. Unfortunately, high levels of adherence to antiretroviral therapy are required to maintain virologic suppression. Alternative approaches are being explored to decrease the burden of daily pill administration, including long-acting injectable, oral, and implantable products. Phase 3 data support the efficacy of nanoformulated injectable cabotegravir and rilpivirine for HIV treatment in patients with undetectable viremia, but we have yet to learn how this strategy may benefit those with medication adherence challenges. Despite this, the affected community and HIV providers are very interested in exploring the role of long-acting therapies to address some types of barriers to medication adherence. This review summarizes available information about the potential for long-acting therapy to improve adherence for some patients and outlines associated opportunities and challenges with the implementation of long-acting therapy for the treatment and prevention of HIV.

Social Vulnerability among Foreign-Born Pregnant Women and Maternal Virologic Control of HIV

2020 ◽  
Author(s):  
Ashish Premkumar ◽  
Lynn M. Yee ◽  
Lia Benes ◽  
Emily S. Miller
Keyword(s):  
Antiretroviral Therapy ◽  
Pregnant Women ◽  
Median Time ◽  
Social Vulnerability ◽  
Viral Suppression ◽  
Foreign Born ◽  
Women Living With Hiv ◽  
Virologic Control ◽  
Clinical Records ◽  
Living With Hiv

Objective The aim of this study was to assess whether social vulnerability among foreign-born pregnant women living with HIV is associated with maternal viremia during pregnancy. Study Design This retrospective cohort study included all foreign-born pregnant women living with HIV who received prenatal care in a multidisciplinary prenatal clinic between 2009 and 2018. A licensed clinical social worker evaluated all women and kept detailed clinical records on immigration status and social support. Social vulnerability was defined as both living in the United States for less than 5 years and reporting no family or friends for support. The primary outcome was evidence of viral non-suppression after achievement of initial suppression. Secondary outcomes were the proportion of women who required > 12 weeks after starting antiretroviral therapy to achieve viral suppression, median time to first viral suppression (in weeks) after initiation of antiretroviral therapy, and the proportion who missed ≥ 5 doses of antiretroviral therapy. Bivariable analyses were performed. Results A total of 111 foreign-born women were eligible for analysis, of whom 25 (23%) were classified as socially vulnerable. Social and clinical characteristics of women diverged by social vulnerability categorization but no differences reached statistical significance. On bivariable analysis, socially-vulnerable women were at increased risk for needing > 12 weeks to achieve viral suppression (relative risk: 1.78, 95% confidence interval: 1.18–2.67), though there was no association with missing ≥ 5 doses of antiretroviral therapy or median time to viral suppression after initiation of antiretroviral therapy. Conclusion Among foreign-born, pregnant women living with HIV, markers of virologic control during pregnancy were noted to be worse among socially-vulnerable women. Insofar as maternal viremia is the predominant driver of perinatal transmission, closer clinical surveillance and support may be indicated in this population. Key Points

scholarly journals Antiretroviral Drugs Impact Autophagy with Toxic Outcomes

Cells ◽  
2021 ◽  
Vol 10 (4) ◽  
pp. 909
Author(s):  
Laura Cheney ◽  
John M. Barbaro ◽  
Joan W. Berman
Keyword(s):  
Quality Control ◽  
Antiretroviral Therapy ◽  
Side Effects ◽  
Viral Suppression ◽  
Antiretroviral Drugs ◽  
People Living With Hiv ◽  
Foreign Material ◽  
Complete Understanding ◽  
Living With Hiv ◽  
Target Effects

Antiretroviral drugs have dramatically improved the morbidity and mortality of people living with HIV (PLWH). While current antiretroviral therapy (ART) regimens are generally well-tolerated, risks for side effects and toxicity remain as PLWH must take life-long medications. Antiretroviral drugs impact autophagy, an intracellular proteolytic process that eliminates debris and foreign material, provides nutrients for metabolism, and performs quality control to maintain cell homeostasis. Toxicity and adverse events associated with antiretrovirals may be due, in part, to their impacts on autophagy. A more complete understanding of the effects on autophagy is essential for developing antiretroviral drugs with decreased off target effects, meaning those unrelated to viral suppression, to minimize toxicity for PLWH. This review summarizes the findings and highlights the gaps in our knowledge of the impacts of antiretroviral drugs on autophagy.

