title: Morbidity and health care resource utilization in HIV-infected children after antiretroviral therapy initiation in Côte d'Ivoire, 2004-2009.
abstract: BACKGROUND
  We describe severe morbidity and health care resource utilization (HCRU) among HIV-infected children on antiretroviral therapy (ART) in Abidjan, Côte d'Ivoire.
  
  
  METHODS
  All HIV-infected children enrolled in an HIV-care program (2004-2009) were eligible for ART initiation until database closeout, death, ART interruption, or loss to follow-up. We calculated incidence rates (IRs) of density per 100 child-years (CYs) for severe morbidity, HCRU (outpatient care and inpatient care), and associated factors using frailty models with a Weibull distribution.
  
  
  RESULTS
  Of 332 children with a median age of 5.7 years and median follow-up of 2.5 years, 65.4% were severely immunodeficient by World Health Organization (WHO) criteria, and all received cotrimoxazole prophylaxis. We recorded 464 clinical events in 228 children; the overall IR was 57.6/100 CYs [95% confidence interval (CI): 52.1 to 62.5]. Severe morbidity was more frequent in children on protease inhibitor (PI)-based ART compared to those on other regimens [adjusted hazards ratio (aHR): 1.83; 95% CI: 1.35 to 2.47] and to those moderately/severely immunodeficient compared to those not (aHR: 1.57; 95% CI: 1.13 to 2.18 and aHR: 2.53; 95% CI: 1.81 to 3.55, respectively). Of the 464 events, 371 (80%) led to outpatient care (IR: 45.6/100 CYs) and 164 (35%) to inpatient care (IR: 20.2/100 CYs). In adjusted analyses, outpatient care was significantly less frequent in children older than 10 years compared with children younger than 2 years (aHR: 0.49; 95% CI: 0.31 to 0.78) and in those living furthest from clinics compared with those living closest (aHR: 0.65; 95% CI: 0.47 to 0.90). Both inpatient and outpatient HCRU were negatively associated with cotrimoxazole prophylaxis.
  
  
  CONCLUSIONS
  Despite ART, HIV-infected children still require substantial utilization of health care services.
authors: *Center INSERM U897, Epidémiologie Biostatistiques, Bordeaux, France; †Université Bordeaux, ISPED, Center INSERM U897, Epidémiologie Biostatistiques, Bordeaux, France; ‡Université de Cocody, Abidjan, Côte d'Ivoire; §CePReF, ACONDA, Abidjan Côte d'Ivoire; ‖Department of Pediatrics, Cocody University Hospital, Abidjan, Côte d'Ivoire; and ¶Massachusetts General Hospital, Boston, MA.
authors: Sophie
authors: S
authors: Desmonde
authors: Jean-Bosco
authors: JB
authors: Essanin
authors: Addi E
authors: AE
authors: Aka
authors: Eugène
authors: E
authors: Messou
authors: Madeleine
authors: M
authors: Amorissani-Folquet
authors: Virginie
authors: V
authors: Rondeau
authors: Andrea
authors: A
authors: Ciaranello
authors: Valériane
authors: V
authors: Leroy
mesh_terms: D000293:Adolescent; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D002648:Child; D002675:Child, Preschool; D007560:Cote d'Ivoire; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006268:Health Facilities / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies
chemical_list: D044966:Anti-Retroviral Agents