The HIV care cascade for adolescents initiated on antiretroviral therapy in a health district of South Africa: a retrospective cohort study
| dc.contributor.author | Haghighat, Roxanna | |
| dc.contributor.author | Toska, Elona | |
| dc.contributor.author | Bungane, Nontuthuzelo | |
| dc.contributor.author | Cluver, Lucie | |
| dc.date.accessioned | 2021-10-11T08:58:25Z | |
| dc.date.available | 2021-10-11T08:58:25Z | |
| dc.date.issued | 2021-01-13 | |
| dc.date.updated | 2021-01-17T04:08:29Z | |
| dc.description.abstract | Background Little evidence exists to comprehensively estimate adolescent viral suppression after initiation on antiretroviral therapy in sub-Saharan Africa. This study examines adolescent progression along the HIV care cascade to viral suppression for adolescents initiated on antiretroviral therapy in South Africa. Methods All adolescents ever initiated on antiretroviral therapy (n=1080) by 2015 in a health district of the Eastern Cape, South Africa, were interviewed in 2014–2015. Clinical records were extracted from 52 healthcare facilities through January 2018 (including records in multiple facilities). Mortality and loss to follow-up rates were corrected for transfers. Predictors of progression through the HIV care cascade were tested using sequential multivariable logistic regressions. Predicted probabilities for the effects of significant predictors were estimated by sex and mode of infection. Results Corrected mortality and loss to follow-up rates were 3.3 and 16.9%, respectively. Among adolescents with clinical records, 92.3% had ≥1 viral load, but only 51.1% of viral loads were from the past 12 months. Adolescents on ART for ≥2 years (AOR 3.42 [95%CI 2.14–5.47], p< 0.001) and who experienced decentralised care (AOR 1.39 [95%CI 1.06–1.83], p=0.018) were more likely to have a recent viral load. The average effect of decentralised care on recent viral load was greater for female (AOR 2.39 [95%CI 1.29–4.43], p=0.006) and sexually infected adolescents (AOR 3.48 [95%CI 1.04–11.65], p=0.043). Of the total cohort, 47.5% were recorded as fully virally suppressed at most recent test. Only 23.2% were recorded as fully virally suppressed within the past 12 months. Younger adolescents (AOR 1.39 [95%CI 1.06–1.82], p=0.017) and those on ART for ≥2 years (AOR 1.70 [95%CI 1.12–2.58], p=0.013) were more likely to be fully viral suppressed. Conclusions Viral load recording and viral suppression rates remain low for ART-initiated adolescents in South Africa. Improved outcomes for this population require stronger engagement in care and viral load monitoring. | en_US |
| dc.identifier.apacitation | Haghighat, R., Toska, E., Bungane, N., & Cluver, L. (2021). The HIV care cascade for adolescents initiated on antiretroviral therapy in a health district of South Africa: a retrospective cohort study. <i>BMC Infectious Diseases</i>, 21(Article number: 60), http://hdl.handle.net/11427/35146 | en_ZA |
| dc.identifier.chicagocitation | Haghighat, Roxanna, Elona Toska, Nontuthuzelo Bungane, and Lucie Cluver "The HIV care cascade for adolescents initiated on antiretroviral therapy in a health district of South Africa: a retrospective cohort study." <i>BMC Infectious Diseases</i> 21, Article number: 60. (2021) http://hdl.handle.net/11427/35146 | en_ZA |
| dc.identifier.citation | Haghighat, R., Toska, E., Bungane, N. & Cluver, L. 2021. The HIV care cascade for adolescents initiated on antiretroviral therapy in a health district of South Africa: a retrospective cohort study. <i>BMC Infectious Diseases.</i> 21(Article number: 60) http://hdl.handle.net/11427/35146 | en_ZA |
