Association of Care Environment With HIV Incidence and Death Among Orphaned, Separated, and Street-Connected Children and Adolescents in Western Kenya

Braitstein, Paula; DeLong, Allison; Ayuku, David; Ott, Mary A.; Atwoli, Lukoye; Galárraga, Omar; Sang, Edwin; Hogan, Joseph W.

doi:10.1001/jamanetworkopen.2021.25365

Cited by 10 publications

(17 citation statements)

References 47 publications

(129 reference statements)

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“… 19 Additional details regarding the OSCAR study and its cohort have been previously reported. 15 , 18 …”

Section: Methodsmentioning

confidence: 99%

“… 21 The mean age of children entering the model was 10.4 y to align with that of the OSCAR cohort. 15 …”

Section: Methodsmentioning

confidence: 99%

“…21 The mean age of children entering the model was 10.4 y to align with that of the OSCAR cohort. 15 Intervention strategies. For this analysis, we chose to compare 2 care environments for which we previously found statistically significant differences in health effectiveness outcomes.…”

Section: Model Frameworkmentioning

confidence: 99%

“…This analysis builds on evidence from our prior work demonstrating a lower hazard of incident HIV and death among OSCA living in family-based care compared with those on the street. 15 Our hypothesis is that annual costs per child will be higher for orphans living in family-based care than for those living on the street but that family-based environments will be cost-effective for preventing HIV and death among this population in the medium term.…”

mentioning

confidence: 99%

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Cost Utility of Supporting Family-Based Care to Prevent HIV and Deaths among Orphaned and Separated Children in East Africa: A Markov Model–Based Simulation

Wilson-Barthes

Braitstein

DeLong

et al. 2022

MDM Policy & Practice

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Purpose. Strengthening family-based care is a key policy response to the more than 15 million orphaned and separated children who have lost 1 or both parents in sub-Saharan Africa. This analysis estimated the cost-effectiveness of family-based care environments for preventing HIV and death in this population. Design. We developed a time-homogeneous Markov model to simulate the incremental cost per disability-adjusted life year (DALY) averted by supporting family-based environments caring for orphaned and separated children in western Kenya. Model parameters were based on data from the longitudinal OSCAR’s Health and Well-Being Project and published literature. We used a societal perspective, annual cycle length, and 3% discount rate. Incremental cost-effectiveness ratios were simulated over 5- to 15-y horizons, comparing family-based settings to street-based “self-care.” Parameter uncertainty was addressed via deterministic and probabilistic sensitivity analyses. Results. Under base-case assumptions, family-based environments prevented 422 HIV infections and 298 deaths in a simulated cohort of 1,000 individuals over 10 y. Compared with street-based self-care, family-based care had an incremental cost of $2,528 per DALY averted (95% confidence interval [CI]: 1,798, 2,599) and $2,355 per quality-adjusted life year gained (95% CI: 1,667, 2,413). The probability of family-based care being highly cost-effective was >80% at a willingness-to-pay (WTP) threshold of $2,250/DALY averted. Households receiving government cash transfers had minimally higher cost-effectiveness ratios than households without cash transfers but were still cost-effective at a WTP threshold of twice Kenya’s GDP per capita. Conclusions. Compared with the status quo of street-based self-care, family-based environments offer a cost-effective approach for preventing HIV and death among orphaned children in lower-middle income countries. Decision makers should consider increasing resources to these environments in tandem with social protection programs. Highlights UNICEF and more than 200 other international organizations endorsed efforts to redirect services toward family-based care as part of the 2019 UN Resolution on the Rights of the Child; yet this study is one of the first to quantify the cost-effectiveness of family-based care environments serving some of the world’s most vulnerable children. This health economic modeling analysis found that family-based environments would prevent 422 HIV infections and 298 deaths in a cohort of 1,000 orphaned and separated children over a 10-y time horizon. Compared with street-based “self-care,” family-based care resulted in an incremental cost of $2,528 per DALY averted (95% CI: 1,798, 2,599) and $2,355 per quality-adjusted life year gained (95% CI: 1,667, 2,413) after 10 y. Annual per-child expenditures for children living in family-based care environments in sub-Saharan Africa could potentially be increased by at least 25% and remain highly cost-effective.

