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5th International AIDS Society Conference on HIV Pathogenesis and TreatmentCape Town - July 19 - 22, 2009 |
LONG TERM PROGRAMMATIC OUTCOMES FOR ADULTS AND CHILDREN AT A PRIMARY HEALTH CARE ANTIRETROVIRAL CLINIC IN SOUTH AFRICA
IAS Conf HIV Pathog Treat 2009 Jul 19-22;5th: Abstract No. MOAD105
R. Kaplan
1, L.-G. Bekker1,2, E. Zwane3, E. Campbell1, C. Orrell1, R. Wood1,2
1Desmond Tutu HIV Foundation, Cape Town, South Africa, 2University of Cape Town, Department of Medicine, Cape Town, South Africa, 3University of Cape Town, Infectious Disease Epidemiology Unit, School of Public Health and Family Medicine, Cape Town, South Africa
BACKGROUND: Primary health care clinics with integrated adult and paediatric services have become the focus for the delivery of antiretroviral treatment (ART) in sub-Saharan Africa. Treatment outcomes at these clinics will determine the success of this public health intervention.
METHODS: This prospective cohort study examined mortality and loss to follow-up (LTFU) pre and on-ART as well as rates of immunological recovery and virological failure for ART naïve children and adults at a community clinic in Cape Town, South Africa from Sept 02 to March 08.
RESULTS: 169 children (0-17years) and 3377 adults were eligible for ART. 2.9% children (n=5) and 5.0% adults (n=168; p=0.22) died and 3.5% children (n=6) and 8.1% adults (n=274; p=0.03) were LTFU pre-treatment. 140 children and 2766 adults started ART. Baseline characteristics showed 76% adults (n=2098) had stage III and IV disease compared to 63% (n=88; p<0.001) children. Median absolute CD4 count for adults was 101 (IQR 89-182) compared to 312 (IQR157-494) for children (p<0.001). Median log HIV viral load was 5.11 for children and 4.90 for adults (p<0.001). 3 (2.3%) children died on treatment, all in the first year. Adult on-treatment mortality was 12.9% at 5 years with 209 of 249 deaths (84%) within the first year. Kaplan-Meier estimates for LTFU were 8.5% for children and 16.5% for adults at 3 years. Overall retention in care at 3 years was 89.3% for children and 74.1% for adults with 68.0% of adults still estimated to be in care at 5 years. Virological failure, defined as two sequential viral loads >1000 copies/ml, averaged 6.0% per year for children and 3.5% per year for adults (p=0.656) Median CD4 recovery rates, calculated for children aged 0-4, 5-17 and adults, were equivalent.
CONCLUSION: Favourable paediatric outcomes provide support for integrated adult and paediatric services in community ART clinics.
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2009-07-22
MOAD105
Oral Abstract Session MOAD1 - Innovative Methods for Effectively Delivering HIV Care Interventions
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