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...

Descripción completa

Detalles Bibliográficos
Autores principales: Somi, G, Majigo, M, Manyahi, J, Nondi, J, Agricola, J, Sambu, V, Todd, J, Rwebembera, A, Makyao, N, Ramadhani, A, Matee, MIN
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