title: Factors Determining Survival and Retention among HIV-Infected Children and Adolescents in a Community Home-Based Care and a Facility-Based Family-Centred Approach in Kampala, Uganda: A Cohort Study.
abstract: We describe factors determining retention and survival among HIV-infected children and adolescents engaged in two health care delivery models in Kampala, Uganda: one is a community home-based care (CHBC) and the other is a facility-based family-centred approach (FBFCA). This retrospective cohort study reviewed records from children aged from 0 to 18 years engaged in the two models from 2003 to 2010 focussing on retention/loss to follow-up, mortality, use of antiretroviral therapy (ART), and clinical characteristics. Kaplan Meier survival curves with log rank tests were used to describe and compare retention and survival. Overall, 1,623 children were included, 90.0% (1460/1623) from the CHBC. Children completed an average of 4.2 years of follow-up (maximum 7.7 years). Median age was 53 (IQR: 11-109) months at enrolment. In the CHBC, retention differed significantly between patients on ART and those not (log-rank test, adjusted, P < 0.001). Comparing ART patients in both models, there was no significant difference in long-term survival (log-rank test, P = 0.308, adjusted, P = 0.489), while retention was higher in the CHBC: 94.8% versus 84.7% in the FBFCA (log-rank test, P < 0.001, adjusted P = 0.006). Irrespective of model of care, children receiving ART had better retention in care and survival.
authors.affiliation: Department of Paediatrics, University of Padua, Via Giustiniani 3, 35128 Padua, Italy ; St. Raphael of St. Francis Hospital (Nsambya Hospital), Kampala, Uganda.
authors.forename: W
authors.initials: W
authors.lastname: Massavon
authors.affiliation: Makerere University, Johns Hopkins University Research Collaboration, Kampala, Uganda.
authors.forename: L
authors.initials: L
authors.lastname: Barlow-Mosha
authors.affiliation: Infectious Diseases Research Collaboration, Mulago Hospital Complex, Kampala, Uganda.
authors.forename: L
authors.initials: L
authors.lastname: Mugenyi
authors.affiliation: Department of Global Health Sciences, University of California San Francisco, 50 Beale Street, 12th Floor, San Francisco, CA 94105, USA.
authors.forename: W
authors.initials: W
authors.lastname: McFarland
authors.affiliation: University of Witwatersrand, 1 Jan Smuts Avenue, Braamfontein 2000, Johannesburg, South Africa.
authors.forename: G
authors.initials: G
authors.lastname: Gray
authors.affiliation: Department of Paediatrics, University of Padua, Via Giustiniani 3, 35128 Padua, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Lundin
authors.affiliation: Department of Paediatrics, University of Padua, Via Giustiniani 3, 35128 Padua, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Costenaro
authors.affiliation: St. Raphael of St. Francis Hospital (Nsambya Hospital), Kampala, Uganda.
authors.forename: M M
authors.initials: MM
authors.lastname: Nannyonga
authors.affiliation: Department of Paediatrics, University of Padua, Via Giustiniani 3, 35128 Padua, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Penazzato
authors.affiliation: Makerere University, Johns Hopkins University Research Collaboration, Kampala, Uganda ; Department of Global Heath and Population, Harvard University School of Public Health, Boston, MA, USA.
authors.forename: D
authors.initials: D
authors.lastname: Bagenda
authors.affiliation: St. Raphael of St. Francis Hospital (Nsambya Hospital), Kampala, Uganda.
authors.forename: C P
authors.initials: CP
authors.lastname: Namisi
authors.affiliation: Makerere University, Johns Hopkins University Research Collaboration, Kampala, Uganda.
authors.forename: D
authors.initials: D
authors.lastname: Wabwire
authors.affiliation: Makerere University, Johns Hopkins University Research Collaboration, Kampala, Uganda.
authors.forename: M
authors.initials: M
authors.lastname: Mubiru
authors.affiliation: St. Raphael of St. Francis Hospital (Nsambya Hospital), Kampala, Uganda.
authors.forename: S
authors.initials: S
authors.lastname: Kironde
authors.affiliation: Department of Paediatrics, University of Padua, Via Giustiniani 3, 35128 Padua, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Bilardi
authors.affiliation: Santa Chiara Hospital, Via Largo Gold Medals 9, 38122 Trento, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Mazza
authors.affiliation: Makerere University, Johns Hopkins University Research Collaboration, Kampala, Uganda ; Department of Pathology, Johns Hopkins School of Medicine 600 N. Wolfe Street/Carnegie 43 Baltimore, MD 21287, USA.
authors.forename: M G
authors.initials: MG
authors.lastname: Fowler
authors.affiliation: Makerere University, Johns Hopkins University Research Collaboration, Kampala, Uganda ; Department of Paediatrics and Child Health, Makerere University, Kampala, Uganda.
authors.forename: P
authors.initials: P
authors.lastname: Musoke
authors.affiliation: Department of Paediatrics, University of Padua, Via Giustiniani 3, 35128 Padua, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Giaquinto