Setting and patient characteristicsIn June 2004, Aconda, a nongovernmental organization created by researchers who had studied cohorts of HIV-infected adults and children in Abidjan, Côte d'Ivoire, between 1996 and 2003, 9,16 formed a partnership with the Institute of Public Health, Epidemiology and Development in Bordeaux, France, to study access to HIV care and treatment.The study was funded by the United States President's Emergency Plan for AIDS Relief through the Elizabeth Glaser Pediatric AIDS Foundation in Washington, DC, United States of America (USA).Details of the Aconda programme have been described elsewhere. 17Briefly, the Aconda team trained health workers in HIV care and implemented a standardized computer data management system which was controlled by a designated Une traduction en français de ce résumé figure à la fin de l'article.Al final del artículo se facilita una traducción al español. املقالة. لهذه الكامل النص نهاية يف الخالصة لهذه العربية الرتجمةObjective To investigate deaths and losses to follow-up in a programme designed to scale up antiretroviral therapy (ART) for HIVinfected children in Côte d'Ivoire.Methods Between 2004 and 2007, HIV-exposed children at 19 centres were offered free HIV serum tests (polymerase chain reaction tests in those aged < 18 months) and ART.Computerized monitoring was used to determine: (i) the number of confirmed HIV infections, (ii) losses to the programme (i.e.death or loss to follow-up) before ART, (iii) mortality and loss-to-programme rates during 12 months of ART, and (iv) determinants of mortality and losses to the programme.Findings The analysis included 3876 ART-naïve children.Of the 1766 with HIV-1 infections (17% aged < 18 months), 124 (7.0%) died, 52 (2.9%) left the programme, 354 (20%) were lost to follow-up before ART, 259 (15%) remained in care without ART, and 977 (55%) started ART (median age: 63 months).The overall mortality rate during ART was significantly higher in the first 3 months than in months 4-12: 32.8 and 6.9 per 100 child-years of follow-up, respectively.Loss-to-programme rates were roughly double mortality rates and followed the same trend with duration of ART.Independent predictors of 12-month mortality on ART were pre-ART weightfor-age z-score < -2, percentage of CD4+ T lymphocytes < 10, World Health Organization HIV/AIDS clinical stage 3 or 4, and blood haemoglobin < 8 g/dl.Conclusion The large-scale programme to scale up paediatric ART in Côte d'Ivoire was effective.However, ART was often given too late, and early mortality and losses to programme before and just after ART initiation were major problems.
Abstract Objective We report the first national programme in Côte d'Ivoire to evaluate the feasibility of nurse‐led HIV care as a model of task‐sharing with nurses to increase coverage and decentralisation of HIV services. Methods Twenty‐six public HIV facilities implemented either a nurse‐with‐onsite‐physician or a nurse‐with‐visiting‐physician model of HIV task‐sharing. Routinely collected patient data were reviewed to analyse patient characteristics of those enrolling in care and initiating antiretroviral therapy ( ART ). Retention, loss to programme and death were compared across facility‐level characteristics. Results A total of 1224 patients enrolled in HIV care, with 666 initiating ART , from January 2012 to May 2013 (median follow‐up 13 months). The majority (94%) were adults ≥15 years. Fourteen facilities provided ART initiation for the first time during the pilot period; 20 facilities were primary level. Nurse‐led care with a visiting physician was provided in 14 of the primary‐level facilities. Nurse‐led ART care with an onsite physician was provided in all secondary‐level facilities and six of the primary‐level facilities. During the pilot, 567 (85%) of patients were retained, 28 (4.2%) died, 47 (7.1%) were lost to follow‐up, and 24 (3.6%) transferred. Five deaths (10.9%) were recorded among children as compared to 23 deaths (3.7%) among adults ( P = 0.037). There were no differences in retention by model of nurse‐led ART care. Conclusion Task‐sharing of HIV care and ART initiation with nurses in Côte d'Ivoire is feasible. This pilot illustrates two models of nurse‐led HIV care and has informed national policy on nurse‐led HIV care in Côte d'Ivoire.
Background: In the 2008 UNAIDS epidemic update, 33 million people worldwide were estimated infected with HIV, including 2.2 million children. In Côte d’Ivoire, 480 000 adults and 60 000 children were HIV-infected. Studies in developed countries have shown an improvement of children's morbidity under HAART treatment.
