Good Results for Primary Care HIV Treatment in Zambia

But early mortality rate remains high

WEDNESDAY, Oct. 24 (HealthDay News) -- In sub-Saharan Africa, pediatric antiretroviral therapy delivered in a primary health care setting by nurses and physician assistants can achieve good results, but earlier intervention is needed to reduce the high levels of mortality in the first 90 days of therapy, researchers report in the Oct. 24/31 issue of the Journal of the American Medical Association.

Carolyn Bolton-Moore, of the Centre for Infectious Disease Research in Zambia, and colleagues analyzed data on 4,975 children enrolled into HIV care in 18 government primary health care facilities in Lusaka, Zambia. Of these, 2,938 (59.1 percent) started antiretroviral therapy, including 2,087 who were in stage III or IV of infection.

When the data was analyzed, among the children who started antiretroviral therapy, 158 (5.4 percent) had withdrawn from treatment, and 382 (13 percent) were 30 days or more late for follow-up. Of those who continued on antiretroviral therapy, 198 (8.3 percent) died over 3,018 child-years of follow-up, with 112 deaths (56.6 percent) occurring within the first 90 days of onset of treatment.

"Care provided by clinicians such as nurses and clinical officers can result in good outcomes for HIV-infected children in primary health care settings in sub-Saharan Africa. Mortality during the first 90 days of therapy is high, pointing to a need for earlier intervention," the authors conclude.

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