20th International AIDS Conference - Melbourne, Australia

Abstract

WEPE099 - Poster Exhibition


Long-term outcomes among children receiving antiretroviral therapy enrolled in a community-based accompaniment program in rural Rwanda

F. Cyamatare Rwabukwisi1, M. Ribakare2, B. Hedt-Gauthier1,3, C. Amoroso1, P. Niyigena1, N. Gupta1,4

1Partners In Health, Rwinkwavu, Rwanda, 2Rwanda Biomedical Center, Kigali, Rwanda, 3Harvard Medical School, Department of Global Health and Social Medicine, Boston, United States, 4Brigham & Women's Hospital, Divison of Global Health Equity, Boston, United States

Background: As more children living with HIV are initiated and maintained on antiretroviral therapy (ART) in sub-Saharan Africa, treatment delivery strategies need to be optimized to promote maximal retention in care. In recent multi-country evaluations, retention in care for children on ART in sub-Saharan African countries ranges from 71-95% at 12 months and 62-93% at 24 months. However, few reports exist regarding outcomes of children beyond two years in care in this setting.
Methods: Partners In Health (PIH), a non-governmental organization supporting the Ministry of Health of Rwanda, has established a community-based accompaniment model for ART delivery, which includes integrated monthly facility visits with psychosocial support, daily home visits by community health workers, and socioeconomic and food support for vulnerable families. We conducted a retrospective cohort study using routinely collected data on pediatric patients (< 15 years old) initiating ART from 2005 to 2011 in two rural districts at PIH-supported health facilities with community-based accompaniment. Patients transferring out of the program were censored at the time of transfer. Retention is defined as a recorded clinic visit within 60 days of the selected time point.
Results: Four-hundred sixty-one patients were initiated on ART during the study period. Median age at the time of enrollment was 5.6 years (IQR 2.8- 10.6), with 19.1% of patients under 2 years of age. Median baseline CD4 for patients < 5 years at ART initiation was 17.5% and for patients ≥5 years was 327.5 cells/µL. Five-year retention on ART was 94.4%.

Retention in ART Program Over Time
[Retention in ART Program Over Time]

There was no significant difference in retention by year cohort or age at ART initiation.
Conclusions: We demonstrate sustained high retention among pediatric patients on ART enrolled in a community-based accompaniment program in a rural Rwandan setting. Further study is needed to determine treatment success, risk factors for attrition, and costs and benefits of the community-based accompaniment model.


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