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Published in: BMC Public Health 1/2011

Open Access 01-12-2011 | Research article

12-month mortality and loss-to-program in antiretroviral-treated children: The IeDEA pediatric West African Database to evaluate AIDS (pWADA), 2000-2008

Authors: Didier K Ekouevi, Alain Azondekon, Fatoumata Dicko, Karen Malateste, Pety Touré, François T Eboua, Kouakou Kouadio, Lorna Renner, Kevin Peterson, François Dabis, Haby Signaté Sy, Valeriane Leroy, the IeDEA pediatric West Africa Working Group pWADA

Published in: BMC Public Health | Issue 1/2011

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Abstract

Background

The IeDEA West Africa Pediatric Working Group (pWADA) was established in January 2007 to study the care and treatment of HIV-infected children in this region. We describe here the characteristics at antiretroviral treatment (ART) initiation and study the 12-month mortality and loss-to-program of HIV-infected children followed in ART programs in West Africa.

Methods

Standardized data from HIV-infected children followed-up in ART programs were included. Nine clinical centers from six countries contributed to the dataset (Benin, Côte d'Ivoire, Gambia, Ghana, Mali and Senegal). Inclusion criteria were the followings: age 0-15 years and initiated triple antiretroviral drug regimens. Baseline time was the date of ART initiation. WHO criteria was used to define severe immunosuppression based on CD4 count by age or CD4 percent < 15%. We estimated the 12-month Kaplan-Meier probabilities of mortality and loss-to-program (death or loss to follow-up > 6 months) after ART initiation and factors associated with these two outcomes.

Results

Between June 2000 and December 2007, 2170 children were included. Characteristics at ART initiation were the following: median age of 5 years (Interquartile range (IQR: 2-9) and median CD4 percentage of 13% (IQR: 7-19). The most frequent drug regimen consisted of two nucleoside reverse transcriptase inhibitors and one non-nucleoside reverse transcriptase inhibitors (62%). During the first 12 months, 169 (7.8%) children died and 461(21.2%) were lost-to-program. Overall, in HIV-infected children on ART, the 12-month probability of death was 8.3% (95% Confidence Interval (CI): 7.2-9.6%), and of loss-to-program was 23.1% (95% CI: 21.3-25.0%). Both mortality and loss-to program were associated with advanced clinical stage, CD4 percentage < 15% at ART initiation and year (> 2005) of ART initiation.

