Abstract
Although antiretroviral therapy (ART) significantly improves the survival status and quality of life among human immunodeficiency virus (HIV)-infected children, loss to follow-up (LTFU) from HIV-care profoundly affecting the treatment outcomes of this vulnerable population. For better interventions, up-to-date information concerning LTFU among HIV-infected children on ART is vital. However, only a few studies have been conducted in Ethiopia to address this concern. Thus, this study aims to identify the predictors of LTFU among HIV-infected children receiving ART at Debre Markos Referral Hospital. An institution-based retrospective follow-up study was done among 408 HIV-infected children receiving ART at Debre Markos Referral Hospital between 2005 and March 15, 2019. Data were abstracted from the medical records of HIV-infected children using a standardized data abstracted checklist. We used Epi-Data Version 3.1 for data entry and Stata Version 14 for statistical analysis. The Kaplan-Meier survival curve was used to estimate the survival time. A generalized log-rank test was used to compare the survival curves of different categorical variables. Finally, both bi-variable and multivariable Cox proportional hazard regression models were used to identify the predictors of LTFU. Of 408 HIV-infected children included in the final analysis, 70 (17.1%) children were LTFU at the end of the study. The overall incidence rate of LTFU among HIV-infected children was found to be 4.5 (95%CI: 3.5-5.7) per 100-child years of observation. HIV-infected children living in rural areas (AHR: 3.2, 95%CI: 2.0-5.3), having fair or poor ART drug adherence (AHR: 2.3, 95%CI: 1.4-3.7), children started ART through test and treat approach (AHR: 2.7, 95%CI: 1.4-5.5), and children started protease inhibiter (PI)-based ART regimens (AHR: 2.2, 95%CI: 1.1-4.4) were at higher risk of LTFU. This study found that one in every six HIV-infected children lost form ART follow-up. HIV-infected children living in rural areas, having fair or poor ART drug adherence, started ART based on test and treat approach, and taking PI-based ART regimens were at higher risk of LTFU.
Highlights
Though the concept of “child at risk” highly varies across the continents, in Africa, it commonly refers to socially disadvantaged children, including human immunodeficiency virus (HIV) exposed infants [1]
This study found that one in every six HIV-infected children lost form Antiretroviral therapy (ART) follow-up
HIVinfected children living in rural areas, having fair or poor ART drug adherence, started ART based on test and treat approach, and taking PI-based ART regimens were at higher risk of loss to follow-up (LTFU)
Summary
Though the concept of “child at risk” highly varies across the continents, in Africa, it commonly refers to socially disadvantaged children, including human immunodeficiency virus (HIV) exposed infants [1]. HIV is a global challenge for humankind’s survival, as Sub-Saharan Africa (SSA) is profoundly affected. In 2014, 87% of new HIV infections and 86% of AIDSrelated deaths among children were from SSA [3, 4]. Ethiopia is one of the SSA countries with a high HIV prevalence; nearly 62,000 children were living with HIV in 2017 [5, 6]. Antiretroviral therapy (ART) improves the survival status and quality of life among HIV-infected children through viral load suppression and increasing CD4 counts [7]. Antiretroviral therapy (ART) significantly improves the survival status and quality of life among human immunodeficiency virus (HIV)-infected children, loss to follow-up (LTFU) from HIV-care profoundly affecting the treatment outcomes of this vulnerable population. Up-to-date information concerning LTFU among HIV-infected children on ART is vital.
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