Low Risk of Death, but Substantial Program Attrition, in Pediatric HIV Treatment Cohorts in Sub-Saharan Africa

Blesson, Séverine; Bazin, Brigitte; Marquis, Benoit; Azondekon, Alain; Carter, R; Newell, Marie‐Louise; Arrivé, Élise; Holland, Michelle; Boulle, Andrew; Miotti, Paolo; Wemin, Louise; Renner, Lorna; Cotton, Mark F.; Franco, Patricia; Tumwesigye, Nazarius Mbona; Namale, Leticia; Mp, Kieffer; Kariyo, P.; Brinkhof, Martin W. G.; Mbori-Ngacha, D; Leroy, Valériane; Aveika, Akum; Whitescarter, J

doi:10.1097/qai.0b013e31818aadce

Cited by 98 publications

(55 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Compared to data from similar pediatric and adolescent cohorts in sub-Saharan Africa, mortality was lower in the Nigerian program. [44], [45] Similar to other studies, loss to follow-up was high at 19.0%. [46], [47] …”

Section: Discussionsupporting

confidence: 83%

The Association between Quality of HIV Care, Loss to Follow-Up and Mortality in Pediatric and Adolescent Patients Receiving Antiretroviral Therapy in Nigeria

et al. 2014

View full text Add to dashboard Cite

Access to pediatric HIV treatment in resource-limited settings has risen significantly. However, little is known about the quality of care that pediatric or adolescent patients receive. The objective of this study is to explore quality of HIV care and treatment in Nigeria and to determine the association between quality of care, loss-to-follow-up and mortality. A retrospective cohort study was conducted including patients ≤18 years of age who initiated ART between November 2002 and December 2011 at 23 sites across 10 states. 1,516 patients were included. A quality score comprised of 6 process indicators was calculated for each patient. More than half of patients (55.5%) were found to have a high quality score, using the median score as the cut-off. Most patients were screened for tuberculosis at entry into care (81.3%), had adherence measurement and counseling at their last visit (88.7% and 89.7% respectively), and were prescribed co-trimoxazole at some point during enrollment in care (98.8%). Thirty-seven percent received a CD4 count in the six months prior to chart review. Mortality within 90 days of ART initiation was 1.9%. A total of 4.2% of patients died during the period of follow-up (mean: 27 months) with 19.0% lost to follow-up. In multivariate regression analyses, weight for age z-score (Adjusted Hazard Ratio (AHR): 0.90; 95% CI: 0.85, 0.95) and high quality indicator score (compared a low score, AHR: 0.43; 95% CI: 0.26, 0.73) had a protective effect on mortality. Patients with a high quality score were less likely to be lost to follow-up (Adjusted Odds Ratio (AOR): 0.42; 95% CI: 0.32, 0.56), compared to those with low score. These findings indicate that providing high quality care to children and adolescents living with HIV is important to improve outcomes, including lowering loss to follow-up and decreasing mortality in this age group.

show abstract

Section: Discussionsupporting

confidence: 83%

The Association between Quality of HIV Care, Loss to Follow-Up and Mortality in Pediatric and Adolescent Patients Receiving Antiretroviral Therapy in Nigeria

et al. 2014

View full text Add to dashboard Cite

show abstract

“…A South African study observing healthcare workers who had been specifically trained on the screening algorithms failed to classify 40% of children with significant risk [45]. Even when the classification system is used correctly and captures children with HIV signs or symptoms, by definition these children are symptomatic and likely have later stage disease and, therefore, worse outcomes [46]. …”

Section: Promising Strategies For Pediatric Case Findingmentioning

confidence: 99%

Beyond early infant diagnosis

Ahmed¹,

Kim²,

Sugandhi

et al. 2013

Aids

View full text Add to dashboard Cite

There are 3.4 million children infected with HIV worldwide, with up to 2.6 million eligible for treatment under current guidelines. However, roughly 70% of infected children are not receiving live-saving HIV care and treatment. Strengthening case finding through improved diagnosis strategies, and actively linking identified HIV-infected children to care and treatment is essential to ensuring that these children benefit from the care and treatment available to them. Without attention or advocacy, the majority of these children will remain undiagnosed and die from complications of HIV. In this article, we summarize the challenges of identifying HIV-infected infants and children, review currently available evidence and guidance, describe promising new strategies for case finding, and make recommendations for future research and interventions to improve identification of HIV-infected infants and children.

show abstract

“…Like other countries in Southern Africa, children living with HIV in Swaziland tend to initiate treatment at advanced stages of HIV disease (Boender, et al, 2012; Davies, et al, 2009; Davies, et al, 2013; Kabue, et al, 2012; KIDS-ART-LINC Collaboration., 2008; Lahuerta, et al, 2013; Sauvageot, Schaefer, Olson, Pujades-Rodriguez, & O’Brien, 2010; Ubesie, 2012). However, early initiation of antiretroviral therapy (ART) has been shown to significantly reduce early infant mortality by 76% and HIV disease progression by 75% (Violari, et al, 2008).…”

Section: Introductionmentioning

confidence: 99%

A qualitative analysis of the barriers to antiretroviral therapy initiation among children 2 to 18 months of age in Swaziland

Ahmed

Jolly

Padilla

et al. 2017

African Journal of AIDS Research

View full text Add to dashboard Cite

HIV/AIDS remains one of the leading causes of death among children under 5 years in Swaziland. Although it has been shown that early initiation of infants and children diagnosed with HIV on antiretroviral therapy (ART) significantly reduces mortality, many children do not initiate ART until at the later stages of disease. This study was designed to collect qualitative data from mothers and caregivers of HIV-positive children to identify the barriers to ART initiation. Focus group discussion (FGD) sessions were conducted in siSwati between July and September 2014 among caregivers of children 2–18 months in Swaziland who did or did-not initiate ART between January 2011 and December 2012 after HIV DNA PCR-positive diagnosis of the infants. Denial, guilt, lack of knowledge, TB/HIV co-infection, HIV-related stigma, lack of money, and distance to clinics were reported by the participants as barriers to ART initiation. The findings further revealed that non-initiation on ART was not linked to a negative perception of the treatment. Findings suggest a need to improve sensitivity among health care workers as well as education and counselling services that will facilitate the ART initiation process.

show abstract

Low Risk of Death, but Substantial Program Attrition, in Pediatric HIV Treatment Cohorts in Sub-Saharan Africa

Abstract: Once on treatment, the 2-year risk of death is low but the LTFU risk is substantial. ART is still mainly initiated at advanced disease stage in African children, reinforcing the need for early HIV diagnosis, early initiation of ART, and procedures to increase program retention.

Cited by 98 publications

References 24 publications

The Association between Quality of HIV Care, Loss to Follow-Up and Mortality in Pediatric and Adolescent Patients Receiving Antiretroviral Therapy in Nigeria

The Association between Quality of HIV Care, Loss to Follow-Up and Mortality in Pediatric and Adolescent Patients Receiving Antiretroviral Therapy in Nigeria

Beyond early infant diagnosis

A qualitative analysis of the barriers to antiretroviral therapy initiation among children 2 to 18 months of age in Swaziland

Contact Info

Product

Resources

About