Long-term survival outcomes of HIV infected children receiving antiretroviral therapy: an observational study from Zambia (2003–2015)
Abstract Background In 2017, 64% of children living with HIV in Zambia accessed Antiretroviral Therapy (ART). Despite expanded ART coverage, there is paucity of information on effectiveness of pediatric ART in reducing mortality. The aim of this research is to describe treatment outcomes, measure mo...
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| Format: | Article |
| Language: | English |
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BMC
2019-01-01
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| Series: | BMC Public Health |
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| Online Access: | http://link.springer.com/article/10.1186/s12889-019-6444-7 |
| _version_ | 1828749607249641472 |
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| author | Jane N. Mutanga Simon Mutembo Amara E. Ezeamama Xiao Song Robert C. Fubisha Kunda Mutesu-Kapembwa Derrick Sialondwe Brenda Simuchembu Jelita Chinyonga Philip E. Thuma Christopher C. Whalen |
| author_facet | Jane N. Mutanga Simon Mutembo Amara E. Ezeamama Xiao Song Robert C. Fubisha Kunda Mutesu-Kapembwa Derrick Sialondwe Brenda Simuchembu Jelita Chinyonga Philip E. Thuma Christopher C. Whalen |
| author_sort | Jane N. Mutanga |
| collection | DOAJ |
| description | Abstract Background In 2017, 64% of children living with HIV in Zambia accessed Antiretroviral Therapy (ART). Despite expanded ART coverage, there is paucity of information on effectiveness of pediatric ART in reducing mortality. The aim of this research is to describe treatment outcomes, measure mortality rates and assess predictors of mortality among children receiving ART. Methods Using a retrospective cohort study design, we abstracted routinely collected clinical data from medical records of children from birth to 15 years old, who had received ART for at least 6 months at Livingstone Central Hospital in Southern Province Zambia, between January 2003 and June 2015. The primary outcome was death. Cause of death was ascertained from medical records and death certificates. Distribution of survival times according to baseline covariates were estimated using Kaplan Meier and Cox Proportional Hazards methods. Results Overall, 1039 children were commenced on ART during the study period. The median age at treatment initiation was 3.6 years (IQR: 1.3–8.6) and 520 (50%) children were female. Of these, 71 (7%) died, 164 (16%) were lost to follow-up, 210 (20%) transferred and 594 (56%) were actively on treatment. After 4450 person years, mortality rate was 1.6/100 (95% CI: 1.4–1.8). Mortality was highest during the first 3 months of treatment (11.7/100 (95% CI: 7.6–16.3). In multivariable proportional hazards regression, the adjusted hazards of death were highest among children aged < 1 year (aHR = 3.1 (95% CI: 1.3–6.4), compared to those aged 6–15 years, WHO stage 4 (aHR =4.8 (95% CI: 2.3–10), compared to WHO stage 1 and 2. In the sensitivity analysis to address bias due to loss to follow-up, mortality increased 5 times when we assumed that all the children who were lost to follow up died within 90 days of their last visit. Conclusion We observed low attrition due to mortality among children on ART. Loss to follow-up was high (16%). Mortality was highest during the first 3 months of treatment. Children aged less than one year and those with advanced WHO disease stage had higher mortality. We recommend effective interventions to improve retention in care and early diagnosis of HIV in children. |
| first_indexed | 2024-12-10T20:25:28Z |
| format | Article |
| id | doaj.art-1ef5f23d92ee46d78587168532b7e3c0 |
| institution | Directory Open Access Journal |
| issn | 1471-2458 |
| language | English |
| last_indexed | 2024-12-10T20:25:28Z |
| publishDate | 2019-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Public Health |
