Abstract
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.
Highlights
The Indian National AIDS Control Program (NACP) is globally acclaimed as one of the most successful programs, attributable to its successful prevention-focused policies, evidence-driven strategies, and openness for innovations
There has been a steady increase in the number of Antiretroviral Therapy Centers (ARTCs) providing care to HIV-infected individuals, with a total of 537 ART centers spread across the country; since the launch of the pediatric ART initiative in November 2006 by the National AIDS Control Organization (NACO), over 80000 children living with HIV (CLHA) are in active care [1]
In the pre-ART group, we found that children who were in the age group of 5-9.9 years (OR: 2.3, 95% CI: 1.5, 3.5), 10-14.9 years (OR: 2.1, 95% CI: 1.4, 3.2), and 15-18 years (OR: 1.9, 95% CI: 1.2, 3.1) were significantly more likely to be alive compared with children who were in the age group of 0-4.9 years
Summary
The Indian National AIDS Control Program (NACP) is globally acclaimed as one of the most successful programs, attributable to its successful prevention-focused policies, evidence-driven strategies, and openness for innovations. The seven PCoEs in the country are as follows: (1) Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra; (2) Institute of Child Health, Chennai, Tamil Nadu; (3) Government Medical College and Hospital, Kolkatta, West Bengal; (4) Kalawati Saran Children’s Hospital, New Delhi; (5) J N Hospital, Imphal, Manipur; (6) Indira Gandhi Children’s Hospital, Bengaluru, Karnataka; and (7) Niloufer Hospital, Hyderabad, Telangana These PCoEs are responsible for the care and treatment of children, management of complicated opportunistic infections, specialized laboratory services, training, and researchrelated activities. 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
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