Conclusion

Innovative and sustainable approaches are needed to better document causes of death and increase retention in HIV pediatric clinics in West Africa.
Appendix
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Literature
1.
2.
3.
KIDS-ART-LINC Collaboration: Low risk of death, but substantial program attrition, in pediatric HIV treatment cohorts in Sub-Saharan Africa. J Acquir Immune Defic Syndr. 2008, 49 (5): 523-31. 10.1097/QAI.0b013e31818aadce.CrossRef
4.
Anaky MF, Duvignac J, Wemin L, Kouakoussui A, Karcher S, Touré S, Seyler C, Fassinou P, Dabis F, N'Dri-Yoman T, Anglaret X, Leroy V: Scaling up antiretroviral therapy for HIV-infected children in Cote d'Ivoire: determinants of survival and loss to programme. Bull World Health Organ. 2010, 88 (7): 490-9. 10.2471/BLT.09.068015.CrossRefPubMed
5.
Bolton-Moore C, Mubiana-Mbewe M, Cantrell RA, Chintu N, Stringer EM, Chi BH, Sinkala M, Kankasa C, Wilson CM, Wilfert CM, Mwango A, Levy J, Abrams EJ, Bulterys M, Stringer JS: Clinical outcomes and CD4 cell response in children receiving antiretroviral therapy at primary health care facilities in Zambia. JAMA. 2007, 298 (16): 1888-99. 10.1001/jama.298.16.1888.CrossRefPubMed
6.
Davies MA, Keiser O, Technau K, Eley B, Rabie H, van Cutsem G, Giddy J, Wood R, Boulle A, Egger M, Moultrie H, International Epidemiologic Databases to Evaluate AIDS Southern Africa (IeDEA-SA) Collaboration: Outcomes of the South African National Antiretroviral Treatment Programme for children: the IeDEA Southern Africa collaboration. S Afr Med J. 2009, 99 (10): 730-7.PubMedPubMedCentral
7.
Fassinou P, Elenga N, Rouet F, Laguide R, Kouakoussui KA, Timite M, Blanche S, Msellati P: Highly active antiretroviral therapies among HIV-1-infected children in Abidjan, Cote d'Ivoire. AIDS. 2004, 18 (14): 1905-13. 10.1097/00002030-200409240-00006.CrossRefPubMed
8.
Sauvageot D, Schaefer M, Olson D, Pujades-Rodriguez M, O'Brien DP: Antiretroviral therapy outcomes in resource-limited settings for HIV-infected children < 5 years of age. Pediatrics. 125 (5): e1039-47.
9.
Violari A, Cotton MF, Gibb DM, Babiker AG, Steyn J, Madhi SA, Jean-Philippe P, McIntyre JA, CHER Study Team: Early antiretroviral therapy and mortality among HIV-infected infants. N Engl J Med. 2008, 359 (21): 2233-44. 10.1056/NEJMoa0800971.CrossRefPubMedPubMedCentral
10.
11.
12.
Ekouevi DK, Balestre E, Ba-Gomis FO, Eholie SP, Maiga M, Amani-Bosse C, Minga A, Messou E, Sow PS, Lewden C, Traoré HA, Bissagnene E, Dabis F, IeDEA West Africa Collaboration: Low retention of HIV-infected patients on antiretroviral therapy in 11 clinical centres in West Africa. Trop Med Int Health. 2011, 15 (Suppl 1): 34-42.
13.
Fox MP, Rosen S: Patient retention in antiretroviral therapy programs up to three years on treatment in sub-Saharan Africa, 2007-2009: systematic review. Trop Med Int Health. 2011, 15 (Suppl 1): 1-15.
14.
Rosen S, Fox MP, Gill CJ: Patient retention in antiretroviral therapy programs in sub-Saharan Africa: a systematic review. PLoS Med. 2007, 4 (10): e298-10.1371/journal.pmed.0040298.CrossRefPubMedPubMedCentral
15.
Kjaer J, Ledergerber B: HIV cohort collaborations: proposal for harmonization of data exchange. Antivir Ther. 2004, 9 (4): 631-3.PubMed
16.
WHO: Care, treatment, and support for women living with HIV/AIDS and their children in resource-constrained settings. Antiretroviral drugs for treatment in pregnant women and for prevention of HIV infection in infants and young children. 2004, Revision, Accessed date 10 May 2011, [http://​www.​who.​int/​hiv/​pub/​mtct/​guidelines/​en/​]
17.
18.
Rouet F, Fassinou P, Inwoley A, Anaky MF, Kouakoussui A, Rouzioux C, Blanche S, Msellati P: Programme Enfants Yopougon. Long-term survival and immuno-virological response of African HIV-1-infected children to highly active antiretroviral therapy regimens. AIDS. 2006, 20 (18): 2315-9. 10.1097/QAD.0b013e328010943b. ANRS 1244/1278CrossRefPubMed
