integrating research into care: working with children and adolescents
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Integrating research into care: working with children and adolescents. Mark Cotton Children’s Infectious Diseases Clinical Research Unit Tygerberg Children’s Hospital Stellenbosch University. Using data to influence policy: pre PMTCT 1991 - 1996. N = 91 189 episodes of hospitalization - PowerPoint PPT PresentationTRANSCRIPT
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Integrating research into care: working with children and adolescents
Mark CottonChildren’s Infectious Diseases Clinical Research Unit
Tygerberg Children’s Hospital
Stellenbosch University
www.aids2014.org
Using data to influence policy:pre PMTCT1991 - 1996
• N = 91 189 episodes of hospitalization• 1st episode
– Age 7.2 (1 to 141) months– Weight for age Z-score -2.6 (-6.4 to 2.5)
• ICU admissions 42• Deaths – 36 (40%)
Burden of mother to child transmission of HIV: 5 year study of hospitalized children
Cotton et al S Afr J Epidemiol Infect 1998: 13: 46-49
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Days in hospital & cost per year – all patients1991 - 1996
Hospital days = Hospital costs
PMTCT would have saved days & costs
Day
s
Cost
s
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Success of PMTCT in South Africa
Sherman GG, S Afr Med J 2014; 104 (suppl) 235-8
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% new registrations <1 year of age – Aid for AIDS
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Age spectrum change over time
Age at registration: 1998 - 2013 Current age (2014)
Open access www.jiasociety.orgFree Downloads
Opportunity to comment on individual articles
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• Epidemiology• Treatment• Mental health• Neurodevelopment• Cardiac effects• Metabolic complications• Bone health• Kidney disease• Chronic lung disease• Disclosure (website)
Executive editor - Shirin HeidariManaging editor - Mirjam Curno
The challenges of success Adolescents with perinatal HIV infection
Lynne Mofenson & Mark Cotton
• Cross-section study
• Adolescents t/f 1999 – 2011
• N = 45
• Median age of transfer 18.1 years
The Young & the Resistant HIV-Infected Adolescents Transfer
to Adult Care St Justine, Montreal, Canada
10Vd Linden D JPIDS 2012, Dec 19
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Mode of transmission
Mode of HIV transmission n (%)
Mother to child transmission 32/45 (71%)
Blood transfusion 2/45 (4.4%)
Sexual 2/45 (4.4%)
Unknown 9/45 (20%)
11
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Initial mono- or bi-therapy
ART naive
Initial cART
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The young and the resilient6th HIV Pediatrics Workshop
• Same adolescents• Doing well• Not easy
F Kakkar et al
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Poorer virologic suppression in adolescents – AID for AIDS
Nachega et al AIDS 2009; 51: 65-71
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Adolescents and technology
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Acknowledgements:
• Sam Waters, St. Mary’s Hospital, London• Dimitri vd Linden – St. Luc, Brussels• Michael Hislop & Leon Regensberg – Aid
for AIDS, Medscheme