Pediatric ART Research Articles

Assessing user preferences for design characteristics of oral dissolvable strips for pediatric HIV medication: a qualitative study

BackgroundCurrent infant antiretroviral therapy formulations pose barriers to daily adherence due to complex weight-based dosing, conspicuous preparation, and poor palatability. These adherence barriers jeopardize adherence, making patients vulnerable to virologic failure, development of drug resistance, and preventable mortality. Our team has previously established proof-of-principle for multi-drug oral dissolvable strips as alternative pediatric antiretroviral formulations with the potential to overcome these challenges and improve pediatric ART adherence and outcomes. The objective of this study was to assess caregiver and provider preferences for oral dissolvable strips and its packaging to inform its development.MethodsGuided by concepts of user-centered design, we conducted key informant interviews with 30 HIV care providers and focus group discussions targeting caregivers of children < 10 years of age living with HIV at 3 Kenyan hospitals. Key informant interviews and focus group discussions were audio recorded, translated/transcribed verbatim, and hand coded for a-priori and emergent themes.ResultsA total of 30 providers and 72 caregivers (caring for 83 children, aged 5 months to 18 years) participated in the study. Caregivers and providers expressed a strong desire for an easier way to administer medication, especially among children too young to swallow tablets whole, and expressed enthusiasm around the idea of oral dissolvable strips. Key preferences included a pleasant taste; one strip per dose; small size with rapid dissolution; clear markings and instructions; and no special storage requirements. For packaging, stakeholders preferred individually wrapped strips within a dispenser. The individual packaging should be durable, waterproof, and easy to dispose of in communal spaces. They should also be easy to open, with clear indications where to open. The packaging holding the strips should be durable, re-usable, accommodating of various refill frequencies, and easy to use for children as young as 6.DiscussionThe concept of oral dissolvable strips was highly acceptable to caregivers of children living with HIV and HIV care providers. By engaging stakeholders in an iterative design process starting from the early phases of design and development, we will maximize the likelihood of developing a product that is acceptable to the caregiver and infant, therefore leading to sustainable adherence.

Human immunodeficiency virus positive status disclosure among children in northwest Ethiopia: a cross-sectional study.

Human Immunodeficiency Virus positive status disclosure is an essential component of pediatric care and longterm disease management. However, one of the greatest challenges that caregiver/mothers and health care workers face is the disclosure of HIV positive status to children living with the virus. Therefore, the objective of this study was to assess HIV positive status disclosure and associated factors among HIV positive children in northwest Ethiopia. Institutional based cross-sectional study was conducted among 417 sampled HIV positive children attending pediatric ART clinics of public health facilities from February 01 to March 30 2020 in northwest Ethiopia. Simple random sampling technique was used to select study participants. A structured interviewer administered questionnaire was used for data collection and the collected data entered into Epi data software. Binary logistic regression analysis was done and variables with P-value <0.05 was considered as a significant predictors of HIV positive status disclosure of HIV positive children. From 417 sampled population, 390 were involved in this study making 93.5% response rate. The study revealed that 53.6% with 95% CI (0.486-0.586) of HIV positive children knew their HIV positive sero status. Caregiver/mothers who had greater than three family sizes (AOR=1.984, 95% CI=1.046-3.762), children whose ages greater than 10 years (AOR=6.679, 95% CI=3.372-13.227) and children on ART for more than 5 years (AOR=8.96, 95% CI=6.402-12.257) were predictors of HIV positive status disclosure. The HIV positive status disclosure was high in the study area relative to other studies. Family size, children age, and length of children on ART were predictors of HIV positive status disclosure for HIV positive children. Health care providers, especially those working at pediatrics ART clinics should keep these factors in mid while working with caregivers to encourage disclosure of HIV positive status.

513 - Acceptability and perceived student social-emotional benefits from a pediatric school-based group art therapy intervention according to caregivers

513 - Acceptability and perceived student social-emotional benefits from a pediatric school-based group art therapy intervention according to caregivers

Half-life time prediction of developing first-line antiretroviral treatment failure and its risk factors among TB and HIV co-infected children in Northwest Ethiopia; multi setting historical follow-up study

