§The family approach leads to high identification, linkage, and ART initiation for HIV-positive children§Although HIV positivity among children were lower than observed in previous family approach studies and appear to be declining, it continues to have a higher

yield in comparison to program-wide inpatient and outpatient testing§The family approach offers an important entry point for identification of children and adolescents at risk of HIV and the opportunity for targeted follow-up

through the HIV care cascade

Can children with HIV reach the 90-90-90 goals?: Viral suppression in a pediatric patient population in

western Kenya

Background

Prior Family Approach Evaluation Findings

• Routine viral load monitoring is critical in measuring treatment efficacy and achieving the UNAIDS 90-90-90 goals

• There are an estimated 190,000 HIV-infected children in Kenya with 53% on ART

• Routine viral load monitoring was rolled out in Kenya in 2013

• We investigated potential risk factors associated with failure to reach virologic suppression in a pediatric patient population in

Results

11,937 index patients led to the identification of 3,033 children

Acknowledgments

Conclusions

Comparison: 3 Approaches

We would like to thank the Ministry of Health, Kenya; PEPFAR Kenya – U.S. Centers for Disease Control and Prevention; Children’s Investment Fund Foundation – Accelerating Children’s HIV/AIDS Treatment Initiative; Research Care and Training Program-Family Aids Care and Education Services (RCTP- FACES), our clients and their families..

This publication was made possible by support from the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) through cooperative agreement U2GPS001913-05 from the U.S. Centers for Disease Control and Prevention (CDC), Division of Global HIV/TB (DGHT).

CONTACTS: Julie Kadima; jkadima@kemri-uscf.orgDISCLAIMER: The findings and conclusions in this poster are those of the authors and do not necessarily represent the official position of the U.S Centers

for Disease Control and Prevention or the Government of Kenya.

Presented at the AIDS 2016 CONFERENCE DURBAN INTERNATIONAL CONFERENCE CENTRE 18th - 22nd July 2016

1 2 2 3 2 3 2 4Patterson , B., Kadima , J., Mburu M., Blat , C., Bukusi , EA., Cohen , CR., Oyaro , P., Abuogi , L.

Methods

References

§Retrospective review of clinical records§Convenience sample of 60 high-volume clinics across three Nyanza counties: Kisumu, Homabay, and Migori§Adult index patients who enrolled in HIV care May–July 2015 were followed until October 2015§Family member testing status, results, and enrolment and ART initiation for those positive were abstracted and summarized and p-trends and chi-square were

conducted§Comparison of positivity proportion among children to:

1. Prior studies that used the family approach in the same region, 2. Outpatient and inpatient testing data performed in the same region from July–September 2015, respectively.

3033

1869 (62%)

1164 (38%)

100 (5.4%) 87 (87%) 73 (84%)0

500

1000

1500

2000

2500

3000

3500

Eligible Tested Need to be tested

Positive Linked Initiated HAART

Family Approach to Identify, Test, and Enroll Children (0-14)

May – October 2015 (60 sites)

Testing Approach for

Children (0 -14)

Time Period Number of

Sites

HIV Positivity Yield

Family Approach May – Oct 2015 60 100/1869 (5.4%)

Outpatient Jul – Sep 2015 148 309/46,002 (<1%)

Inpatient Jul – Sep 2015 148 24/1,636 (1.5%)

1. National AIDS and STI Control Programme (NASCOP), Kenya. Kenya AIDS Indicator Survey 2012: Final Report. Nairobi, NASCOP, June 20142. If you build it, will they come? Kenya healthy start pediatric HIV study: A diagnostic study investigating barriers to HIV treatment and care among children.