| dc.identifier.ris | TY - Journal Article AU - Haghighat, Roxanna AU - Toska, Elona AU - Bungane, Nontuthuzelo AU - Cluver, Lucie AB - Background Little evidence exists to comprehensively estimate adolescent viral suppression after initiation on antiretroviral therapy in sub-Saharan Africa. This study examines adolescent progression along the HIV care cascade to viral suppression for adolescents initiated on antiretroviral therapy in South Africa. Methods All adolescents ever initiated on antiretroviral therapy (n=1080) by 2015 in a health district of the Eastern Cape, South Africa, were interviewed in 2014–2015. Clinical records were extracted from 52 healthcare facilities through January 2018 (including records in multiple facilities). Mortality and loss to follow-up rates were corrected for transfers. Predictors of progression through the HIV care cascade were tested using sequential multivariable logistic regressions. Predicted probabilities for the effects of significant predictors were estimated by sex and mode of infection. Results Corrected mortality and loss to follow-up rates were 3.3 and 16.9%, respectively. Among adolescents with clinical records, 92.3% had ≥1 viral load, but only 51.1% of viral loads were from the past 12 months. Adolescents on ART for ≥2 years (AOR 3.42 [95%CI 2.14–5.47], p< 0.001) and who experienced decentralised care (AOR 1.39 [95%CI 1.06–1.83], p=0.018) were more likely to have a recent viral load. The average effect of decentralised care on recent viral load was greater for female (AOR 2.39 [95%CI 1.29–4.43], p=0.006) and sexually infected adolescents (AOR 3.48 [95%CI 1.04–11.65], p=0.043). Of the total cohort, 47.5% were recorded as fully virally suppressed at most recent test. Only 23.2% were recorded as fully virally suppressed within the past 12 months. Younger adolescents (AOR 1.39 [95%CI 1.06–1.82], p=0.017) and those on ART for ≥2 years (AOR 1.70 [95%CI 1.12–2.58], p=0.013) were more likely to be fully viral suppressed. Conclusions Viral load recording and viral suppression rates remain low for ART-initiated adolescents in South Africa. Improved outcomes for this population require stronger engagement in care and viral load monitoring. DA - 2021-01-13 DB - OpenUCT DP - University of Cape Town IS - Article number: 60 J1 - BMC Infectious Diseases KW - Adolescent KW - HIV KW - Antiretroviral therapy KW - South Africa KW - Care cascade KW - Continuum of care LK - https://open.uct.ac.za PY - 2021 T1 - The HIV care cascade for adolescents initiated on antiretroviral therapy in a health district of South Africa: a retrospective cohort study TI - The HIV care cascade for adolescents initiated on antiretroviral therapy in a health district of South Africa: a retrospective cohort study UR - http://hdl.handle.net/11427/35146 ER - | en_ZA |
| dc.identifier.uri | https://doi.org/10.1186/s12879-020-05742-9 | |
| dc.identifier.uri | http://hdl.handle.net/11427/35146 | |
| dc.identifier.vancouvercitation | Haghighat R, Toska E, Bungane N, Cluver L. The HIV care cascade for adolescents initiated on antiretroviral therapy in a health district of South Africa: a retrospective cohort study. BMC Infectious Diseases. 2021;21(Article number: 60) http://hdl.handle.net/11427/35146. | en_ZA |
| dc.language.iso | en | en_US |
| dc.language.rfc3066 | en | |
| dc.publisher.department | Centre for Social Science Research(CSSR) | en_US |
| dc.publisher.faculty | Faculty of Humanities | en_US |
| dc.rights.holder | The Author(s) | |
| dc.rights.uri | http://creativecommons.org/licenses/by/4.0/ | en_US |
| dc.source | BMC Infectious Diseases | en_US |
| dc.source.journalissue | Article number: 60 | en_US |
| dc.source.journalvolume | 21 | en_US |
| dc.source.uri | https://bmcinfectdis.biomedcentral.com/ | |
| dc.subject | Adolescent | en_US |
| dc.subject | HIV | en_US |
| dc.subject | Antiretroviral therapy | en_US |
| dc.subject | South Africa | en_US |
| dc.subject | Care cascade | en_US |
| dc.subject | Continuum of care | en_US |
| dc.title | The HIV care cascade for adolescents initiated on antiretroviral therapy in a health district of South Africa: a retrospective cohort study | en_US |
| dc.type | Journal Article | en_US |