BackgroundEven though treatment failure is higher among TB and HIV infected children in a resource-limited setting, there is no prior evidence in general and in the study area in particular. Hence, this study was aimed at determining the half-life time prediction of developing first-line antiretroviral treatment failure and its risk factors among TB and HIV co-infected children.MethodsA historical follow-up study was employed among 239 TB and HIV co-infected children from January 2010-December 2020. The data was entered into Epi data version 4.2.2 and exported to STATA 14.0 Software for analysis. The Kaplan-Meier plot was used to estimate the half-life time to develop treatment failure. The required assumption was fulfilled for each predictor variable. Additionally, those variables having a p-value ≤0.25 in the bivariable analysis were fitted into a multivariable Cox-proportional hazards regression model. P-value, < 0.05 was used to declare a significant association.ResultsA total of 239 TB and HIV co-infected children were involved in this study. The overall half-life time to develop first treatment failure was found to be 101 months, with a total of 1027.8 years’ follow-up period. The incidence rate and proportion of developing first-line treatment failure were 5.5 per 100 PPY (Person-Year) [CI (confidence interval): 3.7, 6.9] 100 PPY and 23.8% (CI; 18.8, 29.7) respectively. Factors such as hemoglobin 10 mg/dl [AHR (Adjusted Hazard Ratio): 3.2 (95% CI: 1.30, 7.73), severe acute malnutrition [AHR: 3.8 (95% CI: 1.51, 79.65), World Health Organization stage IV [AHR: 2.4 (95% CI: 1.15, 4.93)], and cotrimoxazole prophylaxis non user [AHR: 2.3 (95% CI: 1.14, 4.47)] were found to be a risk factor to develop treatment failure.ConclusionIn this study, the half-life time to develop first-line treatment failure was found to be very low. In addition, the incidence was found to be very high. The presence of hemoglobin 10 mg/dl, severe acute malnutrition, World Health Organization stage, and non-use of cotrimoxazole prophylaxis were discovered to be risk factors for treatment failure. Further prospective cohort and qualitative studies should be conducted to improve the quality of care in paediatric ART clinics to reduce the incidence or burden of first line treatment failure among TB and HIV co-infected children.

Effect of antiretroviral therapy care interruptions on mortality in children living with HIV.

To evaluate the characteristics and outcomes of HIV-infected children that have care interruptions, during which the child's health status and use of medication is unknown. We included data on children initiating ART between 2004 and 2016 at less than 16 years old at 16 International Epidemiologic Databases to Evaluate AIDS Southern Africa cohorts. Children were classified as loss to follow up (LTFU) if they had not attended clinic for more than 180 days. Children had a care interruption if they were classified as LTFU, and subsequently returned to care. Children who died within 180 days of ART start were excluded. The main outcome was all cause mortality. Two exposed groups were considered: those with a first care interruption within the first 6 months on ART, and those with a first care interruption after 6 months on ART. Adjusted hazard ratios were determined using a Cox regression model. Among 53 674 children included, 23 437 (44%) had a care interruption, of which 10 629 (20%) had a first care interruption within 6 months on ART and 12 808 (24%) had a first care interruption after 6 months on ART. Increased mortality was associated with a care interruption within 6 months on ART [adjusted hazard ratio (AHR) = 1.52, 95% CI 1.12-2.04] but not with a care interruption after 6 months on ART (AHR = 1.05, 95% CI 0.77-1.44). The findings suggest that strengthening retention of children in care in the early period after ART initiation is critical to improving paediatric ART outcomes.

Alteration of the gut fecal microbiome in children living with HIV on antiretroviral therapy in Yaounde, Cameroon

Multiple factors, such as immune disruption, prophylactic co-trimoxazole, and antiretroviral therapy, may influence the structure and function of the gut microbiome of children infected with HIV from birth. In order to understand whether HIV infection altered gut microbiome and to relate changes in microbiome structure and function to immune status, virological response and pediatric ART regimens, we characterized the gut microbiome of 87 HIV-infected and 82 non-exposed HIV-negative children from Yaounde, a cosmopolitan city in Cameroon. We found that children living with HIV had significantly lower alpha diversity in their gut microbiome and altered beta diversity that may not be related to CD4+ T cell count or viral load. There was an increased level of Akkermansia and Faecalibacterium genera and decreased level of Escherichia and other Gamma proteobacteria in children infected with HIV, among other differences. We noted an effect of ethnicity/geography on observed gut microbiome composition and that children on ritonavir-boosted protease inhibitor (PI/r)-based ART had gut microbiome composition that diverged more from HIV-negative controls compared to those on non-nucleoside reverse-transcriptase inhibitors-based ART. Further studies investigating the role of this altered gut microbiome in increased disease susceptibility are warranted for individuals who acquired HIV via mother-to-child transmission.

