title: Temporal Trends in Patient Characteristics and Outcomes Among Children Enrolled in Mozambique's National Antiretroviral Therapy Program.
abstract: BACKGROUND
  During 2004-2009, >12,000 children (<15 years old) initiated antiretroviral therapy (ART) in Mozambique. Nationally representative outcomes and temporal trends in outcomes were investigated.
  
  
  METHODS
  Rates of death, loss to follow-up (LTFU) and attrition (death or LTFU) were evaluated in a nationally representative sample of 1054 children, who initiated ART during 2004-2009 at 25 facilities randomly selected using probability-proportional-to-size sampling.
  
  
  RESULTS
  At ART initiation during 2004-2009, 50% were male; median age was 3.3 years; median CD4% was 13%; median CD4 count was 375 cells/μL; median weight-for-age Z score was -2.1. During 2004-2009, median time from HIV diagnosis to care initiation declined from 33 to 0 days (P = 0.001); median time from care to ART declined from 93 to 62 days (P = 0.004); the percentage aged <2 at ART initiation increased from 16% to 48% (P = 0.021); the percentage of patients with prior tuberculosis declined from 50% to 10% (P = 0.009); and the percentage with prior lymphocytic interstitial pneumonia declined from 16% to 1% (P < 0.001). Over 2652 person-years of ART, 183 children became LTFU and 26 died. Twelve-month attrition was 11% overall but increased from 3% to 22% during 2004-2009, mainly because of increases in 12-month LTFU (from 3% to 18%).
  
  
  CONCLUSIONS
  Declines in the prevalence of markers of advanced HIV disease at ART initiation probably reflect increasing ART access. However, 12-month LTFU increased during program expansion, and this negated any program improvements in outcomes that might have resulted from earlier ART initiation.
authors.affiliation: From the *Division of Global HIV/AIDS, Centers For Disease Control and Prevention, Atlanta, Georgia; †Division of Global HIV/AIDS, Centers For Disease Control and Prevention, Maputo, Mozambique; ‡Ministerio Da Saude, Programa TARV Pediatrico, Maputo, Mozambique; and §Fundação Ariel Glaser Contra O SIDA Pediátrico, Maputo, Mozambique.
authors.forename: Andrew F
authors.initials: AF
authors.lastname: Auld
authors.forename: Charity
authors.initials: C
authors.lastname: Alfredo
authors.forename: Eugenia
authors.initials: E
authors.lastname: Macassa
authors.forename: Kebba
authors.initials: K
authors.lastname: Jobarteh
authors.forename: Ray W
authors.initials: RW
authors.lastname: Shiraishi
authors.forename: Emilia D
authors.initials: ED
authors.lastname: Rivadeneira
authors.forename: James
authors.initials: J
authors.lastname: Houston
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Spira
authors.forename: Tedd V
authors.initials: TV
authors.lastname: Ellerbrock
authors.forename: Paula
authors.initials: P
authors.lastname: Vaz
mesh_terms: D000293:Adolescent; D044966:Anti-Retroviral Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology* / Q000401:mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D059012:Lost to Follow-Up; D008297:Male; D009073:Mozambique / Q000453:epidemiology; D012189:Retrospective Studies
chemical_list: D044966:Anti-Retroviral Agents