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Risk and Protective Factors Associated With HIV-Related Mortality in Children Receiving Antiretroviral Therapy: A
Jiawei He1,2, Reshma Kassanjee3, Amanda Movo1
1Institute for Health Metrics and Evaluation, University of Washington, Seattle.
JAMA Pediatrics
|May 4, 2026
Summary
Improving water access, pneumococcal conjugate vaccine third-dose (PCV3) coverage, and maternal education significantly reduces HIV-related mortality in children on antiretroviral therapy (ART). These factors are crucial for global child survival strategies beyond ART alone.
Area of Science:
- Global Health
- Pediatric Infectious Diseases
- Public Health Interventions
Background:
- Child and adolescent mortality on antiretroviral therapy (ART) is higher in resource-limited settings.
- Modifiable risk and protective factors contributing to this disparity are poorly understood.
Purpose of the Study:
- To identify and quantify country-level modifiable factors associated with HIV-related mortality in children and adolescents on ART.
Main Methods:
- Model-based meta-regression analysis of 67 cohort studies.
- Linked HIV mortality data with Global Burden of Diseases, Injuries, and Risk Factors 2023 data.
- Utilized penalized regression (ridge) and XGBoost machine learning algorithms.
Main Results:
- Improved water access, PCV3 coverage, and maternal education showed the strongest protective associations with lower HIV-related mortality.
- A 10% increase in these factors reduced mortality odds (ORs: 0.83, 0.980, 0.997).
- SHAP analyses confirmed these factors as most predictive of mortality outcomes.
Conclusions:
- Integrated public health strategies focusing on water infrastructure, vaccination, and education are vital.
- These interventions can help reduce global survival disparities for children and adolescents with HIV on ART.
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