Quality of care, loss to follow-up and mortality among paediatric and adolescent HIV patients on antiretroviral therapy in Abuja, Nigeria: a 15-year retrospective review

Background: Loss to follow up, and mortality still remains very high among HIV positive children and adolescents in many under privileged settings, in spite of massive scale up of anti-retroviral treatment. We assessed the quality of care using 7-point indicators, loss to follow up, and mortality among HIV positive children and adolescents in our health institution.Method: A 15-year (2006 to 2020) retrospective review was conducted among HIV positive children who assessed care in paediatric out-patient special treatment clinic of our tertiary health institution in Nigeria for above objective.Results: Of the 563 subjects initiated on antiretroviral therapy, 349 (62.0%) still remained on treatment. There were 285 (50.6%) males, highest enrollment 280 (49.7%) was at 2006-2010, most 192 (34.1%) were 0-24 months of age, 244 (43.3%) were under-weight, and 176 (31.3%) had severe immune suppression at enrollment. Sixty-eight (12.1%) were lost to follow-up, mortality was 14 (2.5%), 103 (18.3.1%), and 25 (4.4%) were transferred to adult clinic, and to other centers. While over 85% had a high-quality indicator score of 458 (81.4%), with significant difference between the male and female (x2=8.56, p=0.003,), only 231 (66.2%) had adequate viral suppression of 0.001 with multivariate analysis.Conclusions: Though the study recorded high quality score services to HIV positive children and adolescents in our center, loss to follow-up, and mortality was however high. More is needed to be done to improve the viral load suppression among our clients

Anaemia in HIV positive mothers on antiretroviral therapy for prevention of mother-to-child transmission HIV in a tertiary health institution in North Central Nigeria

Background: Anaemia in pregnancy and HIV infection are two common public health issues in sub-Saharan African with Nigeria bearing the greatest burden. The duo occurring together poses a higher risk of morbidity and mortality for both the foetus and the mother. We therefore conducted this study to determine the burden of anaemia and other haematological abnormalities among HIV positive pregnant mothers on antiretroviral therapy who attended antenatal clinical services in our health institution.Methods: A 10-year retrospective review from January 2010 to December 2019 of medical records of HIV positive mothers on highly anti-retroviral therapy in attendance for antenatal clinical services in our health institution was carried out for the above objectives. Information extracted were, age, HIV status, gestational age at delivery, type of antiretroviral drugs used, duration of use, haemoglobin level, platelet, and complete blood count at booking of the positive mothers.Results: Of a total of 330 HIV positive mothers seen during the review period, 82.7% were from rural communities, 88.8% were from middle socio-economic class, 80.0% were Christians, and 80.3% started their highly active antiretroviral therapy before their index pregnancy. Most, 51.5% and 42.7% were on zidovudine, lamivudine and nevirapine, and tenofovir with lamivudine and lopinavir boasted ritonavir combinations, while 94.2% were on 1st line antiretroviral medication. Their mean age, gestational age at delivery, and parity were 31.11±4.7 years, 38.57±3.1 weeks, and 2.0±1.6 respectively. The prevalence of anaemia, thrombocytopenia and leucopoenia were 36.1%, 4.8%, and 6.7% respectively while their mean CD4 cell count and viral loads at the point of booking were 543.63±283.7 cells/μl, and 2953.02±1619.9 copies/ml. The two maternal variables that showed significant relationship with haemoglobin concentration of <10 gm/dl was mother’s level of education x2=6.29, p=0.043, and her socio=economic class, x2=10.162, p=0.006.Conclusions: There is high burden of anaemia among HIV positive mothers on antiretroviral therapy in our environment. The prevalence of thrombocytopenia and leucopoenia was much lower. The burden of maternal anaemia was associated with maternal level of education and her socio-economic class

Burden of HIV Infection in Children with Severe Acute Malnutrition at the University of Abuja Teaching Hospital Gwagwalada, Nigeria