scholarly journals Multilevel of Factors Affected Optimal Adherence to Antiretroviral Therapy and Viral Suppression Amongst HIV-infected Prisoners in South Ethiopia: A Prospective Cohort Study

2021 ◽  
Author(s):  
Terefe Gone Fuge ◽  
George Tsourtos ◽  
Emma R Miller
Keyword(s):  
Cohort Study ◽  
Antiretroviral Therapy ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Viral Suppression ◽  
People Living With Hiv ◽  
South Ethiopia ◽  
Pharmacy Refill ◽  
Living With Hiv ◽  
Optimal Adherence

Abstract ObjectivesMaintaining optimal adherence and viral suppression in people living with HIV (PLWHA) is essential to ensure both preventative and therapeutic benefits of antiretroviral therapy (ART). Prisoners bear a particularly high burden of HIV infection and are highly likely to transmit to others during and after incarceration. However, the level of treatment adherence and viral suppression in incarcerated populations in low-income countries is unknown. This study aimed to determine the prevalence of non-adherence and viral failure, and contributing factors amongst prisoners in South Ethiopia. MethodsA prospective cohort study was conducted between June 1, 2019 and May 31, 2020 to compare the level of adherence and viral suppression between incarcerated and non-incarcerated PLWHA. The study involved 74 inmates living with HIV (ILWHA) and 296 non-incarcerated PLWHA. Background information (including sociodemographic, socioeconomic, psychosocial, behavioural, and incarceration related characteristics) was collected using a structured questionnaire. Adherence was determined based on the participants’ self-report and pharmacy refill records. Plasma viral load measurements undertaken within the study period were prospectively extracted to determine viral suppression. Univariate and multivariate regression models were used to analyse data. ResultsWhile prisoners had a significantly higher pharmacy refill adherence compared to non-incarcerated PLWHA (89% vs 75%), they had a slightly lower dose adherence (81% vs 83%). The prevalence of viral failure (VF) was also slightly higher (6%) in ILWHA compared to non-incarcerated PLWHA (4.4%). The overall dose non-adherence (NA) was significantly associated with missing ART appointments, level of satisfaction with ART services, patient’s ability to comply with a specified medication schedule and types of methods used to monitor the schedule. In ILWHA specifically, accessing ART services from a hospital compared to a health centre, an inability to always attend clinic appointments, experience of depression and a lack of social support predicted NA. VF was significantly higher in males, people of age 31to 35 years and in those who experienced social stigma, regardless of their incarceration status. ConclusionsThis study revealed that HIV-infected prisoners in South Ethiopia were more likely to be non-adherent to ART doses and to develop viral failure compared to their non-incarcerated counterparts. A multitude of factors were found to be responsible for this requiring multilevel intervention strategies focusing on the specific needs of prisoners.

scholarly journals Risk factors for delayed viral suppression on first-line antiretroviral therapy among persons living with HIV in Haiti, 2013–2017

PLoS ONE ◽  
2020 ◽  
Vol 15 (10) ◽  
pp. e0240817
Author(s):  
Shannan N. Rich ◽  
Robert L. Cook ◽  
Lusine Yaghjyan ◽  
Kesner Francois ◽  
Nancy Puttkammer ◽  
...  
Keyword(s):  
Risk Factors ◽  
Antiretroviral Therapy ◽  
Viral Suppression ◽  
First Line ◽  
Persons Living With Hiv ◽  
Living With Hiv

scholarly journals Viral Suppression and Its Associated Factors in HIV Patients on Highly Active Antiretroviral Therapy (HAART): A Retrospective Study in the Ho Municipality, Ghana

2020 ◽  
Vol 2020 ◽  
pp. 1-7 ◽  
Author(s):  
Sylvester Yao Lokpo ◽  
Patrick Jnr Ofori-Attah ◽  
Louis Selassie Ameke ◽  
Christian Obirikorang ◽  
Verner Ndudiri Orish ◽  
...  
Keyword(s):  
Viral Load ◽  
Medication Adherence ◽  
Antiretroviral Therapy ◽  
Highly Active Antiretroviral Therapy ◽  
Associated Factors ◽  
Viral Suppression ◽  
Similar Proportion ◽  
Clinic Attendance ◽  
Hiv Patients ◽  
Highly Active

