Family Matters: Co-enrollment of Family Members Into Care Is Associated With Improved Outcomes for HIV-Infected Women Initiating Antiretroviral Therapy
Identifieur interne : 002D27 ( Ncbi/Merge ); précédent : 002D26; suivant : 002D28Family Matters: Co-enrollment of Family Members Into Care Is Associated With Improved Outcomes for HIV-Infected Women Initiating Antiretroviral Therapy
Auteurs : Landon Myer [Afrique du Sud, États-Unis] ; Elaine J. Abrams [États-Unis] ; Yuan Zhang [États-Unis] ; Jimmy Duong [États-Unis] ; Wafaa M. El-Sadr [États-Unis] ; Rosalind J. Carter [États-Unis]Source :
- Journal of Acquired Immune Deficiency Syndromes (1999) [ 1525-4135 ] ; 2014.
Abstract
Although there is widespread interest in understanding how models of care for delivering antiretroviral therapy (ART) may influence patient outcomes, family-focused approaches have received little attention. In particular, there have been few investigations of whether the co-enrollment of HIV-infected family members may improve adult ART outcomes over time.
We examined the association between co-enrollment of HIV-infected family members into care and outcomes of women initiating ART in 12 HIV care and treatment programs across sub-Saharan Africa. Using data from the mother-to-child transmission-(MTCT) Plus Initiative, women starting ART were categorized according to the co-enrollment of an HIV-infected partner and/or HIV-infected child within the same program. Mortality and loss to follow-up were assessed for up to 5 years after women's ART initiation.
Of the 2877 women initiating ART included in the analysis, 31% (n = 880) had at least 1 HIV-infected family member enrolled into care at the same program, including 24% (n = 689) who had an HIV-infected male partner, and 10% (n = 295) who had an HIV-infected child co-enrolled. There was no significant difference in the risk of death of women by family co-enrollment status (
These data provide novel evidence for the association between adult outcomes on ART and co-enrollment of HIV-infected family members into care at the same program. Interventions that build on women's family contexts warrant further consideration in both research and policies to promote retention in ART services across sub-Saharan Africa.
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DOI: 10.1097/QAI.0000000000000379
PubMed: 25436824
PubMed Central: 4252141
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Abrams</name><affiliation wicri:level="2"><nlm:aff id="aff3">ICAP at Columbia University and Department of Epidemiology, Mailman School of Public Health, New York, NY;</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">État de New York</region></placeName><wicri:cityArea>ICAP at Columbia University and Department of Epidemiology, Mailman School of Public Health, New York</wicri:cityArea></affiliation><affiliation wicri:level="2"><nlm:aff id="aff4">College of Physicians & Surgeons, Columbia University, New York, NY;</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">État de New York</region></placeName><wicri:cityArea>College of Physicians & Surgeons, Columbia University, New York</wicri:cityArea></affiliation></author><author><name sortKey="Zhang, Yuan" sort="Zhang, Yuan" uniqKey="Zhang Y" first="Yuan" last="Zhang">Yuan Zhang</name><affiliation wicri:level="2"><nlm:aff wicri:cut="; and" id="aff5">Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">État de New York</region></placeName><wicri:cityArea>Department of Biostatistics, Mailman School of Public Health, Columbia University, New York</wicri:cityArea></affiliation></author><author><name sortKey="Duong, Jimmy" sort="Duong, Jimmy" uniqKey="Duong J" first="Jimmy" last="Duong">Jimmy Duong</name><affiliation wicri:level="2"><nlm:aff wicri:cut="; and" id="aff5">Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">État de New York</region></placeName><wicri:cityArea>Department of Biostatistics, Mailman School of Public Health, Columbia University, New York</wicri:cityArea></affiliation></author><author><name sortKey="El Sadr, Wafaa M" sort="El Sadr, Wafaa M" uniqKey="El Sadr W" first="Wafaa M." last="El-Sadr">Wafaa M. El-Sadr</name><affiliation wicri:level="2"><nlm:aff id="aff3">ICAP at Columbia University and Department of Epidemiology, Mailman School of Public Health, New York, NY;</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">État de New York</region></placeName><wicri:cityArea>ICAP at Columbia University and Department of