Posted: Jul 19, 2017
Living and dying to be counted: What we know about the epidemiology of the global adolescent HIV epidemic
Introduction: With increasing survival of vertically HIV-infected children and ongoing new horizontal HIV infections, the population of adolescents (age 10–19 years) living with HIV is increasing. This review aims to describe the epidemiology of the adolescent HIV epidemic and the ability of national monitoring systems to measure outcomes in HIV-infected adolescents through the adolescent transition to adulthood.
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Methods: Differences in global trends between younger (age 10–14 years) and older (age 15–19 years) adolescents in key epidemic indicators are interrogated using 2016 UNAIDS estimates. National population-based survey data in the 15 highest adolescent HIV burden countries are evaluated and examples of national case-based surveillance systems described. Finally, we consider the potential impact of adolescent-specific recommendations in the 2016 WHO Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection.
Discussion: UNAIDS estimates indicate the population of adolescents living with HIV is increasing, new HIV infections in older adolescents are declining, and while AIDS-related deaths are beginning to decline in younger adolescents, they are still increasing in older adolescents. National population-based surveys provide valuable estimates of HIV prevalence in older adolescents and recent surveys include data on younger adolescents. Only a few countries have nationwide electronic case-based HIV surveillance, with the ability to provide population-level data on key HIV outcomes in the diagnosed population living with HIV. However, in the 15 highest adolescent HIV burden countries, there are no systems tracking adolescent transition to adulthood or healthcare transition. The strength of the 2016 WHO adolescent-specific recommendations on antiretroviral therapy and provision of HIV services to adolescents was hampered by the lack of evidence specific to this age group.
Conclusions: Progress is being made in national surveillance and global monitoring systems to specifically identify trends in adolescents living with HIV. However, HIV programmes responsive to the evolving HIV prevention and treatment needs of adolescents can be facilitated further by: data disaggregation to younger and older adolescents and mode of HIV infection where feasible; implementation of tools to achieve expanded national case-based surveillance; streamlining consent/assent procedures in younger adolescents and consensus on indicators of adolescent healthcare transition and transition to adulthood.
Slogrove, A. L., et al. (2017). "Living and dying to be counted: What we know about the epidemiology of the global adolescent HIV epidemic." J Int AIDS Soc 20(Suppl 3): 4-15.
Posted: Jan 17, 2017
Sustained High HIV Incidence in Young Women in Southern Africa: Social, Behavioral and Structural Factors and Emerging Intervention Approaches
Young women in southern Africa experience some of the highest incidence rates of HIV infection in the world. Across southern Africa, HIV prevalence among women increases rapidly between the teenage years and young adulthood. Adult HIV prevalence is 16.8 percent in South Africa, 23 percent in Botswana, 23 percent in Lesotho and 26.5 percent in Swaziland. Existing research has illuminated some of the key social, behavioral and structural factors associated with young women’s disproportionate HIV risk, including gendered social norms that advantage male power in sexual relationships, and age disparities in relationships between younger women and older male partners. Important structural factors include the region’s history of labor migration and legacy of family disruption, and entrenched social and economic inequalities. New interventions are emerging to address these high levels of HIV risk in the key population of young women, including structural interventions, biomedical prevention such as PrEP, and combined HIV prevention approaches.
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Harrison, A., Colvin, C. J., Kuo, C., Swartz, A., & Lurie, M. (2015). Sustained High HIV Incidence in Young Women in Southern Africa: Social, Behavioral and Structural Factors and Emerging Intervention Approaches. Current HIV/AIDS Reports, 12(2), 207–215. http://doi.org/10.1007/s11904-015-0261-0
Posted: Jan 17, 2017
A multi-sectoral approach to providing reproduction health information and services to young people in Western Kenya: Kenya Adolescent Reproductive Health Project
To respond to this situation, the Population Council’s Frontiers in Reproductive Health Program (FRONTIERS) and the Program for Appropriate Technology in Heath (PATH) Kenya office collaborated with three Government of Kenya ministries – the Ministry of Education, Science and Technology (MOEST), the Ministry of Health (MOH) and the former Department of Social Services (now within the Ministry of Gender, Sports, Culture and Social Services (MOGSCSS) – to design and implement a multi-sectoral project with the following ultimate goals:
• To improve knowledge about reproductive health and encourage a responsible and healthy attitude towards sexuality among adolescents;
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• To delay the onset of sexual activity among younger adolescents;
• To decrease risky behaviours among sexually active adolescents.
