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Prevalence of pretreatment drug resistance in persons initiating and reinitiating antiretroviral therapy in Sri Lanka: results from a national representative survey

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JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY 2023年第6期78卷 1476-1479页

作者： Elwitigala, J. Rajapaksa, L. Inzaule, S. C. Ariyaratne, K. A. M. Jayasena, S. Kurle, S. Patil, A. Kale, D. Siriwardna, L. Samaraweera, G. Perera, H. Jayakody, C. Minist Hlth Natl STD AIDS Control Programme Colombo Sri Lanka Univ Amsterdam Amsterdam Inst Global Hlth & Dev Amsterdam Netherlands Univ Amsterdam Dept Global Hlth Amsterdam UMC Amsterdam Netherlands Natl AIDS Res Inst HIV Drug Resistance Lab Pune India

Background We conducted a nationwide cross-sectional study to estimate pretreatment drug resistance (PDR) prevalence in adults initiating ART in Sri Lanka following the WHO's recommendations. Methods HIV drug resistance was determined on dried blood spots (DBSs) using population-based sequencing of the protease and reverse transcriptase genes and interpretation was based on Stanford HIVdb v9.0. Analyses were weighted to adjust for multistage sampling and genotypic failure rate. We used logistic regression to assess differences between groups. Results Overall, in 10% (15 of 150) of patients initiating ART, HIV drug resistance mutations were detected. The prevalence of resistance to NNRTI drugs efavirenz/nevirapine was 8.4% (95% CI 4.6-15.0) but differed among those reporting having prior antiretroviral (ARV) exposure (24.4%, 95% CI 13.8-39.5) compared with 4.6% (95% CI 1.6-12.8) for those reporting as being ARV naive (OR 4.6, 95% CI 1.3-16.6, P = 0.021). PDR to efavirenz/nevirapine was also nearly twice as high among women (14.1%, 95% CI 6.1-29.4) compared with men (7.0%, 95% CI 3.1-14.7) (P = 0.340) and three times high among heterosexuals (10.4%, 95% CI 2.4-35.4) compared with MSM (3.8%, 95% CI 1.1-12.7) (P = 0.028). NRTI PDR prevalence was 3.8% (95% CI 1.1-12.1) and no PI PDR was observed in the study. Conclusions A high prevalence of efavirenz/nevirapine PDR was reported, especially in patients with prior ARV exposure, in women and those reporting being heterosexual. These findings highlight the need to fast-track the transition to the WHO-recommended dolutegravir-based first-line ART.

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Prevalence and correlates of violence among sexual and injecting partners of people who inject drugs living with HIV in Kenya: a cross-sectional study

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HARM REDUCTION JOURNAL 2023年第1期20卷 1-14页

作者： Aung, Sai Win Kyaw Htet Kingston, Hanley Mbogo, Loice W. Sambai, Betsy Monroe-Wise, Aliza Ludwig-Barron, Natasha T. Bukusi, David Sinkele, William Gitau, Esther Masyuko, Sarah Herbeck, Joshua T. Farquhar, Carey Guthrie, Brandon L. Univ Washington Seattle WA 98195 USA Univ Washington Global Assistance Program Kenya Nairobi Kenya Kenyatta Natl Hosp Nairobi Kenya Support Addict Prevent & Treatment Africa SAPTA Nairobi Kenya Kenya Minist Hlth Natl AIDS & STI Control Programme NASCOP Nairobi Kenya

BackgroundIn Kenya, violence is common among people who inject drugs (PWID) living with HIV and their sexual and injecting partners and may lead to decreased uptake of HIV services, increased HIV risk behaviors, and increased HIV transmission. Violence is defined as any physical harm, threatened harm, or forced sexual acts inflicted on a person in the past year. Understanding the nature of violence and its correlates among PWID and their partners will inform population-specific public health interventions and policy *** is a cross-sectional study nested in a prospective cohort study conducted in eight public health centers, methadone clinics, and needle syringe programs in Nairobi, Kilifi, and Mombasa counties in Kenya. 3,302 sexual and/or injecting partners of PWID living with HIV were recruited through assisted partner services and participated in the study. Prevalence and correlates of violence were identified using the Wald test and negative binomial *** of 3302 study participants, 1439 (44%) had experienced violence within the past year. Physical violence was the most common form of violence experienced (35%), followed by being threatened (23%) or subjected to sexual violence (7%). In an adjusted analysis, female participants reported higher experiences of sexual violence (prevalence ratio [PR] = 2.46;95% confidence interval [CI] 1.62, 3.74;p < 0.001) compared to male participants. In adjusted analysis, coastal residents had a higher experience of overall violence (PR = 1.48;95% CI 1.27, 1.72;p < 0.001) than those living in Nairobi. This regional effect was relatively stronger among the female respondents (pinteraction = 0.025). Participants' sex modified the association between region and experiencing violence after adjusting potential confounding *** study reveals the prevalence of violence among PWID and identifies high-risk sub-groups, including women, specifically for sexual violence, and coastal

