Viral load care of HIV-1 infected children and adolescents: A longitudinal study in rural Zimbabwe
Maintaining virologic suppression of children and adolescents on ART in rural communities in sub-Saharan Africa is challenging. We explored switching drug regimens to protease inhibitor (PI) based treatment and reducing nevirapine and zidovudine use in a differentiated community service delivery mod...
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| Veröffentlicht in: | PloS one 2021-01, Vol.16 (1), p.e0245085 |
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| creator | Mapangisana, Tichaona Machekano, Rhoderick Kouamou, Vinie Maposhere, Caroline McCarty, Kathy Mudzana, Marceline Munyati, Shungu Mutsvangwa, Junior Manasa, Justen Shamu, Tinei Bogoshi, Mampedi Israelski, Dennis Katzenstein, David |
| description | Maintaining virologic suppression of children and adolescents on ART in rural communities in sub-Saharan Africa is challenging. We explored switching drug regimens to protease inhibitor (PI) based treatment and reducing nevirapine and zidovudine use in a differentiated community service delivery model in rural Zimbabwe.
From 2016 through 2018, we followed 306 children and adolescents on ART in Hurungwe, Zimbabwe at Chidamoyo Christian Hospital, which provides compact ART regimens at 8 dispersed rural community outreach sites. Viral load testing was performed (2016) by Roche and at follow-up (2018) by a point of care viral load assay. Virologic failure was defined as viral load ≥1,000 copies/ml. A logistic regression model which included demographics, treatment regimens and caregiver's characteristics was used to assess risks for virologic failure and loss to follow-up (LTFU).
At baseline in 2016, 296 of 306 children and adolescents (97%) were on first-line ART, and only 10 were receiving a PI-based regimen. The median age was 12 years (IQR 8-15) and 55% were female. Two hundred and nine (68%) had viral load suppression ( |
| doi_str_mv | 10.1371/journal.pone.0245085 |
| format | Article |
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From 2016 through 2018, we followed 306 children and adolescents on ART in Hurungwe, Zimbabwe at Chidamoyo Christian Hospital, which provides compact ART regimens at 8 dispersed rural community outreach sites. Viral load testing was performed (2016) by Roche and at follow-up (2018) by a point of care viral load assay. Virologic failure was defined as viral load ≥1,000 copies/ml. A logistic regression model which included demographics, treatment regimens and caregiver's characteristics was used to assess risks for virologic failure and loss to follow-up (LTFU).
At baseline in 2016, 296 of 306 children and adolescents (97%) were on first-line ART, and only 10 were receiving a PI-based regimen. The median age was 12 years (IQR 8-15) and 55% were female. Two hundred and nine (68%) had viral load suppression (<1,000 copies/ml) and 97(32%) were unsuppressed (viral load ≥1000). At follow-up in 2018, 42/306 (14%) were either transferred 23 (7%) or LTFU 17 (6%) and 2 had died. In 2018, of the 264 retained in care, 107/264 (41%), had been switched to second-line, ritonavir-boosted PI with abacavir as a new nucleotide analog reverse transcriptase inhibitor (NRTI). Overall viral load suppression increased from 68% in 2016 to 81% in 2018 (P<0.001).
Viral load testing, and switching to second-line, ritonavir-boosted PI with abacavir significantly increased virologic suppression among HIV-infected children and adolescents in rural Zimbabwe.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0245085</identifier><identifier>PMID: 33444325</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Adolescent ; Adolescents ; Age ; Anti-Retroviral Agents - administration & dosage ; Antiretroviral agents ; Antiretroviral therapy ; Biology and Life Sciences ; Biomedical research ; Caregivers ; Child ; Children ; Children & youth ; Computer programs ; Correlation analysis ; Data analysis ; Diagnosis ; Disease transmission ; Drafting software ; Drug resistance ; Drug therapy ; Editing ; Efavirenz ; Electronic mail ; Epidemiology ; Female ; Follow-Up Studies ; Funding ; Health care ; Health sciences ; HIV ; HIV infection in children ; HIV Infections - blood ; HIV Infections - drug therapy ; HIV-1 - metabolism ; Hospitals ; Human immunodeficiency virus ; Humans ; Lamivudine ; Longitudinal Studies ; Male ; Measurement ; Medical personnel ; Medicine ; Medicine and Health Sciences ; Microbiology ; Non-nucleoside reverse transcriptase inhibitors ; Nucleoside reverse transcriptase inhibitors ; Nucleotides ; Pediatric research ; Pediatrics ; People and Places ; Pharmacy ; Preventive medicine ; Public health ; RNA-directed DNA polymerase ; Rural areas ; Rural health ; Rural Population ; Software ; Teenagers ; Tenofovir ; Training ; Viral Load ; Viremia ; Zimbabwe</subject><ispartof>PloS one, 2021-01, Vol.16 (1), p.e0245085</ispartof><rights>COPYRIGHT 2021 Public Library of Science</rights><rights>2021 Mapangisana et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2021 Mapangisana et al 2021 Mapangisana et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-a557b90e0a13b7c3852a009515cb2f0c07cb2a19bf50ceed6ccbe299a118f6e23</citedby><cites>FETCH-LOGICAL-c692t-a557b90e0a13b7c3852a009515cb2f0c07cb2a19bf50ceed6ccbe299a118f6e23</cites><orcidid>0000-0001-8931-4484 ; 