Epidemiology, Mailman School of Public Health, New York</wicri:cityArea></affiliation></author><author><name sortKey="Carter, Rosalind J" sort="Carter, Rosalind J" uniqKey="Carter R" first="Rosalind J." last="Carter">Rosalind J. Carter</name><affiliation wicri:level="2"><nlm:aff id="aff3">ICAP at Columbia University and Department of Epidemiology, Mailman School of Public Health, New York, NY;</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">État de New York</region></placeName><wicri:cityArea>ICAP at Columbia University and Department of Epidemiology, Mailman School of Public Health, New York</wicri:cityArea></affiliation><affiliation><nlm:aff id="aff6">UNICEF, New York, NY.</nlm:aff><wicri:noCountry code="subfield">NY.</wicri:noCountry></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">25436824</idno><idno type="pmc">4252141</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4252141</idno><idno type="RBID">PMC:4252141</idno><idno type="doi">10.1097/QAI.0000000000000379</idno><date when="2014">2014</date><idno type="wicri:Area/Pmc/Corpus">002600</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002600</idno><idno type="wicri:Area/Pmc/Curation">002599</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">002599</idno><idno type="wicri:Area/Pmc/Checkpoint">001384</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">001384</idno><idno type="wicri:Area/Ncbi/Merge">002D27</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Family Matters: Co-enrollment of Family Members Into Care Is Associated With Improved Outcomes for HIV-Infected Women Initiating Antiretroviral Therapy</title><author><name sortKey="Myer, Landon" sort="Myer, Landon" uniqKey="Myer L" first="Landon" last="Myer">Landon Myer</name><affiliation wicri:level="1"><nlm:aff id="aff1">Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa;</nlm:aff><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town</wicri:regionArea><wicri:noRegion>Cape Town</wicri:noRegion></affiliation><affiliation wicri:level="2"><nlm:aff id="aff2">Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY;</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">État de New York</region></placeName><wicri:cityArea>Department of Epidemiology, Mailman School of Public Health, Columbia University, New York</wicri:cityArea></affiliation></author><author><name sortKey="Abrams, Elaine J" sort="Abrams, Elaine J" uniqKey="Abrams E" first="Elaine J." last="Abrams">Elaine J. Abrams</name><affiliation wicri:level="2"><nlm:aff id="aff3">ICAP at Columbia University and Department of Epidemiology, Mailman School of Public Health, New York, NY;</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">État de New York</region></placeName><wicri:cityArea>ICAP at Columbia University and Department of Epidemiology, Mailman School of Public Health, New York</wicri:cityArea></affiliation><affiliation wicri:level="2"><nlm:aff id="aff4">College of Physicians & Surgeons, Columbia University, New York, NY;</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">État de New York</region></placeName><wicri:cityArea>College of Physicians & Surgeons, Columbia University, New York</wicri:cityArea></affiliation></author><author><name sortKey="Zhang, Yuan" sort="Zhang, Yuan" uniqKey="Zhang Y" first="Yuan" last="Zhang">Yuan Zhang</name><affiliation wicri:level="2"><nlm:aff wicri:cut="; and" id="aff5">Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">État de New York</region></placeName><wicri:cityArea>Department of Biostatistics, Mailman School of Public Health, Columbia University, New York</wicri:cityArea></affiliation></author><author><name sortKey="Duong, Jimmy" sort="Duong, Jimmy" uniqKey="Duong J" first="Jimmy" last="Duong">Jimmy Duong</name><affiliation wicri:level="2"><nlm:aff wicri:cut="; and" id="aff5">Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">État de New York</region></placeName><wicri:cityArea>Department of Biostatistics, Mailman School of Public Health, Columbia University, New York</wicri:cityArea></affiliation></author><author><name sortKey="El Sadr, Wafaa M" sort="El Sadr, Wafaa M" uniqKey="El Sadr W" first="Wafaa M." last="El-Sadr">Wafaa M. El-Sadr</name><affiliation wicri:level="2"><nlm:aff id="aff3">ICAP at Columbia University and Department of Epidemiology, Mailman School of Public Health, New York, NY;</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">État de New York</region></placeName><wicri:cityArea>ICAP at Columbia University and Department