Virological failure among adolescents on ART, Harare City, 2017- a case-control study

Sithole, Zvanaka; Mbizvo, Elizabeth; Chonzi, Prosper; Mungati, More; Juru, Tsitsi; Shambira, Gerald; Gombe, Notion Tafara; Tshimanga, Mufuta

doi:10.1186/s12879-018-3372-6

Cited by 65 publications

(95 citation statements)

References 16 publications

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“…It has been previously reported that ALHIV not disclosed of their HIV-serostatus increases virological failure by a 5-fold [53]. The identi cation of virological failure is possible where viral load measurement is available, which was not routinely done in West Africa.…”

Section: Discussionmentioning

confidence: 99%

“…The COHADO study is one of the rst cohort to provide viral load data in West-Africa, with measurements substantially more available after 24 months of followup. Viral load access is a real issue in ALHIV care monitoring in Africa, and the prioritization of viral load measurement is universally recommended since 2016 particularly for ALHIV who have high risk of virological failure [53]. In the COHADO clinical sites, the annual viral load measurement is a recent opportunity that should be scaled up and supported in every HIV-care facility, as virological success could be also an indicator used to encourage treatment adherence and therefore outcomes of APHIV.…”

Section: Discussionmentioning

confidence: 99%

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24-month clinical, immune-virological outcomes and HIV status disclosure in adolescents living with perinatally-acquired HIV in the COHADO cohort, in Togo and Côte d’Ivoire, 2015-2017

Revegue

Takassi

Eboua

et al. 2020

Preprint

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Background: Adolescents living with perinatally-acquired HIV (APHIV) face challenges including the disclosure of their HIV-serostatus that we explored in the West-African COHADO cohort. We assessed the 24-month outcomes among APHIV in relation to the disclosure of their own HIV-serostatus.Methods: Nested within the International epidemiologic Database to Evaluate AIDS pediatric West African prospective cohort (IeDEA pWADA), the COHADO cohort included antiretroviral (ART)-treated APHIV aged 10–19 years, enrolled in HIV-care <10 years, in Abidjan (Côte d’Ivoire) and Lomé (Togo) in 2015. An unfavorable outcome was defined when either death, loss to follow-up, progression to WHO-AIDS stage, a decrease of CD4 count >10% compared to baseline, or a detectable viral load (>50copies/mL) were notified at 24 months. None of these events defined a favorable outcome. We investigated correlates of APHIV favorable 24-month outcome using a logistic regression model.Results: Overall, 209 APHIV were included, 51.6% in Abidjan, 54.5% were females. At inclusion, median CD4 cell count was 521/mm3 (IQR[281-757]); 29.6% had a VL measurement of whom 3.2% in virological suppression. APHIV were younger in Lomé (median age: 12 years (interquartile range [IQR]:11-15) compared to Abidjan (14 years (IQR:12-15, p=0.01). Full HIV-disclosure increased from 41.6% at inclusion to 74.1% after 24 months. After 24 months of follow-up, 6 (2.9%) died, 8 (3.8%) were lost to follow-up, 4 (1.9%) were transferred out. Overall, 73.7% did not progress to WHO-AIDS stage, 62.7% had CD4 count above (± 10%) of the baseline value (48.6% in Abidjan versus 69.0% in Lomé, p<0.001). Among the 83.7% with VL measurements, 48.8% were in virological suppression (Abidjan: 45.4%, Lomé: 52.5%, p<0.01). The 24-month combined outcome was favorable for 45% (29.6% in Abidjan and 61.4% in Lomé, p<0.01): adjusted on baseline variables, it was not significantly associated with HIV-disclosure but significantly higher for APHIV living in Lomé compared to those in Abidjan (aOR: 17.24, 95%CI [3.69-80.44]).Conclusions: 24-month favorable outcome rates were low among West-African APHIV and differed across countries. HIV-disclosure frequency improved over time but remained low. Context-specific responses are urgently needed to improve adolescent’s care to reach the UNAIDS 90% target of virological success for those on ART.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

24-month clinical, immune-virological outcomes and HIV status disclosure in adolescents living with perinatally-acquired HIV in the COHADO cohort, in Togo and Côte d’Ivoire, 2015-2017

Revegue

Takassi

Eboua

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…It has been previously reported that ALHIV non-disclosure of HIV-serostatus increases virological failure by a 5-fold [53]. The identification of virological failure is possible where viral load measurement is available, which was not routinely done in West Africa.…”

Section: Discussionmentioning

confidence: 99%

“…The COHADO cohort is one of the first study to provide viral load data in West-Africa, with measurements more available at the 24 th month of follow-up. Viral load access is a real issue in ALHIV care monitoring in Africa, and the prioritization of viral load measurement is universally recommended since 2016 particularly among ALHIV who have high risk of virological failure [53]. In the COHADO clinical sites, the annual viral load measurement is a recent opportunity that should be scaled up and supported in every HIV-care facility, as virological success could be also used to optimize treatment adherence and outcomes of APHIV.…”

