B17. PROMISING EARLY RESULTS FROM STARTING ARV IN CHILDREN IN THYOLO DISTRICT.
K Frederix, G Malata, N Magwira, JA Khonje,M Fitzgerald, R Teck, MSF Luxembourg Thyolo District
Globally children are often poorly included in anti-retroviral treatment (ART) programmes. As ARV become increasingly available in Malawi, there is a need to ensure equitable access for infants and children. The objective of this study is to show that ART for children is needed and can be implemented at district level in Malawi.
Children started on ARV since April 2003 are registered in a Ministry of Health register and entered in a database. In addition, since November 2004 all children whether eligible for ARV or not are registered including information on their clinical classification severity. The feasibility of ART is documented in terms of uptake and outcome, both clinically and immunologically.
A total number of 119 children were put on ARV since the beginning of the ART program in April 2003. At present 109 children are still under treatment (with a median duration of 7 months of ART). On average 12 children are enrolled on a monthly basis or 10% of the total enrolment. Of the total of 119 enrolled to date, two children absconded, two stopped and 6 died giving a mortality of 5%. Favourable immunological outcome is described by a substantial increase in mean CD4%: mean of 10% at baseline versus 19%, 19.5 and 27% after 6, 12 and 18 months respectively.
In a four month time period a total of 100 new children were assessed and registered of whom 50% had moderate or sever immune suppression.
ART in children is needed and feasible in a Malawian setting. We recommend that at least 10% of patients enrolled in ARV programme should be children.