Morbidity and Health care Resource Utilization in HIV-Infected Children After Antiretroviral Therapy Initiation in Côte d'Ivoire, 20042009

Desmonde, Sophie MSc*,†; Essanin, Jean-Bosco MD; Aka, Addi E. MD§; Messou, Eugène MD, PhD§; Amorissani-Folquet, Madeleine MD, PhD‡,‖; Rondeau, Virginie PhD*,†; Ciaranello, Andrea MD, MPH; Leroy, Valériane MD, PhD*,†

JAIDS Journal of Acquired Immune Deficiency Syndromes:
doi: 10.1097/QAI.0b013e3182a4ea6f
Implementation and Operational Research: Epidemiology and Prevention
IOR articles

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.

Author Information

*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.

Correspondence to: Sophie Desmonde, MSc, ISPED, INSERM U897, Bordeaux 33076, France (e-mail:

Supported in part by the National Cancer Institute, the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), and the National Institute of Allergy and Infectious Diseases (NIAID) of the US National Institutes of Health, Grants U01AI069919 (Epidemiologic Databases to Evaluate AIDS, West Africa), R01 A1058736, R01AI05873, and K01AI078754, and the International Maternal Pediatric Adolescent AIDS Clinical Trials network (A.C.). Overall support for International Maternal Pediatric Adolescent AIDS Clinical Trials was provided by the NIAID Grant U01 AI068632, the NICHD, and the National Institute of Mental Health Grant AI068632. S.D. is a fellow of the Ecole des Hautes Etudes en Santé Publique, Rennes, France. The Aconda program was funded by the United States President's Emergency Plan for AIDS Relief, through the Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, with additional support from the French GIP ESTHER and the Côte d′Ivoire Ministry of Public Health.

The authors have no conflicts of interest to disclose.

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Received April 12, 2013

Accepted June 28, 2013

© 2014 by Lippincott Williams & Wilkins