Predictors of mortality among adolescents and young adults living with HIV on antiretroviral therapy in Dar es Salaam, Tanzania: a retrospective cohort study

Amour, Maryam; Shayo, Grace A.; Matee, Mecky; Machumi, Lameck; Rugarabamu, Angelica; Aris, Eric; Sunguya, Bruno F.; Mugusi, Ferdinand

doi:10.1002/jia2.25886

Cited by 13 publications

(11 citation statements)

References 31 publications

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“…In addition, a meta-analysis by Belay demonstrated that TB infected children with co-infection of HIV had a higher likelihood of experiencing adverse treatment outcomes compared to HIV-negative children, about 3.2 times [53]. Regarding a single infection of HIV, a retrospective study reported a mortality rate of 2.3% among adolescents infected with HIV in Tanzania [54].…”

Section: Discussionmentioning

confidence: 99%

Mortality of children and adolescents co-infected with tuberculosis and HIV: a systematic review and meta-analysis

Hu,

Tang,

et al. 2024

Aids

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Objective: Children and adolescents with HIV infection are well-known to face a heightened risk of tuberculosis. However, the exact mortality rates and temporal trends of those with HIV-TB co-infection remain unclear. We aimed to identify the overall mortality and temporal trends within this population. Methods: PubMed, Web of Science, and Embase were employed to search for publications reporting on the mortality rates of children and adolescents with HIV-TB co-infection from inception to March 2, 2024. The outcome is the mortality rate for children and adolescents with HIV-TB co-infection during the follow-up period. In addition, we evaluate the temporal trends of mortality. Results: During the follow-up period, the pooled mortality was 16% (95% CI 13–20). Single infection of either HIV or TB exhibit lower mortality rates (6% and 4%, respectively). We observed elevated mortality risks among individuals aged less than 12 months, those with EPTB, poor adherence to ART, and severe immunosuppression. In addition, we observed a decreasing trend in mortality before 2008 and an increasing trend after 2008, although the trends were not statistically significant (P = 0.08 and 0.2 respectively). Conclusions: Children and adolescents with HIV-TB co-infection bear a significant burden of mortality. Timely screening, effective treatment, and a comprehensive follow-up system contribute to reducing the mortality burden in this population.

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Section: Discussionmentioning

confidence: 99%

Mortality of children and adolescents co-infected with tuberculosis and HIV: a systematic review and meta-analysis

Hu,

Tang,

et al. 2024

Aids

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“…Our results indicated that being male was a risk prognostic factor for KS-specific mortality, whereas being female was a risk prognostic factor for non-KS-specific mortality. Published studies have shown that the reasons for increased mortality observed in men living with HIV are poor health-seeking behaviour; delay in HIV status disclosure; poor access to HIV services, including testing and treatment; poor engagement with HIV services; late presentation to healthcare; delayed initiation of treatment; poor adherence to ART; and poor retention [46,47]. On the other hand, being female was associated more with non-KS-specific mortality, which might be because of earlier ART initiation avoiding HIV-related infections [48].…”

Section: Discussionmentioning

confidence: 99%

Prognostic factors for competing risk in patients with AIDS‐related Kaposi's sarcoma: A SEER population‐based study

et al. 2023

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ObjectivesDespite the improved survival of patients with AIDS and Kaposi's sarcoma (KS), competing events are a non‐negligible issue affecting the survival of such patients. In this study, we explored the prognostic factors of KS‐specific and non‐KS‐specific mortality in patients with AIDS‐related KS (AIDS‐KS), accounting for competing risk.MethodsWe identified 17 103 patients with AIDS‐KS aged 18–65 years between 1980 and 2016 from the Surveillance, Epidemiology, and End Results (SEER) 18 registry database. Prognostic factors for KS‐specific and non‐KS‐specific mortality were determined by the Fine and Grey proportional subdistribution hazard model. We built competing risk nomograms and assessed their predictive performance based on the identified prognostic factors.ResultsIn total, 12 943 (75.68%) patients died, 1965 (15.50%) of whom died from competing events. The KS‐specific mortality rate was 14 835 per 100 000 person‐years, and the non‐KS specific mortality rate was 2719 per 100 000 person‐years. Specifically, age >44 years was associated with an 11% decrease in the subdistribution hazard of KS‐specific mortality compared with age <43 years but a 50% increase in the subdistribution hazard of non‐KS‐specific mortality. Being male was associated with a 26% increase in the subdistribution hazard of KS‐specific mortality compared with being female but a 32% decrease in the subdistribution hazard of non‐KS‐specific mortality. Notably, being in the antiretroviral therapy (ART) era consistently showed a decrease in the subdistribution hazard of both KS‐specific and non‐KS‐specific mortality than being in the pre‐ART era.ConclusionsCompeting events commonly occurred among patients with AIDS‐KS, which deserves further attention to improve the prognosis of these patients.