‘It was not okay because you leave your friends behind’: A prospective analysis of transition to adult care for adolescents living with perinatally-acquired HIV in South Africa

ABSTRACT Our objective was to determine facilitators and barriers to successful transition to adult care for adolescents living with perinatally-acquired HIV in South Africa. We prospectively enrolled 30 adolescents living with perinatally-acquired HIV after their pediatrician deemed them ready for transition to adult care but prior to their transition. Eighteen months after enrollment, we measured transition status, engagement in care (i.e., viral load within 12 months of transition), and viral suppression (<200 copies/ml). Additionally, we conducted in-depth interviews with adolescents before and after transition to explore facilitators and barriers to successful transition. A total of 19/30 (63%) adolescents transitioned to adult care. Of those who transitioned, 11 (58%) were retained in care and 7 (37%) were virally suppressed one year after transition to adult care. Insufficient staff training, lack of availability of pediatric ART formulations in adult clinics, and insufficient clinical monitoring contributed to delayed transition. Rigid clinical scheduling that interfered with school and loss of clinic relationships with peers and clinical staff were major factors in contributing to poor engagement in care after transition. Maturity of the adolescent, reduced distance to clinic, and reduced length of time in the clinic were seen as facilitators to transition to adult care. In conclusion, improved preparation for transition by pediatric and adult clinical staff, including restructuring of care delivery, may improve successful transition of adolescents living with perinatally acquired HIV to adult care. Transition readiness assessments are needed to determine optimal timing of transition and which adolescents are ready to transition to adult care.

Implementation of blanket provider-initiated testing and counselling: Predictors of HIV seropositivity among infants, children and adolescents in Cameroon

ObjectivesThe number needed to test (NNT) to identify a child infected with HIV remains high in the context of the implementation of the blanket provider-initiated testing and counselling (bPITC) strategy. This study assessed the predictors of HIV seropositivity among outpatient children/adolescents (6 weeks-19 years) in Cameroon. This information is needed to improve the yield of bPITC and reduce the current gap in pediatric and adolescent ART coverage in this country and beyond. Study designCross-sectional study conducted in 3 hospitals in Cameroon. MethodsThrough biological parents and guardians we systematically invited children and adolescents visiting the outpatient departments for any reason to test for HIV (bPITC) in a 6-month period. Children and adolescents were tested for HIV following the national guidelines and the predictors of HIV seropositivity were assessed using multivariate logistic regression at 5% significant level. ResultsA total of 2729 eligible children/adolescents were enrolled. Among these, 90.3% (2465/2729) were tested for HIV. Out of these, 1.6% (40/2465) tested HIV-positive, corresponding to a NNT of 62. In multivariate analysis, HIV seropositivity was 2.5, 3.3, and 5 times more likely to be reported among children/adolescents of the female sex [aOR ​= ​0.4 (0.2–0.8), p ​= ​0.008]; whose fathers had no formal school education [aOR ​= ​0.3 (0.1–0.6), p ​= ​0.004] and those whose mothers had died [aOR ​= ​0.2 (0.0–0.9), p ​= ​0.041], respectively. ConclusionsFocusing HIV testing among female children/adolescents, whose fathers had no education level and whose mothers had died could reduce the NNT, improve the yield of bPITC and increase the pediatric and adolescent ART coverage.

Malnutrition as predictor of survival from anti-retroviral treatment among children living with HIV/AIDS in Southwest Ethiopia: survival analysis