Background. The WHO targets to end HIV/AIDS as a public health problem by 2030. The introduction of the ambitious “90-90-90” strategy to attain this target is expected to be achieved by the year 2020. However, there is lack of regional data, especially on the third “90.” This study sought to assess the rate and associated factors of viral suppression among people living with HIV (PLWH) on highly active antiretroviral therapy (HAART) at the Antiretroviral Therapy (ART) Clinic in a Ghanaian health facility. Method. The study design was a retrospective analysis of secondary data of 284 HIV registrants on HAART for at least 6 months at the ART Clinic from July 2016 to April 2019. Data on sociodemography including age, gender, marital status, education, and occupation as well as pharmacological (type of medication and duration on medication) and laboratory variable (current viral load results) were extracted from patients’ folders. Viral suppression and failure were determined using the WHO definitions (viral suppression as viral load <1000 copies/ml and virologic failure ≥1000 copies/ml). Regular clinic attendance (used as a proxy measure for medication adherence) was defined as consistent monthly clinic attendance for HAART medication and other clinical management within the past 12 months. Results. Out of the 284 HIV patients, 195 (69%) achieved viral suppression. Of the 195 who were virally suppressed, 77 (39.5%) had undetectable levels, with a similar proportion (39.5%) achieving viral load results ranging from 20 to 200 copies/ml. Moreover, 27 (13.8%) patients had viral load ranging from 201 to 500 copies/ml while 14 (7.2%) recorded viral load from 501 to 1000 copies/ml. No clear pattern in the viral suppression rate was associated with the age groups (p=0.1152). However, regular clinic attendance (used as proxy for medication adherence) (p<0.0001) and being on HAART for more than three (3) years (p=0.03) were associated with viral suppression. Conclusion. The rate of viral suppression among PLWH on HAART in the Ho municipality fell short of the WHO target. However, the study identified regular ART clinic attendance and treatment >3 years as factors associated with viral suppression.

scholarly journals Rapid Antiretroviral Therapy (ART) Initiation at a Community-Based Clinic in Jackson, MS

2020 ◽  
Vol 17 (1) ◽  
Author(s):  
Courtney E. Sims Gomillia ◽  
Kandis V. Backus ◽  
James B. Brock ◽  
Sandra C. Melvin ◽  
Jason J. Parham ◽  
...  
Keyword(s):  
Viral Load ◽  
Antiretroviral Therapy ◽  
Median Time ◽  
Viral Suppression ◽  
Hiv Care ◽  
Virologic Suppression ◽  
Community Based ◽  
Art Initiation ◽  
Healthcare Center ◽  
The Impact

Abstract Background Rapid antiretroviral therapy (ART), ideally initiated within twenty-four hours of diagnosis, may be crucial in efforts to increase virologic suppression and reduce HIV transmission. Recent studies, including demonstration projects in large metropolitan areas such as Atlanta, Georgia; New Orleans, Louisiana; San Francisco, California; and Washington D.C., have demonstrated that rapid ART initiation is a novel tool for expediting viral suppression in clinical settings. Here we present an evaluation of the impact of a rapid ART initiation program in a community-based clinic in Jackson, MS. Methods We conducted a retrospective chart review of patients who were diagnosed with HIV at Open Arms Healthcare Center or were linked to the clinic for HIV care by the Mississippi State Department of Health Disease Intervention Specialists from January 1, 2016 to December 31, 2018. Initial viral load, CD4+ T cell count, issuance of an electronic prescription (e-script), subsequent viral loads until suppressed and patient demographics were collected for each individual seen in clinic during the review period. Viral suppression was defined as a viral load less than 200 copies/mL. Rapid ART initiation was defined as receiving an e-script for antiretrovirals within seven days of diagnosis. Results Between January 1, 2016 and December 31, 2018, 70 individuals were diagnosed with HIV and presented to Open Arms Healthcare Center, of which 63 (90%) completed an initial HIV counseling visit. Twenty-seven percent of patients were provided with an e-script for ART within 7 days of diagnosis. The median time to linkage to care for this sample was 12 days and 5.5 days for rapid ART starters (p < 0.001). Median time from diagnosis to viral suppression was 55 days for rapid ART starters (p = 0.03), a 22 day decrease from standard time to viral suppression. Conclusion Our results provide a similar level of evidence that rapid ART initiation is effective in decreasing time to viral suppression. Evidence from this evaluation supports the use of rapid ART initiation after an initial HIV diagnosis, including same-day treatment.

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