Long-Term Impact of the Kenya Postelection Crisis on Clinic Attendance and Medication Adherence for HIV-Infected Children in Western Kenya

Yoder, Rachel; Nyandiko, Winstone; Vreeman, Rachel C.; Ayaya, Samwel O.; Gisore, Peter; Braitstein, Paula; Wiehe, Sarah E.

doi:10.1097/qai.0b013e31823b4448

Cited by 15 publications

(27 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[55,56] Interruptions in antiretroviral treatment, promoted by political crisis or conflicts in sub-Saharan Africa, may lead to unplanned treatment interruptions due to medical supplies disruption, displacement of the population, unsafe travel, limited access to health care, and incapability to obtain medications, and may be associated with worsening HIV infection [57] as well as with virological failure. [58] Children are particularly vulnerable in crises and are at increased risk of abandonment, abduction, malnutrition, and communicable diseases.…”

Section: Discussionmentioning

confidence: 99%

“…[58] Children are particularly vulnerable in crises and are at increased risk of abandonment, abduction, malnutrition, and communicable diseases. [56] Studies on the impact of the political and humanitarian crisis after the contested 2007 Kenyan presidential election showed small but statistically significant disruptions in clinical care and medication adherence among children on antiretroviral treatment despite a comprehensive health care response. [56,59,60] The Central African Republic was suffering during the study period from a major and out of control health and humanitarian crisis [44,61,62] which affected particularly the HIV epidemic.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

High levels of virological failure with major genotypic resistance mutations in HIV-1-infected children after 5 years of care according to WHO-recommended 1st-line and 2nd-line antiretroviral regimens in the Central African Republic

et al. 2017

View full text Add to dashboard Cite

A large cohort of 220 HIV-1-infected children (median [range] age: 12 [4–17] years) was cared and followed up in the Central African Republic, including 198 in 1st-line and 22 in 2nd-line antiretroviral regimens. Patients were monitored clinically and biologically for HIV-1 RNA load and drug resistance mutations (DRMs) genotyping. A total of 87 (40%) study children were virological responders and 133 (60%) nonresponders. In children with detectable viral load, the majority (129; 97%) represented a virological failure. In children receiving 1st-line regimens in virological failure for whom genotypic resistance test was available, 45% displayed viruses harboring at least 1 DRM to NNRTI or NRTI, and 26% showed at least 1 major DRM to NNRTI or NRTI; more than half of children in 1st-line regimens were resistant to 1st-generation NNRTI and 24% of the children in 1st-line regimens had a major DRMs to PI. Virological failure and selection of DRMs were both associated with poor adherence. These observations demonstrate high rate of virological failure after 3 to 5 years of 1st-line or 2nd-line antiretroviral treatment, which is generally associated with DRMs and therapeutic failure. Overall, more than half (55%) of children receiving 1st-line antiretroviral treatment for a median of 3.4 years showed virological failure and antiretroviral-resistance and thus eligible to 2nd-line treatment. Furthermore, two-third (64%) of children under 2nd-line therapy were eligible to 3rd-line regimen. Taken together, these observations point the necessity to monitor antiretroviral-treated children by plasma HIV-1 RNA load to diagnose as early as possible the therapeutic failure and operate switch to a new therapeutic line.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

High levels of virological failure with major genotypic resistance mutations in HIV-1-infected children after 5 years of care according to WHO-recommended 1st-line and 2nd-line antiretroviral regimens in the Central African Republic

et al. 2017

View full text Add to dashboard Cite

show abstract

“…34 Although this crisis was associated with treatment interruptions for HIV-infected children enrolled in Western Kenya, 35 several factors were reported that may have minimized disruptions in clinical care, including an established network of health facilities, resilient supply chain systems for food and medicines, dedicated community health workers, radio and print communication campaigns, and electronic medical records systems. 36 …”

