Laetitia Kampiire
(MPH 2013)

March 13, 2017

Laetitia’s MPH thesis determined the probability of and reasons for stopping/changing of antiretroviral drugs in South African pediatric sites of IeDEA-SA. The study population included all HIV infected children ≤16 years of age at ART initiation with a documented date of birth and initial regimen of ≥3 antiretroviral (ARV) drugs, and attending any one of 7 South African pediatric HIV clinic sites that contribute data to the IeDEA-SA database. Data from 5517 children with median [IQR] age at ART start of 42 [15-82] months were included in the analysis. By 3 years on ART, 81% of children alive and in care were still taking their initial regimen. Drug stops/changes for reasons other than treatment failure were mainly due to potential drug interaction in the 1st year on therapy, while in the 3rd year toxicity, potential drug interaction, treatment simplification (e.g. changing from syrup to tablet formulations) and other unspecified reasons were the main contributors. Nevirapine, zidovudine and stavudine were responsible for most treatment-limiting toxicity by 2 years on ART. Nevirapine toxicity occurred almost entirely in the first six months whereas stavudine toxicity occurred mostly after 1 year of therapy. Half of the zidovudine toxicity occurred in the first 3 months with the remainder evenly spread over the following 21 months. Laetitia concluded that pediatric ART durability in resource-limited settings was good but complex, with treatment changes due to toxicity, treatment failure and drug interactions, as well as treatment simplification. After completing her MPH, Leatitia worked with the Infectious Diseases Research Collaboration in Uganda as a study coordinator of an implementation science project called STARTs (Streamlined ART Initiation Strategy study), which was aimed at starting as many HIV-infected adults on ART as possible once they were eligible by CD4 count. Leatitia is currently doing an MMED in Pediatrics and Child Health at Makerere University in Uganda.