Two-year viral load suppression among adolescents receiving antiretroviral therapy in the Cape Metropole, South Africa, 2013 - 2015: A retrospective cohort analysis.

BACKGROUND: In 2018, 4% of all people living with HIV globally were adolescents aged 10 - 19 years. It is reported that adolescents on antiretroviral therapy (ART) are at increased risk of poor viral load suppression (VLS) compared with children and adults. OBJECTIVES: To determine the 24-month prevalence of VLS among adolescents initiated on ART in 2013 in public health facilities in the Metro District Health Services of Western Cape Province, South Africa. METHODS: A retrospective cohort analysis was done on 220 adolescents initiated on ART in 2013; they were followed up for 24 months. Data were extracted from the provincial Tier.Net electronic database and patients' clinical records, and captured in Excel. SPSS statistical software was used for descriptive and inferential analysis; bivariate analysis was used to determine significance and strength of associations between VLS and various sociodemographic and clinical characteristics at 4, 12 and 24 months (with significance set at p<0.05). RESULTS: VLS declined over the study period, with rates of 59.5%, 40.0% and 25.0% at 4, 12 and 24 months post initiation on treatment, respectively. In bivariate analysis, VLS was significantly associated with younger age (10 - 14 years) at month 12 (crude risk ratio (RR) 1.83 (95% confidence interval (CI) 1.35 - 2.49)) and month 24 (RR 3.38 (95% CI 2.24 - 5.10)) after initiation on ART. Male adolescents were significantly more likely to achieve VLS than females (month 4: RR 1.49 (95% CI 1.22 - 1.81); month 12: RR 1.50 (95% CI 1.07 - 2.12); and month 24: RR 2.33 (95% CI 1.50 - 3.62)). Pregnant adolescents were significantly less likely to attain VLS (month 4: RR 0.69 (95% CI 0.53 - 0.89); month 12: RR 0.64 (95% CI 0.44 - 0.94); and month 24: RR 0.24 (95% CI 0.11 - 0.50)) compared with those who were not pregnant. However, of those adolescents who were retained in care, VLS was higher at months 4, 12 and 24, with rates of 86.8%, 79.3% and 68.8%, respectively. CONCLUSIONS: Targeted interventions are required to improve retention in care and VLS among adolescents on ART, with specific focus on older (15 - 19-year-olds) and pregnant adolescents.

The effectiveness of continuous passive motion on range of motion, pain and muscle strength following rotator cuff repair: a systematic review.

OBJECTIVE: To systematically review the evidence on the effect of continuous passive motion, combined with usual physiotherapy management, on increasing shoulder joint range of motion and muscle strength, and reducing shoulder pain in adults following rotator cuff repair, compared with standard physiotherapy. DATA SOURCES: A comprehensive search in available bibliographic electronic databases was undertaken to locate eligible studies. Reference tracing was also used to locate studies. REVIEW METHODS: Randomized controlled trials reporting on the effect of continuous passive motion on increasing shoulder joint range of motion and muscle strength and reducing shoulder pain in adults following rotator cuff repair were included in the review. The PEDro scale was used to determine the methodological quality of the studies. Data were summarized in a narrative form because of their heterogeneity. RESULTS: Four randomized controlled trials were eligible for this review. One Japanese article was excluded as the text was unavailable in English. The methodological quality of the included studies averaged 7.67. Continuous passive motion was found to improve shoulder range of motion in two studies. One study found a decrease in pain in the intervention group and one study found that continuous passive motion improves muscle strength. CONCLUSION: Continuous passive motion is safe to use with physiotherapy treatment following rotator cuff repair surgery. It may help to prevent secondary complications post operatively.