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Linking HIV-infected infants to survival

Linking HIV-infected infants to survival. Mark Cotton Children’s Infectious Disease Clinical Research Unit (KID-CRU) Faculty of Health Sciences, Stellenbosch University & Tygerberg Children’s Hospital. Infants <6m of age in TCH - week of 30/1/06 - 3/2/06 Burden of disease. 25 infants

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Linking HIV-infected infants to survival

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  1. Linking HIV-infected infants to survival Mark Cotton Children’s Infectious Disease Clinical Research Unit (KID-CRU) Faculty of Health Sciences, Stellenbosch University & Tygerberg Children’s Hospital

  2. Infants <6m of age in TCH - week of 30/1/06 - 3/2/06Burden of disease • 25 infants • Median age 4m (IQ: 2.4 - 4.8) • HIV-exposed - 15 (60%) • HIV+ - 6 (24%) Not HIV HIV-infected HIV exposed uninfected

  3. AIDS 2009; 23: 101-106

  4. Annual post-neonatal deaths (X), Age 1-11 months, & antenatal HIV prevalence (%) (--), South Africa, 1990-2002

  5. Observed and fitted likely HIV/AIDS-related deaths, Age 1-11 months, South Africa, 1997-2002

  6. Non-HIV/AIDS-related deaths, Age 1-11 months, South Africa, 1997-2002

  7. N Engl J Med 2008; 359: 2233-44

  8. Screening & Enrolment Number of Participants prescreened: 5985 Number of Participants HIV+: 405 (6.8% of prescreened) Number of referred HIV+ participants: 155 Total Number of HIV+ Participants: 560 Number of Participants screened: 532 Participants enrolled CHER: 377 Participants with CD4<25%:104 (19.5%) Median 7.4 weeks of age Not enrolled for Other reasons:51

  9. Risk of death Death rate per 100 person-years (Early vs Deferred) • 3 months 10 vs 41 • 3 to 6 months 4 vs 23 • 6 to 12 months 3 vs 9

  10. South Africa • Infants born in Midwife obstetric Units or Hospitals • Referred to Community Clinics from 2 weeks if replacement feeding • At 6 weeks • Immunization • Diagnostic PCR • PCP prophylaxis • Turn-around time 1 to 2 weeks?

  11. Characteristics at start of ART: reports from sub-Saharan Africa

  12. Ikwezi Clinic • Since May 2007 • 20 or 34 infants still in care • Referred appropriately but delay care • 3 - 4m of age • 1st visit only • ARV clinic in separate building • Stigma • But slowly, clinic growing Annalize Paling - SUFHS

  13. TB exposure - infants between 3 and 4 months of age screened for TB prevention trial

  14. TB contact per 100 000 HIV-exposed infants 3-4 months of age

  15. The clock is ticking

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