Browsing by Author "Vreeman R"

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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; Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, South Africa.; Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, United States of America.; Inserm U1027, Toulouse III University, Toulouse, France.; Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.; Inserm U1219, University of Bordeaux, Bordeaux, France.; Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.; CHU Sylvanus Olympio, Lomé, Togo.; Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, 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.; School of Medicine, Universide Federal de Minas Gerais, Belo Horizonte, Brazil.; School of Medicine, Indiana University, Indianapolis, Indiana, United States of America.; Bordeaux School of Public Health, University of Bordeaux, Bordeaux, France.; Khon Kaen University, Khon Kaen, Thailand.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; Division of Epidemiology, College of Public Health, Ohio State University, Columbus, Ohio, United States of America.; 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.
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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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    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; Baylor College of Medicine Children's Foundation, Mbabane, eSwatini.; University Hospital Yopougon, Abidjan, Côte d'Ivoire.; Siriraj Institute of Clinical Research, Faculty of Medicine Siriraj Hospital, Mahidol University, Salaya, Thailand.; Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden.; Pediatric Hospital Kalembe Lembe, Lingwala, Demogratic Republic of Congo.; Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA.; Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.; Department of Pediatrics, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.; CHU Gabriel Toure, Bamako, Mali.; Hospital de Santa Maria, Lisboa, Portugal.; Hospital Universitari Vall d' Hebron, Vall d' Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain.; Baylor College of Medicine Children's Foundation, Kampala, Uganda.; Baylor International Pediatric AIDS Initiative, Texas Children's Hospital-USA, Houston, Texas, USA.; Hospital St Pierre, Brussels, Belgium.; Centro Hospitalar do Porto, Porto, Portugal.; Baylor College of Medicine Children's Foundation, Lilongwe, Botswana.; Republican Hospital of Infectious Diseases, St Petersburg, Russian Federation.; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.; MRC Clinical Trials Unit, University College London, London, UK.; Moi Teaching and Referral Hospital, Eldoret, Kenya.; Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA.; Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, USA.; Medical University of Warsaw, Hospital of Infectious Diseases in Warsaw, Warsaw, Poland.; Korle Bu Teaching Hospital, Accra, Ghana.; Institut de Recherche pour le Developpement (IRD), UMI-174/PHPT, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand.; Epicentre, Médecins Sans Frontières, Paris, France.; Tulane University Health Sciences Center, New Orleans, Louisiana, USA.; Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya.; Institut National d'Etude Demographique (INED), Mortality, Health and Epidemiology Unit, Paris, France.; Department of Health Sciences, University of Florence, Florence, Italy.; CERPOP, Inserm, Université Paul Sabatier Toulouse 3, Toulouse, France.; Lighthouse Trust Clinic, Lilongwe, Malawi.; Padova University/PENTA Foundation, Padua, Italy.; University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado, USA.; Children's Hospital of Eastern Switzerland, Saint Gallen, Switzerland.; Shupyk National Medical Academy of Postgraduate Education, Kiev, Ukraine.; TREAT Asia/amfAR, Bangkok, Thailand.; Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.; Morogoro Regional Hospital, Morogoro, Tanzania.; SolidarMed, Lesotho, Zimbabwe.; Department of Global Health, Icahn School of Medicine at Mount Sinai, New York, USA.; Baylor College of Medicine Children's Foundation, Mwanza, Tanzania.; Victor Babes Hospital, Bucharest, Romania.; Bronx-Lebanon Hospital Center, Bronx, New York, USA.; UNICEF, New York, USA.; Department of Paediatrics & Child Health, Faculty of Medicine & Health Sciences, Stellenbosch University, Worcester, South Africa.; Centre National Hospitalier Universitaire Hubert K. Maga, Cotonou, Benin.; International AIDS Society, Geneva, Switzerland.; School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.; Rutgers - New Jersey Medical School, Newark, New Jersey, USA.; Infection Disease Unit, Meyer Children's University Hospital, Florence, Italy.; Inserm U1018, Centre de recherche en Epidémiologie et Santé des Populations, Paris, France.; Erasmus MC University Medical Center Rotterdam-Sophia Children's Hospital, Rotterdam, The Netherlands.; Universidade Federal de Sao Paulo, Sao Paulo, Brazil.; Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa.; HIV Department, World Health Organization, Geneva, Switzerland.; GHESKIO Center, Port-au-Prince, Haiti.; UCL Great Ormond Street Institute of Child Health, University College London, London, UK.; Baylor College of Medicine Children's Foundation, Maseru, Lesotho.; ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, USA.; Indiana University School of Medicine, Indianapolis, Indiana, USA.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; Hospital General Universitario "Gregorio Marañón", Madrid, Spain.; Baylor College of Medicine Children's Foundation, Lilongwe, Malawi.; 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.
