Steep Declines in Pediatric AIDS Mortality in South Africa, Despite Poor Progress Toward Pediatric Diagnosis and Treatment Targets
Few attempts have been made to monitor progress toward HIV diagnosis and antiretroviral treatment (ART) coverage targets in children, and the impact that ART and prevention of mother-to-child transmission (PMTCT) programs have had on pediatric HIV incidence and mortality. A multiparameter evidence s...
Saved in:
| Published in: | The Pediatric infectious disease journal Vol. 39; no. 9; p. 843 |
|---|---|
| Main Authors: | , , , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
United States
01.09.2020
|
| ISSN: | 1532-0987, 1532-0987 |
| Online Access: | Get more information |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| Abstract | Few attempts have been made to monitor progress toward HIV diagnosis and antiretroviral treatment (ART) coverage targets in children, and the impact that ART and prevention of mother-to-child transmission (PMTCT) programs have had on pediatric HIV incidence and mortality.
A multiparameter evidence synthesis approach was adopted to integrate South African pediatric HIV data sources. A previously developed model of HIV in South Africa was calibrated to household survey HIV prevalence data, routine antibody testing data, data on numbers and ages of children on ART, vital registration data and data on HIV diagnosis at death. The impact of ART and PMTCT was estimated by comparing validated model outputs against model predictions of the trends that would have been expected in the absence of ART and PMTCT.
By mid-2018, the model estimated that 75.2% (95% CI: 73.9%-76.8%) of HIV-positive children were diagnosed, substantially lower than the corresponding estimates in HIV-positive adults (91.0%). ART coverage in children in 2018 (51.2%, 95% CI: 49.4%-52.7%) was also lower than that in adults (62.0%). In 2017-2018, the numbers of new cases of mother-to-child transmission and pediatric AIDS deaths were reduced by 84% and 94%, respectively, relative to what would have been expected in the absence of interventions, but reductions in mortality were driven largely by PMTCT.
Although levels of AIDS mortality in children have declined dramatically in South Africa, this has mostly been due to successful PMTCT programs, and progress toward the 90-90-90 targets appears relatively poor when compared with that in adults. |
|---|---|
| AbstractList | Few attempts have been made to monitor progress toward HIV diagnosis and antiretroviral treatment (ART) coverage targets in children, and the impact that ART and prevention of mother-to-child transmission (PMTCT) programs have had on pediatric HIV incidence and mortality.BACKGROUNDFew attempts have been made to monitor progress toward HIV diagnosis and antiretroviral treatment (ART) coverage targets in children, and the impact that ART and prevention of mother-to-child transmission (PMTCT) programs have had on pediatric HIV incidence and mortality.A multiparameter evidence synthesis approach was adopted to integrate South African pediatric HIV data sources. A previously developed model of HIV in South Africa was calibrated to household survey HIV prevalence data, routine antibody testing data, data on numbers and ages of children on ART, vital registration data and data on HIV diagnosis at death. The impact of ART and PMTCT was estimated by comparing validated model outputs against model predictions of the trends that would have been expected in the absence of ART and PMTCT.METHODSA multiparameter evidence synthesis approach was adopted to integrate South African pediatric HIV data sources. A previously developed model of HIV in South Africa was calibrated to household survey HIV prevalence data, routine antibody testing data, data on numbers and ages of children on ART, vital registration data and data on HIV diagnosis at death. The impact of ART and PMTCT was estimated by comparing validated