Higher retention and viral suppression with adolescent-focused HIV clinic in South Africa

Zanoni, Brian C.; Sibaya, Thobekile; Cairns, Chelline; Lammert, Sara; Haberer, Jessica

doi:10.1371/journal.pone.0190260

Cited by 90 publications

(109 citation statements)

References 42 publications

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“…A recent study conducted in Canada reported that a quarter of transitioned patients were no longer engaged in care [55]. Although these data are from high-income settings, we may expect similar findings in low-resource settings where report of transition outcomes are less common [48,50]. Descriptions of ongoing research efforts to capture transition outcomes in African settings and how they differ from high- and middle-income settings are necessary in order to identify key steps in the HIV cascade for interventions.…”

Section: Discussionmentioning

confidence: 66%

“…Support groups and greater involvement of adolescent healthcare providers have been suggested by healthcare providers themselves to facilitate transition [22,30]. Teen clinics have also been found in a small number of studies to improve retention compared to the standard model of care which is the most prevalent [48,50]. Although these youth-focused health services may improve their retention in HIV care, it is difficult to generalize study results due to their limited numbers, sample sizes, and short follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…52–1.0) experienced significantly lower attrition after ART initiation.– Adolescents and youth enrolled with CD4 cell count lower than 100/mL or higher than 200/mL had a significant higher pre-ART attrition than those between 100 and 200 cells/mL. Those with missing CD4 at ART initiation, CD4 >350 and those <100/mL had higher attrition compared with those initiating ART between 100 and 350 cells/mL.– enrolling into HIV care while on treatment for TB lower attrition in pre-ART phase (RR = 0, 60, 95%CI: 0, 48–0, 73) but no difference in attrition after ART initiation.– Kenya, Mozambique, Tanzania had higher pre-ART attrition compared with adolescents and young adults attending clinics in RwandaMSF report, 2011–2015, unpublished [26]Khayelitsha, Cape Town, South AfricaProspective cohort providing a youth differentiated model of care: with same day point of care CD4 testing and rapid ART initiation, without comparison group337 HIV-infected adolescents and young adults, 12–25 years, enrolled from 2012 to 2015MSF-funded youth clubs with psychosocial support, HIV clinical management, family planning, linkage to mentor via mobile phoneOverall 12-month retention outcome: 82% (95% CI: 76–86%).Varying significantly by enrolment category ( p < 0.001):Ineligible to start ART: 53% (95% CI: 40–64%)Newly initiated on ART: 86% (95% CI: 79–91%)Stable on ART: 94% (95% CI: 85–97%)Zanoni, (Int HIV ped W 2016) [48]KwaZulu-Natal, South AfricaRetrospective cohort comparing a Saturday teen clinic compared to standard weekday paediatric clinics254 perinatally HIV-infected adolescentsSaturday teen clinic was implemented was dedicated peer support and structured social activities after 6 months on ARTOverall viral suppression was 85% and retention 89%. Significantly higher retention rates in adolescents attending the dedicated teen clinic (97%) versus adolescents in standard care (85%) ( p = 0.0005)Teasdale, C.J.Aquir Immune Defic Syndr2016 [49]Nyanza, KenyaRetrospective analysis comparing LTFU pre-YAFS (youth- adolescent-friendly services) to LTFU post YAFS in 6 YAFS.…”

Section: Adolescent and Youth Post-transition Outcomes In Sub-saharanmentioning

confidence: 99%

“…Further studies are needed to determine the factors that facilitate successful delivery of care for HIV-infected adolescents as they prepare to transition into adults care [48]. In a retrospective study comparing pre and post-ART retention before and after the implementation of youth-friendly services in Nyanza, Kenya, results suggest that offering a basic set of youth-friendly services, including dedicated clinics and support groups targeted to adolescents and youth, may not be adequate to surmount the retention barriers faced by adolescents and young adults [49].…”

Section: Adolescent and Youth Post-transition Outcomes In Sub-saharanmentioning

confidence: 99%

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Transition from paediatric to adult care of adolescents living with HIV in sub‐Saharan Africa: challenges, youth‐friendly models, and outcomes