Section: Discussionmentioning

confidence: 99%

24-month clinical, immuno-virological outcomes and HIV status disclosure in adolescents living with perinatally-acquired HIV in the COHADO cohort, in Togo and Côte d’Ivoire, 2015-2017

Revegue

Takassi

Eboua

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Adolescents living with perinatally-acquired HIV (APHIV) face challenges including timely disclosure of their HIV-serostatus that was explored in the West-African COHADO cohort. We assessed the 24-month outcomes in COHADO, among APHIV in relation to the disclosure of their own HIV-serostatus. Methods: Nested within the International epidemiologic Database to Evaluate AIDS pediatric West African prospective cohort (IeDEA pWADA), the COHADO cohort included antiretroviral (ART)-treated APHIV aged 10–19 years, enrolled in HIV-care <10 years, in Abidjan (Côte d’Ivoire) and Lomé (Togo) in 2015. A favorable 24-month outcome was defined when combining being retained in care, without progression to WHO-AIDS stage, with CD4 cell count > baseline CD4 (± 10%) and with virological suppression (viral load [VL] <50 copies/mL). We investigated correlates of APHIV favorable 24-month outcome using multivariate logistic regression. Results: Overall, 209 APHIV were included, 51.6% in Abidjan, 54.5% were females. At inclusion, median CD4 cell count was 521/mm3 (IQR[281-757]); only 29.6% had a VL measurement of whom 3.2% in virological suppression. APHIV were younger in Lomé (median age: 12 years (interquartile range [IQR]:11-15) compared to Abidjan (14 years (IQR:12-15, p=0.01). Full HIV-disclosure increased from 41.6% at inclusion to 74.1% after 24 months. After 24 months of follow-up, 6 (2.9%) died, 8 (3.8%) were lost to follow-up, 4 (1.9%) were transferred out. Overall, 73.7% did not progress to WHO-AIDS stage, 62.7% had CD4 count above (± 10%) of the baseline value (48.6% in Abidjan versus 69.0% in Lomé, p<0.001). Among the 83.7% with VL measurements, 48.8% were in virological suppression (Abidjan: 45.4%, Lomé: 52.5%, p<0.01). The 24-month combined outcome was favorable for 45% (29.6% in Abidjan and 61.4% in Lomé, p<0.01). Adjusted on sex, age, a 24-month favorable outcome was not associated with HIV-disclosure status but was significantly higher for APHIV living in Lomé compared to those living Abidjan (adjusted odds ratio =4.41, 95%CI:2.29-8.50). Conclusions: 24-month favorable outcome rates were low among West-African APHIV and differed accross countries. HIV-disclosure frequency improved over time but remained low. Context-specific responses are urgently needed to improve adolescent’s care to reach the UNAIDS 90% target of virological success for those on ART.

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“…Treatment failure is common among HIV patients 7,8 . Poor adherence was strongly associated with virological failure among patients on ART 9,10 . HIV/AIDS patients should have an adherence level of at least 95% as a requirement for optimizing ART and maximizing virological suppression 11 …”

Section: Introductionmentioning

confidence: 99%

An assessment of HIV patient's adherence to treatment and need for pharmaceutical care in Jordan

et al. 2020

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Objective The objective of the present study was to explore the barriers and supporting factors for adherence among HIV patients and to explore their needs for pharmaceutical care services. Methods This study utilizes in‐depth interviews with HIV patients. Out of 50 patients approached, a total of 30 patients agreed to participate in the study. The researchers used a predesigned topic guide. The interview guide included two parts; the first one focused on the assessment of HIV patients' adherence to their treatment. The second part focused on patients' need for pharmaceutical care services. Results Three main themes emerged from the interviews. Those included patient‐related factors, medication‐related factors and Healthcare professional related factors. This study found that a number of barriers that decreased adherence in HIV patients included stigmatisation, fear from disclosure, dosage form of the drug, adverse events and poor cooperation from healthcare professionals. On the other side supporting factors included family and friends support, electronic mobile reminders, feeling responsible to raising children, religious beliefs and feeling improvement while using therapy. Furthermore, the study illustrated that HIV patients need to have a specialist pharmacist in their healthcare team who delivers specialised pharmaceutical care services which may increase patients' adherence. Conclusions The current study reveals a margin for medication adherence improvement in HIV patients. Patients in this study demonstrated the need for a pharmaceutical care. Future disease management and clinical pharmacy services programs should address the current study findings in order to improve the health service for HIV patients.

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Virological failure among adolescents on ART, Harare City, 2017- a case-control study

Cited by 65 publications

References 16 publications

24-month clinical, immune-virological outcomes and HIV status disclosure in adolescents living with perinatally-acquired HIV in the COHADO cohort, in Togo and Côte d’Ivoire, 2015-2017

24-month clinical, immune-virological outcomes and HIV status disclosure in adolescents living with perinatally-acquired HIV in the COHADO cohort, in Togo and Côte d’Ivoire, 2015-2017

24-month clinical, immuno-virological outcomes and HIV status disclosure in adolescents living with perinatally-acquired HIV in the COHADO cohort, in Togo and Côte d’Ivoire, 2015-2017

An assessment of HIV patient's adherence to treatment and need for pharmaceutical care in Jordan

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