Cargando…

Rates and Determinants of Retention on ART Among Orphans and Vulnerable Children Living With HIV in Tanzania

Despite the global progress in response to HIV and AIDS, notable challenges remain for children, especially identification, linkage, and retention in HIV care and treatment services. To succeed in pediatric HIV programming requires the linkage and retention of the children in those services over tim...

Descripción completa

Detalles Bibliográficos
Autores principales: Charles, John, Exavery, Amon, Ally, Amal, Mseya, Remmy, Mbwambo, Tumainiel, Barankena, Asheri, Kyaruzi, Christina, Kikoyo, Levina
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9366305/
https://www.ncbi.nlm.nih.gov/pubmed/35968450
http://dx.doi.org/10.3389/fpubh.2022.934412
_version_ 1784765533143433216
author Charles, John
Exavery, Amon
Ally, Amal
Mseya, Remmy
Mbwambo, Tumainiel
Barankena, Asheri
Kyaruzi, Christina
Kikoyo, Levina
author_facet Charles, John
Exavery, Amon
Ally, Amal
Mseya, Remmy
Mbwambo, Tumainiel
Barankena, Asheri
Kyaruzi, Christina
Kikoyo, Levina
author_sort Charles, John
collection PubMed
description Despite the global progress in response to HIV and AIDS, notable challenges remain for children, especially identification, linkage, and retention in HIV care and treatment services. To succeed in pediatric HIV programming requires the linkage and retention of the children in those services over time. This study assessed the level of retention to antiretroviral therapy (ART) and its associated factors among orphans and vulnerable children living with HIV (OVCLHIV) in Tanzania. Data were obtained from the USAID Kizazi Kipya project that collected pediatric ART data from October 2017 to October 2019 in 81 district councils of Tanzania. Community-based volunteers supported the linkage and retention of the OVCLHIV on ART. Analysis of on-ART status was conducted in a cohort of OVCLHIV aged 0–20 years enrolled in the project and monitored for 24 months. OVCLHIV who remained on ART until the end of the follow-up period were referred to as “retained,” otherwise, “not retained”. Multivariable analysis was conducted using logistic regression, adjusting for baseline characteristics. Of the 5,304 OVCLHIV analyzed, the mean age was 13.1 years, 51.5% were female, and 72.2% were living with female caregivers. Their overall rate of retention on ART over the 24 months was 86.7%. Multivariable analysis showed that as the higher frequency of home visit by the project staff increased, the likelihood of retention increased by 8% [adjusted odds ratio (aOR) = 1.08, 95% CI 1.06–1.11, p < 0.001]. Membership in people living with HIV (PLHIV) support groups was associated with a higher likelihood of retention compared to nonmembership (aOR = 3.31, 95% CI 2.60–4.21, p < 0.001). Children in larger family size were 22% less likely to sustain ART (aOR = 0.78, 95% CI 0.72–0.84, p < 0.001). Urban OVCLHIV were 18% less likely to remain on ART than their rural counterparts (aOR = 0.82, 95% CI 0.69–0.98, p = 0.030). Remaining on ART was 49% more likely for OVC in economically better-off households than those in destitute households (aOR = 1.49, 95% CI 1.22–1.81, p < 0.001). Male OVC were 17% less likely to be retained on ART than their female counterparts (aOR = 0.83, 95% CI 0.71–0.99, p = 0.033). Community-based OVC support resulted in a high pediatric retention rate over the 24 months of follow-up. While key enablers of retention were higher frequency of home visits by the project volunteer, participation in PLHIV support groups, and better economic status, large family sizes, urban place of residence, and male gender of the OVC were barriers. This study brings useful evidence to inform strategies for advancing retention of OVCLHIV on ART for their better health outcomes and overall wellbeing.
format Online
Article
Text
id pubmed-9366305
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher Frontiers Media S.A.
record_format MEDLINE/PubMed
