23111575

PMC5094048

Background

Retention of children in HIV care is essential for prevention of disease progression and mortality.

Methods

Retrospective cohort of children (0 to <15 years) initiating antiretroviral treatment (ART) at health facilities in Kenya, Mozambique, Rwanda and Tanzania, January 2005–June 2011. Retention was defined as the proportion of children known to be alive and attending care at their initiation facility; lost to follow-up (LTF) was defined as no clinic visit for > 6 months. Cumulative incidence of ascertained survival and retention after ART initiation was estimated through 24 months using Kaplan-Meier methods. Factors associated with LTF and death were assessed using Cox proportional hazard modeling.

Results

17,712 children initiated ART at 192 facilities: median age was 4.6 years (IQR: 1.9–8.3), median CD4 was 15% (IQR: 10–20) for children < 5 years and 265 cells/uL (IQR: 111–461) for children ≥ 5 years. At 12 and 24 months, 80% and 72% of children were retained with 16% and 22% LTF and 5% and 7% known deaths respectively. Retention ranged from 71–95% and 62–93% at 12 and 24 months across countries, and was lowest for children < 1 year (51% at 24 months). LTF and death were highest in children < 1 year of age and children with advanced disease.

Conclusion

Retention was lowest in young children and differed across country programs. Young children and those with advanced disease are at highest risk for LTF and death. Further evaluation of patient- and program-level factors is needed to improve health outcomes.

CDC Public Access

U2G PS001537/PS/NCHHSTP CDC HHS/United States
5U2GPS001537-03/PHS HHS/United States