Short-term outcomes of downreferral in provision of paediatric antiretroviral therapy at Red Cross War Memorial Childrens Hospital, Cape Town

Copelyn, Julie

Short-term outcomes of downreferral in provision of paediatric antiretroviral therapy at Red Cross War Memorial Childrens Hospital, Cape Town

dc.contributor.advisor	Eley, Brian	en_ZA
dc.contributor.author	Copelyn, Julie	en_ZA
dc.date.accessioned	2017-01-17T12:24:00Z
dc.date.available	2017-01-17T12:24:00Z
dc.date.issued	2016	en_ZA
dc.description.abstract	Background: The large scale-up of paediatric HIV care necessitated down-referral of many children receiving antiretroviral therapy (ART) from Red Cross War Memorial Children's Hospital (RCWMCH). No published data exists on the outcomes of these children. Objectives: To assess clinical, immunological and virological outcomes of children receiving ART in the first 12 months after down-referral to primary health care (PHC) clinics, and identify determinants of successful down-referral. Methods: We conducted a retrospective cohort study of children <15 years of age who commenced ART at RCWMCH and were subsequently down-referred to one of two PHC clinics between January 2006 and December 2012. Baseline characteristics of patients and caregivers as well as CD4 counts, viral loads and weights were collected at 6 and 12 months post-down-referral. Outcomes included retention in care and viral suppression. Results: One hundred and sixteen children down-referred to Heideveld and Gugulethu were included. After down-referral 13.8% of the cohort never arrived at the designated clinic and 10% took longer than 8 weeks, therefore probably experiencing treatment interruption. At 12 months post down-referral only 68.2% remained in care at the designated clinics. No factors were associated with retention in care. For those children who remained in care at the PHC clinics, the clinical and immunological gains achieved prior to down-referral were sustained through 12 months of follow up, and 54.7% of the retained cohort had documented viral suppression at 12 months. Conclusion: Down-referral of children on ART is a vulnerable process with risk of loss to follow-up and treatment interruption.	en_ZA
dc.identifier.apacitation	Copelyn, J. (2016). <i>Short-term outcomes of downreferral in provision of paediatric antiretroviral therapy at Red Cross War Memorial Childrens Hospital, Cape Town</i>. (Thesis). University of Cape Town ,Faculty of Health Sciences ,Department of Paediatrics and Child Health. Retrieved from http://hdl.handle.net/11427/22761	en_ZA
dc.identifier.chicagocitation	Copelyn, Julie. <i>"Short-term outcomes of downreferral in provision of paediatric antiretroviral therapy at Red Cross War Memorial Childrens Hospital, Cape Town."</i> Thesis., University of Cape Town ,Faculty of Health Sciences ,Department of Paediatrics and Child Health, 2016. http://hdl.handle.net/11427/22761	en_ZA
dc.identifier.citation	Copelyn, J. 2016. Short-term outcomes of downreferral in provision of paediatric antiretroviral therapy at Red Cross War Memorial Childrens Hospital, Cape Town. University of Cape Town.	en_ZA
dc.identifier.ris	TY - Thesis / Dissertation AU - Copelyn, Julie AB - Background: The large scale-up of paediatric HIV care necessitated down-referral of many children receiving antiretroviral therapy (ART) from Red Cross War Memorial Children's Hospital (RCWMCH). No published data exists on the outcomes of these children. Objectives: To assess clinical, immunological and virological outcomes of children receiving ART in the first 12 months after down-referral to primary health care (PHC) clinics, and identify determinants of successful down-referral. Methods: We conducted a retrospective cohort study of children <15 years of age who commenced ART at RCWMCH and were subsequently down-referred to one of two PHC clinics between January 2006 and December 2012. Baseline characteristics of patients and caregivers as well as CD4 counts, viral loads and weights were collected at 6 and 12 months post-down-referral. Outcomes included retention in care and viral suppression. Results: One hundred and sixteen children down-referred to Heideveld and Gugulethu were included. After down-referral 13.8% of the cohort never arrived at the designated clinic and 10% took longer than 8 weeks, therefore probably experiencing treatment interruption. At 12 months post down-referral only 68.2% remained in care at the designated clinics. No factors were associated with retention in care. For those children who remained in care at the PHC clinics, the clinical and immunological gains achieved prior to down-referral were sustained through 12 months of follow up, and 54.7% of the retained cohort had documented viral suppression at 12 months. Conclusion: Down-referral of children on ART is a vulnerable process with risk of loss to follow-up and treatment interruption. DA - 2016 DB - OpenUCT DP - University of Cape Town LK - https://open.uct.ac.za PB - University of Cape Town PY - 2016 T1 - Short-term outcomes of downreferral in provision of paediatric antiretroviral therapy at Red Cross War Memorial Childrens Hospital, Cape Town TI - Short-term outcomes of downreferral in provision of paediatric antiretroviral therapy at Red Cross War Memorial Childrens Hospital, Cape Town UR - http://hdl.handle.net/11427/22761 ER -	en_ZA
dc.identifier.uri	http://hdl.handle.net/11427/22761
dc.identifier.vancouvercitation	Copelyn J. Short-term outcomes of downreferral in provision of paediatric antiretroviral therapy at Red Cross War Memorial Childrens Hospital, Cape Town. [Thesis]. University of Cape Town ,Faculty of Health Sciences ,Department of Paediatrics and Child Health, 2016 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/22761	en_ZA
dc.language.iso	eng	en_ZA
dc.publisher.department	Department of Paediatrics and Child Health	en_ZA
dc.publisher.faculty	Faculty of Health Sciences	en_ZA
dc.publisher.institution	University of Cape Town
dc.subject.other	Paediatrics	en_ZA
dc.title	Short-term outcomes of downreferral in provision of paediatric antiretroviral therapy at Red Cross War Memorial Childrens Hospital, Cape Town	en_ZA
dc.type	Master Thesis
dc.type.qualificationlevel	Masters
dc.type.qualificationname	MMed	en_ZA
uct.type.filetype	Text
uct.type.filetype	Image
uct.type.publication	Research	en_ZA
uct.type.resource	Thesis	en_ZA