Abstract
The objective of the study was to determine predictors of survival among HIV-positive children (<15 years) in Swaziland. A retrospective cohort analysis of medical records for 4 167 children living with HIV who were initiated on antiretroviral therapy (ART) between 2004 and 2008, and followed up until 2014 was conducted in clinical settings at 36 health facilities. The Kaplan Meier Estimator, signed-ranks test, and the Cox proportional hazards regression model were applied to determine survival probabilities, significant difference among stratified survival functions and adjusted hazard ratios respectively. The results reveal that the median survival time for children was 78 months (95% CI: 77–79). Children who were initiated early on ART had higher survival probability over time (HR: 0.35 [95% CI: 0.21–0.57], p < 0.001) compared to those whose ART initiation was delayed. Children within the age group of <1 years had higher hazard (HR = 1.55 [95% CI: 1.16–2.08], p < 0.001) of death than children within the age group of 1–14 years. Children who were nourished had 88% lower hazard of death (HR: 0.12 [95% CI: 0.07–0.19], p < 0.001) than severely malnourished children. The study demonstrates that ART paediatric services are effective in increasing survival among HIV infected children and early initiated children have high survival probability. Active tuberculosis (TB), malnutrition, and delayed ART initiation remain predictors of poor survival among children living with HIV.
Highlights
91% of the estimated 3.4 million HIV infected children in the world live in in sub-Saharan Africa, and these children have exceptionally high risk of mortality in absence of any intervention, according to the World Health Organization (WHO, 2013a) and the United Nations Programme on HIV/AIDS (UNAIDS, 2013)
The specific objectives of the study were to: (i) determine clinical outcomes of children on antiretroviral therapy (ART) using immunological response, which was measured as CD4% for children
The results show that children who were on D4T+3TC+EFV (HR: 1.14[95% CI: 0.76–1.67], p = 0.528) and AZT+3TC+EFV (HR: 1.21 [95% CI: 0.77–1.88], p = 0.416) had survival probability that was constantly lower over time than those who were on ABC+3TC+EFV
Summary
91% of the estimated 3.4 million HIV infected children in the world live in in sub-Saharan Africa, and these children have exceptionally high risk of mortality in absence of any intervention, according to the World Health Organization (WHO, 2013a) and the United Nations Programme on HIV/AIDS (UNAIDS, 2013). Up to 52% of HIV infected children born to HIV infected mothers die before the age of 2 years in the absence of prevention of mother-to-child treatment (PMTCT) (Newell et al, 2004) In response to this problem of high mortality among HIV infected children, countries in sub-Saharan Africa have made paediatric HIV care an essential component of HIV, and maternal child and health (MCH) programmes, including early diagnosis of exposed infants to ensure early identification of children living with HIV. This article is a contribution to expanding the literature in sub-Saharan Africa, information that will improve HIV programming among children living with HIV It presents the findings of a retrospective cohort study of 4 167 children in Swaziland who were initiated on ART between 2004 and 2008, and were followed up until 2014
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