Successful paediatric HIV treatment in rural primary care in Africa

Janssen, N., Ndirangu, J., Newell, M.-L. and Bland, R.M. (2010) Successful paediatric HIV treatment in rural primary care in Africa. Archives of Disease in Childhood, 95(6), pp. 414-421. (doi: 10.1136/adc.2009.169367)

Abstract

<p>Objective: Clinical outcomes of HIV-infected children on antiretroviral treatment (ART) in a decentralised, nurse/counsellor-led programme.</p> <p>Design: Clinical cohort.</p> <p>Setting: KwaZulu-Natal, South Africa.</p> <p>Patients: HIV-infected children aged <= 15 years on ART, June 2004-2008.</p> <p>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.</p> <p>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 <= 0.001) and albumin (30 vs 36 g/l; p <= 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 <= 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).</p> <p>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.</p>

• Item Type: Articles
• Keywords: Africa, age, aged, aid, albumin, art, care, childhood, children, cohort, death, design, disease, England, follow-up, growth, health, HIV, increase, infant, infants, mortality, outcome, outcomes, patient, patients, pediatrics, population, primary-care, primary-health-care, ratio, regression, rural, score, South-Africa, survival, therapies, therapy, treatment, young-children
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Bland, Dr Ruth
• Authors: Janssen, N., Ndirangu, J., Newell, M.-L., and Bland, R.M.
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Clinical Specialities
• Journal Name: Archives of Disease in Childhood
• Journal Abbr.: Arch. Dis. Child.
• Publisher: BMJ Publishing Group
• ISSN: 0003-9888
• ISSN (Online): 1468-2044
• Published Online: 29 October 2009
• Copyright Holders: Copyright © 2010 BMJ Publishing Group
• First Published: First published in Archives of Disease in Childhood 95(6):414-421
• Publisher Policy: Reproduced under a Creative Commons Licence