Scaling up antiretroviral therapy for HIV-infected children in Côte d’Ivoire: determinants of survival and loss to programme
Identifieur interne : 001636 ( Pmc/Corpus ); précédent : 001635; suivant : 001637Scaling up antiretroviral therapy for HIV-infected children in Côte d’Ivoire: determinants of survival and loss to programme
Auteurs : M-F Anaky ; J. Duvignac ; L. Wemin ; A. Kouakoussui ; S. Karcher ; S. Touré ; C. Seyler ; P. Fassinou ; F. Dabis ; T. N Ri-Yoman ; X. Anglaret ; V. LeroySource :
- Bulletin of the World Health Organization [ 0042-9686 ] ; 2009.
Abstract
To investigate deaths and losses to follow-up in a programme designed to scale up antiretroviral therapy (ART) for HIV-infected children in Côte d’Ivoire.
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.
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 weight-for-age
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.
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DOI: 10.2471/BLT.09.068015
PubMed: 20616968
PubMed Central: 2897983
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Scaling up antiretroviral therapy for HIV-infected children in Côte d’Ivoire: determinants of survival and loss to programme</title><author><name sortKey="Anaky, M F" sort="Anaky, M F" uniqKey="Anaky M" first="M-F" last="Anaky">M-F Anaky</name><affiliation><nlm:aff id="aff1">Aconda-VS-CI, Abidjan,<country>Côte d’Ivoire</country>.</nlm:aff></affiliation></author><author><name sortKey="Duvignac, J" sort="Duvignac, J" uniqKey="Duvignac J" first="J" last="Duvignac">J. Duvignac</name><affiliation><nlm:aff id="aff2">Centre de Recherche INSERM U897 (ex-U593), Université Victor Segalen Bordeaux 2, 146 rue Léo Saignat, 33076, Bordeaux Cedex,<country>France</country>.</nlm:aff></affiliation></author><author><name sortKey="Wemin, L" sort="Wemin, L" uniqKey="Wemin L" first="L" last="Wemin">L. Wemin</name><affiliation><nlm:aff id="aff1">Aconda-VS-CI, Abidjan,<country>Côte d’Ivoire</country>.</nlm:aff></affiliation></author><author><name sortKey="Kouakoussui, A" sort="Kouakoussui, A" uniqKey="Kouakoussui A" first="A" last="Kouakoussui">A. Kouakoussui</name><affiliation><nlm:aff id="aff1">Aconda-VS-CI, Abidjan,<country>Côte d’Ivoire</country>.</nlm:aff></affiliation></author><author><name sortKey="Karcher, S" sort="Karcher, S" uniqKey="Karcher S" first="S" last="Karcher">S. Karcher</name><affiliation><nlm:aff id="aff2">Centre de Recherche INSERM U897 (ex-U593), Université Victor Segalen Bordeaux 2, 146 rue Léo Saignat, 33076, Bordeaux Cedex,<country>France</country>.</nlm:aff></affiliation></author><author><name sortKey="Toure, S" sort="Toure, S" uniqKey="Toure S" first="S" last="Touré">S. Touré</name><affiliation><nlm:aff id="aff1">Aconda-VS-CI, Abidjan,<country>Côte d’Ivoire</country>.</nlm:aff></affiliation></author><author><name sortKey="Seyler, C" sort="Seyler, C" uniqKey="Seyler C" first="C" last="Seyler">C. Seyler</name><affiliation><nlm:aff id="aff3">Institut de Santé Publique, Epidémiologie et Développement, Université Victor Segalen, Bordeaux,<country>France</country>.</nlm:aff></affiliation></author><author><name sortKey="Fassinou, P" sort="Fassinou, P" uniqKey="Fassinou P" first="P" last="Fassinou">P. Fassinou</name><affiliation><nlm:aff id="aff4">Elizabeth Glaser Pediatric AIDS Foundation, Abidjan,<country>Côte d’Ivoire</country>.</nlm:aff></affiliation></author><author><name sortKey="Dabis, F" sort="Dabis, F" uniqKey="Dabis F" first="F" last="Dabis">F. Dabis</name><affiliation><nlm:aff id="aff2">Centre de Recherche INSERM U897 (ex-U593), Université Victor Segalen Bordeaux 2, 146 rue Léo Saignat, 33076, Bordeaux Cedex,<country>France</country>.