The state of the pediatric HIV epidemic in Lesotho.
Journal
AIDS (London, England)
ISSN: 1473-5571
Titre abrégé: AIDS
Pays: England
ID NLM: 8710219
Informations de publication
Date de publication:
15 07 2023
15 07 2023
Historique:
medline:
4
7
2023
pubmed:
19
4
2023
entrez:
18
4
2023
Statut:
ppublish
Résumé
Lesotho does not have reliable data on HIV prevalence in children, relying on estimates generated from program data. The 2016 Lesotho Population-based HIV Impact Assessment (LePHIA) aimed to determine HIV prevalence among children 0-14 years to assess the effectiveness of the prevention of mother-to-child transmission (PMTCT) program and guide future policy. A nationally representative sample of children under 15 years underwent household-based, two-stage HIV testing from November 2016-May 2017. Children <18 months with a reactive screening test were tested for HIV infection using total nucleic acid (TNA) PCR. Parents (61.1%) or legal guardians (38.9%) provided information on children's clinical history. Children aged 10-14 years also answered a questionnaire on knowledge and behaviors. HIV prevalence was 2.1% [95% confidence interval (CI): 1.5-2.6]. Prevalence in 10-14 year olds (3.2%; 95% CI: 2.1, 4.2) was significantly greater compared to 0-4 year olds (1.0%; 95% CI: 0.5, 1.6). HIV prevalence in girls and boys was 2.6% (95% CI: 1.8-3.3) and 1.5% (95% CI: 1.0-2.1), respectively. Based on reported status and/or the presence of detectable antiretrovirals, 81.1% (95% CI: 71.7-90.4) of HIV-positive children were aware of their status, 98.2% (95% CI: 90.7-100.0) of those aware were on antiretroviral therapy (ART) and 73.9% (95% CI: 62.1-85.8) of those on ART were virally suppressed. Despite the roll-out of Option B+ in Lesotho in 2013, pediatric HIV prevalence remains high. Further research is required to understand the greater prevalence among girls, barriers to PMTCT, and how to better achieve viral suppression in children with HIV.
Identifiants
pubmed: 37070538
doi: 10.1097/QAD.0000000000003581
pii: 00002030-202307150-00005
doi:
Substances chimiques
Anti-Retroviral Agents
0
Types de publication
Journal Article
Research Support, U.S. Gov't, P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
1377-1386Subventions
Organisme : PEPFAR
ID : U2GGH001226
Pays : United States
Informations de copyright
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
Références
UNICEF. HIV and AIDS in adolescents ; 2019.
UNAIDS. UNAIDS data 2021 . Geneva, Switzerland; 2021.
Gray ME, Nieburg P, Dillingham R. Pediatric human immunodeficiency virus continuum of care: a concise review of evidence-based practice . Pediatr Clin North Am 2017; 64:879–891.
Mahy M, Penazzato M, Ciaranello A, Mofenson L, Yianoutsos CT, Davies MA, et al. Improving estimates of children living with HIV from the Spectrum AIDS Impact Model . AIDS 2017; 31: (Suppl 1): S13–S22.
UNAIDS. Improving UNAIDS’ paediatric and adolescent estimates ; 2018.
Cohn J, Whitehouse K, Tuttle J, Lueck K, Tran T. Paediatric HIV testing beyond the context of prevention of mother-to-child transmission: a systematic review and meta-analysis . Lancet HIV 2016; 3:e473–e481.
Kranzer K, Meghji J, Bandason T, Dauya E, Mungofa S, Busza J, et al. Barriers to provider-initiated testing and counselling for children in a high HIV prevalence setting: a mixed methods study . PLoS Med 2014; 11:e1001649.
Govindasamy D, Ferrand RA, Wilmore SM, Ford N, Ahmed S, Afnan-Holmes H, et al. Uptake and yield of HIV testing and counselling among children and adolescents in sub-Saharan Africa: a systematic review . J Int AIDS Soc 2015; 18:20182.
Eaton JW, Garnett GP, Takavarasha FR, Mason PR, Robertson L, Schumacher CM, et al. Increasing adolescent HIV prevalence in Eastern Zimbabwe—evidence of long-term survivors of mother-to-child transmission? . PLoS One 2013; 8:e70447.
Saito S, Chung H, Mahy M, Radin AK, Jonnalagadda S, Hakim A, et al. Pediatric HIV treatment gaps in 7 East and Southern African countries: examination of modeled, survey, and routine program data . J Acquir Immune Defic Syndr 2018; 78: (Suppl 2): S134–S141.
