title: Patching the gaps towards the 90-90-90 targets: outcomes of Nigerian children receiving antiretroviral treatment who are co-infected with tuberculosis.
abstract: BACKGROUND
  Nigeria has a high burden of children living with HIV and tuberculosis (TB). This article examines the magnitude of TB among children receiving antiretroviral treatment (ART), compares their ART outcomes with their non-TB counterparts and argues that addressing TB among children on ART is critical for achieving the 90-90-90 targets.
  
  
  METHODS
  This was a facility-based, retrospective analysis of medical records of children aged <15 years who were newly initiated on ART between 2011 and 2012. Structured tools were used to collect data. STATA software was used to perform descriptive, survival and multivariate analyses.
  
  
  RESULTS
  A total of 1142 children with a median age of 3.5 years from 20 selected facilities were followed for 24 months. Of these, 95.8% were assessed for TB at ART initiation and 14.7% had TB. Children on ART were more likely to have TB if they were aged 5 years or older (p<0.01) and had delayed ART initiation (p<0.05). The cotrimoxazole and isoniazid prophylaxes were provided to 87.9 and 0.8% of children, respectively. The rate of new TB cases was 3 (2.2-4.0) per 100 person-years at six months and declined to 0.2 (0.06-1.4) per 100 person-years at 24 months. TB infection [adjusted hazard ratio (aHR): 4.3; 2.3-7.9], malnutrition (aHR: 5.1; 2.6-9.8), delayed ART initiation (aHR: 3.2; 1.5-6.7) and age less than 1 year at ART initiation (aHR: 4.0; 1.4-12.0) were associated with death. Additionally, patients with TB (aHR: 1.3; 1.1-1.6) and children below the age of 1 at ART initiation (aHR: 2.9; 1.7-5.2) were more likely to be lost to follow-up (LFU).
  
  
  CONCLUSIONS
  Children on ART with TB are less likely to survive and more likely to be LFU. These risks, along with low isoniazid uptake and delayed ART initiation, present a serious challenge to achieving the 90-90-90 targets and underscore an urgent need for inclusion of childhood TB/HIV in global plans and reporting mechanisms.
authors.affiliation: Health Section, UNICEF, New York, NY, USA; dchamla@unicef.org.
authors.forename: Dick D
authors.initials: DD
authors.lastname: Chamla
authors.affiliation: Federal Ministry of Health, NASCP, Abuja, Nigeria.
authors.forename: Chukwuemeka
authors.initials: C
authors.lastname: Asadu
authors.affiliation: Country Office, UNICEF, Abuja, Nigeria.
authors.forename: Abiola
authors.initials: A
authors.lastname: Davies
authors.affiliation: Country Office, UNICEF, Abuja, Nigeria.
authors.forename: Arjan
authors.initials: A
authors.lastname: de Wagt
authors.affiliation: World Health Organization, Abuja, Nigeria.
authors.forename: Oluwafunke
authors.initials: O
authors.lastname: Ilesanmi
authors.affiliation: Federal Ministry of Health, NASCP, Abuja, Nigeria.
authors.forename: Daniel
authors.initials: D
authors.lastname: Adeyinka
authors.affiliation: Obafemi Awolowo University, Ile-Ife, Nigeria.
authors.forename: Ebun
authors.initials: E
authors.lastname: Adejuyigbe
mesh_terms: D000293:Adolescent; D023241:Antiretroviral Therapy, Highly Active; D002648:Child; D002675:Child, Preschool; D060085:Coinfection; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D007223:Infant; D059012:Lost to Follow-Up; D008297:Male; D009549:Nigeria; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use; D014376:Tuberculosis / Q000150:complications* / Q000188:drug therapy
chemical_list: D015662:Trimethoprim, Sulfamethoxazole Drug Combination
keywords: ART; HIV; children; tuberculosis