Attrition and Mortality of Children Receiving Antiretroviral Treatment through the Universal Coverage Health Program in Thailand - 24/08/17
, Stephen J. Kerr, PhD 1, 2, Thanyawee Puthanakit, PhD 1, 3, Torsak Bunupuradah, MD 1, Kiat Ruxrungtham, MD 1, 4, Suchada Chaivooth, MD 5, Matthew G. Law, PhD 2, Kulkanya Chokephaibulkit, MD 6Abstract |
Objective |
To assess mortality and loss to follow-up of children with HIV infection who started antiretroviral therapy (ART) through the Universal Coverage Health Program (UC) in Thailand.
Study design |
Children with HIV infection who initiated ART at age <15 years through the UC between 2008 and 2013 were included in the analysis. Death was ascertained through linkage with the National Death Registry. A competing-risks method was used to calculate subdistribution hazard ratios (SHRs) of predictors for loss to follow-up. Death was considered a competing risk. Cox proportional hazards models were used to assess predictors of mortality.
Results |
A total of 4618 children from 497 hospitals in Thailand were included in the study. Median age at ART initiation was 9 years (IQR, 6-12 years), and the median duration of tracking was 4.1 years (a total of 18 817 person-years). Three hundred and ninety-five children (9%) died, for a mortality rate of 2.1 (95% CI, 1.9-2.3) per 100 person-years, and 525 children (11%) were lost to follow-up, for a lost to follow-up rate of 2.9 (95% CI, 2.7-3.2) per 100 person-years. The cumulative incidence of loss to follow-up increased from 4% at 1 year to 8.8% at 3 years. Children who started ART at age ≥12 years were at the greatest risk of loss to follow-up. The probability of death was 3.2% at 6 months and 6.4% at 3 years. Age ≥12 years at ART initiation, lower baseline CD4%, advanced HIV staging, and loss to follow-up were associated with mortality.
Conclusion |
The Thai national HIV treatment program has been very effective in treating children with HIV infection, with low mortality and modest rates of loss to follow-up.
Le texte complet de cet article est disponible en PDF.Keywords : pediatric, mortality, loss to follow-up, National AIDS Program
Abbreviations : ART, aSHR, CDC, NHSO, NNRTI, NRTIs, PI, PMTCT, SHR, UC
Plan
| The Kirby Institute is funded by the Australian Government Department of Health and is affiliated with the Faculty of Medicine, University of New South Wales. K.R. has received the Senior Research Scholar from the Thailand Research Fund and has received honoraria or consultation fees from Merck, Roche, Jensen-Cilag, Tibotec, Mylan, and the Governmental Pharmaceutical Organization of Thailand (GPO). He also has participated in company-sponsored speaker's bureau from Abbott, Gilead, Bristol-Myers Squibb, Merck, Roche, Jensen-Cilag, GlaxoSmithKline, and GPO. M.L. has received unrestricted research grants from Boehringer Ingelhiem, Gilead Sciences, Merck Sharp & Dohme, Bristol-Myers Squibb, Janssen-Cilag, and ViiV HealthCare; Data and Safety Monitoring Board sitting fees from Sirtex; and consultancy and presentation fees from Gilead Sciences. The other authors declare no conflicts of interest. |
Vol 188
P. 210 - septembre 2017 Retour au numéro
Article précédent
- Size of Facial Port-Wine Birthmark May Predict Neurologic Outcome in Sturge-Weber Syndrome
- Malgorzata Dymerska, Anna Y. Kirkorian, Elizabeth A. Offermann, Doris D. Lin, Anne M. Comi, Bernard A. Cohen
- Real-Time Polymerase Chain Reaction–Based Detection of Bordetella pertussis in Mexican Infants and Their Contacts: A 3-Year Multicenter Study
- Alejandra Aquino-Andrade, Gabriel Martínez-Leyva, Jocelin Mérida-Vieyra, Patricia Saltigeral, Antonino Lara, Wendy Domínguez, Silvestre García de la Puente, Agustín De Colsa
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?