Ugwu RO, Eneh AU. Nonvertical (horizontal) route of HIV transmission in children . J Acquir Immune Defic Syndr 2014; 65:e128–e130.
Maniar JK. Horizontal transmission of HIV-1 infection in a child: with phylodynamic evidence-case study . Indian J Sex Transm Dis AIDS 2019; 40:73–76.
Pufall EL, Nyamukapa C, Eaton JW, Mutsindiri R, Chawira G, Munyati S, et al. HIV in children in a general population sample in East Zimbabwe: prevalence, causes and effects . PLoS One 2014; 9:e113415.
Ng’eno BN, Kellogg TA, Kim AA, Mwangi A, Mwangi M, Wamicwe J, et al. Modes of HIV transmission among adolescents and young adults aged 10−24 years in Kenya . Int J STD AIDS 2018; 29:800–805.
Low A, Teasdale C, Brown K, Barradas DT, Mugurungi O, Sachathep K, et al. Human immunodeficiency virus infection in adolescents and mode of transmission in Southern Africa: a multinational analysis of population-based survey data . Clin Infect Dis 2021; 73:594–604.
Teasdale CA, Zimba R, Abrams EJ, Sachathep K, Ndagije F, Nuwagaba-Biribonwoha H, et al. Estimates of the prevalence of undiagnosed HIV among children living with HIV in Eswatini, Lesotho, Malawi, Namibia, Tanzania, Zambia, and Zimbabwe from 2015 to 2017: an analysis of data from the cross-sectional Population-based HIV Impact Assessment surveys . Lancet HIV 2022; 9:e91–e101.
Lesotho Ministry of Health (MOH). Lesotho Population-based HIV Impact Assessment 2020 (LePHIA 2020): Final Report . Maseru, Lesotho; 2022.
McDougal L, Moteetee MM, Mohai F, Mphale M, Mahanty B, Motaung B, et al. Lesotho's minimum PMTCT package: lessons learned for combating vertical HIV transmission using co-packaged medicines . J Int AIDS Soc 2012; 15:17326.
Government of Lesotho. Guidelines for the Prevention of Mother to Child Transmission of HIV (PMTCT) . Maseru, Lesotho; 2007.
Thin K, Frederix K, McCracken S, Letsie M, Low A, Patel H, et al. Progress toward HIV epidemic control in lesotho: results from a population-based survey . AIDS 2019.
Lesotho Ministry of Health, US Centers for Disease Control and Prevention, ICAP at Columbia University. Lesotho Population-based HIV Impact Assessment (LePHIA) 2016–2017: 2016–2017. Final Report . Maseru, Lesotho; 2019.
Ministry of Health and Social Welfare. Lesotho Demographic and Health Survey . ICF International; 2014.
Koal T, Burhenne H, Romling R, Svoboda M, Resch K, Kaever V. Quantification of antiretroviral drugs in dried blood spot samples by means of liquid chromatography/tandem mass spectrometry . Rapid Commun Mass Spectrom 2005; 19:2995–3001.
Schwitters A, McCracken S, Frederix K, Tierney R, Koto M, Ahmed N, et al. High HIV prevalence and associated factors in Lesotho: results from a population-based survey . PLoS One 2022; 17:e0271431.
ICAP at Columbia University, The United States Centers for Disease Control and Prevention, Westat. Population-based HIV Impact Assessment (PHIA) data use manual . New York, NY; 2019.
Rutstein S. Steps to constructing the new DHS wealth index ; 2015.
Low A, Gummerson E, Schwitters A, Bonifacio R, Teferi M, Mutenda N, et al. Food insecurity and the risk of HIV acquisition: findings from population-based surveys in six sub-Saharan African countries (2016–2017) . BMJ Open 2022; 12:e058704.
Ray N, Ebener S. AccessMod 3.0: computing geographic coverage and accessibility to healthcare services using anisotropic movement of patients . Int J Health Geogr 2008; 7:63.
Rust KF, Rao JN. Variance estimation for complex surveys using replication techniques . Stat Methods Med Res 1996; 5:283–310.
Ng’eno B, Mwangi A, Ng’ang’a L, Kim AA, Waruru A, Mukui I, et al. Burden of HIV infection among children aged 18 months to 14 years in Kenya: results from a nationally representative population-based cross-sectional survey . J Acquir Immune Defic Syndr 2014; 66: (Suppl 1): S82–88.
