Factors Associated with Treatment Outcomes Among Children and Adolescents Living with HIV Receiving Antiretroviral Therapy in Central Kenya

Abstract

Expanded access to HIV treatment services has improved outcomes for children and adolescents living with HIV in Kenya. Minimal data are available on these outcomes. We describe temporal trends in outcomes for children and adolescents initiating antiretroviral therapy (ART) from 2004 to 2014 at sites supported by Centre for Health Solutions-Kenya, in central Kenya. We retrospectively analyzed data from children 0-9 years of age (n = 3,519) and adolescents 10-19 years of age (n = 1,663) living with HIV, who newly initiated ART at 47 health facilities in central Kenya. Year cohorts were analyzed from the Comprehensive Patient Application Database (CPAD) and International Quality Care (IQCare) electronic medical databases, including temporal trends in outcomes and associated factors using multivariable competing risk regression analysis. There were more girls (2,453 [52.7%]) than boys, with most enrolled at World Health Organization (WHO) stage II (1,813 [37.7%]) or III disease (1,694 [35.1%]). Most of the children and adolescents (4,431 [96.4%]) did not have tuberculosis (TB) symptoms. Cumulative lost to follow-up (LTFU) incidence at 6, 12, 24, and 36 months were 5.0%, 9.9%, 22.9%, and 33.1%, respectively. Cumulative mortality incidence at 6, 12, 24, and 36 months were 0.7%, 1.0%, 1.2%, and 1.5%, respectively. The incidence of LTFU was higher among female children and adolescents, those initiated on tenofovir-based regimens, and those with presumptive TB symptoms. Mortality risk was higher among those with WHO stage III or IV disease, and children and adolescents on TB treatment or who had presumptive TB. Enrollment occurred at a young age and pediatric-friendly ART regimens were initiated at earlier WHO stages implying effective early infant diagnosis and treatment for all strategies, resulting in improved treatment outcomes. The higher retention rates in recent years as well as the lower retention after many years of follow-up underscore the importance of implementing longitudinal follow-up strategies targeting this population.

Keywords: HIV positive; Kenya; adolescents; antiretroviral therapy; pediatric; treatment outcomes.

FIG. 1.

Flow diagram of children and adolescents initiating ART in central Kenya (2004–2014). ART, antiretroviral therapy.

FIG. 2.

Overall cumulative incidence of mortality among children and adolescents initiating ART in central Kenya (2004–2014).

FIG. 3.

Overall cumulative incidence of being lost to follow-up among children and adolescents initiating ART in central Kenya (2004–2014).

FIG. 4.

Cumulative incidence of mortality by sex, age, and WHO stage among children and adolescents initiating ART in central Kenya (2004–2014).

FIG. 5.

Cumulative incidence of being LTFU by sex, D4T, TDF, and TB status among children and adolescents initiating ART in central Kenya (2004–2014). LTFU, lost to follow-up; TB, tuberculosis; TDF, tenofovir.