Journal Article > ResearchFull Text
J Int AIDS Soc. 1 December 2024; Volume 27 (Issue 12); e26387.; DOI:10.1002/jia2.26387
Tekpa G, Inikoutiyo J, Yonli C, Noguera C, Lujwiro PP, et al.
J Int AIDS Soc. 1 December 2024; Volume 27 (Issue 12); e26387.; DOI:10.1002/jia2.26387
INTRODUCTION
The retention in care of patients undergoing antiretroviral therapy (ART) is a cornerstone for preventing AIDS‐associated morbidity and mortality, as well as further transmission of HIV. Adherence to ART poses particular challenges in conflict‐affected settings like the Central African Republic (CAR). The study objective was to estimate the rate of lost‐to‐follow‐up (LTFU) and determine factors associated with LTFU among patients living with HIV under ART in CAR.
METHODS
A retrospective cohort analysis was conducted using data from patients being managed at 42 representative ART dispensing sites (i.e. management of ≥200 patients) in the seven health regions of CAR which started ART between January 2019 to September 2021 and followed up to December 2021. The outcome of LTFU was defined as a failure of a patient to attend a scheduled ART refill appointment for at least 90 days from the last appointment. Patients were censored at the first LTFU event.
RESULTS
A total of 6844 patients enrolled in ART care were included in the analysis, of whom 67.5% were females. The mean age (standard deviation) was 35.3 years (10.5). Forty‐two per cent (n = 2874/6844) had an LTFU event during the follow‐up period. However, 23.2% (n = 666/2874) returned to care after LTFU. Overall retention in antiretroviral care at 12 months was 64.2% (CI 63.0−65.5), which ranged from 76.1% in the capital to 48.2% in the inner country region. Risk factors related to LTFU were being male (adjusted hazard ratio [aHR] 1.33; CI 1.1−1.5), age < 25 (aHR 1.46; CI 1.1−1.9), living in regions outside the capital (aHR 1.83; CI 1.6−2.3) and undernutrition (aHR 1.13; CI 1.0−1.3).
CONCLUSIONS
Retention to care in CAR is suboptimal, especially in the inner country. Our results underline the difficulties involved in retaining patients in ART in complex settings, the interplay between poor retention, social unrest, stigma, food insecurity and HIV epidemic control, and the need for tailored programming and interventions like differentiated treatment strategies and complementary food provision.
Journal Article > ResearchFull Text
J Int AIDS Soc. 23 June 2017; Volume 20 (Issue 1); DOI:10.7448/IAS.20.1.21327
Fenner L, Atkinson A, Boulle AM, Fox MP, Prozesky HW, et al.
J Int AIDS Soc. 23 June 2017; Volume 20 (Issue 1); DOI:10.7448/IAS.20.1.21327
Chronic immune activation due to ongoing HIV replication may lead to impaired immune responses against opportunistic infections such as tuberculosis (TB). We studied the role of HIV replication as a risk factor for incident TB after starting antiretroviral therapy (ART).
Journal Article > ReviewFull Text
J Int AIDS Soc. 13 May 2016; Volume 19 (Issue 1); DOI:10.7448/IAS.19.1.20751
Bemelmans M, Baert S, Negussie E, Bygrave H, Biot M, et al.
J Int AIDS Soc. 13 May 2016; Volume 19 (Issue 1); DOI:10.7448/IAS.19.1.20751
Introduction: Counselling services are recommended by the World Health Organization and have been partially adopted by national HIV guidelines. In settings with a high HIV burden, patient education and counselling is often performed by lay workers, mainly supported with international funding. There are few examples where ministries of health have been able to absorb lay counsellors into their health systems or otherwise sustain their work. We document the role of lay cadres involved in HIV testing and counselling and adherence support and discuss approaches to sustainability. Methods: We focused on a purposive sample of eight sub-Saharan African countries where Médecins Sans Frontières supports HIV programmes: Guinea, Lesotho, Malawi, Mozambique, South Africa, Swaziland, Zambia and Zimbabwe. We reviewed both published and grey literature, including national policies and donor proposals, and interviewed key informants, including relevant government staff, donors and non-governmental organizations. Results and discussion: Lay counsellors play a critical role in scaling up HIV services and addressing gaps in the HIV testing and treatment cascade by providing HIV testing and counselling and adherence support at both the facility and community levels. Countries have taken various steps in recognizing lay counsellors, including harmonizing training, job descriptions and support structures. However, formal integration of this cadre into national health systems is limited, as lay counsellors are usually not included in national strategies or budgeting. Conclusions: The current trend of reduced donor support for lay counsellors, combined with lack of national prioritization, threatens the sustainability of this cadre and thereby quality HIV service delivery.
