Factors Determining Survival and Retention among HIV-Infected Children and Adolescents in a Community Home-Based Care and a Facility-Based Family-Centred Approach in Kampala, Uganda: A Cohort Study

Abstract

We describe factors determining retention and survival among HIV-infected children and adolescents engaged in two health care delivery models in Kampala, Uganda: one is a community home-based care (CHBC) and the other is a facility-based family-centred approach (FBFCA). This retrospective cohort study reviewed records from children aged from 0 to 18 years engaged in the two models from 2003 to 2010 focussing on retention/loss to follow-up, mortality, use of antiretroviral therapy (ART), and clinical characteristics. Kaplan Meier survival curves with log rank tests were used to describe and compare retention and survival. Overall, 1,623 children were included, 90.0% (1460/1623) from the CHBC. Children completed an average of 4.2 years of follow-up (maximum 7.7 years). Median age was 53 (IQR: 11–109) months at enrolment. In the CHBC, retention differed significantly between patients on ART and those not (log-rank test, adjusted, P < 0.001). Comparing ART patients in both models, there was no significant difference in long-term survival (log-rank test, P = 0.308, adjusted, P = 0.489), while retention was higher in the CHBC: 94.8% versus 84.7% in the FBFCA (log-rank test, P < 0.001, adjusted P = 0.006). Irrespective of model of care, children receiving ART had better retention in care and survival.

Community-Based ART Programs: Sustaining Adherence and Follow-up

“…Similarly, a matched retrospective cohort study in 10 provinces of Mozambique demonstrated lower lost-to-follow-up rates among patients in Community Adherence and Support Groups than among those in individual care (11 versus 26 %) and lower overall attrition (12 versus 28 %), but similar mortality (1 % in both cohorts) [26]. Other studies have shown similar improvement in retention associated with community-based support but without clear mortality benefit [27, 28]. Only one recent study saw an improvement in mortality associated with community-based support, namely a descriptive case study of a community home-based care organization in Swaziland that provided individual and household support for ART adherence.…”

Outcomes of Paediatrics HIV care at the University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu after ten years of service

“…Adults were more likely to be initiated into HAART than children. 9 This obviously contributed to high rates of deaths and lost-to-follow up among ARV naïve children. In this study, disclosure of HIV status to the child ensured adherence to care and treatment.…”

“…Treatment-eligible children living with HIV in sub-Saharan Africa are only about half as likely to receive antiretroviral therapy as HIV-positive adults. 9 Non-disclosure of HIV status to peri-natally infected children and adolescents is still a major concern in the sub-region. These have implications for adherence and treatment failure.…”

Loss to follow-up among children in pre-ART care under the National AIDS Programme, Tamil Nadu, South India

“…Previous studies have shown better patient retention among those who are on ART compared to those in pre-ART care. 5,15 If we adopt the new WHO policy of universal ART, 16 the need for pre-ART care would be limited. In the study setting, this would mean that an additional one third of children will become eligible for ART, which has resource implications.…”