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Clinical outcomes in children and adolescents initiating antiretroviral therapy in decentralized healthcare settings in Zimbabwe

Introduction: Decentralized HIV care for adults does not appear to compromise clinical outcomes. HIV care for children poses additional clinical and social complexities. We conducted a prospective cohort study to investigate clinical outcomes in children aged 6–15 years who registered for HIV care a...

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Autores principales: McHugh, Grace, Simms, Victoria, Dauya, Ethel, Bandason, Tsitsi, Chonzi, Prosper, Metaxa, Dafni, Munyati, Shungu, Nathoo, Kusum, Mujuru, Hilda, Kranzer, Katharina, Ferrand, Rashida A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: International AIDS Society 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5719665/
https://www.ncbi.nlm.nih.gov/pubmed/28872269
http://dx.doi.org/10.7448/IAS.20.1.21843
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author McHugh, Grace
Simms, Victoria
Dauya, Ethel
Bandason, Tsitsi
Chonzi, Prosper
Metaxa, Dafni
Munyati, Shungu
Nathoo, Kusum
Mujuru, Hilda
Kranzer, Katharina
Ferrand, Rashida A.
author_facet McHugh, Grace
Simms, Victoria
Dauya, Ethel
Bandason, Tsitsi
Chonzi, Prosper
Metaxa, Dafni
Munyati, Shungu
Nathoo, Kusum
Mujuru, Hilda
Kranzer, Katharina
Ferrand, Rashida A.
author_sort McHugh, Grace
collection PubMed
description Introduction: Decentralized HIV care for adults does not appear to compromise clinical outcomes. HIV care for children poses additional clinical and social complexities. We conducted a prospective cohort study to investigate clinical outcomes in children aged 6–15 years who registered for HIV care at seven primary healthcare clinics (PHCs) in Harare, Zimbabwe. Methods: Participants were recruited between January 2013 and December 2014 and followed for 18 months. Rates of and reasons for mortality, hospitalization and unscheduled PHC attendances were ascertained. Cox proportional modelling was used to determine the hazard of death, unscheduled attendances and hospitalization. Results: We recruited 385 participants, median age 11 years (IQR: 9–13) and 52% were female. The median CD4 count was 375 cells/mm(3) (IQR: 215–599) and 77% commenced ART over the study period, with 64% of those who had viral load measured achieving an HIV viral load <400 copies/ml. At 18 months, 4% of those who started ART vs. 24% of those who remained ART‐naïve were lost‐to‐follow‐up (p < 0.001). Hospitalization and mortality rates were low (8.14/100 person‐years (pyrs) and 2.86/100 pyrs, respectively). There was a high rate of unscheduled PHC attendances (34.94/100 pyrs), but only 7% resulted in hospitalization. Respiratory disease was the major cause of hospitalization, unscheduled attendances and death. CD4 count <350cells/mm(3) was a risk factor for hospitalization (aHR 3.6 (95%CI 1.6–8.2)). Conclusions: Despite only 64% of participants achieving virological suppression, clinical outcomes were good and high rates of retention in care were observed. This demonstrates that in an era moving towards differentiated care in addition to implementation of universal treatment, decentralized HIV care for children is achievable. Interventions to improve adherence in this age‐group are urgently needed.
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spelling pubmed-57196652017-12-11 Clinical outcomes in children and adolescents initiating antiretroviral therapy in decentralized healthcare settings in Zimbabwe McHugh, Grace Simms, Victoria Dauya, Ethel Bandason, Tsitsi Chonzi, Prosper Metaxa, Dafni Munyati, Shungu Nathoo, Kusum Mujuru, Hilda Kranzer, Katharina Ferrand, Rashida A. J Int AIDS Soc Research Article Introduction: Decentralized HIV care for adults does not appear to compromise clinical outcomes. HIV care for children poses additional clinical and social complexities. We conducted a prospective cohort study to investigate clinical outcomes in children aged 6–15 years who registered for HIV care at seven primary healthcare clinics (PHCs) in Harare, Zimbabwe. Methods: Participants were recruited between January 2013 and December 2014 and followed for 18 months. Rates of and reasons for mortality, hospitalization and unscheduled PHC attendances were ascertained. Cox proportional modelling was used to determine the hazard of death, unscheduled attendances and hospitalization. Results: We recruited 385 participants, median age 11 years (IQR: 9–13) and 52% were female. The median CD4 count was 375 cells/mm(3) (IQR: 215–599) and 77% commenced ART over the study period, with 64% of those who had viral load measured achieving an HIV viral load <400 copies/ml. At 18 months, 4% of those who started ART vs. 24% of those who remained ART‐naïve were lost‐to‐follow‐up (p < 0.001). Hospitalization and mortality rates were low (8.14/100 person‐years (pyrs) and 2.86/100 pyrs, respectively). There was a high rate of unscheduled PHC attendances (34.94/100 pyrs), but only 7% resulted in hospitalization. Respiratory disease was the major cause of hospitalization, unscheduled attendances and death. CD4 count <350cells/mm(3) was a risk factor for hospitalization (aHR 3.6 (95%CI 1.6–8.2)). Conclusions: Despite only 64% of participants achieving virological suppression, clinical outcomes were good and high rates of retention in care were observed. This demonstrates that in an era moving towards differentiated care in addition to implementation of universal treatment, decentralized HIV care for children is achievable. Interventions to improve adherence in this age‐group are urgently needed. International AIDS Society 2017-09-01 /pmc/articles/PMC5719665/ /pubmed/28872269 http://dx.doi.org/10.7448/IAS.20.1.21843 Text en © 2017 McHugh G et al; licensee International AIDS Society This is an open access article under the terms of the http://creativecommons.org/licenses/by/3.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
McHugh, Grace
Simms, Victoria
Dauya, Ethel
Bandason, Tsitsi
Chonzi, Prosper
Metaxa, Dafni
Munyati, Shungu
Nathoo, Kusum
Mujuru, Hilda
Kranzer, Katharina
Ferrand, Rashida A.
Clinical outcomes in children and adolescents initiating antiretroviral therapy in decentralized healthcare settings in Zimbabwe
title Clinical outcomes in children and adolescents initiating antiretroviral therapy in decentralized healthcare settings in Zimbabwe
title_full Clinical outcomes in children and adolescents initiating antiretroviral therapy in decentralized healthcare settings in Zimbabwe
title_fullStr Clinical outcomes in children and adolescents initiating antiretroviral therapy in decentralized healthcare settings in Zimbabwe
title_full_unstemmed Clinical outcomes in children and adolescents initiating antiretroviral therapy in decentralized healthcare settings in Zimbabwe
title_short Clinical outcomes in children and adolescents initiating antiretroviral therapy in decentralized healthcare settings in Zimbabwe
title_sort clinical outcomes in children and adolescents initiating antiretroviral therapy in decentralized healthcare settings in zimbabwe
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5719665/
https://www.ncbi.nlm.nih.gov/pubmed/28872269
http://dx.doi.org/10.7448/IAS.20.1.21843
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