Journal Article > ResearchFull Text
J Int AIDS Soc. 10 April 2017 (Issue 1)
de Waal R, Cohen K, Fox MP, Stinson K, Maartens G, et al.
J Int AIDS Soc. 10 April 2017 (Issue 1)
Tenofovir has been associated with decline in kidney function, but in patients with low baseline kidney function, improvements over time have been reported. Additionally, the magnitude and trajectory of estimated glomerular filtration rate (eGFR) changes may differ according to how eGFR is calculated. We described changes in eGFR over time, and the incidence of, and risk factors for, kidney toxicity, in a South African cohort.
Journal Article > ResearchFull Text
J Int AIDS Soc. 25 January 2022; Volume 25 (Issue 1); e25854.; DOI:10.1002/jia2.25854
Cassidy T, Cornell M, Runeyi P, Dutyulwa T, Kilani C, et al.
J Int AIDS Soc. 25 January 2022; Volume 25 (Issue 1); e25854.; DOI:10.1002/jia2.25854
INTRODUCTION
Youth living with HIV (YLWH) are less likely to initiate antiretroviral therapy (ART) and remain in care than older adults. It is important to identify effective strategies to address the needs of this growing population and prevent attrition from HIV care. Since 2008, two clinics have offered youth-targeted services exclusively to youth aged 12-25 in Khayelitsha, a high HIV-prevalence, low-income area in South Africa. We compared ART attrition among youth in these two clinics to youth in regular clinics in the same area.
METHODS
We conducted a propensity score matched cohort study of individuals aged 12-25 years initiating ART at eight primary care clinics in Khayelitsha between 1 January 2008 and 1 April 2018. We compared attrition, defined as death or loss to follow-up, between those attending two youth clinics and those attending general primary healthcare clinics, using Cox proportional hazards regression. Follow-up time began at ART initiation and ended at attrition, clinic transfer or dataset closure. We conducted sub-analyses of patients attending adherence clubs.
RESULTS
The distribution of age, sex and CD4 count at ART initiation was similar across Youth Clinic A (N = 1383), Youth Clinic B (N = 1299) and general clinics (N = 3056). Youth at youth clinics were more likely than those at general clinics to have initiated ART before August 2011 (Youth Clinic A: 16%, Youth Clinic B: 23% and general clinics: 11%). Youth clinics were protective against attrition: HR 0.81 (95% CI: 0.71-0.92) for Youth Clinic A and 0.85 (0.74-0.98) for Youth Clinic B, compared to general clinics. Youth Clinic A club patients had lower attrition after joining an adherence club than general clinic patients in adherence clubs (crude HR: 0.56, 95% CI: 0.32-0.96; adjusted HR: 0.48, 95% CI: 0.28-0.85), while Youth Clinic B showed no effect (crude HR: 0.83, 95% CI: 0.48-1.45; adjusted HR: 1.07, 95% CI: 0.60-1.90).
CONCLUSIONS
YLWH were more likely to be retained in ART care in two different youth-targeted clinics compared to general clinics in the same area. Our findings suggest that multiple approaches to making clinics more youth-friendly can contribute to improving retention in this important group.
Youth living with HIV (YLWH) are less likely to initiate antiretroviral therapy (ART) and remain in care than older adults. It is important to identify effective strategies to address the needs of this growing population and prevent attrition from HIV care. Since 2008, two clinics have offered youth-targeted services exclusively to youth aged 12-25 in Khayelitsha, a high HIV-prevalence, low-income area in South Africa. We compared ART attrition among youth in these two clinics to youth in regular clinics in the same area.
METHODS
We conducted a propensity score matched cohort study of individuals aged 12-25 years initiating ART at eight primary care clinics in Khayelitsha between 1 January 2008 and 1 April 2018. We compared attrition, defined as death or loss to follow-up, between those attending two youth clinics and those attending general primary healthcare clinics, using Cox proportional hazards regression. Follow-up time began at ART initiation and ended at attrition, clinic transfer or dataset closure. We conducted sub-analyses of patients attending adherence clubs.
