Despite access to ART, mortality still reported among children in Uganda

WASHINGTON — Careful documentation of CD4 counts and early initiation of ART are being advocated as possible ways to reduce mortality among children in resource-limited settings.

Ruth Atukunda, MD, MPH, of the University of Maryland School of Medicine Institute of Human Virology-Uganda Program in Kampala, Uganda, and colleagues presented data during the XIX International AIDS Conference on 94 children who died of AIDS-related complications in Uganda, despite having access to ART. Atukunda and colleagues gathered their data by looking retrospectively at charts of 1,300 children aged younger than 15 years.

“Out of the 96 patients that died, 6.14% children had documented CD4 absolute count or percentage at ART initiation compared to 28.57% who did not have a baseline CD4 absolute count or percentage (P value <.001). Other factors associated to mortality among children on ART included age less than 2 years and CD4 <200cells/mm³,” the researchers wrote in their abstract. “Lack of information on the causes of death in resource-limited settings hampers the building of scientific evidence to identify factors directly associated with death for HIV patients.”

Atukunda and colleagues said, in most situations, the exact cause of death was unknown or undocumented. Of those causes that were known, malaria was most common, followed by tuberculosis and pneumonia.

“Early initiation of ART, provision and utilization of baseline assessment including absolute CD4 count and percentages among pediatrics at ART initiation is imperative for better treatment outcomes,” Atukunda told Infectious Diseases in Children. “Community-based approaches to track and link children to care need to be strengthened and scaled up in resource limited settings.”

For more information:

Atukunda R. MOPE039. Presented at: XIX International AIDS Conference; July 22-27, 2012; Washington, D.C.