关键词： Violence HIV Drug Use People who inject drugs Kenya

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New progress in HBV control and the cascade of health care for people living with HBV in China: evidence from the fourth national serological survey, 2020

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LANCET REGIONAL HEALTH-WESTERN PACIFIC 2024年 51卷 101193-101193页

作者： Zheng, Hui Wang, Yu Wang, Fuzhen Shen, Liping Zhang, Guomin Liu, Jianhua Wang, Feng Miao, Ning Li, Jian Ding, Guowei Meng, Tongtong Tang, Lin Zhang, Shuang Li, Mingshuang Li, Yuan Wang, Xiaoqi Liu, Qianqian Zhang, Qian Wu, Dan Yan, Tingting Su, Qiudong Wang, Miao Li, Li Hou, Qian Li, Yixing Liu, Yi Ye, Shaodong An, Zhijie Rodewald, Lance E. Jia, Jidong Wang, Huaqing Yu, Wenzhou Liu, Zhongfu Li, Qun Feng, Zijian Yin, Zundong Chinese Ctr Dis Control & Prevent Natl Key Lab Intelligent Tracking & Forecasting In Beijing 102206 Peoples R China Chinese Ctr Dis Control & Prevent Natl Immunizat Programme Beijing 100050 Peoples R China Capital Med Univ Beijing Friendship Hosp Liver Res Ctr Natl Clin Res Ctr Digest Dis Beijing 100050 Peoples R China Chinese Ctr Dis Control & Prevent Natl Inst Viral Dis Control & Prevent Natl Key Lab Intelligent Tracking & Forecasting In Beijing 102206 Peoples R China Guangzhou Ctr Dis Control & Prevent Guangzhou 510440 Peoples R China Chinese Ctr Dis Control & Prevent Natl Ctr AIDS STD Control & Prevent Natl Key Lab Intelligent Tracking & Forecasting In Beijing 102206 Peoples R China

Background Since 1992, when recombinant hepatitis B vaccine was introduced in China, government health officials fi cials have used nationally representative serological surveys to monitor progress in prevention and control of hepatitis B. In 2020, we conducted the fourth seroepidemiological survey, which for the fi rst time included medical evaluation of the clinical status of HBsAg positive subjects over the age of 15 and their medical management. We report survey results in comparison with the three previous surveys. Methods Consistent with previous national surveys, the 2020 survey used a stratified, fi ed, three-stage cluster random sampling method to select for evaluation 1-69-year-olds in 120 national disease surveillance points. Blood samples were tested for HBsAg, anti-HBV surface antigen (anti-HBs), and anti-HBV core antigen (anti-HBc) in the National Hepatitis Laboratory of the Institute for Viral Disease control and Prevention of China CDC. HBsAg positive subjects aged >= 15-year were evaluated for evidence of liver disease, and through face-to-face questionnaire-based survey, we determined the healthcare management cascade of HBV-infected individuals. Findings HBsAg prevalence in 1-69 - 69-year-olds was 5.86%;in children 1-4 - 4 years of age, seroprevalence was 0.30%;75 million people were living with HBV nationwide. Among HBsAg-positive individuals 15 years and older, expert medical examination found that 78.03% were HBsAg carriers with no evidence of liver damage, 19.63% had chronic HBV with liver enzyme abnormalities, 0.84% had evidence of cirrhosis, and 0.15% had evidence of liver cancer. 59.78% of HBsAg + individuals were aware that they were positive before the survey, 30 million were unaware;38.25% of those who knew they were positive (17 million) had medical indications for antiviral treatment, and 17.33% of these individuals (3 million) were being treated with antivirals. Interpretation The decline in HBsAg prevalence in the general population,

关键词： Hepatitis B National serological survey Disease burden

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Leveraging electronic medical records for HIV testing, care, and treatment programming in Kenya-the national data warehouse project

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BMC MEDICAL INFORMATICS AND DECISION MAKING 2023年第1期23卷 1-12页

