Child HIV Research Articles

Cohort profile: the Swiss Mother and Child HIV Cohort Study (MoCHiV)

PurposeProspective, multicentric observational cohort study in Switzerland investigating measures to prevent mother-to-child transmission in pregnant women with HIV (WWH) and assessing health and development of their exposed children as well...

Poor Adherence and Limited Treatment Support are Risk Factors for Second Line Treatment Failure among HIV Children Under 15 Years, 2022: A Case Control Study

Title: Poor adherence and limited treatment support are risk factors associated with second line treatment failure among children under 15 years at Victoria Chitepo provincial hospital, 2022: a case control study. Background: New HIV resistance mutations have been emerging and frequently changing. HIV positive people switching to third line have been increasing in Manicaland Province. Third line anti-retroviral therapy (ART) combinations are not always available. We sort to determine the factors associated with second line treatment failure among HIV positive patients. Methods: We conducted a 1:1 unmatched case-control study among 107 case-control pairs. A case was any HIV positive individual with treatment failure confirmed by 2 viral load of ≥1000 copies/ml while a control was any HIV positive individual with a viral load of <1000/ml copies; on second line therapy at Victoria Chitepo Provincial Hospital (VCPH), in 2022. Systematic random sampling was used to select cases and controls from the line-list. Administered questionnaires were used to ascertain risk factors to second line treatment failure. Patient booklets were reviewed for demographic and clinical characteristics. Frequencies, means, medians and odds ratios were generated. Multivariate analysis and stratified analysis was performed to identify independent risk factors. Permission to proceed was sought from relevant authorities and all ethical considerations were observed. Results: Defaulting treatment (aOR=2.42, 95% CI: 1.03-5.93), missing a viral load test (aOR=5.52, 95% CI: 2.30-13.26) and being under 15 years of age (aOR=6.18, 95% CI: 1.46-26.20) were independent risk factors associated with second line treatment failure. Having a treatment support was an independent protective factor (aOR=0.30, 95% CI: 0.10-0.86). Conclusion: Poor adherence is the key drive to second line treatment failure. Good adherence is critical in children under 15 years. Treatment support promotes viral load suppression.

Study protocol for Sauti ya Vijana (The Voice of Youth): A hybrid-type 1 randomized trial to evaluate effectiveness and implementation of a mental health and life skills intervention to improve health outcomes for Tanzanian youth living with HIV.

Young people living with HIV (YPLWH) experience increased morbidity and mortality compared to all other age groups. Adolescence brings unique challenges related to sexual reproductive health, the elevated importance of peer groups, and often, emerging symptoms of emotional distress. Failure to address this unique life stage for YPLWH can lead to worse HIV and mental health outcomes. Herein lies the protocol for a hybrid-type-1 effectiveness-implementation trial designed to evaluate a mental health and life skills intervention that aims to address these needs for YPLWH in Tanzania. This is an individually randomized group-treatment trial designed to evaluate the effectiveness of Sauti ya Vijana (SYV: The Voice of Youth) toward improving viral suppression (HIV RNA <400 copies/mL) and mental health outcomes and to assess implementation including acceptability, feasibility, fidelity, and cost-effectiveness of the manualized intervention. The trial is being conducted across four geographically distinct regions of Tanzania. Peer group leaders (PGL) with lived HIV experience deliver the 10-session group-based intervention and two individual sessions during which participants describe their disclosure narrative (when they learned they live with HIV) and value-based goal setting. Caregiver or chosen supportive adults are encouraged to attend two specific group sessions with their youth. Participants are 10-24 years of age, prescribed antiretroviral therapy for at least 6 months, fully aware of their HIV status, able to commit to session attendance, and able to understand and meaningfully contribute to group sessions. Participant study visits occur at 5 time points for evaluation: baseline, 4-, 6-, 12-, and 18-months post baseline. A single booster session is conducted before the 12-month visit. Study visits evaluate mental health, adverse childhood events, interpersonal violence, resilience, stigma, HIV knowledge, substance use, sexual relationships, ART adherence, and HIV RNA. Implementation outcomes evaluate feasibility and acceptability through attendance, intervention session notes, focus discussion groups and qualitative interviews. Fidelity to the intervention is measured using fidelity checklists by a PGL observer at each group session. Cost effectiveness is calculated using an incremental cost-effectiveness ratio that utilizes a patient cost questionnaire and financial records of study costs. Few mental health interventions for YPLWH have demonstrated effectiveness. Results from this study will provide information about effectiveness and implementation of a peer-led intervention for delivering a mental health and life skills intervention in low-income settings. This trial is registered at clinicaltrials.gov NCT05374109.