0000-0003-4027-6901</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7808638/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7808638/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2095,2914,23846,27903,27904,53769,53771,79346,79347</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33444325$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Fokam, Joseph</contributor><creatorcontrib>Mapangisana, Tichaona</creatorcontrib><creatorcontrib>Machekano, Rhoderick</creatorcontrib><creatorcontrib>Kouamou, Vinie</creatorcontrib><creatorcontrib>Maposhere, Caroline</creatorcontrib><creatorcontrib>McCarty, Kathy</creatorcontrib><creatorcontrib>Mudzana, Marceline</creatorcontrib><creatorcontrib>Munyati, Shungu</creatorcontrib><creatorcontrib>Mutsvangwa, Junior</creatorcontrib><creatorcontrib>Manasa, Justen</creatorcontrib><creatorcontrib>Shamu, Tinei</creatorcontrib><creatorcontrib>Bogoshi, Mampedi</creatorcontrib><creatorcontrib>Israelski, Dennis</creatorcontrib><creatorcontrib>Katzenstein, David</creatorcontrib><title>Viral load care of HIV-1 infected children and adolescents: A longitudinal study in rural Zimbabwe</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Maintaining virologic suppression of children and adolescents on ART in rural communities in sub-Saharan Africa is challenging. We explored switching drug regimens to protease inhibitor (PI) based treatment and reducing nevirapine and zidovudine use in a differentiated community service delivery model in rural Zimbabwe.
From 2016 through 2018, we followed 306 children and adolescents on ART in Hurungwe, Zimbabwe at Chidamoyo Christian Hospital, which provides compact ART regimens at 8 dispersed rural community outreach sites. Viral load testing was performed (2016) by Roche and at follow-up (2018) by a point of care viral load assay. Virologic failure was defined as viral load ≥1,000 copies/ml. A logistic regression model which included demographics, treatment regimens and caregiver's characteristics was used to assess risks for virologic failure and loss to follow-up (LTFU).
At baseline in 2016, 296 of 306 children and adolescents (97%) were on first-line ART, and only 10 were receiving a PI-based regimen. The median age was 12 years (IQR 8-15) and 55% were female. Two hundred and nine (68%) had viral load suppression (<1,000 copies/ml) and 97(32%) were unsuppressed (viral load ≥1000). At follow-up in 2018, 42/306 (14%) were either transferred 23 (7%) or LTFU 17 (6%) and 2 had died. In 2018, of the 264 retained in care, 107/264 (41%), had been switched to second-line, ritonavir-boosted PI with abacavir as a new nucleotide analog reverse transcriptase inhibitor (NRTI). Overall viral load suppression increased from 68% in 2016 to 81% in 2018 (P<0.001).
Viral load testing, and switching to second-line, ritonavir-boosted PI with abacavir significantly increased virologic suppression among HIV-infected children and adolescents in rural Zimbabwe.</description><subject>Adolescent</subject><subject>Adolescents</subject><subject>Age</subject><subject>Anti-Retroviral Agents - administration & dosage</subject><subject>Antiretroviral agents</subject><subject>Antiretroviral therapy</subject><subject>Biology and Life Sciences</subject><subject>Biomedical research</subject><subject>Caregivers</subject><subject>Child</subject><subject>Children</subject><subject>Children & youth</subject><subject>Computer programs</subject><subject>Correlation analysis</subject><subject>Data analysis</subject><subject>Diagnosis</subject><subject>Disease transmission</subject><subject>Drafting software</subject><subject>Drug resistance</subject><subject>Drug therapy</subject><subject>Editing</subject><subject>Efavirenz</subject><subject>Electronic mail</subject><subject>Epidemiology</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Funding</subject><subject>Health care</subject><subject>Health sciences</subject><subject>HIV</subject><subject>HIV infection in children</subject><subject>HIV Infections - blood</subject><subject>HIV Infections - drug therapy</subject><subject>HIV-1 - metabolism</subject><subject>Hospitals</subject><subject>Human immunodeficiency virus</subject><subject>Humans</subject><subject>Lamivudine</subject><subject>Longitudinal Studies</subject><subject>Male</subject><subject>Measurement</subject><subject>Medical personnel</subject><subject>Medicine</subject><subject>Medicine and Health Sciences</subject><subject>Microbiology</subject><subject>Non-nucleoside reverse transcriptase inhibitors</subject><subject>Nucleoside reverse transcriptase inhibitors</subject><subject>Nucleotides</subject><subject>Pediatric research</subject><subject>Pediatrics</subject><subject>People and 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Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mapangisana, Tichaona</au><au>Machekano, Rhoderick</au><au>Kouamou, Vinie</au><au>Maposhere, Caroline</au><au>McCarty, Kathy</au><au>Mudzana, Marceline</au><au>Munyati, Shungu</au><au>Mutsvangwa, Junior</au><au>Manasa, Justen</au><au>Shamu, Tinei</au><au>Bogoshi, Mampedi</au><au>Israelski, Dennis</au><au>Katzenstein, David</au><au>Fokam, Joseph</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Viral load care of HIV-1 infected children and adolescents: A longitudinal study in rural Zimbabwe</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2021-01-14</date><risdate>2021</risdate><volume>16</volume><issue>1</issue><spage>e0245085</spage><pages>e0245085-</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Maintaining virologic suppression of children and adolescents on ART in rural communities in sub-Saharan Africa is challenging. We explored switching drug regimens to protease inhibitor (PI) based treatment and reducing nevirapine and zidovudine use in a differentiated community service delivery model in rural Zimbabwe.
