Browsing by Author "Kariminia A"

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Access to antiretroviral therapy in HIV-infected children aged 0-19 years in the International Epidemiology Databases to Evaluate AIDS (IeDEA) Global Cohort Consortium, 2004-2015: A prospective cohort study.
(2018-May) Desmonde S; Tanser F; Vreeman R; Takassi E; Edmonds A; Lumbiganon P; Pinto J; Malateste K; McGowan C; Kariminia A; Yotebieng M; Dicko F; Yiannoutsos C; Mubiana-Mbewe M; Wools-Kaloustian K; Davies MA; Leroy V; School of Medicine, Universide Federal de Minas Gerais, Belo Horizonte, Brazil.; CHU Sylvanus Olympio, Lomé, Togo.; Division of Epidemiology, College of Public Health, Ohio State University, Columbus, Ohio, United States of America.; Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, United States of America.; School of Medicine, Indiana University, Indianapolis, Indiana, United States of America.; Hopital Gabriel Touré, Bamako, Mali.; Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.; Bordeaux School of Public Health, University of Bordeaux, Bordeaux, France.; Khon Kaen University, Khon Kaen, Thailand.; Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America.; Inserm U1027, Toulouse III University, Toulouse, France.; Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, South Africa.; Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.; Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; Inserm U1219, University of Bordeaux, Bordeaux, France.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
INTRODUCTION: Access to antiretroviral therapy (ART) is a global priority. However, the attrition across the continuum of care for HIV-infected children between their HIV diagnosis and ART initiation is not well known. We analyzed the time from enrollment into HIV care to ART initiation in HIV-infected children within the International Epidemiology Databases to Evaluate AIDS (IeDEA) Global Cohort Consortium. METHODS AND FINDINGS: We included 135,479 HIV-1-infected children, aged 0-19 years and ART-naïve at enrollment, between 1 January 2004 and 31 December 2015, in IeDEA cohorts from Central Africa (3 countries; n = 4,948), East Africa (3 countries; n = 22,827), West Africa (7 countries; n = 7,372), Southern Africa (6 countries; n = 93,799), Asia-Pacific (6 countries; n = 4,045), and Latin America (7 countries; n = 2,488). Follow-up in these cohorts is typically every 3-6 months. We described time to ART initiation and missed opportunities (death or loss to follow-up [LTFU]: last clinical visit >6 months) since baseline (the date of HIV diagnosis or, if unavailable, date of enrollment). Cumulative incidence functions (CIFs) for and determinants of ART initiation were computed, with death and LTFU as competing risks. Among the 135,479 children included, 99,404 (73.4%) initiated ART, 1.9% died, 1.4% were transferred out, and 20.4% were lost to follow-up before ART initiation. The 24-month CIF for ART initiation was 68.2% (95% CI: 67.9%-68.4%); it was lower in sub-Saharan Africa-ranging from 49.8% (95% CI: 48.4%-51.2%) in Central Africa to 72.5% (95% CI: 71.5%-73.5%) in West Africa-compared to Latin America (71.0%, 95% CI: 69.1%-72.7%) and the Asia-Pacific (78.3%, 95% CI: 76.9%-79.6%). Adolescents aged 15-19 years and infants <1 year had the lowest cumulative incidence of ART initiation compared to other ages: 62.2% (95% CI: 61.6%-62.8%) and 66.4% (95% CI: 65.7%-67.0%), respectively. Overall, 49.1% were ART-eligible per local guidelines at baseline, of whom 80.6% initiated ART. The following children had lower cumulative incidence of ART initiation: female children (p < 0.01); those aged <1 year, 2-4 years, 5-9 years, and 15-19 years (versus those aged 10-14 years, p < 0.01); those who became eligible during follow-up (versus eligible at enrollment, p < 0.01); and those receiving care in low-income or lower-middle-income countries (p < 0.01). The main limitations of our study include left truncation and survivor bias, caused by deaths of children prior to enrollment, and use of enrollment date as a proxy for missing data on date of HIV diagnosis, which could have led to underestimation of the time between HIV diagnosis and ART initiation. CONCLUSIONS: In this study, 68% of HIV-infected children initiated ART by 24 months. However, there was a substantial risk of LTFU before ART initiation, which may also represent undocumented mortality. In 2015, many obstacles to ART initiation remained, with substantial inequities. More effective and targeted interventions to improve access are needed to reach the target of treating 90% of HIV-infected children with ART.