Exploring the burden of care: challenges faced by caregivers of HIV-infected children in Limpopo Province, South Africa

The number of new HIV cases worldwide has gradually declined; however, South African adolescent females and young women continue to account for the most infections. Although the availability and accessibility of antiretroviral drugs have improved the survival rates of women, some still transmit HIV to their children despite the availability of HIV prevention interventions, resulting in a dual responsibility for the care of themselves and their infected children. This study aims to explore the challenges experienced by caregivers of HIV-infected children in Limpopo Province. The study employed qualitative, exploratory, and descriptive designs, and data was collected from 12 caregivers through semi-structured interviews. Data were analysed using Tesch’s eight steps of analysis. The study identified three challenges facing caregivers of HIV-positive children. Caregivers struggled with disclosure and stigma, finding it difficult to reveal the child's HIV status. The burden of care was significant, including the management of the child's unstable health, ensuring compliance with treatment, and attending frequent hospital visits. The unemployment rate posed a financial burden, particularly in arranging hospital travel costs and providing adequate nutrition to HIV-infected children. These challenges highlight the need for increased support for caregivers of HIV-infected children, including education and awareness campaigns to reduce stigma. Policymakers should consider providing financial support to caregivers. A holistic, multisectoral approach involving healthcare, education, social services, and policymakers is essential.

Integrating SARS-CoV-2 rapid antigen testing in maternal, neonatal and child health, HIV, and TB clinics in Kenya and Cameroon: outcomes from the Catalysing COVID-19 Action Project

IntroductionEarly diagnosis of SARS-CoV-2 infection is key to preventing severe disease and poor outcomes in vulnerable populations, such as pregnant women and people living with HIV or diagnosed with tuberculosis...

The Retrospective Implementation of Standardized In Utero HIV Exposure Definitions Using Routinely Collected Public Sector Data Across the Western Cape Province, South Africa.

Using the Data Evaluation and Preparation for HIV-Exposed Uninfected Child Cohorts project's standardized child HIV exposure definitions, 64%, 64% and 90% of children exposed to HIV in utero could be classified as HIV-uninfected with moderate or high certainty at the ages of 1 and 3 years and at the time of first infectious disease hospitalization, respectively. These definitions can be applied retrospectively to routine datasets with linked mother-child data.

HIV in pregnant woman and children: Mother-to-child transmission of HIV in the Brazilian land border from 2010 to 2021.

The aim of the present study was to analyze the profile and trends of HIV mother-to-child transmission (MTCT) in the Brazilian land border strip (LBS). This was a quantitative, ecological, and cross-sectional study using secondary data available in the information systems of the Brazilian Ministry of Health. All cases reported in the Notifiable Diseases Information System between 2010 and 2021 were studied. Between 2010 and 2021, 275 children were born infected through MTCT, and 6076 pregnant women were living with HIV in the Brazilian LBS. HIV detection rates in pregnant women increased in all border arcs. The northern arc experienced the highest increase (19.6%), followed by the central arc (11.4%), and the southern arc (6.1%). Despite historically high detection rates, the southern arc exhibited the smallest increase. While MTCT rate decreased by 37.7% in the border area, the central arc showed no statistically significant reduction. In 2021, the average age of pregnant women was 26.2 years, 25.7% had up to 8 years of schooling, and 55.8% identified as non-white. The majority (92.8%) received antenatal care, and 59.7% were diagnosed with HIV before prenatal care. The use of prophylactic antiretroviral therapy during prenatal care occurred in 69.6% of pregnant women, and infant prophylaxis was provided within first 24 h to 43.6% of live births. The results indicate progress in reducing MTCT cases in Brazilian LBS. Disparities in HIV detection rates may be influenced by differences in testing uptake, despite mandatory testing for all babies. It is crucial to continue implementing strategies to reach these women and ensure equitable access to healthcare services for MTCT prevention.

