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

Hibstie, Yitbarek Tenaw; Kibret, Getiye Dejenu; Talie, Asmare; Temesgen, Belisty; Melkamu, Mamaru Wubale; Alebel, Animut

doi:10.1371/journal.pone.0239013

Cited by 14 publications

(17 citation statements)

References 25 publications

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“…The incidence density of LTFU among children with HIV was 3.3 (95% CI: 2.4-4.4) per 100 Child-Year with a total of 15589-person months of follow-up. This result was in line with the study done in Ethiopia; 4.5 per 100-child years of observation [12], south Africa (5.0 per 100 child-years of observation [29], Asia and Africa 4.1 per 100 years of observation [10]. This might be due to difference in case de nition; in both south Africa and Asia and African studies lost follow up is de ned as ART interruption for >6months.…”

Section: Discussionsupporting

confidence: 87%

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Lost to Follow-Up and Its Predictors among Human Immune Deficiency Virus Infected Children on Antiretroviral Therapy, Southern Oromia, and Ethiopia: A Five Year Retrospective Cohort Study

Bankere

Gemechu

Ami

et al. 2022

Preprint

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Background Lost to follow-up among pediatric human immune deficiency virus infected patients is a major challenge for the global scale-up of lifesaving antiretroviral therapy (ART). It is considerable obstacle for effectiveness of the program which negatively impacted on immunological benefits of ART and drug adherence. Additionally, it increases drug toxicity, resistance and acquired immune deficiency syndrome related morbidity and mortality. Therefore, it is very crucial to identify the incidence and determinants of loss to follow up among children in study area. Objectives To determine incidence and determinants of lost to follow-up among human immune deficiency virus-infected children on Anti-Retroviral Treatment. Method A retrospective cohort study was conducted among 269 randomly selected children who had been on ART in the health facilities of Shashemene Town from January 1, 2015 to December 30, 2020. Data on patients’ medical records such as patient intake form and the registers were collected using standardized checklist. Data were coded and entered by Epidata version 3.1 and analyzed by Statistical Product and Service Solutions (SPSS) version 25. The Cox proportional hazard assumption was checked using Schoenfeld residual test (global test > 0.05). Finally, adjusted hazard ratio with 95% confidence interval was computed, and variables with P-values < 0.05 in multivariable analysis were taken as significant predictors of lost to follow up. Results Of 269 HIV-infected children included in the final analysis, 43 (16%) were loss to follow up. The overall incidence rate of loss to follow up was 3.3 with (95% CI: 2.4–4.4) per 100 Child-Year of observation. Age less than 5 years (AHR:0.03 95% CI: 0.003–0.361), non-orphan status of the child (AHR = 0.13(0.048–0.340), < 30-minute distance from health facility (AHR:0.24 95% CI:0.077–0.728), disclosed HIV status (AHR :0.32 95% CI :0.126–0.795), history of opportunistic infection (AHR: 3.54, 95%CI :1.152–10.866) and CD4 below threshold (AHR:5.17 95%:CI:2.082–12.8490) were significant determinants of loss to follow up. Conclusion The incidence density of loss to follow up in this study was low as compared to other studies. The finding indicated that older children, orphan, low immune status, undisclosed HIV status and distance from health facility were independent determinants of loss to follow up. Giving special attention to older, orphan and those with low CD4 count is mandatory. Age-appropriate disclosure should also be encouraged.

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Section: Discussionsupporting

confidence: 87%

“…According to international epidemiologic database to evaluate AIDS (IEDEA) global cohort in the sub-Saharan Africa, incidence of loss to follow up was reported to be 26% [11]. In Ethiopia, the incidence of loss to follow up ranges from 17.1% [12] to 34% [13].…”

Section: Introductionmentioning

confidence: 99%

Lost to Follow-Up and Its Predictors among Human Immune Deficiency Virus Infected Children on Antiretroviral Therapy, Southern Oromia, and Ethiopia: A Five Year Retrospective Cohort Study

Bankere

Gemechu

Ami

et al. 2022

Preprint

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“…Children with HIV/AIDS have a reduced appetite and ability to consume food, as well as a higher incidence of diarrhea, resulting in malabsorption and nutrient a loss, which makes malnutrition a common phenomenon [ 11 , 12 ]. In 2018, an estimated 1.7 million children (aged <15 years) were living with HIV worldwide [ 13 , 14 ]. In the same year, in Ethiopia, 44229 children were diagnosed with HIV and 2055 died related to AIDS [ 9 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

Effects of Undernutrition and Predictors on the Survival Status of HIV-Positive Children after Started Antiretroviral Therapy (ART) in Northwest Ethiopia

