High risk of loss to follow‐up among South African children on ART during transfer, a retrospective cohort analysis with community tracing

Teasdale, Chloe A; Sogaula, Nonzwakazi; Yuengling, Katharine A.; Peters, Zachary; Mutiti, Anthony; Pepeta, Lungile; Abrams, Elaine J.

doi:10.7448/ias.20.1.21748

Cited by 15 publications

(17 citation statements)

References 27 publications

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“…2004-Dec. 2012<1 years0.551.5Sidamo [44]Ethiopia20172Public407Jan. 2009-Dec. 2016 < 14 years642.8Teasdale [43]South Africa20171681Jan. 2004-Sept. 2015 < 15 years348.5Vermund [27]Mozambique2014753Jun.…”

Section: Resultsmentioning

confidence: 99%

Mortality among pediatric patients on HIV treatment in sub-Saharan African countries: a systematic review and meta-analysis

Ahmed

Lemma

2019

BMC Public Health

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BackgroundDespite substantial improvements in accessibility of Anti-Retroviral Treatment (ART), death of children on ART remains a prevailing challenge in sub-Saharan African (SSA) countries. However, the pooled magnitude of mortality at different ART follow-up periods remains unknown for the region. We estimated the pooled proportion of all-cause mortality for pediatric patients receiving first-line ART at 3, 6, 12, and 24 months follow-up period in SSA.MethodsWe searched for relevant articles published between January 2014 and June 2018 on PubMed, Hinari and Google scholar databases. We searched for additional articles from reference lists and 2014–2018 abstracts archived by the Conference on Retroviruses and Opportunistic Infections (CROI) and the International AIDS Society Conference on HIV Science (IAS).ResultsWe reviewed 29 articles reporting mortality among pediatric ART patients at different follow-up periods in countries from 2001 to 2016. Among the 51,619 pediatric ART patients in these cohorts, studies reported 4061 (7.9%) all-cause cumulative death. The cumulative pooled proportion of mortality at 3, 6, 12 and 24 months of ART were 3% (95% CI: 3.0–4.0), 5% (95% CI: 4.0–6.0), 6% (95% CI: 5.0–7.0) and 7% (95% CI: 6.0–8.0), respectively.ConclusionsIn SSA, significant proportion of mortality among children occurs in the first 3–6 months of ART initiation. Western Africa has a little higher estimate of mortality among pediatric ART patients at 6 and 12 months of follow-up. Strategies to prevent early mortality including thorough screening and management of opportunistic infections before ART initiation are needed.Electronic supplementary materialThe online version of this article (10.1186/s12889-019-6482-1) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Mortality among pediatric patients on HIV treatment in sub-Saharan African countries: a systematic review and meta-analysis

Ahmed

Lemma

2019

BMC Public Health

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“…The Dora Nginza study also failed to identify risk factors for unsuccessful downreferral, but in the study of adolescent transfer in the Western Cape, virological suppression was associated with successful transfer. [15] While documented VL suppression was not associated with retention in care in our study, it would be important to assess this in larger cohorts of similarly aged young children.…”

Section: Discussionmentioning

confidence: 94%

“…In that study, of 644 children receiving ART who were transferred to primary and community health clinics for continuation of care, 33% never arrived at the designated clinic after down-referral. [15] Furthermore, among the 1 582 children initiated on ART during the study period, 53% of all loss to follow-up occurred through unsuccessful down-referral. Finally, by searching the National Health Laboratory Service database, results for 62% (131/211) of those lost to follow-up on down-referral were obtained, and only 5% (10/211) of them were within 18 months of down-referral.…”