Sustained aviremia despite anti-retroviral therapy non-adherence in male children after in utero HIV transmission.

After sporadic reports of post-treatment control of HIV in children who initiated combination anti-retroviral therapy (cART) early, we prospectively studied 284 very-early-cART-treated children from KwaZulu-Natal, South Africa, after vertical HIV transmission to assess control of viremia. Eighty-four percent of the children achieved aviremia on cART, but aviremia persisting to 36 or more months was observed in only 32%. We observed that male infants have lower baseline plasma viral loads (P = 0.01). Unexpectedly, a subset (n = 5) of males maintained aviremia despite unscheduled complete discontinuation of cART lasting 3-10 months (n = 4) or intermittent cART adherence during 17-month loss to follow-up (n = 1). We further observed, in vertically transmitted viruses, a negative correlation between type I interferon (IFN-I) resistance and viral replication capacity (VRC) (P < 0.0001) that was markedly stronger for males than for females (r = -0.51 versus r = -0.07 for IFN-α). Although viruses transmitted to male fetuses were more IFN-I sensitive and of higher VRC than those transmitted to females in the full cohort (P < 0.0001 and P = 0.0003, respectively), the viruses transmitted to the five males maintaining cART-free aviremia had significantly lower replication capacity (P < 0.0001). These data suggest that viremic control can occur in some infants with in utero-acquired HIV infection after early cART initiation and may be associated with innate immune sex differences.

Assessing the impact of autologous neutralizing antibodies on rebound dynamics in postnatally SHIV-infected ART-treated infant rhesus macaques.

The presence of antibodies against HIV in infected children is associated with a greater capacity to control viremia in the absence of therapy. While the benefits of early antiretroviral treatment (ART) in infants are well documented, early ART may interfere with the development of antibody responses. In contrast to adults, early treated children lack detectable HIV-specific antibodies, suggesting a fundamental difference in HIV pathogenesis. Despite this potential adverse effect, early ART may decrease the size of the latent reservoir established early in infection in infants, which can be beneficial in viral control. Understanding the virologic and immunologic aspects of pediatric HIV is crucial to inform innovative targeted strategies for treating children living with HIV. In this study, we investigate how ART initiation time sets the stage for trade-offs in the latent reservoir establishment and the development of humoral immunity and how these, in turn, affect posttreatment dynamics. We also elucidate the biological function of antibodies in pediatric HIV. We employ mathematical modeling coupled with experimental data from an infant nonhuman primate Simian/Human Immunodeficiency Virus (SHIV) infection model. Infant Rhesus macaques (RMs) were orally challenged with SHIV.C.CH505 375H dCT four weeks after birth and started treatment at different times after infection. In addition to viral load measurements, antibody responses and latent reservoir sizes were measured. We estimate model parameters by fitting viral load measurements to the standard HIV viral dynamics model within a nonlinear fixed effects framework. This approach allows us to capture differences between rhesus macaques (RMs) that develop antibody responses or exhibit high latent reservoir sizes compared to those that do not. We find that neutralizing antibody responses are associated with increased viral clearance and decreased viral infectivity but decreased death rate of infected cells. In addition, the presence of detectable latent reservoir is associated with less robust immune responses. These results demonstrate that both immune response and latent reservoir dynamics are needed to understand post-rebound dynamics and point to the necessity of a comprehensive approach in tailoring personalized medical interventions.

Trends in preterm birth in women living with HIV in Switzerland over the last three decades: A multicentric, prospective, cohort study.

