Dataset Information

Low levels of viral suppression among refugees and host nationals accessing antiretroviral therapy in a Kenyan refugee camp.

ABSTRACT:

Background

Refugees and host nationals who accessed antiretroviral therapy (ART) in a remote refugee camp in Kakuma, Kenya (2011-2013) were compared on outcome measures that included viral suppression and adherence to ART.

Methods

This study used a repeated cross-sectional design (Round One and Round Two). All adults (?18 years) receiving care from the refugee camp clinic and taking antiretroviral therapy (ART) for ?30 days were invited to participate. Adherence was measured by self-report and monthly pharmacy refills. Whole blood was measured on dried blood spots. HIV-1 RNA was quantified and treatment failures were submitted for drug resistance testing. A remedial intervention was implemented in response to baseline testing. The primary outcome was viral load <5000 copies/mL. The two study rounds took place in 2011-2013.

Results

Among eligible adults, 86% (73/85) of refugees and 84% (86/102) of Kenyan host nationals participated in the Round One survey; 60% (44/73) and 58% (50/86) of Round One participants were recruited for Round Two follow-up viral load testing. In Round One, refugees were older than host nationals (median age 36 years, interquartile range, IQR 31, 41 vs 32 years, IQR 27, 38); the groups had similar time on ART (median 147 weeks, IQR 38, 64 vs 139 weeks, IQR 39, 225). There was weak evidence for a difference between proportions of refugees and host nationals who were virologically suppressed (<5000 copies/mL) after 25 weeks on ART (58% vs 43%, p?=?0.10) and no difference in the proportions suppressed at Round Two (74% vs 70%, p?=?0.66). Mean adherence within each group in Round One was similar. Refugee status was not associated with viral suppression in multivariable analysis (adjusted odds ratio: 1.69, 95% CI 0.79, 3.57; p?=?0.17). Among those not suppressed at either timepoint, 69% (9/13) exhibited resistance mutations.

Conclusions

Virologic outcomes among refugees and host nationals were similar but unacceptably low. Slight improvements were observed after a remedial intervention. Virologic monitoring was important for identifying an underperforming ART program in a remote facility that serves refugees alongside host nationals. This work highlights the importance of careful laboratory monitoring of vulnerable populations accessing ART in remote settings.

SUBMITTER: Mendelsohn JB

PROVIDER: S-EPMC5450054 | biostudies-literature | 2017

REPOSITORIES: biostudies-literature

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Publications

Low levels of viral suppression among refugees and host nationals accessing antiretroviral therapy in a Kenyan refugee camp.

Mendelsohn Joshua B JB Spiegel Paul P Grant Alison A Doraiswamy Sathyanarayanan S Schilperoord Marian M Larke Natasha N Burton John Wagacha JW Okonji Jully A JA Zeh Clement C Muhindo Bosco B Mohammed Ibrahim M IM Mukui Irene N IN Patterson Njogu N Sondorp Egbert E Ross David A DA

Conflict and health 20170531

<h4>Background</h4>Refugees and host nationals who accessed antiretroviral therapy (ART) in a remote refugee camp in Kakuma, Kenya (2011-2013) were compared on outcome measures that included viral suppression and adherence to ART.<h4>Methods</h4>This study used a repeated cross-sectional design (<i>Round One</i> and <i>Round Two</i>). All adults (≥18 years) receiving care from the refugee camp clinic and taking antiretroviral therapy (ART) for ≥30 days were invited to participate. Adherence was ...[more]

PMID: 28572840

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Dataset Information

Low levels of viral suppression among refugees and host nationals accessing antiretroviral therapy in a Kenyan refugee camp.

Background

Methods

Results

Conclusions

Publications

Low levels of viral suppression among refugees and host nationals accessing antiretroviral therapy in a Kenyan refugee camp.

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