Horizons Final Report. USAID, Washington DC; 2008.3. Global HIV/AIDS Response: Epidemic update and health sector progress towards Universal Access Progress Report. WHO, UNAIDS, and UNICEF, Geneva;

20114. Lewis Kulzer et al. Journal of the International AIDS Society 2012, 15:85. Meyer et al. International Journal of MCH and AIDS (2014), Volume 2, Issue 2, Pages 236-243

Abstract No. TUPEB112

Compared to prior evaluations, a declining trend in HIV positivity among children was found with the family-centered approach: the proportion of children testing positive went from 18% in 2009 to 7.4% in 2012 to 5.4% in 2015 (p<0.001). Positive proportions among children reached through the family approach were higher than inpatient 24/1,636 (1.5%) and outpatient 309/46,002 (<1%) testing proportions (p<0.001)

University of CaliforniaSan Francisco

KENYANS AND AMERICANSIN PARTNERSHIP TO FIGHT HIV/AIDS CENTER FOR MICROBIOLOGY RESEARCH MINISTRY OF HEALTH

CI

FF CHILDREN’S

INVESTMENT FUNDFOUNDATION

FACES is a collaborative KEMRI and UCSF program funded through a cooperative agreement with the U.S. Centers for Disease Control and Prevention (CDC) and U.S. President’s Emergency Funding for AIDS Relief (PEPFAR)

3. University of California San Francisco, San Francisco, California, USA4. Department of Pediatrics, University of Colorado Denver, Aurora, Colorado, USA

1. University of Colorado School of Medicine, Aurora, Colorado, USA2. Family AIDS Care and Education Services (FACES), Research Care and Training Program (RCTP), Centre for Microbiology Research (CMR), Kenya Medical Research Institute (KEMRI), Kisumu, Kenya

Positivity among children reached through the family approach were higher than inpatient (1.5%) or outpatient (<1%) testing rates (p<0.001)

Kenya Pediatric 90-90-90 Cascade of Care

Methods

Results

Conclusion

• Nested case-control study

• Cohort of HIV-infected children < 15 years old on ART who underwent routine VL testing June 2014—May 2015

• Random sample of 299 children: 1 case (VL ≥1000 cp/ml) per 2 controls (VL <1000 cp/ml)

• 5 Family AIDS Care and Education Services (FACES)-supported government clinics in western Kenya

• Retrospective review of clinical records

• Logistic regression analysis was used to analyze data

• 63% (748/1190) of all children undergoing routine VL testing were virologically suppressed

• Majority (72%) of children in the study were between 3 and 10 years old at time of VL testing

• WHO stage, CD4 and time since ART initiation were not associated with failure to suppress

• In multivariable analysis, unsuppressed children were more likely to be male (adjusted Odds Ratio (aOR)=2.1, 95%

Confidence Interval (CI): 1.2-3.6) and have had ≥1 regimen changes (aOR=2.0, 95% CI: 1.0-3.7)

• Children with a history of tuberculosis (TB) were more likely to suppress than those without TB (aOR=0.4, 95% CI: 0.2-0.9)

• Approximately 1 in 3 children undergoing routine VL testing failed to suppress.

• Traditional risk factors for pediatric treatment failure such as CD4 and clinical stage were not shown to have a significant

effect on VL

• Children on second line show higher rates of treatment failure and may require separate focus

• Routine VL testing is critical to evaluate treatment efficacy and diagnose failure

Measure

VL =1000cp/ml(case)

n (%) or median (IQR)

VL <1000 cp/ml

(control)n (%) or median (IQR) p-value OR (95% CI) p-value

aOR (95% CI) p-value

Gender 0.003

Female 33(24.1) 104(75.9) Ref Ref

Male 65(40.1) 97(59.9) 2.1 (1.3-3.5) 0.004 2.1 (1.2-3.6) 0.007

Number of Regimen Changes

0.008

None 60(28.2) 153(71.8) Ref Ref

At Least Once 38(44.2) 48(55.8) 2.0(1.2-3.4) 0.008 2.0(1.0-3.7) 0.041

Current ART Regimen

0.005

NVP Based 50(29.1) 122(70.9) Ref Ref

LVP/r Based 32(49.2) 33(50.8) 2.4(1.3-4.3) 0.004 2.0(1.0-3.9) 0.062

Other 16(25.8) 46(74.2) 0.8(0.4-1.6) 0.625 0.9(0.4-2.0) 0.819

History of TB 0.147

No 12(24.0) 38(76.0) Ref RefYes 86(34.5) 163(65.5) 0.6(0.3-1.2) 0.150 0.4(0.2-0.9) 0.035

Children living with HIV