Treatment outcomes among HIV-positive orphaned and non-orphaned children on antiretroviral therapy in Johannesburg, South Africa

  • South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde, Volume 109, No. 9, Year 2019

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Study Justification:
This study aimed to investigate the treatment outcomes of HIV-positive orphaned and non-orphaned children on antiretroviral therapy (ART) in Johannesburg, South Africa. Limited research has been conducted on this topic, and the existing studies have provided mixed results. Understanding the impact of orphan status on ART outcomes could help improve intervention strategies and long-term treatment outcomes for HIV-positive children.
Highlights:
– The study included HIV-positive children aged

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study is a retrospective cohort study with a large sample size, which adds to its credibility. The use of propensity scores to match orphans and non-orphans for various factors improves the comparability of the groups. The study also reports adjusted hazard ratios and risk ratios, which provide statistical measures of the relationship between orphan status and ART outcomes. However, the study relies on self-reported data and is limited to two HIV clinics in Johannesburg, South Africa, which may affect the generalizability of the findings. To improve the strength of the evidence, future studies could consider a prospective design, include a more diverse population, and use objective measures of ART adherence.

BACKGROUND: Limited research investigating treatment outcomes for HIV-positive orphans compared with non-orphans has shown mixed results, with several studies indicating that HIV-positive orphans are at greater risk of delayed access to HIV care and poor antiretroviral therapy (ART) adherence, while other data suggest that ART outcomes of orphans can be similar to those of non-orphans. Understanding the impact of orphan status on short-term ART outcomes could improve targeted intervention strategies, and subsequent long-term treatment and developmental outcomes, for HIV-positive infants, children and adolescents. OBJECTIVES: To evaluate the relationship between orphan status and ART outcomes among HIV-positive infants, children and adolescents initiating ART at two large public sector HIV clinics in Johannesburg, South Africa. METHODS: This was a retrospective cohort study of HIV-positive children aged <18 years initiating standard first-line ART between June 2004 and May 2013. Using propensity scores, orphans and non-orphans were matched for age, sex, World Health Organization stage and ART regimen. The effect of orphanhood on attrition from care (all-cause mortality and loss to follow-up) was evaluated using Cox proportional hazards regression analysis, and its effect on having a detectable viral load (≥400 copies/mL) at 12 months on ART using binomial regression analysis with modified Poisson distribution. RESULTS: A total of 251 (29.4%) orphans (maternal, paternal or both) and 603 (70.6%) non-orphans were included at ART initiation. Following multiple imputation for missing data and propensity score matching, 222 orphans and 222 non-orphans were included. Orphans had a median age of 8.0 years (interquartile range (IQR) 4.9 – 10.7) and non-orphans 7.4 years (IQR 4.2 – 10.2). A total of 12 (5.4%) orphans and 33 (14.9%) non-orphans experienced attrition from care during the first 12 months on ART (adjusted hazard ratio 0.32, 95% confidence interval (CI) 0.17 – 0.63). Among those alive and in care, with a viral load at 12 months on ART, 18.0% of orphans (33/183) and 14.8% of non-orphans (24/162) had a detectable viral load (adjusted risk ratio 1.15, 95% CI 1.04 – 1.28). CONCLUSIONS: Orphans were less likely than non-orphans to experience attrition, but among those in care at 12 months, orphans were more likely to have detectable viral loads. Lower attrition among orphans may be due to their being in institutional or foster care, ensuring that they make their visits; however, their higher rates of non-suppression may result from lack of psychosocial support or stigma resulting in struggles to adhere. Additional research investigating age-specific outcomes will be important to elucidate these effects further.