Dahourou

Gautier-Lafaye

Teasdale

et al. 2017

Journal of the International AIDS Society

114

145

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Introduction: The number of adolescents with perinatally or behaviourally acquired HIV is increasing in low-income countries, and especially in sub-Saharan Africa where HIV prevalence and incidence are the highest. As they survive into adulthood in the era of antiretroviral therapy, there is a pressing need to transfer them from paediatric to adult care, known as the transition of care. We conducted a narrative review of recent evidence on their transition outcomes in Africa, highlighting the specific needs and challenges in these populations and settings, and the different models of care for transition.Areas covered: We searched PubMed bibliographic database, HIV conference content, and grey literature from January 2000 to August 2016 with the following keywords: HIV infections AND (adolescents or youth) AND transition AND Africa. All qualitative and quantitative, experimental and observational studies including HIV-infected patients aged 10–24 years with information on transition were eligible.Results: Few data on transition outcomes for HIV-infected adolescents are available from Africa settings. Studies mainly from Southern and East Africa reported on the barriers to successful transition, highlighting several gaps. These included lack of adequate infrastructure, staff training and communication between paediatric and adult clinicians as well as the fear of stigma of adolescents and youth living with HIV. Most countries have no specific national guidelines on when to disclose HIV status or when and how to transition to adult care. Several models of care adapted to the adolescent transition question have been implemented in specific settings. These models include teen clinics, peer educators or the use of social media. However, regardless of the model, services are increasingly overburdened and have insufficient human resources. Furthermore, very high attrition has been observed among adolescents and youth compared to younger children or older adults. There is a need to identify sub-groups at higher risk of loss to follow-up for targeted care and peer support.Expert commentary: Although the available HIV-related data on adolescent transition outcomes are limited, there is evidence of their increased vulnerability during this period. Standardized data gathering, analysis, and reporting systems specific to adolescent transition are essential to improve understanding and adolescent outcomes in Africa.

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Section: Discussionmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Section: Adolescent and Youth Post-transition Outcomes In Sub-saharanmentioning

confidence: 99%

Section: Adolescent and Youth Post-transition Outcomes In Sub-saharanmentioning

confidence: 99%

See 2 more Smart Citations

Transition from paediatric to adult care of adolescents living with HIV in sub‐Saharan Africa: challenges, youth‐friendly models, and outcomes

Dahourou

Gautier-Lafaye

Teasdale

et al. 2017

Journal of the International AIDS Society

114

145

View full text Add to dashboard Cite

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“…Work in CCASA has demonstrated the importance of ensuring a comprehensive approach to adolescent HIV care in which factors affecting treatment outcomes can be identified and addressed before the transitioning process begins [73,78,79]. Peer support may improve outcomes [55,98]; however, young people across CCASA, EE and AP who are part of stigmatized or criminalized groups including MSM, sex workers, PWID or their sexual partners may face particular challenges in accessing this. Many adolescent clinics in CCASA are admitting MSM youth who subsequently identify as transgender females.…”

Section: Resultsmentioning

confidence: 99%

Adolescents with HIV and transition to adult care in the Caribbean, Central America and South America, Eastern Europe and Asia and Pacific regions

