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Temporal Trends in Patient Characteristics and Outcomes Among Children Enrolled in Mozambique’s National Antiretroviral Therapy Program
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8 2015
Source: Pediatr Infect Dis J. 34(8):e191-e199 -
Alternative Title:Pediatr Infect Dis J
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Personal Author:
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Description:Background:
During 2004–2009, >12,000 children (<15 years old) initiated antiretroviral therapy (ART) in Mozambique. Nationally representative outcomes and temporal trends in outcomes were investigated.
Methods:
Rates of death, loss to follow-up (LTFU), and attrition (death or LTFU) were evaluated in a nationally representative sample of1,054 children, who initiated ART during 2004–2009 at 25 facilities randomly selected using probability-proportional-to-size sampling.
Results:
At ART initiation during 2004–2009, 50% were male, median age was 3.3 years, median CD4% was 13%, median CD4 count was 375 cells/μL, and median weight-for-age z-score was −2.1. During 2004–2009, median time from HIV diagnosis to care initiation declined from 33 to 0 days (p=0.001), median time from care to ART declined from 93 to 62 days (p=0.004), the percentage aged <2 at ART initiation increased from 16% to 48% (p=0.021), the percentage of patients with prior tuberculosis declined from 50% to 10% (p=0.009), and the percentage with prior lymphocytic interstitial pneumonia declined from 16% to 1% (p<0.001). Over 2,652 person-years of ART, 183 children became LTFU and 26died. Twelve-month attrition was 11% overall, but increased from 3% to 22% during 2004–2009, due mainly to increases in 12-month LTFU (from 3% to 18%).
Conclusion:
Declines in the prevalence of markers of advanced HIV diseaseat ART initiation probably reflect increasing ART access. However, 12-month LTFU increased during program expansion, and this negated any program improvements in outcomes that might have resulted from earlier ART initiation.
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Pubmed ID:25955836
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Pubmed Central ID:PMC7430037
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