Inequality in outcomes for adolescents living with perinatally acquired HIV in sub‐Saharan Africa: a Collaborative Initiative for Paediatric HIV Education and Research (CIPHER) Cohort Collaboration analysis. (27th February 2018)

• Record Type: Journal Article
• Other Names: Slogrove Amy L investigator.; Botswana Baylor investigator.; Anabwani Gabriel investigator.; Lesotho Baylor investigator.; Mohapi Edith investigator.; Malawi Baylor investigator.; Kazembe Peter N. investigator.; Swaziland Baylor investigator.; Hlatshwayo Makhosazana investigator.; Tanzania Baylor investigator.; Lumumba Mwita investigator.; Uganda Baylor investigator.; Kekitiinwa‐Rukyalekere Adeodata investigator.; Twizere Christelle investigator.; Yotebieng Marcel investigator.; Sinayobye Jean D'amour investigator.; Ayaya Samuel investigator.; Bukusi Elizabeth investigator.; Somi Geoffrey investigator.; Lyumuya Rita investigator.; Kapella Ngonyani investigator.; Urassa Mark investigator.; Ssali Mark investigator.; Nalugoda Fred investigator.; Maartens Gary investigator.; Hoffmann Christopher J. investigator.; Vinikoor Michael investigator.; Maceta Eusebio investigator.; van Lettow Monique investigator.; Wood Robin investigator.; Sawry Shobna investigator.; Tanser Frank investigator.; Boulle Andrew investigator.; Fatti Geoffrey investigator.; Phiri Sam investigator.; Giddy Janet investigator.; Chimbetete Cleophas investigator.; Malisita Kennedy investigator.; Technau Karl investigator.; Eley Brian investigator.; Fritz Christiane investigator.; Hobbins Michael investigator.; Kamenova Kamelia investigator.; Fox Matthew P. investigator.; Dabis François investigator.; Bissagnene Emmanuel investigator.; Arrivé Elise investigator.; Coffie Patrick investigator.; Ekouevi Didier investigator.; Jaquet Antoine investigator.; Leroy Valériane investigator.; Koumakpaï Sikiratou investigator.; N'Gbeche Marie‐Sylvie investigator.; Kouakou Kouadio investigator.; Amorissani Folquet Madeleine investigator.; Eboua Tanoh François investigator.; Renner Lorna investigator.; Dicko Fatoumata investigator.; Sylla Mariam investigator.; Takassi Elom investigator.; Signate‐Sy Haby investigator.; Dior Hélène investigator.; Yé Diarra investigator.; Kouéta Fla investigator.; Ahmed Mohamed investigator.; Habtamu Zelalem investigator.; Hailegiorgis Kassahun investigator.; Melaku Zenebe investigator.; Hawken Mark investigator.; Kimenye Maureen Kamene investigator.; Mukui Irene N. investigator.; Lima Josue investigator.; Mussa Antonio investigator.; Assan Américo Rafi investigator.; Mutabazi Vincent investigator.; Sahabo Ruben investigator.; Prison Gisenyi investigator.; Antelman Gretchen investigator.; Mbatia Redempta investigator.; Somi Geoffrey investigator.; Lamb Matthew investigator.; Nash Denis investigator.; Nuwagaba‐Biribonwoha Harriet investigator.;
• Is Part Of: Journal of the International AIDS Society. Volume 21(2018)Supplement 1
• Page Start: n/a
• Page End: n/a
• Publication Date: 2018-02-27
• Subjects: adolescent -- HIV -- perinatally acquired -- sub‐Saharan Africa -- Sustainable Development Goals; AIDS (Disease) -- Periodicals; HIV infections -- Periodicals; 616.9792005
• DOI: 10.1002/jia2.25044
• Languages: English
• ISSNs: 1758-2652

Abstract

Abstract: Introduction: Eighty percent of adolescents living with perinatally and behaviourally acquired HIV live in sub‐Saharan Africa (SSA), a continent with marked economic inequality. As part of our global project describing adolescents living with perinatally acquired HIV (APH), we aimed to assess whether inequality in outcomes exists by country income group (CIG) for APH within SSA. Methods: Through the CIPHER cohort collaboration, individual retrospective data from 7 networks and 25 countries in SSA were included. APH were included if they entered care at age <10 years (as a proxy for perinatally acquired HIV) and had follow‐up at age >10 years. World Bank CIG classification for median year of first visit was used. Cumulative incidence of mortality, transfer‐out and loss‐to‐follow‐up was calculated by competing risks analysis. Mortality was compared across CIG by Cox proportional hazards models. Results: A total of 30, 296 APH were included; 50.9% were female and 75.7% were resident in low‐income countries (LIC). Median [interquartile range (IQR)] age at antiretroviral therapy (ART) start was 8.1 [6.3; 9.5], 7.8 [6.2; 9.3] and 7.3 [5.2; 8.9] years in LIC, lower‐middle income countries (LMIC) and upper‐middle income countries (UMIC) respectively. Median age at last follow‐up was 12.1 [10.9; 13.8] years, with no difference between CIG. Cumulative incidence (95% CI) for mortality between age 10 and 15 years was lowest in UMIC (1.1% (0.8; 1.4)) compared to LIC (3.5% (3.1; 3.8)) and LMIC (3.9% (2.7; 5.4)). Loss‐to‐follow‐up was highest in UMIC (14.0% (12.9; 15.3)) compared to LIC (13.1% (12.4; 13.8)) and LMIC (8.3% (6.3; 10.6)). Adjusted mortality hazard ratios (95% CI) for APH in LIC and LMIC in reference to UMIC were 2.50 (1.85; 3.37) and 2.96 (1.90; 4.61) respectively, with little difference when restricted only to APH who ever received ART. In adjusted analyses mortality was similar for male and female APH. Conclusions: Results highlight probable inequality in mortality according to CIG in SSA even when ART was received. These findings highlight that without attention towards SDG 10 (to reduce inequality within and among countries), progress towards ensuring healthy lives and promoting wellbeing for all at all ages (SDG 3) will be hampered for APH in LIC and LMIC.