Multimonth Prescription of Antiretroviral Therapy Among Children and Adolescents: Experiences From the Baylor International Pediatric AIDS Initiative in 6 African Countries

Kim, Maria H.; Wanless, Richard Sebastian; Caviness, A. Chantal; Golin, Rachel; Amzel, Anouk; Ahmed, Saeed; Mhango, Joseph; Damba, David; Kayabu, Angelina; Chodota, Moses; Dlamini, Sandile; Chidah, Nodumo; Mokhali, Mokhitli; Calles, Nancy R.; Abrams, Elaine J.

doi:10.1097/qai.0000000000001730

Cited by 25 publications

(14 citation statements)

References 12 publications

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“…Other studies have also found that one-and two-month ART regimens have greater odds of treatment interruption. More specifically, 49.4 and 26.7% of interruption in treatment associated with one-and two-month ART regimen, respectively, compared with our study which has 78% of interruption in treatment associated with a two-month ART regimen [20,21]. Findings from a similar study indicated 49% of clients on one-month regimens had interrupted treatment [10], while that proportion was 50% in this cohort.…”

Section: Discussioncontrasting

confidence: 46%

Factors associated with an interruption in treatment of people living with HIV in USAID-supported states in Nigeria: a retrospective study from 2000–2020

et al. 2021

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Background Patient interruption of antiretroviral therapy (ART) continues to limit HIV programs’ progress toward epidemic control. Multiple factors have been associated with client interruption in treatment (IIT)— including age, gender, CD4 count, and education level. In this paper, we explore the factors associated with IIT in people living with HIV (PLHIV) in United States Agency for International Development (USAID)-supported facilities under the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) program in Nigeria. Methods We conducted cross-sectional analyses on data obtained from Nigeria’s National Data Repository (NDR), representing a summarized record of 573 630 ART clients that received care at 484 PEPFAR/USAID-supported facilities in 16 states from 2000–2020. IIT was defined as no clinical contact for 28 days or more after the last expected clinical contact. Univariate and multivariate logistic regression models were computed to explore the factors associated with IIT. The variables included in the analysis were sex, age group, zone, facility level, regimen line, multi-month dispensing (MMD), and viral load category. Results Of the 573 630 clients analysed in this study, 32% have been recorded as having interrupted treatment. Of the clients investigated, 66% were female (32% had interrupted treatment), 39% were aged 25–34 at their last ART pick-up date (with 32% of them interrupted treatment), 59% received care at secondary level facilities (37% interrupted treatment) and 38% were last receiving between three- to five-month MMD (with 10% of these interrupted treatment). Those less likely to interrupt ART were males (aOR = 0.91), clients on six-month MMD (aOR = 0.01), adults on 2nd line regimen (aOR = 0.09), and paediatrics on salvage regimen (aOR = 0.02). Clients most likely to interrupt ART were located in the South West Zone (aOR = 1.99), received treatment at a tertiary level (aOR = 12.34) or secondary level facilities (aOR = 4.01), and had no viral load (VL) on record (aOR =10.02). Age group was not significantly associated with IIT. Conclusions Sex, zone, facility level, regimen line, MMD, and VL were significantly associated with IIT. MMD of three months and longer (especially six months) had better retention on ART than those on shorter MMD. Not having a VL on record was associated with a considerable risk of IIT.