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The study titled “Treatment outcomes among HIV-positive orphaned and non-orphaned children on antiretroviral therapy in Johannesburg, South Africa” investigates the impact of orphan status on short-term antiretroviral therapy (ART) outcomes among HIV-positive infants, children, and adolescents. The study aims to evaluate the relationship between orphan status and ART outcomes, specifically attrition from care (mortality and loss to follow-up) and detectable viral load at 12 months on ART. The findings suggest that orphans were less likely to experience attrition but more likely to have detectable viral loads compared to non-orphans. Lower attrition among orphans may be attributed to their institutional or foster care, ensuring regular visits, while higher rates of non-suppression may result from lack of psychosocial support or stigma affecting adherence. Further research is needed to investigate age-specific outcomes and understand these effects better.
AI Innovations Description
The study titled “Treatment outcomes among HIV-positive orphaned and non-orphaned children on antiretroviral therapy in Johannesburg, South Africa” explores the relationship between orphan status and antiretroviral therapy (ART) outcomes among HIV-positive infants, children, and adolescents. The study aims to understand the impact of orphanhood on short-term ART outcomes and improve intervention strategies for this population.

The study used a retrospective cohort design and included HIV-positive children aged
AI Innovations Methodology
The provided description is a research study evaluating the relationship between orphan status and antiretroviral therapy (ART) outcomes among HIV-positive infants, children, and adolescents in Johannesburg, South Africa. The study aims to understand the impact of orphanhood on short-term ART outcomes and potentially improve intervention strategies for this population.

To improve access to maternal health, here are some potential recommendations:

1. Strengthening healthcare infrastructure: Investing in healthcare facilities, equipment, and personnel can improve access to maternal health services. This includes ensuring the availability of skilled healthcare providers, essential medicines, and necessary equipment for safe deliveries.

2. Community-based interventions: Implementing community-based programs can help reach pregnant women in remote or underserved areas. These interventions may include mobile clinics, community health workers, or telemedicine services to provide prenatal care, education, and support.

3. Maternal health education: Promoting maternal health education can empower women with knowledge about pregnancy, childbirth, and postnatal care. This can be done through community workshops, educational campaigns, or digital platforms to ensure widespread access to information.

4. Financial support: Providing financial assistance, such as subsidies or insurance coverage, can help reduce the financial barriers to accessing maternal health services. This can include covering the costs of antenatal care, delivery, and postnatal care.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Define indicators: Identify key indicators to measure the impact of the recommendations, such as the number of women accessing prenatal care, the percentage of skilled birth attendance, or the reduction in maternal mortality rates.

2. Data collection: Gather relevant data on the current state of maternal health access, including the number of healthcare facilities, healthcare providers, and utilization rates. This can be done through surveys, interviews, or existing data sources.

3. Modeling: Develop a simulation model that incorporates the recommendations and their potential effects on the identified indicators. This can be done using statistical software or simulation tools.

4. Parameter estimation: Estimate the parameters of the simulation model based on available data and expert knowledge. This may involve using historical data, expert opinions, or conducting additional research.

5. Scenario analysis: Run the simulation model with different scenarios, varying the implementation of the recommendations. This can help assess the potential impact of each recommendation individually or in combination.

6. Evaluation: Analyze the simulation results to evaluate the potential impact of the recommendations on improving access to maternal health. This can include comparing the outcomes of different scenarios and identifying the most effective strategies.

7. Sensitivity analysis: Conduct sensitivity analysis to assess the robustness of the results and identify key factors that may influence the impact of the recommendations. This can help understand the uncertainties and limitations of the simulation model.

By following this methodology, policymakers and stakeholders can gain insights into the potential impact of different recommendations on improving access to maternal health and make informed decisions on implementing effective interventions.


Statistics:
Citations: 4
Identifiers:
DOI: 10.7196/SAMJ.2019.v109i9.13462
Research Areas:
Community Interventions, Disparities, Environmental, Health System and Policy, Infectious Diseases, Maternal Access, Maternal and Child Health
Study Countries:
South Africa
Study Design:
Case-Control Study, Cohort Study, randomised-control-trial
Study Approach:
Quantitative
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