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Outcomes Among Children Enrolled in HIV Care in Mozambique 2009-2013
Chloe A Teasdale1, Jingyan Yang, Beatriz Thome
1From the *ICAP-Columbia University, †Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York; and ‡US Centers for Disease Control and Prevention, Maputo, Mozambique.
Insights
High rates of children lost to follow-up (LTF) were observed in Mozambique for HIV care and antiretroviral therapy (ART). Urgent interventions are needed to improve retention in routine HIV care for pediatric patients.
Area of Science:
- Pediatric HIV/AIDS care
- Public Health
- Epidemiology
Background:
- Scaling up pediatric HIV care and antiretroviral therapy (ART) has improved access but faces persistent gaps.
- Significant challenges in retaining children in HIV care remain, particularly in resource-limited settings.
Purpose of the Study:
- To examine rates of loss to follow-up (LTF) and mortality in a large cohort of children receiving HIV care in Mozambique.
- To identify trends in LTF and mortality before and after initiating ART.
Main Methods:
- Utilized routinely collected medical data from children aged 0-14 years enrolled in HIV care between 2009-2013.
- Defined LTF based on visit frequency (12 months pre-ART, 6 months on ART).
- Employed competing risk and Kaplan-Meier estimators to assess LTF and mortality.
Main Results:
- A total of 13,695 children were enrolled; 7733 initiated ART.
- Cumulative incidence of pre-ART LTF was 32.9% at 12 months and 34.4% at 24 months, highest in children under 5.
- On ART, LTF reached 28.6% at 12 months and 37.6% at 24 months, with 12-month mortality at 8.0%.
Conclusions:
- High rates of LTF were observed in HIV-infected children in Mozambique, both before and after ART initiation.
- These findings underscore the critical need for interventions to enhance retention in pediatric HIV care.
- Improving patient retention is essential for effective long-term management of HIV in children.
Background:
Scale-up of HIV care and antiretroviral therapy (ART) services for children has expanded access, but significant gaps and challenges remain. We examined lost to follow-up (LTF) and mortality in a large cohort of children enrolled in HIV care in Mozambique.
Methods:
Routinely collected medical data on children 0-14 years enrolled in care 2009-2013 at ICAP-supported health facilities in 5 provinces of Mozambique were used. Children not receiving ART (pre-ART) were considered LTF if they did not a have a visit within 12 months of the end of data collection; for those receiving ART, LTF was no visit within 6 months. Competing risk and Kaplan-Meier estimators were used, respectively, to estimate pre-ART and on ART LTF and mortality.
Results:
A total of 13,695 children enrolled in HIV care at 64 health facilities (48.6%, <2 years), and 7733 (56.5%) initiated ART during follow-up. Cumulative incidence of pre-ART LTF was 32.9% [95% confidence interval (CI): 32.1-33.7] and 34.4% (95% CI: 33.6-35.2) by 12 and 24 months, respectively, and was highest in children <5 years (12-month LTF in children 2-4 years, 34.2%, 95% CI: 32.6-35.9). Pre-ART mortality at 12 months was 3.3% (95% CI: 3.0-3.6) and was highest in children <2 years (4.1%, 95% CI: 3.6-4.6). On ART, LTF was 28.6% (95% CI: 27.6-29.7) and 37.6 (95% CI: 36.4-38.8) at 12 and 24 months, and 12 months mortality after ART was 8.0% (95% CI: 7.3-8.7).
Conclusions:
High rates of LTF were observed in this large cohort of HIV-infected children accessing care in Mozambique both before and after ART initiation highlighting the urgent need for interventions to improve retention in routine care settings.
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