Time to First-Line ART Failure and Time to Second-Line ART Switch in the IeDEA Pediatric Cohort

Wools‐Kaloustian, Kara; Marete, Irene; Ayaya, Samuel; Sohn, Annette H.; Nguyen, Lam Van; Li, Shanshan; Leroy, Valériane; Musick, Beverly; Newman, Jamie; Edmonds, Andrew; Davies, Mary‐Ann; Eboua, François Tanoh; Obama, Marie-Thérèse; Yotebieng, Marcel; Sawry, Shobna; Mofenson, Lynne; Yiannoutsos, Constantin T.

doi:10.1097/qai.0000000000001667

Cited by 20 publications

(25 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“… Context: Differentiated care strategies are essential for meeting the needs of underserved groups and key populations who do not access routine services and/or require additional support to achieve optimal HIV outcomes . It is estimated that about 15% of patients on first‐line ART do not achieve viral suppression within 12 months , with children and adolescents more likely to have elevated viral loads . Moreover, even when patients fail to achieve viral suppression on first‐line ART, rates of regimen switching are lower than expected, and loss to care rates are high .…”

Section: Resultsmentioning

confidence: 99%

Research priorities to inform “Treat All” policy implementation for people living with HIV in sub‐Saharan Africa: a consensus statement from the International epidemiology Databases to Evaluate AIDS (IeDEA)

et al. 2019

Self Cite

View full text Add to dashboard Cite

Introduction “Treat All” – the treatment of all people with HIV, irrespective of disease stage or CD4 cell count – represents a paradigm shift in HIV care that has the potential to end AIDS as a public health threat. With accelerating implementation of Treat All in sub‐Saharan Africa (SSA), there is a need for a focused agenda and research to identify and inform strategies for promoting timely uptake of HIV treatment, retention in care, and sustained viral suppression and addressing bottlenecks impeding implementation. Methods The Delphi approach was used to develop consensus around research priorities for Treat All implementation in SSA. Through an iterative process (June 2017 to March 2018), a set of research priorities was collectively formulated and refined by a technical working group and shared for review, deliberation and prioritization by more than 200 researchers, implementation experts, policy/decision‐makers, and HIV community representatives in East, Central, Southern and West Africa. Results and discussion The process resulted in a list of nine research priorities for generating evidence to guide Treat All policies, implementation strategies and monitoring efforts. These priorities highlight the need for increased focus on adolescents, men, and those with mental health and substance use disorders – groups that remain underserved in SSA and for whom more effective testing, linkage and care strategies need to be identified. The priorities also reflect consensus on the need to: (1) generate accurate national and sub‐national estimates of the size of key populations and describe those who remain underserved along the HIV‐care continuum; (2) characterize the timeliness of HIV care and short‐ and long‐term HIV care continuum outcomes, as well as factors influencing timely achievement of these outcomes; (3) estimate the incidence and prevalence of HIV‐drug resistance and regimen switching; and (4) identify cost‐effective and affordable service delivery models and strategies to optimize uptake and minimize gaps, disparities, and losses along the HIV‐care continuum, particularly among underserved populations. Conclusions Reflecting consensus among a broad group of experts, researchers, policy‐ and decision‐makers, PLWH, and other stakeholders, the resulting research priorities highlight important evidence gaps that are relevant for ministries of health, funders, normative bodies and research networks.

show abstract

Section: Resultsmentioning

confidence: 99%

Research priorities to inform “Treat All” policy implementation for people living with HIV in sub‐Saharan Africa: a consensus statement from the International epidemiology Databases to Evaluate AIDS (IeDEA)

et al. 2019

Self Cite

View full text Add to dashboard Cite

show abstract

“…Several studies examined outcomes in people living with HIV-1 or HIV-2 who initiate ART, including determinants of mortality, of switching to second-line and third-line ART, drug resistance, loss to follow-up and the immunological and virological response to different ART regimens [24][25][26][27][28][29][30][31][32][33][34][35][36][37]. For example, the African IeDEA regions contributed importantly to a large-scale analysis of outcomes in adolescents living with perinatally acquired HIV, which showed that HIV-associated mortality during adolescence was substantially higher in sub-Saharan Africa, South and Southeast Asia, and South America and the Caribbean than in Europe [36].…”

Section: Treatment Outcomes In Adults Adolescents Children and Pregmentioning

confidence: 99%

Cohort profile: The International epidemiology Databases to Evaluate AIDS (IeDEA) in sub-Saharan Africa, 2012-2019

