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. Braitstein1,2, A. Katschke3, C. Shen3, E. Sang4, W. Nyandiko2, V.O. Ochieng4, C. Yiannoutsos3, R. Vreeman3, K. Wools-Kaloustian3, S. Ayaya2
1Indiana 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.
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
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.
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