Outcomes among HIV-infected children initiating HIV care and antiretroviral treatment in Ethiopia

Abstract

Objective: To describe pediatric ART scale-up in Ethiopia, one of the 21 global priority countries for elimination of pediatric HIV infection.

Methods: A descriptive analysis of routinely collected HIV care and treatment data on HIV-infected children (<15 years) enrolled at 70 health facilities in four regions in Ethiopia, January 2006-September 2013. Characteristics at enrollment and ART initiation are described along with outcomes at 1 year after enrollment. Among children who initiated ART, cumulative incidence of death and loss to follow-up (LTF) were estimated using survival analysis.

Results: 11 695 children 0-14 years were enrolled in HIV care and 6815 (58.3%) initiated ART. At enrollment, 31.2% were WHO stage III and 6.3% stage IV. The majority (87.9%) were enrolled in secondary or tertiary facilities. At 1 year after enrollment, 17.9% of children were LTF prior to ART initiation. Among children initiating ART, cumulative incidence of death was 3.4%, 4.1% and 4.8%, and cumulative incidence of LTF was 7.7%, 11.8% and 16.6% at 6, 12 and 24 months, respectively. Children <2 years had higher risk of LTF and death than older children (P < 0.0001). Children with more advanced disease and those enrolled in rural settings were more likely to die. Children enrolled in more recent years were less likely to die but more likely to be LTF.

Conclusions: Over the last decade large numbers of HIV-infected children have been successfully enrolled in HIV care and initiated on ART in Ethiopia. Retention prior to and after ART initiation remains a major challenge.

Keywords: VIH pediátrico; VIH pédiatrique; ART scale-up; Ethiopia; Ethiopie; Etiopía; HIV retention; ampliación del TAR; antiretroviral treatment; déploiement de l’ART; paediatric HIV; retención en VIH; rétention VIH; traitement antirétroviral; tratamiento antirretroviral.

Figure 1

Median CD4+ cell count (cells/mm³) at enrolment and ART initiation among paediatric patients in Ethiopia between 2006 and 2012. Key: Black lines refer to patients aged 0–4 years and grey lines to patients aged 5–14 years. Solid lines represent median CD4+ cell count at enrolment into HIV care and dotted lines represent median CD4+ cell count at ART initiation.

Figure 2

Cumulative incidence of recorded death and loss to follow-up after ART initiation. (a) Cumulative incidence of recorded death, LTF and attrition (all age groups). (b) Cumulative incidence of recorded death. (c) Cumulative incidence of LTF.