Attrition among HIV positive children enrolled under integrated HIV care programme in Myanmar: 12 years cohort analysis

Abstract

Background: In Myanmar, HIV seropositive children are being enrolled in an integrated HIV care (IHC) Program for HIV treatment and care since 2005. Objectives: To assess the: (a) attrition (death or loss-to-follow-up) rates among children (aged ≥ 18 months to < 15 years) enrolled into the programme before and after initiation of anti-retroviral therapy (ART) (pre-ART and ART periods); (b) demographic and clinical factors associated with attrition during these two periods. Methods: Children enrolled in IHC Programme and their status (death, lost to follow-up, regular follow-up or transferred out) was assessed as on 30 June 2017. Attrition rates (per 100 person-years) at pre – ART and ART periods were calculated and the association between demographic and clinical characteristics with attrition was assessed using Cox proportional hazards model. Results: Among 2,736 children enrolled, pre-ART attrition rate was 19 per 100 person-years of follow-up (95% CI: 17–21) and ART attrition rate was 4 per 100 person-years of follow-up (95% CI: 3–4) with higher levels during the initial few months of enrolment. The 36-month retention rates during pre-ART period was 75% (95% CI: 72–78) and during ART period was 87% (95% CI: 86–88). The children ‘at enrolment’ with relatively lower levels of haemoglobin, immune deficiency, underweight for age, higher WHO clinical stages, presence of hepatitis B infection had higher hazards of attrition in both periods. Conclusion: The attrition rates are high particularly among children with relatively poorer clinical, nutritional profiles at enrolment. The study suggests the urgent need for improving adherence counselling especially during the initial few months of enrolment and early ART initiation.

A 17 year experience of attrition from care among HIV infected children in Nnewi South-East Nigeria

“…Furthermore, programmes should ensure potent age-appropriate regimens and dosages. Our finding that about two-thirds of all children had advanced WHO clinical stage at enrolment agrees with previous African reports [ 13,17,[25][26][27][28][29][30][31]. This calls for intensified efforts at identifying infected pregnant women and linking them to prevention of MTCT programmes as well as early infant diagnosis.…”

“…Urgent innovative interventions are needed to address the high attrition rates in West Africa in order to achieve the 2030 global targets [ 7 ]. Reports consistently show that loss to follow-up constitute majority of attrition among children enrolled in HIV treatment programmes in developing countries [ 12 – 19 , 27 , 28 ]. However, this should be interpreted with caution because a significant proportion of loss to-follow up may be actual deaths.…”

Short-term outcomes of rapid initiation of antiretroviral therapy among HIV-positive patients: real-world experience from a single-centre retrospective cohort in Taiwan

“…However, although the WHO has recommended a ‘treat-all’ policy since 2015,1 1.8 million people were still newly infected with HIV in 2017 10. The substantial loss of patients during linkage to medical care, ART initiation and engagement in care among the most vulnerable populations has been a major concern in ART scale-up efforts 11 12. Therefore, the concept of rapid ART initiation—defined as starting ART within 7 days or even on the same day after HIV diagnosis—has been introduced to improve the HIV care continuum 13…”

Attrition during pre-ART and ART time periods among adolescents enrolled in Integrated HIV Care Programme in Myanmar, 2005–2017

“…The lower attrition rates in our setting indicate relatively better organisation and/or delivery of services under the IHC Programme. On the other hand, the pre-ART and ART attrition rates were higher than the attrition rates among paediatric patients in the IHC Programme [18]. This calls for focused attention towards providing additional care to ALHIV under IHC.…”

“…In a few centres, adolescents also participate in youth club activities, which additionally give them information on HIV disease and life skills training. The patient flow and treatment monitoring processes under the IHC Programme have been described in previous studies of The Union [9, 18]. At every visit, the medical officers fill out all the information into the standardised visit forms and trained data assistants transcribe the paper-based data to the electronic database created using PHP (Hypertext Preprocessor) and MySQL (My Structured Query Language).…”