Abstract
Current UNAIDS goals aimed to end the AIDS epidemic set out to ensure that 90% of all people living with HIV know their status, 90% initiate and continue life-long anti-retroviral therapy (ART), and 90% achieve viral load suppression. In 2014 there were an estimated 2.6 million children under 15 years of age living with HIV, of which only one-third were receiving ART. Little literature exists describing retention of HIV-infected children in the first year on ART. We conducted a systematic search for English language publications reporting on retention of children with median age at ART initiation less than ten years in resource limited settings. The proportion of children retained in care on ART and predictors of attrition were identified. Twelve studies documented retention at one year ranging from 71–95% amongst 31877 African children. Among the 5558 children not retained, 4082 (73%) were reported as lost to follow up (LFU) and 1476 (27%) were confirmed to have died. No studies confirmed the outcomes of children LFU. Predictors of attrition included younger age, shorter duration of time on ART, and severe immunosuppression. In conclusion, significant attrition occurs in children in the first 12 months after ART initiation, the majority attributed to LFU, although true outcomes of children labeled as LFU are unknown. Focused efforts to ensure retention and minimize early mortality are needed as universal ART for children is scaled up.
Highlights
In 2014, the Joint United Nations Programme on HIV/AIDS (UNAIDS) outlined ambitious targets to end the HIV epidemic by ensuring that 90% of people living with HIV know their diagnosis, 90% of those diagnosed receive sustained anti-retroviral therapy (ART), and 90% on ART achieve viral suppression
While post-ART retention in care has been well described in adults, it has only been systematically reviewed in children in a single report by Fox and Rosen. [9,10,11,12] The authors reported a 12 month retention rate on ART of 85% for all children and youth
A total of 5,790 articles were identified through electronic bibliographic databases and reference review. (Fig 1) After removing duplicates, 3,189 were screened, identifying 164 full text articles of which 35 published between 2006 and 2014 met inclusion criteria for this systematic review
Summary
In 2014, the Joint United Nations Programme on HIV/AIDS (UNAIDS) outlined ambitious targets to end the HIV epidemic by ensuring that 90% of people living with HIV know their diagnosis, 90% of those diagnosed receive sustained anti-retroviral therapy (ART), and 90% on ART achieve viral suppression (the so-called 90-90-90 goals). [1] In the same year, UNAIDSPLOS ONE | DOI:10.1371/journal.pone.0156506 June 9, 2016Retention of HIV-Infected Children on ART estimated that there were 2.6 million children under 15 years of age living with HIV, the majority of whom are living in resource limited settings (RLS). [2] In 2013, the World Health Organization (WHO) expanded the number of children recommended to initiate ART, including all those under 5 years of age. [2, 3] In response to results from the Strategic Timing of Antiretroviral Treatment (START) trial demonstrating benefit to early initiation of ART, WHO released rapid advice in September 2015 recommending that all people living with HIV be offered ART. [4,5,6] Despite these recommendations, only one out of three HIV-infected children is currently receiving ART by best estimates. [2]In order to achieve 90-90-90 targets for children, HIV-infected children must be identified, linked to care, initiated on ART, retained in care, and achieve sustained virologic suppression. [7] the HIV treatment cascade is not well characterized in children. Retention of HIV-Infected Children on ART estimated that there were 2.6 million children under 15 years of age living with HIV, the majority of whom are living in resource limited settings (RLS). [9,10,11,12] The authors reported a 12 month retention rate on ART of 85% for all children and youth
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