Browsing by Author "Wools-Kaloustian K"

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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.
Authors' Reply: Early Initiation of Antiretroviral Therapy Among Young Children: A Long Way to Go.
(2015-Oct-01) Koller M; Patel K; Chi BH; Wools-Kaloustian K; Dicko F; Chokephaibulkit K; Chimbetete C; Hazra R; Ayaya S; Leroy V; Trong HK; Egger M; Davies MA; *Institute of Social & Preventive Medicine (ISPM), University of Bern, Switzerland †Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA ‡Centre for Infectious Disease Research in Zambia, Lusaka, Zambia §Department of Medicine, Indiana University School of Medicine, Indianapolis, IN ‖Department of Pediatrics, Gabriel Toure Hospital, Bamako, Mali ¶Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand #Newlands Clinic, Harare, Zimbabwe **Maternal and Pediatric Infectious Disease Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Bethesda, MD ††Department of Pediatrics, College of Health Sciences, Moi University, Kenya ‡‡INSERM, French National Institute for Health and Medical Research, U897, Bordeaux, France §§Children's Hospital 1, Ho Chi Minh City, Vietnam ‖‖School of Public Health and Family Medicine, University of Cape Town Faculty of Health Sciences, South Africa.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
Cervical cancer prevention and care in HIV clinics across sub-Saharan Africa: results of a facility-based survey.
(2024-Jul) Asangbeh-Kerman SL; Davidović M; Taghavi K; Dhokotera T; Manasyan A; Sharma A; Jaquet A; Musick B; Twizere C; Chimbetete C; Murenzi G; Tweya H; Muhairwe J; Wools-Kaloustian K; Technau KG; Anastos K; Yotebieng M; Jousse M; Ezechi O; Orang'o O; Bosomprah S; Pierre Boni S; Basu P; Bohlius J; Department of Biostatistics, School of Public Health, University of Ghana, Accra, Ghana.; SolidarMed, Partnerships for Health, Maseru, Lesotho.; Programme National de Lutte contre le Cancer (PNLCa), Abidjan, Côte d'Ivoire.; Department of Medicine and Epidemiology, Albert Einstein College of Medicine, Bronx, New York, USA.; Moi University, Eldoret, Kenya.; Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.; Programme PAC-CI, Site ANRS Treichville, Abidjan, Côte d'Ivoire.; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.; Newlands Clinic, Harare, Zimbabwe.; Department of Clinical Sciences, Nigerian Institute of Medical Research, Lagos, Nigeria.; Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA.; Department of Paediatrics and Child Health, Rahima Moosa Mother and Child Hospital, Johannesburg-Braamfontein, South Africa.; University of Basel, Basel, Switzerland.; Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.; Graduate School for Health Sciences, University of Bern, Bern, Switzerland.; Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France.; SolidarMed, Partnership for Health, Chiure, Mozambique.; Institute of Global Health, University of Geneva, Geneva, Switzerland.; Centre National de Reference en Matière de VIH/SIDA, Bujumbura, Burundi.; Division of Neonatology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA.; Einstein-Rwanda Research and Capacity Building Programme, Research for Development and Rwanda Military Hospital, Kigali, Rwanda.; Graduate School of Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland.; University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Centre, Bordeaux, France.; International Training and Education Centre for Health (I-TECH), Lilongwe, Malawi.; Swiss Tropical and Public Health Institute, Allschwil, Switzerland.; Department of Biostatistics and Health Data Science, School of Medicine, Indiana University, Indianapolis, Indiana, USA.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
INTRODUCTION: To eliminate cervical cancer (CC), access to and quality of prevention and care services must be monitored, particularly for women living with HIV (WLHIV). We assessed implementation practices in HIV clinics across sub-Saharan Africa (SSA) to identify gaps in the care cascade and used aggregated patient data to populate cascades for WLHIV attending HIV clinics. METHODS: Our facility-based survey was administered between November 2020 and July 2021 in 30 HIV clinics across SSA that participate in the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium. We performed a qualitative site-level assessment of CC prevention and care services and analysed data from routine care of WLHIV in SSA. RESULTS: Human papillomavirus (HPV) vaccination was offered in 33% of sites. Referral for CC diagnosis (42%) and treatment (70%) was common, but not free at about 50% of sites. Most sites had electronic health information systems (90%), but data to inform indicators to monitor global targets for CC elimination in WLHIV were not routinely collected in these sites. Data were collected routinely in only 36% of sites that offered HPV vaccination, 33% of sites that offered cervical screening and 20% of sites that offered pre-cancer and CC treatment. CONCLUSIONS: Though CC prevention and care services have long been available in some HIV clinics across SSA, patient and programme monitoring need to be improved. Countries should consider leveraging their existing health information systems and use monitoring tools provided by the World Health Organization to improve CC prevention programmes and access, and to track their progress towards the goal of eliminating CC.