作者： Ndisha, Margaret Hassan, Amin S. Ngari, Faith Munene, Evans Gikura, Mary Kimutai, Koske Muthoka, Kennedy Murie, Lisa Amai Tolentino, Herman Odhiambo, Jacob Mwele, Pascal Odero, Lydia Mbaire, Kate Omoro, Gonza Kimanga, Davies O. US Ctr Dis Control & Prevent CDC Ctr Global Hlth Div Global HIV & TB DGHT POB 606 Nairobi 00621 Kenya KEMRI Wellcome Trust Res Programme Kilifi Kenya Minist Hlth Natl AIDS & STI Control Programme NASCOP Nairobi Kenya Palladium Grp Nairobi Kenya US Ctr Dis Control & Prevent CDC Ctr Global Hlth Div Global HIV & TB DGHT Atlanta GA USA US Agcy Int Dev USAID Nairobi Kenya PEPFAR Coordinating Off PCO Nairobi Kenya US Dept Def DOD Nairobi Kenya

BackgroundAggregate electronic data repositories and population-level cross-sectional surveys play a critical role in HIV programme monitoring and surveillance for data-driven decision-making. However, these data sources have inherent limitations including inability to respond to public health priorities in real-time and to longitudinally follow up clients for ascertainment of long-term outcomes. Electronic medical records (EMRs) have tremendous potential to bridge these gaps when harnessed into a centralised data repository. We describe the evolution of EMRs and the development of a centralised national data warehouse (NDW) repository. Further, we describe the distribution and representativeness of data from the NDW and explore its potential for population-level surveillance of HIV testing, care and treatment in *** bodyHealth information systems in Kenya have evolved from simple paper records to web-based EMRs with features that support data transmission to the NDW. The NDW design includes four layers: data warehouse application programming interface (DWAPI), central staging, integration service, and data visualization application. The number of health facilities uploading individual-level data to the NDW increased from 666 in 2016 to 1,516 in 2020, covering 41 of 47 counties in Kenya. By the end of 2020, the NDW hosted longitudinal data from 1,928,458 individuals ever started on antiretroviral therapy (ART). In 2020, there were 936,869 individuals who were active on ART in the NDW, compared to 1,219,276 individuals on ART reported in the aggregate-level Kenya Health Information System (KHIS), suggesting 77% coverage. The proportional distribution of individuals on ART by counties in the NDW was consistent with that from KHIS, suggesting representativeness and generalizability at the population *** NDW presents opportunities for individual-level HIV programme monitoring and surveillance because of its longitudinal design and its ability to r

关键词： Electronic medical records Repository Data warehouse HIV Surveillance

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Lessons Learned From Global Hepatitis C Elimination Programs

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JOURNAL OF INFECTIOUS DISEASES 2024年第SUPPLEMENT_3期229卷 S334-S341页

作者： Handanagic, Senad Shadaker, Shaun Drobeniuc, Jan Tsereteli, Maia Alkhazashvili, Maia Adesigbin, Clement Adamu, Ibrahim Adabe, Ruth Agwuocha, Chukwuemeka Adisa, Olayinka Azania, Amy Boeke, Caroline E. Ngwije, Alida Serumondo, Janvier Armstrong, Paige A. CDCP Div Viral Hepatitis Atlanta GA USA Natl Ctr Dis Control & Publ Hlth Georgia Tbilisi Georgia Fed Minist Hlth Natl AIDS STIs Control Programme Abuja Nigeria Nasarawa State Minist Hlth Lafia Nasarawa Nigeria Clinton Hlth Access Initiat Abuja Nigeria Clinton Hlth Access Initiat Boston MA USA Clinton Hlth Access Initiat Kigali Rwanda Rwanda Biomed Ctr Kigali Rwanda US Ctr Dis Control & Prevent Div Viral Hepatitis Natl Ctr HIV Viral Hepatitis STD & TB Prevent 1600 Clifton Rd Atlanta GA 30333 USA

