Risk Factors of Loss to Follow up Among HIV Positive Pediatric Patients in Dar es Salaam, Tanzania

Details

• Alternative Title:
  J Acquir Immune Defic Syndr
• Personal Author:
  MCCORMICK, Nora M. ; LI, Nan ; SANDO, David ; MUYA, Aisa ; MANJI, Karim P. ; KISENGE, Rodrick ; DUGGAN, Christopher ; CHALAMILLA, Guerino ; FAWZI, Wafaie W. ; SPIEGELMAN, Donna
• Description:
  Objective ; To identify risk factors for loss to follow up (LTFU) in an HIV-infected pediatric population in Dar es Salaam, Tanzania between 2004 and 2011. ; Design ; Longitudinal analysis of 6236 HIV-infected children. ; Methods ; We conducted a prospective cohort study of 6236 pediatric patients enrolled in care and treatment in Dar es Salaam from October 2004 to September 2011. LTFU was defined as missing a clinic visit for >90 days for patients on ART and for >180 days for patients in care and monitoring. The relationship of baseline and time-varying characteristics to risk of LTFU was examined using a Cox proportional hazards model. ; Results ; 2130 children (34%) were LTFU over a median follow up of 16.7 months (IQR, 3.4–36.9). Factors independently associated with a higher risk of LTFU were age 2 years (RR=1.59, 95% CI 1.40–1.80), diarrhea at enrollment (RR=1.20, 95% CI 1.03–1.41), a low mid-upper arm circumference for age (RR=1.20, CI 1.05–1.37), eating protein 3 times a week (RR=1.39, 95% CI 1.05–1.90), taking cotrimoxazole (RR=1.39, 95% CI 1.06–1.81), initiating onto antiretrovirals (RR=1.37, 95% CI 1.17–1.61), receiving treatment at a hospital instead of a local facility (RR=1.39, 95% CI 1.06–1.41), and starting treatment in 2006 or later (RR=1.10, 95% CI 1.04–1.16). ; Conclusions ; Health workers should be aware of pediatric patients who are at greatest risk of LTFU, such as younger and undernourished patients, so that they can proactively counsel families about the importance of visit adherence. Findings support decentralization of HIV care to local facilities as opposed to hospitals.
• Keywords:
  • Africa
  • Tanzania
  • antiretroviral therapy
  • pediatrics
  • HIV/AIDS
  • adherence
  • Anti-HIV Agents
  • Child
  • Child Nutritional Physiological Phenomena
  • Child, Preschool
  More +
• Source:
  J Acquir Immune Defic Syndr. 70(3):e73-e83
• Pubmed ID:
  26247894
• Pubmed Central ID:
  PMC4650894
• Document Type:
  Journal Article
• Funding:
  K24 HD058795/HD/NICHD NIH HHSUnited States/ ; K24 DK104676/DK/NIDDK NIH HHSUnited States/ ; R01 HD043688-01/HD/NICHD NIH HHSUnited States/ ; U2G PS001966/PS/NCHHSTP CDC HHSUnited States/ ; R01 HD043688/HD/NICHD NIH HHSUnited States/ ; K24HD058795/HD/NICHD NIH HHSUnited States/ ; 5U2GPS001966-04/PHS HHSUnited States/
• Volume:
  70
• Issue:
  3
• Download URL:
  https://stacks.cdc.gov/view/cdc/36503/cdc_36503_DS1.pdf
• File Type:
  [PDF - 602.38 KB]
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:2057df98b73a67a2175c97349330f825a57006596aa977f22808c24b71b08029