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    Mar 04, 2021
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    Outcomes of the South African National Antiretroviral Treatment Programme for children: the IeDEA Southern Africa collaboration.

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    Name:
    Davies MA. Outcomes of the SA ...
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    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
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    Affiliation
    School of Public Health and Family Medicine, University of Cape Town. Mary-Ann.Davies@uct.ac.za
    Issue Date
    2009-10
    
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    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.
    URI
    http://hdl.handle.net/10144/112715
    PubMed ID
    20128272
    Language
    en
    ISSN
    0256-9574
    Collections
    HIV/AIDS

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