TY - JOUR
T1 - Secular trends in pediatric antiretroviral treatment programs in rural and urban Zambia
T2 - A retrospective cohort study
AU - Sutcliffe, Catherine G.
AU - Bolton-Moore, Carolyn
AU - van Dijk, Janneke H.
AU - Cotham, Matt
AU - Tambatamba, Bushimbwa
AU - Moss, William J.
N1 - Funding Information:
We thank the staff at Macha, Mukinge and Matero ART clinics for their help with this study. Financial support CGS was supported by a Doctoral Research Award in the area of HIV research from the Canadian Institutes of Health Research. This research was supported by the Department of Epidemiology Doctoral Thesis Research Award and Global Field Experience Fund from the Johns Hopkins Bloomberg School of Public Health.
PY - 2010/7/30
Y1 - 2010/7/30
N2 - Background: Since 2003 pediatric antiretroviral treatment (ART) programs have scaled-up in sub-Saharan Africa and should be evaluated to assess progress and identify areas for improvement. We evaluated secular trends in the characteristics and treatment outcomes of children in three pediatric ART clinics in urban and rural areas in Zambia.Methods: Routinely collected data were analyzed from three ART programs in rural (Macha and Mukinge) and urban (Lusaka) Zambia between program implementation and July 2008. Data were obtained from electronic medical record systems and medical record abstraction, and were categorized by year of program implementation. Characteristics of all HIV-infected and exposed children enrolled in the programs and all children initiating treatment were compared by year of implementation.Results: Age decreased and immunologic characteristics improved in all groups over time in both urban and rural clinics, with greater improvement observed in the rural clinics. Among children both eligible and ineligible for ART at clinic enrollment, the majority started treatment within a year. A high proportion of children, particularly those ineligible for ART at clinic enrollment, were lost to follow-up prior to initiating ART. Among children initiating ART, clinical and immunologic outcomes after six months of treatment improved in both urban and rural clinics. In the urban clinics, mortality after six months of treatment declined with program duration, and in the rural clinics, the proportion of children defaulting by six months increased with program duration.Conclusions: Treatment programs are showing signs of progress in the care of HIV-infected children, particularly in the rural clinics where scale-up increased rapidly over the first three years of program implementation. However, continued efforts to optimize care are needed as many children continue to enroll in ART programs at a late stage of disease and thus are not receiving the full benefits of treatment.
AB - Background: Since 2003 pediatric antiretroviral treatment (ART) programs have scaled-up in sub-Saharan Africa and should be evaluated to assess progress and identify areas for improvement. We evaluated secular trends in the characteristics and treatment outcomes of children in three pediatric ART clinics in urban and rural areas in Zambia.Methods: Routinely collected data were analyzed from three ART programs in rural (Macha and Mukinge) and urban (Lusaka) Zambia between program implementation and July 2008. Data were obtained from electronic medical record systems and medical record abstraction, and were categorized by year of program implementation. Characteristics of all HIV-infected and exposed children enrolled in the programs and all children initiating treatment were compared by year of implementation.Results: Age decreased and immunologic characteristics improved in all groups over time in both urban and rural clinics, with greater improvement observed in the rural clinics. Among children both eligible and ineligible for ART at clinic enrollment, the majority started treatment within a year. A high proportion of children, particularly those ineligible for ART at clinic enrollment, were lost to follow-up prior to initiating ART. Among children initiating ART, clinical and immunologic outcomes after six months of treatment improved in both urban and rural clinics. In the urban clinics, mortality after six months of treatment declined with program duration, and in the rural clinics, the proportion of children defaulting by six months increased with program duration.Conclusions: Treatment programs are showing signs of progress in the care of HIV-infected children, particularly in the rural clinics where scale-up increased rapidly over the first three years of program implementation. However, continued efforts to optimize care are needed as many children continue to enroll in ART programs at a late stage of disease and thus are not receiving the full benefits of treatment.
UR - http://www.scopus.com/inward/record.url?scp=77955067914&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=77955067914&partnerID=8YFLogxK
U2 - 10.1186/1471-2431-10-54
DO - 10.1186/1471-2431-10-54
M3 - Article
C2 - 20673355
AN - SCOPUS:77955067914
SN - 1471-2431
VL - 10
JO - BMC Pediatrics
JF - BMC Pediatrics
M1 - 54
ER -