Traversing the cascade: urgent research priorities for implementing the ‘treat all’ strategy for children and adolescents living with HIV in sub-Saharan Africa

Enane, Leslie A.; Davies, Mary Ann; Leroy, Valériane; Edmonds, Andrew; Apondi, Edith; Adedimeji, Adebola; Vreeman, Rachel C.

doi:10.1016/s2055-6640(20)30344-7

Cited by 53 publications

(45 citation statements)

References 86 publications

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“…We saw gaps in the second 90 among older adolescents aged 15–19 years in both countries. Data from SSA show poor ART initiation and retention among ALHIV [ 38 ]. In the SEARCH study, only 64% of previously diagnosed youth LHIV were on ART at baseline, compared with 81% of older adults [ 38 ].…”

Section: Discussionmentioning

confidence: 99%

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HIV Care Cascade Among Adolescents in a “Test and Treat” Community-Based Intervention: HPTN 071 (PopART) for Youth Study

Shanaube

Macleod

Chaila

et al. 2021

Journal of Adolescent Health

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Purpose The PopART for Youth (P-ART-Y) study was nested within the HPTN 071 (PopART) trial, a three-arm community randomized trial in 21 communities in Zambia and South Africa. The P-ART-Y study evaluated the acceptability and uptake of a combination HIV prevention package among young people. We report on the HIV care cascade for adolescents aged 10–19 years from 14 communities receiving the full HIV prevention package in Zambia and South Africa. Methods Adolescents were offered participation in the PopART intervention, which included universal home-based HIV testing, linkage to care, antiretroviral therapy (ART) adherence, and other services. Data were collected from September 2016 to December 2017, covering the third round (R3) of the intervention. Results We enumerated (listed) 128,241 adolescents (Zambia: 95,295 and South Africa: 32,946). Of the adolescents offered HIV testing, 81.9% accepted in Zambia and 70.3% in South Africa. Knowledge of HIV status was higher among older adolescents and increased from 31.4% before R3 to 88.3% at the end of R3 in Zambia and from 28.3% to 79.5% in South Africa. Overall, there were 1,710 (1.9%) adolescents identified as living with HIV by the end of R3 (515 new diagnoses and 1,195 self-reported). Of the new diagnoses, 335 (65.0%) were girls aged 15–19 years. The median time to initiate ART was 5 months. ART coverage before and after R3 increased from 61.3% to 78.7% in Zambia and from 65.6% to 87.8% in South Africa, with boys having higher uptake than girls in both countries. Conclusions The PopART intervention substantially increased coverage toward the first and second UNAIDS 90-90-90 targets in adolescents.

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Section: Discussionmentioning

confidence: 99%

“…Data from SSA show poor ART initiation and retention among ALHIV [ 38 ]. In the SEARCH study, only 64% of previously diagnosed youth LHIV were on ART at baseline, compared with 81% of older adults [ 38 ]. In this study, we put in place several strategies to encourage LTC.…”

Section: Discussionmentioning

confidence: 99%

HIV Care Cascade Among Adolescents in a “Test and Treat” Community-Based Intervention: HPTN 071 (PopART) for Youth Study

Shanaube

Macleod

Chaila

et al. 2021

Journal of Adolescent Health

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“…In this context of widespread scaleup of ART, it is essential also to escalate efforts to identify and combat HIV drug resistance (HIVDR), as well as to study and implement strategies to improve adherence and retention on treatment [23]. This is especially the case for infants, children and adolescents who have lower rates of adherence, retention and viral suppression (VS), placing them at risk of acquired drug resistance (ADR); or those who may experience transmitted drug resistance (TDR), for example, when HIV with resistant mutations is transmitted perinatally [24][25][26][27]. Vulnerable groups including infants, children and adolescents must be prioritised to achieve the 90-90-90 goals to improve treatment outcomes and avoid increasing rates of HIVDR which threaten progress to end the global HIV epidemic [24,27].…”

Section: Emerging Hiv Resistance In Paediatricsmentioning

confidence: 99%

“…Children and adolescents have specific challenges and risks that can contribute to ADR. These include complex barriers to adherence, limitations in access to ART medication, a lack of paediatric-friendly formulations and barriers to retention in HIV care [25,36,37]. Measurements of adherence in paediatrics are heterogeneous, and, consequently, estimates of adherence may be wide-ranging [36].…”

Section: Emerging Hiv Resistance In Paediatricsmentioning

confidence: 99%

Global emerging resistance in pediatric infections with TB, HIV, and gram-negative pathogens

Enane

Christenson

2020

Paediatrics and International Child Health

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Infants, children and adolescents are at risk of life-threatening, antimicrobial-resistant infections. Global burdens of drug-resistant TB, HIV and gram-negative pathogens have a particular impact on paediatric age groups, necessitating a paediatric-focused agenda to address emerging resistance. Dedicated approaches are needed to find, successfully treat and prevent resistant infections in paediatric populations worldwide. Challenges include the diagnosis and identification of resistant infections, limited access to novel antimicrobials or to paediatric-friendly formulations, limited access to research and clinical trials and implementation challenges related to prevention and successful completion of treatment. In this review, the particular complexities of emerging resistance in TB, HIV and gram-negative pathogens in children, with attention to both clinical and public health challenges, are highlighted. Key principles of a paediatric-focused agenda to address antimicrobial resistance are outlined. They include quality of care, increasing equitable access to key diagnostics, expanding antimicrobial stewardship and infection prevention across global settings, and health system strengthening. Increased access to research studies, including clinical trials, is needed. Further study and implementation of care models and strategies for child-or adolescent-centred management of infections such as HIV and TB can critically improve outcome and avoid development of resistance. As the current global pandemic of a novel coronavirus, SARS-CoV-2, threatens to disrupt health systems and services for vulnerable populations, this is a critical time to mitigate against a potential surge in the incidence of resistant infections.

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“…At the end of 2018, IeDEA published a consensus statement [61] and a journal supplement [62] on research priorities to inform the implementation of the “Treat All” policy in children and adolescents[63], pregnant and post-partum women [64], and for mental health, substance use [65] and drug resistance [66]. These documents will guide IeDEA’s future research agenda in sub-Saharan Africa.…”

Section: The Futurementioning

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

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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.

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Traversing the cascade: urgent research priorities for implementing the ‘treat all’ strategy for children and adolescents living with HIV in sub-Saharan Africa

Cited by 53 publications

References 86 publications

HIV Care Cascade Among Adolescents in a “Test and Treat” Community-Based Intervention: HPTN 071 (PopART) for Youth Study

HIV Care Cascade Among Adolescents in a “Test and Treat” Community-Based Intervention: HPTN 071 (PopART) for Youth Study

Global emerging resistance in pediatric infections with TB, HIV, and gram-negative pathogens

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

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