ArticleThe lancet. HIV2021
Variations in the characteristics and outcomes of children living with HIV following universal ART in sub-Saharan Africa (2006-17): a retrospective cohort study.
Article in The lancet. HIV, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 3 of them syntheses that pooled it.
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Who cites it
17 citing papers in PubMed, 3 syntheses or guidelines pooled it, 32 citations in OpenAlex.
- Characterizing the HIV care continuum among children and adolescents with HIV in eastern and southern Africa in the era of "Universal Test and Treat": A systematic review and meta-analysis.Journal of the International AIDS Society · 2025Pooled it
- Pooled it
- Pooled it
- Investigating strategies to enhance access to HIV services among children in Malawi: A multifaceted research approach, study protocol.PloS one · 2026Article
- Early infant diagnosis: a pillar in preventing mother-to-child HIV transmission - a narrative review.Annals of medicine and surgery (2012) · 2025Review
- Trends of severe HIV disease and mortality among children in rural Tanzania.HIV medicine · 2025Article
- Global Trends in CD4 Measurement and Immunosuppression at ART Initiation Among Children With HIV.The Pediatric infectious disease journal · 2025Article
- Social determinants of adherence to antiretroviral therapy among adolescents and young people living with HIV: a scoping review.Revista da Escola de Enfermagem da U S P · 2025Article
- Article
- Improving early infant diagnosis for HIV-exposed infants using unmanned aerial vehicles for blood sample transportation in Conakry, Guinea: a comparative cost-effectiveness analysis.BMJ global health · 2023Article
- Impaired Bone Architecture in Peripubertal Children With HIV, Despite Treatment With Antiretroviral Therapy: A Cross-Sectional Study From Zimbabwe.Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research · 2023Article
- The changing characteristics of a cohort of children and adolescents living with HIV at antiretroviral therapy initiation in Asia.PloS one · 2023Article
- Temporal changes in paediatric and adolescent HIV outcomes across the care continuum in Zambia: an interrupted time-series analysis.The lancet. HIV · 2022Article
- COVID-19 Ignited a Successful Growth Spurt in Pediatric HIV Differentiated Service Delivery Programming.Current tropical medicine reports · 2022Review
- Treatment Outcomes of HIV Infected Children After Initiation of Antiretroviral Therapy in Southwest China: An Observational Cohort Study.Frontiers in pediatrics · 2022Article
- Heavy episodic drinking and HIV disclosure by HIV treatment status among People with HIV in IeDEA Cameroon.The International journal on drug policy · 2021Article
- Are we there yet? 40 years of successes and challenges for children and adolescents living with HIV.Journal of the International AIDS Society · 2021Article
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Authors and funding
11 authors at 8 institutions in 5 countries.
Funding
Abstract
backgroundThe proportion of children living with HIV and receiving antiretroviral therapy (ART) in sub-Saharan Africa has increased greatly since 2006, yet the changes in their demographic characteristics and treatment outcomes have not been well described. We examine the trends in characteristics and outcomes of children living with HIV who were younger than 5 years at ART initiation, and compare outcomes over time and across country income groups.
methodsWe conducted a retrospective cohort analysis of data from children living with HIV who were younger than 5 years at ART initiation from 45 paediatric sites in 16 low-income, lower-middle-income, and upper-middle-income countries in sub-Saharan Africa (Benin, Burundi, Côte d'Ivoire, Democratic Republic of the Congo, Ghana, Kenya, Lesotho, Malawi, Mali, Mozambique, Rwanda, South Africa, Togo, Uganda, Zambia, and Zimbabwe). Outcomes were trends in patient characteristics at ART initiation (age, weight, height, and CD4%), and comparisons of mortality and loss to follow-up during ART over time and in various economic settings. We identified risk factors for mortality using Cox proportional hazards models. Each participating region had relevant institutional ethics review board approvals to contribute data to the analysis.
findingsWe included 32 221 children living with HIV and initiating ART younger than 5 years between Jan 1, 2006, and Dec 31, 2017. Median age at ART initiation was 20·4 months (IQR 9·4-36·0) in 2006-10, 19·2 months (8·3-33·6) in 2011-13, and 19·2 months (8·8-33·7) in 2014-17. Median age at ART initiation was 13·2 months (IQR 4·7-26·8) in upper-middle-income countries, 22·6 months (13·2-37·5) in lower-middle-income countries and 24·2 months (13·5-39·1) in low-income countries. The proportion of children initiating ART younger than 3 months increased from 770 (5·1%) of 14 943 children in 2006-10 to 728 (10·0%) of 7290 children in 2014-17. The proportion of children initiating ART with severe immunosuppression decreased from 5469 (74·7%) of 7314 children for whom CD4% data were available in 2006-10 to 2353 (55·2%) of 4269 children in 2014-17. Mortality at 24 months on ART decreased from 970 (6·5%) of 14 943 children in 2006-10 to 214 (2·9%) of 7290 children in 2014-17. Loss to follow-up was 20·5% (95% CI 20·1-21·0) overall, and was similar across time periods. In multivariable analysis, lower mortality was observed for more recent ART initiation cohorts (adjusted hazard ratio 0·70, 95% CI 0·63-0·79 for 2011-13; 0·53, 0·45-0·72 for 2014-17 vs 2006-10) and for those residing in an upper-middle-income country (0·42, 0·35-0·49 vs low-income countries).
interpretationMortality declined significantly after universal ART recommendations for children younger than 2 years in 2010 and children younger than 5 years in 2013. However, substantial variations persisted across country income groups, and one in five children continue to be lost to follow-up. Targeted interventions are required to improve outcomes of children living with HIV, especially in the poorest countries.
fundingNational Institute of Allergy and Infectious Disease.
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