</nlm:aff></affiliation></author><author><name sortKey="N Ri Yoman, T" sort="N Ri Yoman, T" uniqKey="N Ri Yoman T" first="T" last="N Ri-Yoman">T. N Ri-Yoman</name><affiliation><nlm:aff id="aff1">Aconda-VS-CI, Abidjan,<country>Côte d’Ivoire</country>.</nlm:aff></affiliation></author><author><name sortKey="Anglaret, X" sort="Anglaret, X" uniqKey="Anglaret X" first="X" last="Anglaret">X. Anglaret</name><affiliation><nlm:aff id="aff2">Centre de Recherche INSERM U897 (ex-U593), Université Victor Segalen Bordeaux 2, 146 rue Léo Saignat, 33076, Bordeaux Cedex,<country>France</country>.</nlm:aff></affiliation></author><author><name sortKey="Leroy, V" sort="Leroy, V" uniqKey="Leroy V" first="V" last="Leroy">V. Leroy</name><affiliation><nlm:aff id="aff2">Centre de Recherche INSERM U897 (ex-U593), Université Victor Segalen Bordeaux 2, 146 rue Léo Saignat, 33076, Bordeaux Cedex,<country>France</country>.</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">20616968</idno><idno type="pmc">2897983</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2897983</idno><idno type="RBID">PMC:2897983</idno><idno type="doi">10.2471/BLT.09.068015</idno><date when="2009">2009</date><idno type="wicri:Area/Pmc/Corpus">001636</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">001636</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Scaling up antiretroviral therapy for HIV-infected children in Côte d’Ivoire: determinants of survival and loss to programme</title><author><name sortKey="Anaky, M F" sort="Anaky, M F" uniqKey="Anaky M" first="M-F" last="Anaky">M-F Anaky</name><affiliation><nlm:aff id="aff1">Aconda-VS-CI, Abidjan,<country>Côte d’Ivoire</country>.</nlm:aff></affiliation></author><author><name sortKey="Duvignac, J" sort="Duvignac, J" uniqKey="Duvignac J" first="J" last="Duvignac">J. Duvignac</name><affiliation><nlm:aff id="aff2">Centre de Recherche INSERM U897 (ex-U593), Université Victor Segalen Bordeaux 2, 146 rue Léo Saignat, 33076, Bordeaux Cedex,<country>France</country>.</nlm:aff></affiliation></author><author><name sortKey="Wemin, L" sort="Wemin, L" uniqKey="Wemin L" first="L" last="Wemin">L. Wemin</name><affiliation><nlm:aff id="aff1">Aconda-VS-CI, Abidjan,<country>Côte d’Ivoire</country>.</nlm:aff></affiliation></author><author><name sortKey="Kouakoussui, A" sort="Kouakoussui, A" uniqKey="Kouakoussui A" first="A" last="Kouakoussui">A. Kouakoussui</name><affiliation><nlm:aff id="aff1">Aconda-VS-CI, Abidjan,<country>Côte d’Ivoire</country>.</nlm:aff></affiliation></author><author><name sortKey="Karcher, S" sort="Karcher, S" uniqKey="Karcher S" first="S" last="Karcher">S. Karcher</name><affiliation><nlm:aff id="aff2">Centre de Recherche INSERM U897 (ex-U593), Université Victor Segalen Bordeaux 2, 146 rue Léo Saignat, 33076, Bordeaux Cedex,<country>France</country>.</nlm:aff></affiliation></author><author><name sortKey="Toure, S" sort="Toure, S" uniqKey="Toure S" first="S" last="Touré">S. Touré</name><affiliation><nlm:aff id="aff1">Aconda-VS-CI, Abidjan,<country>Côte d’Ivoire</country>.</nlm:aff></affiliation></author><author><name sortKey="Seyler, C" sort="Seyler, C" uniqKey="Seyler C" first="C" last="Seyler">C. Seyler</name><affiliation><nlm:aff id="aff3">Institut de Santé Publique, Epidémiologie et Développement, Université Victor Segalen, Bordeaux,<country>France</country>.</nlm:aff></affiliation></author><author><name sortKey="Fassinou, P" sort="Fassinou, P" uniqKey="Fassinou P" first="P" last="Fassinou">P. Fassinou</name><affiliation><nlm:aff id="aff4">Elizabeth Glaser Pediatric AIDS Foundation, Abidjan,<country>Côte d’Ivoire</country>.</nlm:aff></affiliation></author><author><name sortKey="Dabis, F" sort="Dabis, F" uniqKey="Dabis F" first="F" last="Dabis">F. Dabis</name><affiliation><nlm:aff id="aff2">Centre de Recherche INSERM U897 (ex-U593), Université Victor Segalen Bordeaux 2, 146 rue Léo Saignat, 33076, Bordeaux Cedex,<country>France</country>.