Successful clinical outcomes following decentralization of tertiary paediatric HIV care to a community‐based paediatric antiretroviral treatment network, Chiangrai, Thailand, 2002 to 2008

Introduction Most paediatric antiretroviral treatments (ARTs) in Thailand are limited to tertiary care hospitals. To decentralize paediatric HIV treatment and care, Chiangrai Prachanukroh Hospital (CRH) strengthened a provincial paediatric HIV care network by training community hospital (CH) care teams to receive referrals of children for community follow‐up. In this study, we assessed factors associated with death and clinical outcomes of HIV‐infected children who received care at CRH and CHs after implementation of a community‐based paediatric HIV care network. Methods Clinical records were ed for all children who initiated ART at CRH. Paired Wilcoxon signed rank tests were used to assess CD4% and virological change among all children. Cox proportional hazard models were used to assess factors associated with death. Treatment outcomes (CD4%, viral load (VL) and weight‐for‐age Z‐score (WAZ)) were compared between CRH and CH children who met the criteria for analysis. Results Between February 2002 and April 2008, 423 HIV‐infected children initiated ART and 410 included in the cohort analysis. Median follow‐up for the cohort was 28 months (interquartile range (IQR)=12 to 42); 169 (41%) children were referred for follow‐up at CH. As of 31 March 2008, 42 (10%) children had died. Baseline WAZ (