Changes in rapid HIV treatment initiation after national "treat all" policy adoption in 6 sub-Saharan African countries: Regression discontinuity analysis.
(2019-Jun) Tymejczyk O; Brazier E; Yiannoutsos CT; Vinikoor M; van Lettow M; Nalugoda F; Urassa M; Sinayobye JD; Rebeiro PF; Wools-Kaloustian K; Davies MA; Zaniewski E; Anderegg N; Liu G; Ford N; Nash D; Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, United States of America.; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.; Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.; Global Hepatitis Programme, HIV/AIDS Department, World Health Organization, Geneva, Switzerland.; Department of Medicine, University of Alabama, Birmingham, Alabama, United States of America.; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.; Institute for Implementation Science in Population Health, City University of New York, New York, New York, United States of America.; Graduate School of Public Health and Health Policy, City University of New York, New York, New York, United States of America.; Rakai Health Sciences Program, Kalisizo and Entebbe, Uganda.; Rwanda Military Hospital, Kigali, Rwanda.; Dignitas International, Zomba, Malawi.; Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; Division of Infectious Diseases, Indiana University School of Medicine, Indianapolis, Indiana, United States of America.; Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
BACKGROUND: Most countries have formally adopted the World Health Organization's 2015 recommendation of universal HIV treatment ("treat all"). However, there are few rigorous assessments of the real-world impact of treat all policies on antiretroviral treatment (ART) uptake across different contexts. METHODS AND FINDINGS: We used longitudinal data for 814,603 patients enrolling in HIV care between 1 January 2004 and 10 July 2018 in 6 countries participating in the global International epidemiology Databases to Evaluate AIDS (IeDEA) consortium: Burundi (N = 11,176), Kenya (N = 179,941), Malawi (N = 84,558), Rwanda (N = 17,396), Uganda (N = 96,286), and Zambia (N = 425,246). Using a quasi-experimental regression discontinuity design, we assessed the change in the proportion initiating ART within 30 days of enrollment in HIV care (rapid ART initiation) after country-level adoption of the treat all policy. A modified Poisson model was used to identify factors associated with failure to initiate ART rapidly under treat all. In each of the 6 countries, over 60% of included patients were female, and median age at enrollment ranged from 32 to 36 years. In all countries studied, national adoption of treat all was associated with large increases in rapid ART initiation. Significant increases in rapid ART initiation immediately after treat all policy adoption were observed in Rwanda, from 44.4% to 78.9% of patients (34.5 percentage points [pp], 95% CI 27.2 to 41.7; p < 0.001), Kenya (25.7 pp, 95% CI 21.8 to 29.5; p < 0.001), Burundi (17.7 pp, 95% CI 6.5 to 28.9; p = 0.002), and Malawi (12.5 pp, 95% CI 7.5 to 17.5; p < 0.001), while no immediate increase was observed in Zambia (0.4 pp, 95% CI -2.9 to 3.8; p = 0.804) and Uganda (-4.2 pp, 95% CI -9.0 to 0.7; p = 0.090). The rate of rapid ART initiation accelerated sharply following treat all policy adoption in Malawi, Uganda, and Zambia; slowed in Kenya; and did not change in Rwanda and Burundi. In post hoc analyses restricted to patients enrolling under treat all, young adults (16-24 years) and men were at increased risk of not rapidly initiating ART (compared to older patients and women, respectively). However, rapid ART initiation following enrollment increased for all groups as more time elapsed since treat all policy adoption. Study limitations include incomplete data on potential ART eligibility criteria, such as clinical status, pregnancy, and enrollment CD4 count, which precluded the assessment of rapid ART initiation specifically among patients known to be eligible for ART before treat all. CONCLUSIONS: Our analysis indicates that adoption of treat all policies had a strong effect on increasing rates of rapid ART initiation, and that these increases followed different trajectories across the 6 countries. Young adults and men still require additional attention to further improve rapid ART initiation.
Global HIV prevention, care and treatment services for children: a cross-sectional survey from the International Epidemiology Databases to Evaluate AIDS (IeDEA) consortium.
