Penazzato M., Crowley S., Mofenson L., Franceschetto G., Nannyonga M.-M., Mazza A., Giaquinto C.
Department of Paediatrics, University of Padua, via Giustiniani 3, Padua, Italy; Clinical Trial Unit, Medical Research Council, London, United Kingdom; Health and Nutrition Unit, UNICEF South Africa, Pretoria, South Africa; Pediatric, Adolescent and Maternal AIDS (PAMA) Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health, Bethesda, MD, United States; Department of Pediatrics, University of Padua, Italy; Nsambya Home Care, St. Raphael of St. Francis Nsambya Hospital, Kampala, Uganda; Department of Paediatrics, Santa Chiara Hospital, Trento, Italy; Department of Paediatrics, University of Padua, Italy
Penazzato, M., Department of Paediatrics, University of Padua, via Giustiniani 3, Padua, Italy, Clinical Trial Unit, Medical Research Council, London, United Kingdom; Crowley, S., Health and Nutrition Unit, UNICEF South Africa, Pretoria, South Africa; Mofenson, L., Pediatric, Adolescent and Maternal AIDS (PAMA) Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health, Bethesda, MD, United States; Franceschetto, G., Department of Pediatrics, University of Padua, Italy; Nannyonga, M.-M., Nsambya Home Care, St. Raphael of St. Francis Nsambya Hospital, Kampala, Uganda; Mazza, A., Department of Paediatrics, Santa Chiara Hospital, Trento, Italy; Giaquinto, C., Department of Paediatrics, University of Padua, Italy
BACKGROUND: World Health Organization (WHO) recommendations for the initiation of antiretroviral therapy (ART) in children were revised in 2010, but the programmatic impact has had limited study. METHODS: We used a cohort of 985 Ugandan children followed since 2003 by the Tukula Fenna project to model the differential impact of the 2006, 2008, and 2010 WHO pediatric ART inititation criteria on the proportion of children eligible for ART at enrollment and over time. RESULTS: Using the WHO 2006, 2008, and 2010 ART criteria, 40%, 57%, and 66% of children, respectively, would have been eligible for ART at enrollment and 76%, 84%, and 88% 2 years later. Evaluating the entire cohort followed for 6 years using the 2006, 2008, and 2010 guidelines, the proportion in need of ART was found to be 70%, 82%, and 87%, respectively. Between 2006 and 2008, the proportions of eligible children starting ART within 6 and 12 months were 39% and 50%, respectively; after this, the proportions starting within 6 and 12 months were 50% and 52%. Before 2008, the most common criterion met in children who did not start ART was WHO clinical stage (odds ratio = 2.0, CI 95% = 1.2 to 3.2); after the 2008 recommendations, the most common eligibility criterion in children who did not start ART was age <12 months (odds ratio = 10.5, CI 95% = 3.8 to 31.1). CONCLUSIONS: An overall increase of 17% (from 70% to 87%) in children in need of ART was observed in our cohort comparing the 2006 and 2010 guidelines; this increase was primarily driven by the introduction of universal treatment for infants <12 months in 2008. Copyright © 2012 by Lippincott Williams & Wilkins.
antiretrovirus agent; cotrimoxazole; article; child; child care; cohort analysis; female; health care planning; human; Human immunodeficiency virus infection; major clinical study; male; organization and management; practice guideline; preschool child; priority journal; school child; treatment outcome; Uganda; world health organization; Anti-Retroviral Agents; Child; Child, Preschool; Cohort Studies; Developing Countries; Drug Utilization; Female; Follow-Up Studies; Guidelines as Topic; HIV Infections; Humans; Infant; Male; Uganda; World Health Organization
