Factors associated with death and loss to follow-up in children on antiretroviral care in Mingalardon Specialist Hospital, Myanmar, 2006–2016

Abstract

BackgroundMyanmar National AIDS programme’s priority is to improve the survival of all people living with HIV by providing anti-retroviral therapy (ART) care. More than 7200 children (aged <15 years) have been enrolled into ART care from 2005 to 2016. A previous study showed that ~11% children on ART care had either died or were lost to follow-up by 60 months. Factors associated with death and lost-to follow-up (adverse outcomes) have not been previously studied.ObjectivesTo describe the association between demographic and clinical characteristics at enrollment into ART care with adverse outcomes.MethodsCohort study using records of children enrolled for ART care at Mingalardon Specialist Hospital (main Paediatric ART center in Myanmar) from 2006–2016. We used multivariable Cox proportional hazards regression models for analysis.Results1,159 children were enrolled for ART care and they contributed a total of 1.45 million person-days of follow-up period. 112 (10%) had an adverse outcome during the follow-up time period (55 deaths, 57 lost to follow-up). Enrollment into the ART care through in-patient care department of the hospital, CD4 Cell count <50/mm3, enrollment during changing ART guidelines (different ART eligibility criteria and preferred ART regimen) were independently associated with higher hazards of adverse outcome. Receiving protease inhibitor-based ART regimen at enrollment was independently associated with lower hazards of adverse outcome. Age, sex, residing in urban or rural areas, WHO clinical stage, having TB at the time of enrollment, receiving cotrimoxazole prophylaxis were not statistically associated with adverse outcomes.ConclusionOur analysis reconfirms good survival of children on ART care (including those with TB). The characteristics associated with adverse outcomes (other than CD4 cell count<50) are surrogates of some unmeasured underlying health system/ patient related factors that needs further exploration to improve the survival of children on ART care.

Nearly one in every six HIV-infected children lost from ART follow-up at Debre Markos Referral Hospital, Northwest Ethiopia: A 14-year retrospective follow-up study

“…Finally, children who started PI-based ART regimens were at higher risk of LTFU as compared to those who started non-nucleoside reverse transcriptase inhibitors (Nevirapine or Efavirenz) based ART regimens. This finding contradicts a previous study done in Myanmar [ 28 ]. This variation could be due to the baseline differences between study participants at ART initiation, leading to the prescription of PI-based regimens.…”

“…The incidence density of LTFU in this study was estimated to be 4.5 (95% CI: 3.5, 5.7) per 100 child-years of observation. Our finding is in line with studies done in South Africa (5.0 per 100 child-years) [ 27 ], Myanmar (4.7 per 100 child-years) [ 28 ], and Asia and Africa (4.1 per 100 child-years) [ 29 ]. Conversely, our finding is much lower than studies conducted in India (14.4 per 100-child years) [ 30 ], South Africa (10.8 per 100 child-years) [ 31 ], Tanzania (18.2 per 100-child years) [ 32 ], multicountry study (14.2 per 100-child years) [ 33 ], Malawi (12.6 per-100 child-years) [ 19 ], and Ethiopia (6.22 per 100 child-years) [ 11 ].…”

“…A high rate of LTFU in the early ART phase was observed. This finding is comparable with studies conducted in South Africa, which showed that LTFU was higher in the first six months of ART follow-up [ 28 , 31 ]. Supportive findings were also reported from studies done in multicountry based studies [ 9 , 33 ], Tanzania [ 32 ], and Ethiopia [ 11 ].…”

“…Another possible justification might be due to the difference in length of follow-up. Our study had relatively longer follow-up time (14 years) compared to previous studies conducted in SSA [ 19 , 28 , 31 ]. A further explanation for the variations could be due to differences in the characteristics of included participants.…”

Early Success With Retention in Care Among People Living With HIV at Decentralized ART Satellite Sites in Yangon, Myanmar, 2015–2016

“…In 2014, the NAP launched a new service delivery model to reach urban PLHIV and key populations through clinic-based testing and treatment sites in partnership with iNGOs called ART satellite sites. Several studies have reported retention in care with rates ranging from (30 to 90%) (7–11). There have been no previous studies assessing the outcomes of PLHIV on ART at ART satellite sites in Myanmar.…”