19.
Brinkhof MW, Dabis F, Myer L, Bangsberg DR, Boulle A, Nash D, Schechter M, Laurent C, Keiser O, May M, Sprinz E, Egger M, Anglaret X, ART-LINC, IeDEA: Early loss of HIV-infected patients on potent antiretroviral therapy programmes in lower-income countries. Bull World Health Organ. 2008, 86 (7): 559-67. 10.2471/BLT.07.044248.CrossRefPubMedPubMedCentral
20.
Brinkhof MW, Pujades-Rodriguez M, Egger M: Mortality of patients lost to follow-up in antiretroviral treatment programmes in resource-limited settings: systematic review and meta-analysis. PLoS ONE. 2009, 4 (6): e5790-10.1371/journal.pone.0005790.CrossRefPubMedPubMedCentral
21.
Yu JK, Chen SC, Wang KY, Chang CS, Makombe SD, Schouten EJ, Harries AD: True outcomes for patients on antiretroviral therapy who are "lost to follow-up" in Malawi. Bull World Health Organ. 2007, 85 (7): 550-4. 10.2471/BLT.06.037739.CrossRefPubMedPubMedCentral
22.
Tonwe-Gold B, Ekouevi DK, Bosse CA, Toure S, Koné M, Becquet R, Leroy V, Toro P, Dabis F, El Sadr WM, Abrams EJ: Implementing family-focused HIV care and treatment: the first 2 years' experience of the mother-to-child transmission-plus program in Abidjan, Cote d'Ivoire. Trop Med Int Health. 2009, 14 (2): 204-12. 10.1111/j.1365-3156.2008.02182.x.CrossRefPubMedPubMedCentral
23.
Creek T, Tanuri A, Smith M, Seipone K, Smit M, Legwaila K, Motswere C, Maruping M, Nkoane T, Ntumy R, Bile E, Mine M, Lu L, Tebele G, Mazhani L, Davis MK, Roels TH, Kilmarx PH, Shaffer N: Early diagnosis of human immunodeficiency virus in infants using polymerase chain reaction on dried blood spots in Botswana's national program for prevention of mother-to-child transmission. Pediatr Infect Dis J. 2008, 27 (1): 22-6. 10.1097/INF.0b013e3181469050.CrossRefPubMed
24.
Lofgren SM, Morrissey AB, Chevallier CC, Malabeja AI, Edmonds S, Amos B, Sifuna DJ, von Seidlein L, Schimana W, Stevens WS, Bartlett JA, Crump JA: Evaluation of a dried blood spot HIV-1 RNA program for early infant diagnosis and viral load monitoring at rural and remote healthcare facilities. AIDS. 2009, 23 (18): 2459-66. 10.1097/QAD.0b013e328331f702.CrossRefPubMedPubMedCentral
25.
Ngo-Giang-Huong N, Khamduang W, Leurent B, Collins I, Nantasen I, Leechanachai P, Sirirungsi W, Limtrakul A, Leusaree T, Comeau AM, Lallemant M, Jourdain G: Early HIV-1 diagnosis using in-house real-time PCR amplification on dried blood spots for infants in remote and resource-limited settings. J Acquir Immune Defic Syndr. 2008, 49 (5): 465-71. 10.1097/QAI.0b013e31818e2531.CrossRefPubMedPubMedCentral
26.
Newell ML, Coovadia H, Cortina-Borja M, Rollins N, Gaillard P, Dabis F: Mortality of infected and uninfected infants born to HIV-infected mothers in Africa. a pooled analysis Lancet. 2004, 364 (9441): 1236-43.CrossRefPubMed
27.
Kiboneka A, Wangisi J, Nabiryo C, Tembe J, Kusemererwa S, Olupot-Olupot P, Joffres M, Anema A, Cooper CL, Montaner JS, Mills EJ: Clinical and immunological outcomes of a national paediatric cohort receiving combination antiretroviral therapy in Uganda. AIDS. 2008, 22 (18): 2493-9. 10.1097/QAD.0b013e328318f148.CrossRefPubMed
28.
Harries AD, Zachariah R, Lawn SD, Rosen S: Strategies to improve patient retention on antiretroviral therapy in sub-Saharan Africa. Trop Med Int Health. 15 (Suppl 1): 70-5.
Metadata
Title
12-month mortality and loss-to-program in antiretroviral-treated children: The IeDEA pediatric West African Database to evaluate AIDS (pWADA), 2000-2008
Authors
Didier K Ekouevi
Alain Azondekon
Fatoumata Dicko
Karen Malateste
Pety Touré
François T Eboua
Kouakou Kouadio
Lorna Renner
Kevin Peterson
François Dabis
Haby Signaté Sy
Valeriane Leroy
the IeDEA pediatric West Africa Working Group pWADA
Publication date
01-12-2011
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2011
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-11-519

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