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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

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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