(2023-Mar-13) Vreeman RC; Yiannoutsos CT; Yusoff NKN; Wester CW; Edmonds A; Ofner S; Davies MA; Leroy V; Lumbiganon P; de Menezes Succi RC; Twizere C; Brown S; Bolton-Moore C; Takassi OE; Scanlon M; Martin R; Wools-Kaloustian K; Center for Epidemiology and Research in POPulation Health (CERPOP), Inserm, Université de Toulouse, Université Paul Sabatier, Toulouse, France.; Department of Global Health and Health System Design, Icahn School of Medicine at Mount Sinai Arnhold Institute for Global Health, New York, New York, USA rachel.vreeman@mssm.edu.; Department of Epidemiology, The University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA.; Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.; Department of Biostatistics and Health Data Science, Indiana University Richard M Fairbanks School of Public Health, Indianapolis, Indiana, USA.; Center for Infectious Disease Research in Zambia, Lusaka, Zambia.; Department of Medicine, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA.; Vanderbilt Institute for Global Health, Nashville, Tennessee, USA.; Department of Pediatrics, Universidade Federal de São Paulo, Sao Paulo, Brazil.; Département de Pédiatrie, Université de Lomé, Lomé, Togo.; Indiana University Center for Global Health, Indianapolis, Indiana, USA.; Centre National de Référence en Matière de VIH/SIDA, Bujumbura, Burundi.; Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.; Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.; Department of Paediatrics, Hospital Raja Perempuan Zainab II, Kota Bharu, Malaysia.; Department of Global Health and Health System Design, Icahn School of Medicine at Mount Sinai Arnhold Institute for Global Health, New York, New York, USA.; Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
OBJECTIVES: To assess access children with HIV have to comprehensive HIV care services, to longitudinally evaluate the implementation and scale-up of services, and to use site services and clinical cohort data to explore whether access to these services influences retention in care. METHODS: A cross-sectional standardised survey was completed in 2014-2015 by sites providing paediatric HIV care across regions of the International Epidemiology Databases to Evaluate AIDS (IeDEA) consortium. We developed a comprehensiveness score based on the WHO's nine categories of essential services to categorise sites as 'low' (0-5), 'medium', (6-7) or 'high' (8-9). When available, comprehensiveness scores were compared with scores from a 2009 survey. We used patient-level data with site services to investigate the relationship between the comprehensiveness of services and retention. RESULTS: Survey data from 174 IeDEA sites in 32 countries were analysed. Of the WHO essential services, sites were most likely to offer antiretroviral therapy (ART) provision and counselling (n=173; 99%), co-trimoxazole prophylaxis (168; 97%), prevention of perinatal transmission services (167; 96%), outreach for patient engagement and follow-up (166; 95%), CD4 cell count testing (126; 88%), tuberculosis screening (151; 87%) and select immunisation services (126; 72%). Sites were less likely to offer nutrition/food support (97; 56%), viral load testing (99; 69%) and HIV counselling and testing (69; 40%). 10% of sites rated 'low', 59% 'medium' and 31% 'high' in the comprehensiveness score. The mean comprehensiveness of services score increased significantly from 5.6 in 2009 to 7.3 in 2014 (p<0.001; n=30). Patient-level analysis of lost to follow-up after ART initiation estimated the hazard was highest in sites rated 'low' and lowest in sites rated 'high'. CONCLUSION: This global assessment suggests the potential care impact of scaling-up and sustaining comprehensive paediatric HIV services. Meeting recommendations for comprehensive HIV services should remain a global priority.
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, University of California San Diego, USA.; Institute for Implementation Science in Population Health, City University of New York, USA.; 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.; 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.; Association Nationale de Soutien aux Séropositifs et malades du SIDA-Santé PLUS (ANSS-Santé PLUS), Burundi.; Kinshasa School of Public Health, University of Kinshasa, Democratic Republic of Congo.; Centre for Reproduction and Population Health Studies, Nigerian Institute for Medical Research, Lagos, Nigeria.; Infectious Diseases Medical Centre, CART CRS, Voluntary Health Services, Chennai, India.; Fundacion Huesped, Argentina.; Emory University School of Medicine and Rollins School of Public Health, Atlanta, USA.; Research for Development (RD Rwanda), and Rwanda Military Referral and Teaching Hospital, Kigali, Rwanda.; Research Institute for Tropical Medicine, Muntinlupa City, Philippines.; 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.; Department of Internal Medicine, Faculty of Medicine, University of Chile, and Hospital Clínico San Borja Arriarán & Fundación Arriarán, Santiago, Chile.; Department of Biomedical Informatics, Vanderbilt University Medical Center, USA.; VA Connecticut Healthcare System, Yale Schools of Medicine and Public Health, Yale University, USA.; Department of Community Health, Mbarara University of Science and Technology, Uganda.; Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea.; The Kirby Institute, University of New South Wales, Sydney, Australia.; Lighthouse Trust, Lilongwe, Malawi.; Centre de Prise en charge, de Recherche et de Formation (CePReF) Yopougon-Attié, Abidjan, Côte d'Ivoire.; Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland.; SolidarMed Zimbabwe.; Infectious Diseases Institute, Makerere University, Uganda.; Division of Infectious Diseases, Vanderbilt University Medical Center, TN, USA.; Masaka Regional Referral Hospital, Masaka City, Uganda.; Department of Medicine, Indiana University School of Medicine, USA.; 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.