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“… 19 Additional details regarding the OSCAR study and its cohort have been previously reported. 15 , 18 …”

Section: Methodsmentioning

confidence: 99%

“… 21 The mean age of children entering the model was 10.4 y to align with that of the OSCAR cohort. 15 …”

Section: Methodsmentioning

confidence: 99%

Section: Model Frameworkmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Cost Utility of Supporting Family-Based Care to Prevent HIV and Deaths among Orphaned and Separated Children in East Africa: A Markov Model–Based Simulation

Wilson-Barthes

Braitstein

DeLong

et al. 2022

MDM Policy & Practice

Self Cite

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“…However, among adolescents (10 to 19 years old), progress is slower, with AIDS-related deaths declining by only 37% over the same period (UNAIDS, 2021). Braitstein et al (2021) observed that living in a street environment versus a family environment was associated with the incidence of HIV and death. Substantial inadequacies with vulnerable young people, extreme poverty, family conflict, child abuse, and neglect are the main reasons why children migrate to the streets and are susceptible to HIV.Current studies highlight that, globally, 1.7 million adolescents are living with HIV in 2019.…”

mentioning

confidence: 99%

COVID-19 and HIV among children and adolescents: Current inequalities

Silva

Machado

Moreira

et al. 2022

Journal of Pediatric Nursing

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A prolonged COVID-19 pandemic is deepening the inequalities that have long driven the HIV epidemic, putting vulnerable children, adolescents, pregnant women, and breastfeeding mothers at higher risk of missing HIV prevention and treatment from life-saving services. The increasing poverty, mental health problems, and abuse are raising the risk of infection for children and women. Alarmingly, two out of five children living with HIV worldwide are unaware of their status, and just over half of children with HIV are receiving antiretroviral treatment (UNICEF, 2021a). In this context, current inequalities in HIV testing and treatment for children living with HIV and trends in historical coverage of services to prevent mother-to-child transmission of HIV are driving annual trends in AIDS-related mortality. Reductions in AIDS-related deaths among children and adolescents are steepest among children between 0 and 9 years (down 60% from 2010), reflecting improved efforts to prevent new vertical infections and diagnose and treat children in the months after childbirth and during breastfeeding. However, among adolescents (10 to 19 years old), progress is slower, with AIDS-related deaths declining by only 37% over the same period (UNAIDS, 2021). Braitstein et al. (2021) observed that living in a street environment versus a family environment was associated with the incidence of HIV and death. Substantial inadequacies with vulnerable young people, extreme poverty, family conflict, child abuse, and neglect are the main reasons why children migrate to the streets and are susceptible to HIV.Current studies highlight that, globally, 1.7 million adolescents are living with HIV in 2019. High population growth in many low and middle-income countries (LMICs) has created a 'youth rise' that makes essential to increase efforts to delay new infections by HIV among adolescents. Projections show that, at current rates of progress in reducing the adolescent HIV incidence rate, the number of new infections would decline from 250,000 in 2017 to nearly 183,000 in 2030 -an improvement but still far from the global targets. The situation is particularly terrible for girls. Adolescent girls are disproportionately affected by these trends, accounting for about 76% of all new HIV infections in the age group between 10 and 19 years worldwide. Girls and members of vulnerable populations tend to be at higher risk of contracting HIV as adolescents, a period when they are less likely to have access to treatment and other services (AVERT -Global Information and Education on HIV and AIDS, 2021; UNICEF, 2021b; Unidet Nations, 2021). Another situation that is important to highlight is that this year -2021marks two decades of progressive reductions in the prevalence of HIV/AIDS, but as a lasting legacy, close to the 14 million children who have lost one or both parents to AIDS remain. Today, the world faces another devastating new pandemic that has left vast numbers of mourning children in its wake at unprecedented speed. The COVID-19 pandemic had, by the e...

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Where Should Orphaned and Separated Children and Adolescents Live: Comparing Institutionalized- and Family-Based Venues in Kenya

Vermund¹

2021

JAMA Netw Open

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Parents and children from low-and middle-income countries (LMIC) may have a myriad of health and social challenges that increase the risk of parental death, chronic conditions, or acute serious illnesses in parents or children, or family economic hardships that can result in child abandonment or orphanhood. Such conditions can include HIV/AIDS, COVID-19, physical or mental trauma, undermanaged chronic diseases, mental health disabilities, 1 civil strife, extreme poverty with food and housing insecurities, and many others. The intergenerational consequence of such parental

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Association of Care Environment With HIV Incidence and Death Among Orphaned, Separated, and Street-Connected Children and Adolescents in Western Kenya

Cited by 10 publications

References 47 publications

Cost Utility of Supporting Family-Based Care to Prevent HIV and Deaths among Orphaned and Separated Children in East Africa: A Markov Model–Based Simulation

Cost Utility of Supporting Family-Based Care to Prevent HIV and Deaths among Orphaned and Separated Children in East Africa: A Markov Model–Based Simulation

COVID-19 and HIV among children and adolescents: Current inequalities

Where Should Orphaned and Separated Children and Adolescents Live: Comparing Institutionalized- and Family-Based Venues in Kenya

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