RESULTS
The distribution of age, sex and CD4 count at ART initiation was similar across Youth Clinic A (N = 1383), Youth Clinic B (N = 1299) and general clinics (N = 3056). Youth at youth clinics were more likely than those at general clinics to have initiated ART before August 2011 (Youth Clinic A: 16%, Youth Clinic B: 23% and general clinics: 11%). Youth clinics were protective against attrition: HR 0.81 (95% CI: 0.71-0.92) for Youth Clinic A and 0.85 (0.74-0.98) for Youth Clinic B, compared to general clinics. Youth Clinic A club patients had lower attrition after joining an adherence club than general clinic patients in adherence clubs (crude HR: 0.56, 95% CI: 0.32-0.96; adjusted HR: 0.48, 95% CI: 0.28-0.85), while Youth Clinic B showed no effect (crude HR: 0.83, 95% CI: 0.48-1.45; adjusted HR: 1.07, 95% CI: 0.60-1.90).
CONCLUSIONS
YLWH were more likely to be retained in ART care in two different youth-targeted clinics compared to general clinics in the same area. Our findings suggest that multiple approaches to making clinics more youth-friendly can contribute to improving retention in this important group.
Journal Article > ResearchFull Text
J Int AIDS Soc. 6 July 2011; Volume 14; DOI:10.1186/1758-2652-14-S1-S1
Heidari S, Harries AD, Zachariah R
J Int AIDS Soc. 6 July 2011; Volume 14; DOI:10.1186/1758-2652-14-S1-S1
Journal Article > ResearchFull Text
J Int AIDS Soc. 16 March 2017; Volume 20; DOI:10.7448/IAS.20.4.21668
Davies MA, Tsondai PR, Tiffin N, Eley B, Rabie H, et al.
J Int AIDS Soc. 16 March 2017; Volume 20; DOI:10.7448/IAS.20.4.21668
To evaluate long-term outcomes in HIV-infected adolescents, it is important to identify ways of tracking outcomes after transfer to a different health facility. The Department of Health (DoH) in the Western Cape Province (WCP) of South Africa uses a single unique identifier for all patients across the health service platform. We examined adolescent outcomes after transfer by linking data from four International epidemiology Databases to Evaluate AIDS Southern Africa (IeDEA-SA) cohorts in the WCP with DoH data.
Journal Article > ResearchFull Text
J Int AIDS Soc. 21 October 2018; Volume 21 (Issue 10); DOI:10.1002/jia2.25194
Etoori D, Ciglenecki I, Ndlangamandla M, Edwards CG, Jobanputra K, et al.
J Int AIDS Soc. 21 October 2018; Volume 21 (Issue 10); DOI:10.1002/jia2.25194
As antiretroviral therapy (ART) is scaled up, more patients become eligible for routine viral load (VL) monitoring, the most important tool for monitoring ART efficacy. For HIV programmes to become effective, leakages along the VL cascade need to be minimized and treatment switching needs to be optimized. However, many HIV programmes in resource-constrained settings report significant shortfalls.
Journal Article > CommentaryFull Text
J Int AIDS Soc. 19 July 2017; Volume 20 (Issue 1); DOI:10.7448/IAS.20.1.22098
Kosack CS, Page AL, Beelaert G, Benson TT, Savane A, et al.
J Int AIDS Soc. 19 July 2017; Volume 20 (Issue 1); DOI:10.7448/IAS.20.1.22098
Journal Article > ResearchFull Text
J Int AIDS Soc. 22 March 2017 (Issue 1)
Kosack CS, Page AL, Beelaert G, Benson TT, Savane A, et al.
J Int AIDS Soc. 22 March 2017 (Issue 1)
Although individual HIV rapid diagnostic tests (RDTs) show good performance in evaluations conducted by WHO, reports from several African countries highlight potentially significant performance issues. Despite widespread use of RDTs for HIV diagnosis in resource-constrained settings, there has been no systematic, head-to-head evaluation of their accuracy with specimens from diverse settings across sub-Saharan Africa. We conducted a standardized, centralized evaluation of eight HIV RDTs and two simple confirmatory assays at a WHO collaborating centre for evaluation of HIV diagnostics using specimens from six sites in five sub-Saharan African countries.