Cargando…
Pediatric HIV care and treatment services in Tanzania: implications for survival
BACKGROUND: Improving child survival for HIV-infected children remains an important health agenda. We present progress regarding care and treatment services to HIV infected children in Tanzania. METHODS: The National AIDS Control Programme Care and Treatment (CTC 2) database was used to obtain infor...
Autores principales: | , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2017
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5547461/ https://www.ncbi.nlm.nih.gov/pubmed/28784131 http://dx.doi.org/10.1186/s12913-017-2492-9 |
_version_ | 1783255694688911360 |
---|---|
author | Somi, G Majigo, M Manyahi, J Nondi, J Agricola, J Sambu, V Todd, J Rwebembera, A Makyao, N Ramadhani, A Matee, MIN |
author_facet | Somi, G Majigo, M Manyahi, J Nondi, J Agricola, J Sambu, V Todd, J Rwebembera, A Makyao, N Ramadhani, A Matee, MIN |
author_sort | Somi, G |
collection | PubMed |
description | BACKGROUND: Improving child survival for HIV-infected children remains an important health agenda. We present progress regarding care and treatment services to HIV infected children in Tanzania. METHODS: The National AIDS Control Programme Care and Treatment (CTC 2) database was used to obtain information of all children aged 0-14yearsenrolled in the HIV Care and Treatment Program between January 2011 and December 2014. We assessed eligibility for ART, time from enrolment to ART initiation, nutritional status, and mortality using Kaplan-Meier methods. RESULTS: A total of 29,531 (14,304 boys and 15,227 girls) ART-naive children aged 0–14 years were enrolled during the period, approximately 6700 to 8000 children per year. The male to female ratio was 48:50. At enrolment 72% were eligible for ART, 2–3% of children were positive for TB, and 2–4% were severely malnourished. Between 2011 and 2014, 2368 (8%) died, 9243 (31%) were Lost to Follow-up and 17,920 (61%) were on care or ART. The probability of death was 31% (95% CI 26–35), 43% (40–47), 52% (49–55) and 61% (58–64) by 1,2, 5 and 10 years of age, respectively. The hazard of death was greatest at very young ages (<2 years old), and decreased sharply by 4 years old. Children who were on ART had around 10–15% higher survival over time. CONCLUSIONS: Significant progress has been made regarding provision of paediatric HIV care and treatment in Tanzania. On average 7000 children are enrolled annually, and that approximately two thirds of children diagnosed under the age of 2 years were initiated on ART within a month. Provision of ART as soon as the child is diagnosed is the biggest factor in improving survival. However we noted that i) most children had advanced disease at the time of enrolment ii) approximately two-thirds of children were missing a baseline CD4 measurement and only 35% of children had either a CD4 count or percentage recorded, indicating limited access to CD4 testing services, and iii) 31% were lost to follow-up (LTFU). These challenges need to be addressed to improve early detection, enrolment and retention of HIV-infected children into care and improve documentation of services offered. |
format | Online Article Text |
id | pubmed-5547461 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-55474612017-08-09 Pediatric HIV care and treatment services in Tanzania: implications for survival Somi, G Majigo, M Manyahi, J Nondi, J Agricola, J Sambu, V Todd, J Rwebembera, A Makyao, N Ramadhani, A Matee, MIN BMC Health Serv Res Research Article BACKGROUND: Improving child survival for HIV-infected children remains an important health agenda. We present progress regarding care and treatment services to HIV infected children in Tanzania. METHODS: The National AIDS Control Programme Care and Treatment (CTC 2) database was used to obtain information of all children aged 0-14yearsenrolled in the HIV Care and Treatment Program between January 2011 and December 2014. We assessed eligibility for ART, time from enrolment to ART initiation, nutritional status, and mortality using Kaplan-Meier methods. RESULTS: A total of 29,531 (14,304 boys and 15,227 girls) ART-naive children aged 0–14 years were enrolled during the period, approximately 6700 to 8000 children per year. The male to female ratio was 48:50. At enrolment 72% were eligible for ART, 2–3% of children were positive for TB, and 2–4% were severely malnourished. Between 2011 and 2014, 2368 (8%) died, 9243 (31%) were Lost to Follow-up and 17,920 (61%) were on care or ART. The probability of death was 31% (95% CI 26–35), 43% (40–47), 52% (49–55) and 61% (58–64) by 1,2, 5 and 10 years of age, respectively. The hazard of death was greatest at very young ages (<2 years old), and decreased sharply by 4 years old. Children who were on ART had around 10–15% higher survival over time. CONCLUSIONS: Significant progress has been made regarding provision of paediatric HIV care and treatment in Tanzania. On average 7000 children are enrolled annually, and that approximately two thirds of children diagnosed under the age of 2 years were initiated on ART within a month. Provision of ART as soon as the child is diagnosed is the biggest factor in improving survival. However we noted that i) most children had advanced disease at the time of enrolment ii) approximately two-thirds of children were missing a baseline CD4 measurement and only 35% of children had either a CD4 count or percentage recorded, indicating limited access to CD4 testing services, and iii) 31% were lost to follow-up (LTFU). These challenges need to be addressed to improve early detection, enrolment and retention of HIV-infected children into care and improve documentation of services offered. BioMed Central 2017-08-07 /pmc/articles/PMC5547461/ /pubmed/28784131 http://dx.doi.org/10.1186/s12913-017-2492-9 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Somi, G Majigo, M Manyahi, J Nondi, J Agricola, J Sambu, V Todd, J Rwebembera, A Makyao, N Ramadhani, A Matee, MIN Pediatric HIV care and treatment services in Tanzania: implications for survival |
title | Pediatric HIV care and treatment services in Tanzania: implications for survival |
title_full | Pediatric HIV care and treatment services in Tanzania: implications for survival |
title_fullStr | Pediatric HIV care and treatment services in Tanzania: implications for survival |
title_full_unstemmed | Pediatric HIV care and treatment services in Tanzania: implications for survival |
title_short | Pediatric HIV care and treatment services in Tanzania: implications for survival |
title_sort | pediatric hiv care and treatment services in tanzania: implications for survival |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5547461/ https://www.ncbi.nlm.nih.gov/pubmed/28784131 http://dx.doi.org/10.1186/s12913-017-2492-9 |
work_keys_str_mv | AT somig pediatrichivcareandtreatmentservicesintanzaniaimplicationsforsurvival AT majigom pediatrichivcareandtreatmentservicesintanzaniaimplicationsforsurvival AT manyahij pediatrichivcareandtreatmentservicesintanzaniaimplicationsforsurvival AT nondij pediatrichivcareandtreatmentservicesintanzaniaimplicationsforsurvival AT agricolaj pediatrichivcareandtreatmentservicesintanzaniaimplicationsforsurvival AT sambuv pediatrichivcareandtreatmentservicesintanzaniaimplicationsforsurvival AT toddj pediatrichivcareandtreatmentservicesintanzaniaimplicationsforsurvival AT rwebemberaa pediatrichivcareandtreatmentservicesintanzaniaimplicationsforsurvival AT makyaon pediatrichivcareandtreatmentservicesintanzaniaimplicationsforsurvival AT ramadhania pediatrichivcareandtreatmentservicesintanzaniaimplicationsforsurvival AT mateemin pediatrichivcareandtreatmentservicesintanzaniaimplicationsforsurvival |