</nlm:aff></affiliation></author><author><name sortKey="N Ri Yoman, T" sort="N Ri Yoman, T" uniqKey="N Ri Yoman T" first="T" last="N Ri-Yoman">T. N Ri-Yoman</name><affiliation><nlm:aff id="aff1">Aconda-VS-CI, Abidjan,<country>Côte d’Ivoire</country>.</nlm:aff></affiliation></author><author><name sortKey="Anglaret, X" sort="Anglaret, X" uniqKey="Anglaret X" first="X" last="Anglaret">X. Anglaret</name><affiliation><nlm:aff id="aff2">Centre de Recherche INSERM U897 (ex-U593), Université Victor Segalen Bordeaux 2, 146 rue Léo Saignat, 33076, Bordeaux Cedex,<country>France</country>.</nlm:aff></affiliation></author><author><name sortKey="Leroy, V" sort="Leroy, V" uniqKey="Leroy V" first="V" last="Leroy">V. Leroy</name><affiliation><nlm:aff id="aff2">Centre de Recherche INSERM U897 (ex-U593), Université Victor Segalen Bordeaux 2, 146 rue Léo Saignat, 33076, Bordeaux Cedex,<country>France</country>.</nlm:aff></affiliation></author></analytic><series><title level="j">Bulletin of the World Health Organization</title><idno type="ISSN">0042-9686</idno><idno type="eISSN">1564-0604</idno><imprint><date when="2009">2009</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><title>Abstract</title><sec><title>Objective</title><p>To investigate deaths and losses to follow-up in a programme designed to scale up antiretroviral therapy (ART) for HIV-infected children in Côte d’Ivoire.</p></sec><sec><title>Methods</title><p>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.</p></sec><sec><title>Findings</title><p>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 weight-for-age <italic>z</italic>-score < –2, percentage of CD4+ T lymphocytes < 10, World Health Organization HIV/AIDS clinical stage 3 or 4, and blood haemoglobin < 8 g/dl.</p></sec><sec><title>Conclusion</title><p>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.</p></sec></div></front></TEI><pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Bull World Health Organ</journal-id><journal-id journal-id-type="publisher-id">BLT</journal-id><journal-title-group><journal-title>Bulletin of the World Health Organization</journal-title></journal-title-group><issn pub-type="ppub">0042-9686</issn><issn pub-type="epub">1564-0604</issn><publisher><publisher-name>World Health Organization</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">20616968</article-id><article-id pub-id-type="pmc">2897983</article-id><article-id pub-id-type="publisher-id">BLT.09.068015</article-id><article-id pub-id-type="doi">10.2471/BLT.09.068015</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research</subject></subj-group><subj-group subj-group-type="article-subtype"><subject>Non theme issue</subject></subj-group></article-categories><title-group><article-title>Scaling up antiretroviral therapy for HIV-infected children in Côte d’Ivoire: determinants of survival and loss to programme</article-title><trans-title-group xml:lang="ar"><trans-title>توسيع مجال المعالجة بمضادات الفيروسات للأطفال المصابين بفيروس العوز المناعي البشري في ساحل العاج: محددات البقاء على قيد الحياة والخسائر في البرنامج</trans-title></trans-title-group><trans-title-group xml:lang="fr"><trans-title>Élargissement du traitement antirétroviral pour les enfants infectés par le VIH en Côte d'Ivoire : déterminants de la survie et des pertes pour le programme </trans-title></trans-title-group><trans-title-group xml:lang="es"><trans-title>Expansión del tratamiento antirretroviral entre niños infectados por el VIH en Côte d'Ivoire: determinantes de la supervivencia y de las pérdidas de seguimiento </trans-title></trans-title-group><alt-title alt-title-type="author-running-head">M-F Anaky et al.