title: Retention of HIV-infected children on antiretroviral treatment in HIV care and treatment programs in Kenya, Mozambique, Rwanda, and Tanzania.
abstract: BACKGROUND
  Retention of children in HIV care is essential for prevention of disease progression and mortality.
  
  
  METHODS
  Retrospective cohort of children (aged 0 to <15 years) initiating antiretroviral treatment (ART) at health facilities in Kenya, Mozambique, Rwanda, and Tanzania, from January 2005 to June 2011. Retention was defined as the proportion of children known to be alive and attending care at their initiation facility; lost to follow-up (LTF) was defined as no clinic visit for more than 6 months. Cumulative incidence of ascertained survival and retention after ART initiation was estimated through 24 months using Kaplan-Meier methods. Factors associated with LTF and death were assessed using Cox proportional hazard modeling.
  
  
  RESULTS
  A total of 17,712 children initiated ART at 192 facilities: median age was 4.6 years [interquartile ratio (IQR), 1.9-8.3], median CD4 percent was 15% (IQR, 10-20) for children younger than 5 years and 265 cells per microliter (IQR, 111-461) for children aged 5 years or older. At 12 and 24 months, 80% and 72% of children were retained with 16% and 22% LTF and 5% and 7% known deaths, respectively. Retention ranged from 71% to 95% at 12 months and from 62% to 93% at 24 months across countries, respectively, and was lowest for children younger than 1 year (51% at 24 months). LTF and death were highest in children younger than 1 year and children with advanced disease.
  
  
  CONCLUSIONS
  Retention was lowest in young children and differed across country programs. Young children and those with advanced disease are at highest risk for LTF and death. Further evaluation of patient- and program-level factors is needed to improve health outcomes.
authors.affiliation: ICAP, Mailman School of Public Health, Columbia University, New York, NY 10031, USA. mm3780@columbia.edu
authors.forename: Margaret L
authors.initials: ML
authors.lastname: McNairy
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Lamb
authors.forename: Rosalind J
authors.initials: RJ
authors.lastname: Carter
authors.forename: Ruby
authors.initials: R
authors.lastname: Fayorsey
authors.forename: Gilbert
authors.initials: G
authors.lastname: Tene
authors.forename: Vincent
authors.initials: V
authors.lastname: Mutabazi
authors.forename: Eduarda
authors.initials: E
authors.lastname: Gusmao
authors.forename: Millembe
authors.initials: M
authors.lastname: Panya
authors.forename: Mushin
authors.initials: M
authors.lastname: Sheriff
authors.forename: Elaine J
authors.initials: EJ
authors.lastname: Abrams
mesh_terms: D000293:Adolescent; D023241:Antiretroviral Therapy, Highly Active; D002648:Child; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D007630:Kenya / Q000453:epidemiology; D008297:Male; D009073:Mozambique / Q000453:epidemiology; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D015397:Program Evaluation; D012189:Retrospective Studies; D012307:Risk Factors; D012432:Rwanda / Q000453:epidemiology; D013636:Tanzania / Q000453:epidemiology