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Short-term outcomes of downreferral in provision of paediatric antiretroviral therapy at Red Cross War Memorial Childrens Hospital, Cape Town
Background: The large scale-up of paediatric HIV care necessitated down-referral of many children receiving antiretroviral therapy (ART) from Red Cross War Memorial Children's Hospital (RCWMCH). No published data exists on the outcomes of these children. Objectives: To assess clinical, immunological...
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| Format: | Thesis |
| Language: | English |
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Department of Paediatrics and Child Health
2017
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| _version_ | 1867613721525747712 |
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| access_status_str | Open Access |
| author | Copelyn, Julie |
| author2 | Eley, Brian |
| author_browse | Copelyn, Julie Eley, Brian |
| author_facet | Eley, Brian Copelyn, Julie |
| author_sort | Copelyn, Julie |
| collection | Thesis |
| description | Background: The large scale-up of paediatric HIV care necessitated down-referral of many children receiving antiretroviral therapy (ART) from Red Cross War Memorial Children's Hospital (RCWMCH). No published data exists on the outcomes of these children. Objectives: To assess clinical, immunological and virological outcomes of children receiving ART in the first 12 months after down-referral to primary health care (PHC) clinics, and identify determinants of successful down-referral. Methods: We conducted a retrospective cohort study of children <15 years of age who commenced ART at RCWMCH and were subsequently down-referred to one of two PHC clinics between January 2006 and December 2012. Baseline characteristics of patients and caregivers as well as CD4 counts, viral loads and weights were collected at 6 and 12 months post-down-referral. Outcomes included retention in care and viral suppression. Results: One hundred and sixteen children down-referred to Heideveld and Gugulethu were included. After down-referral 13.8% of the cohort never arrived at the designated clinic and 10% took longer than 8 weeks, therefore probably experiencing treatment interruption. At 12 months post down-referral only 68.2% remained in care at the designated clinics. No factors were associated with retention in care. For those children who remained in care at the PHC clinics, the clinical and immunological gains achieved prior to down-referral were sustained through 12 months of follow up, and 54.7% of the retained cohort had documented viral suppression at 12 months. Conclusion: Down-referral of children on ART is a vulnerable process with risk of loss to follow-up and treatment interruption. |
| format | Thesis |
| id | oai:open.uct.ac.za:11427/22761 |
| institution | University of Cape Town (South Africa) |
| language | eng |
| last_indexed | 2026-06-10T12:40:39.187Z |
| license_str | Not specified — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from UCTD — University of Cape Town Open Access Repository |
| publishDate | 2017 |
| publishDateRange | 2017 |
| publishDateSort | 2017 |
| publisher | Department of Paediatrics and Child Health |
| publisherStr | Department of Paediatrics and Child Health |
| record_format | dspace |
| source_str | UCTD — University of Cape Town Open Access Repository |
| spelling | oai:open.uct.ac.za:11427/22761 Short-term outcomes of downreferral in provision of paediatric antiretroviral therapy at Red Cross War Memorial Childrens Hospital, Cape Town Copelyn, Julie Eley, Brian Paediatrics Background: The large scale-up of paediatric HIV care necessitated down-referral of many children receiving antiretroviral therapy (ART) from Red Cross War Memorial Children's Hospital (RCWMCH). No published data exists on the outcomes of these children. Objectives: To assess clinical, immunological and virological outcomes of children receiving ART in the first 12 months after down-referral to primary health care (PHC) clinics, and identify determinants of successful down-referral. Methods: We conducted a retrospective cohort study of children <15 years of age who commenced ART at RCWMCH and were subsequently down-referred to one of two PHC clinics between January 2006 and December 2012. Baseline characteristics of patients and caregivers as well as CD4 counts, viral loads and weights were collected at 6 and 12 months post-down-referral. Outcomes included retention in care and viral suppression. Results: One hundred and sixteen children down-referred to Heideveld and Gugulethu were included. After down-referral 13.8% of the cohort never arrived at the designated clinic and 10% took longer than 8 weeks, therefore probably experiencing treatment interruption. At 12 months post down-referral only 68.2% remained in care at the designated clinics. No factors were associated with retention in care. For those children who remained in care at the PHC clinics, the clinical and immunological gains achieved prior to down-referral were sustained through 12 months of follow up, and 54.7% of the retained cohort had documented viral suppression at 12 months. Conclusion: Down-referral of children on ART is a vulnerable process with risk of loss to follow-up and treatment interruption. 2017-01-17T12:24:00Z 2017-01-17T12:24:00Z 2016 Master Thesis Masters MMed http://hdl.handle.net/11427/22761 eng application/pdf application/pdf application/pdf application/pdf application/pdf Department of Paediatrics and Child Health Faculty of Health Sciences University of Cape Town |
| spellingShingle | Paediatrics Copelyn, Julie Short-term outcomes of downreferral in provision of paediatric antiretroviral therapy at Red Cross War Memorial Childrens Hospital, Cape Town |
| thesis_degree_str | Master's |
| title | Short-term outcomes of downreferral in provision of paediatric antiretroviral therapy at Red Cross War Memorial Childrens Hospital, Cape Town |
| title_full | Short-term outcomes of downreferral in provision of paediatric antiretroviral therapy at Red Cross War Memorial Childrens Hospital, Cape Town |
| title_fullStr | Short-term outcomes of downreferral in provision of paediatric antiretroviral therapy at Red Cross War Memorial Childrens Hospital, Cape Town |
| title_full_unstemmed | Short-term outcomes of downreferral in provision of paediatric antiretroviral therapy at Red Cross War Memorial Childrens Hospital, Cape Town |
| title_short | Short-term outcomes of downreferral in provision of paediatric antiretroviral therapy at Red Cross War Memorial Childrens Hospital, Cape Town |
| title_sort | short term outcomes of downreferral in provision of paediatric antiretroviral therapy at red cross war memorial childrens hospital cape town |
| topic | Paediatrics |
| url | http://hdl.handle.net/11427/22761 |
| work_keys_str_mv | AT copelynjulie shorttermoutcomesofdownreferralinprovisionofpaediatricantiretroviraltherapyatredcrosswarmemorialchildrenshospitalcapetown |