Long-term outcomes of a pediatric HIV treatment program in Maputo, Mozambique: a cohort study.
OBJECTIVE
To describe long-term treatment outcomes of a pediatric HIV cohort in Mozambique.


METHODS
Retrospective analysis of routine monitoring data.


METHODS
Secondary health care facilities in the Chamanculo Health District of Maputo.


METHODS
A total of 1,335 antiretroviral treatment (ART) naïve children <15 years of age enrolled in HIV care between 2002 and 2010.


METHODS
HIV care, ART (since 2003), task shifting to lower cadre nurses, counseling by lay counselors, active patient tracing, nutritional support, support by a psychologist, targeted viral load testing, and switch to second-line treatment.


METHODS
Kaplan-Meier estimates for retention in care (RIC), CD4 cell percentage, body mass index for age z-score, and adjusted incidence rate ratios for attrition (death or loss to follow-up) as calculated by Poisson regression.


RESULTS
The RIC at 6 years in the pre-ART cohort was 44% (95% confidence interval: 38-49), and the one at 8 years in the ART cohort was 70% (64-75). Risk factors for attrition included young age, low CD4 percentage, underweight, active tuberculosis, and enrollment/treatment initiation after 2006. The mean CD4 percentage increased strongly at 1 year on treatment and remained high thereafter. The body mass index for age z-score sharply increased at 1 year after treatment initiation before stabilizing at pre-ART levels thereafter.


CONCLUSIONS
Good clinical and immunological treatment outcomes up to 8 years of follow-up on ART can be achieved in a context of shortage of health workers and a high level of task-shifting approach.
Médecins Sans Frontières, Maputo, Mozambique.
Jan
J
Walter
Médecins Sans Frontières, Maputo, Mozambique; lucasmolfino@yahoo.com.ar.
Lucas
L
Molfino
Médecins Sans Frontières, Maputo, Mozambique.
Verena
V
Moreno
Médecins Sans Frontières, Maputo, Mozambique.
Celeste G
CG
Edwards
Médecins Sans Frontières, Maputo, Mozambique.
Mafalda
M
Chissano
Médecins Sans Frontières, Maputo, Mozambique.
Angels
A
Prieto
Ministry of Health, Maputo, Mozambique.
Tatiana
T
Bocharnikova
Médecins Sans Frontières, Geneva, Switzerland.
Annick
A
Antierens
Médecins Sans Frontières, Geneva, Switzerland.
Johnny
J
Lujan
D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology; D000293:Adolescent; D000367:Age Factors; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D015992:Body Mass Index; D018791:CD4 Lymphocyte Count; D002648:Child; D002675:Child, Preschool; D003376:Counseling; D004032:Diet; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000401:mortality* / Q000523:psychology / Q000628:therapy*; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D059012:Lost to Follow-Up; D008297:Male; D009073:Mozambique / Q000453:epidemiology; D010353:Patient Education as Topic / Q000458:organization & administration*; D012189:Retrospective Studies; D012307:Risk Factors; D014376:Tuberculosis / Q000453:epidemiology; D019562:Viral Load
D019380:Anti-HIV Agents
CD4 cell count; HIV; Mozambique; anthropometric scores; pediatric HIV care; task shifting