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Excessive mortality and loss to follow‐up among HIV ‐infected children in Guinea‐Bissau, West Africa: a retrospective follow‐up study
Author(s) -
Steiniche Ditte,
Jespersen Sanne,
Medina Candida,
Sanha Fatima Corona,
Wejse Christian,
Hønge Bo Langhoff
Publication year - 2018
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/tmi.13136
Subject(s) - medicine , underweight , proportional hazards model , hazard ratio , retrospective cohort study , pediatrics , mortality rate , human immunodeficiency virus (hiv) , demography , immunology , body mass index , confidence interval , overweight , sociology
Objectives To estimate the magnitude of mortality and loss to follow‐up and describe predictors of mortality among HIV ‐infected children in Guinea‐Bissau. Methods Retrospective follow‐up study among HIV ‐infected children under 15 years of age at the largest HIV ‐clinic in Guinea‐Bissau from 2006–2016. A multivariate Cox proportional hazards model was used to identify predictors of mortality. Results Of 525 children were included in the analysis: 371 (70.7%) with HIV ‐1, 17 (3.2%) with HIV ‐2, 25 (4.8%) with HIV ‐1/2, and 112 (21.3%) with HIV of unknown type. At diagnosis, the median age was 3.5 years, 44.7% met the WHO criteria for severe immunodeficiency by age based on CD 4 cell count, and 59.4% were underweight. The median follow‐up time was 6 months. Despite the availability of antiretroviral treatment, the mortality rate was 10.4 deaths per 100 person‐years of follow‐up. Within the first year of follow‐up, 11.0% died, 3.1% were transferred and 38.8% were lost to follow‐up, leaving 47.1% in follow‐up. Severe immunodeficiency (adjusted hazard ratio ( aHR ) = 2.52, 95% CI : 1.22–5.21) and underweight ( aHR = 3.14, 95% CI : 1.40–7.02) were independent predictors of mortality. Conclusions This study reveals a high rate of early mortality and loss to follow‐up among HIV ‐infected children in Guinea‐Bissau. Initiatives to improve patient retention are urgently needed.