of Epidemiology, Mailman School of Public Health, New York</wicri:cityArea></affiliation></author><author><name sortKey="Carter, Rosalind J" sort="Carter, Rosalind J" uniqKey="Carter R" first="Rosalind J." last="Carter">Rosalind J. Carter</name><affiliation wicri:level="2"><nlm:aff id="aff3">ICAP at Columbia University and Department of Epidemiology, Mailman School of Public Health, New York, NY;</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">État de New York</region></placeName><wicri:cityArea>ICAP at Columbia University and Department of Epidemiology, Mailman School of Public Health, New York</wicri:cityArea></affiliation><affiliation><nlm:aff id="aff6">UNICEF, New York, NY.</nlm:aff><wicri:noCountry code="subfield">NY.</wicri:noCountry></affiliation></author></analytic><series><title level="j">Journal of Acquired Immune Deficiency Syndromes (1999)</title><idno type="ISSN">1525-4135</idno><idno type="eISSN">1944-7884</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background:</title><p>Although there is widespread interest in understanding how models of care for delivering antiretroviral therapy (ART) may influence patient outcomes, family-focused approaches have received little attention. In particular, there have been few investigations of whether the co-enrollment of HIV-infected family members may improve adult ART outcomes over time.</p></sec><sec><title>Methods:</title><p>We examined the association between co-enrollment of HIV-infected family members into care and outcomes of women initiating ART in 12 HIV care and treatment programs across sub-Saharan Africa. Using data from the mother-to-child transmission-(MTCT) Plus Initiative, women starting ART were categorized according to the co-enrollment of an HIV-infected partner and/or HIV-infected child within the same program. Mortality and loss to follow-up were assessed for up to 5 years after women's ART initiation.</p></sec><sec><title>Results:</title><p>Of the 2877 women initiating ART included in the analysis, 31% (n = 880) had at least 1 HIV-infected family member enrolled into care at the same program, including 24% (n = 689) who had an HIV-infected male partner, and 10% (n = 295) who had an HIV-infected child co-enrolled. There was no significant difference in the risk of death of women by family co-enrollment status (<italic>P</italic> = 0.286). However, the risk of loss to follow-up was greatest among women who did not have an HIV-infected family member co-enrolled (19% after 36 months on ART) compared with women who had an HIV-infected family member co-enrolled (3%–8% after 36 months on ART) (<italic>P</italic> < 0.001). These associations persisted after adjustment for demographic and clinical covariates and were consistent across countries and care programs.</p></sec><sec><title>Discussion:</title><p>These data provide novel evidence for the association between adult outcomes on ART and co-enrollment of HIV-infected family members into care at the same program. Interventions that build on women's family contexts warrant further consideration in both research and policies to promote retention in ART services across sub-Saharan Africa.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Harries, Ad" uniqKey="Harries A">AD Harries</name></author><author><name sortKey="Makombe, Sd" uniqKey="Makombe S">SD Makombe</name></author><author><name sortKey="Schouten, Ej" uniqKey="Schouten E">EJ Schouten</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Cornell, M" uniqKey="Cornell M">M Cornell</name></author><author><name sortKey="Grimsrud, A" uniqKey="Grimsrud A">A Grimsrud</name></author><author><name sortKey="Fairall, L" uniqKey="Fairall L">L Fairall</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Grimsrud, A" uniqKey="Grimsrud A">A Grimsrud</name></author><author><name sortKey="Kaplan, R" 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uniqKey="Rosenfield A">A Rosenfield</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Martire, Lm" uniqKey="Martire L">LM Martire</name></author><author><name sortKey="Schulz, R" uniqKey="Schulz R">R Schulz</name></author><author><name sortKey="Helgeson, Vs" uniqKey="Helgeson V">VS Helgeson</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Von Korff, M" uniqKey="Von Korff M">M Von Korff</name></author><author><name sortKey="Gruman, J" uniqKey="Gruman J">J Gruman</name></author><author><name sortKey="Schaefer, J" uniqKey="Schaefer J">J