Increased vulnerability of rural children on antiretroviral therapy attending public health facilities in South Africa: a retrospective cohort study

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dc.contributor.authorFatti, Geoffreyen_ZA
dc.contributor.authorBock, Peteren_ZA
dc.contributor.authorGrimwood, Ashrafen_ZA
dc.contributor.authorEley, Brianen_ZA
dc.date.accessioned2015-11-11T11:49:48Z
dc.date.available2015-11-11T11:49:48Z
dc.date.issued2010en_ZA
dc.description.abstractBACKGROUND: A large proportion of the 340,000 HIV-positive children in South Africa live in rural areas, yet there is little sub-Saharan data comparing rural paediatric antiretroviral therapy (ART) programme outcomes with urban facilities. We compared clinical, immunological and virological outcomes between children at seven rural and 37 urban facilities across four provinces in South Africa. METHODS: We conducted a retrospective cohort study of routine data of children enrolled on ART between November 2003 and March 2008 in three settings, namely: urban residence and facility attendance (urban group); rural residence and facility attendance (rural group); and rural residents attending urban facilities (rural/urban group). Outcome measures were: death, loss to follow up (LTFU), virological suppression, and changes in CD4 percentage and weight-for-age-z (WAZ) scores. Kaplan-Meier estimates, logrank tests, multivariable Cox regression and generalized estimating equation models were used to compare outcomes between groups. RESULTS: In total, 2332 ART-naive children were included, (1727, 228 and 377 children in the urban, rural and rural/urban groups, respectively). At presentation, rural group children were older (6.7 vs. 5.6 and 5.8 years), had lower CD4 cell percentages (10.0% vs. 12.8% and 12.7%), lower WAZ scores (-2.06 vs. -1.46 and -1.41) and higher proportions with severe underweight (26% vs.15% and 15%) compared with the urban and rural/urban groups, respectively. Mortality was significantly higher in the rural group and LTFU significantly increased in the rural/urban group. After 24 months of ART, mortality probabilities were 3.4% (CI: 2.4-4.8%), 7.7% (CI: 4.5-13.0%) and 3.1% (CI: 1.7-5.6%) p = 0.0137; LTFU probabilities were 11.5% (CI: 9.3-14.0%), 8.8% (CI: 4.5-16.9%) and 16.6% (CI: 12.4-22.6%), p = 0.0028 in the urban, rural and rural/urban groups, respectively. The rural group had an increased adjusted mortality probability, adjusted hazards ratio 2.41 (CI: 1.25-4.67) and the rural/urban group had an increased adjusted LTFU probability, aHR 2.85 (CI: 1.41-5.79). The rural/urban group had a decreased adjusted probability of virological suppression compared with the urban group at any timepoint on treatment, adjusted odds ratio 0.67 (CI: 0.48-0.93). CONCLUSIONS: Rural HIV-positive children are a vulnerable group, exhibiting delayed access to ART and an increased risk of poor outcomes while on ART. Expansion of rural paediatric ART programmes, with future research exploring improvements to rural health system effectiveness, is required.en_ZA
dc.identifier.apacitationFatti, G., Bock, P., Grimwood, A., & Eley, B. (2010). Increased vulnerability of rural children on antiretroviral therapy attending public health facilities in South Africa: a retrospective cohort study. <i>Journal of the International AIDS Society</i>, http://hdl.handle.net/11427/14847en_ZA
dc.identifier.chicagocitationFatti, Geoffrey, Peter Bock, Ashraf Grimwood, and Brian Eley "Increased vulnerability of rural children on antiretroviral therapy attending public health facilities in South Africa: a retrospective cohort study." <i>Journal of the International AIDS Society</i> (2010) http://hdl.handle.net/11427/14847en_ZA
dc.identifier.citationFatti, G., Bock, P., Grimwood, A., & Eley, B. (2010). Increased vulnerability of rural children on antiretroviral therapy attending public health facilities in South Africa: a retrospective cohort study. Journal of the International AIDS Society, 13(1), 46.en_ZA