HIV infection and its management during pregnancy to reduce perinatal transmission has been associated with preterm birth (PTB). This management has drastically changed. We aimed to evaluate changes in rates of PTB over 34 years in women living with HIV (WLWH) in Switzerland, and to identify factors and interventions associated with these changes. We analysed data from 1238 singleton pregnancies, prospectively collected by the Swiss Mother and Child HIV Cohort Study (MoCHiV) and the Swiss HIV Cohort Study (SHCS) between 1986 and 2020. Rates of PTB in this cohort were compared with that of the general Swiss population for three time periods according to changing treatment strategies recommended at the time. We evaluated the association of PTB with sociodemographic, HIV infection and obstetric variables in uni- and multivariate logistic regression. Rate of PTB in WLWH was highest prior to 2010 (mean 20.4%), and progressively decreased since then (mean 11.3%), but always remained higher than in the general population (5%). Older maternal age, lower CD4 count and detectable viraemia at third trimester (T3), drug consumption and mode of delivery were all significantly associated with both PTB and period of study in univariate analysis. There was no association between PTB and type of antiretroviral regimen. No difference was found in the rate of spontaneous labor between PTB and term delivery groups. Only higher CD4 count at T3 and vaginal delivery were significantly associated with a decrease in PTB over time in multivariate analysis. Preterm birth in WLWH in Switzerland has drastically decreased over the last three decades, but remains twice the rate of that in the general population. Improved viral control and changes in mode of delivery (vaginal birth recommended if viral loads are low near birth) have led to this progress.

The Analysis of Factors Influencing Behavior of Pregnant Mother in Performing Prevention Mother to Child HIV Transmission (PMTCT) in PHC Pesantren I Kediri

Background: Mother to child transmission of HIV can be prevented, but the incident of HIV in children from year to year continues to increase. Purpose: The research objective is to analyze the factors influencing behavior of pregnant mothers in performing Prevention Mother to Child HIV Transmission (PMTCT). Method: The research design was analytic observational with cross sectional approach. The population was all of pregnant mothers in working area of PHC Pesantren I Kediri. The samples were 63 respondents using simple random sampling. Data were collected using questionnaires given to pregnant mothers at the time of antenatal care in PHC Pesantren I Kediri and then analyzed using logistic regression. Results: The results showed that variable X1 (role of officer) with p = 0.104; OR = 4.609, Variable X2 (knowledge) with p = 0.004; OR = 31.057, Variable X3 (attitude) with p = 0.030; OR = 8.993, Variable X4 (husband support) with p = 0.015; OR = 4.789, Variable X5 (house distance) with p = 0.720; OR = 1.232 and Variable X6 (interest) with p = 0.014; OR = 2.863. In conclusion, the factors influencing Y (behavior of pregnant mothers in performing PMTCT examination) were knowledge and attitude, with the most dominant factor was knowledge with the influence of 31.057. Conclusion: Shows that,The low level of mother’s knowledge about PMTCT, uncooperative mother’s attitude, lack of husband support and lack of mother’s interest caused the low coverage of PMTCT examination in PHC Pesantren I Kediri. The health promotion efforts need more intensive so that the success of PMTCT program can be achieved.

Characteristics of children living with HIV in a referral center in Iran: a cross-sectional study

