@article{fdi:010075170,
  title = {{H}igh level of treatment failure and drug resistance to first-line antiretroviral therapies among {HIV}-infected children receiving decentralized care in {S}enegal},
  author = {{C}iss{\'e}, {A}. {M}. and {L}aborde-{B}alen, {G}. and {K}{\'e}b{\'e}-{F}all, {K}. and {D}ram{\'e}, {A}. and {D}iop, {H}. and {D}iop, {K}. and {N}iasse-{T}raor{\'e}, {F}. and {C}oulibaly, {M}. and {H}ave, {N}. {N}. and {V}idal, {N}icole and {T}hiam, {S}. and {W}ade, {A}. {S}. and {P}eeters, {M}artine and {T}averne, {B}ernard and {M}sellati, {P}hilippe and {T}our{\'e}-{K}ane, {C}.},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground{I}n {S}enegal in 2015, an estimated 4800 children were living with {HIV}, with 1200 receiving {ARV} treatment, of whom half had follow-up care in decentralized sites outside {D}akar.{H}owever, until now no studies have determined the efficacy of pediatric treatment in decentralized settings, even though the emergence of viral resistance, particularly among children in {A}frica, is a well-known phenomenon. {T}his study aimed to assess the virological status of {HIV}-infected children in all decentralized facilities to help improve access to quality care.{M}ethods{A} cross-sectional epidemiological and virological study was conducted in all of {S}enegal's regions, except {D}akar, between {M}arch and {J}une 2015 and sought to include all {HIV}-infected children and adolescents (0-19years), treated or not with {ARV}s.{S}ocio-demographic and clinical data and a blood sample on blotting paper were collected for children from treatment sites. {S}amples were routed on public transportation, assisted by a network of community health workers. {A} viral load ({VL}) assay was performed for each child, followed by genotyping when it exceeded 1000 copies/m{L} (3 log(10)).{R}esults{O}f the 851 identified children, 666 (78%) were enrolled in the study. {H}alf of the children were girls, and the average age was 8years (6months-19years). {M}ost of the children (96.7%) were infected with {HIV}-1, and 90% were treated with {ART}, primarily with {AZT}+3{TC}+{NVP}/{EFV} therapeutic regimen. {T}he median duration of time on {ART} was 21months (1-129). {VL} was measured for 2% of children before this study. {A}lmost two-thirds (64%) of the children are experiencing virological failure. {A}mong them, there was resistance to at least one drug for 86.5% of cases. {A}lso, 25% children presented resistance to one drug and 40% to two out of three. {F}or nearly one-third of the children presenting resistance, none of the three drugs of the treatment was active. {F}actors associated with virological failure were male sex, follow-up by a generalist rather than a specialist, and treatment interruptions.{C}onclusions{W}e observed a high level of virological failure and a high percentage of viral resistance among children receiving health care in decentralized facilities in {S}enegal.},
  keywords = {{P}ediatric {HIV} ; {A}ntiretroviral ; {V}iral resistance ; {D}ecentralization ; {S}enegal ; {SENEGAL}},
  booktitle = {},
  journal = {{BMC} {P}ediatrics},
  volume = {19},
  numero = {},
  pages = {art. 47 [8 p.]},
  ISSN = {1471-2431},
  year = {2019},
  DOI = {10.1186/s12887-019-1420-z},
  URL = {https://www.documentation.ird.fr/hor/fdi:010075170},
}