Schaefer</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Berg, Ca" uniqKey="Berg C">CA Berg</name></author><author><name sortKey="Upchurch, R" uniqKey="Upchurch R">R Upchurch</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Rochat, Tj" uniqKey="Rochat T">TJ Rochat</name></author><author><name sortKey="Bland, R" uniqKey="Bland R">R Bland</name></author><author><name sortKey="Coovadia, H" uniqKey="Coovadia H">H Coovadia</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Tolle, Ma" uniqKey="Tolle M">MA Tolle</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Leeper, Sc" uniqKey="Leeper S">SC Leeper</name></author><author><name sortKey="Montague, Bt" uniqKey="Montague B">BT Montague</name></author><author><name sortKey="Friedman, Jf" uniqKey="Friedman J">JF Friedman</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Van Kooten Niekerk, Nk" uniqKey="Van Kooten Niekerk N">NK van Kooten Niekerk</name></author><author><name sortKey="Knies, Mm" uniqKey="Knies M">MM Knies</name></author><author><name sortKey="Howard, J" uniqKey="Howard J">J Howard</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Richter, L" uniqKey="Richter L">L 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<front><journal-meta><journal-id journal-id-type="nlm-ta">J Acquir Immune Defic Syndr</journal-id><journal-id journal-id-type="iso-abbrev">J. Acquir. Immune Defic. Syndr</journal-id><journal-id journal-id-type="publisher-id">qai</journal-id><journal-title-group><journal-title>Journal of Acquired Immune Deficiency Syndromes (1999)</journal-title></journal-title-group><issn pub-type="ppub">1525-4135</issn><issn pub-type="epub">1944-7884</issn><publisher><publisher-name>JAIDS Journal of Acquired Immune Deficiency Syndromes</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">25436824</article-id><article-id pub-id-type="pmc">4252141</article-id><article-id pub-id-type="publisher-id">QAIV14858</article-id><article-id pub-id-type="doi">10.1097/QAI.0000000000000379</article-id><article-id pub-id-type="art-access-id">00011</article-id><article-categories><subj-group subj-group-type="heading"><subject>Supplement Article</subject></subj-group></article-categories><title-group><article-title>Family Matters: Co-enrollment of Family Members Into Care Is Associated With Improved Outcomes for HIV-Infected Women Initiating Antiretroviral Therapy</article-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>Myer</surname><given-names>Landon</given-names></name><degrees>MBChB, PhD</degrees><xref ref-type="aff" rid="aff1">*</xref><xref ref-type="aff" rid="aff2">†</xref></contrib><contrib contrib-type="author"><name><surname>Abrams</surname><given-names>Elaine J.</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="aff3">‡</xref><xref ref-type="aff" rid="aff4">§</xref></contrib><contrib contrib-type="author"><name><surname>Zhang</surname><given-names>Yuan</given-names></name><degrees>MS, MA</degrees><xref ref-type="aff" rid="aff5">‖</xref></contrib><contrib contrib-type="author"><name><surname>Duong</surname><given-names>Jimmy</given-names></name><degrees>MPH</degrees><xref ref-type="aff" rid="aff5">‖</xref></contrib><contrib contrib-type="author"><name><surname>El-Sadr</surname><given-names>Wafaa M.</given-names></name><degrees>MD, MPH</degrees><xref ref-type="aff" rid="aff3">‡</xref></contrib><contrib contrib-type="author"><name><surname>Carter</surname><given-names>Rosalind J.</given-names></name><degrees>PhD</degrees><xref ref-type="aff" rid="aff3">‡</xref><xref ref-type="aff" rid="aff6">¶</xref></contrib><aff id="aff1"><label>*</label>Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa;</aff><aff id="aff2"><label>†</label>Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY;</aff><aff id="aff3"><label>‡</label>ICAP at Columbia University and Department of Epidemiology, Mailman School of Public Health, New York, NY;</aff><aff id="aff4"><label>§</label>College of Physicians & Surgeons, Columbia University, New York, NY;</aff><aff id="aff5"><label>‖</label>Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY; and</aff><aff id="aff6"><label>¶</label>UNICEF, New York, NY.</aff></contrib-group><author-notes><corresp>Correspondence to: Landon Myer, MBChB, PhD, School of Public Health & Family Medicine, University of Cape Town, Anzio Road, Observatory 7925, Cape Town, South Africa (e-mail: <email>landon.myer@uct.ac.za</email>).