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Open Access Research article

12-month mortality and loss-to-program in antiretroviral-treated children: The IeDEA pediatric West African Database to evaluate AIDS (pWADA), 2000-2008

Didier K Ekouevi12*, Alain Azondekon3, Fatoumata Dicko4, Karen Malateste1, Pety Touré56, François T Eboua7, Kouakou Kouadio8, Lorna Renner9, Kevin Peterson10, François Dabis1, Haby Signaté Sy11, Valeriane Leroy1 and the IeDEA pediatric West Africa Working Group pWADA

Author Affiliations

1 INSERM, U897, & Institut de Santé Publique, Epidémiologie et Développement (ISPED), Université Victor Segalen Bordeaux 2, Bordeaux, France

2 Programme PAC-CI, CHU de Treichville, Abidjan, Côte d'Ivoire

3 Hôpital d'Instruction des Armées, Cotonou, Benin

4 Hôpital Gabriel Touré, Service de Pédiatrie Bamako, Mali

5 MTCT-Plus initiative, ACONDA, Abidjan, Côte d'Ivoire

6 CePReF, ACONDA, Abidjan Côte d'Ivoire

7 CHU de Yopougon, Service de Pédiatrie, Abidjan, Côte d'Ivoire

8 Centre Intégré de Recherche Bioclinique d'Abidjan (CIRBA), Abidjan, Côte d'Ivoire

9 Korlebu Hospital, Pediatric ward, Accra, Ghana

10 Medical Research Council, Fajara Cohort, Banjul, Gambia

11 Hôpital d'Enfants Albert-Royer, Dakar, Senegal

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BMC Public Health 2011, 11:519  doi:10.1186/1471-2458-11-519

Published: 30 June 2011

Abstract

Background

The IeDEA West Africa Pediatric Working Group (pWADA) was established in January 2007 to study the care and treatment of HIV-infected children in this region. We describe here the characteristics at antiretroviral treatment (ART) initiation and study the 12-month mortality and loss-to-program of HIV-infected children followed in ART programs in West Africa.

Methods

Standardized data from HIV-infected children followed-up in ART programs were included. Nine clinical centers from six countries contributed to the dataset (Benin, Côte d'Ivoire, Gambia, Ghana, Mali and Senegal). Inclusion criteria were the followings: age 0-15 years and initiated triple antiretroviral drug regimens. Baseline time was the date of ART initiation. WHO criteria was used to define severe immunosuppression based on CD4 count by age or CD4 percent < 15%. We estimated the 12-month Kaplan-Meier probabilities of mortality and loss-to-program (death or loss to follow-up > 6 months) after ART initiation and factors associated with these two outcomes.

Results

Between June 2000 and December 2007, 2170 children were included. Characteristics at ART initiation were the following: median age of 5 years (Interquartile range (IQR: 2-9) and median CD4 percentage of 13% (IQR: 7-19). The most frequent drug regimen consisted of two nucleoside reverse transcriptase inhibitors and one non-nucleoside reverse transcriptase inhibitors (62%). During the first 12 months, 169 (7.8%) children died and 461(21.2%) were lost-to-program. Overall, in HIV-infected children on ART, the 12-month probability of death was 8.3% (95% Confidence Interval (CI): 7.2-9.6%), and of loss-to-program was 23.1% (95% CI: 21.3-25.0%). Both mortality and loss-to program were associated with advanced clinical stage, CD4 percentage < 15% at ART initiation and year (> 2005) of ART initiation.

Conclusion

Innovative and sustainable approaches are needed to better document causes of death and increase retention in HIV pediatric clinics in West Africa.