Secular trends in pediatric antiretroviral treatment programs in rural and urban Zambia: a retrospective cohort study.

Catherine G Sutcliffe,Bushimbwa Tambatamba,Carolyn Bolton-Moore,Matt Cotham,William J Moss,Janneke H Van Dijk

doi:10.1186/1471-2431-10-54

Abstract

BackgroundSince 2003 pediatric antiretroviral treatment (ART) programs have scaled-up in sub-Saharan Africa and should be evaluated to assess progress and identify areas for improvement. We evaluated secular trends in the characteristics and treatment outcomes of children in three pediatric ART clinics in urban and rural areas in Zambia.MethodsRoutinely collected data were analyzed from three ART programs in rural (Macha and Mukinge) and urban (Lusaka) Zambia between program implementation and July 2008. Data were obtained from electronic medical record systems and medical record abstraction, and were categorized by year of program implementation. Characteristics of all HIV-infected and exposed children enrolled in the programs and all children initiating treatment were compared by year of implementation.ResultsAge decreased and immunologic characteristics improved in all groups over time in both urban and rural clinics, with greater improvement observed in the rural clinics. Among children both eligible and ineligible for ART at clinic enrollment, the majority started treatment within a year. A high proportion of children, particularly those ineligible for ART at clinic enrollment, were lost to follow-up prior to initiating ART. Among children initiating ART, clinical and immunologic outcomes after six months of treatment improved in both urban and rural clinics. In the urban clinics, mortality after six months of treatment declined with program duration, and in the rural clinics, the proportion of children defaulting by six months increased with program duration.ConclusionsTreatment programs are showing signs of progress in the care of HIV-infected children, particularly in the rural clinics where scale-up increased rapidly over the first three years of program implementation. However, continued efforts to optimize care are needed as many children continue to enroll in ART programs at a late stage of disease and thus are not receiving the full benefits of treatment.

Highlights

Since 2003 pediatric antiretroviral treatment (ART) programs have scaled-up in sub-Saharan Africa and should be evaluated to assess progress and identify areas for improvement
We evaluated secular trends in the characteristics and treatment outcomes of children in three pediatric ART clinics in urban and rural areas of Zambia between 2004 and 2008
Enrollment increased over time (Table 2), largely due to an increase in the number of HIV-exposed children in Macha, which lead to a significant decrease in the age at enrollment

Summary

Introduction

Since 2003 pediatric antiretroviral treatment (ART) programs have scaled-up in sub-Saharan Africa and should be evaluated to assess progress and identify areas for improvement. We evaluated secular trends in the characteristics and treatment outcomes of children in three pediatric ART clinics in urban and rural areas in Zambia. At the end of 2008, approximately 3 million people were receiving antiretroviral therapy (ART) in sub-Saharan Africa, including over 200,000 children, representing a substantial increase in coverage for those in need since the World Health Organization (WHO) announced its ‘3 by 5’ initiative in 2003 [1,2]. Recent studies have demonstrated that children receiving ART in subSaharan Africa can achieve comparable outcomes to disease. Several studies found increases in loss-tofollow-up as programs expanded and are burdened with tracking growing patient populations [7,8]

Methods

Results

Discussion

Conclusion