Background. With an estimated 38.4 million people worldwide living with HIV in 2021, including 2.73 million children, there is a pressing need to understand and address HIV transmission and its impact on children’s health. This study aims to describe the demographic characteristics, clinical profiles, and outcomes of Iranian children living with HIV referred to one of the largest center for counseling HIV patients in Iran. Materials and methods. In this descriptive cross-sectional study, we assessed clinical and biological markers in HIV-infected children treated at the counseling center for behavioral diseases in a referral Hospital in Tehran. The study included a total of 60 records of children and adolescents under the age of 18, spanning from 2004 to 2020. We collected detailed clinical and laboratory data, including demographic information, treatment history, comorbidities, opportunistic infections, adherence to treatment, side effects of HIV treatment, and laboratory test results. Additionally, the study investigated any history of COVID-19 infection during the follow-up period, which coincided with the pandemic. Results. Out of the 60 patients included in the study, there were 23 females (38.3%) and 37 males (61.6%), with a mean age of 10.03 years. About 16.7% of patients had at least one comorbidity, including epilepsy, ADHD, autoimmune hepatitis, ITP, allergic asthma, alopecia areata, and cystic fibrosis. Among the mothers of these children, 93.9% were HIV-positive. Out of the 60 mothers, 6.7% were not infected with the virus, 60% were receiving treatment, and 10% had passed away. Treatment adherence was acceptable in 93.3% of patients. Opportunistic infectious diseases were experienced by 36.7% of patients, with oral candidiasis being the most common. Hospitalizations occurred in 21 patients, primarily due to pneumonia, fever, weakness, lethargy, and oral thrush. Conclusions. Investigating the demographic, clinical profile, and long-term outcomes of pediatric HIV is crucial for policymakers to effectively address the ongoing HIV epidemic. Given the significant knowledge gap on pediatric HIV in Iran, further studies in this area are necessary to improve understanding and inform strategies for the prevention, management, and treatment of HIV in children in the country.

Pharmacokinetics and safety of coformulated bictegravir, emtricitabine, and tenofovir alafenamide in children aged 2 years and older with virologically suppressed HIV: a phase 2/3, open-label, single-arm study

Coformulated bictegravir, emtricitabine, and tenofovir alafenamide is a single-tablet regimen and was efficacious and well tolerated in children and adolescents with HIV (aged 6 years to <18 years) in a 48-week phase 2/3 trial. In this study, we report data from children aged at least 2 years and weighing 14 kg to less than 25 kg. We conducted this open-label, multicentre, multicohort, single-arm study in South Africa, Thailand, Uganda, and the USA. Participants were virologically suppressed children with HIV, aged at least 2 years, weighing 14 kg to less than 25 kg. Participants received bictegravir (30 mg), emtricitabine (120 mg), and tenofovir alafenamide (15 mg) once daily, switching to bictegravir (50 mg), emtricitabine (200 mg), and tenofovir alafenamide (25 mg) upon attaining a bodyweight of at least 25 kg. The study included pharmacokinetic evaluation at week 2 to confirm the dose of coformulated bictegravir, emtricitabine, and tenofovir alafenamide for this weight band by comparing with previous adult data. Primary outcomes were bictegravir area under the curve over the dosing interval (AUCtau) and concentration at the end of the dosing interval (Ctau) at week 2, and incidence of treatment-emergent adverse events and laboratory abnormalities until the end of week 24 in all participants who received at least one dose of bictegravir, emtricitabine, and tenofovir alafenamide. This study is registered with ClinicalTrials.gov, NCT02881320. Overall, 22 participants were screened (from Nov 14, 2018, to Jan 11, 2020), completed treatment with bictegravir, emtricitabine, and tenofovir alafenamide (until week 48), and entered an extension phase. The geometric least squares mean (GLSM) ratio for AUCtau for bictegravir was 7·6% higher than adults (GLSM ratio 107·6%, 90% CI 96·7-119·7); Ctau was 34·6% lower than adults (65·4%, 49·1-87·2). Both parameters were within the target exposure range previously found in adults, children, or both". Grade 3-4 laboratory abnormalities occurred in four (18%) participants by the end week 24 and six (27%) by the end of week 48. Drug-related adverse events occurred in three participants (14%) by the end of week 24 and week 48; none were severe. No Grade 3-4 adverse events, serious adverse events, or adverse events leading to discontinuation occurred by the end of week 24 and week 48. Data support the use of single-tablet coformulated bictegravir (30 mg), emtricitabine (120 mg), and tenofovir alafenamide (15 mg) for treatment of HIV in children aged at least 2 years and weighing 14 kg to less than 25 kg. Gilead Sciences.

Time to develop adverse drug reactions and associated factors among children HIV positive patients on antiretroviral treatment in North West Amhara Specialized Hospitals: Retrospective cohort study, 2022.

