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Acceptable adherence and treatment outcomes among refugees and host community on HAART in an urban refugee setting in Ku

Acceptable adherence and treatment outcomes among refugees and host community on HAART in an urban refugee setting in Kuala Lumpur, Malaysia THPDD0103. Poor treatment outcomes among both refugees and host community accessing HAART from Kakuma refugee camp, Northwestern Kenya THPDD0102.

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Acceptable adherence and treatment outcomes among refugees and host community on HAART in an urban refugee setting in Ku

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  1. Acceptable adherence and treatment outcomes among refugees and host community on HAART in an urban refugee setting in Kuala Lumpur, Malaysia THPDD0103 Poor treatmentoutcomesamongbothrefugeesandhostcommunityaccessing HAART fromKakumarefugee camp, NorthwesternKenya THPDD0102 J.B. Mendelsohn, M. Schilperoord, P. Spiegel, J.W. Burton, J.A. Okonji, B.Muhindo, P. Njogu, N. Larke, A. Grant, I.M. Mohamed, I.N. Mukui, D.A. Ross J.B. Mendelsohn, P. Spiegel, M. Schilperoord, S. Balasundaram, A. Radhakrishnan, C. Lee, N. Larke, A. Grant, D.A. Ross joshua.mendelsohn@lshtm.ac.uk
  2. Background/Objective Refugee Convention: refugees should receive equitable access to public relief/health care Tight link between adherence and treatment outcomes Few data on adherence and treatment outcomes in clinics providing HAART to refugees in asylum; comparison with host nationals Are refugees and host community clients achieving Optimal adherence? Acceptable and equitable treatment outcomes? What is driving outcomes?
  3. Methods Cross-sectional surveys Sungai Buloh Hospital: public urban reference hospital on the outskirts of Kuala Lumpur Comprehensive Care Clinic, Kakuma Refugee Camp, an NGO-run, remote clinic, Northwestern Kenya ≥18 years; HAART for ≥30 days; ≥6 mo. defaulters excluded Structured questionnaire with self-reported (SR) adherence measures Pharmacy-based measure of adherence to prescription (Rx) refills over 24 months prior HIV viral loads (phlebotomy / dried blood spots)
  4. Malaysia 91,985 registered by UNHCR as refugees and asylum seekers 171 refugees on HAART, 98% Burmese 2,900 Malaysians on HAART at SB hospital 153 refugees;148 Malaysians serially-recruited 90% participation rate among refugees; 89% response rate among Malaysians
  5. Results - Malaysia Risk factors for lack of viral suppression (≥25wks) Refugee status (aOR=1.28, 0.52-3.14, p=0.60) Female (aOR=0.39, 0.14-1.05, p=0.05) Optimal adherence Rx (aOR=0.47, 0.27- 0.81, p=0.007) Longer time from diagnosis to HAART (aOR=0.64, 0.41-0.99, p=0.04) Temporary migration, ≥1 mo. in the past year (aOR=4.12, 1.70-9.99, p=0.002) Clinic transit times ≥1hr (aOR=3.05, 95%CI 1.09-8.49, p=0.02)
  6. Kenya 446,946 refugees from the Horn of Africa registered by UNHCR Kakuma Refugee Camp, pop. 82,409 84 refugees;104 Kenyans on HAART 73 refugees, 86 Kenyans serially recruited / actively traced ~85% participation rates in each group
  7. Results - Kenya Risk factors for lack of viral suppression (≥25wks) Refugee status (aOR=0.64, 0.20-2.08, p=0.46) Larger household sizes (aOR=0.26, 0.11-0.61, p<0.001) Underdosing(aOR=7.48, 0.74-27.22, p=0.07)
  8. Conclusions Adherenceand viral suppression: refugee=host Equal HAART provisionandsupporttorefugeesandthehostcommunityhaspublichealthandclinicalbenefits Enlightenedself-interestofhost countries Outcomes in Kenyarequire urgent response Implementingpartnerworkingtoimproveadherence; assessmentplanned Pastadherencelapsesmay not be well capturedbyRxorself-reportedadherence High levelsofresistance? Drug potency?
  9. Acknowledgements Canadian Institutes of Health Research The Parkes Foundation UNHCR London School of Hygiene and Tropical Medicine Hospital Sungai Buloh International Rescue Committee Kenya KEMRI (Kisumu)
  10. UNHCR Alan Vernon, Liz Ahua, Nadine Cornier, HerveIsambert, Ann Burton, Chunting Wong, Fiona Chuah, MadhaviMadhu, RajeswariElumalai, Peter Daniels, Jacqueline Dache, SathyaDoraiswamy Hospital Sungai BulohChung Han Yang, Mohamed Sufian, Bernard Lee, Hui Moon, JayanthiArumugam, Wong KokMun Standard Pharmacy, Kuala Lumpur M. Lim IRC KenyaMwitiMungania, Jonathan Imaana, Geoffrey Lutta, Monica Eshikeda KEMRI (Kisumu)Clement Zeh Refugee and local research staffJerry Manuel, Ngui Sui Sin (Mai Mai), William Khor, Angelina Hejazi, Min Ye Tun, Par Mawii, La Seng, MaranSeng Raw, Aung Win, Juliana Ooi, Tan SokTeng, AungZanWai (Saw), Frankie Kai-Pong Law, El Sheila Kavanathi, SangeethaShyam, Liang Yaw Wen, Betty Akot, HabibaAbdiAdan, Abdikarim Sharif Mohamed, Honey AbdiIsse, Kevin EkalEkutan, Patrick EjoriLobali, MuthomiPhineasGitonga, Rhoda Payo, Moses Lujang, Kagoyire Marie Louise, Jean De DieuKiza, TibeyenMekonnen, Fasil Asmara, ConsolataWanyonyi, Nicodemus Erupe, Richard Loris, Mohammed Ahmed Osman, Abraham Dulacha, SaudaMukanyarwaya, Lula Gabratasea, LapsonOpaka Lot, AminaHamadiOsma, and Esther Tito.
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