[MoAb0201] Children enrolled in a public HIV care and treatment program in Lusaka, Zambia: rapid scale-up and first-year clinical outcomes

16th International AIDS Conference

Toronto, Canada - August 13 - 18, 2006

CHILDREN ENROLLED IN A PUBLIC HIV CARE AND TREATMENT PROGRAM IN LUSAKA, ZAMBIA: RAPID SCALE-UP AND FIRST-YEAR CLINICAL OUTCOMES

Int Conf AIDS. 2006 Aug 13-18;16 Abstract No. MoAb0201

Mbewe M.¹, Bolton C.¹, Levy J.¹, Sinkala M.², Bulterys M.³, Chi B.¹, Wilfert C.⁴, Stringer J.¹, Dumas A.¹, Chintu N.¹, Stringer E.¹
¹Centre for Infectious Disease Research in Zambia, Lusaka, Zambia, ²Lusaka Urban District Health Management Team, Lusaka, Zambia, ³U.S. CDC-GAP, Lusaka, Zambia, ⁴Elizabeth Glaser Pediatric AIDS Foundation, Washington, D.C., United States

BACKGROUND: Access to and uptake of pediatric HIV care and treatment in most resource-limited settings remain inadequate, with few programs meeting the WHO target that 10% of patients on antiretroviral therapy (ART) be children.

METHODS: Pediatric ART services are provided in primary government clinics. ART eligibility is based on WHO staging and age-based CD4 criteria. Virologic diagnosis is limited; most children <18 months start therapy on clinical criteria.

RESULTS: Between May-04 and Oct-05, 1815 children were enrolled. Of these, 1319 (629 girls, 690 boys) initiated ART. Median age was 6.5 years; 74% were <5% weight-for-age. Mean CD4+ at ART initiation was 650 (±520) for children <1 year; 484 (±390) for children age 1-5 years; and 254 (±234) for children ≥6 years. Initial regimens included: 545(41%) ZDV+3TC +NVP; 610(46%) D4T+3TC +NVP; 48(3.6%) ZDV+3TC +EFV; 68(5.2%) D4T+3TC +EFV; and 48(3.6%) other regimens.

	<1 year (n=53)		1-5 years (n=524)		≥6 years (n=742)
	6 months	12 months	6 months	12 months	6 months	12 months
Mean change in CD4 count	223 (±448)	--	393 (±581)	337 (±516)	242 (±310)	305 (±370)
Mean change in hemoglobin	--	--	0.27 (±2.27)	0.00 (±3.76)	1.12 (±2.28)	1.25 (±1.70)

Over 664 child-years on ART, 60 children died (9.0/100 child-years). In Cox proportional hazard modeling, WHO stage III or IV (HR 3.0; CI 1.7-5.7) and low CD4 (HR 2.4; CI 1.1-5.4) were predictors of mortality on ART. Weight-for-age <5%, adherence, gender, and TB at enrollment were not associated with death. The proportion of total ART program enrollment comprising children increased modestly from 5.8% in the first 6 months to 7.3% in the last 6 months (p<0.001).

CONCLUSIONS: In this population without full access to infant HIV diagnostics, more than two-thirds of HIV-infected children presenting for care were eligible for ART. Providing quality HIV care and treatment to children on a large scale in a resource-limited setting is feasible but requires a strong commitment to pediatric care.

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2006-08-13
MoAb0201

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