INTRODUCTION: Previous studies performed in low- and middle-income countries have shown that nearly half of HIV-infected adults not eligible for antiretroviral therapy (ART) at the time of enrolment in care are lost to follow-up (LTFU). However, data about the attrition from enrolment in care to ART eligibility of HIV-infected children are scarce, especially outside sub-Saharan Africa. METHODS: This is a retrospective study about the attrition before ART eligibility of 282 children ineligible for ART at enrolment in care in a cohort study in India. Multivariate analysis was performed using competing risk regression. RESULTS: During 5695 child-months of follow-up, three children died, 36 were LTFU and 144 became ART eligible. The cumulative incidence of attrition (mortality and LTFU) was 15.6% (95% confidence interval [CI], 11.3-20.5) at five years, and the attrition rate was higher during the first year after enrolment in care. The cumulative incidence of LTFU and mortality was 14.4% (95% CI, 10.2-19.2) and 1.2% (95% CI, 0.3-3.3) at five years, respectively. Children with a 12-month AIDS risk <3% had a higher risk of LTFU (subdistribution hazard ratio [SHR] 10.77, 95% CI 1.93-60.07) than those with a risk >4%. Those children whose father had died had a lower risk of LTFU (SHR 0.26, 95% CI 0.09-0.75) than those whose parents were alive and were living in a rented house. Children aged 10-14 had a lower risk of LTFU (SHR 0.12, 95% CI 0.03-0.55) than those aged 5-9 years. CONCLUSION: In our setting, a substantial proportion of children ineligible for ART are lost to follow-up before ART eligibility, especially those with younger age, less severe immunosuppression or living with parents in poor socio-economic conditions. These findings can be used by HIV programmes to design interventions aimed at reducing the attrition of pre-ART care of HIV-infected children in India.
INTRODUCTION: Previous studies performed in low- and middle-income countries have shown that nearly half of HIV-infected adults not eligible for antiretroviral therapy (ART) at the time of enrolment in care are lost to follow-up (LTFU). However, data about the attrition from enrolment in care to ART eligibility of HIV-infectedchildren are scarce, especially outside sub-Saharan Africa. METHODS: This is a retrospective study about the attrition before ART eligibility of 282 children ineligible for ART at enrolment in care in a cohort study in India. Multivariate analysis was performed using competing risk regression. RESULTS: During 5695 child-months of follow-up, three children died, 36 were LTFU and 144 became ART eligible. The cumulative incidence of attrition (mortality and LTFU) was 15.6% (95% confidence interval [CI], 11.3-20.5) at five years, and the attrition rate was higher during the first year after enrolment in care. The cumulative incidence of LTFU and mortality was 14.4% (95% CI, 10.2-19.2) and 1.2% (95% CI, 0.3-3.3) at five years, respectively. Children with a 12-month AIDS risk <3% had a higher risk of LTFU (subdistribution hazard ratio [SHR] 10.77, 95% CI 1.93-60.07) than those with a risk >4%. Those children whose father had died had a lower risk of LTFU (SHR 0.26, 95% CI 0.09-0.75) than those whose parents were alive and were living in a rented house. Children aged 10-14 had a lower risk of LTFU (SHR 0.12, 95% CI 0.03-0.55) than those aged 5-9 years. CONCLUSION: In our setting, a substantial proportion of children ineligible for ART are lost to follow-up before ART eligibility, especially those with younger age, less severe immunosuppression or living with parents in poor socio-economic conditions. These findings can be used by HIV programmes to design interventions aimed at reducing the attrition of pre-ART care of HIV-infectedchildren in India.
Entities:
Keywords:
HIV; India; antiretroviral therapy; eligibility determination; lost to follow-up; mortality; pediatrics; rural
Authors: K Boyd; David T Dunn; H Castro; D M Gibb; T Duong; J P Aboulker; M Bulterys; M Cortina-Borja; C Gabiano; L Galli; C Giaquinto; D R Harris; M HugheS; R McKinney; L Mofenson; J Moye; M L Newell; S Pahwa; P Palumbo; C Rudin; M Sharland; W Shearer; B Thompson; P Tookey Journal: AIDS Date: 2010-05-15 Impact factor: 4.177
Authors: Bruce A Larson; Alana Brennan; Lynne McNamara; Lawrence Long; Sydney Rosen; Ian Sanne; Matthew P Fox Journal: Trop Med Int Health Date: 2010-06 Impact factor: 2.622
Authors: Benjamin H Chi; Constantin T Yiannoutsos; Andrew O Westfall; Jamie E Newman; Jialun Zhou; Carina Cesar; Martin W G Brinkhof; Albert Mwango; Eric Balestre; Gabriela Carriquiry; Thira Sirisanthana; Henri Mukumbi; Jeffrey N Martin; Anna Grimsrud; Melanie Bacon; Rodolphe Thiebaut Journal: PLoS Med Date: 2011-10-25 Impact factor: 11.069