Higher Retention and Viral Suppression with Adolescent-focused HIV Clinic in South Africa

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2017 Dec 30

PMID 29287088

Citations 70

Authors

Brian C Zanoni

Thobekile Sibaya

Chelline Cairns

Sara Lammert

Jessica E Haberer

Affiliations

Soon will be listed here.

Abstract

Objective: To determine retention in care and virologic suppression among HIV-infected adolescents and young adults attending an adolescent-friendly clinic compared to those attending the standard pediatric clinic at the same site.

Design: Retrospective cohort analysis.

Setting: Government supported, hospital-based antiretroviral clinic in KwaZulu-Natal, South Africa.

Participants: Two hundred forty-one perinatally HIV-infected adolescents and young adults aged 13 to 24 years attending an adolescent-friendly clinic or the standard pediatric clinic from April 2007 to November 2015.

Intervention: Attendance in an adolescent-friendly clinic compared to a standard pediatric clinic.

Outcomes Measures: Retention in care defined as one clinic visit or pharmacy refill in the prior 6 months; HIV-1 viral suppression defined as < 400 copies/ml.

Results: Overall, among 241 adolescents and young adults, retention was 89% (214/241) and viral suppression was 81% (196/241). Retention was higher among those attending adolescent clinic (95%) versus standard pediatric clinic (85%; OR 3.7; 95% confidence interval (CI) 1.2-11.1; p = 0.018). Multivariable logistic regression adjusted for age at ART initiation, gender, pre-ART CD4 count, months on ART, and tuberculosis history indicated higher odds of retention in adolescents and young adults attending adolescent compared to standard clinic (AOR = 8.5; 95% CI 2.3-32.4; p = 0.002). Viral suppression was higher among adolescents and young adults attending adolescent (91%) versus standard pediatric clinic (80%; OR 2.5; 95% CI 1.1-5.8; p = 0.028). A similar multivariable logistic regression model indicated higher odds of viral suppression in adolescents and young adults attending adolescent versus standard pediatric clinic (AOR = 3.8; 95% CI 1.5-9.7; p = 0.005).

Conclusion: Adolescents and young adults attending an adolescent-friendly clinic had higher retention in care and viral suppression compared to adolescents attending the standard pediatric clinic. Further studies are needed to prospectively assess the impact of adolescent-friendly services on these outcomes.

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References

Barth R, van der Meer J, Hoepelman A, Schrooders P, van de Vijver D, Geelen S . Effectiveness of highly active antiretroviral therapy administered by general practitioners in rural South Africa. Eur J Clin Microbiol Infect Dis. 2008; 27(10):977-84. DOI: 10.1007/s10096-008-0534-2. View

Ruel T, Zanoni B, Ssewanyana I, Cao H, Havlir D, Kamya M . Sex differences in HIV RNA level and CD4 cell percentage during childhood. Clin Infect Dis. 2011; 53(6):592-9. PMC: 3160805. DOI: 10.1093/cid/cir484. View

MacPherson P, Munthali C, Ferguson J, Armstrong A, Kranzer K, Ferrand R . Service delivery interventions to improve adolescents' linkage, retention and adherence to antiretroviral therapy and HIV care. Trop Med Int Health. 2015; 20(8):1015-32. PMC: 4579546. DOI: 10.1111/tmi.12517. View

Mori M, Adland E, Paioni P, Swordy A, Mori L, Laker L . Sex Differences in Antiretroviral Therapy Initiation in Pediatric HIV Infection. PLoS One. 2015; 10(7):e0131591. PMC: 4494714. DOI: 10.1371/journal.pone.0131591. View

Davies M, Tsondai P, Tiffin N, Eley B, Rabie H, Euvrard J . Where do HIV-infected adolescents go after transfer? - Tracking transition/transfer of HIV-infected adolescents using linkage of cohort data to a health information system platform. J Int AIDS Soc. 2017; 20(Suppl 3):21668. PMC: 5577779. DOI: 10.7448/IAS.20.4.21668. View

Van Cutsem G, Ford N, Hildebrand K, Goemaere E, Mathee S, Abrahams M . Correcting for mortality among patients lost to follow up on antiretroviral therapy in South Africa: a cohort analysis. PLoS One. 2011; 6(2):e14684. PMC: 3040750. DOI: 10.1371/journal.pone.0014684. View