Slogrove AL, Sohn AH. The global epidemiology of adolescents living with HIV: time for more granular data to improve adolescent health outcomes . Curr Opin HIV AIDS 2018; 13:170–178.
Slogrove AL, Mahy M, Armstrong A, Davies MA. Living and dying to be counted: what we know about the epidemiology of the global adolescent HIV epidemic . J Int AIDS Soc 2017; 20: (Suppl 3): 21520.
Galli L, Puliti D, Chiappini E, Gabiano C, Tovo PA, Pezzotti P, et al. Lower mother-to-child HIV-1 transmission in boys is independent of type of delivery and antiretroviral prophylaxis: the Italian Register for HIV Infection in Children . J Acquir Immune Defic Syndr 2005; 40:479–485.
Taha TE, Nour S, Kumwenda NI, Broadhead RL, Fiscus SA, Kafulafula G, et al. Gender differences in perinatal HIV acquisition among African infants . Pediatrics 2005; 115:e167–e172.
Brody S, Gisselquist D, Potterat JJ, Drucker E. Evidence of iatrogenic HIV transmission in children in South Africa . BJOG 2003; 110:450–452.
Brewer DD, Gisselquist D, Brody S, Potterat JJ. Investigating iatrogenic HIV transmission in Ugandan children . J Acquir Immune Defic Syndr 2007; 45:253–254.
Lalor K. Child sexual abuse in sub-Saharan Africa: a literature review . Child Abuse Negl 2004; 28:439–460.
Ministry of Social Development of Lesotho, ICAP at Columbia University, Centers for Disease Control and Prevention. Violence against Children and Youth Survey, 2018 . Maseru, Lesotho; 2020.
Ferrand RA, Corbett EL, Wood R, Hargrove J, Ndhlovu CE, Cowan FM, et al. AIDS among older children and adolescents in Southern Africa: projecting the time course and magnitude of the epidemic . AIDS 2009; 23:2039–2046.
Bauermeister JA, Elkington K, Brackis-Cott E, Dolezal C, Mellins CA. Sexual behavior and perceived peer norms: comparing perinatally HIV-infected and HIV-affected youth . J Youth Adolesc 2009; 38:1110–1122.
Elkington KS, Bauermeister JA, Robbins RN, Gromadzka O, Abrams EJ, Wiznia A, et al. Individual and contextual factors of sexual risk behavior in youth perinatally infected with HIV . AIDS Patient Care STDS 2012; 26:411–422.
Brittain K, Myer L, Phillips N, Cluver LD, Zar HJ, Stein DJ, et al. Behavioural health risks during early adolescence among perinatally HIV-infected South African adolescents and same-age, HIV-uninfected peers . AIDS Care 2019; 31:131–140.
Low A, Thin K, Davia S, Mantell J, Koto M, McCracken S, et al. Correlates of HIV infection in adolescent girls and young women in Lesotho: results from a population-based survey . Lancet HIV 2019; 6:e613–e622.
Ayton S, Schwitters A, Mantell JE, Nuwagaba-Biribonwoha H, Hakim A, Hoffman S, et al. Male partner age, viral load, and HIV infection in adolescent girls and young women: Evidence from eight sub-Saharan African countries . AIDS 2022.
Wong VJ, Murray KR, Phelps BR, Vermund SH, McCarraher DR. Adolescents, young people, and the 90-90-90 goals: a call to improve HIV testing and linkage to treatment . AIDS 2017; 31: (Suppl 3): S191–S194.
Clemens SL, Macneal KD, Alons CL, Cohn JE. Screening algorithms to reduce burden of pediatric HIV testing: a systematic review and meta-analysis . Pediatr Infect Dis J 2020; 39:e303–e309.
Desmonde S, Tanser F, Vreeman R, Takassi E, Edmonds A, Lumbiganon P, et al. Access to antiretroviral therapy in HIV-infected children aged 0−19 years in the International Epidemiology Databases to Evaluate AIDS (IeDEA) Global Cohort Consortium, 2004-2015: a prospective cohort study . PLoS Med 2018; 15:e1002565.
Kakkar F, Lee T, Hawkes MT, Brophy J, Lindy S, Singer J, et al. Challenges to achieving and maintaining viral suppression among children living with HIV . AIDS 2020; 34:687–697.
Penazzato M, Townsend CL, Rakhmanina N, Cheng Y, Archary M, Cressey TR, et al. Prioritising the most needed paediatric antiretroviral formulations: the PADO4 list . Lancet HIV 2019; 6:e623–e631.