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“…However, consistent with the evidence, globally, high ART uptake and VLS rates are only observed among the general population with adolescents reporting lower rates, yet adolescents account for 5% of all PLHIV [3,8]. The rates are even lower among ALHIV in sub-Sahara Africa (SSA) [1,3,9–11]. For instance, in 2021, VLS was only 30% among the 43% ALHIV on ART in SSA [12].…”

Section: Introductionmentioning

confidence: 90%

Determinants of anti-retroviral therapy adherence among adolescents living with HIV in the Kingdom of Eswatini

Hlophe,

Shumba,

Bedada

et al. 2023

Preprint

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BackgroundThe success of antiretroviral therapy (ART) depends on a high level of adherence to the life-long therapy of 95% and above. However, in Eswatini, adolescents and young people aged 15 to 24 years, have poor ART adherence as evidenced by low viral load (VL) suppression rates (76% and 63% among female and males respectively) compared to the general population (96%). The wide age-band of 15 to 24 years in reporting viral suppression rates means that adolescent specific data is limited, and younger adolescents aged 10-14 years are excluded. This study explored the level of ART adherence and associated factors among adolescents living with HIV (ALHIV) aged 10 to 19 years on ART in Eswatini.MethodsWe performed a retrospective analysis of 911 medical records of ALHIV aged 10 to 19 years on ART for at least a month in Eswatini for the period 1stJanuary 2017 to 30thSeptember 2022. Bivariate logistic regression was fitted for each predictor variable. Missing values were imputed using multiple imputation by chained equation (MICE). Statistically significant (p-value ≤0.2) predictor variables were included in a multivariable logistic regression model. P-value ≤0.05 was used to declare statistical significance in the final regression model.ResultsART adherence of 88.5% was recorded with higher adherence among males (88.9%) than females (87.8%). Hhohho region had highest adherence (90.7%) while Shiselweni region had lowest adherence (82%). Adherence was low among ALHIV with a non-suppressed baseline VL result (65.3%) and those assigned to multi-month ART model of care at ART initiation (66.7%). The Shiselweni region (OR 0.47; 95%CI 0.26-2.78), suppressed baseline VL result (OR 5.49; 95%CI 3.36-8,96) and assigned to the main-stream ART care model (OR 0.22; 95%CI 0.05-0.95) were statistically associated with ART adherence. In the multivariable regression analysis, only Shiselweni region and suppressed baseline VL result were statistically associated with ART adherence.ConclusionEswatini ALHIV have a low ART adherence compared to general population. Shiselweni region is negatively associated with ART adherence among ALHIV while a suppressed baseline VL is positively associated with improved ART adherence. There is therefore a need to intensify interventions aimed at early ART initiation and intensive follow-up and support among ALHIV especially in the Shiselweni region.

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Predictors of mortality among adolescents and young adults living with HIV on antiretroviral therapy in Dar es Salaam, Tanzania: a retrospective cohort study

Cited by 13 publications

References 31 publications

Mortality of children and adolescents co-infected with tuberculosis and HIV: a systematic review and meta-analysis

Mortality of children and adolescents co-infected with tuberculosis and HIV: a systematic review and meta-analysis

Prognostic factors for competing risk in patients with AIDS‐related Kaposi's sarcoma: A SEER population‐based study

Determinants of anti-retroviral therapy adherence among adolescents living with HIV in the Kingdom of Eswatini

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