Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Oct 20;9(10):e110116.
doi: 10.1371/journal.pone.0110116. eCollection 2014.

Poor clinical outcomes for HIV infected children on antiretroviral therapy in rural Mozambique: need for program quality improvement and community engagement

Sten H Vermund  1 , Meridith Blevins  2 , Troy D Moon  1 , Eurico José  3 , Linda Moiane  3 , José A Tique  4 , Mohsin Sidat  5 , Philip J Ciampa  6 , Bryan E Shepherd  2 , Lara M E Vaz  7
Affiliations

Poor clinical outcomes for HIV infected children on antiretroviral therapy in rural Mozambique: need for program quality improvement and community engagement

Sten H Vermund et al. PLoS One. .

Abstract

Introduction: Residents of Zambézia Province, Mozambique live from rural subsistence farming and fishing. The 2009 provincial HIV prevalence for adults 15-49 years was 12.6%, higher among women (15.3%) than men (8.9%). We reviewed clinical data to assess outcomes for HIV-infected children on combination antiretroviral therapy (cART) in a highly resource-limited setting.

Methods: We studied rates of 2-year mortality and loss to follow-up (LTFU) for children <15 years of age initiating cART between June 2006-July 2011 in 10 rural districts. National guidelines define LTFU as >60 days following last-scheduled medication pickup. Kaplan-Meier estimates to compute mortality assumed non-informative censoring. Cumulative LTFU incidence calculations treated death as a competing risk.

Results: Of 753 children, 29.0% (95% CI: 24.5, 33.2) were confirmed dead by 2 years and 39.0% (95% CI: 34.8, 42.9) were LTFU with unknown clinical outcomes. The cohort mortality rate was 8.4% (95% CI: 6.3, 10.4) after 90 days on cART and 19.2% (95% CI: 16.0, 22.3) after 365 days. Higher hemoglobin at cART initiation was associated with being alive and on cART at 2 years (alive: 9.3 g/dL vs. dead or LTFU: 8.3-8.4 g/dL, p<0.01). Cotrimoxazole use within 90 days of ART initiation was associated with improved 2-year outcomes Treatment was initiated late (WHO stage III/IV) among 48% of the children with WHO stage recorded in their records. Marked heterogeneity in outcomes by district was noted (p<0.001).

Conclusions: We found poor clinical and programmatic outcomes among children taking cART in rural Mozambique. Expanded testing, early infant diagnosis, counseling/support services, case finding, and outreach are insufficiently implemented. Our quality improvement efforts seek to better link pregnancy and HIV services, expand coverage and timeliness of infant diagnosis and treatment, and increase follow-up and adherence.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: Dr. Vermund is a member of the PLOS ONE editorial board. This does not alter the authors’ adherence to PLOS ONE editorial policies and criteria.

Figures

Figure 1
Figure 1. Variation by district in pediatric loss to follow up (LTFU), death, and death or LTFU for 2 years following combination antiretroviral therapy initiation, 10 districts of Zambézia Province, Mozambique, 2006–2011.
See this image and copyright information in PMC

References

    1. Ministério da Saúde Instituto Nacional de Saúde (INS), Instituto Nacional de Estatística (INE), ICF Macro (2010) Inquérito Nacional de Prevalência, Riscos Comportamentais e Informação sobre o HIV e SIDA (INSIDA) em Moçambique 2009. Calverton, Maryland, EUA: INS, INE, e ICF Macro.
    1. Auld AF, Mbofana F, Shiraishi RW, Sanchez M, Alfredo C, et al. (2011) Four-year treatment outcomes of adult patients enrolled in Mozambique’s rapidly expanding antiretroviral therapy program. PLoS One 6: e18453. - PMC - PubMed
    1. U.S. State Department (2011) The United States President’s Emergency Plan for AIDS Relief.
    1. Republic of Mozambique, National AIDS Council, CNCS (2012) 2012 Global AIDS Response Progress Report for the Period 2010–2011. Mozambique: Ministério da Saúde Instituto Nacional de Saúde (INS).
    1. National Public Health Directorate MoH, Republic of Mozambique (2011) Preliminary Report of the National Evaluation of the Prevention of Mother-to-Child Transmission Program.

Publication types

Substances