Global Trends in CD4 Measurement and Immunosuppression at ART Initiation Among Children With HIV.
(2025-Apr-04) Patten G; Malateste K; Bolton Moore C; Sipambo N; Mokone L; Anderegg N; Wools-Kaloustian K; Michael D; Odhiambo F; Kasozi C; Desmonde S; Amorissani-Folquet M; Leroy V; Kumara Wati D; Nallusamy R; Kinikar A; Quy DT; Yotebieng M; Ebasone PV; Lelo P; Pinto J; Rouzier V; Machado DM; Haw NJ; Ford N; Department of Pediatrics, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Udayana University, Bali, Indonesia.; School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.; Pediatric Department, Cocody University Hospital, Abidjan, Cote d'Ivoire.; Department of Medicine, Indiana University School of Medicine; Indianapolis, Indiana.; Department of Pediatrics, BJ Government Medical College and Sassoon General Hospital, Pune, India.; Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia.; Kalembe Lembe Pediatric Hospital, Kinshasa, Democratic Republic of the Congo.; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.; Clinical Research Education, Networking and Consultancy (CRENC), Yaoundé, Cameroon.; Department of Pediatrics, Escola Paulista de Medicina, Federal University of Sao Paulo (UNIFESP), São Paulo, Brazil.; Centres GHESKIO, Port-au-Prince, Haiti.; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.; SolidarMed, Maseru, Lesotho.; World Health Organization, Geneva, Switzerland.; Children's Hospital 1, Ho Chi Minh City, Vietnam.; University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Research Centre, Bordeaux, France.; Department of Paediatrics and Child Health, Harriet Shezi Children's Clinic, Chris Hani Baragwanath Academic Hospital, University of Witwatersrand, Johannesburg, South Africa.; From the Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa.; Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya.; Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York.; Centre d'Epidémiologie et de Recherche en santé des POPulations (CERPOP), French National Institute for Health and Medical Research (Inserm), University of Toulouse 3, UMR 1295, Toulouse, France.; Department of Pediatrics, Penang Hospital, Penang, Malaysia.; Masaka Regional Referral Hospital, Masaka City, Uganda.; Tanzanian National Institute of Medical Research, Mwanza, Tanzania.
Eligibility for antiretroviral therapy is no longer based on immune criteria. In a global cohort of 97,453 children, between 2005 and 2021, we observed large declines in CD4 measurement, from 51% to 12% among <5 seconds, and from 74% to 20% among those 5-14 years of age. Lack of CD4 testing may negatively affect clinical care and surveillance of severe immune suppression.
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.
Immunodeficiency in children starting antiretroviral therapy in low-, middle-, and high-income countries.
