Trends Over Time for Adolescents Enrolling in HIV Care in Kenya, Tanzania, and Uganda From 2001-2014.

BACKGROUND: The data needed to understand the characteristics and outcomes, over time, of adolescents enrolling in HIV care in East Africa are limited. SETTING: Six HIV care programs in Kenya, Tanzania, and Uganda. METHODS: This retrospective cohort study included individuals enrolling in HIV care as younger adolescents (10-14 years) and older adolescents (15-19 years) from 2001-2014. Descriptive statistics were used to compare groups at enrollment and antiretroviral therapy (ART) initiation over time. The proportion of adolescents was compared with the total number of individuals aged 10 years and older enrolling over time. Competing-risk analysis was used to estimate 12-month attrition after enrollment/pre-ART initiation; post-ART attrition was estimated by Kaplan-Meier method. RESULTS: A total of 6344 adolescents enrolled between 2001 and 2014. The proportion of adolescents enrolling among all individuals increased from 2.5% (2001-2004) to 3.9% (2013-2014, P < 0.0001). At enrollment, median CD4 counts in 2001-2004 compared with 2013-2014 increased for younger (188 vs. 379 cells/mm, P < 0.0001) and older (225 vs. 427 cells/mm, P < 0.0001) adolescents. At ART initiation, CD4 counts increased for younger (140 vs. 233 cells/mm, P < 0.0001) and older (64 vs. 323 cells/mm, P < 0.0001) adolescents. Twelve-month attrition also increased for all adolescents both after enrollment/pre-ART initiation (4.7% vs. 12.0%, P < 0.001) and post-ART initiation (18.7% vs. 31.2%, P < 0.001). CONCLUSIONS: Expanding HIV services and ART coverage was likely associated with earlier adolescent enrollment and ART initiation but also with higher attrition rates before and after ART initiation. Interventions are needed to promote retention in care among adolescents.

High prevalence of malaria parasitemia and anemia among hospitalized children in Rakai, Uganda.

BACKGROUND: There is a paucity of data on malaria among hospitalized children in malaria endemic areas. We determined the prevalence, presentation and treatment outcomes of malaria and anemia among children in two hospitals in Rakai, Uganda. METHODS: Children under five years hospitalized in Kalisizo hospital or Bikira health center in Rakai district, Uganda between May 2011 and May 2012 were enrolled and followed-up until discharge, death or referral. Data were collected on social-demographic characteristics, current and past illnesses and clinical signs and symptoms. Blood smears, hemoglobin (Hgb) levels and HIV testing were performed from finger/heel prick blood. The associations between malaria infection and other factors were estimated using log-binomial regression to estimate adjusted prevalence risk ratios (aPRR) and 95% confidence intervals (CIs), controlling for clustering at health facilities. RESULTS: 2471 children were enrolled. The most common medical presentations were fever (96.2%), cough (61.7%), vomiting (44.2%), diarrhea (20.8%), and seizures (16.0%). The prevalence of malaria parasitemia was 54.6%. Children with malaria were more likely to present with a history of fever (aPRR 2.23; CI 1.18-4.24) and seizures (aPRR 1.12; CI 1.09-1.16). Confirmed malaria was significantly lower among girls than boys (aPRR 0.92; CI 0.91-0.93), HIV infected children (aPRR 0.60 CI 0.52-0.71), and children with diarrhea (aPRR 0.76; CI 0.65-0.90). The overall prevalence of anemia (Hgb<10 g/dl) was 56.3% and severe anemia (Hgb<6 g/dL) was 17.8%. Among children with severe anemia 76.8% had malaria parasitemia, of whom 93.1% received blood transfusion. Malaria associated mortality was 0.6%. CONCLUSION: There was a high prevalence of malaria parasitemia and anemia among inpatient children under five years. Malaria prevention is a priority in this population.

Sexual coercion among adolescent women in Rakai, Uganda: does family structure matter?

Studies on adolescent girls' vulnerability to sexual coercion in Sub-Saharan Africa have focused mainly on individual and partner risk factors, rarely investigating the role the family might play in their vulnerability. This study examined whether household family structure and parental vital status were associated with adolescent girls' risk of sexual coercion in Rakai, Uganda. Modified Poisson regression was used to estimate relative risk of sexual coercion in the prior 12 months among 1,985 unmarried and married adolescent girls aged 15 to 19 who were participants in the Rakai Community Cohort Study between 2001 and 2008. Among sexually active girls, 11% reported coercion in a given past year. Unexpectedly, living with a single mother was protective against experiencing coercion. As much as 4.1% of never-married girls living with single mothers reported coercion, compared to 7.8% of girls living with biological fathers (adj. relative risk [RR] = 2.24, 95% confidence interval [CI]: 0.98-5.08) and 20% of girls living in stepfather households (adj. RR = 4.73, 95% CI: 1.78-12.53). Ever-married girls whose mothers alone were deceased were more likely to report coercion than those with both parents alive (adj. RR = 1.56, 95% CI: 1.08-2.30). Protecting adolescent girls from sexual coercion requires prevention approaches that incorporate the family, with particular emphasis on including the men (e.g. fathers) who might play an influential role in young girls' sexual development. Understanding the family dynamics underlying the risk and protective effects of a given household structure might highlight new ways in which to prevent sexual coercion.