Growth and CD4 patterns of adolescents living with perinatally acquired HIV worldwide, a CIPHER cohort collaboration analysis.
(2022-Mar) Jesson J; Crichton S; Quartagno M; Yotebieng M; Abrams EJ; Chokephaibulkit K; Le Coeur S; Aké-Assi MH; Patel K; Pinto J; Paul M; Vreeman R; Davies MA; Ben-Farhat J; Van Dyke R; Judd A; Mofenson L; Vicari M; Seage G; Bekker LG; Essajee S; Gibb D; Penazzato M; Collins IJ; Wools-Kaloustian K; Slogrove A; Powis K; Williams P; Matshaba M; Thahane L; Nyasulu P; Lukhele B; Mwita L; Kekitiinwa-Rukyalekere A; Wanless S; Goetghebuer T; Thorne C; Warszawski J; Galli L; van Rossum AMC; Giaquinto C; Marczynska M; Marques L; Prata F; Ene L; Okhonskaya L; Navarro M; Frick A; Naver L; Kahlert C; Volokha A; Chappell E; Pape JW; Rouzier V; Marcelin A; Succi R; Sohn AH; Kariminia A; Edmonds A; Lelo P; Lyamuya R; Ogalo EA; Odhiambo FA; Haas AD; Bolton C; Muhairwe J; Tweya H; Sylla M; D'Almeida M; Renner L; Abzug MJ; Oleske J; Purswani M; Teasdale C; Nuwagaba-Biribonwoha H; Goodall R; Leroy V; Medical University of Warsaw, Hospital of Infectious Diseases in Warsaw, Warsaw, Poland.; TREAT Asia/amfAR, Bangkok, Thailand.; Baylor College of Medicine Children's Foundation, Mwanza, Tanzania.; Hospital St Pierre, Brussels, Belgium.; Inserm U1018, Centre de recherche en Epidémiologie et Santé des Populations, Paris, France.; Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA.; Moi Teaching and Referral Hospital, Eldoret, Kenya.; Hospital General Universitario "Gregorio Marañón", Madrid, Spain.; HIV Department, World Health Organization, Geneva, Switzerland.; Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, USA.; Padova University/PENTA Foundation, Padua, Italy.; School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.; Baylor College of Medicine Children's Foundation, Maseru, Lesotho.; Baylor College of Medicine Children's Foundation, Lilongwe, Botswana.; Baylor College of Medicine Children's Foundation, Kampala, Uganda.; Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.; Department of Global Health, Icahn School of Medicine at Mount Sinai, New York, USA.; International AIDS Society, Geneva, Switzerland.; Epicentre, Médecins Sans Frontières, Paris, France.; Baylor College of Medicine Children's Foundation, Lilongwe, Malawi.; Hospital de Santa Maria, Lisboa, Portugal.; Institut National d'Etude Demographique (INED), Mortality, Health and Epidemiology Unit, Paris, France.; Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa.; Centro Hospitalar do Porto, Porto, Portugal.; Indiana University School of Medicine, Indianapolis, Indiana, USA.; Korle Bu Teaching Hospital, Accra, Ghana.; UCL Great Ormond Street Institute of Child Health, University College London, London, UK.; Morogoro Regional Hospital, Morogoro, Tanzania.; Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya.; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.; Department of Health Sciences, University of Florence, Florence, Italy.; Baylor International Pediatric AIDS Initiative, Texas Children's Hospital-USA, Houston, Texas, USA.; Victor Babes Hospital, Bucharest, Romania.; MRC Clinical Trials Unit, University College London, London, UK.; Children's Hospital of Eastern Switzerland, Saint Gallen, Switzerland.; University Hospital Yopougon, Abidjan, Côte d'Ivoire.; Erasmus MC University Medical Center Rotterdam-Sophia Children's Hospital, Rotterdam, The Netherlands.; Department of Paediatrics & Child Health, Faculty of Medicine & Health Sciences, Stellenbosch University, Worcester, South Africa.; Lighthouse Trust Clinic, Lilongwe, Malawi.; Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.; Rutgers - New Jersey Medical School, Newark, New Jersey, USA.; Institut de Recherche pour le Developpement (IRD), UMI-174/PHPT, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand.; Siriraj Institute of Clinical Research, Faculty of Medicine Siriraj Hospital, Mahidol University, Salaya, Thailand.; Baylor College of Medicine Children's Foundation, Mbabane, eSwatini.; SolidarMed, Lesotho, Zimbabwe.; CHU Gabriel Toure, Bamako, Mali.; Centre National Hospitalier Universitaire Hubert K. Maga, Cotonou, Benin.; Bronx-Lebanon Hospital Center, Bronx, New York, USA.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden.; Tulane University Health Sciences Center, New Orleans, Louisiana, USA.; University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado, USA.; GHESKIO Center, Port-au-Prince, Haiti.; Republican Hospital of Infectious Diseases, St Petersburg, Russian Federation.; Department of Pediatrics, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.; UNICEF, New York, USA.; CERPOP, Inserm, Université Paul Sabatier Toulouse 3, Toulouse, France.; Universidade Federal de Sao Paulo, Sao Paulo, Brazil.; Infection Disease Unit, Meyer Children's University Hospital, Florence, Italy.; Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA.; Pediatric Hospital Kalembe Lembe, Lingwala, Demogratic Republic of Congo.; Shupyk National Medical Academy of Postgraduate Education, Kiev, Ukraine.; ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, USA.; Hospital Universitari Vall d' Hebron, Vall d' Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
INTRODUCTION: Adolescents living with HIV are subject to multiple co-morbidities, including growth retardation and immunodeficiency. We describe growth and CD4 evolution during adolescence using data from the Collaborative Initiative for Paediatric HIV Education and Research (CIPHER) global project. METHODS: Data were collected between 1994 and 2015 from 11 CIPHER networks worldwide. Adolescents with perinatally acquired HIV infection (APH) who initiated antiretroviral therapy (ART) before age 10 years, with at least one height or CD4 count measurement while aged 10-17 years, were included. Growth was measured using height-for-age Z-scores (HAZ, stunting if <-2 SD, WHO growth charts). Linear mixed-effects models were used to study the evolution of each outcome between ages 10 and 17. For growth, sex-specific models with fractional polynomials were used to model non-linear relationships for age at ART initiation, HAZ at age 10 and time, defined as current age from 10 to 17 years of age. RESULTS: A total of 20,939 and 19,557 APH were included for the growth and CD4 analyses, respectively. Half were females, two-thirds lived in East and Southern Africa, and median age at ART initiation ranged from <3 years in North America and Europe to >7 years in sub-Saharan African regions. At age 10, stunting ranged from 6% in North America and Europe to 39% in the Asia-Pacific; 19% overall had CD4 counts <500 cells/mm CONCLUSIONS: Growth patterns during adolescence differed substantially by sex and region, while CD4 patterns were similar, with an observed CD4 decline that needs further investigation. Early diagnosis and timely initiation of treatment in early childhood to prevent growth retardation and immunodeficiency are critical to improving APH growth and CD4 outcomes by the time they reach adulthood.
Stunting and growth velocity of adolescents with perinatally acquired HIV: differential evolution for males and females. A multiregional analysis from the IeDEA global paediatric collaboration.
