Decentralization of Pediatric HIV Care and Treatment in Five Sub-Saharan African Countries

Details

• Alternative Title:
  J Acquir Immune Defic Syndr
• Personal Author:
  Fayorsey, Ruby N. ; Saito, Suzue ; Carter, Rosalind J. ; Gusmao, Eduarda ; Frederix, Koen ; Koech-Keter, Emily ; Tene, Gilbert ; Panya, Milembe ; Abrams, Elaine J.
• Description:
  Background
  
  In resource-limited settings, decentralization of HIV care and treatment is a cornerstone of universal care and rapid scale-up. We compared trends in pediatric enrollment and outcomes at primary (PHFs) vs secondary/tertiary health facilities (SHFs).
  
  Methods
  
  Using aggregate program data reported quarterly from 274 public facilities in Kenya, Lesotho, Mozambique, Rwanda, and Tanzania from January 2008 to March 2010, we examined trends in number of children younger than 15 years of age initiating antiretroviral treatment (ART) by facility type. We compared clinic-level lost to follow-up (LTFU) and mortality per 100 person-years (PYs) on ART during the period by facility type.
  
  Results
  
  During the 2-year period, 17,155 children enrolled in HIV care and 8475 initiated ART in 182 (66%) PHFs and 92(34%) SHFs. PHFs increased from 56 to 182, whereas SHFs increased from 72 to 92 sites. SHFs accounted for 71% of children initiating ART; however, the proportion of children initiating ART each quarter at PHFs increased from 17% (129) to 44% (463) in conjunction with an increase in PHFs during observation period. The average LTFU and mortality rates for children on ART were 9.8/100 PYs and 5.2/100 PYs, respectively, at PHFs and 20.2/100 PYs and 6.0/100 PYs, respectively, at SHFs. Adjusted models show PHFs associated with lower LTFU (adjusted rate ratio = 0.55; P = 0.022) and lower mortality (adjusted rate ratio = 0.66; P = 0.028).
  
  Conclusions
  
  The expansion of pediatric services to PHFs has resulted in increased numbers of children on ART. Early findings suggest lower rates of LTFU and mortality at PHFs. Successful scale-up will require further expansion of pediatric services within PHFs.
  
  
• Subjects:
  Adolescent Anti-HIV Agents Article CD4 Lymphocyte Count Child Child, Preschool Decentralization Health Facilities HIV HIV Infections Humans Infant Pediatrics Politics Primary Health Facilities Regression Analysis Retrospective Studies

  More +
• Source:
  J Acquir Immune Defic Syndr. 62(5):e124-e130.
• Pubmed ID:
  23337367
• Pubmed Central ID:
  PMC5902810
• Document Type:
  Journal Article
• Funding:
  U2G PS002005/PS/NCHHSTP CDC HHS/United States ; U2G PS002756/PS/NCHHSTP CDC HHS/United States ; U2G GH001036/GH/CGH CDC HHS/United States ; 5U2GPS001537-03/PHS HHS/United States ; U2G PS000950/PS/NCHHSTP CDC HHS/United States ; U2G GH000204/GH/CGH CDC HHS/United States
• Place as Subject:
  Africa South of the Sahara
• Volume:
  62
• Issue:
  5
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:bf48c353313e4874107509a1e1d00155bc6dd57117746c8ccd8983a5c84880a7
• Download URL:
  https://stacks.cdc.gov/view/cdc/53506/cdc_53506_DS1.pdf
• File Type:
  [PDF - 389.38 KB ]