Survival outcomes of hiv exposed and HIV infected children
Mutanga, Jane Namangolwa
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Statement of the Problem: Despite expanded pediatric antiretroviral therapy (ART) coverage, there is paucity of information on effectiveness of the pediatric ART programs in reducing mortality and morbidity among HIV infected children in high HIV burden settings. The goal of this research is to evaluate treatment outcomes and generate program relevant information to improve ART outcomes for infants and children in Zambia and similar settings. Methods: Using a retrospective cohort study design, we abstracted data from medical records of HIV infected children who received ART and HIV exposed infants who had dry blood spots done for HIV diagnosis using DNA-PCR at Livingstone Central Hospital in Zambia. We carried out descriptive analysis and estimated distributions of survival times for the baseline covariates using the Kaplan-Meier (KM) method. Log-rank tests were used to compare the survival curves. Cox Proportional Hazards models were used to estimate the hazard ratios Results: 3,301 dry blood spot tests were collected from HIV exposed infants and data were abstracted from medical records of 1045 children aged from birth to 20 years who were enrolled in HIV care for 4450-person years between 2003 and 2015. 71 (7%) died, 167 (16%) were lost to follow-up and 216 (20%) were transferred to other health facilities. 17% of the infants tested at birth were HIV infected. MTCT rate declined from 19% in 2009 to 1.4% in 2016. Mortality and loss to follow-up were highest within the first 3 months of treatment (30% and 40% respectively). Younger age at enrollment (<5 years), (HR=3.1 [1.3-6.4]) and WHO stage 4 (HR =4.8 [2.3-10]), were predictive of mortality. Incidence of loss to follow-up declined from 29/100-person years in 2004 to 1.6/100-person years in 2014. Risk factors for loss to follow-up were; 1) lack of disclosure of HIV status to older children at baseline, HR=1.9(1.2-2.9), 2) no phone, HR=2.1(1.6-2.9), 3) starting treatment between 2012 to 2014 HR=5.6 (2.2-14.1). Conclusion: Birth testing HIV exposed infants is a high yield strategy for early infant diagnosis. Pretreatment screening and engagement in care among children commencing cART needs to be strengthened.