USAID (2004) A MULTI-SECTORAL APPROACH TO PROVIDING REPRODUCTIVE HEALTH INFORMATION AND SERVICES TO YOUNG PEOPLE IN WESTERN KENYA: KENYA ADOLESCENT REPRODUCTIVE HEALTH PROJECT
Posted: Jan 9, 2017
Using a Multisectoral Approach to Assess HIV/AIDS Services in the Western Region of Puerto Rico
The Enhancing Care Initiative of Puerto Rico assessed services available to people living with HIV/AIDS in the western region of Puerto Rico. Participants were 212 people living with HIV/AIDS and 116 employees from 6 agencies providing HIV/AIDS services in the region. Two main findings were that depression symptoms were present in 98.1%of people living with HIV/AIDS, and 7 of the 15 municipalities in the region did not provide any specific services to this population.
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Most urgent needs identified by people living with HIV/AIDS were economic support, housing, mental and psychological services, medicines, medical treatment, and transportation. The Enhancing Care Initiative provides an example of a successful multisectoral, multidimensional volunteer team effectively overcoming challenges while translating research into interventions to enhance HIV/AIDS care.
Asencio Toro, G., Burns, P., Pimentel, D., Sánchez Peraza, L. R., & Rivera Lugo, C. (2006). Using a Multisectoral Approach to Assess HIV/AIDS Services in the Western Region of Puerto Rico. American Journal of Public Health, 96(6), 995–1000. http://doi.org/10.2105/AJPH.2005.071696
Posted: Nov 2, 2016
Shamba Maisha: Randomized controlled trial of an agricultural and finance intervention to improve HIV health outcomes in Kenya
Objectives: Food insecurity and HIV/AIDS outcomes are inextricably linked in sub-Saharan Africa. We report on health and nutritional outcomes of a multisectoral agricultural intervention trial among HIV-infected adults in rural Kenya.
Design: Pilot cluster randomized controlled trial.
Methods: The intervention included a human-powered water pump, a microfinance loan to purchase farm commodities, and education in sustainable farming practices and financial management. Two health facilities in Nyanza Region, Kenya were randomly assigned as intervention or control. HIV-infected adults 18 to 49 years old who were on antiretroviral therapy and had access to surface water and land were enrolled beginning in April 2012 and followed quarterly for one year. Data were collected on nutritional parameters, CD4 T lymphocyte counts, and HIV RNA. Difference in difference fixed-effects regression models were used to test whether patterns in health outcomes differed over time from baseline between the intervention and control arms.
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Results: We enrolled 72 and 68 participants in the intervention and control groups, respectively. At 12 months follow-up, we found a statistically significant increase in CD4 cell counts (165 cells/mm3, p<0.001) and proportion virologically suppressed in the intervention arm compared to the control arm (comparative improvement in proportion of 0.33 suppressed, OR 7.6, 95% CI: 2.2–26.8). Intervention participants experienced significant improvements in food security (3.6 scale points higher, p<0.001) and frequency of food consumption (9.4 times per week greater frequency, p=0.013) compared to controls.
Conclusion: Livelihood interventions may be a promising approach to tackle the intersecting problems of food insecurity, poverty and HIV/AIDS morbidity.
Weiser SD, Bukusi EA, Steinfeld RL, et al. Shamba Maisha: randomized controlled trial of an agricultural and finance intervention to improve HIV health outcomes. AIDS (London, England) 2015;29(14):1889-94