(2015-Jan-01) Koller M; Patel K; Chi BH; Wools-Kaloustian K; Dicko F; Chokephaibulkit K; Chimbetete C; Avila D; Hazra R; Ayaya S; Leroy V; Truong HK; Egger M; Davies MA; *Institute of Social & Preventive Medicine (ISPM), University of Bern, Bern, Switzerland; †Department of Epidemiology, Harvard School of Public Health, Boston, MA; ‡Centre for Infectious Disease Research in Zambia, Lusaka, Zambia; §Department of Medicine, Indiana University School of Medicine, Indianapolis, IN; ‖Department of Pediatrics, Gabriel Toure Hospital, Bamako, Mali; ¶Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; #Newlands Clinic, Harare, Zimbabwe; **Maternal and Pediatric Infectious Disease Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Bethesda, MD; ††Department of Pediatrics, College of Health Sciences, Moi University, Kenya; ‡‡INSERM, French National Institute for Health and Medical Research, U897, Bordeaux, France; §§Children's Hospital 1, Ho Chi Minh City, Vietnam; and ‖‖School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
BACKGROUND: The CD4 cell count or percent (CD4%) at the start of combination antiretroviral therapy (cART) is an important prognostic factor in children starting therapy and an important indicator of program performance. We describe trends and determinants of CD4 measures at cART initiation in children from low-, middle-, and high-income countries. METHODS: We included children aged <16 years from clinics participating in a collaborative study spanning sub-Saharan Africa, Asia, Latin America, and the United States. Missing CD4 values at cART start were estimated through multiple imputation. Severe immunodeficiency was defined according to World Health Organization criteria. Analyses used generalized additive mixed models adjusted for age, country, and calendar year. RESULTS: A total of 34,706 children from 9 low-income, 6 lower middle-income, 4 upper middle-income countries, and 1 high-income country (United States) were included; 20,624 children (59%) had severe immunodeficiency. In low-income countries, the estimated prevalence of children starting cART with severe immunodeficiency declined from 76% in 2004 to 63% in 2010. Corresponding figures for lower middle-income countries were from 77% to 66% and for upper middle-income countries from 75% to 58%. In the United States, the percentage decreased from 42% to 19% during the period 1996 to 2006. In low- and middle-income countries, infants and children aged 12-15 years had the highest prevalence of severe immunodeficiency at cART initiation. CONCLUSIONS: Despite progress in most low- and middle-income countries, many children continue to start cART with severe immunodeficiency. Early diagnosis and treatment of HIV-infected children to prevent morbidity and mortality associated with immunodeficiency must remain a global public health priority.
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.
Monitoring and switching of first-line antiretroviral therapy in adult treatment cohorts in sub-Saharan Africa: collaborative analysis.
(2015-Jul) Haas AD; Keiser O; Balestre E; Brown S; Bissagnene E; Chimbetete C; Dabis F; Davies MA; Hoffmann CJ; Oyaro P; Parkes-Ratanshi R; Reynolds SJ; Sikazwe I; Wools-Kaloustian K; Zannou DM; Wandeler G; Egger M; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.; Newlands Clinic, Harare, Zimbabwe.; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Department of Infectious Diseases, Bern University Hospital and University of Bern, Bern, Switzerland.; Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa.; Kenya Medical Research Institute - RCTP FACES Program, Kisumu, Kenya.; Johns Hopkins University, Baltimore, MD, USA; Aurum Institute, Johannesburg, South Africa.; Rakai Health Sciences Program, Entebbe, Uganda; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA; Johns Hopkins University School of Medicine, Baltimore, MD, USA.; Indiana University School of Medicine, Indianapolis, IN, USA.; Faculté des Sciences de la Santé de l'Université d'Abomey-Calavi, and Centre de Traitement Ambulatoire du Centre National Hospitalier Universitaire Hubert Koutoukou Maga, Cotonou, Benin.; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa. Electronic address: egger@ispm.unibe.ch.; Infectious Diseases Institute, Mulago Hospital Complex, Kampala, Uganda.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d'Ivoire.; Centre de Recherche INSERM U897, Epidemiologie-Biostatistique, Institut de Santé Publique, Epidémiologie et Développement, Université de Bordeaux, Bordeaux, France.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
BACKGROUND: HIV-1 viral load testing is recommended to monitor antiretroviral therapy (ART) but is not universally available. The aim of our study was to assess monitoring of first-line ART and switching to second-line ART in sub-Saharan Africa. METHODS: We did a collaborative analysis of cohort studies from 16 countries in east Africa, southern Africa, and west Africa that participate in the international epidemiological database to evaluate AIDS (IeDEA). We included adults infected with HIV-1 who started combination ART between January, 2004, and January, 2013. We defined switching of ART as a change from a non-nucleoside reverse-transcriptase inhibitor (NNRTI)-based regimen to one including a protease inhibitor, with adjustment of one or more nucleoside reverse-transcriptase inhibitors (NRTIs). Virological and immunological failures were defined according to WHO criteria. We calculated cumulative probabilities of switching and hazard ratios with 95% CIs comparing routine viral load monitoring, targeted viral load monitoring, CD4 monitoring, and clinical monitoring, adjusting for programme and individual characteristics. FINDINGS: Of 297,825 eligible patients, 10,352 (3%) switched to second-line ART during 782 ,412 person-years of follow-up. Compared with CD4 monitoring, hazard ratios for switching were 3·15 (95% CI 2·92-3·40) for routine viral load monitoring, 1·21 (1·13-1·30) for targeted viral load monitoring, and 0·49 (0·43-0·56) for clinical monitoring. Of 6450 patients with confirmed virological failure, 58·0% (95% CI 56·5-59·6) switched by 2 years, and of 15,892 patients with confirmed immunological failure, 19·3% (18·5-20·0) switched by 2 years. Of 10,352 patients who switched, evidence of treatment failure based on one CD4 count or viral load measurement ranged from 86 (32%) of 268 patients with clinical monitoring to 3754 (84%) of 4452 with targeted viral load monitoring. Median CD4 counts at switching were 215 cells per μL (IQR 117-335) with routine viral load monitoring, but were lower with other types of monitoring (range 114-133 cells per μL). INTERPRETATION: Overall, few patients switched to second-line ART and switching happened late in the absence of routine viral load monitoring. Switching was more common and happened earlier after initiation of ART with targeted or routine viral load testing. FUNDING: National Institute of Allergy and Infectious Diseases, Swiss National Science Foundation.
