Related Experiment Video
Updated: Apr 5, 2026
Humanized NOD/SCID/IL2rγnull (hu-NSG) Mouse Model for HIV Replication and Latency Studies
Published on: January 7, 2019
Long-term outcomes of a pediatric HIV treatment program in Maputo, Mozambique: a cohort study
Jan Walter1, Lucas Molfino2, Verena Moreno1
1Médecins Sans Frontières, Maputo, Mozambique.
Insights
Long-term pediatric HIV treatment in Mozambique shows improved retention in care with antiretroviral therapy (ART). Despite health worker shortages, ART significantly enhances clinical and immunological outcomes for children.
Area of Science:
- Pediatric Infectious Diseases
- Public Health
- HIV/AIDS Research
Background:
- Mozambique faces significant challenges in pediatric HIV care, including limited healthcare resources.
- Task-shifting and integrated support services have been implemented to manage a large pediatric HIV cohort.
Purpose of the Study:
- To evaluate the long-term clinical and immunological outcomes for children <15 years old receiving HIV care in Mozambique.
- To assess the effectiveness of antiretroviral treatment (ART) and associated care strategies in a resource-limited setting.
Main Methods:
- Retrospective analysis of routine monitoring data from secondary health facilities.
- Inclusion of 1,335 ART-naïve children enrolled between 2002 and 2010.
- Analysis of retention in care, CD4 cell percentage, BMI z-score, and attrition using Kaplan-Meier and Poisson regression.
Main Results:
- Retention in care at 8 years was significantly higher in the ART cohort (70%) compared to the pre-ART cohort (44%).
- ART initiation led to substantial improvements in CD4 cell percentage and body mass index z-score within the first year.
- Risk factors for attrition included younger age, low CD4 count, underweight status, active tuberculosis, and later treatment initiation.
Conclusions:
- Long-term ART provides good clinical and immunological outcomes for pediatric HIV patients in resource-limited settings.
- Task-shifting and comprehensive support services are effective strategies for managing pediatric HIV care despite health worker shortages.
Objective:
To describe long-term treatment outcomes of a pediatric HIV cohort in Mozambique.
Design:
Retrospective analysis of routine monitoring data.
Setting:
Secondary health care facilities in the Chamanculo Health District of Maputo.
Subjects:
A total of 1,335 antiretroviral treatment (ART) naïve children <15 years of age enrolled in HIV care between 2002 and 2010.
Intervention:
HIV care, ART (since 2003), task shifting to lower cadre nurses, counseling by lay counselors, active patient tracing, nutritional support, support by a psychologist, targeted viral load testing, and switch to second-line treatment.
Main Outcome Measures:
Kaplan-Meier estimates for retention in care (RIC), CD4 cell percentage, body mass index for age z-score, and adjusted incidence rate ratios for attrition (death or loss to follow-up) as calculated by Poisson regression.
Results:
The RIC at 6 years in the pre-ART cohort was 44% (95% confidence interval: 38-49), and the one at 8 years in the ART cohort was 70% (64-75). Risk factors for attrition included young age, low CD4 percentage, underweight, active tuberculosis, and enrollment/treatment initiation after 2006. The mean CD4 percentage increased strongly at 1 year on treatment and remained high thereafter. The body mass index for age z-score sharply increased at 1 year after treatment initiation before stabilizing at pre-ART levels thereafter.
Conclusions:
Good clinical and immunological treatment outcomes up to 8 years of follow-up on ART can be achieved in a context of shortage of health workers and a high level of task-shifting approach.
Related Concept Videos
01:10Retrovirus Life Cycles
01:26Pharmacokinetics in Pediatric Patients: Drug Excretion