title: Nonadherence to clinic appointments among HIV-infected children in an ambulatory care program in western Kenya.
abstract: BACKGROUND
  Nonadherence to clinic appointments is associated with poor outcomes in HIV-infected adults. We describe the effect of cumulative clinic adherence (CCA) to clinic appointments on mortality and loss to follow-up (LTFU) among HIV-infected children in Kenya.
  
  
  METHODS
  We analyzed retrospective clinical data from HIV-infected children in the United States Agency for International Development-Academic Model Providing Access to Healthcare Partnership in Kenya between 2001 and 2009. We defined CCA as the proportion of days adherent to clinic visits after enrollment. We examined the effects of CCA on both death and LTFU, controlling for demographic and clinical factors at enrollment and over time. Cox proportional hazards models with time-varying coefficients were used to calculate adjusted hazard ratios (AHR) associated with each 10% increase in CCA on mortality and LTFU.
  
  
  RESULTS
  Among 3255 HIV-infected children, 1668 (51.2%) were male, median enrollment age of 5.2 years (interquartile range: 3.6-7.4). Of 2393 children with CD4 within 3 months after enrollment, 1125 (47.0%) were severely immune suppressed, 567 became LTFU, and 88 died. Children with higher CCA had a higher risk of both mortality and LTFU at 3 and 6 months. Higher CCA became protective at 24 months for mortality, AHR at 24 months: 0.7 (95% confidence interval: 0.6 to 0.9), and at 12 months for LTFU, AHR at 24 months: 0.7 (95% confidence interval: 0.7 to 0.7).
  
  
  CONCLUSIONS
  Children adherence to clinic visits during the first 6 months of HIV care was associated with a higher risk of death and LTFU, but by 24 months, children with better CCA had a reduced risk of LTFU and mortality.
authors: Department of Child Health and Pediatrics, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya. nyandikom@yahoo.com
authors: Winstone
authors: W
authors: Nyandiko
authors: Rachel
authors: R
authors: Vreeman
authors: Hai
authors: H
authors: Liu
authors: Sylvia
authors: S
authors: Shangani
authors: Edwin
authors: E
authors: Sang
authors: Samuel
authors: S
authors: Ayaya
authors: Paula
authors: P
authors: Braitstein
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy / Q000401:mortality*; D000553:Ambulatory Care; D000554:Ambulatory Care Facilities; D019380:Anti-HIV Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007630:Kenya; D008297:Male; D055118:Medication Adherence; D010349:Patient Compliance; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D019380:Anti-HIV Agents