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Section: Discussioncontrasting

confidence: 46%

Factors associated with an interruption in treatment of people living with HIV in USAID-supported states in Nigeria: a retrospective study from 2000–2020

et al. 2021

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“…Short duration MMD of 1 to 3 months was identi ed as having the highest odds for an unsuppressed VL in both the univariate and covariate models. This is interesting because shorter MMD is also associated with non-adherence [24]. Shorter MMD is initially prescribed to new clients and longer MMD is prescribed to virally stable clients to reduce the number of clinic visits [25].…”

Section: Discussionmentioning

confidence: 99%

Factors affecting viral load suppression in people living with HIV in Nigeria: cross-sectional analysis from 2001 to 2021

Tomescu¹,

Crompton²,

Adebayo³

et al. 2022

Preprint

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Background Human immunodeficiency virus (HIV) is untransmissible when the viral load (VL) is undetectable, underscoring the importance of achieving VL suppression for HIV epidemic control. It is estimated that 78% of people living with HIV (PLHIV) on antiretroviral therapy (ART) in Nigeria are virally suppressed. The need to improve VL suppression rates raises questions about the factors associated with an unsuppressed VL, which this study explored using a large cross-sectional database of clients who received ART over a period of 20 years. Methods Data from 517,012 clients with a documented VL were analyzed using univariate and adjusted multivariate logistic regression. The independent variables investigated were sex, age group, facility type, time on ART until last VL test, multi-month dispensing (MMD), and geopolitical zone. To verify model improvement by variable, we performed backward elimination for the logistic regression model. Results Sixty-six percent of the study population were females. The largest age groups were 35–44 and 25–34, accounting for 32% and 31%, respectively. The greatest adjusted odds for an unsuppressed VL were associated with shorter duration MMD prescriptions of 1–2 months (adjusted odds ratio [AOR]=14.05) and 3 months (AOR=3.13). Males had 8% greater odds (AOR=1.08) of being unsuppressed. The age groups below the 45–59 age group (AOR=0.84) had higher odds of having an unsuppressed VL, with the highest odds in the 0–14 age group (AOR=1.87). Clients enrolled at tertiary and secondary level facilities had the greatest odds of having an unsuppressed VL. A shorter time on ART until the last VL (1–3 years [AOR=1.14]) was associated with a higher risk of an unsuppressed VL. Clients in the North-Central (AOR=1.83) and North-East (AOR=1.49) zones had the greatest odds of viral non-suppression. Conclusions Enabling the provision of 3+ months of MMD to PLHIV and targeting younger age groups, tertiary and secondary health facilities, small and medium facilities, and the North-Central and North-East zones for interventions could lead to improvements in VL suppression in Nigeria. The independent factors associated with an unsuppressed VL can guide improvements in ART program development and VL suppression of PLHIV in Nigeria.

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“…12 Observational studies have also previously indicated that MMD of ART has favourable patient outcomes; however, patients from these studies primarily received ART refills at facilities. [19][20][21][22] In our study, participants who received MMD in CAGs had higher retention than those who received 6-monthly outof-facility MMD without CAG peer support, which is a new finding compared to the original trials. ART patients receiving out-of-facility 6-monthly MMD with only annual facility clinical visits who do not participate in small peer groups with other ART patients may receive insufficient interaction with health services and peers receiving ART to sustain high levels of retention and adherence to ART.…”

Section: Discussionmentioning

confidence: 46%

Section: Discussionmentioning

confidence: 99%

Out-of-Facility Multimonth Dispensing of Antiretroviral Treatment: A Pooled Analysis Using Individual Patient Data From Cluster-Randomized Trials in Southern Africa

Lopes

Grimwood

Ngorima‐Mabhena

et al. 2021

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Multimonth Prescription of Antiretroviral Therapy Among Children and Adolescents: Experiences From the Baylor International Pediatric AIDS Initiative in 6 African Countries

Cited by 25 publications

References 12 publications

Factors associated with an interruption in treatment of people living with HIV in USAID-supported states in Nigeria: a retrospective study from 2000–2020

Factors associated with an interruption in treatment of people living with HIV in USAID-supported states in Nigeria: a retrospective study from 2000–2020

Factors affecting viral load suppression in people living with HIV in Nigeria: cross-sectional analysis from 2001 to 2021

Out-of-Facility Multimonth Dispensing of Antiretroviral Treatment: A Pooled Analysis Using Individual Patient Data From Cluster-Randomized Trials in Southern Africa

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