Browsing by Author "Elul B"

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    Characterizing adolescent and youth-friendly HIV services: a cross-sectional assessment across 16 global sites.
    (2025-Apr) Embleton L; Sudjaritruk T; Machado DM; Chihota B; Musabyimana F; Jesson J; Apondi E; Puthanakit T; Luque MT; van Dongen NE; Murenzi G; Amorissani-Folquet M; Kwena Z; Perreras N; Rouzier V; Lyamuya R; Anderson K; Elul B; Leroy V; Enane LA; Martin R; Lancaster K; Parcesepe AM; Vreeman R; Empilweni Services and Research Unit, Department of Paediatrics and Child Health, Rahima Moosa Mother and Child Hospital, University of the Witwatersrand, Johannesburg, South Africa.; Department of Health, AIDS Research Group, Research Institute for Tropical Medicine, Manila, Philippines.; Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti.; The Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA.; Clinical and Molecular Epidemiology of Emerging and Re-emerging Infectious Diseases Cluster, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.; Pediatric Department, Centre Hospitalier Universitaire de Cocody, Abidjan, Côte d'Ivoire.; Research, Care and Treatment Programme, Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya.; Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.; Department of Implementation Science, Wake Forest University, School of Medicine, Winston-Salem, North Carolina, USA.; Mailman School of Public Health, Columbia University, New York, New York, USA.; University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.; Centre for Epidemiology and Research in POPulation Health (CERPOP), Inserm, Toulouse III University, Toulouse, France.; Moi Teaching and Referral Hospital, Eldoret, Kenya.; Einstein-Rwanda Research and Capacity Building Progam, Research for Development and Rwanda Military Hospital, Kigali, Rwanda.; Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.; Morogoro Regional Referral Hospital, Morogoro, Tanzania.; Arnhold Institute for Global Health, Department of Global Health and Health Systems Design, Icahn School of Medicine at Mount Sinai, New York, New York, USA.; Servicio de Infectología, Departamento de Pediatría, Hospital Escuela; Servicio de Infectología, Instituto Hondureño de Seguridad Social, Tegucigalpa, Honduras.; Pediatric Infectious Diseases Division, Department of Pediatrics, Escola Paulista de Medicina-Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.; Centre for Infectious Disease Epidemiology and Research, School of Public Health, University of Cape Town, Cape Town, South Africa.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
    INTRODUCTION: Adolescent and youth-friendly health services (AYFHS) have been promoted as a best practice for adolescents and young people living with HIV (AYLH). However, thorough descriptions of AYFHS for AYLH remain scarce. We sought to characterize adolescent-friendly HIV services in a global paediatric research consortium. METHODS: Cross-sectional data were collected from 16 global sites in the Adolescent and Young Adult Network of IeDEA (AYANI) of the International epidemiology Databases to Evaluate AIDS consortium between August 2020 and October 2022 using a standardized site assessment tool that collected data on clinic, patient and provider characteristics, differentiated care, and transition to adult services processes. Descriptive analyses characterized the health services available across the participating sites, using frequencies and proportions for categorical variables and medians and interquartile range for continuous variables. Data were analysed using RStudio. RESULTS: Overall, 13 of 16 sites (81%) reported having dedicated adolescent services, which most often consisted of dedicated clinic days (62%, n = 8/13), primarily offered on weekdays. Across all sites, nurses and counsellors delivered services to adolescents. Over half of all clinics (69%, n = 11/16) reported offering health education to adolescents to facilitate adolescent health literacy. Peer educators and navigators were involved in delivering services at 62% of sites, primarily in those with dedicated adolescent services (69%, n = 9/13). There was limited integration of sexual and reproductive health services into HIV clinics for adolescents. With 63% of clinics conducting pregnancy screening, 50% providing family planning methods and 38% providing cervical cancer screening. Under half of all HIV clinics screened for physical abuse or violence (44%, n = 7/16) and sexual abuse or rape (38%, n = 6/16). A low proportion of clinics screened for risk factors related to young key populations, including drug use (56%, n = 9/16), homelessness (38%, n = 6/16) young men having sex with men (31%, n = 5/16) and transactional sex (31%, n = 5/16). Mental health screening for concerns was variable. CONCLUSIONS: Findings suggest gaps in AYFHS for AYLH across the HIV clinics included in this analysis. There is a vital need to design health services for AYLH that are accessible, equitable, and effective and meet the global standards for delivering high-quality healthcare to adolescents.
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    Increased prevalence of pregnancy and comparative risk of program attrition among individuals starting HIV treatment in East Africa.
    (2018) Holmes CB; Yiannoutsos CT; Elul B; Bukusi E; Ssali J; Kambugu A; Musick BS; Cohen C; Williams C; Diero L; Padian N; Wools-Kaloustian KK; Masaka Regional Hospital, Masaka, Uganda.; National Institute of Allergies and Infectious Diseases, Bethesda, Maryland, United States of America.; Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya.; University of California San Francisco, San Francisco, California, United States of America.; University of California, Berkeley, California, United States of America.; Academic Model Providing Access to Health Care (AMPATH), Eldoret, Kenya.; Georgetown University School of Medicine, Washington, DC, United States of America.; Indiana University School of Medicine, Indianapolis, Indiana, United States of America.; Mailman School of Public Health, Columbia University, ICAP at Columbia University, New York, New York, United States of America.; Infectious Diseases Institute, Kampala, Uganda.; Indiana University R.M. Fairbanks School of Public Health, Indianapolis, Indiana, United States of America.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
    BACKGROUND: The World Health Organization now recommends initiating all pregnant women on life-long antiretroviral therapy (ART), yet there is limited information about the characteristics and program outcomes of pregnant women already on ART in Africa. Our hypothesis was that pregnant women comprised an increasing proportion of those starting ART, and that sub-groups of these women were at higher risk for program attrition. METHODS AND FINDINGS: We used the International Epidemiology Databases to Evaluate AIDS- East Africa (IeDEA-EA) to conduct a retrospective cohort study including HIV care and treatment programs in Kenya, Uganda, and Tanzania. The cohort consecutively included HIV-infected individuals 13 years or older starting ART 2004-2014. We examined trends over time in the proportion pregnant, their characteristics and program attrition rates compared to others initiating and already receiving ART. 156,474 HIV-infected individuals (67.0% women) started ART. The proportion of individuals starting ART who were pregnant women rose from 5.3% in 2004 to 12.2% in 2014. Mean CD4 cell counts at ART initiation, weighted for annual program size, increased from 2004 to 2014, led by non-pregnant women (annual increase 20 cells/mm3) and men (17 cells/mm3 annually), with lower rates of change in pregnant women (10 cells/mm3 per year) (p<0.0001). There was no significant difference in the cumulative incidence of program attrition at 6 months among pregnant women starting ART and non-pregnant women. However, healthy pregnant women starting ART (WHO stage 1/2) had a higher rate of attrition rate (9.6%), compared with healthy non-pregnant women (6.5%); in contrast among women with WHO stage 3/4 disease, pregnant women had lower attrition (8.4%) than non-pregnant women (14.4%). Among women who initiated ART when healthy and remained in care for six months, subsequent six-month attrition was slightly higher among pregnant women at ART start (3.5%) compared to those who were not pregnant (2.4%), (absolute difference 1.1%, 95% CI 0.7%-1.5%). CONCLUSIONS: Pregnant women comprise an increasing proportion of those initiating ART in Africa, and pregnant women starting ART while healthy are at higher risk for program attrition than non-pregnant women. As ART programs further expand access to healthier pregnant women, further studies are needed to better understand the drivers of loss among this high risk group of women to optimize retention.