</corresp></author-notes><pub-date pub-type="ppub"><day>1</day><month>12</month><year>2014</year></pub-date><pub-date pub-type="epub"><day>07</day><month>11</month><year>2014</year></pub-date><volume>67</volume><issue>Suppl 4</issue><fpage>S243</fpage><lpage>S249</lpage><permissions><copyright-statement>Copyright © 2014 by Lippincott Williams & Wilkins</copyright-statement><copyright-year>2014</copyright-year><license license-type="open-access"><license-p>This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivitives 3.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.</license-p></license></permissions><self-uri xlink:type="simple" xlink:href="qai-67-s243.pdf"></self-uri><abstract><sec><title>Background:</title><p>Although there is widespread interest in understanding how models of care for delivering antiretroviral therapy (ART) may influence patient outcomes, family-focused approaches have received little attention. In particular, there have been few investigations of whether the co-enrollment of HIV-infected family members may improve adult ART outcomes over time.</p></sec><sec><title>Methods:</title><p>We examined the association between co-enrollment of HIV-infected family members into care and outcomes of women initiating ART in 12 HIV care and treatment programs across sub-Saharan Africa. Using data from the mother-to-child transmission-(MTCT) Plus Initiative, women starting ART were categorized according to the co-enrollment of an HIV-infected partner and/or HIV-infected child within the same program. Mortality and loss to follow-up were assessed for up to 5 years after women's ART initiation.</p></sec><sec><title>Results:</title><p>Of the 2877 women initiating ART included in the analysis, 31% (n = 880) had at least 1 HIV-infected family member enrolled into care at the same program, including 24% (n = 689) who had an HIV-infected male partner, and 10% (n = 295) who had an HIV-infected child co-enrolled. There was no significant difference in the risk of death of women by family co-enrollment status (<italic>P</italic> = 0.286). However, the risk of loss to follow-up was greatest among women who did not have an HIV-infected family member co-enrolled (19% after 36 months on ART) compared with women who had an HIV-infected family member co-enrolled (3%–8% after 36 months on ART) (<italic>P</italic> < 0.001). These associations persisted after adjustment for demographic and clinical covariates and were consistent across countries and care programs.</p></sec><sec><title>Discussion:</title><p>These data provide novel evidence for the association between adult outcomes on ART and co-enrollment of HIV-infected family members into care at the same program. Interventions that build on women's family contexts warrant further consideration in both research and policies to promote retention in ART services across sub-Saharan Africa.</p></sec></abstract><kwd-group><title>Key Words:</title><kwd>antiretroviral therapy</kwd><kwd>family care</kwd><kwd>loss to follow-up</kwd><kwd>women's health</kwd><kwd>models of care</kwd><kwd>Africa</kwd></kwd-group><custom-meta-group><custom-meta><meta-name>OPEN-ACCESS</meta-name><meta-value>TRUE</meta-value></custom-meta></custom-meta-group></article-meta></front></pmc><affiliations><list><country><li>Afrique du Sud</li><li>États-Unis</li></country><region><li>État de New York</li></region></list><tree><country name="Afrique du Sud"><noRegion><name sortKey="Myer, Landon" sort="Myer, Landon" uniqKey="Myer L" first="Landon" last="Myer">Landon Myer</name></noRegion></country><country name="États-Unis"><region name="État de New York"><name sortKey="Myer, Landon" sort="Myer, Landon" uniqKey="Myer L" first="Landon" last="Myer">Landon Myer</name></region><name sortKey="Abrams, Elaine J" sort="Abrams, Elaine J" uniqKey="Abrams E" first="Elaine J." last="Abrams">Elaine J. Abrams</name><name sortKey="Abrams, Elaine J" sort="Abrams, Elaine J" uniqKey="Abrams E" first="Elaine J." last="Abrams">Elaine J. Abrams</name><name sortKey="Carter, Rosalind J" sort="Carter, Rosalind J" uniqKey="Carter R" first="Rosalind J." last="Carter">Rosalind J. Carter</name><name sortKey="Duong, Jimmy" sort="Duong, Jimmy" uniqKey="Duong J" first="Jimmy" last="Duong">Jimmy Duong</name><name sortKey="El Sadr, Wafaa M" sort="El Sadr, Wafaa M" uniqKey="El Sadr W" first="Wafaa M." last="El-Sadr">Wafaa M. El-Sadr</name><name sortKey="Zhang, Yuan" sort="Zhang, Yuan" uniqKey="Zhang Y" first="Yuan" last="Zhang">Yuan Zhang</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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