Section: Figurementioning

confidence: 99%

Scale-up of HIV Treatment Through PEPFAR

El‐Sadr

Holmes

Mugyenyi³

et al. 2012

JAIDS Journal of Acquired Immune Deficiency Syndromes

100

View full text Add to dashboard Cite

Since its inception in 2003, the US President’s Emergency Plan for AIDS Relief (PEPFAR) has been an important driving force behind the global scale-up of HIV care and treatment services, particularly in expansion of access to antiretroviral therapy. Despite initial concerns about cost and feasibility, PEPFAR overcame challenges by leveraging and coordinating with other funders, by working in partnership with the most affected countries, by supporting local ownership, by using a public health approach, by supporting task-shifting strategies, and by paying attention to health systems strengthening. As of September 2011, PEPFAR directly supported initiation of antiretroviral therapy for 3.9 million people and provided care and support for nearly 13 million people. Benefits in terms of prevention of morbidity and mortality have been reaped by those receiving the services, with evidence of societal benefits beyond the anticipated clinical benefits. However, much remains to be accomplished to achieve universal access, to enhance the quality of programs, to ensure retention of patients in care, and to continue to strengthen health systems.

show abstract

“…Several anecdotal reports have speculated on the likelihood of negative effects of the epidemic on established treatment programs (such as for malaria [8]), leading in turn to a probable rise in non-Ebola related health problems [9]. Previous reports have documented the impact of man-made threats on HIV care [10, 11]. The present epidemic is an opportunity to look at the impact of a major threat of natural origin on HIV care [12].…”

Section: Introductionmentioning

confidence: 99%

Impact of the Ebola epidemic on general and HIV care in Macenta, Forest Guinea, 2014

Leuenberger¹,

Hébélamou²,

Strahm³

et al. 2015

Aids

View full text Add to dashboard Cite

Objective The current Ebola epidemic massively affected the Macenta district in Forest Guinea. We aimed at investigating its impact on general and HIV care at the only HIV care facility in the district. Design Prospective observational single-facility study Methods Routinely collected data on use of general hospital services and HIV care were linked to Ebola surveillance data published by the Guinea Ministry of Health. In addition we compared retention among HIV-infected patients enrolled into care in the first semesters of 2013 and 2014. Results Throughout 2014, service offer was continuous and unaltered at the facility. During the main epidemic period (August – December 2014), compared to the same period of 2013, there were important reductions in attendance at the primary care outpatient clinic (−40%), in HIV tests done (−46%), in new diagnoses of tuberculosis (−53%), in patients enrolled into HIV care (−47%). There was a smaller reduction in attendance at the HIV follow-up clinic (−11%). Kaplan-Meier estimates of retention were similar among the patients enrolled into care in 2014 and 2013. In a multivariable Cox regression analysis, the year of enrolment was not associated with attrition (hazard ratio 1.02; 95% confidence interval: 0.72–1.43). Conclusions The Ebola epidemic resulted in an important decrease of utilization of the facility despite unaltered service offer. Effects on care of HIV-positive patients enrolled prior to the epidemic were limited. HIV care in such circumstances is challenging, but not impossible.

show abstract

Long-Term Impact of the Kenya Postelection Crisis on Clinic Attendance and Medication Adherence for HIV-Infected Children in Western Kenya

Abstract: HIV-infected children are at risk for disruptions in clinic follow-up and medication adherence after a humanitarian crisis. Individual and contextual factors moderate the effects of these disruptions.

Cited by 15 publications

References 30 publications

High levels of virological failure with major genotypic resistance mutations in HIV-1-infected children after 5 years of care according to WHO-recommended 1st-line and 2nd-line antiretroviral regimens in the Central African Republic

High levels of virological failure with major genotypic resistance mutations in HIV-1-infected children after 5 years of care according to WHO-recommended 1st-line and 2nd-line antiretroviral regimens in the Central African Republic

Scale-up of HIV Treatment Through PEPFAR

Impact of the Ebola epidemic on general and HIV care in Macenta, Forest Guinea, 2014

Contact Info

Product

Resources

About