Amy Styles

Although early antiretroviral therapy (ART) reduces HIV-related mortality in children by up to 75%, almost half of HIV-positive children younger than 1 year old in Swaziland do not initiate ART. This study was conducted to identify barriers to early ART initiation among HIV-positive infants. This was a case-control study among HIV-positive infants, aged 2 to 18 months, who either did not initiate ART (cases), or initiated ART (controls), during 18 months after testing. Multivariable logistic regression showed that infants who visited the clinic every month, or every 2 months, were 5.78 and 6.20 times more likely to initiate ART than those who visited less often (OR 5.78, 95% CI 1.82-18.33 and OR 6.20, 95% CI 1.30-29.60 respectively). Children who lived ≤30 and 31-60 minutes from the nearest clinic were 84% and 79% less likely respectively to initiate ART (OR 0.16, 95% CI 0.03-0.78 and OR 0.21, 95% CI 0.04-0.98) compared with those who lived more than 60 minutes away. Children who re...

HIV/AIDS remains one of the leading causes of death among children under 5 years old in Swaziland. Although studies have shown that early initiation of infants and children diagnosed with HIV on antiretroviral therapy (ART) significantly reduces mortality, many children do not initiate ART until the later stages of disease. This study was designed to collect qualitative data from mothers and caregivers of HIV-positive children to identify the barriers to ART initiation. Focus group discussion (FGD) sessions were conducted in siSwati between July and September 2014 among caregivers of aged children 2-18 months in Swaziland who did or did not initiate ART between January 2011 and December 2012 after HIV DNA PCR-positive diagnosis of the infants. Denial, guilt, lack of knowledge, tuberculosis (TB)/HIV co-infection, HIV-related stigma, lack of money, and distance to clinics were reported by the participants as barriers to ART initiation. The findings further revealed that non-initiation...

In this study, cytogenetic response rate after timely switching to a second-generation tyrosine kinase inhibitor (TKI) was evaluated among patients with CML-CP, after failure to achieve CCyR 1 year after imatinib initiation. An online physician-administered medical chart review was used to retrospectively collect information from 108 US-based hematologists and oncologists on CML-CP patients who initiated imatinib as first-line therapy and failed to achieve CCyR at 12 months after imatinib initiation. Patients who switched to a second-generation TKI within 3 months after the CCyR failure were defined as timely switchers, and those who continued taking imatinib for at least 3 months after the CCyR failure were defined as nonswitchers. CCyR achievement was compared between timely switchers and nonswitchers using multivariate Cox proportional hazard models. Physicians provided information on 593 patients, with 306 defined as timely switchers and 287 defined as nonswitchers. Among the nonswitchers, 78 switched to a second-generation TKI at a later date. After adjusting for potential confounding factors, timely switchers had statistically significantly greater likelihood of achieving CCyR (hazard ratio, 1.80; P = .002) compared with nonswitchers. Timely switching from imatinib to a second-generation TKI after CCyR failure 1 year after imatinib initiation was associated with a greater likelihood of achieving CCyR compared with delaying the switch or not switching to a second-generation TKI.