model outputs against model predictions of the trends that would have been expected in the absence of ART and PMTCT.By mid-2018, the model estimated that 75.2% (95% CI: 73.9%-76.8%) of HIV-positive children were diagnosed, substantially lower than the corresponding estimates in HIV-positive adults (91.0%). ART coverage in children in 2018 (51.2%, 95% CI: 49.4%-52.7%) was also lower than that in adults (62.0%). In 2017-2018, the numbers of new cases of mother-to-child transmission and pediatric AIDS deaths were reduced by 84% and 94%, respectively, relative to what would have been expected in the absence of interventions, but reductions in mortality were driven largely by PMTCT.RESULTSBy mid-2018, the model estimated that 75.2% (95% CI: 73.9%-76.8%) of HIV-positive children were diagnosed, substantially lower than the corresponding estimates in HIV-positive adults (91.0%). ART coverage in children in 2018 (51.2%, 95% CI: 49.4%-52.7%) was also lower than that in adults (62.0%). In 2017-2018, the numbers of new cases of mother-to-child transmission and pediatric AIDS deaths were reduced by 84% and 94%, respectively, relative to what would have been expected in the absence of interventions, but reductions in mortality were driven largely by PMTCT.Although levels of AIDS mortality in children have declined dramatically in South Africa, this has mostly been due to successful PMTCT programs, and progress toward the 90-90-90 targets appears relatively poor when compared with that in adults.CONCLUSIONSAlthough levels of AIDS mortality in children have declined dramatically in South Africa, this has mostly been due to successful PMTCT programs, and progress toward the 90-90-90 targets appears relatively poor when compared with that in adults. Few attempts have been made to monitor progress toward HIV diagnosis and antiretroviral treatment (ART) coverage targets in children, and the impact that ART and prevention of mother-to-child transmission (PMTCT) programs have had on pediatric HIV incidence and mortality. A multiparameter evidence synthesis approach was adopted to integrate South African pediatric HIV data sources. A previously developed model of HIV in South Africa was calibrated to household survey HIV prevalence data, routine antibody testing data, data on numbers and ages of children on ART, vital registration data and data on HIV diagnosis at death. The impact of ART and PMTCT was estimated by comparing validated model outputs against model predictions of the trends that would have been expected in the absence of ART and PMTCT. By mid-2018, the model estimated that 75.2% (95% CI: 73.9%-76.8%) of HIV-positive children were diagnosed, substantially lower than the corresponding estimates in HIV-positive adults (91.0%). ART coverage in children in 2018 (51.2%, 95% CI: 49.4%-52.7%) was also lower than that in adults (62.0%). In 2017-2018, the numbers of new cases of mother-to-child transmission and pediatric AIDS deaths were reduced by 84% and 94%, respectively, relative to what would have been expected in the absence of interventions, but reductions in mortality were driven largely by PMTCT. Although levels of AIDS mortality in children have declined dramatically in South Africa, this has mostly been due to successful PMTCT programs, and progress toward the 90-90-90 targets appears relatively poor when compared with that in adults. |
| Author | Johnson, Leigh F Maskew, Mhairi Stephen, Cindy Jamieson, Lise Patrick, Mark Patten, Gabriela Davies, Mary-Ann Dorrington, Rob E |