</alt-title><alt-title alt-title-type="title-running-head">Paediatric antiretroviral therapy in Côte d’Ivoire</alt-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Anaky</surname><given-names>M-F</given-names></name><xref ref-type="aff" rid="aff1"><sup>a</sup></xref></contrib><contrib contrib-type="author"><name><surname>Duvignac</surname><given-names>J</given-names></name><xref ref-type="aff" rid="aff2"><sup>b</sup></xref></contrib><contrib contrib-type="author"><name><surname>Wemin</surname><given-names>L</given-names></name><xref ref-type="aff" rid="aff1"><sup>a</sup></xref></contrib><contrib contrib-type="author"><name><surname>Kouakoussui</surname><given-names>A</given-names></name><xref ref-type="aff" rid="aff1"><sup>a</sup></xref></contrib><contrib contrib-type="author"><name><surname>Karcher</surname><given-names>S</given-names></name><xref ref-type="aff" rid="aff2"><sup>b</sup></xref></contrib><contrib contrib-type="author"><name><surname>Touré</surname><given-names>S</given-names></name><xref ref-type="aff" rid="aff1"><sup>a</sup></xref></contrib><contrib contrib-type="author"><name><surname>Seyler</surname><given-names>C</given-names></name><xref ref-type="aff" rid="aff3"><sup>c</sup></xref></contrib><contrib contrib-type="author"><name><surname>Fassinou</surname><given-names>P</given-names></name><xref ref-type="aff" rid="aff4"><sup>d</sup></xref></contrib><contrib contrib-type="author"><name><surname>Dabis</surname><given-names>F</given-names></name><xref ref-type="aff" rid="aff2"><sup>b</sup></xref></contrib><contrib contrib-type="author"><name><surname>N’Dri-Yoman</surname><given-names>T</given-names></name><xref ref-type="aff" rid="aff1"><sup>a</sup></xref></contrib><contrib contrib-type="author"><name><surname>Anglaret</surname><given-names>X</given-names></name><xref ref-type="aff" rid="aff2"><sup>b</sup></xref></contrib><contrib contrib-type="author" corresp="yes"><name><surname>Leroy</surname><given-names>V</given-names></name><xref ref-type="aff" rid="aff2"><sup>b</sup></xref></contrib><aff id="aff1"><label>a</label>Aconda-VS-CI, Abidjan,<country>Côte d’Ivoire</country>.</aff><aff id="aff2"><label>b</label>Centre de Recherche INSERM U897 (ex-U593), Université Victor Segalen Bordeaux 2, 146 rue Léo Saignat, 33076, Bordeaux Cedex,<country>France</country>.</aff><aff id="aff3"><label>c</label>Institut de Santé Publique, Epidémiologie et Développement, Université Victor Segalen, Bordeaux,<country>France</country>.</aff><aff id="aff4"><label>d</label>Elizabeth Glaser Pediatric AIDS Foundation, Abidjan,<country>Côte d’Ivoire</country>.</aff></contrib-group><author-notes><corresp id="cor1">Correspondence to Valériane Leroy (e-mail: <email xlink:href="valeriane.leroy@isped.u-bordeaux2.fr">valeriane.leroy@isped.u-bordeaux2.fr</email>).</corresp></author-notes><pub-date pub-type="ppub"><day>01</day><month>7</month><year>2010</year></pub-date><pub-date pub-type="epub"><day>21</day><month>12</month><year>2009</year></pub-date><volume>88</volume><issue>7</issue><fpage>490</fpage><lpage>499</lpage><history><date date-type="received"><day>30</day><month>5</month><year>2009</year></date><date date-type="rev-recd"><day>19</day><month>8</month><year>2009</year></date><date date-type="accepted"><day>02</day><month>11</month><year>2009</year></date></history><permissions><copyright-statement>(c) World Health Organization (WHO) 2010. All rights reserved.</copyright-statement><copyright-year>2010</copyright-year></permissions><abstract><title>Abstract</title><sec><title>Objective</title><p>To investigate deaths and losses to follow-up in a programme designed to scale up antiretroviral therapy (ART) for HIV-infected children in Côte d’Ivoire.</p></sec><sec><title>Methods</title><p>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.