Chammartin

Ostinelli

Anastos

et al. 2019

Preprint

Self Cite

View full text Add to dashboard Cite

Purpose: The objectives of the International epidemiology Databases to Evaluate AIDS (IeDEA) are to (i) evaluate the delivery of combination antiretroviral therapy (ART) in children, adolescents and adults in sub-Saharan Africa, (ii) to describe ART regimen effectiveness, durability and tolerability, (iii) to examine HIV-related comorbidities and co-infections, and (iv) to examine the pregnancy- and HIV-related outcomes of women on ART and their infants exposed to HIV or antiretroviral therapy in utero or via breastmilk. Participants: IeDEA is organized in four regions (Central, East, Southern and West Africa), with 240 treatment and care sites, six data centres at African, European and US universities, and almost 1.4 million children, adolescents and adult people living with HIV (PLWHIV) enrolled. Findings to date: The data include socio-demographic characteristics, clinical outcomes, opportunistic events, treatment regimens, clinic visits and laboratory measurements. They have been used to analyse outcomes in people living with HIV-1 or HIV-2 who initiate ART, including determinants of mortality, of switching to second-line and third-line ART, drug resistance, loss to follow-up and the immunological and virological response to different ART regimens. Programme-level estimates of mortality have been corrected for loss to follow-up. We examined the impact of co-infection with hepatitis B and C, and the epidemiology of different cancers and of (multi-drug resistant) tuberculosis, renal disease and of mental illness. The adoption of 'Treat All', making ART available to all PLWHIV regardless of CD4+ cell count or clinical stage was another important research topic. Future plans: IeDEA has formulated several research priorities for the 'Treat All' era in sub-Saharan Africa. It recently obtained funding to set up sentinel sites where additional data are prospectively collected on cardiometabolic risks factors as well as mental health and liver diseases, and is planning to create a drug resistance database.

show abstract

“…Smaller subnational cohorts can be unique in their ability to characterize experiences of patients and providers who may be in rural areas or district-level health care settings. 27 , 28 There are multiple regional and global research-focused pediatric cohort collaborations, including the European Pregnancy and Pediatric HIV Cohort Collaboration, 29 , 30 which links national cohorts across Europe with sites in Thailand, and the International Epidemiology Databases to Evaluate AIDS, 31 – 33 which brings together 6 regional pediatric cohort collaborations on 3 continents. Both use a common data exchange standard ( http://iedea.github.io/; http://www.hicdep.org/ ) to promote harmonization and facilitate comparison.…”

Section: National Databases and Cohorts Of Pediatric And Adolescent Dmentioning

confidence: 99%

Using Observational Data to Inform HIV Policy Change for Children and Youth

Sohn¹,

Judd

Mofenson

et al. 2018

JAIDS Journal of Acquired Immune Deficiency Syndromes

Self Cite

View full text Add to dashboard Cite

Abstract:Observational data characterizing the pediatric and adolescent HIV epidemics in real-world settings are critical to informing clinical guidelines, governmental HIV programs, and donor prioritization. Global expertise in curating and analyzing these data has been expanding, with increasingly robust collaborations and the identification of gaps in existing surveillance capacity. In this commentary, we describe existing sources of observational data for children and youth living with HIV, focusing on larger regional and global research cohorts, and targeted surveillance studies and programs. Observational data are valuable resources to cross-validate other research and to monitor the impact of changing HIV program policies. Observational studies were among the first to highlight the growing population of children surviving perinatal HIV and transitioning to adolescence and young adulthood, and have raised serious concerns about high rates of treatment failure, loss to follow-up, and death among older perinatally infected youth. The use of observational data to inform modeling of the current global epidemic, predict future patterns of the youth cascade, and facilitate antiretroviral forecasting are critical priorities and key end products of observational HIV research. Greater investments into data infrastructure are needed at the local level to improve data quality and at the global level to faciliate reliable interpretation of the evolving patterns of the pediatric and youth epidemics. Although this includes harmonized data forms, use of unique patient identifiers to allow for data linkages across routine data sets and electronic medical record systems, and competent data managers and analysts are essential to make optimal use of the data collected.

show abstract

Time to First-Line ART Failure and Time to Second-Line ART Switch in the IeDEA Pediatric Cohort

Abstract: High rates of first-line failure and attrition were identified in children within 5 years after ART initiation. Of children meeting failure criteria, only one-third were transitioned to second-line ART within 5 years.

Cited by 20 publications

References 18 publications

Research priorities to inform “Treat All” policy implementation for people living with HIV in sub‐Saharan Africa: a consensus statement from the International epidemiology Databases to Evaluate AIDS (IeDEA)

Research priorities to inform “Treat All” policy implementation for people living with HIV in sub‐Saharan Africa: a consensus statement from the International epidemiology Databases to Evaluate AIDS (IeDEA)

Cohort profile: The International epidemiology Databases to Evaluate AIDS (IeDEA) in sub-Saharan Africa, 2012-2019

Using Observational Data to Inform HIV Policy Change for Children and Youth

Contact Info

Product

Resources

About