title: Response to antiretroviral therapy of HIV type 1-infected children in urban and rural settings of Uganda.
abstract: From 2006 to 2011, a cohort study was conducted among 1000 children resident in urban and rural settings of Uganda to ascertain and compare the response to antiretroviral therapy (ART) among urban versus rural children and the factors associated with this response. Clinical, immunological, and virological parameters were ascertained at baseline and weeks 24, 48, 96, and 144 after ART initiation. Adherence to ART was assessed at enrollment by self-report (SR) and pill counts (PC). Overall, 499/948 (52.6%) children were resident in rural areas, 504/948 (53.1%) were male, and their mean age was 11.9±4.4 years (urban children) and 11.4±4.1 years (rural children). The urban children were more likely to switch to second-line ART at a rate of 39.9 per 1000 person-years (95% CI: 28.2-56.4) versus 14.9 per 1000 person-years (95% CI: 8.7-25.7), p=0.0038, develop any new WHO 3/4 events at 127/414 (30.7%) versus 108/466 (23.2%), p=0.012, and have a higher cumulative incidence of hospitalization of 54/449 (12.0%) versus 32/499 (6.4%), p=0.003, when compared to rural children. No differences were observed in mean changes in weight, height, CD4 count and percentage, and hemoglobin and viral load between urban and rural children. Adherence of ≥95% was observed in 88.2% of urban versus 91.3% of rural children by SR (p=0.130), and in 78.8% of urban versus 88.8% of rural children by PC (p<0.0001). In this study rural children had more favorable clinical outcomes and were more likely to adhere optimally to ART than urban children.
authors.affiliation: Joint Clinical Research Centre, Headquarters, Kampala, Uganda. musiimev@yahoo.co.uk
authors.forename: Victor
authors.initials: V
authors.lastname: Musiime
authors.forename: Joshua
authors.initials: J
authors.lastname: Kayiwa
authors.forename: Mary
authors.initials: M
authors.lastname: Kiconco
authors.forename: William
authors.initials: W
authors.lastname: Tamale
authors.forename: Hillary
authors.initials: H
authors.lastname: Alima
authors.forename: Henry
authors.initials: H
authors.lastname: Mugerwa
authors.forename: Mary
authors.initials: M
authors.lastname: Abwola
authors.forename: Eunice
authors.initials: E
authors.lastname: Apilli
authors.forename: Fred
authors.initials: F
authors.lastname: Ahimbisibwe
authors.forename: Hilda
authors.initials: H
authors.lastname: Kizito
authors.forename: George
authors.initials: G
authors.lastname: Abongomera
authors.forename: Asia
authors.initials: A
authors.lastname: Namusoke
authors.forename: Agnes
authors.initials: A
authors.lastname: Makabayi
authors.forename: Francis
authors.initials: F
authors.lastname: Kiweewa
authors.forename: Francis
authors.initials: F
authors.lastname: Ssali
authors.forename: Cissy
authors.initials: C
authors.lastname: Kityo
authors.forename: Robert
authors.initials: R
authors.lastname: Colebunders
authors.forename: Peter
authors.initials: P
authors.lastname: Mugyenyi
mesh_terms: D000293:Adolescent; D044966:Anti-Retroviral Agents / Q000008:administration & dosage*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology / Q000821:virology; D006801:Humans; D008297:Male; D012424:Rural Population; D016896:Treatment Outcome; D014454:Uganda; D014505:Urban Population
chemical_list: D044966:Anti-Retroviral Agents