Browsing by Author "Johnson L"

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    Effect of antiretroviral therapy care interruptions on mortality in children living with HIV.
    (2022-Apr-01) Davies C; Johnson L; Sawry S; Chimbetete C; Eley B; Vinikoor M; Technau KG; Ehmer J; Rabie H; Phiri S; Tanser F; Malisita K; Fatti G; Osler M; Wood R; Newton S; Haas A; Davies MA; Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University.; School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.; Queen Elizabeth Central Hospital, Blantyre, Malawi.; Red Cross War Memorial Children's Hospital and Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.; Lighthouse Trust Clinic, Kamuzu Central Hospital, Lilongwe, Malaysia.; Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.; Gugulethu HIV Programme and Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa.; Department of Paediatrics and Child Health, Tygerberg Academic Hospital, University of Stellenbosch, Stellenbosch, South Africa.; Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, South Africa.; Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town.; Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Harriet Shezi Children's Clinic, Chris Hani Baragwanath Academic Hospital, Soweto, South Africa.; SolidarMed, Lucerne, Switzerland.; Kheth'Impilo AIDS Free Living.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; Institute of Social and Preventive Medicine, University of Bern, Switzerland.; Newlands Clinic, Harare, Zimbabwe.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
    OBJECTIVE: To evaluate the characteristics and outcomes of HIV-infected children that have care interruptions, during which the child's health status and use of medication is unknown. DESIGN: We included data on children initiating ART between 2004 and 2016 at less than 16 years old at 16 International Epidemiologic Databases to Evaluate AIDS Southern Africa cohorts. Children were classified as loss to follow up (LTFU) if they had not attended clinic for more than 180 days. Children had a care interruption if they were classified as LTFU, and subsequently returned to care. Children who died within 180 days of ART start were excluded. METHODS: The main outcome was all cause mortality. Two exposed groups were considered: those with a first care interruption within the first 6 months on ART, and those with a first care interruption after 6 months on ART. Adjusted hazard ratios were determined using a Cox regression model. RESULTS: Among 53 674 children included, 23 437 (44%) had a care interruption, of which 10 629 (20%) had a first care interruption within 6 months on ART and 12 808 (24%) had a first care interruption after 6 months on ART. Increased mortality was associated with a care interruption within 6 months on ART [adjusted hazard ratio (AHR) = 1.52, 95% CI 1.12-2.04] but not with a care interruption after 6 months on ART (AHR = 1.05, 95% CI 0.77-1.44). CONCLUSION: The findings suggest that strengthening retention of children in care in the early period after ART initiation is critical to improving paediatric ART outcomes.
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    Global trends in CD4 count measurement and distribution at first antiretroviral treatment initiation.
    (2024-Nov-06) de Waal R; Wools-Kaloustian K; Brazier E; Althoff KN; Jaquet A; Duda SN; Kumarasamy N; Savory T; Byakwaga H; Murenzi G; Justice A; Ekouevi DK; Cesar C; Pasayan MKU; Thawani A; Kasozi C; Babakazo P; Karris M; Messou E; Cortes CP; Kunzekwenyika C; Choi JY; Owarwo NC; Niyongabo A; Marconi VC; Ezechi O; Castilho JL; Petoumenos K; Johnson L; Ford N; Kassanjee R; Department of Medicine, Indiana University School of Medicine, USA.; Masaka Regional Referral Hospital, Masaka City, Uganda.; Department of Biomedical Informatics, Vanderbilt University Medical Center, USA.; Department of Medicine, University of California San Diego, USA.; VA Connecticut Healthcare System, Yale Schools of Medicine and Public Health, Yale University, USA.; Lighthouse Trust, Lilongwe, Malawi.; Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland.; Centre for Infectious Disease Epidemiology and Research, School of Public Health, University of Cape Town, South Africa. CIDER, Level 3 Falmouth Building, Anzio Road, Observatory, 7925, South Africa.; Fundacion Huesped, Argentina.; Centre de Prise en charge, de Recherche et de Formation (CePReF) Yopougon-Attié, Abidjan, Côte d'Ivoire.; Association Nationale de Soutien aux Séropositifs et malades du SIDA-Santé PLUS (ANSS-Santé PLUS), Burundi.; Institute for Implementation Science in Population Health, City University of New York, USA.; Department of Community Health, Mbarara University of Science and Technology, Uganda.; Université de Lomé, Centre de Formation et de Recherche en Santé Publique, Lomé, Togo.; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, USA.; Research Institute for Tropical Medicine, Muntinlupa City, Philippines.; Infectious Diseases Institute, Makerere University, Uganda.; Emory University School of Medicine and Rollins School of Public Health, Atlanta, USA.; Division of Infectious Diseases, Vanderbilt University Medical Center, TN, USA.; The Kirby Institute, University of New South Wales, Sydney, Australia.; National Institute for Health and Medical Research UMR 1219, Research Institute for Sustainable Development EMR 271, Bordeaux Population Health Research Centre, University of Bordeaux, France.; Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea.; SolidarMed  Zimbabwe.; Centre for Reproduction and Population Health Studies, Nigerian Institute for Medical Research, Lagos, Nigeria.; Kinshasa School of Public Health, University of Kinshasa, Democratic Republic of Congo.; Research for Development (RD Rwanda), and Rwanda Military Referral and Teaching Hospital, Kigali, Rwanda.; Department of Internal Medicine, Faculty of Medicine, University of Chile, and Hospital Clínico San Borja Arriarán & Fundación Arriarán, Santiago, Chile.; Infectious Diseases Medical Centre, CART CRS, Voluntary Health Services, Chennai, India.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
    BACKGROUND: While people with HIV (PWH) start antiretroviral treatment (ART) regardless of CD4 count, CD4 measurement remains crucial for detecting advanced HIV disease and evaluating ART programmes. We explored CD4 measurement (proportion of PWH with a CD4 result available) and prevalence of CD4 <200 cells/µL at ART initiation within the International epidemiology Databases to Evaluate AIDS (IeDEA) global collaboration. METHODS: We included PWH at participating ART programmes who first initiated ART at age 15-80 years during 2005-2019. We described proportions of PWH (i) with CD4 (measured within 6 months before to 2 weeks after ART initiation); and (ii) among those with a CD4, with CD4 <200; by year of ART initiation and region. RESULTS: We included 1,355,104 PWH from 42 countries in 7 regions; 63% were female. Median (interquartile range) age at ART initiation was 37 (31-44) in men and 32 (26-39) in women. CD4 measurement initially increased, or remained stable over time until around 2013, but then declined to low levels in some regions (Southern Africa, except South Africa: from 54 to 13%; East Africa 85 to 31%; Central Africa 72 to 20%; West Africa: 91 to 53%; and Latin America: 87 to 56%). Prevalence of CD4<200 declined over time in all regions, but plateaued after 2015 at ≥30%. CONCLUSIONS: CD4 measurement has declined sharply in recent years, especially in sub-Saharan Africa. Among those with a CD4, the prevalence of CD4 <200 remains concerningly high. Scaling up CD4 testing and securing adequate funding are urgent priorities.