Mortality and ART efficacy outcomes in children < 12 years on ART in Lesotho, Swaziland and Malawi
Presented by Richard Sebastian Wanless (Romania).
R.S. Wanless1, M. Kabue2, P. Kazembe2, E. Mohapi3, L. Thahane3, A. Devlin3, N.S. Hailu4, D. McCollum4, N. Calles5, G. Schutze5, M. Kline5, M. Mizwa5
1Baylor College of Medicine International Pediatric AIDS Initiative at Texas Children's Hospital, Fundatia Baylor Marea Neagra, Constanta, Romania, 2Baylor College of Medicine-Abbott Fund Children's Centre of Excellence, Lilongwe, Malawi, 3Baylor College of Medicine - Bristol Myers Squibb Children's Clinical Centre of Excellence, Maseru, Lesotho, 4Baylor College of Medicine - Bristol Myers Squibb Children's Clinical Centre of Excellence, Mbabane, Swaziland, 5Baylor College of Medicine International Pediatric AIDS Initiative at Texas Children's Hospital, Houston, United States
Background: The effectiveness of antiretroviral therapy (ART) in children in resource-limited settings has not yet been well documented, partly because the proportion of individuals initiated on ART who are children remains low (e.g 7.4% in Lesotho, whereas 15% of all infected individuals in that country are children). Efforts by the Baylor International Pediatric AIDS Initiative (BIPAI) through its Network of Children's Centres of Excellence (COE) have accelerated scale up of pediatric ART in Africa, now allowing evaluation of effectiveness. The objective of the study was to evaluate the mortality rate on HAART and the effectiveness of HAART among children treated at the COEs in southern Africa.
Methods: This retrospective study utilized existing programmatic data from the Lesotho, Malawi, and Swaziland COEs. ART-naïve HIV-infected children < 12 years of age initiating ART and being followed for 12 months were included. Annualized mortality was calculated at three month intervals between February 2008 and September 2009. Efficacy of ART was defined as improvement in CD4 count of >5% from baseline for children < 5 years or increase of >50 CD4+ cells/ml for children >5-12 years during the first year on ART, with all deaths, discontinuations and lost to follow ups being counted failures.
Results: Data were analyzed from 2171 children. Annualized mortality decreased progressively with increasing duration of therapy from 10.1% in February 2008 to 4.7% in September 2009 (p < 0.01). Treatment efficacy differed between the three COEs at 69.1%, 74.6%, and 84.2% (p< 0.05) in Lesotho, Malawi, and Swaziland respectively.
Conclusions: Despite the challenges associated with the public health approach to implementing pediatric-focused ART programs in developing countries, low mortality and good treatment efficacy outcomes in children can been achieved. At BIPAI COEs in southern Africa mortality rates have fallen progressively over time and now approach those observed in developing countries in similar HIV-infected populations.
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