Bailey

Cruz

Songtaweesin

et al. 2017

Journal of the International AIDS Society

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Introduction: The HIV epidemics in the Caribbean, Central America and South America (CCASA), Eastern Europe (EE) and Asia and Pacific (AP) regions are diverse epidemics affecting different key populations in predominantly middle-income countries. This narrative review describes the populations of HIV-positive youth approaching adolescence and adulthood in CCASA, EE and AP, what is known of their outcomes in paediatric and adult care to date, ongoing research efforts and future research priorities.Methods: We searched PubMed and abstracts from recent conferences and workshops using keywords including HIV, transition and adolescents, to identify published data on transition outcomes in CCASA, EE and AP. We also searched within our regional clinical/research networks for work conducted in this area and presented at local or national meetings. To give insight into future research priorities, we describe published data on characteristics and health status of young people as they approach age of transition, as a key determinant of health in early adulthood, and information available on current transition processes.Results and discussion: The perinatally HIV-infected populations in these three regions face a range of challenges including parental death and loss of family support; HIV-related stigma and socio-economic disparities; exposure to maternal injecting drug use; and late disclosure of HIV status. Behaviourally HIV-infected youth often belong to marginalized sub-groups, with particular challenges accessing services and care. Differences between and within countries in characteristics of HIV-positive youth and models of care need to be considered in comparisons of outcomes in young adulthood. The very little data published to date on transition outcomes across these three regions highlight some emerging issues around adherence, virological failure and loss to follow-up, alongside examples of programmes which have successfully supported adolescents to remain engaged with services and virologically suppressed.Conclusions: Limited data available indicate uneven outcomes in paediatric services and some shared challenges for adolescent transition including retention in care and adherence. The impact of issues specific to low prevalence, concentrated epidemic settings are poorly understood to date. Outcome data are urgently needed to guide management strategies and advocate for service provision in these regions.

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Mortality and losses to follow‐up among adolescents living with HIV in the IeDEA global cohort collaboration

et al. 2018

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IntroductionWe assessed mortality and losses to follow‐up (LTFU) during adolescence in routine care settings in the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium.MethodsCohorts in the Asia‐Pacific, the Caribbean, Central, and South America, and sub‐Saharan Africa (Central, East, Southern, West) contributed data, and included adolescents living with HIV (ALHIV) enrolled from January 2003 and aged 10 to 19 years (period of adolescence) while under care up to database closure (June 2016). Follow‐up started at age 10 years or the first clinic visit, whichever was later. Entering care at <15 years was a proxy for perinatal infection, while entering care ≥15 years represented infection acquired during adolescence. Competing risk regression was used to assess associations with death and LTFU among those ever receiving triple‐drug antiretroviral therapy (triple‐ART).ResultsOf the 61,242 ALHIV from 270 clinics in 34 countries included in the analysis, 69% (n = 42,138) entered care <15 years of age (53% female), and 31% (n = 19,104) entered care ≥15 years (81% female). During adolescence, 3.9% died, 30% were LTFU and 8.1% were transferred. For those with infection acquired perinatally versus during adolescence, the four‐year cumulative incidences of mortality were 3.9% versus 5.4% and of LTFU were 26% versus 69% respectively (both p < 0.001). Overall, there were higher hazards of death for females (adjusted sub‐hazard ratio (asHR) 1.19, 95% confidence interval (CI) 1.07 to 1.33), and those starting treatment at ≥5 years of age (highest asHR for age ≥15: 8.72, 95% CI 5.85 to 13.02), and in care in mostly urban (asHR 1.40, 95% CI 1.13 to 1.75) and mostly rural settings (asHR 1.39, 95% CI 1.03 to 1.87) compared to urban settings. Overall, higher hazards of LTFU were observed among females (asHR 1.12, 95% CI 1.07 to 1.17), and those starting treatment at age ≥5 years (highest asHR for age ≥15: 11.11, 95% CI 9.86 to 12.53), in care at district hospitals (asHR 1.27, 95% CI 1.18 to 1.37) or in rural settings (asHR 1.21, 95% CI 1.13 to 1.29), and starting triple‐ART after 2006 (highest asHR for 2011 to 2016 1.84, 95% CI 1.71 to 1.99).ConclusionsBoth mortality and LTFU were worse among those entering care at ≥15 years. ALHIV should be evaluated apart from younger children and adults to identify population‐specific reasons for death and LTFU.

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Higher retention and viral suppression with adolescent-focused HIV clinic in South Africa

Cited by 90 publications

References 42 publications

Transition from paediatric to adult care of adolescents living with HIV in sub‐Saharan Africa: challenges, youth‐friendly models, and outcomes

Transition from paediatric to adult care of adolescents living with HIV in sub‐Saharan Africa: challenges, youth‐friendly models, and outcomes

Adolescents with HIV and transition to adult care in the Caribbean, Central America and South America, Eastern Europe and Asia and Pacific regions

Mortality and losses to follow‐up among adolescents living with HIV in the IeDEA global cohort collaboration

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