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High Retention and Viral Suppression Rates Among HIV-infected Adolescents Attending an Adolescent- friendly Clinic in South Africa PowerPoint Presentation

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Description : High Retention and Viral Suppression Rates Among HIV-infected Adolescents Attending an Adolescent- friendly Clinic in South Africa

Tags : Pediatrics, Child Health, pediatric practice, pediatrician, health providers, HIV-infected infants, Adolescent Transition, HIV-infected adolescents, epidemiology, south africa

Published on : Jul 16, 2020 | Views : 1705 | Downloads : 0

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High Retention and Viral Suppression Rates Among HIV-infected Adolescents Attending an Adolescent- friendly Clinic in South Africa Brian Zanoni MD, MPH; Challine Cairns MBCh; Thobekile Sibaya; Sara Lammert MS; Jessica Haberer MD, MSc
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South African HIV-infected Adolescents Estimated 870,000 infected adolescents and young adults in 2013 ages 15 to 24 Behaviorally infected Perinatally infected
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Approaching Wave of Perinatally HIV- infected Adolescents in South Africa 150,000 200,000 250,000 300,000 350,000 0 20,000 40,000 60,000 80,000 100,000 120,000 400,000 HIV Infections in Children Ages 0-14 Years Perinatally HIV-infected Infants 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 Incidence of HIV-infected Infants Prevalence of HIV-infected Children 0 to 14 Years
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Hypotheses Adolescents attending a dedicated adolescent clinic have higher retention in care compared to those attending the standard pediatric clinic Adolescents attending a dedicated adolescent clinic have higher viral suppression compared to those attending the standard pediatric clinic
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Study Design Cross-sectional, retrospective analysis Perinatally HIV-infected adolescents and young adults ages 13 to 24 Attending Don McKenzie Hospital’s HIV clinic in Botha’s Hill, South Africa
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Durban Pietermaritzburg Don McKenzie Hospital KwaZulu-Natal Province South Africa Durba n
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Setting
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Methods Records from April 2007 to November 2015 Demographic information Clinical data Laboratory data Tracking Patients not in care  no refill or visit in 3 months Contacted by clinic staff via phone Home visit by clinic staff Searched national laboratory database for recent labs
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Study Population Inclusion criteria Attending Don McKenzie Hospital’s clinic Standard Clinic (n=153) Adolescent Clinic (n=88) Ages 13 to 24 years Perinatally HIV-infected Receiving antiretroviral therapy
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Adolescent Clinic Enrollment Adult Clinic Standard Clinic Initiate ART 6 months ART Stable weight After March 2009 Adolescent Clinic Capacity 80 Filled 2012 Transportation Disinterest Schedule conflicts
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Standard vs. Adolescent Clinic
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Outcome Definitions Retention in care Medication refilled in last 3 months Transfers Considered retained if had active prescription within 3 months of documented transfer Viral suppression Viral load <400 copies/ml at most recent results Retained and suppressed Clinic visit, pharmacy refill and viral load <400 copies/ml within the last 12 months
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Tracking Results 254 initiated ART 189 active Not in care at Don McKenzie 5 deaths 29 transfers 18 lost to follow-up 11 alternate site 4 defaulted therapy 3 unknown 13 initiated as inpatients and transferred at discharge
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Demographics
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Overall Outcomes Retention 89% (214/241) Viral suppression 84% (196/233)
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Higher Retention and Viral Suppression with Adolescent Clinic
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Higher Retention in Adolescent Clinic
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Higher Viral Suppression in Adolescent Clinic
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Retained with Viral Suppression in last 12 Months Tracked all 241 patients for viral load results in last 12 months 73% retained and suppressed Standard clinic (64%) Adolescent clinic (90%) Adolescent clinic attendance Adjusted OR 8.4; p<0.001
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Sensitivity Analysis Excluding all subjects (n=3) lost in the first 6 months of therapy o Would not have been eligible for adolescent clinic No change in results for retention, viral suppression or combined retention with viral suppression No difference when adjusting for propensity score
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Limitations Retrospective analysis Not randomized Survival bias
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Next Steps Qualitative analysis Interviews with adolescents in adolescent clinic Interviews with adolescents in standard clinic Interviews with adolescents not in care Interviews with care givers
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Acknowledgements Jessica Haberer David Bangsberg Ken Mayer Bisola Ojikutu Sara Lammert South Africa USA Stephen Carpenter Tappie Cairns Nokuthula Buthulezi Thobekile Sibaya Patients and Staff at Don McKenzie Hospital Funding: NIH T32 NAID AI 007433
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Questions

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MarieAltmann

About : I am a passionate Pediatrician with experience of working in world-renowned hospital systems as well as community-based clinics. I have skills like Advocacy, Team Building, Event Planning, and Public Speaking. A dedicated and worthy healthcare services professional with a MPH focused in International studies from Tulane School of Public Health and Tropical Medicine.
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