(2019-Nov) Jesson J; Schomaker M; Malasteste K; Wati DK; Kariminia A; Sylla M; Kouadio K; Sawry S; Mubiana-Mbewe M; Ayaya S; Vreeman R; McGowan CC; Yotebieng M; Leroy V; Davies MA; Vanderbilt University School of Medicine, Nashville, TN, USA.; Harriet Shezi Children's Clinic, Chris Hani Baragwanath Academic Hospital, Soweto, South Africa.; Faculty of Health Scences, Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa.; Sanglah Hospital, Bali, Indonesia.; The Kirby Institute, UNSW, Sydney, Australia.; Hopital Gabriel Touré, Bamako, Mali.; Department of Child Health and Paediatrics, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya.; Inserm U1027, Université Paul Sabatier Toulouse 3, Toulouse, France.; University of Cape Town, Centre for Infectious Disease Epidemiology and Research, Cape Town, South Africa.; Inserm U1219, Bordeaux Population Health Center, Université de Bordeaux, Bordeaux, France.; Medical Informatics and Technology, Institute of Public Health, UMIT - University for Health Sciences, Medical Decision Making and Health Technology Assessment, Hall in Tirol, Austria.; Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.; Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; CIRBA, Abidjan, Côte d'Ivoire.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
INTRODUCTION: Stunting is a key issue for adolescents with perinatally acquired HIV (APH) that needs to be better understood. As part of the IeDEA multiregional consortium, we described growth evolution during adolescence for APH on antiretroviral therapy (ART). METHODS: We included data from sub-Saharan Africa, the Asia-Pacific, and the Caribbean, Central and South America regions collected between 2003 and 2016. Adolescents on ART, reporting perinatally acquired infection or entering HIV care before 10 years of age, with at least one height measurement between 10 and 16 years of age, and followed in care until at least 14 years of age were included. Characteristics at ART initiation and at 10 years of age were compared by sex. Correlates of growth defined by height-for-age z-scores (HAZ) between ages 10 and 19 years were studied separately for males and females, using linear mixed models. RESULTS: Overall, 8737 APH were included, with 46% from Southern Africa. Median age at ART initiation was 8.1 years (interquartile range (IQR) 6.1 to 9.6), 50% were females, and 41% were stunted (HAZ<-2 SD) at ART initiation. Males and females did not differ by age and stunting at ART initiation, CD4 count over time or retention in care. At 10 years of age, 34% of males were stunted versus 39% of females (p < 0.001). Females had better subsequent growth, resulting in a higher prevalence of stunting for males compared to females by age 15 (48% vs. 25%) and 18 years (31% vs. 15%). In linear mixed models, older age at ART initiation and low CD4 count were associated with poor growth over time (p < 0.001). Those stunted at 10 years of age or at ART initiation had the greatest growth improvement during adolescence. CONCLUSIONS: Prevalence of stunting is high among APH worldwide. Substantial sex-based differences in growth evolution during adolescence were observed in this global cohort, which were not explained by differences in age of access to HIV care, degree of immunosuppression or region. Other factors influencing growth differences in APH, such as differences in pubertal development, should be better documented, to guide further research and inform interventions to optimize growth and health outcomes among APH.
Temporal Trends in Co-trimoxazole Use Among Children on Antiretroviral Therapy and the Impact of Co-trimoxazole on Mortality Rates in Children Without Severe Immunodeficiency.
