Temporal Improvements in Long-Term Outcome in Care Among HIV Infected Children Enrolled in Public ART Care: An Analysis of Outcomes From 2004-2012 in Zimbabwe
Increasing numbers of children are requiring long-term HIV care and antiretroviral treatment (ART) in public ART programs in Africa but temporal trends and long-term outcomes in care remain poorly understood.Methods:
We analyzed outcomes in a longitudinal cohort of infants (<2 years) and children (2-10 years) enrolling in a public tertiary ART center in Zimbabwe over an eight-year period (2004-2012).Results:
The clinic enrolled 1644 infants and children; the median age at enrollment was 39 months (IQR 14-79), with a median CD4% of 17.0 (IQR 11, 24) in infants and 15.0 (9, 23% in children (p=0.0007). Among those linked to care 33.5% dropped out of care within the first 3-months of enrollment. Following implementation of revised guidelines in 2009, decentralization of care and increased access to PMTCT services, we observed an increase in infants (48.9% to 68.3%, p<0.0001) and children (48.9% to 68.3%, p<0.0001) remaining in care for more than 3-months . Children enrolled from 2009 were younger, had lower WHO clinical stage, improved baseline CD4 counts than those who enrolled in 2004-2008. Long-term retention in care also improved with decreasing risk of loss from care at 36-months for infants enrolled from 2009 (aHR 0.57 (95%CI: 0.34-0.95), p=0.031). ART eligibility at enrollment was a significant predictor of long-term retention in care while delayed ART initiation after age 5 years resulted in failure to fully reconstitute CD4 counts to age-appropriate levels despite prolonged ART.Conclusion:
Significant improvements have been made in engaging and retaining children in care in public ART programs in Zimbabwe. Guideline and policy changes that increase access and eligibility will likely to continue to support improvement in pediatric HIV outcomes.