Morbidity in HIV-1-Infected Children Treated or Not Treated with Highly Active Antiretroviral Therapy (HAART), Abidjan, Cote d'Ivoire, 2000-04

Avit

J³

et al. 2016

PLoS ONE

ObjectivesTo access the costs of care for Ivoirian children before and after initiating LPV/r-based antiretroviral therapy (ART) before the age of two.MethodsWe assessed the direct costs of care for all HIV-infected children over the first 12 months on LPV/r-based ART initiated <2 years of age in Abidjan. We recorded all drug prescriptions, ART and cotrimoxazole prophylaxis delivery, medical analyses/examinations and hospital admissions. We compared these costs to those accrued in the month prior to ART initiation. Costs and 95% confidence intervals (95%CI) were estimated per child-month, according to severe morbidity.ResultsOf the 114 children screened, 99 initiated LPV/r-based ART at a median age of 13.5 months (IQR: 6.8–18.6); 45% had reached World Health Organization stage 3 or 4. During the first 12 months on ART, 5% died and 3% were lost to follow-up. In the month before ART initiation, the mean cost of care per child-month reached $123.39 (95%CI:$121.02-$125.74). After ART initiation, it was $42.53 (95%CI:$42.15-$42.91); 50% were ART costs. The remaining costs were non-antiretroviral drugs (18%) and medical analyses/examinations (14%). Mean costs were significantly higher within the first three months on ART ($48.76, 95%CI:$47.95–$49.56) and in children experiencing severe morbidity ($49.76, 95%CI:$48.61–50.90).ConclusionART reduces the overall monthly cost of care of HIV-infected children < 2 years. Because children were treated at an advanced HIV disease stage, the additional costs of treating severe morbidity on ART remain substantial. Strategies for treating HIV-infected children as early as possible must remain a priority in Côte d’Ivoire.

Section: Discussionsupporting

confidence: 80%

Costs of Care of HIV-Infected Children Initiating Lopinavir/Ritonavir-Based Antiretroviral Therapy before the Age of Two in Cote d’Ivoire

Avit

J³

et al. 2016

PLoS ONE

“…Furthermore, since good clinical outcomes depend essentially on treatment adherence, when untreated, these events are liable to lead to other comorbidities and/or death, contributing to the underestimations of our IRs. However, this limitation exists also in many other studies, which demonstrate comparable loss-to-follow-up rate (14, 25, 42). In the light of this trend, expanding an earlier access to ART is essential to avoid severe comorbidities in HIV-infected children.…”

Section: Discussionmentioning

confidence: 88%

Morbidity and Health care Resource Utilization in HIV-Infected Children After Antiretroviral Therapy Initiation in Côte d'Ivoire, 2004–2009

JAIDS Journal of Acquired Immune Deficiency Syndromes

Essanin²,

Aka³

et al. 2014

Background We describe severe morbidity and healthcare resource utilisation (HCRU) among HIV-infected children on antiretroviral therapy (ART) in Abidjan, Côte d’Ivoire. Methods All HIV-infected children enrolled in an HIV-care programme (2004–2009) were eligible from ART initiation until database closeout, death, ART interruption, or loss to follow-up. We calculated incidence density rates (IR) per 100 child-years (CY) for severe morbidity, HCRU (outpatient and inpatient care), and associated factors using frailty models with a Weibull distribution. Results Of 332 children with median age 5.7 years and median follow-up 2.5 years, 65.4% were severely immunodeficient by WHO criteria and all received cotrimoxazole prophylaxis. We recorded 464 clinical events in 228 children; the overall IR was 57.6/100 CY (95%CI: 52.1–62.5). Severe morbidity was more frequent in children on protease inhibitor-based ART compared to those on other regimens (aHR: 1.83, 95%CI: 1.35–2.47) and those moderately/severely immunodeficient compared to those not (aHR: 1.57; 95%CI: 1.13–2.18 and aHR: 2.53, 95%CI: 1.81–3.55 respectively). Of the 464 events, 371 (80%) led to outpatient care (IR: 45.6/100CY) and 164 (35%) to inpatient care (IR: 20.2/100CY). In adjusted analyses, outpatient care was significantly less frequent in children >10 years compared to children <2 years (aHR: 0.49, 95%CI: 0.31–0.78) and in those living furthest from clinic compared to those living closest (aHR: 0.65, 95%CI: 0.47–0.90). Both inpatient and outpatient HCRU were negatively associated with cotrimoxazole prophylaxis. Conclusion Despite ART, HIV-infected children still require substantial utilization of healthcare services.

“…However, this survivorship bias is existent in many other studies. 37,38 Second, severe morbidity and HCRU are likely under-documented in our dataset. For example, the completion of medical charts may vary from one paediatrician to another and over time, and diagnoses could not be routinely confirmed using standardised diagnosic procedures.…”

Section: Discussionmentioning

confidence: 95%

Health Care Resource Utilization in Untreated HIV-Infected Children in A Pediatric Programme, Abidjan, Côte d'Ivoire, 2004–2009

JAIDS Journal of Acquired Immune Deficiency Syndromes

Coffie²,

Amani-Bossé³

et al. 2013

Background We describe healthcare resource utilisation (HCRU) 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 two 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 >6 months). Incidences of HCRU (outpatient care, inpatient daycare, hospitalisation) 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 (IQR: 1.4;30.7). Overall, 371 clinical events occurred in 162 children yielding to an incidence rate (IR) of 60.9/100CY (95% CI: 55.1–67.2): 57% of clinical events led to outpatient care (IR: 33/100CY), 38% to inpatient daycare (IR: 22/100CY), and 10% to hospitalisation (IR: 5.9/100CY). Further medical examinations were made allowing confirmed diagnoses in 40% of those (IR: 22.4/100CY). Outpatient care was less common among immunodeficient children than those not (RR=0.32, IC 95%: 0. 18–0.56), in those whose main caregivers are both parents compared to those who are primarily cared for by their mother only (RR= 0.34, IC 95%:0.15–0.77) 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.