(2019-Nov-06) Boettiger DC; Law MG; Sohn AH; Davies MA; Wools-Kaloustian K; Leroy V; Yotebieng M; Vinikoor M; Vreeman R; Amorissani-Folquet M; Edmonds A; Fatti G; Batte J; Renner L; Adedimeji A; Kariminia A; Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa.; Department of Paediatrics, Korlebu Hospital, Accra, Ghana.; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York.; TREAT Asia/amfAR-Foundation for AIDS Research, Bangkok, Thailand.; Centre for Infectious Disease Research in Zambia, Lusaka.; Department of Medicine, University of North Carolina at Chapel Hill.; INSERM, Laboratoire d'Epidémiologie et Analyses en Santé Publique (LEASP)-UMR 1027, Toulouse, France.; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill.; Indiana University School of Medicine, Indianapolis.; The Kirby Institute, University of New South Wales, Sydney, Australia.; Department of Paediatrics, University Hospital of Cocody, Abidjan, Côte d'Ivoire.; Kheth'Impilo AIDS Free Living, Cape Town, South Africa.; Rakai Health Science Program, Uganda.; Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, South Africa.; College of Public Health, The Ohio State University, Columbus.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
BACKGROUND: Co-trimoxazole is recommended for all children with human immunodeficiency virus. In this analysis, we evaluate trends in pediatric co-trimoxazole use and survival on co-trimoxazole in children using antiretroviral therapy (ART). METHODS: We used data collected between January 1, 2006, and March 31, 2016, from the International Epidemiology Databases to Evaluate AIDS. Logistic regression was used to evaluate factors associated with using co-trimoxazole at ART initiation. Competing risk regression was used to assess factors associated with death. RESULTS: A total of 54113 children were included in this study. The prevalence of co-trimoxazole use at ART initiation increased from 66.5% in 2006 to a peak of 85.6% in 2010 and then declined to 48.5% in 2015-2016. A similar trend was observed among children who started ART with severe immunodeficiency. After adjusting for year of ART initiation, younger age (odds ratio [OR], 1.18 for <1 vs 1 to <5 years of age [95% confidence interval (CI), 1.09-1.28]), lower height-for-age z score (OR, 1.15 for less than -3 vs greater than -2 [95% CI, 1.08-1.22]), anemia (OR, 1.08 [95% CI, 1.02-1.15]), severe immunodeficiency (OR, 1.25 [95% CI, 1.18-1.32]), and receiving care in East Africa (OR, 8.97 vs Southern Africa [95% CI, 8.17-9.85]) were associated with a high prevalence of co-trimoxazole use. Survival did not differ according to co-trimoxazole use in children without severe immunodeficiency (hazard ratio, 1.01 for nonusers versus users [95% CI, 0.77-1.34]). CONCLUSIONS: Recent declines in co-trimoxazole use may not be linked to the current shift toward early ART initiation. Randomized trial data might be needed to establish the survival benefit of co-trimoxazole in children without severe immunodeficiency.
The epidemiology of adolescents living with perinatally acquired HIV: A cross-region global cohort analysis.
(2018-Mar) Slogrove AL; Schomaker M; Davies MA; Williams P; Balkan S; Ben-Farhat J; Calles N; Chokephaibulkit K; Duff C; Eboua TF; Kekitiinwa-Rukyalekere A; Maxwell N; Pinto J; Seage G; Teasdale CA; Wanless S; Warszawski J; Wools-Kaloustian K; Yotebieng M; Timmerman V; Collins IJ; Goodall R; Smith C; Patel K; Paul M; Gibb D; Vreeman R; Abrams EJ; Hazra R; Van Dyke R; Bekker LG; Mofenson L; Vicari M; Essajee S; Penazzato M; Anabwani G; Q Mohapi E; N Kazembe P; Hlatshwayo M; Lumumba M; Goetghebuer T; Thorne C; Galli L; van Rossum A; Giaquinto C; Marczynska M; Marques L; Prata F; Ene L; Okhonskaia L; Rojo P; Fortuny C; Naver L; Rudin C; Le Coeur S; Volokha A; Rouzier V; Succi R; Sohn A; Kariminia A; Edmonds A; Lelo P; Ayaya S; Ongwen P; Jefferys LF; Phiri S; Mubiana-Mbewe M; Sawry S; Renner L; Sylla M; Abzug MJ; Levin M; Oleske J; Chernoff M; Traite S; Purswani M; Chadwick EG; Judd A; Leroy V; Baylor International Pediatric AIDS Initiative, Mbabane, Swaziland.; Medical University of Warsaw, Hospital of Infectious Diseases