Judd A, Sohn A, Collins I . Interventions to improve treatment, retention and survival outcomes for adolescents with perinatal HIV-1 transitioning to adult care: moving on up. Curr Opin HIV AIDS. 2016; 11(5):477-486. DOI: 10.1097/COH.0000000000000302. View

Zanoni B, Phungula T, Zanoni H, France H, Feeney M . Impact of tuberculosis cotreatment on viral suppression rates among HIV-positive children initiating HAART. AIDS. 2010; 25(1):49-55. DOI: 10.1097/QAD.0b013e32833f9e04. View

Grimsrud A, Lesosky M, Kalombo C, Bekker L, Myer L . Implementation and Operational Research: Community-Based Adherence Clubs for the Management of Stable Antiretroviral Therapy Patients in Cape Town, South Africa: A Cohort Study. J Acquir Immune Defic Syndr. 2015; 71(1):e16-23. DOI: 10.1097/QAI.0000000000000863. View

10.

Ferrand R, Briggs D, Ferguson J, Penazzato M, Armstrong A, MacPherson P . Viral suppression in adolescents on antiretroviral treatment: review of the literature and critical appraisal of methodological challenges. Trop Med Int Health. 2015; 21(3):325-33. PMC: 4776345. DOI: 10.1111/tmi.12656. View

11.

Berg-Kelly K . Adolescent-friendly services. Acta Paediatr. 2003; 92(11):1241-2. DOI: 10.1080/08035250310005035. View

12.

Bing E, Burnam M, Longshore D, Fleishman J, Sherbourne C, London A . Psychiatric disorders and drug use among human immunodeficiency virus-infected adults in the United States. Arch Gen Psychiatry. 2001; 58(8):721-8. DOI: 10.1001/archpsyc.58.8.721. View

13.

Fair C, Sullivan K, Dizney R, Stackpole A . "It's like losing a part of my family": transition expectations of adolescents living with perinatally acquired HIV and their guardians. AIDS Patient Care STDS. 2012; 26(7):423-9. DOI: 10.1089/apc.2012.0041. View

14.

Boerma R, Boender T, Bussink A, Calis J, Bertagnolio S, Wit T . Suboptimal Viral Suppression Rates Among HIV-Infected Children in Low- and Middle-Income Countries: A Meta-analysis. Clin Infect Dis. 2016; 63(12):1645-1654. DOI: 10.1093/cid/ciw645. View

15.

Zanoni B, Phungula T, Zanoni H, France H, Feeney M . Risk factors associated with increased mortality among HIV infected children initiating antiretroviral therapy (ART) in South Africa. PLoS One. 2011; 6(7):e22706. PMC: 3146475. DOI: 10.1371/journal.pone.0022706. View

16.

Tanner A, Philbin M, DuVal A, Ellen J, Kapogiannis B, Fortenberry J . "Youth friendly" clinics: considerations for linking and engaging HIV-infected adolescents into care. AIDS Care. 2013; 26(2):199-205. PMC: 4106414. DOI: 10.1080/09540121.2013.808800. View

17.

Ambresin A, Bennett K, Patton G, Sanci L, Sawyer S . Assessment of youth-friendly health care: a systematic review of indicators drawn from young people's perspectives. J Adolesc Health. 2013; 52(6):670-81. DOI: 10.1016/j.jadohealth.2012.12.014. View

18.

Mutevedzi P, Lessells R, Rodger A, Newell M . Association of age with mortality and virological and immunological response to antiretroviral therapy in rural South African adults. PLoS One. 2011; 6(7):e21795. PMC: 3128614. DOI: 10.1371/journal.pone.0021795. View

19.

Lowenthal E, Marukutira T, Tshume O, Chapman J, Nachega J, Anabwani G . Parental absence from clinic predicts human immunodeficiency virus treatment failure in adolescents. JAMA Pediatr. 2015; 169(5):498-500. PMC: 4420689. DOI: 10.1001/jamapediatrics.2014.3785. View

20.

Naar-King S, Montepiedra G, Nichols S, Farley J, Garvie P, Kammerer B . Allocation of family responsibility for illness management in pediatric HIV. J Pediatr Psychol. 2008; 34(2):187-94. PMC: 2722122. DOI: 10.1093/jpepsy/jsn065. View