Successful paediatric HIV treatment in rural primary care in Africa
- 1Africa Centre for Health and Population Studies, University of KwaZulu-Natal, South Africa
- 2Centre for Paediatric Epidemiology and Biostatistics, University College London Institute of Child Health, London, UK
- 3Division of Developmental Medicine, University of Glasgow Medical Faculty, Glasgow, UK
- Correspondence to Ruth M Bland, Africa Centre for Health and Population Studies, University of KwaZulu-Natal, PO Box 198, Mtubatuba, KwaZulu-Natal, 3935, South Africa;
- Accepted 18 September 2009
- Published Online First 29 October 2009
Objective Clinical outcomes of HIV-infected children on antiretroviral treatment (ART) in a decentralised, nurse/counsellor-led programme.
Design Clinical cohort.
Setting KwaZulu-Natal, South Africa.
Patients HIV-infected children aged ≤15 years on ART, June 2004–2008.
Main outcome measures Survival according to baseline characteristics including age, WHO clinical stage, haemoglobin and CD4%, was assessed in Kaplan–Meier analyses. Hazard ratios for mortality were estimated using Cox proportional hazards regression and changes in laboratory parameters and weight-for-age z scores after 6–12 months' treatment were calculated.
Results 477 HIV-infected children began ART at a median age of 74 months (range 4–180), median CD4 count (CD4%) of 433 cells/mm3 (17%) and median HIV viral load of log 4.2 copies/ml; 105 (22%) were on treatment for tuberculosis and 317 (76.6%) were WHO stage 3/4. There were significant increases after ART initiation in CD4% (17% vs 22%; p<0.001), haemoglobin (9.9 vs 11.7 g/l; p≤0.001) and albumin (30 vs 36 g/l; p≤0.001). 32 (6.7%) children died over 732 child-years of follow-up (43.7 deaths/1000 child-years; 95% CI 32.7 to 58.2), 17 (53.1%) within 90 days of treatment initiation; median age of death was 84 (IQR 10–181) months. Children with baseline haemoglobin ≤8 g/l were more likely to die (adjusted HR 4.5; 95% CI 1.6 to 12.3), as were those aged <18 months compared with >60 months (adjusted HR 3.2; 95% CI 1.2 to 9.1).
Conclusions Good clinical outcomes in HIV-infected children on ART are possible in a rural, decentralised service. Few young children are on ART, highlighting the urgent need to identify HIV-exposed infants.
Patient consent Parental consent obtained.
Competing interests None.
Funding The Africa Centre is funded by the Wellcome Trust (grant #050534), and the Hlabisa HIV treatment and care programme receives support through the United States Agency for International Development (USAID) and the President's Emergency Plan for AIDS Relief (PEPFAR) under the terms of Award no. 674-A-00-08-00001-00.
Provenance and peer review Not commissioned; externally peer reviewed.
Ethics approval This study was conducted with the approval of the Biomedical Research Ethics Committee of the University of KwaZulu-Natal, South Africa and the Research Office of the KwaZulu-Natal Department of Health.
This paper is freely available online under the BMJ Journals unlocked scheme, see http://adc.bmj.com/info/unlocked.dtl