Cascade of care in children and adolescents with HIV in Russian Federation
Author: Anna Turkova, Evgeny Voronin, Yulia Plotnikova, Anna Samarina, Edith Milanzi, Vladimir Rozenberg, Liubov Okhonskaia, Inga Latysheva, Aleksey Plynsky, Elena Fertikh, Siobhan Crichton, Charlotte Jackson, Ali Judd, Intira J Collins, on behalf of the European Pregnancy and Paediatric Infections Cohort Collaboration (EPPICC)
Published in: 12th International Workshop on HIV Pediatrics
The cascade of care summarises the 90-90-90 UNAIDS targets, of 90% of HIV+ people knowing their status, of whom 90% receive antiretroviral treatment (ART), of whom 90% are virally suppressed
By 2019, there were 1,068,839 people diagnosed with HIV in Russia, of whom 50% were on ART, and of those 76% were virally suppressed1.
However, there is less data on the HIV care continuum in children and adolescents with HIV in Russia
To summarise the cascade of care in children and adolescents living with HIV in three Russian clinics.
We included data on children/adolescents aged <18 years at HIV diagnosis from three Russian clinics within the European Pregnancy and Paediatric Infections Cohort Collaboration (EPPICC).
Follow-up data from first presentation to HIV care until death, loss to follow-up, transfer to adult care or last visit (data cut-off 1/10/2016) were included.
As all patients were already diagnosed with HIV, we adapted the cascade of care as follows: (a) initiated ART, (b) virally suppressed (VS) ≤1000 copies/ml and (c) having good WHO immune status* at last visit. The analysis was restricted to patients in active paediatric follow-up (FU) in 2015-2016 and had ≥12 months of FU.
Characteristics of patients and cascade results were stratified by age of HIV diagnosis:
i.Diagnosed during “childhood” (age <10) and
ii.Diagnosed during “adolescence” (age ≥10)
The proportion with VS and good immune status* at 12(±3) months after ART start was also summarized overall and by calendar year of ART start.
- Of 922 patients followed in the 3 centres, 703 had ≥12 months FU and were in care in 2015/16 and included in this analysis. Of these:
- 655 (93%) were diagnosed in childhood, of whom 94% had perinatally acquired HIV (Table 1)
- 48 (7%) were diagnosed in adolescence, of whom 27% had perinatally acquired HIV, 25% sexually-acquired, and 48% had other or unknown mode of transmission
- 94% (618/655) in the childhood group initiated ART compared to 81% (39/48) in the adolescent group.
- At ART initiation, the median age was 2.2 years and 16.1 years in the childhood and adolescence group, respectively. 52% and 58% had advanced or severe WHO immunosuppression at ART start, respectively (Table 1).