Original articles

"Outcomes of the South African National Antiretroviral Treatment (ART) programme for children. – The IeDEA Southern Africa Collaboration"

Mary-Ann Davies, Olivia Keiser, Karl Technau, Brian Eley, Helena Rabie, Gilles Van Cutsem, Janet Giddy, Robin Wood, Andrew Boulle, Matthias Egger, Harry Moultrie

Abstract


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.

Authors' affiliations

Mary-Ann Davies, Infectious Disease Epidemiology Unit, School of Public Health and Family Medicine, University of Cape Town

Olivia Keiser, Institute of Social and Preventive Medicine (ISPM), University of Bern

Karl Technau, University of Witwatersrand Paediatric HIV Clinics (Coronation Women and Children’s Hospital)

Brian Eley, Red Cross Children’s Hospital and School of Child and Adolescent Health, University of Cape Town

Helena Rabie, Tygerberg Academic Hospital, University of Stellenbosch

Gilles Van Cutsem, Khayelitsha Community Health Centre and Médecins Sans Frontières

Janet Giddy, McCord Hospital

Robin Wood, Gugulethu Community Health Centre and Desmond Tutu HIV Centre, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town

Andrew Boulle, Infectious Disease Epidemiology Unit, School of Public Health and Family Medicine, University of Cape Town

Matthias Egger, Institute of Social and Preventive Medicine (ISPM), University of Bern

Harry Moultrie, University of Witwatersrand Paediatric HIV Clinics (Harriet Shezi Clinic, Chris Hani Baragwanath Hospital); University of Witwatersrand, School of Public Health

Full Text

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Keywords

Children; infants; antiretroviral therapy, outcomes,

Cite this article

South African Medical Journal 2009;99(10):730.

Article History

Date submitted: 2009-04-08
Date published: 2009-10-01

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