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    Impact of Universal Antiretroviral Treatment Eligibility on Rapid Treatment Initiation Among Young Adolescents with Human Immunodeficiency Virus in Sub-Saharan Africa.
    (2020-Aug-04) Tymejczyk O; Brazier E; Wools-Kaloustian K; Davies MA; Dilorenzo M; Edmonds A; Vreeman R; Bolton C; Twizere C; Okoko N; Phiri S; Nakigozi G; Lelo P; von Groote P; Sohn AH; Nash D; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.; Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA.; Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.; Kenya Medical Research Institute (KEMRI), Nairobi, Kenya.; Department of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.; Kalembelembe Pediatric Hospital, Kinshasa, Democratic Republic of the Congo.; TREAT Asia, amfAR-The Foundation for AIDS Research, Bangkok, Thailand.; Lighthouse Trust, Lilongwe, Malawi.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; Rakai Health Sciences Program, Kalisizo, Uganda.; Department of Epidemiology and Biostatistics, School of Public Health, City University of New York, New York, NY, USA.; Centre Hospitalo-Universitaire de Kamenge, Bujumbura, Burundi.; Indiana University School of Medicine, Indianapolis, Indiana, USA.; Boston Medical Center, Boston, Massachusetts, USA.; Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
    BACKGROUND: Young adolescents with perinatally acquired human immunodeficiency virus (HIV) are at risk for poor care outcomes. We examined whether universal antiretroviral treatment (ART) eligibility policies (Treat All) improved rapid ART initiation after care enrollment among 10-14-year-olds in 7 sub-Saharan African countries. METHODS: Regression discontinuity analysis and data for 6912 patients aged 10-14-years were used to estimate changes in rapid ART initiation (within 30 days of care enrollment) after adoption of Treat All policies in 2 groups of countries: Uganda and Zambia (policy adopted in 2013) and Burundi, Democratic Republic of the Congo, Kenya, Malawi, and Rwanda (policy adopted in 2016). RESULTS: There were immediate increases in rapid ART initiation among young adolescents after national adoption of Treat All. Increases were greater in countries adopting the policy in 2016 than in those adopting it in 2013: 23.4 percentage points (pp) (95% confidence interval, 13.9-32.8) versus 11.2pp (2.5-19.9). However, the rate of increase in rapid ART initiation among 10-14-year-olds rose appreciably in countries with earlier treatment expansions, from 1.5pp per year before Treat All to 7.7pp per year afterward. CONCLUSIONS: Universal ART eligibility has increased rapid treatment initiation among young adolescents enrolling in HIV care. Further research should assess their retention in care and viral suppression under Treat All.
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    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; Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA.; Department of Child Health and Paediatrics, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya.; Sanglah Hospital, Bali, Indonesia.; Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.; Vanderbilt University School of Medicine, Nashville, TN, USA.; The Kirby Institute, UNSW, Sydney, Australia.; University of Cape Town, Centre for Infectious Disease Epidemiology and Research, Cape Town, South Africa.; Hopital Gabriel Touré, Bamako, Mali.; 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.; CIRBA, Abidjan, Côte d'Ivoire.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; 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.; Inserm U1027, Université Paul Sabatier Toulouse 3, Toulouse, France.; 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.
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    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; INSERM, Laboratoire d'Epidémiologie et Analyses en Santé Publique (LEASP)-UMR 1027, Toulouse, France.; Department of Paediatrics, University Hospital of Cocody, Abidjan, Côte d'Ivoire.; Rakai Health Science Program, Uganda.; Department of Paediatrics, Korlebu Hospital, Accra, Ghana.; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York.; 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.; TREAT Asia/amfAR-Foundation for AIDS Research, Bangkok, Thailand.; Centre for Infectious Disease Research in Zambia, Lusaka.; Kheth'Impilo AIDS Free Living, Cape Town, South Africa.; Department of Medicine, University of North Carolina at Chapel Hill.; Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa.; 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.; 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.