</p></sec><sec><title>Findings</title><p>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 weight-for-age <italic>z</italic>-score < –2, percentage of CD4+ T lymphocytes < 10, World Health Organization HIV/AIDS clinical stage 3 or 4, and blood haemoglobin < 8 g/dl.</p></sec><sec><title>Conclusion</title><p>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.</p></sec></abstract><trans-abstract xml:lang="ar"><title>مخلص</title><sec><title>الغرض</title><p>تقصي الوفيات والخسائر التالية لبرنامج معد بغرض تعميم المعالجة بمضادات الفيروسات للأطفال المصابين بفيروس الإيدز في ساحل العاج.</p></sec><sec><title>الطريقة</title><p>خلال الفترة من 2004 حتى 2007، قُدِمَ مجانياً للأطفال المعرضين لفيروس الإيدز في 19 مركزاً اختبارات مصلية للفيروس (اختبارات تفاعل البوليميراز السلسلي لمن هم أقل من عمر 18 شهراً) وعلاجٌ بمضادات الفيروسات القهقرية. واستخدم الرصد المحوسب لتحديد: (ا) عدد العداوى المؤكدة بالفيروس، (ب) خسائر البرنامج (مثل الوفيات أو فقدان المتابعة في البرنامج) قبل المعالجة بمضادات الفيروسات القهقرية، (ج) معدلات الوفيات وخسائر البرنامج خلال 12 شهراً من المعالجة بمضادات الفيروسات القهقرية، (د) محددات الوفيات والخسائر في البرنامج.</p></sec><sec><title>الموجودات</title><p>اشتمل التحليل على 3876 طفلاً لم يعالجوا من قبل بمضادات الفيروسات القهقرية. ومن بين 1766 طفلاً تبين إصابتهم بعدوى فيروس العوز المناعي البشري من النمط -1 (17% منهم أقل من عمر 18 شهراً)، توفي 124 طفلاً (7.0%)، وترك 52 طفلاً البرنامج (2.9%)، وفُقِدَ 354 (20%) طفلاً من المتابعة قبل بدء المعالجة بمضادات الفيروسات القهقرية، وظل 259 طفلاً (15%) يخضعون للرعاية بدون معالجة بمضادات الفيروسات القهقرية، وبدأ 977 طفلاً (55%) المعالجة بمضادات الفيروسات القهقرية (وسيط العمر: 63 شهراً). وكان إجمالي معدل الوفيات أثناء المعالجة بمضادات الفيروسات القهقرية أعلى بدرجة يُعتَد بها خلال الشهور الثلاثة الأولى مقارنة بالشهور من 4 حتى 12 شهراً من المعالجة: حيث كان المعدلان بالترتيب 32.8 و 6.9 لكل 100 طفل بالنسبة لسنوات المتابعة. وبلغت معدلات خسائر متابعة البرنامج ضعف معدلات الوفيات تقريباً، واتبعت نفس النزعة بالنسبة لمدة المعالجة بمضادات الفيروسات القهقرية. والمونبئات المستقلة للوفيات طوال 12شهراً من المعالجة بمضادات الفيروسات القهقرية كانت هي الوزن مقابل العمر قبل بدء المعالجة بمضادات الفيروسات القهقرية للحرز z أقل من 2 -، ونسبة خلايا الليمفاويات التائية CD4+ أقل من 10، والمرحلتان الإكلينيكيتان 3 أو 4 للإيدز والعدوى بفيروسه بحسب تصنيف منظمة الصحة العالمية، وهيموغلوبين الدم أقل من 8 غرام لكل ديسيلتر.</p></sec><sec><title>الاستنتاج</title><p>كان البرنامج الموسع لتعميم معالجة الأطفال بمضادات الفيروسات القهقرية في ساحل العاج فعالاً. إلا أن المعالجة بمضادات الفيروسات القهقرية غالباً ما كانت تُعطى متأخرة جداً، وكانت الوفيات والخسائر المبكرة في البرنامج قبل بدء المعالجة بمضادات الفيروسات القهقرية أو فور بدئها هي المشاكل الكبرى.</p></sec></trans-abstract><trans-abstract xml:lang="fr"><title>Résumé</title><sec><title>Objectif</title><p>Étudier la mortalité et le nombre de perdus de vue dans le cadre d'un programme conçu pour étendre le traitement antirétroviral (ART) des enfants infectés par le VIH en Côte d'Ivoire. </p></sec><sec><title>Méthodes</title><p>Entre 2004 et 2007, on a proposé gratuitement, dans 19 centres, à l'intention des enfants exposés au VIH, un dépistage sérologique de ce virus (un test d'amplification génique pour les moins de 18 mois) et un traitement ART. On a fait appel à un suivi informatisé pour déterminer : (i) le nombre d'infections à VIH confirmées, (ii) les pertes pour le programme (c'est-à-dire les morts et les perdus de vue) avant l'administration du traitement ART, (iii) la mortalité et les taux de perte pour le programme au cours des 12 mois de traitement ART, et (iv) les déterminants de la mortalité et des pertes pour le programme. </p></sec><sec><title>Résultats</title><p>L'analyse a porté sur 3876 enfants encore jamais traités par des antirétroviraux. Parmi les 1766 enfants atteints d'une infection