| Author_xml | – sequence: 1 givenname: Leigh F surname: Johnson fullname: Johnson, Leigh F organization: From the Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town – sequence: 2 givenname: Mark surname: Patrick fullname: Patrick, Mark organization: School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban – sequence: 3 givenname: Cindy surname: Stephen fullname: Stephen, Cindy organization: Red Cross War Memorial Children's Hospital, Cape Town – sequence: 4 givenname: Gabriela surname: Patten fullname: Patten, Gabriela organization: From the Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town – sequence: 5 givenname: Rob E surname: Dorrington fullname: Dorrington, Rob E organization: Centre for Actuarial Research, University of Cape Town, Cape Town – sequence: 6 givenname: Mhairi surname: Maskew fullname: Maskew, Mhairi organization: Health Economics and Epidemiology Research Office, University of the Witwatersrand, Johannesburg – sequence: 7 givenname: Lise surname: Jamieson fullname: Jamieson, Lise organization: Health Economics and Epidemiology Research Office, University of the Witwatersrand, Johannesburg – sequence: 8 givenname: Mary-Ann surname: Davies fullname: Davies, Mary-Ann organization: Department of Health, Provincial Government of the Western Cape, Cape Town, South Africa |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/32433224$$D View this record in MEDLINE/PubMed |
| BookMark | eNpNkMtOwzAQRS1URB_wBwh5yYIUx488llVLoVKBSg3ryHUmxSiJg-0IdcuXE0SROpsZ6Zy5iztGg8Y0gNB1SKYhSeP71ctySk6GRgk5Q6NQMBqQNIkHJ_cQjZ376CXGQ3KBhoxyxijlI_S99QAtXoCqdAMO6wZvoNDSW63wbLXY4mdjvay0P_yyren8O56VPZV3_ZdrtQe8McbijTV7C87hzHxJW5zELLTcN8Zph2VT4MyC9DU0HmfS7sG7S3ReysrB1XFP0NvyIZs_BevXx9V8tg4U5zEJlIwYIUlCYkpBsQRYRNOIhykVSQJxISKuwp6UtARBi2gXx1wUqiQFkWKXSDpBt3-5rTWfHTif19opqCrZgOlcTjkRjBHBea_eHNVuV0ORt1bX0h7y_97oD3uUcdQ |
| CitedBy_id | crossref_primary_10_1097_QAI_0000000000003591 crossref_primary_10_1371_journal_pone_0284032 crossref_primary_10_1093_ofid_ofab603 crossref_primary_10_1007_s00383_024_05762_5 crossref_primary_10_3390_diagnostics13152563 crossref_primary_10_1002_jia2_26026 crossref_primary_10_1002_jia2_26418 crossref_primary_10_1186_s13006_025_00716_6 crossref_primary_10_4102_sajid_v40i1_679 crossref_primary_10_1002_jia2_26410 crossref_primary_10_1016_S0140_6736_21_00570_5 crossref_primary_10_1371_journal_pone_0286906 crossref_primary_10_4054_DemRes_2022_46_18 crossref_primary_10_1002_jia2_26045 crossref_primary_10_4102_sajid_v39i1_629 |
| ContentType | Journal Article |
| DBID | NPM 7X8 |
| DOI | 10.1097/INF.0000000000002680 |
| DatabaseName | PubMed MEDLINE - Academic |
| DatabaseTitle | PubMed MEDLINE - Academic |
| DatabaseTitleList | MEDLINE - Academic PubMed |
| Database_xml | – sequence: 1 dbid: NPM name: PubMed url: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed sourceTypes: Index Database – sequence: 2 dbid: 7X8 name: MEDLINE - Academic url: https://search.proquest.com/medline sourceTypes: Aggregation Database |
| DeliveryMethod | no_fulltext_linktorsrc |
| Discipline | Medicine |
| EISSN | 1532-0987 |
| ExternalDocumentID | 32433224 |
| Genre | Research Support, U.S. Gov't, Non-P.H.S Journal Article Research Support, N.I.H., Extramural |
| GrantInformation_xml | – fundername: PEPFAR – fundername: NIAID NIH HHS grantid: U01 AI069911 – fundername: NIAID NIH HHS grantid: R01 AI115979 – fundername: NIAID NIH HHS grantid: U01 AI069924 |
| GroupedDBID | --- .-D .3C .GJ .XZ .Z2 01R 0R~ 123 1J1 40H 4Q1 4Q2 4Q3 53G 5RE 5VS 71W 77Y 7O~ 8L- AAAAV AAAXR AAGIX AAHPQ AAIQE AAJCS AAMOA AAMTA AAQKA AAQQT AARTV AASCR AASOK AAUEB AAXQO ABASU ABBUW ABDIG ABJNI ABPPZ ABPXF ABVCZ ABXVJ ABXYN ABZAD ABZZY ACCJW ACDDN ACDOF ACEWG ACGFS ACILI ACLDA ACWDW ACWRI ACXJB ACXNZ ACZKN ADFPA ADGGA ADHPY ADNKB AE3 AE6 AEBDS AEETU AENEX AFBFQ AFDTB AFEXH AFFNX AFMBP AFNMH AFSOK AFUWQ AGINI AHOMT AHQNM AHQVU AHRYX AHVBC AIJEX AINUH AJCLO AJIOK AJNWD AJNYG AJZMW AKCTQ AKULP ALKUP ALMA_UNASSIGNED_HOLDINGS ALMTX AMJPA AMKUR AMNEI AOHHW AOQMC BOYCO BQLVK BS7 BYPQX C45 CS3 DIWNM DU5 DUNZO E.X EBS EEVPB EJD ERAAH EX3 F2K F2L F2M F2N F5P FCALG FL- FW0 GNXGY GQDEL H0~ HLJTE HZ~ IKREB IKYAY IN~ IPNFZ JF9 JG8 JK3 JK8 K8S KD2 KMI L-C N9A NPM N~7 N~B N~M O9- OAG OAH OCUKA ODA ODMTH OHYEH OK1 OL1 OLG OLH OLU OLV OLY OLZ OPUJH ORVUJ OUVQU OVD OVDNE OVIDH OVLEI OVOZU OWU OWV OWW OWX OWY OWZ OXXIT P-K P2P R58 RIG RLZ S4R S4S SJN T8P TEORI TSPGW V2I VVN W3M WOQ WOW X3V X3W XXN XYM YFH YOC ZGI ZXP ZZMQN 7X8 ACBKD ADKSD ADSXY |
