Successful Paediatric HIV Treatment in Rural Primary Care in Africa

Overview

Journal Arch Dis Child

Specialty Pediatrics

Date 2009 Nov 3

PMID 19880392

Citations 34

Authors

N Janssen

J Ndirangu

M-L Newell

R M Bland

Affiliations

Soon will be listed here.

Abstract

Objective: Clinical outcomes of HIV-infected children on antiretroviral treatment (ART) in a decentralised, nurse/counsellor-led programme.

Design: Clinical cohort.

Setting: KwaZulu-Natal, South Africa.

Patients: HIV-infected children aged <or=15 years on ART, June 2004-2008.

Main Outcome Measures: Survival according to baseline characteristics including age, WHO clinical stage, haemoglobin and CD4%, was assessed in Kaplan-Meier analyses. Hazard ratios for mortality were estimated using Cox proportional hazards regression and changes in laboratory parameters and weight-for-age z scores after 6-12 months' treatment were calculated.

Results: 477 HIV-infected children began ART at a median age of 74 months (range 4-180), median CD4 count (CD4%) of 433 cells/mm(3) (17%) and median HIV viral load of log 4.2 copies/ml; 105 (22%) were on treatment for tuberculosis and 317 (76.6%) were WHO stage 3/4. There were significant increases after ART initiation in CD4% (17% vs 22%; p<0.001), haemoglobin (9.9 vs 11.7 g/l; p<or=0.001) and albumin (30 vs 36 g/l; p<or=0.001). 32 (6.7%) children died over 732 child-years of follow-up (43.7 deaths/1000 child-years; 95% CI 32.7 to 58.2), 17 (53.1%) within 90 days of treatment initiation; median age of death was 84 (IQR 10-181) months. Children with baseline haemoglobin <or=8 g/l were more likely to die (adjusted HR 4.5; 95% CI 1.6 to 12.3), as were those aged <18 months compared with >60 months (adjusted HR 3.2; 95% CI 1.2 to 9.1).

Conclusions: Good clinical outcomes in HIV-infected children on ART are possible in a rural, decentralised service. Few young children are on ART, highlighting the urgent need to identify HIV-exposed infants.

Citing Articles

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Hirasen K, Evans D, Jinga N, Grabe R, Turner J, Mashamaite S Patient Prefer Adherence. 2020; 14:133-151.

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PMID: 30094952 PMC: 6085595. DOI: 10.1002/jia2.25168.

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