Predictors of survival among HIV-positive children on ART in Swaziland

The objective of the study was to determine predictors of survival among HIV-positive children (<15 years) in Swaziland. A retrospective cohort analysis of medical records for 4 167 children living with HIV who were initiated on antiretroviral therapy (ART) between 2004 and 2008, and followed up until 2014 was conducted in clinical settings at 36 health facilities. The Kaplan Meier Estimator, signed-ranks test, and the Cox proportional hazards regression model were applied to determine survival probabilities, significant difference among stratified survival functions and adjusted hazard ratios respectively. The results reveal that the median survival time for children was 78 months (95% CI: 77­79). Children who were initiated early on ART had higher survival probability over time (HR: 0.35 [95% CI: 0.21­0.57], p < 0.001) compared to those whose ART initiation was delayed. Children within the age group of <1 years had higher hazard (HR = 1.55 [95% CI: 1.16­2.08], p < 0.001) of death than children within the age group of 1­14 years. Children who were nourished had 88% lower hazard of death (HR: 0.12 [95% CI: 0.07­0.19], p < 0.001) than severely malnourished children. The study demonstrates that ART paediatric services are effective in increasing survival among HIV infected children and early initiated children have high survival probability. Active tuberculosis (TB), malnutrition, and delayed ART initiation remain predictors of poor survival among children living with HIV

Factors affecting virological non-suppression amongst HIV-positive patients on antiretroviral therapy: Uganda, August 2014 - July 2015

Introduction: virological suppression is a critical indicator for HIV treatment success and reduction in HIV transmission risk. However, despite the increasing number of people on antiretroviral therapy (ART), there is limited information about non-suppression and its determinants among HIV-positive (HIV+) individuals enrolled in care in many resource-limited settings. This study estimated the virological non-suppression rates amongst HIV+ patients who had been on ART for at least 6 months and the factors associated with non-suppression. Methods: a descriptive cross-sectional study was conducted using routinely collected data from viral load testing samples from 100,678 HIV+ patients enrolled in HIV care across the country between August 2014 and July 2015. Viral load testing was conducted at the Central Public Health Laboratories in Kampala, Uganda. We extracted data on socio-demographic, clinical and viral load testing results. We defined virological non-suppression as having ≥ 1000 copies of viral RNA/ml of blood for plasma or ≥ 5000 copies of viral RNA/ml of blood for dry blood spots. We used logistic regression to identify factors associated with virological non-suppression. Results: majority of the patients (68%) were females. The overall non-suppression rate was 11%. Second-time testers had a higher non-suppression rate than first-time testers (50% vs. 10%, OR = 7.0, 95%CI = 6.2-7.9); and children aged < 5 years (29%, OR = 5.3, 95%CI = 4.8-6.0) and adolescents aged 15-19 (27%, OR = 4.1, 95%CI = 3.7-4.5) had higher non-suppression rates than persons of other age groups. Non-suppression rates were also higher among suspected treatment failures (29%, OR = 4.0, 95%CI = 3.7-4.4), patients with reported adherence levels < 85% (35%, OR = 3.4, 95%CI = 3.0-3.9), and patients with active TB (20%, OR = 2.0, 95%CI = 1.5-2.3) than those without these conditions. Breastfeeding (6%, OR = 0.61, 95%CI = 0.54-0.69) and pregnant women (8%, OR = 0.77, 95%CI = 0.65-0.91) had lower non-suppression rates than non-breastfeeding and non-pregnant women (10%). Conclusion: virological non-suppression was associated with second time testers, young age, poor adherence, and TB co-infection. To maximize the benefits of the expanded ART, we recommend close follow-up and intensified targeted adherence support for second time testers, children and adolescents. Adherence to standard guidelines for managing TB/HIV co-infections should be emphasized by all ART clinics

Les determinants du desir de grossesse chez les femmes seropositives sous traitement antiretroviral dans le District de Rwamagana

L'etude vise a analyser les determinants du desir de grossesse chez les femmes seropositives sous traitement anti-retroviral; afin de contribuer a la reduction de la transmission du virus de la mere a l'enfant. Elle a pour objectifs specifiques de determiner la proportion des grossesses chez les femmes a serologie VIH positive; d'evaluer l'attitude du personnel de sante a l'egard des messages a donner aux femmes seropositives sous ARVs en ce qui concerne le desir de la grossesse; et relever les facteurs determinant le desir d'avoir des enfants apres la mise ne route d'un traitement par antiretroviraux . Il s'agit d'une etude descriptive transversale. Elle a ete conduite aupres de 260 femmes infectees par le VIH sous ARVs et suivies dans les FOSA; ayant les services de VCT/PMTCT et des ARVs. L'etude montre que 26;9 des femmes ont ete enceintes apres avoir ete informees de leur statut serologique positif pour le VIH et que 38;5 des femmes seropositives sous traitement anti-retroviral desirent avoir des enfants dans le futur. La majorite des femmes (82;7) reconnaissent l'importance de l'utilisation des contraceptifs alors que le pourcentage des femmes qui connaissent l'importance d'utiliser les ARVs pendant la grossesse et l'accouchement pour reduire le risque de transmission de la mere a l'enfant est de 76;9. Les facteurs determinant le desir de la grossesse parmi les femmes seropositives sont : La confiance attribuee aux anti-retroviraux; la parite c'est-a-dire les femmes qui n'ont pas eu d'enfant ont un desir de maternite deux fois superieur que les femmes qui ont eu au moins un enfant; et la non utilisation des methodes contraceptives chez les femmes a serologie VIH positives pour reduire le risque de transmission de la mere a l'enfant. Nous recommandons de renforcer l'integration des activites de sante de la reproduction et de Planning familial dans les services de lutte contre le VIH/SIDA;a savoir le PTME; Conseils et depistage volontaire du VIH; ainsi que la prise en charge des patients seropositifs