Molla

Kebede

et al. 2022

International Journal of Pediatrics

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Malnutrition and human immunodeficiency virus/acquired immunodeficiency syndrome have complex and multidirectional relationships. Ethiopia is one of the countries hardest hit by the HIV epidemic as well as malnutrition. This study was aimed at assessing the effects of undernutrition on the survival status of HIV-positive children who received HIV/AIDS care in Northwest Ethiopia. Materials and Methods. A facility-based retrospective follow-up was conducted from January 1, 2009, to December 31, 2020. The data was entered into EpiData version 4.2.0. Then, the entered data was exported to STATA 14 software for further analysis, and the Kaplan-Meier survival curve was used to estimate survival time after the initiation of ART. The Bivariable and multivariable Cox regression analyses were conducted to identify predictors of mortality associated with undernutrition. Results. The mean (±SD) age of participant children was found 118.4 (±38.24) months. The overall mortality rate in this study was determined as 5.4 per 100 child-years (95% CI: 3.6, 5.8). Children with CD4 cell counts below the threshold [ AHR = 1.6 ; 95% CI (1.19, 7.85)], advanced WHO clinical stages (III and IV) HIV [ AHR = 4.5 ; 95% CI (2.80, 8.40)], and being severe stunting at the beginning [ AHR = 2.9 ; 95% CI (1.80, 6.40)] were significantly associated with mortality of HIV-positive children. Conclusion. The findings of the current study indicated that HIV-positive children on ART had a high rate of mortality. Baseline undernutrition has the mortality of children who had CD4 counts below a threshold, advanced WHO HIV clinical staging (III and IV), and being severe stunting ( HAZ ≤ − 3 Z score) which were found to be independent predictors for mortality of undernourished HIV.

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“…In response to ART, there may be individual variability with some individuals having a slower progression in the recovery rate of immune function and remaining at higher risk of dying from opportunistic infections (OIs). 2,7 Globally, 2.1 million of 33 million people living with HIV/AIDS are children aged <15 years, 8,9 and 90% of these reside in SSA. 3 HIV increased poor nutrition as a result of poor food intake and fueled nutrient usage from the body 4 and increased the incidence of lethal OI for further hospitalization.…”

Section: Introductionmentioning

confidence: 99%

Severe Acute Malnutrition (SAM) associated mortality rate of children attending HIV/AIDS care in North West Ethiopia, 2009–2019

Kebede

2022

SAGE Open Medicine

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Objective: This study aimed to assess Severe Acute Malnutrition (SAM) associated mortality rate of children attending HIV/AIDS care in North West Ethiopia 2009–2019. Methods: Institutional-based retrospective cohort study was employed among 721 on antiretroviral therapy care seropositive children since 2009–2019. Data were entered using EpiData version 4.2 and exported to STATA (SE) R-14 version statistical software for further analysis. Beside, Besides, WHO (World Health Organization) Anthro Plus software was used to assess the nutritional status of the children. Bivariable and multivariable Cox regression analyses were conducted to identify the predictors of mortality. Finally, variables with p-value less than 0.05 were considered significant predictors of mortality. Result: Overall, 721 (N = 721) seropositive children were included with a mean (±SD) age of 118.4 ± 38.24 months. A median time of death was reported at 19.5 months (interquartile range = ±8.5). The overall mortality rate in this study was determined as 5.4 per 100 child-years (95% confidence interval: 3.6–5.8). Severe stunting (height for age Z-score <−3) (hazard ratio = 2.9, 95% confidence interval: 1.8–6.4), admission with septic shock (hazard ratio = 2.3, 95% confidence interval: 1.2–4.3, p < 0.008), CD4+ count below threshold (hazard ratio = 1.6, 95% confidence interval: 1.19–7.9), and World Health Organization Stages III and IV (hazard ratio = 2.9, 95% confidence interval: 1.8–6.4) were at high risk of mortality. Conclusion: A high rate of SAM associated mortality rate within short median (±SD) time to death was reported as compared with previous finding in Ethiopia. Seropositive children presenting with CD4 counts being below a threshold, World Health Organization Stages III and IV, and being nutritionally stunted during antiretroviral therapy initiation were at high risk of early mortality.

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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

Cited by 14 publications

References 25 publications

Lost to Follow-Up and Its Predictors among Human Immune Deficiency Virus Infected Children on Antiretroviral Therapy, Southern Oromia, and Ethiopia: A Five Year Retrospective Cohort Study

Lost to Follow-Up and Its Predictors among Human Immune Deficiency Virus Infected Children on Antiretroviral Therapy, Southern Oromia, and Ethiopia: A Five Year Retrospective Cohort Study

Effects of Undernutrition and Predictors on the Survival Status of HIV-Positive Children after Started Antiretroviral Therapy (ART) in Northwest Ethiopia

Severe Acute Malnutrition (SAM) associated mortality rate of children attending HIV/AIDS care in North West Ethiopia, 2009–2019

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