spelling pubmed-93663052022-08-12 Rates and Determinants of Retention on ART Among Orphans and Vulnerable Children Living With HIV in Tanzania Charles, John Exavery, Amon Ally, Amal Mseya, Remmy Mbwambo, Tumainiel Barankena, Asheri Kyaruzi, Christina Kikoyo, Levina Front Public Health Public Health Despite the global progress in response to HIV and AIDS, notable challenges remain for children, especially identification, linkage, and retention in HIV care and treatment services. To succeed in pediatric HIV programming requires the linkage and retention of the children in those services over time. This study assessed the level of retention to antiretroviral therapy (ART) and its associated factors among orphans and vulnerable children living with HIV (OVCLHIV) in Tanzania. Data were obtained from the USAID Kizazi Kipya project that collected pediatric ART data from October 2017 to October 2019 in 81 district councils of Tanzania. Community-based volunteers supported the linkage and retention of the OVCLHIV on ART. Analysis of on-ART status was conducted in a cohort of OVCLHIV aged 0–20 years enrolled in the project and monitored for 24 months. OVCLHIV who remained on ART until the end of the follow-up period were referred to as “retained,” otherwise, “not retained”. Multivariable analysis was conducted using logistic regression, adjusting for baseline characteristics. Of the 5,304 OVCLHIV analyzed, the mean age was 13.1 years, 51.5% were female, and 72.2% were living with female caregivers. Their overall rate of retention on ART over the 24 months was 86.7%. Multivariable analysis showed that as the higher frequency of home visit by the project staff increased, the likelihood of retention increased by 8% [adjusted odds ratio (aOR) = 1.08, 95% CI 1.06–1.11, p < 0.001]. Membership in people living with HIV (PLHIV) support groups was associated with a higher likelihood of retention compared to nonmembership (aOR = 3.31, 95% CI 2.60–4.21, p < 0.001). Children in larger family size were 22% less likely to sustain ART (aOR = 0.78, 95% CI 0.72–0.84, p < 0.001). Urban OVCLHIV were 18% less likely to remain on ART than their rural counterparts (aOR = 0.82, 95% CI 0.69–0.98, p = 0.030). Remaining on ART was 49% more likely for OVC in economically better-off households than those in destitute households (aOR = 1.49, 95% CI 1.22–1.81, p < 0.001). Male OVC were 17% less likely to be retained on ART than their female counterparts (aOR = 0.83, 95% CI 0.71–0.99, p = 0.033). Community-based OVC support resulted in a high pediatric retention rate over the 24 months of follow-up. While key enablers of retention were higher frequency of home visits by the project volunteer, participation in PLHIV support groups, and better economic status, large family sizes, urban place of residence, and male gender of the OVC were barriers. This study brings useful evidence to inform strategies for advancing retention of OVCLHIV on ART for their better health outcomes and overall wellbeing. Frontiers Media S.A. 2022-07-28 /pmc/articles/PMC9366305/ /pubmed/35968450 http://dx.doi.org/10.3389/fpubh.2022.934412 Text en Copyright © 2022 Charles, Exavery, Ally, Mseya, Mbwambo, Barankena, Kyaruzi and Kikoyo. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Public Health
Charles, John
Exavery, Amon
Ally, Amal
Mseya, Remmy
Mbwambo, Tumainiel
Barankena, Asheri
Kyaruzi, Christina
Kikoyo, Levina
Rates and Determinants of Retention on ART Among Orphans and Vulnerable Children Living With HIV in Tanzania
title Rates and Determinants of Retention on ART Among Orphans and Vulnerable Children Living With HIV in Tanzania
title_full Rates and Determinants of Retention on ART Among Orphans and Vulnerable Children Living With HIV in Tanzania
title_fullStr Rates and Determinants of Retention on ART Among Orphans and Vulnerable Children Living With HIV in Tanzania
title_full_unstemmed Rates and Determinants of Retention on ART Among Orphans and Vulnerable Children Living With HIV in Tanzania
title_short Rates and Determinants of Retention on ART Among Orphans and Vulnerable Children Living With HIV in Tanzania
title_sort rates and determinants of retention on art among orphans and vulnerable children living with hiv in tanzania
topic Public Health
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9366305/
https://www.ncbi.nlm.nih.gov/pubmed/35968450
http://dx.doi.org/10.3389/fpubh.2022.934412
work_keys_str_mv AT charlesjohn ratesanddeterminantsofretentiononartamongorphansandvulnerablechildrenlivingwithhivintanzania
AT exaveryamon ratesanddeterminantsofretentiononartamongorphansandvulnerablechildrenlivingwithhivintanzania
AT allyamal ratesanddeterminantsofretentiononartamongorphansandvulnerablechildrenlivingwithhivintanzania
AT mseyaremmy ratesanddeterminantsofretentiononartamongorphansandvulnerablechildrenlivingwithhivintanzania
AT mbwambotumainiel ratesanddeterminantsofretentiononartamongorphansandvulnerablechildrenlivingwithhivintanzania
AT barankenaasheri ratesanddeterminantsofretentiononartamongorphansandvulnerablechildrenlivingwithhivintanzania
AT kyaruzichristina ratesanddeterminantsofretentiononartamongorphansandvulnerablechildrenlivingwithhivintanzania
AT kikoyolevina ratesanddeterminantsofretentiononartamongorphansandvulnerablechildrenlivingwithhivintanzania