Excellent outcomes among HIV+ children on ART, but unacceptably high pre-ART mortality and losses to follow-up: a cohort study from Cambodia

Raguenaud, Marie-Eve; Isaakidis, Petros; Zachariah, Rony; Te, Vantha; Soeung, Seithabot; Akao, Kazumi; Kumar, Varun

doi:10.1186/1471-2431-9-54

Cited by 46 publications

(52 citation statements)

References 9 publications

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“…The median time to ART initiation among eligible children was 2.1 months. Other studies reported an average time of 4.7 months to ART initiation among children in Cambodia [6], 0.9 months among children in Lusaka, Zambia [3], one month among adults in South Africa [7], and 4.3 months among adults in The Gambia [11]. This period of preparation takes several clinic or home visits to ensure caregivers are prepared to administer life-long medication and be responsible for maintaining high adherence in their children.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Pre-Treatment Mortality among HIV-Infected Children in Rural Zambia: A Cohort Study

et al. 2011

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BackgroundMany HIV-infected children in sub-Saharan Africa enter care at a late stage of disease. As preparation of the child and family for antiretroviral therapy (ART) can take several clinic visits, some children die prior to ART initiation. This study was undertaken to determine mortality rates and clinical predictors of mortality during the period prior to ART initiation.MethodsA prospective cohort study of HIV-infected treatment-naïve children was conducted between September 2007 and September 2010 at the HIV clinic at Macha Hospital in rural Southern Province, Zambia. HIV-infected children younger than 16 years of age who were treatment-naïve at study enrollment were eligible for analysis. Mortality rates prior to ART initiation were calculated and risk factors for mortality were evaluated.Results351 children were included in the study, of whom 210 (59.8%) were eligible for ART at study enrollment. Among children ineligible for ART at enrollment, 6 children died (mortality rate: 0.33; 95% CI:0.15, 0.74). Among children eligible at enrollment, 21 children died before initiation of ART and their mortality rate (2.73 per 100 person-years; 95% CI:1.78, 4.18) was significantly higher than among children ineligible for ART (incidence rate ratio: 8.20; 95% CI:3.20, 24.83). In both groups, mortality was highest in the first three months of follow-up. Factors associated with mortality included younger age, anemia and lower weight-for-age z-score at study enrollment.ConclusionsThese results underscore the need to increase efforts to identify HIV-infected children at an earlier age and stage of disease progression so they can enroll in HIV care and treatment programs prior to becoming eligible for ART and these deaths can be prevented.

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Section: Discussionmentioning

confidence: 99%

Risk Factors for Pre-Treatment Mortality among HIV-Infected Children in Rural Zambia: A Cohort Study

et al. 2011

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“…In a cohort study in Cambodia of HIV-infected children, nearly half of the pre- or post-ART deaths were attributed to TB disease (12). In our study the risk of developing TB pre-ART, but not post-ART, was related to the degree of immune deficiency.…”

Section: Discussionmentioning

confidence: 99%

Tuberculosis in human immunodeficiency virus infected Ugandan children starting on antiretroviral therapy

Bakeera-Kitaka

Conesa-Botella

Dhabangi

et al. 2011

int j tuberc lung dis

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Objective To identify the incidence of tuberculosis (TB) in HIV-infected children in a resource-limited setting prior to and after antiretroviral therapy (ART) initiation. A secondary objective was to assess the impact of TB screening by Tuberculin skin testing (TST) and clinical history. Methods A retrospective cohort study of 1806 HIV-infected children and adolescents initiating ART from 2003 through July 1, 2006 in Kampala, Uganda. A TB screening program was instituted clinic-wide in January 2006. Results 311 (17.2%) HIV-infected children had with TB diagnosed among 171 diagnosed pre-ART and among 140 post-ART initiation. During the first 100 days of ART, risk of a new TB diagnosis was 2.7 fold higher compared to the pre-ART period (RR 2.7; 95% CI: 2.1 to 3.5; P<.001). After 100 days of ART, the TB incidence rate decreased below pre-ART levels (RR 0.41; 95% CI: 0.30 to 0.54; P=.002). After TB screening was instituted in 2006, the proportion of new TB cases diagnosed after starting ART decreased by 70% (95% CI: 51 to 82%; P<.001), abating the early excess risk. Conclusions TB is common among African children and adolescents initiating ART in Sub-Saharan Africa. More aggressive screening for active TB prior to starting ART can diminish the rate of TB during immune reconstitution. Future studies are needed to determine optimal screening practice for HIV-infected children.

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“…Similar findings were also reported in a Vietnam study where the attendance rate fell below the 80% target at 21% of the clinics assessed (Nhan et al, 2012). A Cambodian study has also linked missing consecutive clinical appointments to mortality among HIV-infected children (Raguenaud et al, 2009).…”

Section: Art In Cambodiamentioning

confidence: 99%

System-level factors as predictors of adherence to clinical appointment schedules in antiretroviral therapy in Cambodia

et al. 2015

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Adherence to clinical appointment schedules by patients on antiretroviral therapy (ART) is necessary for the prevention of medication interruptions, viral rebound, and the development of drug resistance. An observational study conducted in 2010, Enablers and Adherence to Antiretroviral Therapy in Cambodia, sought to identify factors that predict on-time clinical appointment attendance by patients on ART. Clinical data, including appointment attendance across five consecutive visits, were collected from hospital records on a random sample of ART patients at government referral hospitals (RHs) in Battambang Province, Cambodia. Interviews were conducted to obtain quantitative information from patients on their experiences of support services provided by local NGOs and RHs. This information was used to identify ART patient care and support system factors that could potentially enable patients to adhere to clinical appointment schedules. These factors included adherence counseling, support groups, home-based care (HBC) services, and support provided for transportation to ART appointments. Bivariate and multivariable logistic regression analysis was done to assess relationships between system variables and the ART appointment adherence outcome. Of the 289 study participants, 20.4% had missed at least one of the five appointments in the study period. The hospital source of ART services, participation in a hospital-based support group, receiving a loan from a microfinance institution, and the frequency of adherence counseling were found to be associated with ART appointment adherence. No significant associations were found between other support system factors such as HBC, transportation support, food/monetary support, and appointment adherence.

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Excellent outcomes among HIV+ children on ART, but unacceptably high pre-ART mortality and losses to follow-up: a cohort study from Cambodia

Cited by 46 publications

References 9 publications

Risk Factors for Pre-Treatment Mortality among HIV-Infected Children in Rural Zambia: A Cohort Study

Risk Factors for Pre-Treatment Mortality among HIV-Infected Children in Rural Zambia: A Cohort Study

Tuberculosis in human immunodeficiency virus infected Ugandan children starting on antiretroviral therapy

System-level factors as predictors of adherence to clinical appointment schedules in antiretroviral therapy in Cambodia

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