Section: Discussionmentioning

confidence: 99%

Short-term outcomes of down-referral in provision of paediatric antiretroviral therapy at Red Cross War Memorial Children’s Hospital, Cape Town, South Africa: A retrospective cohort study

et al. 2018

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Background. The large scale-up of paediatric HIV care necessitated down-referral of many children receiving antiretroviral therapy (ART) from Red Cross War Memorial Children's Hospital (RCWMCH), Cape Town, South Africa. Few published data exist on the outcomes of these children. Objectives. To assess outcomes of children receiving ART in the first 12 months after down-referral to primary healthcare (PHC) clinics and identify determinants of successful down-referral. Methods. A retrospective cohort study of children <15 years of age who initiated ART at RCWMCH and were subsequently down-referred to one of two PHC clinics between January 2006 and December 2012 was completed. Baseline characteristics of patients and caregivers as well as CD4+ counts, viral loads (VLs) and weights were collected 6 and 12 months after down-referral. Outcomes included retention in care and viral suppression. Results. Of 116 children down-referred to the two study PHC clinics, 81.9% arrived at the designated PHC clinic and a further 8.6% continued care at other clinics, the remaining 9.5% being lost to follow-up. Of those successfully down-referred, 11.4% took >8 weeks to present, possibly experiencing treatment interruption. At 12 months after down-referral, only 81.0% remained in care. No factors were associated with retention in care in multivariable analysis. For children who remained in care at the designated PHC clinics, the clinical and immunological gains achieved prior to down-referral were sustained through 12 months of follow-up, and 54.7% of this cohort had documented viral suppression at 12 months. However, if only children with VL results are considered, 75.9% (41/54) were virally suppressed 12 months after down-referral. Conclusions. Down-referral of children on ART is complex, with risk of loss to follow-up and treatment interruption.

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“…A few studies have evaluated the transfer of children and adolescents to alternate clinics to decongest tertiary care facilities in South Africa. Teasdale et al found that only 67% of children successfully transferred and an additional 21% were lost to follow-up after successful transfer [ 34 ]. On the other hand, Ramirez-Avila et al found that 88% of adolescents successfully transferred to government clinics after the closure of a Presidents Emergency Plan for AIDS Relief funded clinic, although notably 48% linked to unintended clinics.…”

Section: Discussionmentioning

confidence: 99%

Transition from pediatric to adult care for adolescents living with HIV in South Africa: A natural experiment and survival analysis

et al. 2020

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Objective To determine rates of retention and viral suppression among adolescents living with perinatally-acquired HIV who remained in pediatric care compared to those who transitioned to adult care. Methods We evaluated a natural experiment involving adolescents living with perinatally-acquired HIV who were attending a government-supported antiretroviral clinic in KwaZulu-Natal, South Africa. Prior to 2011, all adolescents transitioned to adult care at 12 years of age. Due to a policy change, all adolescents were retained in pediatric care after 2011. We analyzed adolescents two years before and two years after this policy change. Outcomes were retention in care and HIV viral suppression one year after transition to adult care or the 13 th birthday if remaining in pediatric care. Results In the natural experiment, 180 adolescents who turned 12 years old between 2011 and 2014 were evaluated; 35 (20%) transitioned to adult care under the old policy and 145 (80%) remained in pediatric care under the new policy. Adolescents who transitioned to the adult clinic had lower rates of retention in care (49%; 17/35) compared to adolescents remaining in the pediatric clinic (92%; 134/145; p<0.001). Retention in care was lower (ARR 0.59; 95%CI 0.43–0.82; p = 0.001) and viral suppression was similar (ARR = 1.06, 95%CI 0.89–1.26; p = 0.53) for adolescents who transitioned to adult care compared to adolescents remaining in pediatric care. Conclusion Adolescents living with perinatally-acquired HIV appear to have higher retention in care when cared for in pediatric clinics compared to adult clinics. Longer-term follow-up is needed to fully assess viral suppression.

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High risk of loss to follow‐up among South African children on ART during transfer, a retrospective cohort analysis with community tracing

Cited by 15 publications

References 27 publications

Mortality among pediatric patients on HIV treatment in sub-Saharan African countries: a systematic review and meta-analysis

Mortality among pediatric patients on HIV treatment in sub-Saharan African countries: a systematic review and meta-analysis

Short-term outcomes of down-referral in provision of paediatric antiretroviral therapy at Red Cross War Memorial Children’s Hospital, Cape Town, South Africa: A retrospective cohort study

Transition from pediatric to adult care for adolescents living with HIV in South Africa: A natural experiment and survival analysis

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