in Warsaw, Warsaw, Poland.; Institut National d'Etudes Démograhiques (Ined), F-75020 Paris, France.; TREAT Asia/amfAR, Bangkok, Thailand.; Baylor International Pediatric AIDS Initiative, Lilongwe, Malawi.; CHU Gabriel Touré, Bamako, Mali.; Bronx-Lebanon Hospital Center (Icahn School of Medicine at Mount Sinai), Bronx, New York, United States of America.; Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America.; Baylor International Pediatric AIDS Initiative, Maseru, Lesotho.; Harriet Shezi Children's Clinic, Chris Hani Baragwanath Hospital, Johannesburg, South Africa.; Baylor International Pediatric AIDS Initiative, Texas Children's Hospital-USA, Houston, Texas, United States of America.; Feinberg School of Medicine, Northwestern University, Evanston, Illinois, United States of America.; SolidarMed Lesotho, Mozambique and Zimbabwe, Lucerne, Switzerland.; Hospital Doce de Octubre, Madrid, Spain.; Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.; MRC Clinical Trials Unit at University College London, London, United Kingdom.; Inserm (French Institute of Health and Medical Research), UMR 1027 Université Toulouse 3, Toulouse, France.; Yopougon University Hospital, University Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire.; Indiana University School of Medicine, Indianapolis, Indiana, United States of America.; Baylor International Pediatric AIDS Initiative, Gaborone, Botswana.; Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.; International AIDS Society, Geneva, Switzerland.; Epicentre, Médecins Sans Frontières, Paris, France.; Universidade Federal de São Paulo, São Paulo, Brazil.; Centro Hospitalar do Porto, Porto, Portugal.; Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa.; Pediatric Hospital Kalembe Lembe, Lingwala, Kinshasa, Democratic Republic of Congo.; ICAP at Columbia University Mailman School of Public Health, New York, New York, United States of America.; Karolinska University Hospital, Stockholm, Sweden.; Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.; Hospital St Pierre Cohort, Bruxelles, Belgium.; Center for Infectious Disease Research in Zambia, Lusaka, Zambia.; Institute of Child Health, University College London, London, United Kingdom.; Department of Health Sciences, University of Florence, Florence, Italy.; Victor Babes Hospital, Bucharest, Romania.; University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado, United States of America.; Kirby Institute, UNSW, Sydney, Australia.; UNICEF, New York, New York, United States of America.; Institut de Recherche pour le Développement (IRD) 174/PHPT, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand.; Rutgers New Jersey Medical School, Newark, New Jersey, United States of America.; Lighthouse Trust Clinic, Lilongwe, Malawi.; World Health Organization, Geneva, Switzerland.; College of Public Health, Ohio State University, Columbus, Ohio, United States of America.; Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain.; Center for Infectious Diseases Epidemiology and Research, University of Cape Town, Cape Town, South Africa.; University Children's Hospital, Basel, Switzerland.; Family AIDS Care and Education Services, Kenya Medical Research Institute, Kisumu, Kenya.; Inserm (French Institute of Health and Medical Research), CESP UMR Villejuif, France.; Tulane University, New Orleans, Louisiana, United States of America.; National Institute of Child Health and Human Development (NICHD), US National Institutes of Health, Rockville, Maryland, United States of America.; Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, United States of America.; GHESKIO Center, Port-au-Prince, Haiti.; Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.; School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.; Republican Hospital of Infectious Diseases, St Petersburg, Russian Federation.; Baylor International Pediatric AIDS Initiative, Mbeya, Tanzania.; University of Ghana School of Medicine and Dentistry, Accra, Ghana.; Erasmus MC University Medical Center Rotterdam-Sophia Children's Hospital, Rotterdam, the Netherlands.; Hospital de Santa Maria/CHLN, Lisbon, Portugal.; Shupyk National Medical Academy of Postgraduate Education, Kiev, Ukraine.; Baylor International Pediatric AIDS Initiative, Kampala, Uganda.; PENTA Foundation, Padova, Italy.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
