Differences in presentation, treatment initiation, and response among children infected with human immunodeficiency virus in urban and rural Zambia.
Pediatr Infect Dis J
; 29(9): 849-54, 2010 Sep.
Article
en En
| MEDLINE
| ID: mdl-20526227
ABSTRACT
BACKGROUND:
Access to pediatric antiretroviral therapy (ART) in rural areas remains limited due to the unique challenges faced by providers and patients. Few rural ART programs have been evaluated to determine whether these challenges affect care and treatment response.METHODS:
Routinely collected data from 3 pediatric ART programs in rural and urban Zambia were obtained from medical records. Participants included human immunodeficiency virus-infected children <15 years of age presenting for care between August 2004 and July 2008. Characteristics at presentation, time to ART initiation, and treatment response were compared between urban and rural children.RESULTS:
A total of 863 children were enrolled (562 urban and 301 rural). At presentation, children in rural clinics were significantly younger (3.4 vs. 6.5 years), had higher CD4 T-cell percentages (18.0% vs. 12.8%), less advanced disease (47.5% vs. 62.3% in World Health Organization stage 3/4), lower weight-for-age Z-scores (-2.8 vs. -2.3), and traveled greater distances (29 vs. 2 km). Rural children eligible for ART at presentation took longer to initiate treatment (3.6 vs. 0.9 months); no differences were found in time to ART initiation among children ineligible at presentation (15.4 vs. 12.1 months). For the 607 children initiating ART, clinical and immunologic status improved in both urban and rural clinics. Mortality was highest in the first 90 days of treatment and was higher at all times in rural clinics.CONCLUSIONS:
The findings support expansion of ART programs into rural areas to increase access to treatment services and reduce inequities.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Contexto en salud:
10_ODS3_salud_sexual_reprodutiva
/
2_ODS3
/
4_TD
/
7_ODS3_muertes_prevenibles_nacidos_ninos
Problema de salud:
10_sexually_transmitted_infections
/
2_cobertura_universal
/
2_enfermedades_transmissibles
/
2_muertes_prevenibles
/
4_aids
/
7_infections
Asunto principal:
Infecciones por VIH
/
Fármacos Anti-VIH
/
Terapia Antirretroviral Altamente Activa
Límite:
Child
/
Child, preschool
/
Female
/
Humans
/
Infant
/
Male
/
Newborn
País/Región como asunto:
Africa
Idioma:
En
Revista:
Pediatr Infect Dis J
Asunto de la revista:
DOENCAS TRANSMISSIVEIS
/
PEDIATRIA
Año:
2010
Tipo del documento:
Article
País de afiliación:
Estados Unidos