Adverse drug reactions (ADRs) are harmful and unintended reactions to medicines given at standard doses through a proper route of administration for the purpose of prophylaxis, diagnosis, or treatment. The objective of this research paper was to assess median time to development of ADRs and associated factors among children HIV positive patients on antiretroviral treatment (ART) in North West Amhara Specialized Hospitals. The adverse drug effect survival time was estimated using the Kaplan-Meier survival method and log-rank test curves was applied for analyze "time-to-event" data. Cox regression model was used to identify the associated factors. Adjusted hazard ratios with their respective 95% confidence intervals (CIs) were estimated and a value of p less than 0.05 was used to declare the presence of a significant association. The overall incidence of ADRs was 0.67 (95% CI: 3.74-4.44) per 10,000 person-year observation, with a median of 57 months. Adults are presenting with opportunistic Infections (OIs) experiences, baseline CD4 < 200 cells/µL counts, 1e, tenofovir disoproxil fumarate-lamivudine-efavirenz ART regimen, bedridden baseline functional status, World Health Organization (WHO) clinical stage II and III were notably associated with the incidence of ADRs development. ADRs were uncommon in this study. predictors, such as OIs experiences, a low CD4 count, ART regimen, an advanced WHO stage, and bedridden functional status were significantly associated with ADRs.

Central Nervous System Complications of HIV in Children.

Central Nervous System Complications of HIV in Children.

A community-based child health and parenting intervention to improve child HIV testing, health, and development in rural Lesotho (Early Morning Star): a cluster-randomised, controlled trial

When caregivers live in remote settings characterised by extreme poverty, poor access to health services, and high rates of HIV/AIDS, their caregiving ability and children's development might be compromised. We aimed to test the effectiveness of a community-based child health and parenting intervention to improve child HIV testing, health, and development in rural Lesotho. We implemented a matched cluster-randomised, controlled trial in the Mokhotlong district in northeastern Lesotho with 34 community clusters randomly assigned to intervention or wait-list control groups within a pair. Eligible clusters were villages with non-governmental organisation partner presence and an active preschool. Participants were caregiver-child dyads, where the child was 12-60 months old at baseline. The intervention consisted of eight group sessions delivered at informal preschools to all children in each village. Mobile health events were hosted for all intervention (n=17) and control (n=17) clusters, offering HIV testing and other health services to all community members. Primary outcomes were caregiver-reported child HIV testing, child language development, and child attention. Assessments were done at baseline, immediately post-intervention (3 months post-baseline), and 12 months post-intervention. We assessed child language by means of one caregiver-report measure (MacArthur-Bates Communicative Development Inventory [CDI]) and used two observational assessments of receptive language (the Mullen Scales of Early Learning receptive language subscale, and the Peabody Picture Vocabulary Test 4th edn). Child attention was assessed by means of the Early Childhood Vigilance Task. Assessors were masked to group assignment. Analysis was by intention to treat. This trial was registered with ISRCTN.com, ISRCTN16654287 and is completed. Between Aug 8, 2015, and Dec 10, 2017, 1040 children (531 intervention; 509 control) and their caregivers were enrolled in 34 clusters (17 intervention; 17 control). Compared with controls, the intervention group reported significantly higher child HIV testing at the 12-month follow-up (relative risk [RR] 1·46, 95% CI 1·29 to 1·65, p<0·0001), but not immediately post-intervention. The intervention group showed significantly higher child receptive language on the caregiver report (CDI) at immediate (effect size 3·79, 95% CI 0·78 to 6·79, p=0·028) but not at 12-month follow-up (effect size 2·96, 95% CI -0·10 to 5·98, p=0·056). There were no significant group differences for the direct assessments of receptive language. Child expressive language and child attention did not differ significantly between groups. Integrated child health and parenting interventions, delivered by trained and supervised lay health workers, can improve both child HIV testing and child development. United States Agency for International Development (USAID) and the President's Emergency Plan for AIDS Relief (PEPFAR).

