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    Mar 04, 2021
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    Excellent outcomes among HIV+ children on ART, but unacceptably high pre-ART mortality and losses to follow-up: a cohort study from Cambodia.

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    Raguenaud Peds Outcomes Cambodia ...
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    Authors
    Raguenaud, M-E
    Isaakidis, P
    Zachariah, R
    Te, V
    Soeung, S
    Akao, K
    Kumar, V
    Affiliation
    Médecins Sans Frontières, 72, Street 592, Phnom Penh, Cambodia. eve_raguenaud@hotmail.com
    Issue Date
    2009-08-20
    
    Metadata
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    Journal
    BMC Pediatrics
    Abstract
    BACKGROUND: Although HIV program evaluations focusing on mortality on ART provide important evidence on treatment effectiveness, they do not asses overall HIV program performance because they exclude patients who are eligible but not started on ART for whatever reason. The objective of this study was to measure mortality that occurs both pre-ART and during ART among HIV-positive children enrolled in two HIV-programs in Cambodia. METHODS: Retrospective cohort study on 1168 HIV-positive children <15 years old registered in two HIV-programs over a four-year period. Mortality rates were calculated for both children on treatment and children not started on ART. RESULTS: Over half (53%) of children were 5 years or above and only 69(6%) were <18 months. Overall, 9% (105/1168) of children died since the set-up of the programs. By the end of the observation period, 66(14.5%) patients not on ART had died compared to 39(5.5%) of those under treatment, and 100(22%) who did not start ART were lost-to-follow-up compared to 13(2%) on ART. 66/105 (62.8%) of all in-program deaths occurred before starting ART, of which 56% (37/66) and 79% (52/66) occurred within 3 and 6 months of enrollment respectively. Mortality rate ratio between children not on ART and children on ART was 4.1 (95%CI: 2.7-6.2) (P < 0.001). The most common contributing cause of death in first 3 months of treatment and in first 3 months of program enrollment was tuberculosis. 41/52 (79%) children who died within 6 months of enrollment had met the ART eligibility criteria before death. CONCLUSION: HIV-positive children experienced a high mortality and loss-to-follow-up rates before starting ART. These program outcomes may be improved by a more timely ART initiation. Measuring overall in-program mortality as opposed to only mortality on ART is recommended in order to more accurately evaluate pediatric HIV-programs performance.
    URI
    http://hdl.handle.net/10144/83714
    DOI
    10.1186/1471-2431-9-54
    PubMed ID
    19691853
    Language
    en
    ISSN
    1471-2431
    ae974a485f413a2113503eed53cd6c53
    10.1186/1471-2431-9-54
    Scopus Count
    Collections
    Paediatrics
    HIV/AIDS

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