| spelling | doaj.art-1ef5f23d92ee46d78587168532b7e3c02022-12-22T01:34:52ZengBMCBMC Public Health1471-24582019-01-0119111210.1186/s12889-019-6444-7Long-term survival outcomes of HIV infected children receiving antiretroviral therapy: an observational study from Zambia (2003–2015)Jane N. Mutanga0Simon Mutembo1Amara E. Ezeamama2Xiao Song3Robert C. Fubisha4Kunda Mutesu-Kapembwa5Derrick Sialondwe6Brenda Simuchembu7Jelita Chinyonga8Philip E. Thuma9Christopher C. Whalen10Department of Pediatrics and Child Health, Livingstone Central HospitalDepartment of Epidemiology and Biostatistics, College of Public Health, University of GeorgiaDepartment of Psychiatry, College of Osteopathic Medicine, Michigan State UniversityDepartment of Epidemiology and Biostatistics, College of Public Health, University of GeorgiaDepartment of Pediatrics and Child Health, Livingstone Central HospitalDepartment of Pediatrics and Child Health, Livingstone Central HospitalDepartment of Pediatrics and Child Health, Livingstone Central HospitalDepartment of Pediatrics and Child Health, Livingstone Central HospitalSouthern Province Medical Office, Ministry of HealthMacha Research TrustDepartment of Epidemiology and Biostatistics, College of Public Health, University of GeorgiaAbstract Background In 2017, 64% of children living with HIV in Zambia accessed Antiretroviral Therapy (ART). Despite expanded ART coverage, there is paucity of information on effectiveness of pediatric ART in reducing mortality. The aim of this research is to describe treatment outcomes, measure mortality rates and assess predictors of mortality among children receiving ART. Methods Using a retrospective cohort study design, we abstracted routinely collected clinical data from medical records of children from birth to 15 years old, who had received ART for at least 6 months at Livingstone Central Hospital in Southern Province Zambia, between January 2003 and June 2015. The primary outcome was death. Cause of death was ascertained from medical records and death certificates. Distribution of survival times according to baseline covariates were estimated using Kaplan Meier and Cox Proportional Hazards methods. Results Overall, 1039 children were commenced on ART during the study period. The median age at treatment initiation was 3.6 years (IQR: 1.3–8.6) and 520 (50%) children were female. Of these, 71 (7%) died, 164 (16%) were lost to follow-up, 210 (20%) transferred and 594 (56%) were actively on treatment. After 4450 person years, mortality rate was 1.6/100 (95% CI: 1.4–1.8). Mortality was highest during the first 3 months of treatment (11.7/100 (95% CI: 7.6–16.3). In multivariable proportional hazards regression, the adjusted hazards of death were highest among children aged < 1 year (aHR = 3.1 (95% CI: 1.3–6.4), compared to those aged 6–15 years, WHO stage 4 (aHR =4.8 (95% CI: 2.3–10), compared to WHO stage 1 and 2. In the sensitivity analysis to address bias due to loss to follow-up, mortality increased 5 times when we assumed that all the children who were lost to follow up died within 90 days of their last visit. Conclusion We observed low attrition due to mortality among children on ART. Loss to follow-up was high (16%). Mortality was highest during the first 3 months of treatment. Children aged less than one year and those with advanced WHO disease stage had higher mortality. We recommend effective interventions to improve retention in care and early diagnosis of HIV in children.http://link.springer.com/article/10.1186/s12889-019-6444-7HIVPediatricsTherapeuticsTreatment outcomeSurvival |
| spellingShingle | Jane N. Mutanga Simon Mutembo Amara E. Ezeamama Xiao Song Robert C. Fubisha Kunda Mutesu-Kapembwa Derrick Sialondwe Brenda Simuchembu Jelita Chinyonga Philip E. Thuma Christopher C. Whalen Long-term survival outcomes of HIV infected children receiving antiretroviral therapy: an observational study from Zambia (2003–2015) BMC Public Health HIV Pediatrics Therapeutics Treatment outcome Survival |
| title | Long-term survival outcomes of HIV infected children receiving antiretroviral therapy: an observational study from Zambia (2003–2015) |
| title_full | Long-term survival outcomes of HIV infected children receiving antiretroviral therapy: an observational study from Zambia (2003–2015) |
| title_fullStr | Long-term survival outcomes of HIV infected children receiving antiretroviral therapy: an observational study from Zambia (2003–2015) |
| title_full_unstemmed | Long-term survival outcomes of HIV infected children receiving antiretroviral therapy: an observational study from Zambia (2003–2015) |
| title_short | Long-term survival outcomes of HIV infected children receiving antiretroviral therapy: an observational study from Zambia (2003–2015) |
| title_sort | long term survival outcomes of hiv infected children receiving antiretroviral therapy an observational study from zambia 2003 2015 |
| topic | HIV Pediatrics Therapeutics Treatment outcome Survival |
| url | http://link.springer.com/article/10.1186/s12889-019-6444-7 |
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