BACKGROUND: Globally, the population of adolescents living with perinatally acquired HIV (APHs) continues to expand. In this study, we pooled data from observational pediatric HIV cohorts and cohort networks, allowing comparisons of adolescents with perinatally acquired HIV in "real-life" settings across multiple regions. We describe the geographic and temporal characteristics and mortality outcomes of APHs across multiple regions, including South America and the Caribbean, North America, Europe, sub-Saharan Africa, and South and Southeast Asia. METHODS AND FINDINGS: Through the Collaborative Initiative for Paediatric HIV Education and Research (CIPHER), individual retrospective longitudinal data from 12 cohort networks were pooled. All children infected with HIV who entered care before age 10 years, were not known to have horizontally acquired HIV, and were followed up beyond age 10 years were included in this analysis conducted from May 2016 to January 2017. Our primary analysis describes patient and treatment characteristics of APHs at key time points, including first HIV-associated clinic visit, antiretroviral therapy (ART) start, age 10 years, and last visit, and compares these characteristics by geographic region, country income group (CIG), and birth period. Our secondary analysis describes mortality, transfer out, and lost to follow-up (LTFU) as outcomes at age 15 years, using competing risk analysis. Among the 38,187 APHs included, 51% were female, 79% were from sub-Saharan Africa and 65% lived in low-income countries. APHs from 51 countries were included (Europe: 14 countries and 3,054 APHs; North America: 1 country and 1,032 APHs; South America and the Caribbean: 4 countries and 903 APHs; South and Southeast Asia: 7 countries and 2,902 APHs; sub-Saharan Africa, 25 countries and 30,296 APHs). Observation started as early as 1982 in Europe and 1996 in sub-Saharan Africa, and continued until at least 2014 in all regions. The median (interquartile range [IQR]) duration of adolescent follow-up was 3.1 (1.5-5.2) years for the total cohort and 6.4 (3.6-8.0) years in Europe, 3.7 (2.0-5.4) years in North America, 2.5 (1.2-4.4) years in South and Southeast Asia, 5.0 (2.7-7.5) years in South America and the Caribbean, and 2.1 (0.9-3.8) years in sub-Saharan Africa. Median (IQR) age at first visit differed substantially by region, ranging from 0.7 (0.3-2.1) years in North America to 7.1 (5.3-8.6) years in sub-Saharan Africa. The median age at ART start varied from 0.9 (0.4-2.6) years in North America to 7.9 (6.0-9.3) years in sub-Saharan Africa. The cumulative incidence estimates (95% confidence interval [CI]) at age 15 years for mortality, transfers out, and LTFU for all APHs were 2.6% (2.4%-2.8%), 15.6% (15.1%-16.0%), and 11.3% (10.9%-11.8%), respectively. Mortality was lowest in Europe (0.8% [0.5%-1.1%]) and highest in South America and the Caribbean (4.4% [3.1%-6.1%]). However, LTFU was lowest in South America and the Caribbean (4.8% [3.4%-6.7%]) and highest in sub-Saharan Africa (13.2% [12.6%-13.7%]). Study limitations include the high LTFU rate in sub-Saharan Africa, which could have affected the comparison of mortality across regions; inclusion of data only for APHs receiving ART from some countries; and unavailability of data from high-burden countries such as Nigeria. CONCLUSION: To our knowledge, our study represents the largest multiregional epidemiological analysis of APHs. Despite probable under-ascertained mortality, mortality in APHs remains substantially higher in sub-Saharan Africa, South and Southeast Asia, and South America and the Caribbean than in Europe. Collaborations such as CIPHER enable us to monitor current global temporal trends in outcomes over time to inform appropriate policy responses.
Tuberculosis diagnosis, treatment, and prevention services for children living with HIV in low- and middle-income countries: a multiregional site survey.