In 2016, the World Health Organization introduced global targets for the care and management of hepatitis C virus (HCV) infection to eliminate hepatitis C as a public health threat by 2030. Despite significant improvements in testing and treatment, in 2020 only 23% of all persons infected with HCV globally were diagnosed. We explore examples from global hepatitis C programs in Georgia, Rwanda, and Nigeria that have used decentralized and integrated models to increase access to HCV testing. Georgia established the world's first national hepatitis C elimination program in 2015. In 2022, 2.6 million people (80% of the adults) have been screened for antibodies for HCV infection, and 80 000 persons with HCV RNA detected were treated. To achieve these results, Georgia implemented HCV core antigen testing, utilization of point-of-care (POC) HCV RNA testing, and simplification of HCV viremia detection by qualitative HCV RNA testing. Rwanda was the first country in sub-Saharan Africa to commit to HCV elimination in 2018, and as of 2022 it has achieved its screening target of 7 million people and initiated approximately 60 000 patients on hepatitis C treatment by rapid decentralization and integration of HCV services. In Nigeria, the integrated near-POC testing approach in Nasarawa State has been effective in expanding access to HCV viremia testing and enabling the possibility of same-day testing and treatment initiation. Examples of decentralization and integration of HCV testing and linkage to care in Georgia, Rwanda, and Nigeria could help inform effective strategies to reach 2030 hepatitis C elimination goals in other countries.

关键词： Georgia hepatitis C Nigeria Rwanda viral hepatitis elimination

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High level of HIV viral suppression in a cross-sectional study of Ugandan men with urethritis and bacterial STI

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INTERNATIONAL JOURNAL OF std & aids 2023年第14期34卷 998-1003页

作者： Beck, Evan J. Laeyendecker, Oliver Saraf, Sharada Ashokkumar, Swetha Onzia, Annet Melendez, Johan H. Chan, Justin Kyambadde, Peter Gough, Ethan Parkes-Ratanshi, Rosalind Manabe, Yukari C. Hamill, Matthew M. Natl Inst Allergy & Infect Dis Div Intramural Res NIH Bethesda MD USA Johns Hopkins Univ Sch Med Dept Med Baltimore MD USA Makerere Univ Infect Dis Inst Kampala Uganda Minist Hlth Uganda STD & AIDS Control Programme Kampala Uganda Johns Hopkins Bloomberg Sch Publ Hlth Dept Int Hlth Baltimore MD USA Natl Inst Allergy & Infect Dis Natl Inst Hlth North Wolfe St 855Rangos Bldg Room 540 Baltimore MD 21205 USA

Background Urethritis associated with non-viral sexually transmitted infections (STI) increases the risk of HIV acquisition and transmission in those living with HIV (LWH) without viral load suppression (VLS). Compared to women, men typically have lower rates of HIV VLS. We assessed the prevalence of VLS and drug resistance mutations in men LWH and urethral discharge syndrome (UDS) in Kampala, Uganda. Methods Men with UDS were recruited in Kampala October 2019-November 2020. Medical, demographic, and behavioural data were collected with biological samples. All reactive HIV results (rapid, sequential algorithm) underwent confirmatory HIV antibody- and HIV incidence-testing, and viral load (VL) measurement. The pol and gp41 regions were sequenced on samples with VLs >1000 cpm, phylogenetic trees were generated, and resistance mutations were investigated. Results 50 of 250 participants (20%) had reactive HIV rapid tests and 48/50 (96%) were aware of their HIV status and using antiretroviral therapy (ART). The median age was 38 years (IQR 32-45), 27/50 (54%) had engaged in transactional sex, and 30/50 (60%) reported alcohol before sex. VLS was present in 46/50 (92%). There were no major resistance mutations present in any samples analyzed. Conclusions The prevalence of HIV and VLS was greater in these men than in the general Ugandan adult population. Most men LWH were on ART and thus less likely to transmit HIV despite demonstrating sexual behaviours associated with high-risk of STIs. These data emphasize that high levels of ART coverage and VLS are achievable among men with UDS in urban Kampala.

关键词： HIV viral suppression urethral discharge syndrome sexually transmitted infections antiretroviral therapy resistance factors associated with HIV transmission Uganda men risk behaviours

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Alcohol use among people who inject drugs living with HIV in Kenya is associated with needle sharing, more new sex partners, and lower engagement in HIV care

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aids AND BEHAVIOR 2023年第12期27卷 3970-3980页

作者： DesLauriers, N. Sambai, B. Mbogo, L. Ludwig-Barron, N. Kingston, H. Chohan, B. Gitau, E. Sinkele, W. Masyuko, S. Herbeck, J. Bukusi, D. Guthrie, B. L. Farquhar, C. Monroe-Wise, A. Univ Washington Dept Med Seattle WA 98195 USA Kenyatta Natl Hosp HIV Testing & Counseling & HIV Prevent Nairobi Kenya Univ Washington Dept Global Hlth Seattle WA USA Univ Washington Dept Epidemiol Seattle WA USA Univ Washington Inst Publ Hlth Genet Seattle WA USA Kenya Med Res Inst KEMRI Nairobi Kenya Support Addict Prevent & Treatment Afr Nairobi Kenya Kenya Minist Hlth Natl AIDS & STI Control Programme NASCOP Nairobi Kenya