Modeling Health Systems and Male-Partner Involvement Determinants of Prevention of Mother to Child Transmission of Human Immune-deficiency Virus among Women in Homa Bay County Referral Hospital, Kenya

In 2017, Homa Bay County accounted for 10% of HIV cases among children aged 0-14 years in Kenya. Additionally, it reported 8.8% of new HIV infections among children of the same age group and 9.7% of annual AIDS-related mortalities. In 2018, the County reported a mother-to-child transmission (MTCT) rate of 8.1%, higher than the 5% target set by WHO. Limited studies in Kenya have documented health systems and male-partner involvement determinants of prevention of MTCT (PMTCT) of HIV, which vary by context. Thus, this paper documents health systems and male-partner involvement determinants of PMTCT outcomes among women attending Homa Bay County Referral Hospital. We used an analytical cross-sectional study design that had a sample of 274 (Fishers et al. 1998) randomly selected from 4129 women of reproductive age ever on PMTCT follow-up. Questionnaires were used to collect data from the women on child HIV status, health systems factors, and male partner-involvement factors. The mean age of the women was 32.16 years. Results show that provision and discussion of infant diagnosis results by health care providers increased the chances of occurrence of HIV seronegative PMTCT outcome by 1.5 times (OR=1.530, 95% CI: 0.361-6.486; p&lt;0.0001). Provision of routine pre-conception counselling decreased the odds of determining PMTCT outcome by 60% (OR=0.404, 95% CI: 0.046-3.521; p=0.018). Males knowing the HIV status of their partner had higher odds of determining the occurrence of HIV seronegative PMTCT outcome (OR=6.0, 95% CI: 0.655-54.997; p&lt;0.0001). Health systems factors aligned with the provision and discussion of infant diagnosis results by healthcare provider and male-partner involvement factor related to the male partner knowing the HIV status of participant(s) demonstrated higher chances of predicting the occurrence of HIV seronegative for the child. These findings will inform the formulation of interventions geared towards reducing the high MTCT rates in Homa Bay County

Adverse childhood experiences, HIV and sexual risk behaviors ― Five sub-Saharan countries, 2018–2020

BackgroundAdverse childhood experiences (ACEs) have been shown to have negative, lasting effects on health including increasing the likelihood of engaging in sexual risk behaviors. ObjectiveThis study aimed to identify associations between exposures to ACEs and sexual risk behaviors and HIV service utilization among young people. Participants and settingA sample of 8023 sexually active young people (19–24 year olds) from five sub-Saharan African countries participated Violence Against Children and Youth Surveys (VACS). MethodsDescriptive analysis of demographic variables, individual ACEs, cumulative ACEs, sexual risk behaviors, HIV testing, antiretroviral treatment (ART) and Antenatal Care (ANC) attendance were completed. Bivariate and multivariable logistic regression analyses were conducted to assess the associations between both individual and cumulative ACEs, sexual HIV risk behaviors, and service utilization while controlling for important covariates such as demographic, having ever been pregnant, had an STI, and used contraception. ResultsExposure to three or more ACEs was higher among males (26.1 %) compared to females (21.3 %); p = 0.003. The most prominent sexual risk behavior for females was having sexual partners who were at least 5 years older (45.7 % compared to males 3.7 %; p < 0.0001) whereas in males it was no or infrequent condom use (45.3 % compared to females 30.1 %; p < 0.0001). Males and females exposed to childhood sexual violence had seven and four times the odds of engaging in transactional sex (aOR = 7.34, 95 % CI: [3.5–15.0]) and (aOR =3.75, 95 % CI: [2.3–6.2], respectively. Females exposed to three or more ACEs were four times more likely to engage in transactional sex (aOR = 4.85, 95 %, CI: [1.6–14.4]) compared to those who did not experience any ACEs. Males exposed to three or more ACEs were two times more likely to engage in early sexual debut (aOR = 2.2, 95 % CI: [1.3–3.4]),]) compared to those who did not experience any ACEs. Females who had witnessed IPV or violence in the community had significantly higher odds of getting tested for HIV (aOR = 2.16, 95 % CI: [1.63–2.87]) and (aOR = 1.36, 95 % CI: [1.03–1.81]), respectively. ConclusionsThis study demonstrated that experiencing ACEs during childhood is associated with higher HIV risk behaviors in sub-Saharan Africa (SSA) with unique differences between males and females.

