Successful paediatric HIV treatment in rural primary care in Africa
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作者:
Janssen, N.
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Univ KwaZulu Natal, Africa Ctr Hlth & Populat Studies, ZA-3935 Mtubatuba, KwaZulu Natal, South AfricaUniv KwaZulu Natal, Africa Ctr Hlth & Populat Studies, ZA-3935 Mtubatuba, KwaZulu Natal, South Africa
Janssen, N.
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Ndirangu, J.
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Newell, M-L
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Univ KwaZulu Natal, Africa Ctr Hlth & Populat Studies, ZA-3935 Mtubatuba, KwaZulu Natal, South Africa
UCL, Inst Child Hlth, Ctr Paediat Epidemiol & Biostat, London, EnglandUniv KwaZulu Natal, Africa Ctr Hlth & Populat Studies, ZA-3935 Mtubatuba, KwaZulu Natal, South Africa
Newell, M-L
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Bland, R. M.
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Univ KwaZulu Natal, Africa Ctr Hlth & Populat Studies, ZA-3935 Mtubatuba, KwaZulu Natal, South Africa
Univ Glasgow, Fac Med, Div Dev Med, Glasgow, Lanark, ScotlandUniv KwaZulu Natal, Africa Ctr Hlth & Populat Studies, ZA-3935 Mtubatuba, KwaZulu Natal, South Africa
Bland, R. M.
[1
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机构:
[1] Univ KwaZulu Natal, Africa Ctr Hlth & Populat Studies, ZA-3935 Mtubatuba, KwaZulu Natal, South Africa
Objective Clinical outcomes of HIV-infected children on antiretroviral treatment (ART) in a decentralised, nurse/counsellor-led programme. Design Clinical cohort. Setting KwaZulu-Natal, South Africa. Patients HIV-infected children aged <= 15 years on ART, June 2004-2008. Main outcome measures Survival according to baseline characteristics including age, WHO clinical stage, haemoglobin and CD4%, was assessed in Kaplan-Meier analyses. Hazard ratios for mortality were estimated using Cox proportional hazards regression and changes in laboratory parameters and weight-for-age z scores after 6-12 months' treatment were calculated. Results 477 HIV-infected children began ART at a median age of 74 months (range 4-180), median CD4 count (CD4%) of 433 cells/mm(3) (17%) and median HIV viral load of log 4.2 copies/ml; 105 (22%) were on treatment for tuberculosis and 317 (76.6%) were WHO stage 3/4. There were significant increases after ART initiation in CD4% (17% vs 22%; p<0.001), haemoglobin (9.9 vs 11.7 g/l; p <= 0.001) and albumin (30 vs 36 g/l; p <= 0.001). 32 (6.7%) children died over 732 child-years of follow-up (43.7 deaths/1000 child-years; 95% CI 32.7 to 58.2), 17 (53.1%) within 90 days of treatment initiation; median age of death was 84 (IQR 10-181) months. Children with baseline haemoglobin <= 8 g/l were more likely to die (adjusted HR 4.5; 95% CI 1.6 to 12.3), as were those aged <18 months compared with >60 months (adjusted HR 3.2; 95% CI 1.2 to 9.1). Conclusions Good clinical outcomes in HIV-infected children on ART are possible in a rural, decentralised service. Few young children are on ART, highlighting the urgent need to identify HIV-exposed infants.
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Univ KwaZulu Natal, Africa Ctr Hlth & Populat Studies, Somkhele, KwaZulu Natal, South Africa
Harvard Univ, Sch Publ Hlth, Dept Global Hlth & Populat, Boston, MA 02115 USAINSERM, Ctr Inserm Epidemiol & Biostat, U897, Bordeaux, France
Barnighausen, Till
Dray-Spira, Rosemary
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INSERM, Team Res Social Epidemiol, Pierre Louis Inst Epidemiol & Publ Hlth, UMR S 1136, F-75013 Paris, France
Univ Paris 06, Pierre Louis Inst Epidemiol & Publ Hlth, Sorbonne Univ, Team Res Social Epidemiol,UMR S 1136, F-75013 Paris, FranceINSERM, Ctr Inserm Epidemiol & Biostat, U897, Bordeaux, France
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Massachusetts Gen Hosp, Div Infect Dis, Boston, MA 02114 USAHarvard Univ, Ctr Populat & Dev Studies, Cambridge, MA 02138 USA
Manne-Goehler, Jennifer
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Gomez-Olive, Francesc Xavier
Wagner, Ryan G.
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Univ Witwatersrand, Wits Univ Rural Publ Hlth & Hlth Transit Res Unit, Sch Publ Hlth, Fac Hlth Sci,MRC, Johannesburg, South AfricaHarvard Univ, Ctr Populat & Dev Studies, Cambridge, MA 02138 USA
Wagner, Ryan G.
Rosenberg, Molly
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Indiana Univ, Sch Publ Hlth, Dept Epidemiol & Biostat, Bloomington, IN USAHarvard Univ, Ctr Populat & Dev Studies, Cambridge, MA 02138 USA
Rosenberg, Molly
Geldsetzer, Pascal
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Harvard Univ TH Chan Sch Publ Hlth, Dept Global Hlth & Populat, Boston, MA USAHarvard Univ, Ctr Populat & Dev Studies, Cambridge, MA 02138 USA
Geldsetzer, Pascal
Kabudula, Chodziwadziwa
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Univ Witwatersrand, Wits Univ Rural Publ Hlth & Hlth Transit Res Unit, Sch Publ Hlth, Fac Hlth Sci,MRC, Johannesburg, South AfricaHarvard Univ, Ctr Populat & Dev Studies, Cambridge, MA 02138 USA
Kabudula, Chodziwadziwa
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Kahn, Kathleen
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Tollman, Stephen
Baernighausen, Till
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Univ Witwatersrand, Wits Univ Rural Publ Hlth & Hlth Transit Res Unit, Sch Publ Hlth, Fac Hlth Sci,MRC, Johannesburg, South Africa
Heidelberg Univ, Heidelberg Inst Global Hlth, Heidelberg, Germany
Africa Hlth Res Inst, Mtubatuba, South AfricaHarvard Univ, Ctr Populat & Dev Studies, Cambridge, MA 02138 USA
Baernighausen, Till
Salomon, Joshua A.
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Stanford Univ, Dept Med, Stanford, CA 94305 USAHarvard Univ, Ctr Populat & Dev Studies, Cambridge, MA 02138 USA
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Univ KwaZulu Natal, Africa Ctr Hlth & Populat Studies, Somkhele, South Africa
UCL, Dept Infect & Populat Hlth, London, EnglandUniv KwaZulu Natal, Africa Ctr Hlth & Populat Studies, Somkhele, South Africa
Mutevedzi, Portia C.
Lessells, Richard J.
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Univ KwaZulu Natal, Africa Ctr Hlth & Populat Studies, Somkhele, South Africa
London Sch Hyg & Trop Med, Dept Clin Res, London WC1, EnglandUniv KwaZulu Natal, Africa Ctr Hlth & Populat Studies, Somkhele, South Africa
Lessells, Richard J.
Newell, Marie-Louise
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Univ KwaZulu Natal, Africa Ctr Hlth & Populat Studies, Somkhele, South Africa
UCL, Inst Child Hlth, London, EnglandUniv KwaZulu Natal, Africa Ctr Hlth & Populat Studies, Somkhele, South Africa