HIV Viral Supression and Associated Factors Among Children and Adolescents on Antiretroviral Therapy at Baylor Tanzania - Lake Zone Paediatric HIV Centre of Excellence
Deressa Alemayemu [Male]
HIV Viral Supression and Associated Factors Among Children and Adolescents on Antiretroviral Therapy at Baylor Tanzania - Lake Zone Paediatric HIV Centre of Excellence - Mwanza, Tanzania: Catholic University of Health and Allied Sciences [CUHAS - Bugando] : 2018 - xiii; 56 Pages Includes References and Appendices
Abstract:
Background: Viral Suppression is sub-optimally achieved, particularly in peadiatric patients on cART in resource limited settings, and this problem remains to challenge the attainment of the universal (at least 90%) suppression target which HIV programs are working hard to achieve. Due to routine unavailability of HIV viral load testing, latest reports on viral suppression and its determinants are scanty in Tanzania. This study has examined the most recent viral suppression and potential determinants among children and adolescents on cART at a Paediatric HIV Centre of Excellence in the Lake Zone of Tanzania.
Methods: This is a cross-sectional study with retrospective data review of 539 children, adolescents and young adults age <22 years who received cART for at least 6 months and had Viral Load (HVL) measurement between May 2015 – December 2016 at Tanzania’s Lake Zone Paediatric HIV Centre of Excellence. Associations between the latest HVL <1000c/ml records and different characteristics at the time of enrolment into to care and at least visit dates during the study period were determined by logistic regression analyses. Viral suppression was defined as HIV RNA <1000c/ml in this study.
Results: A total of 539 patients of similar gender distribution (50.8% females) with median age of 11.4 years (IQR: 7-14.8) who have been on cART for median duration of 3.4 years (IQR: 2-5.8) were included in this study. The majority (91.3%) of the study subjects were in WHO clinical stage III/IV at start of cART. The prevalence of HVL <1000c/ml at the latest measurement was 72.4% (n=390). On multivariate logistic regression analysis, being on first line ART regimen compared to second line (aOR: 0.07; 95%CI: 0.02-0.30; p-value <0.001) was independently associated with decreased odds of viral suppression (HVL<1000c/ml) while no parameter was found to be independently associated with increased viral suppression. Improvements in clinical and immunological conditions of study subjects were appreciated in response to cART at the centre.
Conclusion: The majority of subjects were enrolled in to care at advanced HIV disease stage but have showed good clinical and immunological recovery. The viral suppression rate in this study in 72.4%, which is within the range of many reports in LMICS but way below the 90% global target. Only being on first line ART regimen was independently and statistically significantly associated with decreased odds of viral suppression.
Recommendations: Routine virological monitoring needs to be strengthened in resource limited settings in children taking first-line cART to reliably working towards treatment goals. The HIV viral suppression rate in the cohort of children and adolescents put on cART using “test and treat” recommendation needs to be determined alone to see if the practice has uniquely impacted the viral outcome. Nutritional interventions should be strengthened particularly in < 5 yo children and also those for mild acute and chronic malnutrition across all age ranges of children and adolescents at the centre.
= Words: Child HIV treatment; Adolescent HIV treatment; HIV viral suppression; Malnutrition; Anti-retroviral therapy; ART; Sub-Saharan Africa; Tanzania.
Wurzburg Road 35, BMC Premises, Post Code: 33102: P. O Box 1464, Mwanza – Tanzania: Phone: +255 28 298 3384: Fax: +255 28 298 3386: Email: vc@bugando.ac.tz : www.bugando.ac.tz
--Public Health
HIV Viral Supression and Associated Factors Among Children and Adolescents on Antiretroviral Therapy at Baylor Tanzania - Lake Zone Paediatric HIV Centre of Excellence - Mwanza, Tanzania: Catholic University of Health and Allied Sciences [CUHAS - Bugando] : 2018 - xiii; 56 Pages Includes References and Appendices
Abstract:
Background: Viral Suppression is sub-optimally achieved, particularly in peadiatric patients on cART in resource limited settings, and this problem remains to challenge the attainment of the universal (at least 90%) suppression target which HIV programs are working hard to achieve. Due to routine unavailability of HIV viral load testing, latest reports on viral suppression and its determinants are scanty in Tanzania. This study has examined the most recent viral suppression and potential determinants among children and adolescents on cART at a Paediatric HIV Centre of Excellence in the Lake Zone of Tanzania.
Methods: This is a cross-sectional study with retrospective data review of 539 children, adolescents and young adults age <22 years who received cART for at least 6 months and had Viral Load (HVL) measurement between May 2015 – December 2016 at Tanzania’s Lake Zone Paediatric HIV Centre of Excellence. Associations between the latest HVL <1000c/ml records and different characteristics at the time of enrolment into to care and at least visit dates during the study period were determined by logistic regression analyses. Viral suppression was defined as HIV RNA <1000c/ml in this study.
Results: A total of 539 patients of similar gender distribution (50.8% females) with median age of 11.4 years (IQR: 7-14.8) who have been on cART for median duration of 3.4 years (IQR: 2-5.8) were included in this study. The majority (91.3%) of the study subjects were in WHO clinical stage III/IV at start of cART. The prevalence of HVL <1000c/ml at the latest measurement was 72.4% (n=390). On multivariate logistic regression analysis, being on first line ART regimen compared to second line (aOR: 0.07; 95%CI: 0.02-0.30; p-value <0.001) was independently associated with decreased odds of viral suppression (HVL<1000c/ml) while no parameter was found to be independently associated with increased viral suppression. Improvements in clinical and immunological conditions of study subjects were appreciated in response to cART at the centre.
Conclusion: The majority of subjects were enrolled in to care at advanced HIV disease stage but have showed good clinical and immunological recovery. The viral suppression rate in this study in 72.4%, which is within the range of many reports in LMICS but way below the 90% global target. Only being on first line ART regimen was independently and statistically significantly associated with decreased odds of viral suppression.
Recommendations: Routine virological monitoring needs to be strengthened in resource limited settings in children taking first-line cART to reliably working towards treatment goals. The HIV viral suppression rate in the cohort of children and adolescents put on cART using “test and treat” recommendation needs to be determined alone to see if the practice has uniquely impacted the viral outcome. Nutritional interventions should be strengthened particularly in < 5 yo children and also those for mild acute and chronic malnutrition across all age ranges of children and adolescents at the centre.
= Words: Child HIV treatment; Adolescent HIV treatment; HIV viral suppression; Malnutrition; Anti-retroviral therapy; ART; Sub-Saharan Africa; Tanzania.
Wurzburg Road 35, BMC Premises, Post Code: 33102: P. O Box 1464, Mwanza – Tanzania: Phone: +255 28 298 3384: Fax: +255 28 298 3386: Email: vc@bugando.ac.tz : www.bugando.ac.tz
--Public Health