Temporal Improvements in Long-term Outcome in Care Among HIV-infected Children Enrolled in Public Antiretroviral Treatment Care

Makadzange, Tariro; Dougherty, Leanne; Birri, Rutendo; Kupakuwana, Gillian V.; Dijk, Janneke van; Bwakura-Dangarembizi, Mutsa; Mothobi, Nomvuyo; Phelps, B. Ryan; Ojikutu, Bisola; Ndhlovu, Chiratidzo E.

doi:10.1097/inf.0000000000001903

Cited by 1 publication

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“…Nearly half of the children had moderate to severe immunosuppression at enrollment in care. Similar levels in other pediatric cohorts from Mozambique in 2013 (22) and other sub-Saharan African countries in 2004-2012 (23) suggest little improvement over time. Another 20% were missing a CD4 result, which could indicate a lower quality of care and it was associated with a 2.3 higher risk of LTFU as compared to nonimmunosuppressed children.…”

Section: Discussionmentioning

confidence: 56%

Pediatric HIV Care Cascade in Southern Mozambique: Missed Opportunities for Early ART and Re-engagement in Care

Fernández-Luis

Nhampossa

Fuente-Soro

et al. 2020

Pediatric Infectious Disease Journal

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Background: There are 170,000 children living with HIV in 2017 in Mozambique. Scaling-up HIV care requires effective retention along the cascade. We sought to evaluate the pediatric cascade in HIV care at the Manhiça District Hospital. Methods: A prospective cohort of children <15 years was followed from enrollment in HIV care (January 2013 to December 2015) until December 2016. Loss to follow-up (LTFU) was defined as not attending the HIV hospital visits for ≥90 days following last visit attended. Results: From the 438 children included {median age at enrollment in care of 3,6 [interquartile range (IQR): 1.1–8.6] years}, 335 (76%) were antiretroviral therapy (ART) eligible and among those, 263 (78%) started ART at enrollment in HIV care. A total of 362 children initiated ART during the study period and the incidence rate of LTFU at 12, 24, and 36 months post-ART initiation was 41 [95% confidence interval (CI): 34–50], 34 (95% CI: 29–41), and 31 (95% CI: 27–37) per 100 children-years, respectively. Median time to LTFU was 5.8 (IQR: 1.4–12.7) months. Children 5–9 years of age had a lower risk of LTFU compared with children <1 year [adjusted subhazard ratio 0.36 (95% CI: 0.20–0.61)]. Re-engagement in care (RIC) was observed in 25% of the LTFU children. Conclusions: The high LTFU found in this study highlights the special attention that should be given to younger children during the first 6 months post-ART initiation to prevent LTFU. Once LTFU, only a quarter of those children return to the health unit. Elucidating factors associated with RIC could help to fine tune interventions which promote RIC.

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Section: Discussionmentioning

confidence: 56%

Pediatric HIV Care Cascade in Southern Mozambique: Missed Opportunities for Early ART and Re-engagement in Care

Fernández-Luis

Nhampossa

Fuente-Soro

et al. 2020

Pediatric Infectious Disease Journal

View full text Add to dashboard Cite

show abstract

Temporal Improvements in Long-term Outcome in Care Among HIV-infected Children Enrolled in Public Antiretroviral Treatment Care

Abstract: Significant improvements have been made in engaging and retaining children in care in public ART programs in Zimbabwe. Guideline and policy changes that increase access and eligibility will likely to continue to support improvement in pediatric HIV outcomes.

Cited by 1 publication

References 36 publications

Pediatric HIV Care Cascade in Southern Mozambique: Missed Opportunities for Early ART and Re-engagement in Care

Pediatric HIV Care Cascade in Southern Mozambique: Missed Opportunities for Early ART and Re-engagement in Care

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