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Published on: March 30, 2014
Health care resource utilization in untreated HIV-infected children in a pediatric programme, Abidjan, Côte d'Ivoire,
Sophie Desmonde1, Patrick A Coffie, Edmond A Aka
1Centre INSERM, U897-Epidémiologie-Biostatistiques, Bordeaux, France. sophie.desmonde@isped.u-bordeaux2.fr
Insights
Children with untreated HIV require significant healthcare, including outpatient and inpatient services. This highlights the need for continued access to antiretroviral treatment (ART) in regions where it is expanding but not yet universally available.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- This study examines healthcare resource utilization among children infected with HIV-1 in Abidjan, Côte d'Ivoire, who have not yet started antiretroviral treatment (ART).
- Understanding resource needs is crucial in areas with scaling but incomplete ART access.
Purpose of the Study:
- To describe and quantify health care resource utilization in HIV-1-infected children awaiting ART initiation.
- To identify factors associated with healthcare resource utilization in this population.
Main Methods:
- A prospective cohort study followed 405 HIV-infected children in Abidjan from 2004-2009.
- Data on outpatient care, inpatient day care, and hospitalization were collected.
- Mixed-effects log-linear models were used to analyze factors associated with utilization.
Main Results:
- The incidence rate of clinical events was 60.9 per 100 child-years, with 57% leading to outpatient care and 38% to inpatient day care.
- Hospitalization occurred at an incidence rate of 5.9 per 100 child-years.
- Immunodeficient children and those primarily cared for by their mother only utilized less outpatient care.
Conclusions:
- Untreated HIV-infected children incur substantial healthcare costs through both inpatient and outpatient services.
- Despite ART scale-up, significant care demands persist for children without access to treatment.
- Resource allocation must consider the ongoing needs of this vulnerable group.
Background:
We describe health care resource utilization among HIV-1-infected children who have not yet undergone antiretroviral treatment (ART) in Abidjan, Côte d'Ivoire.
Methods:
HIV-infected children enrolled prospectively in an HIV care programme in 2 health facilities in Abidjan (2004-2009) were followed up from date of inclusion until database closeout, death, ART initiation, or loss to follow-up (no clinical contact for more than 6 months). Incidences of health care resource utilization (outpatient care, inpatient day care, and hospitalization) were described according to severe morbidity and mixed effect log linear models were computed to identify associated factors.
Results:
Overall, 405 children were included, entering care at a median age of 4.5 years, 66.9% were receiving cotrimoxazole prophylaxis, and 27.7% met 2006 WHO criteria for immunodeficiency by age. The median follow-up time was 11.6 months (interquartile range: 1.4; 30.7). Overall, 371 clinical events occurred in 162 children yielding to an incidence rate (IR) of 60.9/100 child-years (CY) [95% confidence interval (CI): 55.1 to 67.2]: 57% of clinical events led to outpatient care (IR: 33/100 CY), 38% to inpatient day care (IR: 22/100 CY), and 10% to hospitalization (IR: 5.9/100 CY). Further medical examinations were made allowing confirmed diagnoses in 40% of those (IR: 22.4/100 CY). Outpatient care was less common among immunodeficient children than those not (relative risk [RR] = 0.32, 95% CI: 0.18 to 0.56), in those whose main caregivers are both parents compared with those who are primarily cared for by their mother only (RR = 0.34, 95% CI: 0.15 to 0.77).
Conclusion:
Untreated HIV-infected children require substantial inpatient and outpatient care in a context where ART is scaling up but still not available to all.
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