Pediatric HIV care and treatment services in Tanzania: implications for survival
Abstract Background Improving child survival for HIV-infected children remains an important health agenda. We present progress regarding care and treatment services to HIV infected children in Tanzania. Methods The National AIDS Control Programme Care and Treatment (CTC 2) database was used to obtai...
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| Format: | Article |
| Language: | English |
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BMC
2017-08-01
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| Series: | BMC Health Services Research |
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| Online Access: | http://link.springer.com/article/10.1186/s12913-017-2492-9 |
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| author | G Somi M Majigo J Manyahi J Nondi J Agricola V Sambu J Todd A Rwebembera N Makyao A Ramadhani MIN Matee |
| author_facet | G Somi M Majigo J Manyahi J Nondi J Agricola V Sambu J Todd A Rwebembera N Makyao A Ramadhani MIN Matee |
| author_sort | G Somi |
| collection | DOAJ |
| description | Abstract Background Improving child survival for HIV-infected children remains an important health agenda. We present progress regarding care and treatment services to HIV infected children in Tanzania. Methods The National AIDS Control Programme Care and Treatment (CTC 2) database was used to obtain information of all children aged 0-14yearsenrolled in the HIV Care and Treatment Program between January 2011 and December 2014. We assessed eligibility for ART, time from enrolment to ART initiation, nutritional status, and mortality using Kaplan-Meier methods. Results A total of 29,531 (14,304 boys and 15,227 girls) ART-naive children aged 0–14 years were enrolled during the period, approximately 6700 to 8000 children per year. The male to female ratio was 48:50. At enrolment 72% were eligible for ART, 2–3% of children were positive for TB, and 2–4% were severely malnourished. Between 2011 and 2014, 2368 (8%) died, 9243 (31%) were Lost to Follow-up and 17,920 (61%) were on care or ART. The probability of death was 31% (95% CI 26–35), 43% (40–47), 52% (49–55) and 61% (58–64) by 1,2, 5 and 10 years of age, respectively. The hazard of death was greatest at very young ages (<2 years old), and decreased sharply by 4 years old. Children who were on ART had around 10–15% higher survival over time. Conclusions Significant progress has been made regarding provision of paediatric HIV care and treatment in Tanzania. On average 7000 children are enrolled annually, and that approximately two thirds of children diagnosed under the age of 2 years were initiated on ART within a month. Provision of ART as soon as the child is diagnosed is the biggest factor in improving survival. However we noted that i) most children had advanced disease at the time of enrolment ii) approximately two-thirds of children were missing a baseline CD4 measurement and only 35% of children had either a CD4 count or percentage recorded, indicating limited access to CD4 testing services, and iii) 31% were lost to follow-up (LTFU). These challenges need to be addressed to improve early detection, enrolment and retention of HIV-infected children into care and improve documentation of services offered. |
| first_indexed | 2024-12-12T17:53:08Z |
| format | Article |
| id | doaj.art-728970c43da04a9f91d0a2c4f815c2be |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-12-12T17:53:08Z |
| publishDate | 2017-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-728970c43da04a9f91d0a2c4f815c2be2022-12-22T00:16:47ZengBMCBMC Health Services Research1472-69632017-08-011711810.1186/s12913-017-2492-9Pediatric HIV care and treatment services in Tanzania: implications for survivalG Somi0M Majigo1J Manyahi2J Nondi3J Agricola4V Sambu5J Todd6A Rwebembera7N Makyao8A Ramadhani9MIN Matee10National AIDS Control Programme, Ministry of Health, Community Development, Gender, Elderly and ChildrenDepartment of Microbiology and Immunology, School of Medicine, Muhimbili University of Health and Allied SciencesDepartment of Microbiology and Immunology, School of Medicine, Muhimbili University of Health and Allied SciencesNational AIDS Control Programme, Ministry of Health, Community Development, Gender, Elderly and ChildrenDepartment of Microbiology and Immunology, School of Medicine, Muhimbili University of Health and Allied SciencesNational AIDS Control Programme, Ministry of Health, Community Development, Gender, Elderly and ChildrenLondon School of Hygiene and Tropical Medicine and National Institute for Medical Research (NIMR)National AIDS Control Programme, Ministry of Health, Community Development, Gender, Elderly and ChildrenNational AIDS Control Programme, Ministry of Health, Community Development, Gender, Elderly and ChildrenNational AIDS Control Programme, Ministry of Health, Community Development, Gender, Elderly and ChildrenDepartment of Microbiology and Immunology, School of Medicine, Muhimbili University of Health and Allied SciencesAbstract Background Improving child survival for HIV-infected children remains an important health agenda. We present progress regarding care and treatment services to HIV infected children in Tanzania. Methods The National AIDS Control Programme Care and Treatment (CTC 2) database was used to obtain information of all children aged 0-14yearsenrolled in the HIV Care and Treatment Program between January 2011 and December 2014. We assessed eligibility for ART, time from enrolment to ART initiation, nutritional status, and mortality using Kaplan-Meier methods. Results A total of 29,531 (14,304 boys and 15,227 girls) ART-naive children aged 0–14 years were enrolled during the period, approximately 6700 to 8000 children per year. The male to female ratio was 48:50. At enrolment 72% were eligible for ART, 2–3% of children were positive for TB, and 2–4% were severely malnourished. Between 2011 and 2014, 2368 (8%) died, 9243 (31%) were Lost to Follow-up and 17,920 (61%) were on care or ART. The probability of death was 31% (95% CI 26–35), 43% (40–47), 52% (49–55) and 61% (58–64) by 1,2, 5 and 10 years of age, respectively. The hazard of death was greatest at very young ages (<2 years old), and decreased sharply by 4 years old. Children who were on ART had around 10–15% higher survival over time. Conclusions Significant progress has been made regarding provision of paediatric HIV care and treatment in Tanzania. On average 7000 children are enrolled annually, and that approximately two thirds of children diagnosed under the age of 2 years were initiated on ART within a month. Provision of ART as soon as the child is diagnosed is the biggest factor in improving survival. However we noted that i) most children had advanced disease at the time of enrolment ii) approximately two-thirds of children were missing a baseline CD4 measurement and only 35% of children had either a CD4 count or percentage recorded, indicating limited access to CD4 testing services, and iii) 31% were lost to follow-up (LTFU). These challenges need to be addressed to improve early detection, enrolment and retention of HIV-infected children into care and improve documentation of services offered.http://link.springer.com/article/10.1186/s12913-017-2492-9ChildrenHIVEnrolmentARTCareMortality |
| spellingShingle | G Somi M Majigo J Manyahi J Nondi J Agricola V Sambu J Todd A Rwebembera N Makyao A Ramadhani MIN Matee Pediatric HIV care and treatment services in Tanzania: implications for survival BMC Health Services Research Children HIV Enrolment ART Care Mortality |
| title | Pediatric HIV care and treatment services in Tanzania: implications for survival |
| title_full | Pediatric HIV care and treatment services in Tanzania: implications for survival |
| title_fullStr | Pediatric HIV care and treatment services in Tanzania: implications for survival |
| title_full_unstemmed | Pediatric HIV care and treatment services in Tanzania: implications for survival |
| title_short | Pediatric HIV care and treatment services in Tanzania: implications for survival |
| title_sort | pediatric hiv care and treatment services in tanzania implications for survival |
| topic | Children HIV Enrolment ART Care Mortality |
| url | http://link.springer.com/article/10.1186/s12913-017-2492-9 |
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