HIV/AIDS
Conditions
Keywords
Antiretroviral Therapy, Retention, Loss to Follow Up
Brief summary
The decentralization study will describe children taking antiretroviral therapy (ART) at a larger health facility in the Eastern Cape province of South Africa, between the years of 2004-2013. The study will be conducted at Dora Nginza Hospital (DNH). The study will measure how many children stay in care and how many die, as well as their health status. The study will also compare whether children do better if they stay in care a large hospitals or if they get health care at smaller clinics. A second part of the study will find children in the community who have stopped coming for health care and find out what happened to them and what their health status is.
Detailed description
The investigators propose to conduct a two part study which will include a retrospective cohort study to examine care outcomes among pediatric patients 0-14 years of age initiated on antiretroviral therapy (ART) in 2004-2013 at a larger peri-urban health facility in the Eastern Cape province of South Africa. The study will be conducted at Dora Nginza Hospital (DNH). The outcomes measured in the study will include retention and mortality, as well as virologic suppression rates for children initiated on ART. In addition to reporting outcomes for all children with available data, the study will compare outcomes for children retained in care at DNH (where they initiated ART) to those children who were referred out after initiation for routine follow-up at community health clinics and primary care clinics (down referred). A second part of the study will trace pediatric patients in the community who have been lost to follow-up (LTF) to ascertain their outcomes after they left care at the health facility.
Interventions
OTHERData abstraction
The investigators will abstract clinical data from down-referral sites and from NHLS to determine whether children made it to their down-referral sites or whether children are in care at a different facility.
OTHERTracing questionnaire
The investigators will attempt to contact and visit caregivers of children who are determined to be LTF from DNH or from down-referral sites. If located and after providing consent, caregivers will be administered a tracing questionnaire, or a verbal autopsy if their child has died.
OTHERTier.net
For all children who started ART at DNH between 2004 and 2013, the investigators will abstract data on these children from the electronic medical system in South Africa called Tier.net.
Sponsors
Columbia University
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
No minimum to 14 Years
Healthy volunteers
No
Inclusion criteria
ART Outcomes Study: Inclusion Criteria: * HIV positive; less than 15 years of age; started ART at DNH between 2004 and 2013.
Exclusion criteria
* Anyone not meeting inclusion criteria Tracing Study: Inclusion Criteria: * Legal caregiver (older than 18) a child who was included in the ART Outcomes Study that was found to be LTFU from DNH or from the down-referral facility.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Proportion of children initiated on ART at DNH who are still in care | Baseline (single measure) |
Secondary
| Measure | Time frame |
|---|---|
| Proportion of children with hospitalization and/or death after ART initiation at DNH | Baseline (single measure) |
| Proportion of down-referred children retained in care at their down-referral facility. | Baseline (single measure) |
| Proportion of children who died or were LTF among those who remained at DNH and those down-referred | Baseline (single measure) |
Countries
South Africa
Outcome results
None listed