Scaling up antiretroviral therapy for HIV-infected children in Côte d’Ivoire: determinants of survival and loss to programme

Methods 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.17 Briefly, 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 ‫الرتجمة‬ Objective 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.