Maria H Kim1,2, Richard S Wanless1, Alison Chantal Caviness1, Rachel Golin3, Anouk Amzel3, Saeed Ahmed1,2, Joseph Mhango2, David Damba4, Angelina Kayabu5, Moses Chodota6, Sandile Dlamini7, Nodumo Chidah8, Mokhitli Mokhali9, Nancy R Calles1, Elaine J Abrams10. 1. Department of Pediatrics, Baylor International Pediatric AIDS Initiative, Houston, TX. 2. Baylor College of Medicine Abbott Fund Children's Clinical Centre of Excellence Malawi, Lilongwe, Malawi. 3. United States Agency for International Development, Washington. 4. Baylor College of Medicine, Bristol Myers Squibb's Children's Clinical Centre of Excellence, Mulago Hospital, Kampala, Uganda. 5. Baylor College of Medicine, Lake Zone Children's Clinical Centre of Excellence, Bugando Medical Centre, Mwanza, Tanzania. 6. Baylor College of Medicine, Southern Highlands Zone Children's Clinical Centre of Excellence, Mbeya Referral Hospital, Mbeya, Tanzania. 7. Baylor College of Medicine, Bristol Myers Squibb's Children's Clinical Centre of Excellence, Mbabane, Swaziland. 8. Botswana-Baylor Children's Clinical Centre of Excellence, Botswana, Gaborone, Botswana. 9. Baylor College of Medicine, Bristol Myers Squibb's Children's Clinical Centre of Excellence Lesotho, Maseru, Lesotho; and. 10. ICAP at Columbia, Mailman School of Public Health, Columbia University, New York, NY.
Abstract
BACKGROUND: To reach 90-90-90 targets, differentiated approaches to care are necessary. We describe the experience of delivering multimonth prescription (MMP) schedules of antiretroviral therapy (ART) to youth at centers of excellence in 6 African countries. METHODS: We analyzed data from electronic medical records of patients aged 0-19 years started on ART. Patients were eligible to transition from monthly prescribing to MMP when clinically stable [improving CD4, viral load (VL) suppression, or minimal HIV-associated morbidity] and ART adherent (pill count 95%-105%). Patients were classified as transitioned to MMP after 3 consecutive visits at intervals of >56 days. We used survival analysis to describe death and lost to follow-up. We described adherence and acceptable immunologic response by CD4 using 6-month and VL suppression (<400 copies per milliliter) using 12-month intervals. RESULTS: Twenty-two thousand six hundred fifty-eight patients aged 0-19 years received ART and 14,932 (66%) transitioned to MMP between 2003 and 2015. Of these 2.6% were lost to follow-up and 2.0% died. Median duration of MMP was 3.9 (interquartile range: 2.2-5.9) years. There were significant differences in survival (P < 0.0001) between age groups, worst among those younger than 1 year and 15-19 years. The frequency of favorable clinical endpoints was high throughout the first 5 years of MMP, by year ranging from 87% to 94% acceptable immunologic response, 75% to 80% adherent, and 79% to 85% VL suppression. CONCLUSIONS: These analyses from 6 African countries demonstrate that youth on ART who transitioned to MMP overall maintained favorable outcomes in terms of death, retention, adherence, immunosuppression, and viral suppression. These results reassure that children and adolescents, who are clinically stable and ART adherent, can do well with reduced visit frequencies and extended ART refills.
BACKGROUND: To reach 90-90-90 targets, differentiated approaches to care are necessary. We describe the experience of delivering multimonth prescription (MMP) schedules of antiretroviral therapy (ART) to youth at centers of excellence in 6 African countries. METHODS: We analyzed data from electronic medical records of patients aged 0-19 years started on ART. Patients were eligible to transition from monthly prescribing to MMP when clinically stable [improving CD4, viral load (VL) suppression, or minimal HIV-associated morbidity] and ART adherent (pill count 95%-105%). Patients were classified as transitioned to MMP after 3 consecutive visits at intervals of >56 days. We used survival analysis to describe death and lost to follow-up. We described adherence and acceptable immunologic response by CD4 using 6-month and VL suppression (<400 copies per milliliter) using 12-month intervals. RESULTS: Twenty-two thousand six hundred fifty-eight patients aged 0-19 years received ART and 14,932 (66%) transitioned to MMP between 2003 and 2015. Of these 2.6% were lost to follow-up and 2.0% died. Median duration of MMP was 3.9 (interquartile range: 2.2-5.9) years. There were significant differences in survival (P < 0.0001) between age groups, worst among those younger than 1 year and 15-19 years. The frequency of favorable clinical endpoints was high throughout the first 5 years of MMP, by year ranging from 87% to 94% acceptable immunologic response, 75% to 80% adherent, and 79% to 85% VL suppression. CONCLUSIONS: These analyses from 6 African countries demonstrate that youth on ART who transitioned to MMP overall maintained favorable outcomes in terms of death, retention, adherence, immunosuppression, and viral suppression. These results reassure that children and adolescents, who are clinically stable and ART adherent, can do well with reduced visit frequencies and extended ART refills.
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