BackgroundApproximately 70% of HIV positive people live in Africa where food insecurity and under nutrition are endemic. However the impact of malnutrition on treatment outcome is not clear. This study assessed the effect of under nutrition on Anti-Retroviral Therapy treatment outcome among pediatric age group living with HIV/AIDS in Public Hospitals, Southwest Ethiopia.MethodA retrospective cohort study was conducted on records of 242 pediatric children in Guraghe zone Public Hospitals. Also median, mean, standard deviation and interquartile range were calculated. Life table, hazard function and survival function were plotted. Log rank test with 95% confidence interval of mean survival time was done. The nutritional status data were managed via WHO Anthros plus and BMI for age Z score was calculated. To assess effects of nutritional status on mortality, both Bivariate and multivariate cox proportional hazard regression was conducted with crude (CHR) and adjusted hazard ratio (AHR) (95% confidence interval and p value). P value of less than 0.05 was used as cut off point to declare statistical significance.ResultsA total of 243 records of pediatric ART records with mean age of 11.6 (± 3.8 years) were reviewed. About 178 (73.3%) have got therapeutic feeding on the course of ART treatment. Whereas significant number of children, 163 (67.1%) reported to had eating problems. A total of 13 (5.3%) children were dead with incidence density of 11.2 deaths per 1000 person years. There is significantly higher survival time among well nourished (11.1 years with 95% CI: 10.8 to 11.4) as compared to underweight children (9.76 with 95% CI: 9.19 to 10.32 years). Underweight children had almost three fold increase incidence of death (AHR = 3.01; 95% CI: 0.80–11.4). Similarly children with anemia had higher incidence of death than children without anemia (AHR = 1.55; 95% CI: 0.49–4.84).ConclusionsLow nutritional status at the start of ART evidenced by underweight and anemia were found to be predictors of survival among HIV positive children. There should be improved, sustained and focused nutritional screening, care and treatment for children on ART follow up.

A Conceptual Framework for Approaches to Art Therapy Research in Paediatric Hematology/Oncology Settings (Un cadre conceptuel pour des approches de recherche en art-thérapie en milieu d’hématologie/oncologie pédiatrique)

In this viewpoint paper, we present a conceptual framework for research on art therapy with children/adolescents diagnosed with cancer or blood disorders, their families, and healthcare providers. The framework was developed based on the authors’ extensive clinical experience with the pediatric hematology/oncology population, observations of mechanisms of change through the art therapy process, current literature based on the biological, psychological, social, and spiritual effects of art therapy with the pediatric hematology/oncology population, and identified gaps in research. The purpose of the conceptual framework, referred to as pediatric care and art therapy study (P-CATs) is to serve as a guide for future research studies and to further understand how art therapy serves the pediatric hematology/oncology population, their families, and healthcare providers.

HIV positive status disclosure and associated factor among HIV infected children in pediatric ART clinics in Gondar town public health facilities, North West Ethiopia, 2018

BackgroundDue to the increasing availability of antiretroviral treatment, HIV infected children are living longer which points out the necessity of disclosure. And which is important to support the uptake and adherence to treatment. Disclosure is an important measure to prevent secondary transmission when children are sexually active. ObjectiveThe aim of this study was to determine the prevalence of HIV positive status disclosure and associated factors among human immune virus-infected children in pediatric antiretroviral treatment clinics in Gondar town public health facilities. MethodAn institution based cross-sectional study was conducted among 449 primary caregivers of children aged 6–15years in regular follow-up at pediatric ART clinics in Gondar town public health facilities between March 3, 2018, to April 25, 2018. All subjects in the study area were included in the study. Data was collected in 5 pediatric ART clinics in Gondar town by structured questionnaires through face to face interview and supplemented by chart review to obtain some clinical factors. The variables which have an association with disclosure were identified on the basis of AOR, with 95%CI and p-value <0. 05. Model fitness was checked using Hosmer and Lemeshow goodness of fit test. ResultOut of 449 participants, 418 were interviewed with response rate of 93%. The prevalence of HIV positive status disclosure found to be 44%. Age of child >10years [AOR=5.88, (95% CI: 3.52, 9.81)], duration on ART [AOR=2.67 (95% CI: 1.59, 4.51)], place of follow-up [AOR=2.23 (95% CI: 1.27, 5.01)] and educational status of caregiver [AOR=3.00 (95% CI: 1.62, 5.56)] were identified variables. ConclusionThe prevalence of disclosure found to be low. Therefore appropriate measure should be taken to promote disclosure.

Utilizing the HITSystem for Optimizing Paediatric ART Retention and Adherence in Western Nyanza Province, Kenya

Utilizing the HITSystem for Optimizing Paediatric ART Retention and Adherence in Western Nyanza Province, Kenya

PG-11 Characteristics of a nationwide cohort of Nigerian adolescents living with HIV on ART