From 2016 through 2018, we followed 306 children and adolescents on ART in Hurungwe, Zimbabwe at Chidamoyo Christian Hospital, which provides compact ART regimens at 8 dispersed rural community outreach sites. Viral load testing was performed (2016) by Roche and at follow-up (2018) by a point of care viral load assay. Virologic failure was defined as viral load ≥1,000 copies/ml. A logistic regression model which included demographics, treatment regimens and caregiver's characteristics was used to assess risks for virologic failure and loss to follow-up (LTFU).
At baseline in 2016, 296 of 306 children and adolescents (97%) were on first-line ART, and only 10 were receiving a PI-based regimen. The median age was 12 years (IQR 8-15) and 55% were female. Two hundred and nine (68%) had viral load suppression (<1,000 copies/ml) and 97(32%) were unsuppressed (viral load ≥1000). At follow-up in 2018, 42/306 (14%) were either transferred 23 (7%) or LTFU 17 (6%) and 2 had died. In 2018, of the 264 retained in care, 107/264 (41%), had been switched to second-line, ritonavir-boosted PI with abacavir as a new nucleotide analog reverse transcriptase inhibitor (NRTI). Overall viral load suppression increased from 68% in 2016 to 81% in 2018 (P<0.001).
Viral load testing, and switching to second-line, ritonavir-boosted PI with abacavir significantly increased virologic suppression among HIV-infected children and adolescents in rural Zimbabwe.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>33444325</pmid><doi>10.1371/journal.pone.0245085</doi><tpages>e0245085</tpages><orcidid>https://orcid.org/0000-0001-8931-4484</orcidid><orcidid>https://orcid.org/0000-0003-4027-6901</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2021-01, Vol.16 (1), p.e0245085 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_2478022659 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Public Library of Science (PLoS); PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Adolescent Adolescents Age Anti-Retroviral Agents - administration & dosage Antiretroviral agents Antiretroviral therapy Biology and Life Sciences Biomedical research Caregivers Child Children Children & youth Computer programs Correlation analysis Data analysis Diagnosis Disease transmission Drafting software Drug resistance Drug therapy Editing Efavirenz Electronic mail Epidemiology Female Follow-Up Studies Funding Health care Health sciences HIV HIV infection in children HIV Infections - blood HIV Infections - drug therapy HIV-1 - metabolism Hospitals Human immunodeficiency virus Humans Lamivudine Longitudinal Studies Male Measurement Medical personnel Medicine Medicine and Health Sciences Microbiology Non-nucleoside reverse transcriptase inhibitors Nucleoside reverse transcriptase inhibitors Nucleotides Pediatric research Pediatrics People and Places Pharmacy Preventive medicine Public health RNA-directed DNA polymerase Rural areas Rural health Rural Population Software Teenagers Tenofovir Training Viral Load Viremia Zimbabwe |
| title | Viral load care of HIV-1 infected children and adolescents: A longitudinal study in rural Zimbabwe |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-26T20%3A19%3A15IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Viral%20load%20care%20of%20HIV-1%20infected%20children%20and%20adolescents:%20A%20longitudinal%20study%20in%20rural%20Zimbabwe&rft.jtitle=PloS%20one&rft.au=Mapangisana,%20Tichaona&rft.date=2021-01-14&rft.volume=16&rft.issue=1&rft.spage=e0245085&rft.pages=e0245085-&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0245085&rft_dat=%3Cgale_plos_%3EA648383501%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2478022659&rft_id=info:pmid/33444325&rft_galeid=A648383501&rft_doaj_id=oai_doaj_org_article_f3c7e021e466452d993f61c29ba676dc&rfr_iscdi=true |