Successful clinical outcomes following decentralization of tertiary paediatric HIV care to a community-based paediatric antiretroviral treatment network, Chiangrai, Thailand, 2002 to 2008

Details

• Alternative Title:
  J Int AIDS Soc
• Personal Author:
  Hansudewechakul, Rawiwan ; Naiwatanakul, Thananda ; Katana, Abraham ; Faikratok, Worawan ; Lolekha, Rangsima ; Thainuea, Vorapathu ; McConnell, Michelle S
• Description:
  Introduction
  
  Most paediatric antiretroviral treatments (ARTs) in Thailand are limited to tertiary care hospitals. To decentralize paediatric HIV treatment and care, Chiangrai Prachanukroh Hospital (CRH) strengthened a provincial paediatric HIV care network by training community hospital (CH) care teams to receive referrals of children for community follow-up. In this study, we assessed factors associated with death and clinical outcomes of HIV-infected children who received care at CRH and CHs after implementation of a community-based paediatric HIV care network.
  
  Methods
  
  Clinical records were abstracted for all children who initiated ART at CRH. Paired Wilcoxon signed rank tests were used to assess CD4% and virological change among all children. Cox proportional hazard models were used to assess factors associated with death. Treatment outcomes (CD4%, viral load (VL) and weight-for-age Z-score (WAZ)) were compared between CRH and CH children who met the criteria for analysis.
  
  Results
  
  Between February 2002 and April 2008, 423 HIV-infected children initiated ART and 410 included in the cohort analysis. Median follow-up for the cohort was 28 months (interquartile range (IQR)=12 to 42); 169 (41%) children were referred for follow-up at CH. As of 31 March 2008, 42 (10%) children had died. Baseline WAZ (<−2 (p=0.001)) and baseline CD4% (<5% (p=0.015)) were independently associated with death. At 48 months, 86% of ART-naïve children in follow-up had VL<400 copies/ml. For sub-group analysis, 133 children at CRH and 154 at CHs were included for comparison. Median baseline WAZ was lower in CH children than in CRH children (p=0.001); in both groups, WAZ, CD4% and VL improved after ART with no difference in rate of WAZ and CD4% gain (p=0.421 and 0.207, respectively).
  
  Conclusions
  
  Children at CHs had more severe immunological suppression and low WAZ at baseline. Community- and tertiary care-based paediatric ART follow-ups result in equally beneficial outcomes with the strengthening of a provincial referral network between tertiary and community care. Nutrition interventions may benefit children in community-based HIV treatment and care.
  
  
• Subjects:
  Adolescent Anti-Retroviral Agents Child Child, Preschool Delivery Of Health Care Female Health Services Research HIV Infections Humans Male Politics Treatment Outcome

  More +
• Source:
  J Int AIDS Soc. 2012; 15(2).
• DOI:
  http://dx.doi.org/10.7448/IAS.15.2.17358
• Pubmed ID:
  23078768
• Pubmed Central ID:
  PMC3494174
• Document Type:
  Journal Article
• Funding:
  1U2G GH000616/GH/CGH CDC HHS/United States ; PEPFAR/United States
• Name as Subject:
  United States. President's Emergency Plan For AIDS Relief (PEPFAR)
• Place as Subject:
  Thailand
• Volume:
  15
• Issue:
  2
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:8bca46689316eff1700bfe399d67c52fbbfdf62c4e8a338e56efafc7ed57abc8b9d60868dc1d7964f1a6aaf641df5be268efb4340809c977b148e744ccab84e6
• Download URL:
  https://stacks.cdc.gov/view/cdc/11065/cdc_11065_DS1.pdf
• File Type:
  [PDF - 955.09 KB ]