title: How are children with HIV faring in Nigeria?--a 7 year retrospective study of children enrolled in HIV care.
abstract: BACKGROUND
  To review the pediatric care and treatment program at Massey Street Children Hospital, in Lagos, Nigeria a retrospective analysis of medical records focusing on health services, survival and retention in care.
  
  
  METHODS
  The analysis covered a cohort of children initiated on antiretroviral therapy (ART) from 2005 to 2011. In this population, pediatric HIV care was defined as initiating ART between ages 0 and 14 years. Treatment initiation and follow-up were according to the Nigerian national guidelines for pediatric ART, which are based on World Health Organization guidelines adapted to our local context. The primary endpoint was mortality measured as cumulative survival. Other outcomes of interest included "loss to follow-up", "transferred out", and "stopped treatment".
  
  
  RESULTS
  Mean (SD) age at ART initiation was 51 (39) months in female children and 52 (42) months in male children. After seven years of ART care, 64% of the 660 study children were retained in care and on treatment, 16% were lost to follow-up, 10% were dead, and 9% had discontinued HIV care at this facility for other reasons. World Health Organization disease stage, CD4 count, age, and year of ART initiation were highly predictive of mortality, while anemia at baseline was not statistically significantly associated.
  
  
  CONCLUSIONS
  Overall study results suggest a viable pediatric HIV program exists at the study facility. Retention rates were lowest for the earliest cohort of infected children, which implies long-term challenges. Mother-to-child transmission programs need to be dynamic to stem the scourge of pediatric HIV in Nigeria.
authors.affiliation: Lifescope Integrated Services, Lagos, Nigeria. moyinolu@gmail.com.|School of Public Health, Hebrew University Hadassah, Jerusalem, Israel. moyinolu@gmail.com.|Massey Street Children's Hospital, Lagos, Nigeria. moyinolu@gmail.com.
authors.forename: Moyinoluwa A
authors.initials: MA
authors.lastname: Ojeniran
authors.affiliation: Massey Street Children's Hospital, Lagos, Nigeria. osabisco@hotmail.com.
authors.forename: Abieyuwa
authors.initials: A
authors.lastname: Emokpae
authors.affiliation: Massey Street Children's Hospital, Lagos, Nigeria. cmabogunje@yahoo.co.uk.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Mabogunje
authors.affiliation: Massey Street Children's Hospital, Lagos, Nigeria. akintanpatricia@yahoo.com.
authors.forename: Patricia
authors.initials: P
authors.lastname: Akintan
authors.affiliation: Clalit Research Institute, Jerusalem, Israel. mbhoshen@gmail.com.
authors.forename: Moshe
authors.initials: M
authors.lastname: Hoshen
authors.affiliation: Massey Street Children's Hospital, Lagos, Nigeria. ramw@ekmd.huji.ac.il.
authors.forename: Ram
authors.initials: R
authors.lastname: Weiss
mesh_terms: D000293:Adolescent; D000367:Age Factors; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D002648:Child; D002675:Child, Preschool; D003266:Continuity of Patient Care; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality; D006452:Hemoglobinometry; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009549:Nigeria / Q000453:epidemiology; D012189:Retrospective Studies; D016019:Survival Analysis
chemical_list: D019380:Anti-HIV Agents