ArticlePloS one2014
Poor clinical outcomes for HIV infected children on antiretroviral therapy in rural Mozambique: need for program quality improvement and community engagement.
Article in PloS one, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 33 papers, 5 of them syntheses that pooled it.
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Who cites it
33 citing papers in PubMed, 5 syntheses or guidelines pooled it.
- HIV-related mortality time trends among children and young adolescents on antiretroviral therapy by age, treatment duration, and region: a systematic review and meta-regression analysis.The lancet. HIV · 2025Pooled it
- Attrition of HIV-positive children from HIV services in low and middle-income countries.AIDS (London, England) · 2019Pooled it
- Mortality among pediatric patients on HIV treatment in sub-Saharan African countries: a systematic review and meta-analysis.BMC public health · 2019Pooled it
- Attrition of HIV-exposed infants from early infant diagnosis services in low- and middle-income countries: a systematic review and meta-analysis.Journal of the International AIDS Society · 2018Pooled it
- Pooled it
- Factors associated with viral suppression and antiretroviral therapy adherence among adolescents and young adults living with HIV in the African Cohort Study.Journal of acquired immune deficiency syndromes (1999) · 2026Article
- Article
- A comparison of clinical outcomes among people living with HIV of different age groups attending queen Elizabeth central hospital outpatient ART Clinic in Malawi.Frontiers in medicine · 2023Article
- Added Value of Next Generation over Sanger Sequencing in Kenyan Youth with Extensive HIV-1 Drug Resistance.Microbiology spectrum · 2022Article
- Survival and predictors of mortality among HIV-positive children on antiretroviral therapy in public hospitals.Journal of pharmaceutical policy and practice · 2022Article
- Article
- Incidence and predictors of attrition among children on antiretroviral therapy at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia, 2019: Retrospective follow-up study.SAGE open medicine · 2022Article
- Childhood HIV-associated nephropathy: 36 years later.Pediatric nephrology (Berlin, Germany) · 2021Review
- Incidence and Predictors of Loss to Follow-Up Among Children Attending ART Clinics in Northeast Ethiopia: A Retrospective Cohort Study.HIV/AIDS (Auckland, N.Z.) · 2021Article
- Observational
- Monitoring Pharmacy and Test Kit Stocks in Rural Mozambique: U.S. President's Emergency Plan for AIDS Relief Surveillance to Help Prevent Ministry of Health Shortages.AIDS research and human retroviruses · 2020Article
- Multiple Concurrent Illnesses Associated with Anemia in HIV-Infected and HIV-Exposed Uninfected Children Aged 6-59 Months, Hospitalized in Mozambique.The American journal of tropical medicine and hygiene · 2020Article
- [Determinants of survival of HIV-infected children aged 6 months to 15 years on follow-up in the town of Ebolowa, Cameroon from 2008 to 2018].The Pan African medical journal · 2020Article
- Late antiretroviral therapy initiation and associated factors among children on antiretroviral therapy at University of Gondar Comprehensive Specialized Hospital, Gondar, Northwest Ethiopia: a cross-sectional study.BMC research notes · 2019Article
- HIV Rapid Diagnostic Test Inventories in Zambézia Province, Mozambique: A Tale of 2 Test Kits.International journal of health policy and management · 2019Article
Corrections and comments
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Authors and funding
10 authors.
Funding
Abstract
introductionResidents of Zambézia Province, Mozambique live from rural subsistence farming and fishing. The 2009 provincial HIV prevalence for adults 15-49 years was 12.6%, higher among women (15.3%) than men (8.9%). We reviewed clinical data to assess outcomes for HIV-infected children on combination antiretroviral therapy (cART) in a highly resource-limited setting.
methodsWe studied rates of 2-year mortality and loss to follow-up (LTFU) for children <15 years of age initiating cART between June 2006-July 2011 in 10 rural districts. National guidelines define LTFU as >60 days following last-scheduled medication pickup. Kaplan-Meier estimates to compute mortality assumed non-informative censoring. Cumulative LTFU incidence calculations treated death as a competing risk.
resultsOf 753 children, 29.0% (95% CI: 24.5, 33.2) were confirmed dead by 2 years and 39.0% (95% CI: 34.8, 42.9) were LTFU with unknown clinical outcomes. The cohort mortality rate was 8.4% (95% CI: 6.3, 10.4) after 90 days on cART and 19.2% (95% CI: 16.0, 22.3) after 365 days. Higher hemoglobin at cART initiation was associated with being alive and on cART at 2 years (alive: 9.3 g/dL vs. dead or LTFU: 8.3-8.4 g/dL, p<0.01). Cotrimoxazole use within 90 days of ART initiation was associated with improved 2-year outcomes Treatment was initiated late (WHO stage III/IV) among 48% of the children with WHO stage recorded in their records. Marked heterogeneity in outcomes by district was noted (p<0.001).
conclusionsWe found poor clinical and programmatic outcomes among children taking cART in rural Mozambique. Expanded testing, early infant diagnosis, counseling/support services, case finding, and outreach are insufficiently implemented. Our quality improvement efforts seek to better link pregnancy and HIV services, expand coverage and timeliness of infant diagnosis and treatment, and increase follow-up and adherence.
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