In utero/peripartum antiretroviral therapy exposure and mental health outcomes at 8-18 years old: A longitudinal comparative study of children with perinatally acquired HIV, children perinatally HIV exposed but uninfected, and children unexposed uninfected from Uganda.

In utero/peripartum antiretroviral therapy (IPA) exposure type was examined in relationship to mental health symptoms among 577 children with perinatally acquired HIV (CPHIV), children perinatally HIV exposed but uninfected (CHEU), and children HIV unexposed uninfected (CHUU). IPA exposure was categorized for CPHIV and CHEU as none, single-dose nevirapine with or without zidovudine (sdNVP±AZT), sdNVP+AZT+lamivudine (3TC), or combination antiretroviral therapy (cART). Anxiety and depressive symptoms were reported at baseline, 6-, and 12-month follow-up per behavioral assessment system for children. Multivariable linear mixed models were used to estimate differences (b) with 95% confidence intervals (95% CI) for IPA exposure types versus CHEU without IPA exposure. Depressive and anxiety symptoms were lower in CHUU relative to CHEU and CPHIV but did not differ between CPHIV and CHEU. CHEU with sdNVP±AZT exposure had greater anxiety (b = 0.51, 95% CI: [0.06, 0.96]) and depressive symptoms (b = 0.48, 95% CI: [0.07, 0.89]) than CHEU without IPA exposure. CHEU with sdNVP+AZT+3TC exposure had higher anxiety (b = 0.0.45, 95% CI: [0.03, 0.86]) and depressive symptoms (b = 0.72, 95% CI: [0.27, 1.17]) versus CHEU without IPA exposure. Depressive and anxiety symptoms were not different for CHEU and CPHIV exposed to cART (b = 0.12-0.60, 95% CI: [-0.41, 1.30]) and CHEU and CHUU (b = -0.04 to 0.08, 95% CI: [-0.24, 0.29]) without IPA exposure. Among CHEU, peripartum sdNVP±AZT and sdNVP+AZT+3TC but not cART compared to no IPA exposure was associated with clinically important elevations in anxiety and depressive symptoms. Monitoring of mental health trajectory of HIV-affected children considering IPA is needed to inform mental health interventions. Patient Contribution: Caregivers and their dependents provided consent for participation and collaborated with study team to identify mutually convenient times for protocol implementation.

Integrated model of maternal caregiving in child HIV management in Chinese mother–child dyads living with HIV: A qualitative dyadic analysis

AbstractPerinatally HIV‐positive (PHIV+) children face challenges arising from their complicated and highly stigmatized chronic illness throughout childhood and adolescence. Caring and support from caregivers are vital, especially from their mothers who also live with HIV. However, little is known regarding how HIV+ mothers coach their PHIV+ children to adjust to HIV. This study used dyadic‐level qualitative analyses of semi‐structured, one‐on‐one interviews among 20 mother–child dyads (n = 40; children aged 12–18 years) living with HIV in southern China. Interviews examined the perspectives of both mothers and children on the maternal caregiving in child HIV management and child adaptation outcomes. Our findings showed that based on a dual‐dimension model of the extent of maternal involvement in child HIV management and the intimacy of the mother–child relationship, four categories of maternal caring emerged among the mother–child dyads: supportiveness (n = 4, 20%), independence (n = 9, 45%), contradiction (n = 4, 20%) and alienation (n = 3, 15%). The PHIV+ children's selected HIV management indicators (including disclosure of HIV status, HIV‐related communication, antiretroviral therapy adherence, stigma coping and emotion management) also showed some variations among these four categories. The integrated model may inform the development of dyadic intervention programmes tailored for mothers and children both living with HIV.