Background: At an estimated 240,000, Nigeria has the second highest number of adolescents living with HIV (ALHIV) globally. Treatment outcomes for ALHIV have been poorer than for adults and younger children living with HIV. In order to improve outcomes for this population, comprehensive profile information is needed for programming innovations and differentiated care. We collated patient-level data from a large cohort of Nigerian ALHIV on ART to facilitate high-level decision-making for better outcomes. Methods: Between April and September 2017, data from all sites supported by 6 of the largest member organizations of the Nigeria Implementation Science Alliance were collected from the relevant State Health agencies. These 6 PEPFAR-implementing partners (IPs) supported healthcare facilities across all 6 of Nigeria's geopolitical zones. Data from 10 to 19 year old ALHIV enrolled in care and on ART during the review period were targeted. Data collected were extracted from IP-verified de-identified programmatic databases that included socio-demographic and clinical treatment information. Data from each partner were merged into a single Microsoft Excel database and descriptive analysis conducted using STATA 13. Results: A total of 22,551 unique ALHIV entries were identified, from 29 of Nigeria's 37 states and the Federal Capital Territory. The highest proportion of ALHIV (34.1%) came from the North-Central Zone, and the lowest proportion (9.3%) from the South-West. ALHIV in this cohort comprised 13,473 (59.7%) females, and were spread at 30.5%, 33.5% and 36.0% across early (10–13 years), mid (14–16 years) and late (17–19 years) adolescence, respectively. The greatest proportion of females (77.5%) was in the 19 year age group, with the lowest proportion (∼50%) across the 10–14 year age group. After excluding 4% missing data, approximately 91% of adolescents in the cohort were documented as being currently on first line NNRTI-based adult or pediatric combination ART. The remaining 5% of ALHIV were on PI-based second-line regimens. Facility-based ART refills for the majority (59.4%) of this cohort were on a two-monthly cycle; 29.7% on a one-monthly cycle and 10.2% on a three-monthly schedule. There were significant data gaps, with little to no information available on source of HIV infection and point of service entry into care, marital or sexual activity status, HIV disclosure status, or viral suppression. Conclusions: This ALHIV cohort represents nearly 10% of the estimated 240,000 ALHIV in Nigeria, and offers an opportunity to understand and program for impactful differentiated ALHIV care in the country. Questions remain on the relative absence of older adolescent males in care, regimen adjustments and switching based on weight and viral load data, and the best schedule and approach for delivering ART to this challenging population. Missing and non-prioritized data is an issue, specifically that needed to provide adherence support and comprehensive sexual and reproductive health services, including PMTCT and partner notification. Data collection for relevant indicators need to be incorporated into routine programming for improved service delivery. Longitudinal monitoring for this cohort can potentially yield valuable data to improve treatment outcomes.

Challenges faced by caregivers of virally non-suppressed children on the intensive adherence counselling program in Uganda: a qualitative study

BackgroundOf the estimated 130,000 children living with HIV in Uganda, 47% are receiving ART. Only 39.3% have suppressed HIV-1 viral load to levels below 50 copies per ml. Caregivers are key drivers of adherence to achieve viral suppression in children. We investigated the challenges and potential support required by caregivers of ART-treated children.MethodsA qualitative study was conducted within the Infectious Diseases Institute paediatric ART program in Kampala and Hoima districts. Caregivers of children with viral loads above 1000 copies were purposively sampled and engaged in five focus group discussions (FGD). The FGD guide highlighted questions on challenges that caregivers face and the kind of support they required to improve children’s ART adherence. Thematic analysis using the inductive approach was used. All the transcripts were read, coded and emergent themes determined.ResultsOverall, 37 caregivers participated in five FGD, of whom 29 (78%) were female, 28 (76%) were HIV-infected and 25 (68%) were biological parents of the children. The elicited challenges were either in failure to attend the counselling sessions or in supporting adherence to medication. Individual and health system challenges such as competing priorities, logistics, poor quality of counselling and lack of reminders prevented attendance at counselling sessions. Five themes emerged as challenges to supporting adherence: i) environmental (school activities, working away from home), ii) personal (non-disclosure, stigma), iii) psychological (guilt), iv) financial (lack of food and transport) and v) child-related (fatigue and peer influence). Three major themes emerged for the support that caregivers needed namely: a) health system reforms (clinic appointments outside school hours, minimize ART drug stock outs and improve quality of counselling), b) psychosocial support (support with disclosure of HIV status to children and their families, more frequent peer support groups and parenting classes) and c) economic empowerment (training in vocational skills, school fees support and opportunities to initiate income generating activities).Discussion and conclusionTo achieve viral suppression, ART programs require targeted efforts to provide specific health facility requirements, psychological and economic needs of ART-treated children and their caregivers. Integration of HIV treatment with programs for orphans and vulnerable children may improve viral suppression rates.