| ID | FETCH-LOGICAL-c4470-ca6300880722ec38e362964192588e7d564c12ecf2fe52d6b7745dcf0d0a5b8a2 |
| IEDL.DBID | 7X8 |
| ISICitedReferencesCount | 17 |
| ISICitedReferencesURI | http://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=Summon&SrcAuth=ProQuest&DestLinkType=CitingArticles&DestApp=WOS_CPL&KeyUT=00006454-202009000-00019&url=https%3A%2F%2Fcvtisr.summon.serialssolutions.com%2F%23%21%2Fsearch%3Fho%3Df%26include.ft.matches%3Dt%26l%3Dnull%26q%3D |
| ISSN | 1532-0987 |
| IngestDate | Sun Nov 09 12:06:35 EST 2025 Mon Jul 21 05:55:53 EDT 2025 |
| IsDoiOpenAccess | false |
| IsOpenAccess | true |
| IsPeerReviewed | true |
| IsScholarly | true |
| Issue | 9 |
| Language | English |
| LinkModel | DirectLink |
| MergedId | FETCHMERGED-LOGICAL-c4470-ca6300880722ec38e362964192588e7d564c12ecf2fe52d6b7745dcf0d0a5b8a2 |
| Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
| OpenAccessLink | https://www.ncbi.nlm.nih.gov/pmc/articles/7958302 |
| PMID | 32433224 |
| PQID | 2405330544 |
| PQPubID | 23479 |
| ParticipantIDs | proquest_miscellaneous_2405330544 pubmed_primary_32433224 |
| PublicationCentury | 2000 |
| PublicationDate | 2020-09-00 20200901 |
| PublicationDateYYYYMMDD | 2020-09-01 |
| PublicationDate_xml | – month: 09 year: 2020 text: 2020-09-00 |
| PublicationDecade | 2020 |
| PublicationPlace | United States |
| PublicationPlace_xml | – name: United States |
| PublicationTitle | The Pediatric infectious disease journal |
| PublicationTitleAlternate | Pediatr Infect Dis J |
| PublicationYear | 2020 |
| SSID | ssj0003410 |
| Score | 2.4081283 |
| Snippet | Few attempts have been made to monitor progress toward HIV diagnosis and antiretroviral treatment (ART) coverage targets in children, and the impact that ART... |
| SourceID | proquest pubmed |
| SourceType | Aggregation Database Index Database |
| StartPage | 843 |
| Title | Steep Declines in Pediatric AIDS Mortality in South Africa, Despite Poor Progress Toward Pediatric Diagnosis and Treatment Targets |
| URI | https://www.ncbi.nlm.nih.gov/pubmed/32433224 https://www.proquest.com/docview/2405330544 |
| Volume | 39 |
| WOSCitedRecordID | wos00006454-202009000-00019&url=https%3A%2F%2Fcvtisr.summon.serialssolutions.com%2F%23%21%2Fsearch%3Fho%3Df%26include.ft.matches%3Dt%26l%3Dnull%26q%3D |
| hasFullText | |
| inHoldings | 1 |
| isFullTextHit | |
| isPrint | |
| link | http://cvtisr.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwpV1bS8MwFA7qRHzxfpk3IvhoWUyTJn2S4RzuYaWwCnsbbZLCXtq5Tn-Av9yTtHW-CIJ9KJRwSklzTr7kfDkfQndE-zLz7b5bTpnHBNdeRrIQHoOQCsk1MdqJTYgoktNpGDcbblVDq2xjogvUulR2j7wHM48lQnLGHhdvnlWNstnVRkJjE3V8gDLWMcV0XS0cIjSp66VSj8Diuj06F4reKBrWpQubiwaS_A4y3WQz3P_vZx6gvQZm4n49Lg7RhimO0M64SaQfo8_JypgFHhh7MtJUeF7gb9EO3B8NJnjscDlgdNvmhPZwrSl0D1ZWa8TguCyXOLYELwiXOHEE3B-vGdQsvnmF00LjpGW048SRz6sT9Dp8Tp5evEaOwVOMCeKp1JbnAn8XlBrlSwNzXxjYLDKX0gjNA6YeoCWnueFUBxkgS65VTjRJeSZTeoq2irIw5wiDra8AmnAZpCzNpGSAJHIjIATkISesi27b3p3BcLc5jLQw5Xs1W_dvF53Vv2i2qOtyzAAb-hCf2MUfrC_RLrUrZ8cWu0KdHJzdXKNt9bGaV8sbN47gHsXjL8BKz7c |
| linkProvider | ProQuest |
| openUrl | ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Steep+Declines+in+Pediatric+AIDS+Mortality+in+South+Africa%2C+Despite+Poor+Progress+Toward+Pediatric+Diagnosis+and+Treatment+Targets&rft.jtitle=The+Pediatric+infectious+disease+journal&rft.au=Johnson%2C+Leigh+F&rft.au=Patrick%2C+Mark&rft.au=Stephen%2C+Cindy&rft.au=Patten%2C+Gabriela&rft.date=2020-09-01&rft.issn=1532-0987&rft.eissn=1532-0987&rft.volume=39&rft.issue=9&rft.spage=843&rft_id=info:doi/10.1097%2FINF.0000000000002680&rft.externalDBID=NO_FULL_TEXT |
| thumbnail_l | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=1532-0987&client=summon |
| thumbnail_m | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=1532-0987&client=summon |
| thumbnail_s | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=1532-0987&client=summon |