A comparison of clinical outcomes among people living with HIV of different age groups attending queen Elizabeth central hospital outpatient ART Clinic in Malawi

Frontiers in Medicine

Medicine

Bernadette O’Hare¹  Jessica Chakakala-Chaziya²  Danilo Buonsenso³  Master Chisale⁴  John Mbotwa⁵  Vincent Samuel⁶  Noel Patson⁷  Eddie Phiri⁸ 

[1]Department of Paediatrics and Child Health, College of Medicine, University of Malawi, Zomba, Malawi

[2]The Division of Infection and Global Health, University of St Andrews, St Andrews, United Kingdom

[3]Department of Paediatrics and Child Health, Mzuzu Central Hospital, Ministry of Health, Lilongwe, Malawi

[4]Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

[5]Faculty of Science Technology and Innovations, Biological Sciences Department, Mzuzu University, Mzuzu, Malawi

[6]Malawi Liverpool Wellcome Trust Research Programme, Blantyre, Malawi

[7]The Department of Applied Studies, Division of Statistics, Malawi University of Science and Technology, Mikolongwe, Malawi

[8]The School of Public Health and Family Medicine, College of Medicine, University of Malawi, Zomba, Malawi

[9]Malawi Liverpool Wellcome Trust Research Programme, Blantyre, Malawi

[10]The School of Public Health, University of Witswaterands, Johannesburg, South Africa

[11]The Umodzi Family ART Clinic, Queen Elizabeth Central Hospital, Blantyre, Malawi

关键词: virological suppression;    adolescent HIV;    pediatrics;    retention;    HIV continuum care;   

DOI  :  10.3389/fmed.2023.1175553

 received in 2023-02-27, accepted in 2023-08-23,  发布年份 2023

来源: Frontiers

【 摘 要 】

IntroductionAdherence to Antiretroviral Treatment (ART) in children and adolescents living with HIV in low-resource settings is not extensively studied in large cohort studies including both adults and pediatric patients. We compared rates of virological suppression, adherence and defaulting among children, adolescents and adults attending a family ART clinic at Queen Elizabeth Central Hospital; a tertiary hospital situated in the southern region of Malawi.MethodsThe study was longitudinal and made use of routinely collected data for all 27,229 clinic attendees. Clinical information obtained at routine clinical visits entered electronically since 2008 was extracted in February 2017. This data was used to ascertain differences across the different age groups. Logistic regression and Cox regression models were fitted to compare rates of Virological Suppression (VS), adherence, and defaulting, respectively.ResultsYounger and older adolescents (ages 10–14 years and 15–19 years respectively) were less likely to achieve VS compared to adults in the final model AOR 0.4 (0.2–0.9, 95% CI) and AOR 0.2 (0.1–0.4, 95% CI) respectively. Young children (ages 0–4 years), older children (ages 5–9 years) and younger adolescents were less adherent to ART compared to adults AOR 0.1 (0.1–0.2, 95% CI), AOR 0.2 (0.1–0.3, 95% CI), and AOR 0.4 (0.3–0.5, 95% CI) respectively. Young adults and younger children had an increased likelihood of defaulting compared to adults.ConclusionPoor performance on ART of children and adolescents highlights unaddressed challenges to adherence. Ongoing research to explore these potential barriers and possible interventions needs to be carried out. The adherence assessment methods used and strategies for improving it among children and adolescents need to be revised at the clinic.

【 授权许可】

Unknown   
Copyright © 2023 Chakakala-Chaziya, Patson, Samuel, Mbotwa, Buonsenso, Chisale, Phiri and O’Hare.