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Health Care Resource Utilization in Untreated HIV-Infected Children in A Pediatric Programme, Abidjan, Côte d'Ivoire, 2004–2009

Desmonde, Sophie MSc*,†; Coffie, Patrick A. MD, PhD; Aka, Edmond A. MD§; Amani-Bosse, Clarisse MD‡,‖; Messou, Eugène MD, PhD§; Dabis, François MD, PhD*,†; Ciaranello, Andrea MD, MPH; Leroy, Valériane MD, PhD*,†

JAIDS Journal of Acquired Immune Deficiency Syndromes: January 1st, 2013 - Volume 62 - Issue 1 - p e14–e21
doi: 10.1097/QAI.0b013e3182739c95
Implementation and Operational Research: Epidemiology and Prevention

Background: We describe health care resource utilization among HIV-1–infected children who have not yet undergone antiretroviral treatment (ART) in Abidjan, Côte d'Ivoire.

Methods: HIV-infected children enrolled prospectively in an HIV care programme in 2 health facilities in Abidjan (2004–2009) were followed up from date of inclusion until database closeout, death, ART initiation, or loss to follow-up (no clinical contact for more than 6 months). Incidences of health care resource utilization (outpatient care, inpatient day care, and hospitalization) were described according to severe morbidity and mixed effect log linear models were computed to identify associated factors.

Results: Overall, 405 children were included, entering care at a median age of 4.5 years, 66.9% were receiving cotrimoxazole prophylaxis, and 27.7% met 2006 WHO criteria for immunodeficiency by age. The median follow-up time was 11.6 months (interquartile range: 1.4; 30.7). Overall, 371 clinical events occurred in 162 children yielding to an incidence rate (IR) of 60.9/100 child-years (CY) [95% confidence interval (CI): 55.1 to 67.2]: 57% of clinical events led to outpatient care (IR: 33/100 CY), 38% to inpatient day care (IR: 22/100 CY), and 10% to hospitalization (IR: 5.9/100 CY). Further medical examinations were made allowing confirmed diagnoses in 40% of those (IR: 22.4/100 CY). Outpatient care was less common among immunodeficient children than those not (relative risk [RR] = 0.32, 95% CI: 0.18 to 0.56), in those whose main caregivers are both parents compared with those who are primarily cared for by their mother only (RR = 0.34, 95% CI: 0.15 to 0.77).

Conclusion: Untreated HIV-infected children require substantial inpatient and outpatient care in a context where ART is scaling up but still not available to all.

*Centre INSERM, U897—Epidémiologie—Biostatistiques, Bordeaux, France

Université Bordeaux, ISPED, Centre INSERM, U897—Epidémiologie—Biostatistiques, Bordeaux, France

Programme PAC-CI, CHU de Treichville, Abidjan, Côte d'Ivoire

§Centre de Prise en Charge, de Recherche et de Formation, ACONDA, Abidjan, Côte d'Ivoire

MTCT-Plus Initiative, ACONDA, Abidjan, Côte d'Ivoire

Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA.

Correspondence to: S. Desmonde, Centre de recherche INSERM, U897, Equipe—VIH, cancer et santé globale dans les pays à ressources limitées, Institut de Santé Publique, d'Epidémiologie et de Développement, Université de Bordeaux 2, Case 11, 146 rue Leo Saignat, 33076 Bordeaux Cedex, France (e-mail:

Supported in part by the US National Institutes of Health: National Institute of Allergy and Infectious Diseases Grants R01 A1058736, 5U01AI09919-01–05 (IeDEA West Africa), R01AI05873, and K01AI078754. S. Desmonde is a fellow of the Ecole des Hautes Etudes en Santé Publique, Rennes, France. The content of this publication is solely the responsibility of the authors and does not necessarily represent the official views of any of the institutions mentioned above.

Presented in part at the 6th IAS Conference on HIV pathogenesis, treatment, and prevention, July 2011, Rome, Italy; poster # MOPE129.

The authors have no conflicts of interest to disclose.

Received April 10, 2012

Accepted August 14, 2012

© 2013 Lippincott Williams & Wilkins, Inc.