We assessed the prevalence and correlates of alcohol use among 870 people who inject drugs living with HIV in Kenya, with attention toward (1) sexual and injecting risk behaviors for HIV transmission and (2) HIV care engagement. We defined heavy alcohol use as > 14 drinks/week for men and > 7 drinks/week for women, moderate alcohol use as any lesser but non-zero amount, and any alcohol use as either moderate or heavy use. Approximately 39% of participants reported any alcohol use and 15% heavy use. In multivariate analysis, any alcohol use compared to no use was associated with needle sharing, > 3 new sex partners in the past 3 months, being unaware of HIV status, never enrolling in HIV care, and not being on ART (all p < 0.05). Heavy alcohol use as compared to no use was associated with needle sharing (aOR = 2.72;95% CI 1.43, 5.13), injection equipment sharing (aOR = 1.80;95% CI 1.00, 3.16), > 3 new sex partners in the past 3 months (aOR = 1.99;95% CI 1.12, 3.49), and being unaware of HIV status (aOR = 2.77;95% CI 1.46, 5.19). There was no association between any measure of alcohol use and unsuppressed viral load. Alcohol use among people who inject drugs living with HIV may carry elevated risk of HIV transmission mediated by sexual and injecting practices and is associated with lower engagement in multiple stages of the HIV care cascade.

关键词： HIV Alcohol Injection drug use HIV risk behaviors Care engagement Kenya

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Beach boys in Galle, Sri Lanka: multiple HIV risk behaviours and potential for HIV bridging

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BMC PUBLIC HEALTH 2020年第1期20卷 1-8页

作者： Bozicevic, Ivana Manathunge, Ariyaratne Beneragama, Sriyakanthi Gadjaweera, Chathrini Univ Zagreb World Hlth Org Collaborating Ctr HIV Strateg Info Sch Med Zagreb Croatia Minist Hlth Natl STD AIDS Control Programme Colombo Sri Lanka

Background There are limited data globally on HIV in men who engage in casual and transactional sex with female tourists. Methods In 2018 we carried out a respondent-driven sampling (RDS) survey among beach boys in Galle, Sri Lanka, to determine prevalence of HIV and other infections, HIV risk behaviours and utilisation of HIV prevention services. Eligibility criteria included men who cruise in and around beach areas and who had anal and/or vaginal sex with female or male tourists in the 12 months before the survey. Results We recruited 373 beach boys. Approximately 49.6% of the participants were married, while 45.7% were single and 4.7% divorced, separated or widowed. A lower percentage of beach boys reported regular partners in the past 12 months (52.3%) compared to casual partners (95.4%). Condom use at last sex with a casual partner was higher (76.7%) compared to condom use with regular partners (58.3%). Condom use at last sex with a tourist was reported by 75.3%. Ever receiving money, goods or services in exchange for sex was reported by 39.7%. For 85.5% of beach boys who sold sex, the last paying partner was a tourist (85.5%) and a woman (82.0%). In the past 12 months before the survey, 32.3% of beach boys paid money for sex, and 99.5% did so from women. Ever been tested for HIV was reported by 35.3, and 69.1% of those were tested in the 6 months before the survey. In the adjusted multivariate analysis, significant correlates of never testing for HIV were lack of comprehensive knowledge about HIV and unprotected last sexual intercourse with tourists. The prevalent infections were: HIV, 0.3% (95% CI 0.0-0.4%);syphilis, 0.5% (0.0-1.2%);herpes virus type-2, 5.0% (2.5-7.5%). Conclusions There are low level HIV and syphilis prevalence among beach boys in Galle but a high level of sexual risk taking. Beach boys may be acting as a bridge for HIV transmission between higher-risk groups (paying female tourists, men who have sex with men) and lower-risk heterosexual fem

关键词： HIV Transactional sex Tourists Sri Lanka

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Genital Immune Cell Activation and Tenofovir Gel Efficacy: A Case-control Study

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CLINICAL INFECTIOUS DISEASES 2022年第6期75卷 1088-1091页

