Clinical Differences between Younger and Older Adults with HIV/AIDS Starting Antiretroviral Therapy in Uganda and Zimbabwe: A Secondary Analysis of the DART Trial

Objective: Clinical and immunological data about HIV in older adults from low and middle income countries is scarce. We aimed to describe differences between younger and older adults with HIV starting antiretroviral therapy in two low–income African countries. Methods: Setting:: HIV clinics in Uganda and Zimbabwe. Design:: Secondary exploratory cross-sectional analysis of the DART randomized controlled trial. Outcome Measures: Clinical and laboratory characteristics were compared between adults aged 18-49 years (younger) and ≥ 50 years (older), using two exploratory multivariable logistic regression models, one with HIV viral load (measured in a subset pre-ART) and one without. Results: A total of 3316 eligible participants enrolled in DART were available for analysis; 219 (7%) were ≥ 50 years and 1160 (35%) were male. Across the two adjusted regression models, older adults had significantly higher systolic blood pressure, lower creatinine clearance and were consistently less likely to be females compared to younger adults with HIV. Paradoxically, the models separately suggested that older adults had statistically significant (but not clinically important) higher CD4+ cell counts and higher plasma HIV–1 viral copies at initiation. Crude associations between older age and higher baseline hemoglobin, body mass index, diastolic blood pressure and lower WHO clinical stage were not sustained in the adjusted analysis. Conclusions: Our study found clinical and immunological differences between younger and older adults, in a cohort of Africans starting antiretroviral therapy. Further investigations should explore how these differences could be used to ensure equity in service delivery and affect outcomes of antiretroviral therapy

Clinical differences between younger and older adults with HIV/AIDS starting antiretroviral therapy in Uganda and Zimbabwe: a secondary analysis of the DART trial

Clinical and immunological data about HIV in older adults from low and middle income countries is scarce. We aimed to describe differences between younger and older adults with HIV starting antiretroviral therapy in two low-income African countries

A pilot study of the neuropsychological benefits of computerized cognitive rehabilitation in Ugandan children with HIV.

Objective: Because antiretroviral treatment (ART) fails to improve neurocognitive impairment in children with HIV, we completed a pilot study evaluating the feasibility and cognitive benefit of computerized cognitive rehabilitation therapy (CCRT) in Ugandan children with HIV. Method: Sixty Ugandan children with HIV (23 on ART) were randomly assigned to 10 sessions of Captain\u27s Log CCRT (Sandford, 2007) training configured for attention and memory skills or no intervention. Kaufman Assessment Battery for Children (2nd ed., KABC–2; Kaufman & Kaufman, 2004) performance at baseline indicated pervasive neurocognitive impairment. Cognitive ability was assessed before and after training using the Cogstate computerized neuropsychological test (Darby, Maruff, Collie, & McStephen, 2002). Viral load along with CD4 and CD8 absolute and activation levels also were measured posttest. Results: CCRT was well received with a 95% adherence rate to scheduled training sessions. CCRT intervention children showed greater improvement on a Cogstate card detection task of simple attention (p = .02), and speed of correct moves on a Groton Maze Learning Task (p \u3c .001). These analyses were completed using an analysis of covariance model that adjusted Cogstate performance for the child\u27s age, standardized weight for age, gender, socioeconomic status, school grade level, and baseline KABC–2 performance. ART treatment was not related to Cogstate performance or improvement as a result of CCRT. CD4 and CD8 activation levels were correlated with Cogstate improvement specifically for the CCRT group. Conclusions: CCRT was feasible with our study population and improved maze learning and attention on a detection task. This supports previous findings by our group with cerebral malaria survivors (Bangirana, Giordani, et al., 2009). (PsycINFO Database Record (c) 2016 APA, all rights reserved

Determinants of clinician knowledge on aging and HIV/AIDS: a survey of practitioners and policy makers in Kampala District, Uganda.

