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Integrating research into care: working with children and adolescents

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

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Integrating research into care: working with children and adolescents

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  1. Integrating research into care: working with children and adolescents Mark Cotton Children’s Infectious Diseases Clinical Research Unit Tygerberg Children’s Hospital Stellenbosch University

  2. 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

  3. Days in hospital & cost per year – all patients1991 - 1996 Days Costs Hospital days = Hospital costs PMTCT would have saved days & costs

  4. Success of PMTCT in South Africa Sherman GG, S Afr Med J 2014; 104 (suppl) 235-8

  5. % new registrations <1 year of age – Aid for AIDS

  6. Age spectrum change over time Age at registration: 1998 - 2013 Current age (2014)

  7. Open access www.jiasociety.org • Free Downloads • Opportunity to comment on individual articles

  8. The challenges of success Adolescentswith perinatal HIV infection Lynne Mofenson & Mark Cotton Executive editor - ShirinHeidari Managing editor - MirjamCurno • Epidemiology • Treatment • Mental health • Neurodevelopment • Cardiaceffects • Metabolic complications • Bonehealth • Kidneydisease • Chroniclungdisease • Disclosure (website)

  9. Cross-section study Adolescents t/f 1999 – 2011 N = 45 Medianage of transfer 18.1 years The Young & the Resistant HIV-Infected Adolescents Transfer to Adult Care St Justine, Montreal, Canada Vd Linden D JPIDS 2012, Dec 19

  10. Mode of transmission

  11. Initial mono- or bi-therapy ART naive Initial cART

  12. The young and the resilient6th HIV Pediatrics Workshop • Same adolescents • Doing well • Not easy F Kakkar et al

  13. Poorer virologic suppression in adolescents – AID for AIDS Nachega et al AIDS 2009; 51: 65-71

  14. Adolescents and technology

  15. Acknowledgements: • Sam Waters, St. Mary’s Hospital, London • Dimitri vd Linden – St. Luc, Brussels • Michael Hislop & Leon Regensberg – Aid for AIDS, Medscheme

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