Mortality Among Children Aged <5 Years Living with HIV Who Are Receiving Antiretroviral Treatment - U.S. President's Emergency Plan for AIDS Relief, 28 Supported Countries and Regions, October 2020-September 2022

Abstract

Globally, children aged <5 years, including those living with HIV who are not receiving antiretroviral treatment (ART), experience disproportionately high mortality. Global mortality among children living with HIV aged <5 years receiving ART is not well described. This report compares mortality and related clinical measures among infants aged <1 year and children aged 1-4 years living with HIV with those among older persons aged 5-14, 15-49, and ≥50 years living with HIV receiving ART services at all clinical sites supported by the U.S. President's Emergency Plan for AIDS Relief. During October 2020-September 2022, an average of 11,980 infants aged <1 year and 105,510 children aged 1-4 years were receiving ART each quarter; among these infants and children receiving ART, 586 (4.9%) and 2,684 (2.5%), respectively, were reported to have died annually. These proportions of infants and children who died ranged from four to nine times higher in infants aged <1 year, and two to five times higher in children aged 1-4 years, than the proportions of older persons aged ≥5 years receiving ART. Compared with persons aged ≥5 years living with HIV, the proportions of children aged <5 years living with HIV who experienced interruptions in treatment were also higher, and the proportions who had a documented HIV viral load result or a suppressed viral load were lower. Prioritizing and optimizing HIV and general health services for children aged <5 years living with HIV receiving ART, including those recommended in the WHO STOP AIDS Package, might help address these disproportionately poorer outcomes.

FIGURE

Annual percentage of reported deaths among persons living with HIV and receiving antiretroviral treatment — U.S. President’s Emergency Plan for AIDS Relief, 28 supported countries and regions, 2021–2022 Abbreviations: ART = antiretroviral therapy; PEPFAR = U.S. President’s Emergency Plan for AIDS Relief. * Percentage of reported deaths was calculated for fiscal years 2021 and 2022 by summing the reported number of deaths across the four quarters and dividing by the mean number of persons living with HIV receiving ART estimated from each of the four quarters. The number of persons living with HIV receiving ART estimated from each quarter equals the number of persons living with HIV reported to be newly initiated on ART in the current quarterly reporting period plus the number reported to be receiving ART at the end of the previous quarterly reporting period. ^† Sites from 25 PEPFAR-supported countries and three PEPFAR-supported regions were included in this analysis. The 25 countries include Angola, Botswana, Burundi, Cameroon, Côte d’Ivoire, Democratic Republic of the Congo, Dominican Republic, Eswatini, Ethiopia, Haiti, Kenya, Lesotho, Malawi, Mozambique, Namibia, Nigeria, Rwanda, South Africa, South Sudan, Tanzania, Uganda, Ukraine, Vietnam, Zambia, and Zimbabwe. The three regions include Asia Region (Burma, India, Indonesia, Kazakhstan, Kyrgyzstan, Laos, Nepal, Papua New Guinea, Philippines, Tajikistan, and Thailand), West Africa Region (Benin, Burkina Faso, Ghana, Liberia, Mali, Senegal, Sierra Leone, and Togo), and Western Hemisphere Region (Barbados, Brazil, Colombia, El Salvador, Guatemala, Guyana, Honduras, Jamaica, Nicaragua, Panama, Peru, and Trinidad and Tobago). ^§ 2021–2022 represents fiscal years, which start in the previous October (e.g., October 2021–September 2022 represents 2022).