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Temporal Trends in Patient Characteristics and Outcomes Among Children Enrolled in Mozambique’s National Antiretroviral Therapy Program

Auld, Andrew F. MBChB, MSc*; Alfredo, Charity MD, MPH; Macassa, Eugenia MD; Jobarteh, Kebba MD, MPH; Shiraishi, Ray W. PhD*; Rivadeneira, Emilia D. MD*; Houston, James MD, MPH*; Spira, Thomas J. MD*; Ellerbrock, Tedd V. MD*; Vaz, Paula MD, MMED, PhD‡§

The Pediatric Infectious Disease Journal: August 2015 - Volume 34 - Issue 8 - p e191–e199
doi: 10.1097/INF.0000000000000741
HIV Reports
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Background: During 2004–2009, >12,000 children (<15 years old) initiated antiretroviral therapy (ART) in Mozambique. Nationally representative outcomes and temporal trends in outcomes were investigated.

Methods: Rates of death, loss to follow-up (LTFU) and attrition (death or LTFU) were evaluated in a nationally representative sample of 1054 children, who initiated ART during 2004–2009 at 25 facilities randomly selected using probability-proportional-to-size sampling.

Results: At ART initiation during 2004–2009, 50% were male; median age was 3.3 years; median CD4% was 13%; median CD4 count was 375 cells/μL; median weight-for-age Z score was −2.1. During 2004–2009, median time from HIV diagnosis to care initiation declined from 33 to 0 days (P = 0.001); median time from care to ART declined from 93 to 62 days (P = 0.004); the percentage aged <2 at ART initiation increased from 16% to 48% (P = 0.021); the percentage of patients with prior tuberculosis declined from 50% to 10% (P = 0.009); and the percentage with prior lymphocytic interstitial pneumonia declined from 16% to 1% (P < 0.001). Over 2652 person-years of ART, 183 children became LTFU and 26 died. Twelve-month attrition was 11% overall but increased from 3% to 22% during 2004–2009, mainly because of increases in 12-month LTFU (from 3% to 18%).

Conclusion: Declines in the prevalence of markers of advanced HIV disease at ART initiation probably reflect increasing ART access. However, 12-month LTFU increased during program expansion, and this negated any program improvements in outcomes that might have resulted from earlier ART initiation.

From the *Division of Global HIV/AIDS, Centers For Disease Control and Prevention, Atlanta, Georgia; Division of Global HIV/AIDS, Centers For Disease Control and Prevention, Maputo, Mozambique; Ministerio Da Saude, Programa TARV Pediatrico, Maputo, Mozambique; and §Fundação Ariel Glaser Contra O SIDA Pediátrico, Maputo, Mozambique.

Accepted for publication December 15, 2014.

Presented in part at the 5th Pediatric HIV Conference; June 28–29, 2013; Kuala Lumpur, Malaysia.

This research has been supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Centers for Disease Control and Prevention. Use of trade names is for identification purposes only and does not imply endorsement by the U.S. Centers for Disease Control and Prevention or the U.S. Department of Health and Human Services. The findings and conclusions in this manuscript are those of the authors and do not necessarily represent the views of the U.S. Centers for Disease Control and Prevention. The authors have no conflicts of interest or funding to disclose.

Address for correspondence: Andrew F. Auld, MBChB, MSc, United States Centers For Disease Control and Prevention, 1600 Clifton Road, Mailstop-E04, Atlanta, GA 30333. E-mail: aauld@cdc.gov.

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