A biregional survey and review of first-line treatment failure and second-line paediatric antiretroviral access and use in Asia and southern Africa

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dc.date.accessioned2021-10-08T07:08:15Z
dc.date.available2021-10-08T07:08:15Z
dc.date.issued2011
dc.description.abstractBackgroundTo better understand the need for paediatric second-line antiretroviral therapy (ART), an ART management survey and a cross-sectional analysis of second-line ART use were conducted in the TREAT Asia Paediatric HIV Observational Database and the IeDEA Southern Africa (International Epidemiologic Databases to Evaluate AIDS) regional cohorts.MethodsSurveys were conducted in April 2009. Analysis data from the Asia cohort were collected in March 2009 from 12 centres in Cambodia, India, Indonesia, Malaysia, and Thailand. Data from the IeDEA Southern Africa cohort were finalized in February 2008 from 10 centres in Malawi, Mozambique, South Africa and Zimbabwe.ResultsSurvey responses reflected inter-regional variations in drug access and national guidelines. A total of 1301 children in the TREAT Asia and 4561 children in the IeDEA Southern Africa cohorts met inclusion criteria for the cross-sectional analysis.Ten percent of Asian and 3.3% of African children were on second-line ART at the time of data transfer. Median age (interquartile range) in months at second-line initiation was 120 (78-145) months in the Asian cohort and 66 (29-112) months in the southern African cohort. Regimens varied, and the then current World Health Organization-recommended nucleoside reverse transcriptase combination of abacavir and didanosine was used in less than 5% of children in each region.ConclusionsIn order to provide life-long ART for children, better use of current first-line regimens and broader access to heat-stable, paediatric second-line and salvage formulations are needed. There will be limited benefit to earlier diagnosis of treatment failure unless providers and patients have access to appropriate drugs for children to switch to.
dc.identifier.issn1758-2652
dc.identifier.ris TY - Journal Article AB - BackgroundTo better understand the need for paediatric second-line antiretroviral therapy (ART), an ART management survey and a cross-sectional analysis of second-line ART use were conducted in the TREAT Asia Paediatric HIV Observational Database and the IeDEA Southern Africa (International Epidemiologic Databases to Evaluate AIDS) regional cohorts.MethodsSurveys were conducted in April 2009. Analysis data from the Asia cohort were collected in March 2009 from 12 centres in Cambodia, India, Indonesia, Malaysia, and Thailand. Data from the IeDEA Southern Africa cohort were finalized in February 2008 from 10 centres in Malawi, Mozambique, South Africa and Zimbabwe.ResultsSurvey responses reflected inter-regional variations in drug access and national guidelines. A total of 1301 children in the TREAT Asia and 4561 children in the IeDEA Southern Africa cohorts met inclusion criteria for the cross-sectional analysis.Ten percent of Asian and 3.3% of African children were on second-line ART at the time of data transfer. Median age (interquartile range) in months at second-line initiation was 120 (78-145) months in the Asian cohort and 66 (29-112) months in the southern African cohort. Regimens varied, and the then current World Health Organization-recommended nucleoside reverse transcriptase combination of abacavir and didanosine was used in less than 5% of children in each region.ConclusionsIn order to provide life-long ART for children, better use of current first-line regimens and broader access to heat-stable, paediatric second-line and salvage formulations are needed. There will be limited benefit to earlier diagnosis of treatment failure unless providers and patients have access to appropriate drugs for children to switch to. DA - 2011 DB - OpenUCT DP - University of Cape Town IS - 1 J1 - Journal of the International AIDS Society LK - https://open.uct.ac.za PY - 2011 SM - 1758-2652 T1 - A biregional survey and review of first-line treatment failure and second-line paediatric antiretroviral access and use in Asia and southern Africa TI - A biregional survey and review of first-line treatment failure and second-line paediatric antiretroviral access and use in Asia and southern Africa UR - http://hdl.handle.net/11427/34537 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/34537
dc.language.isoeng
dc.publisher.departmentDepartment of Psychiatry and Mental Health
dc.publisher.facultyFaculty of Health Sciences
dc.sourceJournal of the International AIDS Society
dc.source.journalissue1
dc.source.journalvolume14
dc.source.pagination7 - 177
dc.source.urihttps://dx.doi.org/10.1186/1758-2652-14-7
dc.subject.otherAdolescent
dc.subject.otherAfrica, Southern
dc.subject.otherAnti-HIV Agents
dc.subject.otherAntiretroviral Therapy, Highly Active
dc.subject.otherAsia
dc.subject.otherChild
dc.subject.otherChild, Preschool
dc.subject.otherCross-Sectional Studies
dc.subject.otherDrug Utilization
dc.subject.otherFemale
dc.subject.otherHIV Infections
dc.subject.otherHealth Services Accessibility
dc.subject.otherHealth Services Research
dc.subject.otherHumans
dc.subject.otherMale
dc.subject.otherTreatment Failure
dc.subject.otherAnti-HIV Agents
dc.titleA biregional survey and review of first-line treatment failure and second-line paediatric antiretroviral access and use in Asia and southern Africa
dc.typeJournal Article
uct.type.publicationResearch
uct.type.resourceJournal Article
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