Outcomes of the South African National Antiretroviral Treatment Programme for children: the IeDEA Southern Africa collaboration.

Hdl Handle:
http://hdl.handle.net/10144/112715
Title:
Outcomes of the South African National Antiretroviral Treatment Programme for children: the IeDEA Southern Africa collaboration.
Authors:
Davies, Mary-Ann; Keiser, Olivia; Technau, Karl; Eley, Brian; Rabie, Helena; van Cutsem, Gilles; Giddy, Janet; Wood, Robin; Boulle, Andrew; Egger, Matthias; Moultrie, Harry
Journal:
South African Medical Journal = Suid-Afrikaanse tydskrif vir geneeskunde
Abstract:
OBJECTIVES: To assess paediatric antiretroviral treatment (ART) outcomes and their associations from a collaborative cohort representing 20% of the South African national treatment programme. DESIGN AND SETTING: Multi-cohort study of 7 public sector paediatric ART programmes in Gauteng, Western Cape and KwaZulu-Natal provinces. SUBJECTS: ART-naive children (< or = 16 years) who commenced treatment with > or = 3 antiretroviral drugs before March 2008. OUTCOME MEASURES: Time to death or loss to follow-up were assessed using the Kaplan-Meier method. Associations between baseline characteristics and mortality were assessed with Cox proportional hazards models stratified by site. Immune status, virological suppression and growth were described in relation to duration of ART. RESULTS: The median (interquartile range) age of 6 078 children with 9 368 child-years of follow-up was 43 (15 - 83) months, with 29% being < 18 months. Most were severely ill at ART initiation. More than 75% of children were appropriately monitored at 6-monthly intervals with viral load suppression (< 400 copies/ml) being 80% or above throughout 36 months of treatment. Mortality and retention in care at 3 years were 7.7% (95% confidence interval 7.0 - 8.6%) and 81.4% (80.1 - 82.6%), respectively. Together with young age, all markers of disease severity (low weight-for-age z-score, high viral load, severe immune suppression, stage 3/4 disease and anaemia) were independently associated with mortality. CONCLUSIONS: Dramatic clinical benefit for children accessing the national ART programme is demonstrated. Higher mortality in infants and those with advanced disease highlights the need for early diagnosis of HIV infection and commencement of ART.
Affiliation:
School of Public Health and Family Medicine, University of Cape Town. Mary-Ann.Davies@uct.ac.za
Issue Date:
Oct-2009
URI:
http://hdl.handle.net/10144/112715
PubMed ID:
20128272
Language:
en
ISSN:
0256-9574
Appears in Collections:
HIV/AIDS

Full metadata record

DC FieldValue Language
dc.contributor.authorDavies, Mary-Annen
dc.contributor.authorKeiser, Oliviaen
dc.contributor.authorTechnau, Karlen
dc.contributor.authorEley, Brianen
dc.contributor.authorRabie, Helenaen
dc.contributor.authorvan Cutsem, Gillesen
dc.contributor.authorGiddy, Janeten
dc.contributor.authorWood, Robinen
dc.contributor.authorBoulle, Andrewen
dc.contributor.authorEgger, Matthiasen
dc.contributor.authorMoultrie, Harryen
dc.date.accessioned2010-10-08T22:39:25Z-
dc.date.available2010-10-08T22:39:25Z-
dc.date.issued2009-10-
dc.identifier.citationOutcomes of the South African National Antiretroviral Treatment Programme for children: the IeDEA Southern Africa collaboration. 2009, 99 (10):730-7 S. Afr. Med. J.en
dc.identifier.issn0256-9574-
dc.identifier.pmid20128272-
dc.identifier.urihttp://hdl.handle.net/10144/112715-
dc.description.abstractOBJECTIVES: To assess paediatric antiretroviral treatment (ART) outcomes and their associations from a collaborative cohort representing 20% of the South African national treatment programme. DESIGN AND SETTING: Multi-cohort study of 7 public sector paediatric ART programmes in Gauteng, Western Cape and KwaZulu-Natal provinces. SUBJECTS: ART-naive children (< or = 16 years) who commenced treatment with > or = 3 antiretroviral drugs before March 2008. OUTCOME MEASURES: Time to death or loss to follow-up were assessed using the Kaplan-Meier method. Associations between baseline characteristics and mortality were assessed with Cox proportional hazards models stratified by site. Immune status, virological suppression and growth were described in relation to duration of ART. RESULTS: The median (interquartile range) age of 6 078 children with 9 368 child-years of follow-up was 43 (15 - 83) months, with 29% being < 18 months. Most were severely ill at ART initiation. More than 75% of children were appropriately monitored at 6-monthly intervals with viral load suppression (< 400 copies/ml) being 80% or above throughout 36 months of treatment. Mortality and retention in care at 3 years were 7.7% (95% confidence interval 7.0 - 8.6%) and 81.4% (80.1 - 82.6%), respectively. Together with young age, all markers of disease severity (low weight-for-age z-score, high viral load, severe immune suppression, stage 3/4 disease and anaemia) were independently associated with mortality. CONCLUSIONS: Dramatic clinical benefit for children accessing the national ART programme is demonstrated. Higher mortality in infants and those with advanced disease highlights the need for early diagnosis of HIV infection and commencement of ART.en
dc.language.isoenen
dc.rightsArchived with thanks to South African Medical Journal = Suid-Afrikaanse tydskrif vir geneeskundeen
dc.subject.meshAnti-Retroviral Agentsen
dc.subject.meshChilden
dc.subject.meshChild, Preschoolen
dc.subject.meshDisease Progressionen
dc.subject.meshFemaleen
dc.subject.meshHIV Infectionsen
dc.subject.meshHumansen
dc.subject.meshInfanten
dc.subject.meshKaplan-Meiers Estimateen
dc.subject.meshMaleen
dc.subject.meshSeverity of Illness Indexen
dc.subject.meshSouth Africaen
dc.subject.meshTreatment Outcomeen
dc.titleOutcomes of the South African National Antiretroviral Treatment Programme for children: the IeDEA Southern Africa collaboration.en
dc.contributor.departmentSchool of Public Health and Family Medicine, University of Cape Town. Mary-Ann.Davies@uct.ac.zaen
dc.identifier.journalSouth African Medical Journal = Suid-Afrikaanse tydskrif vir geneeskundeen

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