BackgroundIndia has recently introduced telemedicine initiatives to enhance access to specialized care at a low cost for the pediatric HIV patients, who face multiple challenges due to growing disease burden and limited preparedness of the health system to address it. There are limited evidences on the cost-effectiveness of these interventions. This study was undertaken in Maharashtra, a province, located in the western region of the country, to inform policy regarding the effectiveness of this programme. The objective was to estimate the unit cost of ART services for pediatric HIV patients and examine the efficiency in the use of resource and treatment compliance resulting from telemedicine initiatives in pediatric HIV compared to usual ART services.MethodsWe selected 6 ART centers (3 from linked centers linked to Pediatric HIV Centre of Excellence (PCoE) and 3 from non-linked centers) randomly from three high, middle and low ART centers, categorized on the basis of case load in each arm. A bottom up costing methodology was adopted to understand the unit cost of services. Loss to follow up and timeliness of the visits were compared between the two arms and were linked to the cost.ResultsThe average cost per-visit was INR 1803 in the linked centers and that for the non-linked centers was INR 3412. There has been 5 percentage point improvement in lost to follow-up in the linked centers compared to non-linked centers against a back-drop of a reduction in per-pediatric patient cost of INR 557. The linkage has resulted in increase in timeliness of the visits in linked centers compared to non-linked centers.Discussion and conclusionThe telemedicine linkage led to an increase in the case load leading to a decrease in cost. The evidence on efficiency in the use of resource and improvement in treatment compliance as suggested by this study could be used to scale up this initiative.

Optic nerve involvement is a rare side effect of isoniazid (INH) and has not been described in children. We describe this adverse reaction in a 10-year-old boy, who was treated for tuberculous meningitis. The patient showed almost complete resolution following withdrawal of INH and administration of pyridoxine and steroids.

Background. The National AIDS Control Organization (NACO) of India created the Regional Pediatric Antiretroviral Therapy (ART) Center; this was subsequently upgraded to seven Pediatric Centers of Excellence (PCoEs) to strengthen the quality of treatment and care of children living with HIV/AIDS (CLHAs). In October 2013, the pediatric HIV telemedicine initiative, an e-decentralized (care provided by local healthcare providers and support provided by a central agency through telemedicine facilities) model of expert pediatric HIV care and referral services, was established as a pilot project at the Pediatric Center of Excellence for HIV Care in Maharashtra. We designed the present study to compare management, compliance to ART, and mortality in children in the ART centers linked to the PCoE through telemedicine versus those that are not linked to the PCoE. Methods. It was a retrospective cross-sectional study of secondary data from CLHAs from October 2013 through August 2015 in the ART centers to document the intermediate outcomes and to determine if the initiative has improved the quality of care for the CLHAs enrolled in the linked ART centers with nonlinked ART centers. The centers in which the telemedicine sessions were conducted regularly were called linked-regular centers and in whom it was conducted irregularly (less than the median of 12 videoconference cases), it was called a linked-irregular center. Data from 2803 children in 31 linked (1365 in irregular and 1438 in regular centers) and 2608 children in 28 nonlinked centers were analyzed. The outcomes in children in the pre-ART group (ART naïve) were (1) alive on pre-ART, (2) lost to follow-up on pre-ART, (3) death during the pre-ART period, (4) eligible but not initiated on ART, and (5) missing baseline and latest CD4 counts. The outcomes of children on ART were (1) alive on ART, (2) lost to follow-up on ART, (3) death on ART, and (4) missing baseline and latest CD4 counts. Results. We found that a higher proportion of children in the linked-regular centers (79% vs. 70%, p < 0.001 ) and linked-irregular centers (76% vs. 70%, p = 0.04 ) was alive compared with that in the nonlinked centers in the pre-ART group. In this group, the proportion of children with missing baseline CD4 counts and latest CD4 counts was significantly low in linked (regular centers) centers. In the ART group, we found that a higher proportion of children in the linked-regular centers was alive compared with that in the linked-irregular centers (77% vs. 69%, p < 0.001 ); the proportion was not significantly different in nonlinked centers (77% vs. 78%, p = 0.56 ). In this group, the proportion of missing baseline CD4 counts was significantly lower in the linked-regular centers (3% vs 13%, p<0.001) and linked-irregular centers (1% vs. 13%, p < 0.001 ) compared with that in the nonlinked centers. Furthermore, the latest CD4 counts were missing in a significantly lower proportion of children in the linked-regular centers compared with those in the linked-irregular centers (6% vs. 18%, p < 0.001 ) and nonlinked centers (6% vs. 18%, p < 0.001 ). Conclusion. Our study shows that the centers linked through telemedicine performed better in terms of patient care and treatment, with a lesser loss to follow-up and lesser deaths in CLHA. Overall, this pilot project of telemedicine for pediatric HIV has been proven to be acceptable, feasible, and effective in improving the quality of care for children living with HIV across the state of Maharashtra.

HLA-B*5701 allele was present in 11 (11%) of HIV-infected children, of which two developed Abacavir hypersensitivity. None of the patients without the allele developed hypersensitivity.

Background: Adherence to antiretroviral therapy (ART) is the strongest indicator of successful treatment of Human Immunodeficiency Virus (HIV) among children. The main aim of the present study was to know the prevalence of adherence at our centre and various factors affecting the adherence in children.Methods: It was an observational study done in children less than 15 years of age, affected with HIV.  78 children attending Paediatric Centre of Excellence (PCOE) for HIV L.T.M.G. Hospital, Sion, Mumbai were included in study, Study period was 18 months from January 2012 to June 2013. Complete history of the patients was noted in a pre-designed proforma. Baseline investigations related to HIV were done in all children. Fixed dose combination ART was started in children who fulfilled clinical and/or immunological criteria as per the NACO guidelines. Adherence was estimated using Pill count method..All the data were analysed by using 10.0 version of statistical software SPSS.Results: In this study, male children (57.7%) out numbered the females (42.3%). Majority of study subjects were more than 10 years of age. Overall adherence among subjects was 82.1% at the end of one year and non-adherence was 17.9%. There was no significant association of age and gender of the patients with adherence (p>0.05). Education, employment and knowledge towards medication of care takers was significantly associated with adherence of ART (p<0.05). Adherence of study cases had not showed any significant association with ART treatment regimen (p=0.99). At the end of one year, the mean CD4 count was significantly more as compared to baseline among adherence group and the mean CD4 count was significantly less as compared to baseline among non-adherence group. The most common reason for missed dosage was forgot to take medicine in 29 subjects (37.1 %)..Conclusion: Adherence level in this study was good. Forgot to take the medicine was the main reason given by the patients for non-adherence. Education, employment and knowledge towards medication of care takers was significantly associated with adherence of ART .But further studies are needed to explore various other factors related to adherence in children.