Need for Timely Paediatric HIV Treatment within Primary Health Care in Rural South Africa 英文参考文献.docVIP

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Need for Timely Paediatric HIV Treatment within Primary Health Care in Rural South Africa 英文参考文献.doc

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Need for Timely Paediatric HIV Treatment within Primary Health Care in Rural South Africa 英文参考文献

NeedforTimelyPaediatricHIVTreatmentwithinPrimary HealthCareinRuralSouthAfrica GrahamS.Cooke1,2*,KirstyE.Little3,RuthM.Bland1,4,HilaryThulare1,Marie-LouiseNewell1,3 1Africa Centre for Health and Population Studies, University of KwaZulu-Natal, KwaZulu-Natal, South Africa, 2Imperial College London, London, United Kingdom, 3UniversityCollegeLondonInstituteofChildHealth,London,UnitedKingdom,4DivisionofDevelopmentalMedicine,UniversityofGlasgowMedicalFaculty,Glasgow, UnitedKingdom Abstract Background:InareaswhereadultHIVprevalencehasreachedhyperendemiclevels,manyinfantsremainatriskofacquiring HIV infection. Timely access to care and treatment for HIV-infected infants and young children remains an important challenge.Weexploretheextenttowhichpublicsectorroll-outhasmettheestimatedneedforpaediatrictreatmentina ruralSouthAfricansetting. Methods:Localfacilityandpopulation-baseddatawereusedtocomparethenumberofHIVinfectedchildrenaccessing HAARTbefore2008,withestimatesofthoseinneedoftreatmentfromadeterministicmodelingapproach.Theimpactof programmaticimprovementsonestimatednumbersofchildreninneedoftreatmentwasassessedinsensitivityanalyses. Findings:IntheprimaryhealthcareprogrammeofHIVtreatment346children,16yearsofageinitiatedHAARTby2008; 245(70.8%)wereaged10yearsoryounger,andonly2(,1%)underoneyearofage.Deterministicmodelingpredicted2,561 HIVinfectedchildrenaged10oryoungertobealivewithinthearea,ofwhomatleast521(20.3%)wouldhaverequired immediatetreatment.WereextendedPMTCTuptaketoreach100%coverage,theannualnumberofinfectedinfantscould bereducedby49.2%. Conclusion: Despite progress in delivering decentralized HIV services to a rural sub-district in South Africa, substantial unmetneedfortreatmentremains.Inalocalsetting,veryfewchildrenwereinitiatedontreatmentunder1yearofageand stepshavenowbeentakentosuccessfullyimproveearlydiagnosisandreferralofinfectedinfants. Citation: Cooke GS, Little KE, Bland RM, Thulare H, Newell M-L (2009) Need for Timely Paediatric HIV Treatment within Primary