(2025-May-28) Laycock K; Technau KG; Lelo P; Jantarabenjakul W; Yonaba C; Pinto J; Menser M; Maruri F; Odhiambo F; Rambiki E; Babakazo P; Van Lam N; Folquet M; Machado DM; Kalema N; Muula G; Brazier E; Dinh Qui N; Dame J; Luque MT; Semeere A; Eley B; Yotebieng M; Kariminia A; Rouzier V; Byakwaga H; Marcy O; Enane LA; Lighthouse Clinic Trust, Lilongwe, Malawi.; The Kirby Institute, UNSW Sydney, Australia.; Kalembelembe Pediatric Hospital, Unit of Infectious Diseases, Kinshasa, Democratic Republic of Congo.; CHU Cocody, Service Pédiatrie, Abidjan, Côte d'Ivoire.; Center of Excellence for Pediatric Infectious Diseases and Vaccines, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.; Red Cross War Memorial Children's Hospital and the Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.; Pediatric Department, Centre Hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso.; Infectious Diseases Department, Children's Hospital 2, Ho Chi Minh City, Vietnam.; Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda.; Kinshasa School of Public Health, Democratic Republic of Congo.; Empilweni Services and Research Unit (ESRU), Rahima Moosa Mother and Child Hospital, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of The Witwatersrand, Johannesburg, South Africa.; University of Ghana Medical School and Korle Bu Teaching Hospital, Accra Ghana.; Center for Infectious Disease Research in Zambia, Lusaka, Zambia.; Instituto Hondureño de Seguridad Social, Tegucigalpa, Honduras.; Indiana University Department of Biostatistics and Health Data Science, Indianapolis, United States.; Indiana University Center for Global Health Equity, Indianapolis, United States.; The Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, United States.; Center for Tropical Diseases, Vietnam National Children's Hospital, Hanoi, Vietnam.; Federal University of Minas Gerais, Belo Horizonte, Brazil.; City University of New York, Institute for Implementation Science in Population Health, New York, United States.; Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, The Bronx, New York, United States.; Mbarara University of Science and Technology, Mbarara, Uganda.; Family AIDS Care and Education Services, Kenya Medical Research Institute, Kisumu, Kenya.; University of Bordeaux, Inserm U1219 Bordeaux Population Health, IRD EMR271 GHiGS, Bordeaux, France.; Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville, United States.; Les Centres GHESKIO, Port-au-Prince, Haiti.; Escola Paulista de Medicina - Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
BACKGROUND: Tuberculosis (TB) remains a leading cause of morbidity and mortality for children living with HIV (CLHIV), with gaps in TB screening, diagnostics, management, and TB preventive therapy (TPT). We investigated reported practices in these domains at sites caring for CLHIV in low- and middle-income countries (LMICs) within the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium. METHODS: We implemented a site survey during September 2020-February 2021, querying pre-pandemic practices. This analysis included sites in LMICs providing care for CLHIV that diagnosed TB in 2019. We analyzed responses using descriptive statistics and assessed regional differences using Fisher's exact or chi-square tests. RESULTS: Of 238 IeDEA sites, 227 (95%) responded and 135 met inclusion criteria. Most (90%) reported screening for TB at HIV care enrollment. Access to diagnostics varied significantly by region, including for nucleic acid amplification testing (NAAT, range 67-100%), mycobacterial culture (range 43-83%), and drug susceptibility testing (range 30-82%) (p<0.001). On-site TB treatment was high (90%). Reported stock-outs occurred for isoniazid (23/116, 20%) and other TB medications (11/114, 9.6%, range 0-33%, p=0.008). TPT provision ranged 50-100% (p<0.001). Six months of isoniazid was the most common TPT regimen for children (88%). Shorter TPT regimens were uncommon (0.9-2.8%), as were regimens for multidrug-resistant TB exposure (4.6%). CONCLUSIONS: Overall reported availability of NAAT and integrated TB/HIV treatment for CLHIV cared for at these IeDEA sites in LMICs is encouraging but varies by context. Heterogeneous implementation gaps remain-particularly for drug susceptibility testing, TPT delivery and TPT regimens-which successful outcomes for CLHIV, warranting continued close attention over time and as global TB care guidelines and services evolve.