à VIH-1 (dont 17 % de moins de 18 mois), 124 (7,0 %) sont décédés, 52 (2,9 %) ont quitté le programme, 354 (20 %) ont été perdus de vue avant la mise en route du traitement ART, 259 (15 %) ont continué de recevoir des soins sans prendre d'ARV et 977 (55 %) ont débuté un traitement ART (âge médian : 63 mois). Le taux de mortalité global au cours du traitement était significativement plus élevé pendant les 3 premiers mois qu'au cours des mois 4 à 12, soit 32,8 et 6,9 décès pour 100 enfants-années de suivi, respectivement. Les taux de perte pour le programme atteignaient approximativement le double des taux de mortalité et suivaient les mêmes tendances avec la durée du traitement. Les facteurs prédictifs indépendants de la mortalité à 12 mois sous ART étaient : rapport poids/âge avant le traitement en z-score < -2, pourcentage de lymphocytes T CD4+ < 10, stade clinique du VIH/sida selon l'Organisation mondiale de la Santé 3 ou 4 et taux d'hémoglobine < 8 g/dl. </p></sec><sec><title>Conclusion</title><p>Le programme à grande échelle pour étendre le traitement ART pédiatrique en Côte d'Ivoire s'est révélé efficace. Néanmoins, ce traitement était souvent administré trop tard. La mortalité précoce et les pertes pour le programme avant et juste après la mise en route du traitement constituaient des problèmes majeurs. </p></sec></trans-abstract><trans-abstract xml:lang="es"><title>Resumen</title><sec><title>Objetivo</title><p>Investigar las defunciones y las pérdidas de seguimiento en un programa concebido para extender masivamente el tratamiento antirretroviral (TAR) entre niños infectados por el VIH en Côte d'Ivoire.</p></sec><sec><title>Métodos</title><p>Entre 2004 y 2007, en 19 centros se ofreció a los niños expuestos al VIH pruebas gratuitas del VIH en suero (reacción en cadena de la polimerasa para menores de 18 meses) y TAR. Se instauró un sistema de vigilancia computadorizada para determinar: (i) el número de infecciones confirmadas por el VIH, (ii) las bajas del programa (es decir, las defunciones o las pérdidas de seguimiento) antes del TAR, (iii) las tasas de mortalidad y de pérdida de seguimiento durante 12 meses de TAR, y (iv) los determinantes de la mortalidad y las pérdidas de seguimiento.</p></sec><sec><title>Resultados</title><p>El análisis abarcó a 3876 niños no sometidos anteriormente a TAR. De los 1766 con infección por VIH-1 (17% menores de 18 meses), 124 (7,0%) murieron, 52 (2,9%) abandonaron el programa, 354 (20%) se perdieron durante el seguimiento antes del TAR, 259 (15 %) siguieron atendidos sin TAR, y 977 (55%) comenzaron el TAR (mediana de la edad: 63 meses). La tasa de mortalidad global durante el TAR fue significativamente mayor en los tres primeros meses que en los meses 4 a 12: 32,8 y 6,9 por 100 niños-año de seguimiento, respectivamente. Las tasas de pérdida de seguimiento fueron aproximadamente el doble de las tasas de mortalidad y siguieron la misma tendencia con la duración de la TAR. Los factores predictivos independientes de la mortalidad a 12 meses entre los sometidos a TAR fueron un valor < –2 del estadístico <italic>Z</italic> del peso para la edad antes del TAR, un porcentaje de linfocitos T CD4+ < 10, la fase clínica 3 o 4 del VIH/sida según definición de la OMS, y una hemoglobinemia < 8 g/dl.</p></sec><sec><title>Conclusión</title><p>El programa a gran escala implantado para extender masivamente el TAR pediátrico en Côte d'Ivoire fue eficaz. Sin embargo, dicha terapia se instauró a menudo demasiado tarde, y los principales problemas fueron la mortalidad temprana y las pérdidas de seguimiento antes e inmediatamente después del inicio del TAR.</p></sec></trans-abstract></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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