Temporal Trends in Mortality and Loss to Follow-up Among Children Enrolled in Côte d’Ivoire’s National Antiretroviral Therapy Program

Auld, Andrew F.; Tuho, Moise Z.; Ekra, Kunomboa A.; Shiraishi, Ray W.; Mohamed, Fayama; Kouakou, Joseph S.; Ettiègne-Traoré, Virginie; Sabatier, Jennifer; Essombo, Joseph; Rivadeneira, Emilia D.; Adjorlolo-Johnson, Georgette; Marlink, Richard; Ellerbrock, Tedd V.

doi:10.1097/INF.0000000000000457

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Temporal Trends in Mortality and Loss to Follow-up Among Children Enrolled in Côte d’Ivoire’s National Antiretroviral Therapy Program

11 2014
By Auld, Andrew F. ; Tuho, Moise Z. ; Ekra, Kunomboa A. ; ...
http://dx.doi.org/10.1097/INF.0000000000000457
Source: Pediatr Infect Dis J. 33(11):1134-1140

[PDF-797.70 KB]

English

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Details:

Alternative Title:

Pediatr Infect Dis J
Personal Author:

Auld, Andrew F. ; Tuho, Moise Z. ; Ekra, Kunomboa A. ; Shiraishi, Ray W. ; Mohamed, Fayama ; ... More +

Auld, Andrew F. ; Tuho, Moise Z. ; Ekra, Kunomboa A. ; Shiraishi, Ray W. ; Mohamed, Fayama ; Kouakou, Joseph S. ; Ettiègne-Traoré, Virginie ; Sabatier, Jennifer ; Essombo, Joseph ; Rivadeneira, Emilia D. ; Adjorlolo-Johnson, Georgette ; Marlink, Richard ; Ellerbrock, Tedd V. Less -
Description:

Background:

During 2004–2008, >2000 children (<15 years old) initiated antiretroviral therapy (ART) in Côte d’Ivoire. Nationally representative outcomes, temporal trends in outcomes during 2004–2008 and site-level outcome determinants have not been investigated.

Methods:

Incidence rates of death, loss to follow-up (LTFU) and attrition (death or LTFU) were evaluated in a nationally representative, retrospective cohort study among 2,110 children, who initiated ART at 29 facilities in Côte d’Ivoire during 2004–2008.

Results:

At ART initiation, 54% were male, 1% was HIV-2-infected and median age was 5.1 years. Median CD4% was 11%, and 61% had weight-for-age Z-score (WAZ) ≤−2. Vaccination completion was documented for 9% of children. Eleven of 29 facilities had an integrated nutrition program. Over 4585 person-years of ART, 237 children died and 427 became LTFU. Twelve-month attrition was 22% overall, but increased from 4% to 34% during 2004–2008, due to increases in 12-month mortality (from 3–11%) and 12-month LTFU (from 2% to 23%). In adjusted analysis, compared with enrollees in 2004, enrollees in 2008 had nearly 4-fold higher mortality and 8-fold higher LTFU. World Health Organization stage III/IV, CD4% <10%, WAZ ≤2 and hemoglobin <8 g/dL, were predictive of mortality. Incomplete vaccination was predictive of mortality and LTFU. Facilities with nutrition programs had lower LTFU and mortality rates. Clinics reporting nurse dissatisfaction with working conditions had higher LTFU rates.

Conclusion:

Investigation of causes of increasing mortality and LTFU is needed. Ensuring earlier ART initiation, vaccination completion, scale-up of site-level nutrition programs and nurse work-environment satisfaction, could improve pediatric ART program outcomes.
Subjects:

[+]

Adolescent Ambulatory Care Facilities Anti-HIV Agents CD4 Lymphocyte Count Child Child, Preschool Cote D'Ivoire Female Hemoglobins HIV-1 HIV-2 HIV Infections Humans Infant Job Satisfaction Lost To Follow-Up Male Nurses Primary Health Care Retrospective Studies Time Factors
Keywords:

[+]

Côte D’Ivoire Outcomes Pediatric Antiretroviral Therapy
Source:

Pediatr Infect Dis J. 33(11):1134-1140
Pubmed ID:

25093975
Pubmed Central ID:

PMC11440633
Document Type:

Journal Article
Funding:

CC999999/ImCDC/Intramural CDC HHSUnited States/ ; PEPFAR/PEPFARUnited States/

CC999999/ImCDC/Intramural CDC HHSUnited States/ ; PEPFAR/PEPFARUnited States/ Less -
Volume:

33
Issue:

11
Collection(s):

CDC Public Access
Main Document Checksum:

[+]

urn:sha-512:79b0882eee6031bf2eca797d9cd95cdc40fe42ffb5870fffff5d814a47f9654cc99dd924a93d7f8fad888aae32390a7dd203b73b07913eb39c76d2c4e486fbbc
Download URL:

https://stacks.cdc.gov/view/cdc/164635/cdc_164635_DS1.pdf
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	NIHMS1053849-supplement-SDC1.pdf	pdf
	NIHMS1053849-supplement-SDC2.pdf	pdf
	NIHMS1053849-supplement-SDC3.pdf	pdf

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