Predictors of loss to follow-up among children in the first and second years of antiretroviral treatment in Johannesburg, South Africa.
BACKGROUND
Ninety percent of the world's 2.1 million HIV-infected children live in sub-Saharan Africa, and 2.5% of South African children live with HIV. As HIV care and treatment programmes are scaled-up, a rise in loss to follow-up (LTFU) has been observed.


OBJECTIVE
The aim of the study was to determine the rate of LTFU in children receiving antiretroviral treatment (ART) and to identify baseline characteristics associated with LTFU in the first year of treatment. We also explored the effect of patient characteristics at 12 months treatment on LTFU in the second year.


METHODS
The study is an analysis of prospectively collected routine data of HIV-infected children at the Harriet Shezi Children's Clinic (HSCC) in Soweto, Johannesburg. Cox proportional hazards models were fitted to investigate associations between baseline characteristics and 12-month characteristics with LTFU in the first and second year on ART, respectively.


RESULTS
The cumulative probability of LTFU at 12 months was 7.3% (95% CI 7.1-8.8). In the first 12 months on ART, independent predictors of LTFU were age <1 year at initiation, recent year of ART start, mother as a primary caregiver, and being underweight (WAZ ≤ -2). Among children still on treatment at 1 year from ART initiation, characteristics that predicted LTFU within the second year were recent year of ART start, mother as a primary caregiver, being underweight (WAZ ≤ -2), and low CD4 cell percentage.


CONCLUSIONS
There are similarities between the known predictors of death and the predictors of LTFU in the first and second years of ART. Knowing the vital status of children is important to determine LTFU. Although HIV-positive children cared for by their mothers appear to be at greater risk of becoming LTFU, further research is needed to explore the challenges faced by mothers and other caregivers and their impact on long-term HIV care. There is also a need to investigate the effects of differential access to ART between mothers and children and its impact on ART outcomes in children.
Wits Reproductive Health and HIV Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. mazvita.sengayi@nhls.ac.za
Mazvita
M
Sengayi
Ntabozuko
N
Dwane
Edmore
E
Marinda
Nosisa
N
Sipambo
Lee
L
Fairlie
Harry
H
Moultrie
D000367:Age Factors; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D017028:Caregivers / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D007223:Infant; D059012:Lost to Follow-Up; D008297:Male; D016016:Proportional Hazards Models; D011446:Prospective Studies; D013019:South Africa / Q000453:epidemiology; D013851:Thinness / Q000453:epidemiology; D013997:Time Factors
D019380:Anti-HIV Agents
HIV; South Africa; antiretroviral treatment; children; loss to follow-up