Clinical Practice Guidelines for Child Sexual Abuse.

Child sexual abuse (CSA) is the involvement of children and adolescents in sexual activities (usually for adult sexual stimulation or gratification) that they cannot fully comprehend and to which they cannot consent as a fully equal, self-determining participant, because of their early stage of development [Box 1]. Open in a separate window Box 1 Defining child sexual abuse

600. To Study the Status of HIV Disclosure in Children and Adolescents

BackgroundDisclosure to HIV-infected children regarding their diagnosis is important as expanding numbers of HIV-infected children attain adolescence and may become sexually active. HIV disclosure is an important step toward long-term disease management and necessary for the transition from pediatric care into adolescent and adult care settings.MethodsThis was a cross-sectional study carried out in 144 caregivers of Children and adolescents aged between 6 and 16 years of age attending the pediatric ART clinic. The subjects were enrolled consecutively and were interviewed using a structured questionnaire after taking written informed consent. The questionnaire included information on the demographic details, the disclosure status of HIV infection in children and perceptions about disclosure of status to the child.ResultsThe mean age of children was 11.40 ± 2.86 years. Although 93.8% of caregivers believed children should know their HIV status, the prevalence of disclosure to the child was only 33.3%. Disclosure had been done primarily by caregivers (72.9%). Caregivers reported that (22.9%) children self-disclosed. Majority of caregivers felt 10–12 years as the appropriate age for disclosing the HIV infection status. Most of children 89.6% acquired HIV through vertical transmission. Majority of care givers 83.3% believed that care givers are most suitable person for disclosure. Furthermore, in our study 66.7% children were unaware of this HIV status and most common reason (92.7%) for their nondisclosure was child does not understand about illness and others to be 82.3% did not disclose as child may tell secret to others and 66.7% child is too young to understand the disease. There was increase in drug compliance 47.9% and improvement in behavior 12.5% noticed in children.ConclusionIn our study prevalence of HIV disclosure was 33.3% there was increase in drug compliance, improvement in behavior, school performance and attendance. Most common reason for their nondisclosure was child does not understand illness and child may tell secret to others.Disclosures All authors: No reported disclosures.

Anaemia in HIV infected HAART naïve and HAART exposed children

Background: The 2016 UNAIDS report estimates about 2.1 million people living with HIV in India, of whom about 7 per cent are children under the age of 15 year. The primary objective of this study was to analyze the prevalence of anaemia in HIV Infected HAART naïve and HAART exposed children. The secondary objectives were to analyze the type of anaemia and correlation of anaemia with dietary habits and associated opportunistic infections. Present study was a cross-sectional, observational study carried out in pediatric ART OPD and ward of a tertiary care teaching hospital, from June 2011 to May 2013.Methods: Complete haemogram, peripheral smear and CD4 counts were done on 130 children with confirmed diagnosis of HIV infection. CDC staging was used to stratify children. We used Chi square test to determine the association between CDC staging, HAART therapy, diet and opportunistic infection with anaemia. P-value &lt;0.05 was taken as significant.Results: 80% (n = 27) of the children with no immunosuppression, 86% (n = 58) of the children with moderate immunosuppression and 84% (n = 24) children with severe immunosuppression were anemic. There was no statistically significant relation between worsening immunosuppression and prevalence of anaemia (p = 0.715). 88% of the children with no opportunistic infection (n = 72) were anemic, while 76% (n = 34) children with opportunistic infection were anemic. This difference was statistically significant (p = 0.016). 88% (n = 53) of the children on HAART were anemic while 74% (n = 51) of the children not on HAART were anemic. Children on HAART did not have significantly high prevalence of anaemia when compared to children not on HAART (p = 0.99). Anaemia was significantly more common in children consuming vegetarian diet (88%, n = 46) compared to children consuming mixed diet (74%, n = 58, p &lt;0.01).Conclusions: Prevalence of anaemia is similar in children on HAART compared to HAART naïve children and at all stages of immunosuppression. Anaemia was more common in the presence opportunistic infections and in children consuming vegetarian diet. Microcytic hypochromic anemia was most common type of anaemia followed by normocytic normochromic anaemia.

