Abstract

Losses to follow-up among HIV-infected and HIV-exposed children from a comprehensive HIV clinical care program in Western Kenya

Presented by Paula Braitstein (United States).

P. Braitstein^1,2, A. Katschke³, C. Shen³, E. Sang⁴, W. Nyandiko², V.O. Ochieng⁴, C. Yiannoutsos³, R. Vreeman³, K. Wools-Kaloustian³, S. Ayaya<sup>2

1</sup>Indiana University, Moi University, Medicine, Indianapolis, United States, ²Moi University School of Medicine, Eldoret, Kenya, ³Indiana University School of Medicine, Indianapolis, United States, ⁴USAID-AMPATH Partnership, Eldoret, Kenya

Background: Losses to follow-up (LTFU) are an important clinical and epidemiological challenge for HIV programs, particularly in resource-constrained settings. Little is known about LTFU among HIV affected children.
Methods: The USAID-AMPATH Partnership has enrolled > 110,000 patients (20% children) at 23 clinic sites throughout western Kenya. LTFU means being absent from the clinic for >3 months if on combination antiretroviral treatment (cART) and >6 months if not. Included in this analysis were children aged < 14 years, HIV-exposed or infected at enrolment, and enrolled between 2002-2009. Incidence rates (IR) are presented per 100 child-years (CY) of follow-up. Proportional hazards models with time independent and dependent covariates were used to model factors associated with LTFU. Z-scores were calculated using EpiInfo, with severe malnutrition being defined as a Z-score ≤-3.0. Immune suppression was defined as per WHO age-specific categories.
Results: There were 13,510 children eligible for analysis: 3106 HIV-infected and 10,404 HIV-exposed. The overall IR of LTFU was 18.4/100. Among HIV-infected children, 15.2 and 14.1/100 CY became LTFU, pre- and post-cART initiation respectively. The only risk factor among them was severe immune-suppression (AHR: 2.17, 95%CI: 1.51-3.12). Among HIV-exposed children, 20.1/100 became LTFU. Independent risk factors were being severely low weight for height (AHR: 1.69, 95%CI: 1.25-2.28), being orphaned at enrolment (AHR: 1.57, 95% CI: 1.23-1.64), being CDC Class B/C (AHR: 1.41, 95% CI: 1.14-1.74), and having received cART (AHR: 1.56, 95% CI: 1.23-1.99). Protective against becoming LTFU among the HIV-exposed were testing HIV-positive (AHR: 0.26, 95%CI: 0.21-0.32), older age (AHR: 0.90, 95% CI: 0.85-0.96), enrolling in later time periods, and receiving food supplementation (AHR: 0.58, 95% CI: 0.32-1.04).
Conclusions: There is a high rate of LTFU among these highly vulnerable children. These data suggest that they are at especially high risk for LTFU if they are sick or malnourished, suggesting a high probability of mortality.