title: National program scale-up and patient outcomes in a pediatric antiretroviral treatment program, Thailand, 2000-2007.
abstract: 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.
authors.affiliation: Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand. zmd8@cdc.gov
authors.forename: Michelle S
authors.initials: MS
authors.lastname: McConnell
authors.forename: Sanchai
authors.initials: S
authors.lastname: Chasombat
authors.forename: Umaporn
authors.initials: U
authors.lastname: Siangphoe
authors.forename: Porntip
authors.initials: P
authors.lastname: Yuktanont
authors.forename: Rangsima
authors.initials: R
authors.lastname: Lolekha
authors.forename: Naparat
authors.initials: N
authors.lastname: Pattarapayoon
authors.forename: Surapol
authors.initials: S
authors.lastname: Kohreanudom
authors.forename: Philip A
authors.initials: PA
authors.lastname: Mock
authors.forename: Kimberley
authors.initials: K
authors.lastname: Fox
authors.forename: Sombat
authors.initials: S
authors.lastname: Thanprasertsuk
mesh_terms: 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
chemical_list: D019380:Anti-HIV Agents; D015704:CD4 Antigens