Positive Parenting Styles Tied to Less Unmet Dental Needs in Children with Developmental Disabilities.

This study aimed to identify factors, particularly positive parenting styles, associated with unmet dental needs, defined as no dental visit for the past 12 months, in children with developmental disabilities (DD). Participants included 263 primary caregivers of children with DD. Children exposed to less positive parenting styles were more than two times (aOR, 2.19, 95%CI, 1.12-4.32) more likely to have unmet dental needs. Children who were male (aOR, 1.88, 95%CI, 1.04-3.41), aged < 4 years (aOR, 2.95, 95%CI, 1.2-7.27) or aged ≥ 11 years (aOR, 2.65, 95%CI, 1.25-5.64), had higher illness severity (aOR, 2.04, 95%CI, 1.09-3.81), had primary caregivers with less than or equal to high school education (aOR, 2.45, 95%CI, 1.13-5.30) were also more likely to have unmet dental needs.

Attrition and Mortality of Children Receiving Antiretroviral Treatment through the Universal Coverage Health Program in Thailand.

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.

First-Line Antiretroviral Treatment Outcomes and Durability in HIV-Infected Children Treated Through the Universal Coverage Health Program in Thailand.

BACKGROUND: We assessed the treatment outcomes on first-line antiretroviral therapy (ART), and factors associated with switching regimen in HIV-infected children treated through the universal coverage health program (UC) in Thailand. METHODS: Children aged <15 years at ART initiation who had been receiving ART for at least 6 months between 2008 and 2014 through UC were included in the analysis. The Kaplan-Meier method was used to estimate immunological recovery (IMR), immunological failure, and virological failure (VF). Cox models were used to assess predictors of IMR and VF. Competing risk models were used to assess factors associated with switching to a second-line regimen, with death considered as a competing risk. RESULTS: A total of 4120 children initiated ART at a median (interquartile range) age of 9.3 (5.8-12.0) years. The median duration of ART was 3.7 years with 17,950 person-years of follow-up. Two thousand eight hundred five children achieved IMR, and the probability of IMR increased to 76% by 3 years after ART initiation. Among 1054 children switched to second-line regimens, 84% had VF and 19% had immunological failure. The cumulative rate of switching regimen increased from 4% to 20% from 1 to 3 years after treatment. Children aged ≥12 years at ART initiation, starting with nonnucleoside reverse-transcriptase inhibitors, and baseline CD4% <10% had an increased risk of switching to second-line regimens. CONCLUSIONS: Children receiving ART through UC had good treatment outcomes, although a fifth required switching regimen by 3 years. Earlier treatment initiation and avoiding nonnucleoside reverse-transcriptase inhibitor first-line regimens in high-risk children may prevent treatment failure.

A qualitative assessment of barriers and facilitators to antiretroviral adherence in Thai patients.

OBJECTIVES: Excellent adherence to combination antiretroviral therapy can suppress HIV replication and produce life expectancies nearing those of individuals without HIV infection. This qualitative study sought to identify the barriers and facilitators to good antiretroviral medication adherence in Thai patients living with HIV. METHODS: Semi-structured interviews were conducted with a convenience sample (n=21) of patients attending routine clinic visits at Srinagarind Hospital in Khon Kaen, or HIV-NAT, the Thai Red Cross AIDS Research Centre in Bangkok. RESULTS: Median informant age was 43 years (range 27-60 years) and 43% were female. We identified key facilitators and barriers to adherence among HIV-infected Thai patients along three major themes (patient-related, health system-related and medication-related). Stigma was a primary concern for most informants, operating throughout Thai society to induce feelings of shame for Thai people living with HIV. Determination to stay healthy and incorporate taking cART into their daily routine were key components of good adherence. Supportive and trusting relationships, particularly with the clinic team, empowered patients to maintain good medication adherence. CONCLUSIONS: Changing public perceptions about HIV, and training of HIV clinic staff on the importance of trusting and supportive provider-patient relationships in promoting good health outcomes, will help Thailand achieve its aim of having zero new HIV infections, zero discrimination and zero AIDS-related deaths by 2030.

Nadir CD4 count and monthly income predict cervical squamous cell abnormalities in HIV-positive women in a resource-limited setting.

We conducted a cross-sectional study with 385 HIV-positive women in Bangkok to assess the prevalence and predictors of cervical abnormalities on Papanicolaou (Pap) smear. Low-grade squamous intraepithelial lesions (LSIL), high-grade SIL (HSIL) and invasive cervical cell cancer (ICC) were assessed by cytological examination after Pap smear and logistic regression models were used to assess associations with patient characteristics. Overall prevalence of LSIL, HSIL and ICC were 11.2% (95% confidence interval [CI] 8.2-14.7%), 4.7% (95%CI 2.8-7.3%) and 0.5% (95%CI 0.06-1.9%), respectively. In multivariate models, only the nadir CD4 count and income remained significantly associated with cytological abnormalities, whereas smoking, hormonal contraceptive or antiretroviral use, condom use, parity and number of lifetime sexual partners were not associated. The odds ratio for having cytological abnormalities was 2.6 (95% CI 1.24-5.34) in those with a nadir CD4 count <200 cells/mm3 compared with those with a higher nadir CD4 count, and 1.99 (1.11-3.57) in those with an income of <125 US dollars/month compared with those with higher incomes. In settings where access to affordable treatment is improving, this study reinforces the importance of regular Pap smear screening in HIV-positive women, particularly those with low nadir CD4 counts and lower incomes.