Browsing by Subject "Viremia"

Now showing 1 - 3 of 3
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    Contraception use and HIV outcomes among women initiating dolutegravir-containing antiretroviral therapy in Kenya: a retrospective cohort study
    (Wiley, 2022) Humphrey, John M.; Omodi, Victor; Bernard, Caitlin; Maina, Mercy; Thorne, Julie; Mwangi, Ann; Wools-Kaloustian, Kara; Patel, Rena C.; Medicine, School of Medicine
    Introduction: The rollout of dolutegravir (DTG) in low- and middle-income countries was disrupted by a potential association reported with periconceptional DTG exposure among women living with HIV (WLHIV) and infant neural tube defects. This prompted countries to issue interim guidance limiting DTG use among women of reproductive potential to those on effective contraception. Data to understand the potential impact of such guidance on WLHIV are limited. Methods: We conducted a retrospective cohort analysis of WLHIV 15-49 years initiating DTG-containing antiretroviral treatment (ART) in Kenya from 2017 to 2020. We determined baseline effective (oral, injectable or lactational amenorrhea) and very effective (implant, intrauterine device or female sterilization) contraception use among women who initiated DTG before (Group 1) or during (Group 2) the interim guideline period. We defined incident contraception use in each group as the number of contraceptive methods initiated ≤180 days post-guideline (Group 1) or post-DTG initiation (Group 2). We determined the proportions of all women who switched from DTG- to non-nucleoside reverse transcriptase inhibitor (NNRTI)- (efavirenz or nevirapine) containing ART ≤12 months post-DTG initiation, compared their viral suppression (<1000 copies/ml) and conducted multivariable logistic regression to determine factors associated with switching from DTG to NNRTI-containing ART. Results: Among 5155 WLHIV in the analysis (median age 43 years), 89% initiated DTG after transitioning from an NNRTI. Baseline effective and very effective contraception use, respectively, by the group were: Group 1 (12% and 13%) and Group 2 (41% and 35%). Incident contraception use in each group was <5%. Overall, 498 (10%) women switched from DTG to an NNRTI. Viral suppression among those remaining on DTG versus switched to NNRTI was 95% and 96%, respectively (p = 0.63). In multivariable analysis, incident effective and very effective contraception use was not associated with switching. Conclusions: Baseline, but not incident, effective contraception use was higher during the interim guideline period compared to before it, suggesting women already using effective contraception were preferentially selected to initiate DTG after the guideline was released. These findings reveal challenges in the implementation of policy which ties antiretroviral access to contraceptive use. Future guidance should capture nuances of contraception decision-making and support women's agency to make informed decisions.
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    Implementing WHO Differentiated Service Delivery Model for Pregnant and Breastfeeding Women and Infants Living with HIV: Insights from Kenyan Healthcare Providers
    (Global Health and Education Projects, 2025-01-22) Humphrey, John; Carlucci, James G.; Wanjama, Esther Karen; Naanyu, Violet; Muli, Lindah; Alera, Joy Marsha; Were, Edwin; McGuire, Alan; Nyandiko, Winstone; Zimet, Gregory; Jerono Songok, Julia; Wools-Kaloustian, Kara; Medicine, School of Medicine
    Background and Objective:: Differentiated service delivery (DSD) is a strategy endorsed by the World Health Organization that simplifies and adapts human immunodeficiency (HIV) services to meet the needs of people living with HIV (PLHIV) while reducing unnecessary health system burdens. DSD for PLHIV has been widely adopted in sub-Saharan Africa, but DSD for women and infants enrolled in prevention of mother-to-child HIV transmission (PMTCT) services is lacking. Methods:: We conducted in-depth interviews with healthcare providers (i.e., clinicians, nurses, and mentor mothers) in antenatal and postnatal clinics at two facilities affiliated with the Academic Model Providing Access to Healthcare (AMPATH) in Kenya to explore perspectives on the adaptation of DSD for PMTCT. Providers were recruited in person at each facility. Interview guides focused on their views on DSD implementation for PMTCT, characteristics of stable and unstable PMTCT clients, and strategies to improve PMTCT services. We used inductive coding with illustrative quotes to highlight emerging themes. Results:: 12 PMTCT providers (6 antenatal, 6 postnatal; 4 clinicians, 4 nurses, and 4 mentor mothers) were enrolled; 10 (83%) were female, with a median age of 40 years, and a median of 7 years of PMTCT experience. Providers held positive views about the potential benefits of DSD for PMTCT but expressed concern about reducing service intensity during pregnancy/breastfeeding. Providers also suggested specific criteria defining stable PMTCT clients beyond those used for non-pregnant PLHIV, such as having no pregnancy complications, psychosocial or socioeconomic barriers, or breastfed infants. Conclusion and Global Health Implications:: Filling the gap in DSD guidance for this population will require adaptations to the DSD model that are responsive to providers’ concerns and the unique aspects of the pregnancy-postpartum service continuum, which may vary across settings based on contextual and client-level factors. Such nuanced guidance will need to remain clear and simple to implement to ensure implementation fidelity at scale.
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    Retention in care and viral suppression in the PMTCT continuum at a large referral facility in western Kenya
    (Springer, 2022) Humphrey, John M.; Songok, Julia; Ofner, Susan; Musick, Beverly; Alera, Marsha; Kipchumba, Bett; McHenry, Megan S.; Carlucci, James G.; Park, Jun; Mwangi, Winfred; Yiannoutsos, Constantin; Bakoyannis, Giorgos; Wools-Kaloustian, Kara; Medicine, School of Medicine
    Medical records of pregnant and postpartum women living with HIV and their infants attending a large referral facility in Kenya from 2015 to 2019 were analyzed to identify characteristics associated with retention in care and viral suppression. Women were stratified based on the timing of HIV care enrollment: known HIV-positive (KHP; enrolled pre-pregnancy) and newly HIV-positive (NHP; enrolled during pregnancy). Associations with retention at 18 months postpartum and viral suppression (< 1000 copies/mL) were determined. Among 856 women (20% NHP), retention was 83% for KHPs and 53% for NHPs. Viral suppression was 88% for KHPs and 93% for NHPs, but 19% of women were missing viral load results. In a competing risk model, viral suppression increased by 18% for each additional year of age but was not associated with other factors. Overall, 1.9% of 698 infants with ≥ 1 HIV test result were HIV-positive. Tailored interventions are needed to promote retention and viral load testing, particularly for NHPs, in the PMTCT continuum.