tailieunhanh - báo cáo hóa học:" Increased vulnerability of rural children on antiretroviral therapy attending public health facilities in South Africa: a retrospective cohort study"

Tuyển tập các báo cáo nghiên cứu về hóa học được đăng trên tạp chí sinh học đề tài : Increased vulnerability of rural children on antiretroviral therapy attending public health facilities in South Africa: a retrospective cohort study | Fatti et al. Journal of the International AIDS Society 2010 13 46 http content 13 1 46 JOURNALOF THE INTERNATIONAL AIDS SOCIETY RESEARCH Open Access Increased vulnerability of rural children on antiretroviral therapy attending public health facilities in South Africa a retrospective cohort study 13 1 4 Geoffrey Fatti 1 Peter Bock 1 Ashraf Grimwood Brian Eley Abstract Background A large proportion of the 340 000 HIV-positive children in South Africa live in rural areas yet there is little sub-Saharan data comparing rural paediatric antiretroviral therapy ART programme outcomes with urban facilities. We compared clinical immunological and virological outcomes between children at seven rural and 37 urban facilities across four provinces in South Africa. Methods We conducted a retrospective cohort study of routine data of children enrolled on ART between November 2003 and March 2008 in three settings namely urban residence and facility attendance urban group rural residence and facility attendance rural group and rural residents attending urban facilities rural urban group . Outcome measures were death loss to follow up LTFU virological suppression and changes in CD4 percentage and weight-for-age-z WAZ scores. Kaplan-Meier estimates logrank tests multivariable Cox regression and generalized estimating equation models were used to compare outcomes between groups. Results In total 2332 ART-naive children were included 1727 228 and 377 children in the urban rural and rural urban groups respectively . At presentation rural group children were older vs. and years had lower CD4 cell percentages vs. and lower WAZ scores vs. and and higher proportions with severe underweight 26 and 15 compared with the urban and rural urban groups respectively. Mortality was significantly higher in the rural group and LTFU significantly increased in the rural urban group. After 24 months of ART mortality probabilities .