High levels of viral repression, malnutrition and second-line ART use in adolescents living with HIV: a mixed methods study from Myanmar

Jillian Murray,Elkin Bermudez,Janet Ousley,Kyi Pyar Soe,Theint Thida Soe,Kyaw Tint Tun,Win Le Shwe Sin Ei,Iza Ciglenecki,Adelene Hilbig,Joanne Cyr,Phyu Ei Mon,Katherine Whitehouse,Carole Deglise

doi:10.1186/s12879-020-04968-x

Abstract

BackgroundAdolescents living with HIV/AIDS (ALHIV) are a particularly vulnerable but often overlooked group in the HIV response despite additional disease management challenges.MethodsAll ALHIV (10–19 years), on ART for ≥6 months, presenting to care at a Médecins Sans Frontières (MSF) clinic in Myanmar from January–April 2016 were eligible for the quantitative study component (clinical history, medical examination, laboratory investigation). A subset of these respondents were invited to participate in qualitative interviews. Interviews and focus groups were also conducted with other key informants (care givers, clinicians).ResultsOf 177 ALHIV, 56% (100) were aged 9–13 years and 77 (44%) were 14–19. 49% (86) had been orphaned by one parent, and 19% (33) by both. 59% (104) were severely underweight (BMI < 16). 47% presented with advanced HIV (WHO stage III/IV). 93% were virally supressed (< 250 copies/mL). 38 (21%) of ALHIV were on a second-line ART after first-line virological failure. Qualitative interviewing highlighted factors limiting adherence and the central role that HIV counsellors play for both ALHIV patients and caregivers.ConclusionsOur study shows good clinical, immunological, and virological outcomes for a cohort of Myanmar adolescents living with HIV, despite a majority being severely underweight, presenting with Stage III or IV illness, and the prevalence of comorbid infections (TB). Many treatment and adherence challenges were articulated in qualitative interviewing but emphasized the importance of actively engaging adolescents in their treatment. Comprehensive HIV care for this population must include routine viral load testing and social support programs.

Highlights

Adolescents living with Human immunodeficiency virus (HIV)/AIDS (ALHIV) are a vulnerable but often overlooked group in the HIV response despite additional disease management challenges
Adolescents living with HIV/AIDS (ALHIV) are a vulnerable but often overlooked group in the
Global projections anticipate the number of ALHIV will grow as perinatally infected children survive into adolescence and new horizontal infections start to occur [1]

Summary

Introduction

Adolescents living with HIV/AIDS (ALHIV) are a vulnerable but often overlooked group in the HIV response despite additional disease management challenges. Adolescents living with HIV/AIDS (ALHIV) are a vulnerable but often overlooked group in the HIV response, despite the fact that they have additional challenges managing their disease. They are sometimes born to HIV-positive parents and may have been orphaned, they do not always understand their disease status, and they must navigate a multitude of emotional, psychological, and physical changes [2]. We report the results of a mixedmethods study exploring the clinical characteristics, attitudes, and understanding of HIV in an ALHIV cohort in Southern Myanmar in order to inform clinical practice involving this age group. It is the first study to examine this patient population in the country that distinguishes young (10–13) from older (14–19) adolescents as unique subgroups

Methods

Results

Discussion

Conclusion