title: Paediatric HIV care in sub-Saharan Africa: clinical presentation and 2-year outcomes stratified by age group.
abstract: OBJECTIVE
  To examine age differences in mortality and programme attrition amongst paediatric patients treated in four African HIV programmes.
  
  
  METHODS
  Longitudinal analysis of data from patients enrolled in HIV care. Two-year mortality and programme attrition rates per 1000 person-years stratified by age group (<2, 2-4 and 5-15 years) were calculated. Associations between outcomes and age and other individual-level factors were studied using multiple Cox proportional hazards (mortality) and Poisson (attrition) regression models.
  
  
  RESULTS
  Six thousand two hundred and sixty-one patients contributed 9500 person-years; 27.1% were aged <2 years, 30.1% were 2-4, and 42.8% were 5-14 years old. At programme entry, 45.3% were underweight and 12.6% were in clinical stage 4. The highest mortality and attrition rates (98.85 and 244.00 per 1000 person-years), and relative ratios (adjusted hazard ratio [aHR] = 1.92, 95% CI 1.56-2.37; incidence ratio [aIR] = 2.10, 95% CI 1.86-2.37, respectively, compared with the 5- to 14-year group) were observed amongst the youngest children. Increased mortality and attrition were also associated with advanced clinical stage, underweight and diagnosis of tuberculosis at programme entry.
  
  
  CONCLUSIONS
  These results highlight the need to increase access, diagnose and provide early HIV care and to accelerate antiretroviral treatment initiation for those eligible. Adapted education and support for children and their families would also be important.
authors.affiliation: Epicentre, Clinical Research Department, Paris, France.
authors.forename: Jihane
authors.initials: J
authors.lastname: Ben-Farhat
authors.affiliation: Médecins Sans Frontières, Melbourne, Australia.
authors.forename: Marianne
authors.initials: M
authors.lastname: Gale
authors.affiliation: Médecins Sans Frontières, Paris, France.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Szumilin
authors.affiliation: Médecins Sans Frontières, Paris, France.
authors.forename: Suna
authors.initials: S
authors.lastname: Balkan
authors.affiliation: Epicentre, Clinical Research Department, Paris, France.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Poulet
authors.affiliation: Epicentre, Clinical Research Department, Paris, France.|University College London, London, UK.
authors.forename: Mar
authors.initials: M
authors.lastname: Pujades-Rodríguez
mesh_terms: D000293:Adolescent; D000367:Age Factors; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality*; D006801:Humans; D007223:Infant; D007630:Kenya / Q000453:epidemiology; D008137:Longitudinal Studies; D008295:Malawi / Q000453:epidemiology; D008297:Male; D013851:Thinness / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality; D016896:Treatment Outcome; D014376:Tuberculosis / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality; D014454:Uganda / Q000453:epidemiology
chemical_list: D019380:Anti-HIV Agents
keywords: Africa; HIV; antiretroviral treatment; children; outcome assessment