WEAD0102 - Oral Abstract Session
The role of primary health facilities (PHF) in expanding pediatric care and treatment services in Sub-Saharan Africa
Presented by Ruby Fayorsey (United States).
R. Fayorsey1, S. Saito1, R.J. Carter1, E. Gusmao2, K. Frederix3, E. Koech-Keter4, G. Tene5, M. Panya6, E.J. Abrams1
1ICAP, Columbia University, Mailman School of Public Health, New York, United States, 2ICAP, Maputo, Mozambique, 3ICAP, Maseru, Lesotho, 4ICAP, Nairobi, Kenya, 5ICAP, Kigali, Rwanda, 6ICAP, Dar es Salaam, Tanzania, United Republic of
Background: In resource-limited settings, decentralization of HIV care and treatment is a cornerstone of rapid scale-up. Successful decentralization has been shown for adult programs, but little is known about pediatric services. We compared trends in pediatric ART enrollment and outcomes at primary versus secondary/tertiary health facilities (SHFs).
Methods: Using routinely reported aggregate data from 274 public facilities in Kenya, Lesotho, Mozambique, Rwanda and Tanzania from January 2008- March 2010, we examined trends in number of patients < 15 years initiating ART by facility type. A GEE model was fit to compare lost to follow up (LTF) and mortality per 100 person years (PYs) on ART during the period by facility type, adjusting for years providing comprehensive HIV care, patient load, and percentage children < 2 years of age.
Results: : During the two year period, 17,155 children were enrolled in HIV care in 182(66%) PHFs and 92(34%) SHFs. The number of PHFs increased from 56 to 182, while increase in SHFs was modest (72 to 92 sites). Overall SHFs accounted for 71% of 8,475 children newly initiating ART during the two year period; however, the proportion of children newly initiating ART each quarter at PHFs increased from 17%(129) to 44%(463) during the same time period. The average LTF and mortality rates were 9.8/100PYs and 5.2/100PYs, respectively at PHFs and 20.2/100PYs and 6.0/100PYs at SHFs. Adjusted models show PHFs associated with lower LTF (Adjusted Rate Ratio, ARR=0.4; 95% CI=0.3-0.7) and lower mortality (ARR=0.3; 95% CI=0.2-0.6).
Conclusion: The expansion of pediatric services to PHFs has resulted in increased number of children newly initiating ART. Early findings suggest lower rates of LTF and mortality at PHFs, although referral of children with advanced disease to SHFs may account for higher mortality. Successful scale up in the coming years will require further expansion of pediatric services within PHFs.
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