作者： Liebenberg, Lenine J. P. Passmore, Jo-Ann S. Osman, Farzana Jewanraj, Janine Mtshali, Andile Garcia-Lerma, J. Gerardo Heneine, Walid Holder, Angela Archary, Derseree Ngcapu, Sinaye Sivro, Aida Mansoor, Leila E. Karim, Quarraisha Abdool Karim, Salim S. Abdool McKinnon, Lyle R. Ctr AIDS Programme Res South Africa CAPRISA Durban South Africa Univ KwaZulu Natal Sch Lab Med & Med Sci Durban South Africa Univ Cape Town Inst Infect Dis & Mol Med IDM Cape Town South Africa Natl Hlth Lab Serv Cape Town South Africa Ctr Dis Control & Prevent Div HIV AIDS Prevent Natl Ctr HIV AIDS Viral Hepatitis STD & TB Preven Atlanta GA USA Univ Manitoba Dept Med Microbiol & Infect Dis Winnipeg MB Canada Univ KwaZulu Natal Sch Nursing & Publ Hlth Durban South Africa Columbia Univ Dept Epidemiol New York NY USA

Genital inflammation (GI) undermines topical human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) efficacy through unknown mechanisms. Here, associations between activated endocervical CD4 + T-cell numbers and higher deoxyadenosine triphosphate (dATP) concentrations suggest that competition for intracellular metabolites within HIV target cells may reduce the efficacy of antiretroviral-based PrEP in women with GI.

关键词： immune activation genital inflammation HIV tenofovir dATP

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Group antenatal care for improving retention of adolescent and young pregnant women living with HIV in Kenya

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BMC PREGNANCY AND CHILDBIRTH 2022年第1期22卷 1-10页

作者： Teasdale, Chloe A. Odondi, Judith Kidiga, Catherine Choy, Michelle Fayorsey, Ruby Ngeno, Bernadette Ochanda, Boniface Langat, Agnes Ngugi, Catherine Callahan, Tegan Modi, Surbhi Hawken, Mark Odera, Doris Abrams, Elaine J. CUNY Grad Sch Publ Hlth & Hlth Policy Dept Epidemiol & Biostat 55 W125th StRoom 543 New York NY 10025 USA ICAP Columbia Univ Mailman Sch Publ Hlth New York NY 10032 USA Columbia Univ Mailman Sch Publ Hlth Dept Epidemiol New York NY 10027 USA US Ctr Dis Control & Prevent Div Global HIV & TB Atlanta GA USA US Ctr Dis Control & Prevent Nairobi Kenya Natl AIDS & STI Control Programme NASCOP Nairobi Kenya Columbia Univ Dept Pediat Vagelos Coll Phys & Surg New York NY 10027 USA

Background Pregnant and breastfeeding adolescents and young women living with HIV (AYWLH) have lower retention in prevention of mother-to-child transmission (PMTCT) services compared to older women. Methods We evaluated a differentiated service model for pregnant and postnatal AYWLH at seven health facilities in western Kenya aimed at improving retention in antiretroviral treatment (ART) services. All pregnant AYWLH < 25 years presenting for antenatal care (ANC) were invited to participate in group ANC visits including self-care and peer-led support sessions conducted by health facility nurses per national guidelines. ART register data were used to assess loss to follow-up (LTFU) among newly-enrolled pregnant adolescent (< 20 years) and young women (20-24 years) living with HIV starting ART in the pre-period (January-December 2016) and post-period (during implementation;December 2017-January 2019). Poisson regression models compared LTFU incidence rate ratios (IRR) in the first six months after PMTCT enrollment and risk ratios compared uptake of six week testing for HIV-exposed infants (HEI) between the pre- and post-periods. Results In the pre-period, 223 (63.2%) of 353 pregnant AYWLH newly enrolled in ANC had ART data, while 320 (71.1%) of 450 in the post-period had ART data (p = 0.02). A higher proportion of women in the post-period (62.8%) had known HIV-positive status at first ANC visit compared to 49.3% in the pre-period (p < 0.001). Among pregnant AYWLH < 20 years, the incidence rate of LTFU in the first six months after enrollment in ANC services declined from 2.36 per 100 person months (95%CI 1.06-5.25) in the pre-period to 1.41 per 100 person months (95%CI 0.53-3.77) in the post-period. In both univariable and multivariable analysis, AYWLH < 20 years in the post-period were almost 40% less likely to be LTFU compared to the pre-period, although this finding did not meet the threshold for statistical significance (adjusted incidence rate ratio 0.62, 95%CI 0.

关键词： Prevention of mother-to-child transmission of HIV Group antenatal care Retention Antiretroviral therapy Adolescent pregnancy

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