Background: Human Immunodeficiency Virus (HIV) pandemic has adversely affected the nutritional status of many children in the sub region, an area where malnutrition is also endemic.The study was aimed at assessing the burden of HIV infection among under five with severe acute malnutrition, determine its common forms, the outcomes and associated co-morbidities.Method: A three year prospective study (April 2011 to March 2014) of children aged 6 weeks to 5 years with diagnosis of severe acute malnutrition was carried out in our health institution for the above objectives. Data analysis was conducted using SPSS version 16.0 software and statistical significance set at p &lt; 0.05.Result: Of the 286 severely malnourished children studied, 142(49.2%) males, and 144 (50.3%) females, HIV sero-prevalence was 199 (69.6%, 95% CI = 63.5-76.3%)and highest in the first year of life 85(42.7%). Though uptake of provider-initiated HIV testing and counseling was 100%,95.3% of positive children came in WHO stage 3 and 4 diseases. Persistent diarrhoea 58(29.1%),bronchopneumonia 53(26.6%), septicaemia 49(24.6%), pulmonary tuberculosis 39(19.6%), and oral candidiasis 35(17.6) were the common associated co-morbidities, with vesico-vaginal fistula 4 (2) being the least co-infection.Marasmus 161 (80.9%) was the major form of severe acute malnutrition in positive children, mortality was significantly higher in positive than in negative children (22.6.4%vs. 9.2%; P&lt;0.001), however no difference was seen in those that left against medical advice (13.6% versus 11.5, p value &lt;0.724 among the two groups.Conclusion: Human Immunodeficiency Virus burden was high in children with severe acute malnutrition in our environment, mortality and those that were left against medical advice was also high. Marasmus was the commonest form of severe malnutrition in positive children, and provider initiated counseling should be offered to children at all service delivery points in the hospital and other levels of health services for early detection of HIV infection. Some co-morbidity even when rare could be useful indication for further evaluation for HIV.</p

First and Second Line Highly Active Anti-Retroviral Therapy Failure in HIV Infected Nigerian Children at University of Abuja Teaching Hospital Gwagwalada, Nigeria

Background: In high-income countries, viral load is routinely used for monitoring HIV patients on antiretroviral therapy for early detection of drug failure. This is not the case in most resource limited settings like ours where only WHO immunological and clinical criteria are used for monitoring. This study is aimed at determining the rate/time of failure to 1st and 2nd antiretroviral drugs in children in our centers.Method: Is a retrospective study of children ≤18 years switched to 2nd line antiretroviral regimen and those requiring third line drugs from Jan 2006 to June 2015 in our health institution. Data analysis was conducted using SPSS version 16.0 software and statistical significance set at p &lt; 0.05.Result: Sixteen percent (82/514) of children on 1st line medication were switched to 2nd line drugs with switch over rate of 9 persons/year, and 6/82 (7.3%) required 3rd line medication. The median switch over time was 31.3 months (IQR 26.4-36.2) for 2nd line medication, and 42.6 months (IQR 40.1-44.3) from time of switch to 2nd line drugs for those requiring 3rd line regimen. Over 90% of patients switched to 2nd line drugs were between 9-18 years, none was an infant. The mean CD4 cell count and viral load before switch to 2nd line drugs was 109.09±29.23 cell/mm3 and 180,480.29±35,303 copies/ml, and 89.42±28.67 cell/mm3/ 237,337.5±64,619 copies/ml for those requiring 3rd line medications.There was over 450 fold increase in viral load from the expected undetectable level of 400 copies/ml after 6 months on medication before patients were switch to 2nd line drugs, and over 590 folds increase for those that require 3rd line medications. Significant difference was seen in the mean CD4 cell count and weight of those with adherence of ≥ 95% and ≤ 95% (p values were &lt;0.05).Conclusion: WHO immunological and clinical criteria were found not to be ideal for monitoring of children on antiretroviral therapy. Six monthly viral load monitoring and resistance testing should be introduced in Nigerian guideline for managing HIV children for better therapeutic and pharmacoeconomic outcomes. Third line medication should also be made available in the country and intensification of adherence is required in adolescent age group.</p