Hospitalization trends, costs and risk factors in HIV infected children on antiretroviral therapy (ART) in Thailand.


Collins, IJ; Cairns, J; Jourdain, G; Fregonese, F; Nantarukchaikul, M; Lertpienthum, N; Wannarit, P; Attavinijtrakarn, P; Layangool, P; Le Coeur, S; Lallemant, M; for the Program for HIV Prevention and Treatment (PHPT) study te, ; (2012) Hospitalization trends, costs and risk factors in HIV infected children on antiretroviral therapy (ART) in Thailand. AIDS (London, England). ISSN 0269-9370 DOI: https://doi.org/10.1097/QAD.0b013e328357f7b9

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Abstract

: OBJECTIVE:: To assess hospitalization trends in HIV-infected children on antiretroviral therapy (ART) in Thailand, an important indicator of morbidity, ART effectiveness and health service utilization. DESIGN:: Prospective observational cohort METHOD:: Children initiating ART in 1999-2009 were followed in 40 public hospitals. Hospitalization rate per 100 person-years (PY) were calculated from ART initiation to last follow-up/death. Costs to the healthcare provider were calculated using WHO inpatient estimates for Thailand. Zero inflated Poisson models were used to examine risk factors for early (<12-months of ART) and late hospitalization (?12-months) and frequency of admissions. RESULTS:: 578 children initiated ART, median follow-up was 64 months (IQR 43-82); 211 (37%) children were hospitalized with 451 admissions. Hospitalization rates declined from 63 per 100PY <6-months to ?10 per 100PY after 2 years of ART, and costs fell from $35 per patient-month to under $5, respectively. Age <2-years, CDC stage B/C and stunting at ART initiation were associated with early hospitalization. Among those hospitalized, baseline CD4<5%, wasting, initiation on dual therapy, late calendar year and female sex were associated with higher incidence of early admissions (p<0.02). There were no predictors of late hospitalization, although previous hospitalization <12-months of ART were associated with three times higher incidence of late admissions (p?<?0.0001). CONCLUSIONS:: One in three children required hospitalization after ART. Admissions were highest in the first year of therapy and rapidly declined thereafter. Young age, advanced disease stage and stunting at baseline were predictive of early hospitalization. Treatment initiation before disease progression would likely reduce hospitalization and alleviate demands on healthcare services.

Item Type: Article
Faculty and Department: Faculty of Public Health and Policy > Dept of Health Services Research and Policy
Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology
PubMed ID: 22824633
Web of Science ID: 309224100011
URI: http://researchonline.lshtm.ac.uk/id/eprint/125628

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