Paediatric HIV care in sub‐Saharan Africa: clinical presentation and 2‐year outcomes stratified by age group. Issue 9 (20th June 2013)

• Record Type: Journal Article
• Authors: Ben‐Farhat, Jihane; Gale, Marianne; Szumilin, Elisabeth; Balkan, Suna; Poulet, Elisabeth; Pujades‐Rodríguez, Mar
• Is Part Of: Tropical medicine & international health. Volume 18:Issue 9(2013:Sep.)
• Page Start: 1065
• Page End: 1074
• Publication Date: 2013-06-20
• Subjects: Tropical medicine -- Periodicals; Public health -- Periodicals; 616.988
• DOI: 10.1111/tmi.12142
• Languages: English
• ISSNs: 1360-2276

Abstract

<abstract abstract-type="main" id="tmi12142-abs-0001"> <title>Abstract</title> <sec id="tmi12142-sec-0001" sec-type="section"> <title>Objectives</title> <p>To examine age differences in mortality and programme attrition amongst paediatric patients treated in four African HIV programmes.</p> </sec> <sec id="tmi12142-sec-0002" sec-type="section"> <title>Methods</title> <p>Longitudinal analysis of data from patients enrolled in HIV care. Two‐year mortality and programme attrition rates per 1000 person‐years stratified by age group (<2, 2–4 and 5–15 years) were calculated. Associations between outcomes and age and other individual‐level factors were studied using multiple Cox proportional hazards (mortality) and Poisson (attrition) regression models.</p> </sec> <sec id="tmi12142-sec-0003" sec-type="section"> <title>Results</title> <p>Six thousand two hundred and sixty‐one patients contributed 9500 person‐years; 27.1% were aged <2 years, 30.1% were 2–4, and 42.8% were 5–14 years old. At programme entry, 45.3% were underweight and 12.6% were in clinical stage 4. The highest mortality and attrition rates (98.85 and 244.00 per 1000 person‐years), and relative ratios (adjusted hazard ratio [aHR] = 1.92, 95% CI 1.56–2.37; incidence ratio [aIR] = 2.10, 95% CI 1.86–2.37, respectively, compared with the 5‐ to 14‐year group) were observed amongst the youngest children. Increased mortality and attrition were also associated with advanced clinical stage, underweight and diagnosis of tuberculosis at programme entry.</p> </sec> <sec id="tmi12142-sec-0004" sec-type="section"> <title>Conclusions</title> <p>These results highlight the need to increase access, diagnose and provide early HIV care and to accelerate antiretroviral treatment initiation for those eligible. Adapted education and support for children and their families would also be important.</p> </sec> </abstract>