Outcomes of the South African National Antiretroviral Treatment Programme for children: The IeDEA Southern Africa collaboration

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dc.contributor.authorDavies, M
dc.contributor.authorKeiser, O
dc.contributor.authorTechnau, K
dc.contributor.authorEley, B
dc.contributor.authorRabie, H
dc.contributor.authorVan Cutsem, G
dc.contributor.authorGiddy, J
dc.contributor.authorWood, R
dc.contributor.authorBoulle, A
dc.contributor.authorEgger, M
dc.contributor.authorMoultrie, H
dc.date.accessioned2017-05-03T13:21:03Z
dc.date.available2017-05-03T13:21:03Z
dc.date.issued2009
dc.date.updated2016-01-07T09:02:24Z
dc.description.abstractObjectives: To assess paediatric antiretroviral treatment (ART) outcomes and their associations from a collaborative cohort representing 20% of the South African national treatment programme. Design and setting: Multi-cohort study of 7 public sector paediatric ART programmes in Gauteng, Western Cape and KwaZulu-Natal provinces. Subjects: ART-naïve children (≤16 years) who commenced treatment with ≥3 antiretroviral drugs before March 2008. Outcome measures: Time to death or loss to follow-up were assessed using the Kaplan-Meier method. Associations between baseline characteristics and mortality were assessed with Cox-proportional hazards models stratified by site. Immune status, virologic suppression and growth were also described by duration on ART. Results: The median (IQR) age of 6078 children with 9368 child-years of follow-up was 43 (15 – 83) months, with 29% being <18 months. Most were severely ill at ART initiation. More than 75% of children were appropriately monitored at 6-monthly intervals with viral load suppression (<400 copies/ml) being 80% or above throughout 36 months of treatment. Mortality and retention in care at 3 years were 7.7% (95%CI: 7.0% – 8.6%) and 81.4% (80.1% - 82.6%) respectively. Together with young age, all markers of disease severity (low weight-for-age z-score; high viral load; severe immune suppression, stage 3/4 disease and anaemia) were independently associated with mortality. Conclusions: Dramatic clinical benefit for children accessing the national ART programme is demonstrated. Higher mortality in infants and those with advanced disease highlights the need for early diagnosis of HIV infection and commencement of ART.
dc.identifierhttp://dx.doi.org/10.7196/SAMJ.3422
dc.identifier.apacitationDavies, M., Keiser, O., Technau, K., Eley, B., Rabie, H., Van Cutsem, G., ... Moultrie, H. (2009). Outcomes of the South African National Antiretroviral Treatment Programme for children: The IeDEA Southern Africa collaboration. <i>South African Medical Journal</i>, http://hdl.handle.net/11427/24236en_ZA
dc.identifier.chicagocitationDavies, M, O Keiser, K Technau, B Eley, H Rabie, G Van Cutsem, J Giddy, et al "Outcomes of the South African National Antiretroviral Treatment Programme for children: The IeDEA Southern Africa collaboration." <i>South African Medical Journal</i> (2009) http://hdl.handle.net/11427/24236en_ZA
dc.identifier.citationDavies, M., Keiser, O., Technau, K., Eley, B., Rabie, H., Van Cutsem, G., Giddy, J., Wood, R., Boulle, A., Egger, M., & Moultrie, H. (2009). "Outcomes of the South African National Antiretroviral Treatment (ART) programme for children. – The IeDEA Southern Africa Collaboration". South African Medical Journal, 99(10), 730.
dc.identifier.ris TY - Journal Article AU - Davies, M AU - Keiser, O AU - Technau, K AU - Eley, B AU - Rabie, H AU - Van Cutsem, G AU - Giddy, J AU - Wood, R AU - Boulle, A AU - Egger, M AU - Moultrie, H AB - Objectives: To assess paediatric antiretroviral treatment (ART) outcomes and their associations from a collaborative cohort representing 20% of the South African national treatment programme. Design and setting: Multi-cohort study of 7 public sector paediatric ART programmes in Gauteng, Western Cape and KwaZulu-Natal provinces. Subjects: ART-naïve children (≤16 years) who commenced treatment with ≥3 antiretroviral drugs before March 2008. Outcome measures: Time to death or loss to follow-up were assessed using the Kaplan-Meier method. Associations between baseline characteristics and mortality were assessed with Cox-proportional hazards models stratified by site. Immune status, virologic suppression and growth were also described by duration on ART. Results: The median (IQR) age of 6078 children with 9368 child-years of follow-up was 43 (15 – 83) months, with 29% being <18 months. Most were severely ill at ART initiation. More than 75% of children were appropriately monitored at 6-monthly intervals with viral load suppression (<400 copies/ml) being 80% or above throughout 36 months of treatment. Mortality and retention in care at 3 years were 7.7% (95%CI: 7.0% – 8.6%) and 81.4% (80.1% - 82.6%) respectively. Together with young age, all markers of disease severity (low weight-for-age z-score; high viral load; severe immune suppression, stage 3/4 disease and anaemia) were independently associated with mortality. Conclusions: Dramatic clinical benefit for children accessing the national ART programme is demonstrated. Higher mortality in infants and those with advanced disease highlights the need for early diagnosis of HIV infection and commencement of ART. DA - 2009 DB - OpenUCT DP - University of Cape Town J1 - South African Medical Journal LK - https://open.uct.ac.za PB - University of Cape Town PY - 2009 T1 - Outcomes of the South African National Antiretroviral Treatment Programme for children: The IeDEA Southern Africa collaboration TI - Outcomes of the South African National Antiretroviral Treatment Programme for children: The IeDEA Southern Africa collaboration UR - http://hdl.handle.net/11427/24236 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/24236
dc.identifier.vancouvercitationDavies M, Keiser O, Technau K, Eley B, Rabie H, Van Cutsem G, et al. Outcomes of the South African National Antiretroviral Treatment Programme for children: The IeDEA Southern Africa collaboration. South African Medical Journal. 2009; http://hdl.handle.net/11427/24236.en_ZA
dc.language.isoeng
dc.publisher.departmentDivision of Infectious Disease and HIV Meden_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.sourceSouth African Medical Journal
dc.source.urihttp://www.samj.org.za/index.php/samj
dc.titleOutcomes of the South African National Antiretroviral Treatment Programme for children: The IeDEA Southern Africa collaboration
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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