National program scale-up and patient outcomes in a pediatric antiretroviral treatment program, Thailand, 2000-2007.
BACKGROUND
There are limited reports of public sector scale-up of antiretroviral treatment (ART) for HIV-infected children. We describe patient outcomes for HIV-infected children initiating ART in Thailand from 2000 to 2005.


METHODS
ART-naive patients <15 years old initiating ART from January 2000 to December 2005 were included; follow-up was through March 2007. Survival probabilities were estimated with Kaplan-Meier and hazard ratios for death and loss to follow-up (LTFU) with Cox proportional hazards models.


RESULTS
Analysis included 3409 children. Median follow-up time was 1.7 years (interquartile range = 1.0-2.5). Median age at ART initiation was 7.3 years, weight-for-age z score was -2.0, CD4% was 5.0%. ART was initiated in 1428 (41.9%) children at regional/university hospitals and in 689 (20.2%) at district/community hospitals. At last visit, 346 (10.1%) were LTFU and 305 (9.0%) had died. Age <1 (P = 0.008), weight-for-age z score <-2.0 (P < 0.001), CD4% <5% (P < 0.001), and clinical stage C (P < 0.001) were associated with death; district/community hospital patients had a lower hazard of death (P = 0.011). Clinical stage C (P = 0.052) and regional/university hospital (P < 0.001) were associated with increased LTFU.


CONCLUSIONS
Pediatric ART has been successfully scaled-up in Thailand, including to district/community hospitals. Late entry to care is associated with poorer outcomes, and earlier ART initiation should be prioritized.
McConnell
Michelle S
MS
Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand. zmd8@cdc.gov
Chasombat
Sanchai
S
Siangphoe
Umaporn
U
Yuktanont
Porntip
P
Lolekha
Rangsima
R
Pattarapayoon
Naparat
N
Kohreanudom
Surapol
S
Mock
Philip A
PA
Fox
Kimberley
K
Thanprasertsuk
Sombat
S
D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000706:statistics & numerical data; D001835:Body Weight; D015704:CD4 Antigens / Q000097:blood; D002648:Child; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control*; D006801:Humans; D007223:Infant; D008297:Male; D009313:National Health Programs / Q000458:organization & administration; D010349:Patient Compliance; D013785:Thailand / Q000453:epidemiology; D016896:Treatment Outcome
D019380:Anti-HIV Agents; D015704:CD4 Antigens