Medical and Health Sciences

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Browsing Medical and Health Sciences by Subject "HIV"

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    High Rate of HIV Resuppression After Viral Failure on First-line Antiretroviral Therapy in the Absence of Switch to Second-line Therapy
    (Clinical infectious diseases, 2014) Gupta, Ravindra K.; Goodall, Ruth L.; Kityo, Cissy; Munderi, Paula; Lyagoba, Fred; Mugarura, Lincoln; Kaleebu, Pontiano; Pillay, Deenan
    In a randomized comparison of nevirapine or abacavir with zidovudine plus lamivudine, routine viral load monitoring was not performed, yet 27% of individuals with viral failure at week 48 experienced resuppression by week 96 without switching. This supports World Health Organization recommendations that suspected viral failure should trigger adherence counseling and repeat measurement before a treatment switch is considered.
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    Retention of adolescents living with HIV in care, treatment, and support programs in Uganda
    (USAID, 2014) Ssali, Livingstone; Kalibala, Sam; Birungi, Josephine; Egessa, Aggrey; Wangisi, Jonathan
    In many countries in sub-Saharan Africa, HIV programs are organized around pediatric or adult care, with adolescents who are living with HIV being treated through pediatric care facilities. This has important implications for retention of adolescents in HIV care programs especially as they transition from pediatric to adult care. Although Uganda is considered a success story in HIV/AIDS programming, the extent to which adolescents living with HIV have been retained in care is not well understood. Retention in care is important for positive clinical outcomes such as viral load suppression and survival. The AIDS Support Organization (TASO) and the Population Council undertook a study to generate evidence on the level of and the factors associated with retention of adolescents aged 10–19 years in HIV and AIDS programs in Uganda. The study was conducted under the U.S. Agency for International Development’s (USAID) HIVCore project led by the Population Council. The study specifically examined: (1) the contextual factors that might facilitate or influence retention of adolescents in HIV care, treatment, and support services in Uganda; (2) the cascade of HIV care, treatment, and support services among adolescents aged 10–19 years in Uganda and how these patterns compare with those of adults aged 20 years and above; (3) the level of and trends in retention in care, treatment, and support programs among adolescents aged 10–19 years in the country in the context of current HIV and AIDS programs at 6, 12, 24, 36, and 48 months following initiation of antiretroviral therapy (ART); and (4) the sociodemographic characteristics that are associated with retention in HIV care, treatment, and support programs among adolescents in Uganda at three different follow-up periods (12, 24, and 36 months). The study reviewed existing national policy and program documents on HIV testing, counseling, treatment, and support as well as retrospective secondary cohort clinical data from clinics operated by TASO in Uganda. TASO implements several HIV-related activities including prevention, counseling, testing, treatment, care, and support services as well as capacity development, research, and advocacy. The study population for the clinical component comprised: (1) 22,089 adolescents aged 10–19 years and 33,139 adults aged 20 years and above who received HIV services under the home-based HIV testing and counseling (HBHTC) program from 2005 (when TASO initiated the program) to 2011; and (2) clinical records of 617 adolescent clients aged 10–19 years (at the time of enrollment) who received HIV care, treatment, and support services from TASO clinics between 2006 and 2011. The review of policy and program documents as well as the extraction and merging of clinical datasets took place from 4–15 November 2013. The HBHTC and ART datasets were obtained from 11 TASO centers. The ART datasets were extracted from the following records: Pre-ART Registry, Case Evaluation, ART Commencement, Deaths, Monitoring Refills, and Laboratory. We identified a patient cohort within the TASO Management Information System who initiated ART since 2006. Analysis involved both descriptive statistics and multivariate Cox regression analysis. Descriptive analysis entailed reviewing the cascade of HIV care, treatment, and support services under the HBHTC program as well as estimating the level of retention in TASO ART programs at 6, 12, 24, 36, and 48 months. Multivariate Cox regression analysis was conducted to determine the sociodemographic and clinical factors associated with program attrition at 12, 24, and 36 months.