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Successful paediatric HIV treatment in rural primary care in Africa

N Janssen1, J Ndirangu, M-L Newell

  • 1Africa Centre for Health and Population Studies, University of KwaZulu-Natal, KwaZulu-Natal, South Africa.

Archives of Disease in Childhood
|November 3, 2009
PubMed

Insights

Antiretroviral treatment (ART) in HIV-infected children in a rural South African program showed good clinical outcomes. Lower baseline hemoglobin and younger age (<18 months) were associated with increased mortality risk in children on ART.

Area of Science:

  • Pediatric infectious diseases
  • Public health in resource-limited settings
  • HIV/AIDS clinical management

Background:

  • Decentralized healthcare models are crucial for managing HIV-infected children in resource-limited settings.
  • Nurse/counsellor-led antiretroviral treatment (ART) programs can achieve positive clinical outcomes.
  • Understanding factors influencing treatment success in pediatric HIV is essential for program optimization.

Purpose of the Study:

  • To evaluate the clinical outcomes of HIV-infected children receiving ART within a decentralized, nurse/counsellor-led program in rural South Africa.
  • To identify baseline characteristics associated with mortality in children undergoing ART.
  • To assess treatment efficacy by monitoring laboratory parameters and nutritional status.

Main Methods:

  • A clinical cohort study was conducted in KwaZulu-Natal, South Africa, from June 2004 to 2008.
  • Included HIV-infected children aged 15 years or younger initiating ART.
  • Survival analysis used Kaplan-Meier and Cox proportional hazards regression; laboratory and anthropometric changes were analyzed post-treatment.

Main Results:

  • 477 children initiated ART; 76.6% were WHO stage 3/4. Significant improvements were observed in CD4% (17% to 22%), hemoglobin (9.9 to 11.7 g/l), and albumin (30 to 36 g/l) post-ART initiation.
  • Overall mortality was 43.7 deaths per 1000 child-years, with 53.1% occurring within 90 days of treatment initiation.
  • Increased mortality risk was associated with baseline hemoglobin 60 months; adjusted HR 3.2).

Conclusions:

  • Effective clinical outcomes for HIV-infected children on ART are achievable within rural, decentralized healthcare services.
  • The study highlights a need for improved identification of HIV-exposed infants, as few very young children were enrolled in ART programs.
  • Decentralized, non-physician-led programs can successfully manage pediatric HIV, but early identification of infants is critical.
Abstract

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