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    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; Bronx-Lebanon Hospital Center (Icahn School of Medicine at Mount Sinai), Bronx, New York, United States of America.; National Institute of Child Health and Human Development (NICHD), US National Institutes of Health, Rockville, Maryland, United States of America.; Institute of Child Health, University College London, London, United Kingdom.; UNICEF, New York, New York, United States of America.; Inserm (French Institute of Health and Medical Research), CESP UMR Villejuif, France.; School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.; University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado, United States of America.; ICAP at Columbia University Mailman School of Public Health, New York, New York, United States of America.; Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America.; CHU Gabriel Touré, Bamako, Mali.; Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, United States of America.; Feinberg School of Medicine, Northwestern University, Evanston, Illinois, United States of America.; University Children's Hospital, Basel, Switzerland.; MRC Clinical Trials Unit at University College London, London, United Kingdom.; Centro Hospitalar do Porto, Porto, Portugal.; Republican Hospital of Infectious Diseases, St Petersburg, Russian Federation.; Rutgers New Jersey Medical School, Newark, New Jersey, United States of America.; Tulane University, New Orleans, Louisiana, United States of America.; Medical University of Warsaw, Hospital of Infectious Diseases in Warsaw, Warsaw, Poland.; Karolinska University Hospital, Stockholm, Sweden.; Yopougon University Hospital, University Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire.; Baylor International Pediatric AIDS Initiative, Kampala, Uganda.; Epicentre, Médecins Sans Frontières, Paris, France.; Indiana University School of Medicine, Indianapolis, Indiana, United States of America.; Center for Infectious Diseases Epidemiology and Research, University of Cape Town, Cape Town, South Africa.; College of Public Health, Ohio State University, Columbus, Ohio, United States of America.; Department of Health Sciences, University of Florence, Florence, Italy.; Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.; Lighthouse Trust Clinic, Lilongwe, Malawi.; World Health Organization, Geneva, Switzerland.; Inserm (French Institute of Health and Medical Research), UMR 1027 Université Toulouse 3, Toulouse, France.; Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.; Shupyk National Medical Academy of Postgraduate Education, Kiev, Ukraine.; TREAT Asia/amfAR, Bangkok, Thailand.; Baylor International Pediatric AIDS Initiative, Mbeya, Tanzania.; Hospital Doce de Octubre, Madrid, Spain.; Hospital de Santa Maria/CHLN, Lisbon, Portugal.; Baylor International Pediatric AIDS Initiative, Lilongwe, Malawi.; Baylor International Pediatric AIDS Initiative, Texas Children's Hospital-USA, Houston, Texas, United States of America.; Baylor International Pediatric AIDS Initiative, Mbabane, Swaziland.; Universidade Federal de São Paulo, São Paulo, Brazil.; Pediatric Hospital Kalembe Lembe, Lingwala, Kinshasa, Democratic Republic of Congo.; Family AIDS Care and Education Services, Kenya Medical Research Institute, Kisumu, Kenya.; Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.; International AIDS Society, Geneva, Switzerland.; Baylor International Pediatric AIDS Initiative, Maseru, Lesotho.; PENTA Foundation, Padova, Italy.; Center for Infectious Disease Research in Zambia, Lusaka, Zambia.; Hospital St Pierre Cohort, Bruxelles, Belgium.; Erasmus MC University Medical Center Rotterdam-Sophia Children's Hospital, Rotterdam, the Netherlands.; Institut National d'Etudes Démograhiques (Ined), F-75020 Paris, France.; Institut de Recherche pour le Développement (IRD) 174/PHPT, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand.; Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain.; SolidarMed Lesotho, Mozambique and Zimbabwe, Lucerne, Switzerland.; Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.; Harriet Shezi Children's Clinic, Chris Hani Baragwanath Hospital, Johannesburg, South Africa.; Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa.; GHESKIO Center, Port-au-Prince, Haiti.; Kirby Institute, UNSW, Sydney, Australia.; Victor Babes Hospital, Bucharest, Romania.; Baylor International Pediatric AIDS Initiative, Gaborone, Botswana.; University of Ghana School of Medicine and Dentistry, Accra, Ghana.; 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.
