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Survival rates following expansion of the national pediatric antiretroviral treatment program, Thailand, 2000-2005
Presented by Michelle McConnell (Thailand).
M. McConnell1, P. Yuktanont2, U. Siangphoe1, N. Pattarapayoon2, S. Kohreanudom2, R. Lolekha1, P.A. Mock1, S. Chasombat2, S. Thanprasertsuk3
1Thailand MOPH - U.S. CDC Collaboration, Nonthaburi, Thailand, 2Department of Disease Control, MOPH, Nonthaburi, Thailand, 3World Health Organization, Bangkok, Thailand
Background: There are approximately 16,000 HIV-infected children in Thailand. The Thai government began a national antiretroviral treatment (ART) program in 2000; we describe patient outcomes for HIV-infected children initiating ART between 2000 and 2005.
Methods: Analysis included all ART-naïve patients < 15 years old who initiated ART from January 2000 - December 2005; patient follow-up data were included through March 2007. ART-eligible children were < 1 year old or had CD4%≤ 20 or CDC clinical stage B or C. Lost to follow-up (LFU) patients were >3 months late for a visit or coded by the provider as LFU; LFU patients were cross-checked against the national death registry.
Results: The analysis included 3,409 children who initiated ART at 327 hospitals; 20.2% initiated ART at district/community hospitals and 79.8% at provincial or larger hospitals. Median follow-up time was 1.7 years (IQR = 1.0-2.5). Median age at ART initiation was 7.3 years (IQR = 4.9-9.4), weight-for-age z-score (WAZ) was -2.0 (IQR = -2.6 to -1.4), and CD4% was 5.0% (IQR = 1.9%-13.0%). Baseline ART regimens were nevirapine-based for 2,528 (74.2%) children and efavirenz-based for 698 (20.5%). At the last visit, 346 (10.1%) children were LFU and 305 (9.0%) had died. Of the deaths, 274 (90.1%) were AIDS deaths; median time to death from ART initiation was 3.6 months (IQR = 1.4-10.7). In Kaplan-Meier analysis, the one-year survival probability was 0.93 (95%CI, 0.93-0.94); 5-year survival probability was 0.88 (95%CI, 0.86-0.90). Higher baseline WAZ and CD4% and better clinical stage were associated with survival in the adjusted Cox model (p< 0.001), as was district/community hospital (p< 0.05).
Conclusions: National expansion of the pediatric ART program in Thailand demonstrates good survival rates, including at district/community hospitals. Poorer outcomes were associated with advanced disease at baseline; efforts to promote early initiation of ART for eligible children should be strengthened.
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