Author Affiliations: Centre for Infectious Disease Research in Zambia, Lusaka (Drs Bolton-Moore, Mubiana-Mbewe, Chintu, E. Stringer, Chi, Kankasa, Levy, and J. Stringer and Mr Cantrell); Schools of Medicine and Public Health, University of Alabama at Birmingham (Drs. Stringer, Chi, Sinkala, Wilson, and J. Virtual Dj Pro Apk Free Download there. Stringer and Mr Cantrell); University Teaching Hospital, Lusaka (Dr Kankasa); Zambian Ministry of Health, Lusaka (Drs Sinkala and Mwango); Elizabeth Glaser Pediatric AIDS Foundation, Santa Monica, California (Dr Wilfert); Columbia University College of Physicians and Surgeons, New York, New York (Dr Abrams); and US Centers for Disease Control and Prevention, Global AIDS Program, Lusaka (Dr Bulterys). Abstract Context The Zambian Ministry of Health provides pediatric antiretroviral therapy (ART) at primary care clinics in Lusaka, where, despite scale-up of perinatal prevention efforts, many children are already infected with the human immunodeficiency virus (HIV). Objective To report early clinical and immunologic outcomes of children enrolled in the pediatric treatment program.
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Design, Setting, and Patients Open cohort assessment using routinely collected clinical and outcome data from an electronic medical record system in use at 18 government primary health facilities in Lusaka, Zambia. Care was provided primarily by nurses and clinical officers (“physician extenders” akin to physician assistants in the United States). Patients were children (.
By the end of 2006, an estimated 2.3 million children worldwide were living with human immunodeficiency virus type 1 (HIV-1). Although most children acquire the virus through largely preventable mother-to-child transmission, roll-out of perinatal HIV prevention services has been sluggish worldwide.
As a result, each day more than 1000 children become newly infected. Without treatment, approximately half will die by their second birthday; however, lives can be extended and morbidity avoided with combination antiretroviral therapy (ART). In Zambia, recent progress has been made toward reducing new pediatric infections through aggressive scale-up of perinatal HIV prevention services. Despite these efforts, 130 000 children are believed to be already infected, and 25 000 to 30 000 are in urgent need of ART. During May of 2004, with financial resources from the US President's Emergency Plan for AIDS Relief (PEPFAR), the Global Fund to Fight AIDS, Tuberculosis and Malaria, and other sources, the Zambian Ministry of Health initiated an ART program at primary care sites within the Lusaka Urban Health District. A stated priority of this program has been the inclusion of children. This report describes our early clinical experience treating HIV-infected children in primary health clinics where pediatric specialty expertise is generally not available.
Methods The pediatric treatment program began in May 2004 and operates in 18 of the Lusaka District's 27 primary care facilities. Physicians are scarce —the entire district shares a single pediatrician—but the nearby University Teaching Hospital is well staffed and acts as a referral and training center. We therefore developed pediatric-specific clinical care protocols and training plans that focus on nonphysician clinicians (nurses and clinical officers). Clinical officers provided the preponderance of care to children in this cohort. Clinical officers are “physician extenders” akin to physician assistants in the United States. They have 3 years of training beyond grade 12.