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    Variations in the characteristics and outcomes of children living with HIV following universal ART in sub-Saharan Africa (2006-17): a retrospective cohort study.
    (2021-Jun) Iyun V; Technau KG; Vinikoor M; Yotebieng M; Vreeman R; Abuogi L; Desmonde S; Edmonds A; Amorissani-Folquet M; Davies MA; University Hospital of Cocody, Abidjan, Côte d'Ivoire.; Department of Medicine, Division of General Internal Medicine, Albert Einstein College of Medicine, Bronx, NY, USA.; Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa; Health Impact Assessment, Western Cape Department of Health, Cape Town, South Africa.; Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.; Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa. Electronic address: toyiniyun@gmail.com.; Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA.; Empilweni Service and Research Centre, Rahima Moosa Mother and Child Hospital, University of Witwatersrand, Johannesburg, South Africa.; Department of Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; Inserm U1027, Université Paul Sabatier Toulouse 3, Toulouse, France.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
    BACKGROUND: The proportion of children living with HIV and receiving antiretroviral therapy (ART) in sub-Saharan Africa has increased greatly since 2006, yet the changes in their demographic characteristics and treatment outcomes have not been well described. We examine the trends in characteristics and outcomes of children living with HIV who were younger than 5 years at ART initiation, and compare outcomes over time and across country income groups. METHODS: We conducted a retrospective cohort analysis of data from children living with HIV who were younger than 5 years at ART initiation from 45 paediatric sites in 16 low-income, lower-middle-income, and upper-middle-income countries in sub-Saharan Africa (Benin, Burundi, Côte d'Ivoire, Democratic Republic of the Congo, Ghana, Kenya, Lesotho, Malawi, Mali, Mozambique, Rwanda, South Africa, Togo, Uganda, Zambia, and Zimbabwe). Outcomes were trends in patient characteristics at ART initiation (age, weight, height, and CD4%), and comparisons of mortality and loss to follow-up during ART over time and in various economic settings. We identified risk factors for mortality using Cox proportional hazards models. Each participating region had relevant institutional ethics review board approvals to contribute data to the analysis. FINDINGS: We included 32 221 children living with HIV and initiating ART younger than 5 years between Jan 1, 2006, and Dec 31, 2017. Median age at ART initiation was 20·4 months (IQR 9·4-36·0) in 2006-10, 19·2 months (8·3-33·6) in 2011-13, and 19·2 months (8·8-33·7) in 2014-17. Median age at ART initiation was 13·2 months (IQR 4·7-26·8) in upper-middle-income countries, 22·6 months (13·2-37·5) in lower-middle-income countries and 24·2 months (13·5-39·1) in low-income countries. The proportion of children initiating ART younger than 3 months increased from 770 (5·1%) of 14 943 children in 2006-10 to 728 (10·0%) of 7290 children in 2014-17. The proportion of children initiating ART with severe immunosuppression decreased from 5469 (74·7%) of 7314 children for whom CD4% data were available in 2006-10 to 2353 (55·2%) of 4269 children in 2014-17. Mortality at 24 months on ART decreased from 970 (6·5%) of 14 943 children in 2006-10 to 214 (2·9%) of 7290 children in 2014-17. Loss to follow-up was 20·5% (95% CI 20·1-21·0) overall, and was similar across time periods. In multivariable analysis, lower mortality was observed for more recent ART initiation cohorts (adjusted hazard ratio 0·70, 95% CI 0·63-0·79 for 2011-13; 0·53, 0·45-0·72 for 2014-17 vs 2006-10) and for those residing in an upper-middle-income country (0·42, 0·35-0·49 vs low-income countries). INTERPRETATION: Mortality declined significantly after universal ART recommendations for children younger than 2 years in 2010 and children younger than 5 years in 2013. However, substantial variations persisted across country income groups, and one in five children continue to be lost to follow-up. Targeted interventions are required to improve outcomes of children living with HIV, especially in the poorest countries. FUNDING: National Institute of Allergy and Infectious Disease.