National Program Scale-Up and Patient Outcomes in a Pediatric Antiretroviral Treatment Program, Thailand, 2000-2007

McConnell, Michelle S.; Chasombat, Sanchai; Siangphoe, Umaporn; Yuktanont, Porntip; Lolekha, Rangsima; Pattarapayoon, Naparat; Kohreanudom, Surapol; Mock, Philip A.; Fox, Kimberley; Thanprasertsuk, Sombat

doi:10.1097/qai.0b013e3181dc5eb0

Cited by 21 publications

(23 citation statements)

References 33 publications

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“…However the large majority of these changes were drug substitutions within the same drug class, in response to updated treatment guidelines, namely replacement of stavudine to avoid long-term toxicities 24 . The Thai national pediatric treatment programme with over 3,400 children with a shorter median duration of follow-up of 1.7 years reported that 17.3% had a treatment change for any cause up to 2007 25 . This is consistent with our observation of 61% treatment change over a median 4.5 years of follow-up, taking into account the large phase out of stavudine from 2006 which may not have been fully captured in the national programme.…”

Section: Discussionmentioning

confidence: 99%

Five-Year Trends in Antiretroviral Usage and Drug Costs in HIV-Infected Children in Thailand

Collins¹,

Cairns²,

Cœur³

et al. 2013

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background As antiretroviral treatment (ART) programmes mature, data on drug utilization and costs are needed to assess durability of treatments and inform programme planning. Methods Children initiating ART were followed in an observational cohort in Thailand. Treatment histories from 1999–2009 were reviewed. Treatment changes were categorized as: drug substitution (within class), switch across drug class (non-nucleoside reverse-transcriptase inhibitors (NNRTIs) and protease-inhibitor (PI), and to salvage therapy (dual PI or PI and NNRTI). Antiretroviral drug costs were calculated in six-month cycles (US$ 2009 prices). Predictors of high drug cost including characteristics at start of ART (baseline), initial regimen, treatment change and duration on ART were assessed using mixed-effects regression models. Results 507 children initiated ART with a median 54 (IQR, 36–72) months of follow-up. Fifty-two percent had a drug substitution, 21% switched across class and 2% to salvage therapy. When allowing for drug substitution, 78% remained on their initial regimen. Mean drug cost increased from $251 to $428 per child per year in the first and fifth year of therapy, respectively. PI-based and salvage regimens accounted for 16% and 2% of treatments prescribed and 33% and 5% of total costs, respectively. Predictors of high cost include: baseline age ≥8 years, non nevirapine-based initial regimen; switch across drug class and to salvage regimen (p<0.005). Conclusion At 5 years, 21% of children switched across drug class and 2% received salvage therapy. The mean drug cost increased by 70%. Access to affordable second and third-line drugs is essential for the sustainability of treatment programmes.

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Section: Discussionmentioning

confidence: 99%

Five-Year Trends in Antiretroviral Usage and Drug Costs in HIV-Infected Children in Thailand

Collins¹,

Cairns²,

Cœur³

et al. 2013

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…1,2 This has spurred a growing interest in understanding patterns of paediatric ARV medication adherence, particularly as an increased number of youth are surviving into adolescence. 3 Several studies have reported high adherence rates among Thai youth, ranging from 94% based on self-reports among 17-to 24-year-old youth, 4 to 100% based on reports from caregivers (n ¼ 30; mean age ¼ five years old), 5 to 98% or greater based on pill counts (n ¼ 29; median age ¼ six years old).…”

Section: Introductionmentioning

confidence: 99%

Factors associated with high rates of antiretroviral medication adherence among youth living with perinatal HIV in Thailand

et al. 2014

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Antiretroviral medication adherence behaviour among Thai youth with perinatal HIV in Thailand has received growing attention. However, few studies have examined individual predictors of antiretroviral adherence using multiple self-reports. A convenience sample of 89 Thai youth (interquartile range 14-16 years) with perinatal HIV at three paediatric programmes in Chiang Mai completed a structured questionnaire and reported their antiretroviral adherence in the past one, seven and 30 days using count-based recall and a visual analog scale. Mean self-reported adherence rates ranged from 83.5% (past 30 days) to 99.8% (yesterday) of the time. One-inflated beta regression models were used to examine the associations between antiretroviral adherence outcomes, treatment self-efficacy, depression, anxiety, social support and beliefs/attitudes about medications. Higher percentage of medications taken in the past 30 days was independently associated with higher treatment self-efficacy and fewer symptoms of depression. Adherence monitoring would benefit from focal assessment of youth depression and perceived capacity to follow their antiretroviral regimen.

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“…The lack of individual-level data is a major limitation of reports of many national ART programmes. Though large databases have been analysed [4–9], to our knowledge Thailand is the only country that has published nation-wide data at the level of the individual [10, 11]. Rwanda collected data on a representative sample of patients on ART [12].…”

Section: Introductionmentioning

confidence: 99%

Mortality and loss to follow-up in the first year of ART

Weigel

Estill

Egger

et al. 2012

Aids

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Objectives To analyse mortality, loss to follow-up (LTFU) and retention on antiretroviral treatment (ART) in the first year of ART across all age-groups in the Malawi national ART programme. Design Cohort study including all patients who started ART in Malawi’s public sector clinics between 2004 and 2007. Methods ART registers were photographed, information entered into a database and merged with data from clinics with electronic records. Rates per 100 patient-years and cumulative incidence of retention were calculated. Subhazard ratios (sHR) of outcomes adjusted for patient and clinic level characteristics were calculated in multivariate analysis, applying competing risk models. Results A total of 117,945 patients contributed 85,246 person-years: 1.0% were infants <2 years, 7.4 % children 2–14, 7.5% young people 15–24, and 84.2% adults 25 years and above. Sixty percent of patients were female: women outnumbered men from age 14 to 35 years. Mortality and LTFU were higher in men from age 20 years. Infants and young people had the highest rates per 100 person-years for mortality (23.0 and 19.4) and LTFU (24.7 and 19.3), and the highest adjusted relative risks compared to age group 25–34 years: sHRs were 1.37 (95%CI 1.17–1.60) and 1.17 (95%CI 1.10–1.25) for death and 1.37 (95%CI 1.18–1.59) and 1.27 (95%CI 1.19–1.35) for LTFU, respectively. Conclusion In this country-wide study patients aged 0–1 and 15–24 years had the highest risk of death and LTFU, and from age 20 and older men were at higher risk than women. Interventions to improve outcomes in these patient groups are required.

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National Program Scale-Up and Patient Outcomes in a Pediatric Antiretroviral Treatment Program, Thailand, 2000-2007

Abstract: Pediatric ART has been successfully scaled-up in Thailand, including to district/community hospitals. Late entry to care is associated with poorer outcomes, and earlier ART initiation should be prioritized.

Cited by 21 publications

References 33 publications

Five-Year Trends in Antiretroviral Usage and Drug Costs in HIV-Infected Children in Thailand

Five-Year Trends in Antiretroviral Usage and Drug Costs in HIV-Infected Children in Thailand

Factors associated with high rates of antiretroviral medication adherence among youth living with perinatal HIV in Thailand

Mortality and loss to follow-up in the first year of ART

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