Scaling up pediatric HIV care and treatment in Africa: Clinical site characteristics associated with favorable service utilization

Georgette Adjorlolo-Johnson, Andrea Wahl Uheling, Shobana Ramachandran, Susan Strasser, Joseph Kouakou, Denis Tindyebwa, Cathrien Alons, Tshiwela Neluheni, Stephen Lee, Richard Marlink

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background: To improve pediatric enrollment and retention in HIV treatment programs in Africa, we examined factors associated with service utilization within the Elizabeth Glaser Pediatric AIDS Foundation program in Côte d'Ivoire, Mozambique, South Africa, Tanzania and Zambia. Methods: We retrospectively reviewed characteristics of clinical sites providing HIV treatment services within our program. For each site, favorable pediatric program outcomes were defined as a cumulative number or percentage of pediatric enrollment in care or antiretroviral therapy (ART) more than the pooled median value or an attrition rate less than 10%. We compared proportions of sites with favorable outcomes among those with or without selected characteristics. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were determined using logistic regression analyses, accounting for potential confounding factors. Results: Over 4 years, 33,331 children were enrolled, including 18,255 on ART, across 220 sites. Characteristics associated with favorable pediatric enrollment were nutritional support (aOR = 8.9; CI: 2.8 to 28.4), linkages with associations of people living with HIV (aOR = 4.2; CI: 1.8 to 9.5), early infant diagnosis (aOR = 3.3; CI: 1.5 to 7.1), and on-site prevention of mother-to-child transmission services (aOR = 3.1; CI: 1.0 to 11.1). Similarly, linkages with people living with HIV, early infant diagnosis, and prevention of mother-to-child transmission were associated with high proportion of children on ART younger than 2 years of age. Home-based care was associated with low pediatric attrition rates (aOR = 2.9; CI: 1.4 to 5.8). Conclusions: Certain site characteristics were associated with favorable pediatric enrollment and retention in our program. Expanding these characteristics to improve pediatric HIV treatment in Africa warrants further evaluation.

Original languageEnglish (US)
JournalJournal of Acquired Immune Deficiency Syndromes
Volume62
Issue number1
DOIs
StatePublished - Jan 1 2013
Externally publishedYes

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HIV
Pediatrics
Confidence Intervals
Therapeutics
Early Diagnosis
Mothers
Mozambique
Zambia
Tanzania
Nutritional Support
Home Care Services
South Africa
Acquired Immunodeficiency Syndrome
Logistic Models
Odds Ratio
Regression Analysis

All Science Journal Classification (ASJC) codes

  • Infectious Diseases
  • Pharmacology (medical)

Cite this

Adjorlolo-Johnson, Georgette ; Wahl Uheling, Andrea ; Ramachandran, Shobana ; Strasser, Susan ; Kouakou, Joseph ; Tindyebwa, Denis ; Alons, Cathrien ; Neluheni, Tshiwela ; Lee, Stephen ; Marlink, Richard. / Scaling up pediatric HIV care and treatment in Africa : Clinical site characteristics associated with favorable service utilization. In: Journal of Acquired Immune Deficiency Syndromes. 2013 ; Vol. 62, No. 1.
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Scaling up pediatric HIV care and treatment in Africa : Clinical site characteristics associated with favorable service utilization. / Adjorlolo-Johnson, Georgette; Wahl Uheling, Andrea; Ramachandran, Shobana; Strasser, Susan; Kouakou, Joseph; Tindyebwa, Denis; Alons, Cathrien; Neluheni, Tshiwela; Lee, Stephen; Marlink, Richard.

In: Journal of Acquired Immune Deficiency Syndromes, Vol. 62, No. 1, 01.01.2013.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Scaling up pediatric HIV care and treatment in Africa

T2 - Clinical site characteristics associated with favorable service utilization

AU - Adjorlolo-Johnson, Georgette

AU - Wahl Uheling, Andrea

AU - Ramachandran, Shobana

AU - Strasser, Susan

AU - Kouakou, Joseph

AU - Tindyebwa, Denis

AU - Alons, Cathrien

AU - Neluheni, Tshiwela

AU - Lee, Stephen

AU - Marlink, Richard

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N2 - Background: To improve pediatric enrollment and retention in HIV treatment programs in Africa, we examined factors associated with service utilization within the Elizabeth Glaser Pediatric AIDS Foundation program in Côte d'Ivoire, Mozambique, South Africa, Tanzania and Zambia. Methods: We retrospectively reviewed characteristics of clinical sites providing HIV treatment services within our program. For each site, favorable pediatric program outcomes were defined as a cumulative number or percentage of pediatric enrollment in care or antiretroviral therapy (ART) more than the pooled median value or an attrition rate less than 10%. We compared proportions of sites with favorable outcomes among those with or without selected characteristics. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were determined using logistic regression analyses, accounting for potential confounding factors. Results: Over 4 years, 33,331 children were enrolled, including 18,255 on ART, across 220 sites. Characteristics associated with favorable pediatric enrollment were nutritional support (aOR = 8.9; CI: 2.8 to 28.4), linkages with associations of people living with HIV (aOR = 4.2; CI: 1.8 to 9.5), early infant diagnosis (aOR = 3.3; CI: 1.5 to 7.1), and on-site prevention of mother-to-child transmission services (aOR = 3.1; CI: 1.0 to 11.1). Similarly, linkages with people living with HIV, early infant diagnosis, and prevention of mother-to-child transmission were associated with high proportion of children on ART younger than 2 years of age. Home-based care was associated with low pediatric attrition rates (aOR = 2.9; CI: 1.4 to 5.8). Conclusions: Certain site characteristics were associated with favorable pediatric enrollment and retention in our program. Expanding these characteristics to improve pediatric HIV treatment in Africa warrants further evaluation.

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