Abstract
BackgroundThe IeDEA West Africa Pediatric Working Group (pWADA) was established in January 2007 to study the care and treatment of HIV-infected children in this region. We describe here the characteristics at antiretroviral treatment (ART) initiation and study the 12-month mortality and loss-to-program of HIV-infected children followed in ART programs in West Africa.MethodsStandardized data from HIV-infected children followed-up in ART programs were included. Nine clinical centers from six countries contributed to the dataset (Benin, Côte d'Ivoire, Gambia, Ghana, Mali and Senegal). Inclusion criteria were the followings: age 0-15 years and initiated triple antiretroviral drug regimens. Baseline time was the date of ART initiation. WHO criteria was used to define severe immunosuppression based on CD4 count by age or CD4 percent < 15%. We estimated the 12-month Kaplan-Meier probabilities of mortality and loss-to-program (death or loss to follow-up > 6 months) after ART initiation and factors associated with these two outcomes.ResultsBetween June 2000 and December 2007, 2170 children were included. Characteristics at ART initiation were the following: median age of 5 years (Interquartile range (IQR: 2-9) and median CD4 percentage of 13% (IQR: 7-19). The most frequent drug regimen consisted of two nucleoside reverse transcriptase inhibitors and one non-nucleoside reverse transcriptase inhibitors (62%). During the first 12 months, 169 (7.8%) children died and 461(21.2%) were lost-to-program. Overall, in HIV-infected children on ART, the 12-month probability of death was 8.3% (95% Confidence Interval (CI): 7.2-9.6%), and of loss-to-program was 23.1% (95% CI: 21.3-25.0%). Both mortality and loss-to program were associated with advanced clinical stage, CD4 percentage < 15% at ART initiation and year (> 2005) of ART initiation.ConclusionInnovative and sustainable approaches are needed to better document causes of death and increase retention in HIV pediatric clinics in West Africa.
Highlights
The International epidemiological Database to Evaluate AIDS (IeDEA) West Africa Pediatric Working Group was established in January 2007 to study the care and treatment of HIV-infected children in this region
In sub-Saharan Africa, the daily management of HIV care for children remains a great challenge for the following reasons: first, diagnosing HIV infection early among children less than 18 months is difficult; second, human resources trained to deliver antiretroviral therapy (ART) to children are lacking; third, pediatric antiretroviral formulations are limited; fourth, ART is complex in the context of multiple co-morbidities; and lastly, low-income countries suffer from poor health care systems [2,10,11]
We aimed to describe the characteristics of HIV-infected children at ART initiation and study the 12-month mortality and loss-to-program rates in the paediatric West Africa database (pWADA) database
Summary
The IeDEA West Africa Pediatric Working Group (pWADA) was established in January 2007 to study the care and treatment of HIV-infected children in this region. In sub-Saharan Africa, the daily management of HIV care for children remains a great challenge for the following reasons: first, diagnosing HIV infection early among children less than 18 months is difficult; second, human resources trained to deliver ART to children are lacking; third, pediatric antiretroviral formulations are limited; fourth, ART is complex in the context of multiple co-morbidities (tuberculosis, malaria, malnutrition, etc.); and lastly, low-income countries suffer from poor health care systems [2,10,11]. Few reports on retention in pediatric care are available in subSaharan Africa
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