The HIV/AIDS epidemic has evolved with an increasing burden in older adults. We assessed for knowledge about aging and HIV/AIDS, among clinicians in Kampala district, Uganda.A cross-sectional survey of 301 clinicians complemented by 9 key-informant interviews between May and October 2011. Data was analyzed by multivariable logistic regression for potential determinants of clinician knowledge about HIV/AIDS in older adults, estimating their adjusted Odds Ratios (aOR) and 95% confidence intervals (95% CI) using Stata 11.2 software.Two-hundred and sixty-two questionnaires (87.7%) were returned. Respondents had a median age of 30 years (IQR 27-34) and 57.8% were general medical doctors. The mean knowledge score was 49% (range 8.8%-79.4%). Questions related to co-morbidities in HIV/AIDS (non-AIDS related cancers and systemic diseases) and chronic antiretroviral treatment toxicities (metabolic disorders) accounted for significantly lower scores (mean, 41.7%, 95% CI: 39.3%-44%) compared to HIV/AIDS epidemiology and prevention (mean, 65.7%, 95% CI: 63.7%-67.7%). Determinants of clinician knowledge in the multivariable analysis included (category, aOR, 95% CI): clinician age (30-39 years; 3.28∶1.65-9.75), number of persons with HIV/AIDS seen in the past year (less than 50; 0.34∶0.14-0.86) and clinical profession (clinical nurse practitioner; 0.31∶0.11-0.83). Having diploma level education had a marginal association with lower knowledge about HIV and aging (p = 0.09).Our study identified gaps and determinants of knowledge about HIV/AIDS in older adults among clinicians in Kampala district, Uganda. Clinicians in low and middle income countries could benefit from targeted training in chronic care for older adults with HIV/AIDS and long-term complications of antiretroviral treatment

Background Characteristics and HIVAIDS Knowledge Scores for Clinicians in Kampala District.

*<p>Significant difference (p<0.05) compared to the first category;</p>φ<p>compared to those without specific training Abbreviations: HIV – Human Immunodeficiency Virus; NCD – Non Communicable Diseases; PMTCT – Prevention of Mother to Child Transmission; PHAs – Persons Living with HIV/AIDS; TB – Tuberculosis; CI – Confidence Interval.</p

Clinician knowledge about HIVAIDS in older adults by thematic area (N = 262).

*<p>Correct response may be <b>T</b>-True or <b>F</b>-False.</p>§<p>Mean score.</p>Φ<p>Areas with extremely low scores (less than 40%).</p

Regression model for potential determinants of clinician Knowledge Scores.

<p>aOR – Odds Ratio adjusted for all variables in the model; CI – Confidence Interval; NS – Not Significant; Level of significance P<0.01 (§), P<0.05 (φ) and P<0.1 (***); Probability>F is <0.001 for all variables in the imputed model.</p

Logistic regression model for characteristics at ART initiation for adults who were older (≥ 50 years) compared to younger ones (18-50 years) (N=3316).

<p>Abbreviations: ALT – Alanine transaminase; AST – Aspartate transaminase; BMI – Body Mass Index; clear. – clearance; CD4+ – Cluster of Differentiation; CI – Confidence Interval; cp – copies; Cr. – Creatinine; IQR – Inter Quartile Range; Kg – Kilogramme; M² – Meter; SD – Standard Deviation; WHO – World Health Organization; <i>d</i>L – deciliter; g – grams; Hg – mercury; mmol – millimols; mL − milliliter; mm – millimeters; µL – microliter</p><p>* n=968 (</p><p>< 50 years n = 912; > 50 years n = 56) in log 10 copies per milliliter.</p><p>§ <i>Baseline adjusted model;</i> Ω <i>- model with viral load, interaction between gender and hemoglobin; and creatinine clearance (BMI excluded</i>)</p><p>α − WHO stages 2, 3 & 4 included as a linear trend</p

Characteristics at ART initiation stratified by age < 50 years and age ≥ 50 years.

<p>Abbreviations: ALT – Alanine transaminase; AST – Aspartate transaminase; BMI – Body Mass Index; CD4+ – Cluster of Differentiation; CI – Confidence Interval; cp – copies; IQR – Inter Quartile Range; neg – negative; OR – Odds Ratio; pos – positive; SD – Standard Deviation; WHO – World Health Organization; <i>d</i>L – deciliter; g – grams; Hg – mercury; mmol – millimols; mL − milliliter; mm – millimeters; µL – microliter</p><p>* <i>n=968 (< 50 years n = 912; > 50 years n = 56</i>)<i>.</i></p