Secular trends in pediatric antiretroviral treatment programs in rural and urban Zambia a retrospective cohort study 英文参考文献.docVIP

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Secular trends in pediatric antiretroviral treatment programs in rural and urban Zambia a retrospective cohort study 英文参考文献.doc

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Secular trends in pediatric antiretroviral treatment programs in rural and urban Zambia a retrospective cohort study 英文参考文献

Sutcliffeetal.BMCPediatrics2010,10:54 /1471-2431/10/54 RESEARCH ARTICLE OpenAccess Seculartrendsinpediatricantiretroviraltreatment programsinruralandurbanZambia: aretrospectivecohortstudy CatherineGSutcliffe1*,CarolynBolton-Moore2,JannekeHvanDijk3,MattCotham4,BushimbwaTambatamba5, WilliamJMoss1 Abstract Background:Since2003pediatricantiretroviraltreatment(ART)programshavescaled-upinsub-SaharanAfrica andshouldbeevaluatedtoassessprogressandidentifyareasforimprovement.Weevaluatedseculartrendsinthe characteristicsandtreatmentoutcomesofchildreninthreepediatricARTclinicsinurbanandruralareasin Zambia. Methods:RoutinelycollecteddatawereanalyzedfromthreeARTprogramsinrural(MachaandMukinge)and urban(Lusaka)ZambiabetweenprogramimplementationandJuly2008.Datawereobtainedfromelectronic medicalrecordsystemsandmedicalrecordabstraction,andwerecategorizedbyyearofprogramimplementation. CharacteristicsofallHIV-infectedandexposedchildrenenrolledintheprogramsandallchildreninitiating treatmentwerecomparedbyyearofimplementation. Results:Agedecreasedandimmunologiccharacteristicsimprovedinallgroupsovertimeinbothurbanandrural clinics,withgreaterimprovementobservedintheruralclinics.AmongchildrenbotheligibleandineligibleforART atclinicenrollment,themajoritystartedtreatmentwithinayear.Ahighproportionofchildren,particularlythose ineligibleforARTatclinicenrollment,werelosttofollow-uppriortoinitiatingART.AmongchildreninitiatingART, clinicalandimmunologicoutcomesaftersixmonthsoftreatmentimprovedinbothurbanandruralclinics.Inthe urbanclinics,mortalityaftersixmonthsoftreatmentdeclinedwithprogramduration,andintheruralclinics,the proportionofchildrendefaultingbysixmonthsincreasedwithprogramduration. Conclusions:TreatmentprogramsareshowingsignsofprogressinthecareofHIV-infectedchildren,particularlyin theruralclinicswherescale-upincreasedrapidlyoverthefirstthreeyearsofprogramimplementation.However, continuedeffortstooptimizecareareneededasmanychildrencontinuetoenrollinARTprogramsatalatestage ofdiseaseandt