dc.identifier.ris TY - Journal Article AU - Fatti, Geoffrey AU - Bock, Peter AU - Grimwood, Ashraf AU - Eley, Brian AB - BACKGROUND: A large proportion of the 340,000 HIV-positive children in South Africa live in rural areas, yet there is little sub-Saharan data comparing rural paediatric antiretroviral therapy (ART) programme outcomes with urban facilities. We compared clinical, immunological and virological outcomes between children at seven rural and 37 urban facilities across four provinces in South Africa. METHODS: We conducted a retrospective cohort study of routine data of children enrolled on ART between November 2003 and March 2008 in three settings, namely: urban residence and facility attendance (urban group); rural residence and facility attendance (rural group); and rural residents attending urban facilities (rural/urban group). Outcome measures were: death, loss to follow up (LTFU), virological suppression, and changes in CD4 percentage and weight-for-age-z (WAZ) scores. Kaplan-Meier estimates, logrank tests, multivariable Cox regression and generalized estimating equation models were used to compare outcomes between groups. RESULTS: In total, 2332 ART-naive children were included, (1727, 228 and 377 children in the urban, rural and rural/urban groups, respectively). At presentation, rural group children were older (6.7 vs. 5.6 and 5.8 years), had lower CD4 cell percentages (10.0% vs. 12.8% and 12.7%), lower WAZ scores (-2.06 vs. -1.46 and -1.41) and higher proportions with severe underweight (26% vs.15% and 15%) compared with the urban and rural/urban groups, respectively. Mortality was significantly higher in the rural group and LTFU significantly increased in the rural/urban group. After 24 months of ART, mortality probabilities were 3.4% (CI: 2.4-4.8%), 7.7% (CI: 4.5-13.0%) and 3.1% (CI: 1.7-5.6%) p = 0.0137; LTFU probabilities were 11.5% (CI: 9.3-14.0%), 8.8% (CI: 4.5-16.9%) and 16.6% (CI: 12.4-22.6%), p = 0.0028 in the urban, rural and rural/urban groups, respectively. The rural group had an increased adjusted mortality probability, adjusted hazards ratio 2.41 (CI: 1.25-4.67) and the rural/urban group had an increased adjusted LTFU probability, aHR 2.85 (CI: 1.41-5.79). The rural/urban group had a decreased adjusted probability of virological suppression compared with the urban group at any timepoint on treatment, adjusted odds ratio 0.67 (CI: 0.48-0.93). CONCLUSIONS: Rural HIV-positive children are a vulnerable group, exhibiting delayed access to ART and an increased risk of poor outcomes while on ART. Expansion of rural paediatric ART programmes, with future research exploring improvements to rural health system effectiveness, is required. DA - 2010 DB - OpenUCT DO - 10.1186/1758-2652-13-46 DP - University of Cape Town J1 - Journal of the International AIDS Society LK - https://open.uct.ac.za PB - University of Cape Town PY - 2010 T1 - Increased vulnerability of rural children on antiretroviral therapy attending public health facilities in South Africa: a retrospective cohort study TI - Increased vulnerability of rural children on antiretroviral therapy attending public health facilities in South Africa: a retrospective cohort study UR - http://hdl.handle.net/11427/14847 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/14847
dc.identifier.urihttp://dx.doi.org/10.1186/1758-2652-13-46
dc.identifier.vancouvercitationFatti G, Bock P, Grimwood A, Eley B. Increased vulnerability of rural children on antiretroviral therapy attending public health facilities in South Africa: a retrospective cohort study. Journal of the International AIDS Society. 2010; http://hdl.handle.net/11427/14847.en_ZA
dc.language.isoengen_ZA
dc.publisherBioMed Central Ltd.en_ZA
dc.publisher.departmentPrimary Health Care Directorateen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an Open Access article distributed under the terms of the Creative Commons Attribution Licenseen_ZA
dc.rights.holder2010 Fatti et al; licensee BioMed Central Ltd.en_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/2.0en_ZA
dc.sourceJournal of the International AIDS Societyen_ZA
dc.source.urihttp://www.biomedcentral.com/1758-2652/en_ZA
dc.subject.otherAntiretroviral treatment outcomesen_ZA
dc.subject.otherPublic health facilitiesen_ZA
dc.titleIncreased vulnerability of rural children on antiretroviral therapy attending public health facilities in South Africa: a retrospective cohort studyen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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