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.
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.
The Tuberculosis Sentinel Research Network (TB-SRN) of the International epidemiology Databases to Evaluate AIDS (IeDEA): protocol for a prospective cohort study in Africa, Southeast Asia and Latin America.
(2024-Jan-09) Enane LA; Duda SN; Chanyachukul T; Bolton-Moore C; Navuluri N; Messou E; Mbonze N; McDade LR; Figueiredo MC; Ross J; Evans D; Diero L; Akpata R; Zotova N; Freeman A; Pierre MF; Rupasinghe D; Ballif M; Byakwaga H; de Castro N; Tabala M; Sterling TR; Sohn AH; Fenner L; Wools-Kaloustian K; Poda A; Yotebieng M; Huebner R; Marcy O; Vanderbilt Institute of Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA.; Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA.; Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.; Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA.; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.; Duke Global Health Institute, Duke University, Durham, North Carolina, USA.; Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.; Indiana University Center for Global Health Equity, Indianapolis, Indiana, USA.; Mbarara University of Science and Technology Faculty of Medicine, Mbarara, Uganda.; Department of Infectious Diseases, Bern University Hospital and University of Bern, Bern, Switzerland.; Center for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia.; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.; The Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti.; The Kirby Institute, UNSW, Sydney, New South Wales, Australia.; Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.; Centre Hospitalier Universitaire Sourô Sanou, Bobo Dioulasso, Burkina Faso.; TREAT Asia/amfAR - The Foundation for AIDS Research, Bangkok, Thailand.; Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.; Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo.; The Ryan White Center for Pediatric Infectious Diseases and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA lenane@iu.edu.; Vanderbilt Tuberculosis Center, Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.; Centre de Prise en Charge de Recherche et de Formation (Aconda-CePReF), Abidjan, Côte d'Ivoire.; Université de Bordeaux, Bordeaux, France.; Department of Medicine, Moi University College of Health Sciences, Eldoret, Kenya.
INTRODUCTION: Tuberculosis (TB) is a leading infectious cause of death globally. It is the most common opportunistic infection in people living with HIV, and the most common cause of their morbidity and mortality. Following TB treatment, surviving individuals may be at risk for post-TB lung disease. The TB Sentinel Research Network (TB-SRN) provides a platform for coordinated observational TB research within the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium. METHODS AND ANALYSIS: This prospective, observational cohort study will assess treatment and post-treatment outcomes of pulmonary TB (microbiologically confirmed or clinically diagnosed) among 2600 people aged ≥15 years, with and without HIV coinfection, consecutively enrolled at 16 sites in 11 countries, across 6 of IeDEA's global regions. Data regarding clinical and sociodemographic factors, mental health, health-related quality of life, pulmonary function, and laboratory and radiographic findings will be collected using standardised questionnaires and data collection tools, beginning from the initiation of TB treatment and through 12 months after the end of treatment. Data will be aggregated for proposed analyses. ETHICS AND DISSEMINATION: Ethics approval was obtained at all implementing study sites, including the Vanderbilt University Medical Center Human Research Protections Programme. Participants will provide informed consent; for minors, this includes both adolescent assent and the consent of their parent or primary caregiver. Protections for vulnerable groups are included, in alignment with local standards and considerations at sites. Procedures for requesting use and analysis of TB-SRN data are publicly available. Findings from TB-SRN analyses will be shared with national TB programmes to inform TB programming and policy, and disseminated at regional and global conferences and other venues.