title: The association between quality of HIV care, loss to follow-up and mortality in pediatric and adolescent patients receiving antiretroviral therapy in Nigeria.
abstract: Access to pediatric HIV treatment in resource-limited settings has risen significantly. However, little is known about the quality of care that pediatric or adolescent patients receive. The objective of this study is to explore quality of HIV care and treatment in Nigeria and to determine the association between quality of care, loss-to-follow-up and mortality. A retrospective cohort study was conducted including patients ≤18 years of age who initiated ART between November 2002 and December 2011 at 23 sites across 10 states. 1,516 patients were included. A quality score comprised of 6 process indicators was calculated for each patient. More than half of patients (55.5%) were found to have a high quality score, using the median score as the cut-off. Most patients were screened for tuberculosis at entry into care (81.3%), had adherence measurement and counseling at their last visit (88.7% and 89.7% respectively), and were prescribed co-trimoxazole at some point during enrollment in care (98.8%). Thirty-seven percent received a CD4 count in the six months prior to chart review. Mortality within 90 days of ART initiation was 1.9%. A total of 4.2% of patients died during the period of follow-up (mean: 27 months) with 19.0% lost to follow-up. In multivariate regression analyses, weight for age z-score (Adjusted Hazard Ratio (AHR): 0.90; 95% CI: 0.85, 0.95) and high quality indicator score (compared a low score, AHR: 0.43; 95% CI: 0.26, 0.73) had a protective effect on mortality. Patients with a high quality score were less likely to be lost to follow-up (Adjusted Odds Ratio (AOR): 0.42; 95% CI: 0.32, 0.56), compared to those with low score. These findings indicate that providing high quality care to children and adolescents living with HIV is important to improve outcomes, including lowering loss to follow-up and decreasing mortality in this age group.
authors: John Snow Inc., Boston, Massachusetts, United States of America; Massachusetts General Hospital, Infectious Disease Division, Boston, Massachusetts, United States of America.
authors: Bisola
authors: B
authors: Ojikutu
authors: John Snow Inc., Boston, Massachusetts, United States of America.
authors: Molly
authors: M
authors: Higgins-Biddle
authors: Columbia University, Department of Epidemiology, New York, New York, United States of America.
authors: Dana
authors: D
authors: Greeson
authors: United States Agency for International Development (USAID), Washington, D. C., United States of America.
authors: Benjamin R
authors: BR
authors: Phelps
authors: United States Agency for International Development (USAID), Washington, D. C., United States of America.
authors: Anouk
authors: A
authors: Amzel
authors: United States Agency for International Development (USAID), Abuja, Nigeria.
authors: Emeka
authors: E
authors: Okechukwu
authors: Indepth Precision, Abuja, Nigeria.
authors: Usman
authors: U
authors: Kolapo
authors: Boston University School of Public Health, Department of Biostatistics, Boston, Massachusetts, United States of America.
authors: Howard
authors: H
authors: Cabral
authors: Boston University School of Medicine, Boston, Massachusetts, United States of America.
authors: Ellen
authors: E
authors: Cooper
authors: Harvard Medical School, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America.
authors: Lisa R
authors: LR
authors: Hirschhorn
mesh_terms: D000293:Adolescent; D023241:Antiretroviral Therapy, Highly Active / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D008297:Male; D009549:Nigeria; D011787:Quality of Health Care / Q000706:statistics & numerical data*