A study of clinico-immunological response to art in HIV infected children in western Rajasthan

Background: Study of clinico immunological response to antiretroviral drugs in HIV infected children.Methods: 50 HIV positive children after immunological categorization put on first line pediatric ART treatment according to pediatric ART NACO guideline, side effect, clinical response (in the form of change of WHO clinical staging), and immunological response (in the form of change of CD4 count, and immunological staging) were noted on follow up study.Results: The Correlation between WHO clinical staging and immunological staging was poor so initiating anti retro viral treatment should be preferably based on CD4 count. Children who were initiated on ART have a significant improvement in both WHO clinical and immunological staging at the six and twelve months follow up and ART found to be well tolerated.Conclusions: Significant clinical and immunological improvement occur in the children who were put on ART based on CD4 counts provided if the adherence level is very good.

Sociodemographic Profile and Treatment-Seeking Behavior of HIV Infected Children Accessing Care at Pediatric ART Clinic of a Tertiary Care Hospital in Delhi

Background: Acquired immunodeficiency syndrome (AIDS) has emerged as one of the most serious public health problems in India. The parents of HIV-infected children are more likely to die and thus render the children orphan. The sociodemographic characteristics of children with HIV infection are different than the other children of the same age group. With the diverse range of manifestations, the symptoms of HIV/AIDS can appear in children at any time during the course of infection. After appearance of various signs/symptoms, the parents wander to various health agencies for relief and thus lose their vital time. Aims: The present study was conducted (1) to study the sociodemographic profile of children living with HIV/AIDS and (2) to know the treatment-seeking behavior of HIV/AIDS patients before coming to the tertiary hospital. Materials and Methods: The study was a hospital-based cross-sectional study where 216 children registered at the pediatric ART clinic of a tertiary care hospital in Delhi and their caregivers were included in the study. Semi-structured, pretested interview schedule was used for data collection through face-to-face interviews. Results: Out of the 216 children, males outnumbered females in the ratio of 2.48:1. Most of the children were in the age group of 10–14 years (48.1%) and the majority belonged to urban areas (63.4%). Most of the children were going to school. Majority of children (46.3%) belonged to social class-4. Hospitals (62.5%) were consulted first followed by private practitioners (33.3%) by these patients after appearance of earliest symptoms. Presenting symptoms of HIV in children were not specific and the most common symptom was fever (79.1%) followed by not gaining weight (69.4%), recurrent diarrhea (65.3%), cough (41.7%) and vomiting (30.6%). The average number of consultations sought by these patients before coming to this hospital was 2.34 per patients. Hospitals (39.8%) and prior experience at same hospital (33.3%) were the most common source of information about the ART center.

ВПРОВАДЖЕННЯ В УКРАЇНІ ОНОВЛЕНОЇ СИСТЕМИ ІНДИКАТОРІВ РАННЬОГО ЗАПОБІГАННЯ МЕДИКАМЕНТОЗНІЙ РЕЗИСТЕНТНОСТІ ВІЛ

Вступ. Проведено одномоментні (поперечні) дослідження ретроспективно зібраних даних з 22 центрів СНІДу, які надають антиретровірусну терапію (АРТ) ВІЛ-інфікованим дорослим та дітям. Оцінювалися показники роботи закладів щодо ефективності формування у пацієнта прихильності до лікування (своєчасність отримання пацієнтом антиретровірусних препаратів (АРВП), а також щодо якості виконання програмних факторів (утримання пацієнтів під диспансерним наглядом, безперервність поставок АРВП, практика призначення моно- або бітерапії, максимальна вірусна супресія ВІЛ). Методи. Дані проаналізовані за допомогою електронного інструменту, розробленого Всесвітньою організацією охорони здоров’я (ВООЗ) – індикаторів раннього запобігання (РЗІ) медикаментозній резистентності (МР) ВІЛ. Результати. Встановлено, що в 2014-2015 рр. ВІЛ-інфіковані дорослі пацієнти своєчасно отримували АРВП тільки в 22,7 % центрів СНІДу, діти – у 36,4 % центрів. Утримати під наглядом більше 85 % пацієнтів вдалося 36,4 % центрів. У 9,1 % закладів зафіксовано дефіцит АРВП для дорослих пацієнтів, у 4,5 % – для дітей. Досягнуто максимальної вірусної супресії ВІЛ у дітей в 31,8 % закладів; по дорослим пацієнтам жодний центр СНІДу не зміг досягти цільового показника. Висновки. Впровадження щорічного збору та аналізу РЗІ в України допоможе своєчасно виявляти та вирішувати проблемні питання в системі надання послуг з АРТ, асоційовані з ризиком формування МР ВІЛ, як на рівні окремих закладів, так і на національному рівні.