Scaling up antiretroviral therapy for HIV-infected children in Cote d'Ivoire: determinants of survival and loss to programme/Elargissement du traitement antiretroviral pour les enfants infectes par le VIH en Cote d'Ivoire: determinants de la survie et des pertes pour le programme/Expansion del tratamiento antirretroviral entre ninos infectados por el VIH en Cote d'Ivoire:determinantes de la supervivencia y de las perdidas de seguimiento. Objective To investigate deaths and losses to follow-up in a programme designed to scale up antiretroviral therapy (ART) for HIV-infected children in Cote d'Ivoire. Methods Between 2004 and 2007, HIV-exposed children at 19 centres were offered free HIV serum tests (polymerase chain reaction tests in those aged Findings The analysis included 3876 ART-naive children. Of the 1766 with HIV-1 infections (17% aged Conclusion The large-scale programme to scale up paediatric ART in Cote d'Ivoire was effective. However, ART was often given too late, and early mortality and losses to programme before and just after ART initiation were major problems. Objectif Etudier la mortalite et le nombre de perdus de vue dans le cadre d'un programme concu pour etendre le traitement antiretroviral (ART) des enfants infectes par le VIH en Cote d'Ivoire. Methodes Entre 2004 et 2007, on a propose gratuitement, dans 19 centres, a l'intention des enfants exposes au VIH, un depistage serologique de ce virus (un test d'amplification genique pour les moins de 18 mois) et un traitement ART. On a fait appel a un suivi informatise pour determiner: (i) le nombre d'infections a VIH confirmees, (ii) les pertes pour le programme (c'est-a-dire les morts et les perdus de vue) avant l'administration du traitement ART, (iii) la mortalite et les taux de perte pour le programme au cours des 12 mois de traitement ART, et (iv) les determinants de la mortalite et des pertes pour le programme. Resultats L'analyse a porte sur 3876 enfants encore jamais traites par des antiretroviraux. Parmi les 1766 enfants atteints d'une infection a VlH-1 (dont 17% de moins de 18 mois), 124 (7,0%) sont decedes, 52 (2,9%) ont quitte le programme, 354 (20%) ont ete perdus de vue avant la mise en route du traitement ART, 259 (15%) ont continue de recevoir des soins sans prendre d'ARV et 977 (55%) ont debute un traitement ART (age median: 63 mois). Le taux de mortalite global au cours du traitement etait significativement plus eleve pendant les 3 premiers mois qu'au cours des mois 4 a 12, soit 32,8 et 6,9 deces pour 100 enfantsannees de suivi, respectivement. Les taux de perte pour le programme atteignaient approximativement le double des taux de mortalite et suivaient les memes tendances avec la duree du traitement. Les facteurs predictifs independants de la mortalite a 12 mois sous ART etaient: rapport poids/ age avant le traitement en z-score
Background: To date, an estimated 10% of children eligible for antiretroviral treatment (ART) receive it, and the frequency of retention in programs is unknown. We evaluated the 2-year risks of death and loss to follow-up (LTFU) of children after ART initiation in a multicenter study in sub-Saharan Africa. Methods: Pooled analysis of routine individual data from 16 participating clinics produced overall Kaplan-Meier estimates of the probabilities of death or LTFU after ART initiation. Risk factors analysis used Weibull regression, accounting for between-cohort heterogeneity. Results: The median age of 2405 children at ART initiation was 4.9 years (12%, younger than 12 months), 52% were male, 70% had severe immunodeficiency, and 59% started ART with a nonnucleoside reverse transcriptase inhibitor. The 2-year risk of death after ART initiation was 6.9% (95% confidence interval [CI]: 5.9 to 8.1), independently associated with baseline severe anemia (adjusted hazard ratio [aHR]: 4.10 [CI: 2.36 to 7.13]), immunodeficiency (adjusted aHR: 2.95 [CI: 1.49 to 5.82]), and severe clinical status (adjusted aHR: 3.64 [CI: 1.95 to 6.81]); the 2-year risk of LTFU was 10.3% (CI: 8.9 to 11.9), higher in children with severe clinical status. Conclusions: Once on treatment, the 2-year risk of death is low but the LTFU risk is substantial. ART is still mainly initiated at advanced disease stage in African children, reinforcing the need for early HIV diagnosis, early initiation of ART, and procedures to increase program retention.
